Dietary Approaches To Stop Hypertension Dietary Pattern Research Articles

DASH Diet Concordance Among Adults in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study (2010–2013)

Abstract Objectives South Asian Americans have a disproportionately higher risk of atherosclerotic cardiovascular disease (ASCVD) and risk factors, such as hypertension compared to non-Hispanic whites and other Asian American groups. Our objective was to investigate adherence to Dietary Approaches to Stop Hypertension (DASH), an established dietary pattern to reduce blood pressure, and association with sociodemographic, body composition, and ASCVD risk factors. Methods Baseline data from 893 adults (40–83y, 47% female) recruited between 2010–2013 for the MASALA Study were used in these analyses. We computed a DASH concordance score from the validated 163-item Study of Health Assessment and Risk in Ethnic groups food frequency questionnaire (FFQ), using an established method. We scored concordance based on 8 components: high intake of 1) fruit, 2) vegetables, 3) nuts/legumes, 4) low-fat dairy products, and 5) whole grains, and low intake of 6) sodium, 7) sugar-sweetened beverages, and 8) red/processed meats. The theoretical DASH score may range from 8 (low concordance) to 40 (high concordance). Results The DASH score in MASALA participants ranged 12–35 (mean ± SD, 24.4 ± 4.4). The average score was higher among women (25.4 ± 4.1) than men (23.6 ± 4.5; P < 0.001), higher among adults 65 and older than those ≤50 (24.9 ± 4.3 vs. 23.9 ± 4.6, P = 0.015), and higher among participants who had lived less than 50% of their life in the U.S. (24.9 ± 4.4 vs. 23.9 ± 4.4, p-0.0014). The score was also higher among participants who had a Bachelor's degree or greater (P = 0.0064), but there was no difference in the score based on annual family income (P = 0.07). The score was higher among vegetarians than non-vegetarians (26.7 ± 3.5 vs. 23 ± 4.4; P < 0.001). It was also inversely associated with indicators of central adiposity including waist circumference (P = 0.001) and waist-to-hip ratio (P < 0.001). Conclusions Our results indicate that adherence to the DASH dietary pattern is associated with select sociodemographic factors and body composition among South Asians in the U.S. The computed DASH score will be utilized in forthcoming analyses to determine its associations with risk factors for hypertension, central adiposity, and ASCVD among participants in the MASALA cohort. Funding Sources NHLBI, National Center for Research Resources, National Center for Advancing Translational Sciences, NIH, via UCSF-CTSI.

Long-Term Food Choice and Weight Loss on a Mobile Program With Food Color System

ObjectivesIt is unclear if individuals sustain healthy food choices long-term on a mobile, self-directed weight loss program, or how those choices influence weight loss. We examined differences in food choice and dietary quality by weight lost at 18 months on a mobile behavior change weight loss program with a traffic light food system designed to encourage healthier eating behaviors. We expected that users with greater amounts of weight loss would show healthier food choices and dietary quality. MethodsOn the program, users are encouraged to consume a ratio of 30% green (low-calorie, high-volume, nutrient-rich foods), 45% yellow, and 25% red (high-calorie, low-volume) foods. They are also provided information on behavior change principles. We evaluated food ratios and self-reported dietary quality in 148 adults 18 months after starting the program with a retrospective cohort design. Food ratios were measured via food intake self-reported on the program. Dietary quality was measured using a validated questionnaire assessing adherence to the Dietary Approaches to Stop Hypertension (DASH) diet (DASH-Q). Respondents were categorized into high (>10%, n = 71), moderate (5–10%, n = 35), and low or no (<5%, n = 42) weight loss groups based on weight lost by 18 months. ANOVAs tested differences in food ratios and dietary quality between groups. ResultsBaseline BMI did not differ between weight loss groups (high: 36.9, moderate: 36.0, low: 36.5; P = 0.68). However, there were significant differences in green food ratios across weight loss groups for breakfast (high: 37%, moderate: 37%, low: 34%; P = .02), lunch (29%, 27%, 25%; P < .001), and dinner (22%, 20%, 16%; P < .001). Red food ratios also differed across groups for breakfast (21%, 27%, 26%; P < .001), lunch (34%, 35%, 37%; P < .002), and dinner (36%, 39%, 43%; P < .001). The weight loss groups also differed in DASH dietary pattern scores (high: 41.79, moderate: 42.52, low: 36.95; P = .02). ConclusionsUsers with greater weight loss ate more green foods, fewer red foods, and adhered more to the DASH diet than users with less weight loss. These differences were apparent even 18 months later. This highlights the role of food choice and dietary quality in weight loss and suggests that a mobile behavior change program with a traffic light system could aid in healthier long-term dietary consumption. Funding SourcesThis study was funded by Noom Inc.

