Dietary Approaches To Stop Hypertension Diet Research Articles

The effect of dietary approaches to stop hypertension (DASH) diet on fatty liver and cardiovascular risk factors in subjects with metabolic syndrome: a randomized controlled trial

BackgroundMetabolic syndrome (MetS) as a multifactorial disorder is associated with non-communicable diseases. The dietary approaches to stop hypertension (DASH) diet is a healthy dietary pattern. We investigated the effect of the DASH diet on fatty liver and cardiovascular risk factors in subjects with MetS.Methods60 Subjects with MetS were assigned into the intervention group (DASH diet) or the control group (a healthy diet). Fatty liver index (FLI), hepatic steatosis index (HSI), waist circumference (WC), weight, body mass index (BMI), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) were evaluated at the beginning and after intervention. Equations of fatty liver indices such as FLI and HSI are based on liver enzymes, anthropometric variables, sex and having diabetes.Results30 subjects in the intervention group and 29 subjects in the control group completed the study. We found a significant reduction in the intervention group compared to the control group in FLI (-13.06 ± 10.03 vs. -2.90 ± 6.82;P < 0.001), HSI (-2.72 ± 2.59 vs. -0.81 ± 3.80;P = 0.02), WC (-6.02 ± 4.24 vs. -2.24 ± 4.28;P = 0.001), weight (-3.39 ± 2.53 vs. -1.51 ± 2.72;P = 0.008), BMI (-1.25 ± 0.93 vs. -0.56 ± 1.01;P = 0.008), DBP (-5.16 ± 3.92 vs. -1.50 ± 7.04;P = 0.01), SBP (-6.97 ± 8.21 vs. -1.36 ± 6.83;P = 0.006), TG (-18.50 ± 14.32 vs. 0.60 ± 23.81;P < 0.001), TC (-16.10 ± 17.94 vs. -5.07 ± 23.62;P = 0.04) and LDL-c (-13.50 ± 9.58 vs. -4.90 ± 18.28;P = 0.02). These results remained significant after adjusting for confounding factors, except for TC (P = 0.25).ConclusionsThe DASH diet was more effective than the control diet in managing fatty liver and cardiovascular risk factors.Trial registrationThe trial was registered on 21 October 2022 at Iranian Registry of Clinical Trials (IRCT20180201038585N12, URL: https://irct.behdasht.gov.ir/trial/66161).

Precision Nutrition for Management of Cardiovascular Disease Risk During Menopause.

Women can spend up to 40% of their lives in the postmenopausal state. As women begin to transition into menopause, known as perimenopause, changes in hormonal concentrations and body composition dramatically increase overall cardiometabolic risk. Dietary patterns and interventions can be utilized to prevent and treat cardiovascular disease (CVD) and some dietary patterns over others may be more beneficial due to their specific effects on the health aspects of menopause. In this narrative review, we summarize key cardiovascular alterations that occur during the menopause transition and explore current dietary recommendations to address CVD risk as well as explore the new frontier of precision nutrition and the implications for nutrition prescription during menopause. Popular dietary interventions for CVD such as the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean Diet (MED) have limited data in women following menopause. However, both diets improve CVD risk biomarkers of total cholesterol and low-density lipoprotein cholesterol as well as lower oxidative stress and inflammation and improve endothelial function. As the menopause transition increases the risk for developing metabolic syndrome, insulin insensitivity, and dyslipidemia, the DASH and MED diets may be impactful dietary strategies for mediating CVD risk in menopausal women. However, these are "one-size-fits-all" approaches that neglect individual characteristics such as genetic predisposition and environmental factors. Precision nutrition considers individual factors for nutrition prescription, spanning from evaluating food intake preferences and behaviors to deep phenotyping. Data from a large-scale investigation of the menopause transition suggests nutritional strategies that address postprandial glycemic responses, and the gut microbiome may attenuate some of the unfavorable effects of menopause on CVD risk factors. Considering menopause, women are a clinical population that would greatly benefit from precision nutrition. Future research should explore the use of machine learning and artificial intelligence in a precision nutrition framework to modify the DASH and MED diets to address adverse effects that occur during the menopause transition are vital for supporting women's health as they age.

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is associated with lower visceral and hepatic lipid content in recent-onset type 1 diabetes and type 2 diabetes.