Abstract MP32: The Level Of Adherence To The Dietary Approaches To Stop Hypertension Diet Is Associated With The Severity Of Insulin Resistance Among Community-Dwelling Heart Failure Patients: A National Health And Nutrition Examination Survey Analysis

Introduction: Heart failure (HF) patients are at risk of new-onset diabetes. In non-HF populations, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet has shown to be associated with the delayed onset of insulin resistance; however, such effect remains unknown in HF patients without history of diabetes. Methods: Using data from 1999-2016 National Health and Nutrition Examination Survey cycles, we included 348 HF participants (20+ years) without history of diabetes or diabetes medication use and with data on at least one 24-hour dietary recall. Participants were classified by DASH dietary index score quartiles: quartile 1 indicated lowest DASH index scores and lowest DASH adherence, whereas quartile 4 indicated highest DASH index scores and highest DASH adherence. The severity of insulin resistance was examined using the Homeostatic Model Assessment of Insulin Resistance and was further classified by tertiles, where the upper tertile showed the most severe insulin resistance. Associations between the severity of insulin resistance and DASH dietary adherence and its linear trends were examined using logistic regression models. Results: Participants had a mean age of 65±1 (SE) years, 44.2% were female, and 10.5% were non-Hispanic black. The age-, gender-, and race/ethnicity-adjusted odds ratio for the most severe insulin resistance group in participants with highest DASH adherence was 0.32 (95% CI, 0.11-0.99), compared to participants with lowest DASH adherence. A significant trend of more severe insulin resistance was observed as participants showed less adherence to the DASH diet (p=0.02). Conclusion: Adherence to a DASH dietary pattern was associated with improved insulin resistance among community-dwelling HF patients in the U.S. Heart healthy dietary patterns may protect HF patients against new-onset diabetes. Future research is needed to test dietary interventions aimed at the prevention of HF complications and comorbidities.

Effects of Diet and Sodium Reduction on Cardiac Injury, Strain, and Inflammation: The DASH-Sodium Trial

BackgroundThe DASH (Dietary Approaches to Stop Hypertension) diet has been determined to have beneficial effects on cardiac biomarkers. The effects of sodium reduction on cardiac biomarkers, alone or combined with the DASH diet, are unknown. ObjectivesThe purpose of this study was to determine the effects of sodium reduction and the DASH diet, alone or combined, on biomarkers of cardiac injury, strain, and inflammation. MethodsDASH-Sodium was a controlled feeding study in adults with systolic blood pressure (BP) 120 to 159 mm Hg and diastolic BP 80 to 95 mm Hg, randomly assigned to the DASH diet or a control diet. On their assigned diet, participants consumed each of three sodium levels for 4 weeks. Body weight was kept constant. At the 2,100 kcal level, the 3 sodium levels were low (50 mmol/day), medium (100 mmol/day), and high (150 mmol/day). Outcomes were 3 cardiac biomarkers: high-sensitivity cardiac troponin I (hs-cTnI) (measure of cardiac injury), N-terminal pro–B-type natriuretic peptide (NT-proBNP) (measure of strain), and high-sensitivity C-reactive protein (hs-CRP) (measure of inflammation), collected at baseline and at the end of each feeding period. ResultsOf the original 412 participants, the mean age was 48 years; 56% were women, and 56% were Black. Mean baseline systolic/diastolic BP was 135/86 mm Hg. DASH (vs. control) reduced hs-cTnI by 18% (95% confidence interval [CI]: −27% to −7%) and hs-CRP by 13% (95% CI: −24% to −1%), but not NT-proBNP. In contrast, lowering sodium from high to low levels reduced NT-proBNP independently of diet (19%; 95% CI: −24% to −14%), but did not alter hs-cTnI and mildly increased hs-CRP (9%; 95% CI: 0.4% to 18%). Combining DASH with sodium reduction lowered hs-cTnI by 20% (95% CI: −31% to −7%) and NT-proBNP by 23% (95% CI: −32% to −12%), whereas hs-CRP was not significantly changed (−7%; 95% CI: −22% to 9%) compared with the high sodium-control diet. ConclusionsCombining a DASH dietary pattern with sodium reduction can lower 2 distinct mechanisms of subclinical cardiac damage: injury and strain, whereas DASH alone reduced inflammation. (Dietary Patterns, Sodium Intake and Blood Pressure [DASH – Sodium]; NCT00000608)

The DASH Diet and Cardiometabolic Health and Chronic Kidney Disease: A Narrative Review of the Evidence in East Asian Countries.

The rising incidence of cardiometabolic diseases and chronic kidney disease (CKD) is a leading public health problem in East Asia. Diet is an important modifiable risk factor; thus, adopting a healthy diet such as the Dietary Approaches to Stop Hypertension (DASH) diet may help combat these chronic diseases. The DASH diet was originally developed in a U.S. population, and East Asia is demographically and culturally different from the U.S. Therefore, it is important to examine the evidence regarding the DASH diet and chronic disease in this unique population. This narrative review summarizes the evidence on the DASH diet and cardiometabolic health and CKD in East Asia. Culturally-modified DASH diets have been developed in some East Asian countries. Studies suggest the DASH diet is effective at lowering blood pressure in this population, though the long-term benefits remain unclear. Evidence also suggests the DASH diet may reduce the risk of type 2 diabetes and metabolic syndrome. Further research indicates the DASH diet and its components may reduce CKD risk. However, recommending the DASH diet in those who already have CKD is controversial, as it conflicts with current CKD dietary guidelines, especially in advanced CKD. Notably, current intakes in the general population differ from the DASH dietary pattern, suggesting public health efforts would be needed to encourage adoption of the DASH diet.

Longitudinal changes in adherence to the portfolio and DASH dietary patterns and cardiometabolic risk factors in the PREDIMED-Plus study

The Portfolio and Dietary Approaches to Stop Hypertension (DASH) diets have been shown to lower cardiometabolic risk factors in randomized controlled trials (RCTs). However, the Portfolio diet has only been assessed in RCTs of hyperlipidemic patients. Therefore, to assess the Portfolio diet in a population with metabolic syndrome (MetS), we conducted a longitudinal analysis of one-year data of changes in the Portfolio and DASH diet scores and their association with cardiometabolic risk factors in Prevención con Dieta Mediterránea (PREDIMED)-Plus trial. PREDIMED-Plus is an ongoing clinical trial (Trial registration: ISRCTN89898) conducted in Spain that includes 6874 older participants (mean age 65y, 48% women) with overweight/obesity fulfilling at least three criteria for MetS. Data for this analysis were collected at baseline, six months and one year. Adherence to the Portfolio and DASH diet scores were derived from a validated 143-item food frequency questionnaire. We used linear mixed models to examine the associations of 1-SD increase and quartile changes in the diet scores with concomitant changes in cardiometabolic risk factors. After adjusting for several potential confounders, a 1-SD increase in the Portfolio diet score was significantly associated with lower HbA1c (β [95% CI]:-0.02% [-0.02,-0.01], P<0.001), fasting glucose (-0.47mg/dL [-0.83,-0.11], P=0.01), triglycerides (-1.29mg/dL [-2.31,-0.28], P=0.01), waist circumference (WC) (-0.51cm [-0.59,-0.43], P<0.001), and body mass index (BMI) (-0.17kg/m2 [-0.19,-0.15], P<0.001). A 1-SD increase in the DASH diet score was significantly associated with lower HbA1c (-0.03% [-0.04,-0.02], P<0.001), glucose (-0.84mg/dL [-1.18,-0.51], P<0.001), triglycerides (-3.38mg/dL [-4.37,-2.38], P<0.001), non-HDL-cholesterol (-0.47mg/dL [-0.91,-0.04], P=0.03), WC (-0.69cm [-0.76,-0.60cm], P<0.001), BMI (-0.25kg/m2 [-0.28,-0.26kg/m2], P<0.001), systolic blood pressure (-0.57mmHg [-0.81,-0.32mmHg], P<0.001), diastolic blood pressure (-0.15mmHg [-0.29,-0.01mmHg], P=0.03), and with higher HDL-cholesterol (0.21mg/dL [0.09, 0.34mg/dL, P=0.001]). Similar associations were seen when both diet scores were assessed as quartiles, comparing extreme categories of adherence. Among older adults at high cardiovascular risk with MetS, greater adherence to the Portfolio and DASH diets showed significant favourable prospective associations with several clinically relevant cardiometabolic risk factors. Both diets are likely beneficial for cardiometabolic risk reduction.

Dietary Pattern and Long-Term Effects of Ambient Particulate Matter on Hypertension and Blood Pressure in Chinese Adults

Background: Previous experimental studies have identified specific foods or nutrients that are capable of mitigating adverse health effects induced by air pollution exposure. However, whether the usual dietary pattern can modify the associations between long-term air pollution exposure, hypertension and blood pressure has not yet been assessed. Methods: This cross-sectional study included 61,081 participants aged 30-79 from baseline data of the China Multi-Ethnic Cohort (CMEC). Ambient particulate matter with aerodynamic diameters ≤1 μm, ≤2.5 μm and ≤10 μm (PM1, PM2.5, and PM10) was assessed through a satellite-based random forest approach. The associations between long-term exposure to PM and hypertension were examined by a logistic regression model, and the associations between PM and systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) were assessed by multivariable linear regression models. The Dietary Approaches to Stop Hypertension (DASH) diet, which is a dietary pattern consisting of 7 food items, was calculated for each participant. Findings: Long-term exposure to ambient PM was associated with an increased risk of hypertension and elevated levels of SBP and PP. The DASH diet modified the associations between PM and hypertension as well as some blood pressure components, as those with a higher DASH score had significantly lower rates of PM-related high blood pressure risk (p value of interaction term < 0.05). For each 10 μg/m3 increase in PM1, PM2.5 and PM10, the participants with minimal adherence to the DASH diet had hypertension risks with ORs (95% CI) of 1.196 (1.084, 1.319), 1.145 (1.09, 1.202) and 1.080 (1.045, 1.117), whereas those with maximal adherence to the DASH diet had lower hypertension risks with ORs (95% CI) of 1.063 (0.953, 1.185), 1.074 (1.017, 1.133) and 1.038 (1.000, 1.077). For specific food items, consuming more fresh fruits, vegetables, dairy and whole grains would reduce the risk of high blood pressure caused by atmospheric particulates. Interpretation: The DASH dietary pattern reduced the hypertension risk induced by long-term exposure to ambient particulate matter. Adequate intake of foods rich in antioxidant compounds may be an effective and wide-reaching intervention to reduce the deleterious impact of air pollution on health. Funding: The National Key Research and Development Program of China (Grant No. 2017YFC0907303), the National Natural Science Foundation of China (Grant No. 81773548) and the China Postdoctoral Science Foundation (Grant No. 2020M683335). Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: Ethical approval was received from the Sichuan University Medical Ethical Review Board.

Adherence to Dietary Approaches to Stop Hypertension Eating Plan and Prevalence of Irritable Bowel Syndrome in Adults

Background/AimsDespite huge evidence on the link between adherence to dietary approaches to stop hypertension (DASH) eating pattern and several metabolic abnormalities, the association of this diet with irritable bowel syndrome (IBS) has not been investigated so far. We aim to examine the association between adherence to the DASH diet and prevalence of IBS symptoms and subtypes in adults.MethodsThis cross-sectional study was done among 3362 adult people in Isfahan, Iran. Usual dietary intakes were assessed using a validated 106-item dish-based semi-quantitative food frequency questionnaire. To investigate participants’ adherence to DASH-style diet, we created DASH score based on 8 main foods and nutrients emphasized or minimized in the DASH diet. Participants were classified into 3 categories according to their DASH-style diet scores. A validated modified Persian version of the Rome III questionnaire was applied for assessment of IBS.ResultsTotally, 22.2% of study participants were affected by IBS. After adjustment for potential confounding factors, we found that participants in the highest tertile of DASH score had lower odds of IBS (OR, 0.65; 95% CI, 0.50-0.83) compared with those in the lowest tertile. The same findings were also reached for IBS with constipation (OR for the highest vs the lowest tertile of DASH-style diet = 0.56; 95% CI, 0.38-0.85). No significant association was seen between adherence to DASH-style diet and IBS with diarrhea (OR, 1.31; 95% CI, 0.83-2.06).ConclusionsWe found a significant inverse association between adherence to DASH dietary pattern and odds of IBS and IBS with constipation. Further prospective studies are required to confirm these findings.

Dietary Patterns for Promoting Kidney Health.

Chronic kidney disease (CKD) is considered a public health problem and part of the growing burden of noncommunicable diseases. Many studies have searched for ways to reduce the risk of complications and death. One possible approach to modify the course of this disease is the adoption of healthy dietary habits. Previous studies have suggested that healthy dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH), the Mediterranean diet, the vegetarian diet, and a diet adhering to the Healthy Eating Index, are associated with improved renal health. In this chapter, we reviewed the scientific literature and presented the potential role of dietary patterns in the prevention of CKD, contributing to dietary strategies for promoting kidney health. We found that nutritional planning plays an important role in kidney health maintenance and in the protection of kidneys from further damage. The DASH, Mediterranean, and vegetarian dietary patterns can be viable strategies for CKD prevention. However, individualized nutritional monitoring is necessary for individuals with overt kidney disease. Randomized, controlled, and prospective studies focusing on nutritional interventions applied to renal patients undergoing conservative and dialytic treatment and to the general population are necessary to assess habits that can prevent the occurrence and worsening of kidney disease.

Adherence to dietary approaches to stop hypertension (DASH) and Mediterranean dietary patterns in relation to cardiovascular risk factors in older adults.

The aging process is associated with several chronic diet-related complications, including cardiovascular diseases. Therefore, the objective was to examine the association between DASH and Mediterranean dietary pattern (MDP) on cardiovascular risk factors and inflammatory markers in older adult men. A cross-sectional study was performed on 357 older adult men who were randomly selected from health centers across Tehran, Iran. Dietary intakes, anthropometric measures, biochemical markers, and general characteristics were also collected. Multivariate logistic regression was used to estimate odds ratios of outcomes across medians of dietary patterns, respectively. After adjusting for possible confounders, greater adherence to the MDP was associated with lower waist circumference, triacylglycerol, high-sensitivity c-reactive protein, fibrinogen, and higher HDL-C (p<0.05). Greater adherence to the DASH diet was associated with lower fibrinogen (p<0.05). Adherence to the MDP was inversely associated with diastolic blood pressure (OR, 0.35; 95% CI, 0.14-0.79; P=0.01) and fibrinogen levels (OR, 0.33; 95% CI, 0.20-0.52; P<0.001). Moreover, greater adherence to the DASH diet (second vs first category) was associated with reduced risk of high diastolic blood pressure (OR, 0.11; 95% CI, 0.04-0.34; P<0.001), insulin levels (OR, 0.44; 95% CI, 0.28-0.72; P<0.001), hs-CRP (OR, 0.53; 95% CI, 0.33-0.85; P=0.009), and fibrinogen (OR, 0.37; 95% CI, 0.21-0.64; P<0.001). There was an inverse association between the DASH and MDP with several cardiovascular risk factors. Future, longitudinal study designs are needed to confirm these results.

Mediterranean diet, Dietary Approaches to Stop Hypertension, and Pro-vegetarian dietary pattern in relation to the risk of basal cell carcinoma: a nested case-control study within the Seguimiento Universidad de Navarra (SUN) cohort

The association of dietary pattern with the risk of basal cell carcinoma (BCC) is little understood and has scarcely been investigated. We assessed the association of several complete dietary patterns [Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Pro-vegetarian dietary pattern] with the risk of BCC, conducting a nested case-control study (4 controls for each case). Cases and controls were selected from the SUN (Seguimiento Universidad de Navarra) cohort using risk set sampling. Cases were identified among subjects free of skin cancer at baseline but who later reported a physician-made BCC diagnosis during the follow-up period. In the cohort we identified 101 incident cases of BCC. In multivariable-adjusted conditional logistic regression analyses, better adherence to the Mediterranean diet (highest compared with lowest quintile) was associated with a 72% relative reduction in the odds of BCC (OR: 0.28; 95% CI: 0.10, 0.77; Ptrend=0.014); the DASH diet was associated with a 68% RR reduction (OR: 0.32; 95% CI: 0.14, 0.76; Ptrend=0.013) for the comparison between extreme quintiles. No association was found between a Pro-vegetarian dietary pattern and BCC. Higher fruit consumption (highest compared with lowest quintile, OR: 0.27; 95% CI: 0.11, 0.64; Ptrend<0.001) and low-fat dairy products (OR: 0.39; 95% CI: 0.16, 0.92; Ptrend=0.014) were associated with a lower BCC risk. Our results suggest that Mediterranean and DASH dietary patterns may be associated with a lower risk of BCC, but confirmatory studies are required.

The association of Dietary Approaches to Stop Hypertension-style diet with urinary risk factors of kidney stones formation in men with nephrolithiasis.

The relation of the Dietary Approaches to Stop Hypertension (DASH)-style diet to urinary lithogenic factors is unclear. This study aimed to assess the association between adherence to the DASH diet and urinary risk factors of kidney stones formation. A total of 264 men apparently with nephrolithiasis, aged 18-89 years, participated in this cross-sectional study. The food item-based DASH diet based on 8 components (nuts and legumes, red and processed meat, low-fat dairy products, sweetened beverages, fruits, vegetables, sodium, and whole grains) and nutrient-based DASH score based on 9 target nutrients (protein, fiber, total fat, saturated fat, cholesterol, sodium, calcium, potassium, and magnesium) were calculated using a food frequency questionnaire. Urine analysis was performed to measure hypercalciuria, hypocitraturia, hyperoxaluria, hyperuricosuria, and hypercreatinuria as study outcomes. Multivariate logistic regression analysis was used to evaluate the relation of DASH diet to urinary factors. After multivariate adjustment, high adherence to the food-based or nutrient-based DASH dietary patterns was significantly associated with lower odds for hypercreatininuria, hypocitraturia, and hypercalciuria. Higher nutrient-based DASH diet scores were related to lower odds of hyperuricosuria and moderate adherence to the food-based DASH score increased odds for hyperoxaluria. Moreover, expect for "Nuts and legumes" and sodium, other components of DASH diet were significantly related to urinary lithogenic factors. Adherence to the DASH diet may be a strong preventive approach to decrease urinary risk factors of kidney stone formation.

Adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and osteoporosis risk in postmenopausal Iranian women.

This study was aimed to examine the association of adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and osteoporosis risk in postmenopausal Iranian women, hypothesizing that higher adherence to this pattern is associated with lower risk of postmenopausal osteoporosis. One hundred fifty-one postmenopausal Iranian women aged 50-85years participated in this cross-sectional study. Lumbar spine and femoral neck bone mineral densities (BMDs) were measured via dual-energy X-ray absorptiometry. Postmenopausal osteoporosis was then defined using the WHO criteria as a BMD T-score of ≤ - 2.5 standard deviations. The usual past-year dietary intakes were assessed by a valid and reliable 168-item food frequency questionnaire. The DASH score was then calculated based on energy-adjusted intakes of eight major dietary components usually emphasized (i.e., fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains) or minimized (i.e., sodium, sweets, and red or processed meats) in the DASH diet. The higher the DASH score of a participant, the higher the adherence to the DASH dietary pattern. After adjusting for several potential covariates in the multivariable-adjusted binary logistic regression analysis, participants in the highest tertile of DASH score had lower risk of osteoporosis at lumbar spine than those in the lowest tertile (odds ratio = 0.28; 95% confidence interval, 0.09-0.88; p = 0.029). However, no significant association was observed between adherence to the DASH dietary pattern and risk of osteoporosis at femoral neck. Findings suggest the inverse association of adherence to the DASH dietary pattern and osteoporosis risk in postmenopausal Iranian women.

DASH (Dietary Approaches to Stop Hypertension) dietary pattern and maternal blood pressure in pregnancy.

High blood pressure (BP) in pregnancy is associated with significant adverse outcomes. In nonpregnant populations, the DASH (Dietary Approaches to Stop Hypertension) diet is associated with reductions in blood pressure. The present study investigated the relationship between the DASH dietary pattern and maternal BP in pregnancy. This is an observational study of 511 women who participated in the ROLO study (Randomized cOntrol trial of LOw glycaemic index diet for the prevention of recurrence of macrosomia), 2007-2011, Dublin, Ireland. Auscultatory blood pressure, systolic blood pressure (SBP) and diastolic blood pressure (DBP) measurements were taken. Mean arterial pressure (MAP) was calculated. Dietary intakes were recorded using 3-day food diaries in each trimester. DASH scoring criteria were used to score and rank participants from low to high intakes of foods recommended in the DASH diet. Statistical analysis using analysis of variance and multiple linear regression were used to determine the relationship between maternal BP and DASH scores. Dietary intake more closely resembling the DASH dietary recommendations throughout pregnancy was associated with a lower DBP (mmHg) in trimesters 1 [B: -0.70; 95% confidence interval (CI)=-1.21 to -0.18] and 3 (B: -0.68; 95% CI=-1.19 to -0.17), as well as lower MAP (mmHg) in trimesters 1 (B: -0.78; 95% CI=-1.33 to -0.25) and 3 (B: -0.54; 95% CI=-1.04 to -0.04), controlling for body mass index, age, education, energy intake and intervention grouping. The DASH dietary pattern was associated with lower maternal BP in pregnancy among healthy women without hypertensive disorders of pregnancy. Despite the observational nature of these findings, the results demonstrate the potential for healthcare professionals to intervene to promote cardiovascular health in pregnancy.

Stricter Adherence to Dietary Approaches to Stop Hypertension (DASH) and its Association with Lower Blood Pressure, Visceral Fat, and Waist Circumference in University Students.

How diet affects blood pressure (BP) in young adults has not been studied in sufficient depth. For this purpose, we analyzed adherence to the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and BP in Spanish university students. The sample population of our cross-sectional study consisted of 244 subjects (18–31 years old), who were in good health. Measurements were taken of their systolic and diastolic BP. A food frequency questionnaire and 72 h food record were used to assess their dietary intake in the previous year. The resulting DASH score was based on foodstuffs that were emphasized or minimized in the DASH diet. Analysis of covariance adjusted for potential confounding factors showed that the mean values for systolic BP, visceral fat rating, and waist circumference (WC) of the subjects in the upper third of the DASH score were significantly lower than those of the subjects in the lower third (for systolic BP: mean difference −4.36 mmHg, p = 0.004; for visceral fat rating: mean difference −0.4, p = 0.024; for waist circumference: mean difference −3.2, p = 0.019). Stricter adherence to the DASH dietary pattern led to a lower BP, visceral fat rating, and WC values in these university students. Nevertheless, further prospective studies are needed to confirm these results.

Abstract P205: Long-term Changes in Microbiota-dependent Metabolite Trimethylamine N-oxide and Risks of Hypertension and Coronary Heart Disease, and Their Modulation by Diet: The Nurses' Health Study and the POUNDS Lost Trial

Introduction: A gut microbiota-related metabolite, trimethylamine N-oxide (TMAO) has been related to risks of cardiovascular events, however, whether changes in TMAO may contribute to the incidence of hypertension remains unknown. Gut microbiome may be affected by sodium intake and dietary patterns linked to blood pressure control, while little is known about whether these dietary factors may modify associations between TMAO changes and risks of hypertension and cardiovascular events. Hypothesis: To test whether long-term changes in TMAO are associated with increased risks of hypertension and coronary heart disease (CHD), and whether sodium intake and adherence to the DASH (Dietary Approaches to Stop Hypertension) dietary pattern may modulate these associations. Methods: A prospective nested case-control study was performed in 730 women (including 362 incident cases of fatal CHD and nonfatal myocardial infarction). We measured blood levels of TMAO at 2 time points (in 1989-90 and 2000-01), and prospectively examined associations of 10-year changes in TMAO with CHD events after the date of the second blood collection (through 2016). For the hypertension outcome, we assessed prevalent hypertension at 2nd time point among total participants, as well as the incidence of hypertension over 10 years (between 1989-90 and 2000-01) among people who were initially free of hypertension (n=410). In overweight and obese participants (n=429) from a randomized dietary intervention, we also investigated whether diet-induced changes in TMAO were related to blood pressure changes considering 24-hr urinary sodium excretion as a marker of sodium intake. Results: Elevated TMAO levels were significantly associated with hypertension at the 2nd time point (relative risk (RR): 1.30 (95% CI: 1.09, 1.56) per 1 SD increment). Also, greater 10-year increases in TMAO were significantly associated with increased risks of incident hypertension and CHD, with evidence of significant modification by adherence to the DASH diet (P-interaction =0.02 for hypertension; P-interaction =0.01 for CHD). Among people with lower adherence to the DASH diet (i.e., having unhealthy dietary patterns and higher sodium intake), every 1 SD increase in TMAO was associated with a RR of 2.13 (1.30, 3.49) for hypertension, and a RR of 2.03 (1.42, 2.89) for CHD. Such significantly increased risks of hypertension and CHD by TMAO increases were not found for women with higher adherence to the DASH diet. In a dietary intervention, we also found similar associations; diet-induced changes in TMAO levels with blood pressure changes were modified by urinary sodium excretion. Conclusion: Increases in TMAO, an atherogenic microbial metabolite, were associated with higher risks of hypertension and CHD among women, and heart-healthy dietary patterns and sodium intake modified the unfavorable associations of TMAO with the risks of these diseases.

Adherence to the Dietary Approaches to Stop Hypertension (DASH) dietary pattern reduces the risk of colorectal cancer: A systematic review and meta-analysis

Colorectal cancer (CRC) has become a major concern due to industrialization and dietary changes generated by it. Many of the components of the DASH (Dietary Approach to Stop Hypertension) diet are associated with the risk of CRC. However, the relationship between DASH dietary pattern and CRC has not been studied yet in a systematic review and meta-analysis. The present study was conducted to review the studies investigating the relationship between DASH diet and the risk of CRC. PubMed and Scopus search engines were searched to find relevant publications from inception up to September 2019. All the observational studies that addressed the association between DASH diet and CRC were included in the systematic review and meta-analysis. All the steps including data base search, screening, and data extraction were carried out by two researchers, independently. Eight studies included in this systematic review and 5 studies (out of 8 studies included in the systematic review) were included in the meta-analysis. Combining 12 effects sizes from 5 studies, a significant inverse association between adherence to the DASH diet and risk of CRC was found (RR: 0.80; 95% CI: 0.74, 0.85). Based on the result of this study, individuals with greater adherence to DASH diet had 20% lower risk of CRC. The current study demonstrates that the risk of CRC is negatively associated with the adherence to the DASH dietary pattern.

Adherence to DASH dietary pattern is inversely associated with osteoarthritis in Americans

Osteoarthritis (OA) is one of the most common diseases that cause disability among older adults. The objective of this study was to assess the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) and OA in American adults. This study included adults (≥ aged 20 years) who participated in the National Health and Examination Survey (NHANES) 2007–2016 in the United States. Adherence to the DASH score was calculated from 8 food groups. Higher scores indicate better adherence to the DASH dietary pattern. Among the 21,901 participants included in this study, 10.26% reported having OA. Results of our multivariable logistic regression indicated a statistically significant inverse association between DASH score tertiles and OA. The adjusted ORs (95% CI) were 1.00 (ref), 0.89 (0.72; 1.10), and 0.78 (0.60; 1.00) across increasing DASH score tertiles (P for trend = 0.045). In this representative sample of American adults, greater adherence to the DASH dietary pattern was associated with lower likelihood of having OA.

Dietary Approaches to Stop Hypertension and risk of chronic kidney disease: A systematic review and meta-analysis of observational studies.

Dietary Approaches to Stop Hypertension (DASH) diet has been favorably linked to important risk factors associated with development of chronic kidney disease (CKD), such as insulin resistance, hypertension, and dyslipidemia. However, the protective role of DASH dietary patterns in development of CKD, as measured by estimated glomerular filtration rate (eGFR), remains inconsistent in the literature. The aim of the current systematic review was to summarize the findings of previous observational studies and quantify the potential association between DASH dietary patterns and the risk of CKD using meta-analysis. A comprehensive search was done with the use of MEDLINE, EMBASE, Web of Sciences, and Scopus databases to find relevant articles published prior to June 2019. Search terms included: ([Dietary Approaches to Stop Hypertension] OR [DASH]) AND ([Kidney Failure, Chronic] OR [Renal Insufficiency, Chronic] OR [Chronic Kidney Disease], OR [CKD] OR [End-Stage Renal Disease] OR [ESRD] OR [Kidney] OR [Renal]). To pool the risk estimates, fixed-effects and random-effects models were applied. Cochrane Q test was performed to detect sources of heterogeneity among the included studies. Out of the seven studies included in the systematic review, six were eligible for inclusion in the meta-analysis. The total sample size was 568,213 participants including 16,694 cases of CKD. Combined risk estimates for 2 cross-sectional and 4 prospective cohort studies showed an inverse association between DASH dietary patterns and risk of CKD (Pooled risk estimate: 0.77, 95% CI 0.63-0.94; p=0.01). Stratified analysis showed a marginally significant relationship between DASH dietary patterns and risk of CKD in prospective cohort studies (Pooled risk estimate: 0.79, 95% CI 0.61-1.01; p=0.05), and no significant association in cross-sectional studies (Pooled risk estimate: 0.71, 95% CI 0.38-1.34; p=0.29), respectively. A significant association was observed between DASH dietary patterns and risk of CKD in the studies extracted DASH based on nutrients (Pooled risk estimate: 0.78, 95% CI 0.63-0.97; p=0.02), compared to the studies extracted DASH based on food groups (Pooled risk estimate: 0.66, 95% CI 0.28-1.58; p=0.35). The results of the present study showed a significant inverse association between DASH dietary patterns and the risk of developing CKD. Adherence to DASH dietary patterns might have protective effects against CKD development and progression. Further research is required to confirm the certainty of estimates.

Dietary Patterns and Cardiometabolic Outcomes in Diabetes: A Summary of Systematic Reviews and Meta-Analyses.

The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD) conducted a review of existing systematic reviews and meta-analyses to explain the relationship between different dietary patterns and patient-important cardiometabolic outcomes. To update the clinical practice guidelines for nutrition therapy in the prevention and management of diabetes, we summarize the evidence from these evidence syntheses for the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), Portfolio, Nordic, liquid meal replacement, and vegetarian dietary patterns. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. We summarized the evidence for disease incidence outcomes and risk factor outcomes using risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs), respectively. The Mediterranean diet showed a cardiovascular disease (CVD) incidence (RR: 0.62; 95%CI, 0.50, 0.78), and non-significant CVD mortality (RR: 0.67; 95%CI, 0.45, 1.00) benefit. The DASH dietary pattern improved cardiometabolic risk factors (P < 0.05) and was associated with the decreased incidence of CVD (RR, 0.80; 95%CI, 0.76, 0.85). Vegetarian dietary patterns were associated with improved cardiometabolic risk factors (P < 0.05) and the reduced incidence (0.72; 95%CI: 0.61, 0.85) and mortality (RR, 0.78; 95%CI, 0.69, 0.88) of coronary heart disease. The Portfolio dietary pattern improved cardiometabolic risk factors and reduced estimated 10-year coronary heart disease (CHD) risk by 13% (−1.34% (95%CI, −2.19 to −0.49)). The Nordic dietary pattern was correlated with decreased CVD (0.93 (95%CI, 0.88, 0.99)) and stroke incidence (0.87 (95%CI, 0.77, 0.97)) and, along with liquid meal replacements, improved cardiometabolic risk factors (P < 0.05). The evidence was assessed as low to moderate certainty for most dietary patterns and outcome pairs. Current evidence suggests that the Mediterranean, DASH, Portfolio, Nordic, liquid meal replacement and vegetarian dietary patterns have cardiometabolic advantages in populations inclusive of diabetes.