To investigate the associations of the Dietary Approaches to Stop Hypertension (DASH) score with subcutaneous (SAT) and visceral (VAT) adipose tissue volume and hepatic lipid content (HLC) in people with diabetes and to examine whether changes in the DASH diet were associated with changes in these outcomes. In total, 335 participants with recent-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) from the German Diabetes Study were included in the cross-sectional analysis, and 111 participants in the analysis of changes during the 5-year follow-up. Associations between the DASH score and VAT, SAT and HLC and their changes were investigated using multivariable linear regression models by diabetes type. The proportion mediated by changes in potential mediators was determined using mediation analysis. A higher baseline DASH score was associated with lower HLC, especially in people with T2D (per 5 points: -1.5% [-2.7%; -0.3%]). Over 5 years, a 5-point increase in the DASH score was associated with decreased VAT in people with T2D (-514 [-800; -228] cm3). Similar, but imprecise, associations were observed for VAT changes in people with T1D (-403 [-861; 55] cm3) and for HLC in people with T2D (-1.3% [-2.8%; 0.3%]). Body mass index and waist circumference changes explained 8%-48% of the associations between DASH and VAT changes in both groups. In people with T2D, adipose tissue insulin resistance index (Adipo-IR) changes explained 47% of the association between DASH and HLC changes. A shift to a DASH-like diet was associated with favourable VAT and HLC changes, which were partly explained by changes in anthropometric measures and Adipo-IR.

Association between DASH diet and asthma symptoms among a large sample of adolescents: a cross-sectional study

BackgroundThe Dietary Approaches to Stop Hypertension (DASH) diet, which has a lot of emphasis on the consumption of fruits, vegetables, and whole grains, and on the other hand, the consumption of red meat and sodium is limited, due to its anti-inflammatory properties, which can be related to reducing the risk of asthma.ObjectivesThe aim of this study was to determine the relationship between the DASH diet and asthma symptoms among children and adolescents.MethodsThis cross-sectional study was conducted among7667 children (3414 boys and 4253 girls) aged 6–7 and 13–14 years living in central Iran. Dietary food consumption was assessed using a multiple-choice questionnaire. Logistic regression was used to obtain odds ratios for the association between the DASH-like diet with current asthma and asthma symptoms.ResultsOur findings revealed that higher adherence to a DASH-like diet resulted in lower odds of asthma confirmed by a doctor among the whole population (OR = 0.53; 95%CI: 0.36–0.76) and also in females (OR = 0.47; 95%CI: 0.29–0.78). Moreover, the higher adherence to the DASH-like diet was inversely associated with the chance of wheezing in the past 12 months in all subjects (OR = 0.67; 95%CI: 0.51–0.86) and in boys (OR = 0.57; 95%CI: 0.38–0.85).ConclusionThe findings of the present study showed that following the DASH diet can be associated with the improvement of asthma symptoms in children and adolescents. However, more research is needed to improve dietary recommendations for asthma prevention.

Effects of DASH diet with or without time-restricted eating in the management of stage 1 primary hypertension: a randomized controlled trial

BackgroundTime-restricted eating (TRE), a popular form of intermittent fasting, has shown benefits for improving metabolic diseases and cardiometabolic health. However, the effect of TRE in the regulation of blood pressure in primary hypertension remains unclear.MethodsA 6-week randomized controlled trial was conducted, in which a total of 74 stage 1 primary hypertensive patients without high-risk were randomly assigned to Dietary Approaches to Stop Hypertension (DASH) group (n = 37) or DASH + TRE group (n = 37). Participants in the DASH + TRE group were instructed to consume their food within an 8-h window. Scientific research platform in We Chat application was used to track participants. The primary outcome was blood pressure. The secondary outcomes included body composition, cardiometabolic risk factors, inflammation-related parameters, urinary Na+ excretion, other clinical variables and safety outcomes.ResultsThe reduction of systolic blood pressure and diastolic blood pressure were 5.595 ± 4.072 and 5.351 ± 5.643 mm Hg in the DASH group and 8.459 ± 4.260 and 9.459 ± 4.375 mm Hg in the DASH + TRE group. DASH + TRE group improved blood pressure diurnal rhythm. Subjects in DASH + TRE group had decreased extracellular water and increased urinary Na+ excretion. Furthermore, the decrease in blood pressure was associated with a reduction of extracellular water or increase in urinary Na+ excretion. In addition, safety outcomes such as nighttime hunger were also reported.ConclusionOur study demonstrated that 8-h TRE + DASH diet caused a greater decrease in blood pressure in stage 1 primary hypertensive patients than DASH diet. This study may provide novel insights into the benefits of lifestyle modification in the treatment of primary hypertension.Trial registrationhttps://www.chictr.org.cn/ (ChiCTR2300069393, registered on March 15, 2023).

Associations Between Ultra-Processed Food Consumption and Adverse Brain Health Outcomes.

Ultra-processed foods (UPFs) are linked to cardiometabolic diseases and neurologic outcomes, such as cognitive decline and stroke. However, it is unclear whether food processing confers neurologic risk independent of dietary pattern information. We aimed to (1) investigate associations between UPFs and incident cognitive impairment and stroke and (2) compare these associations with other commonly recommended dietary patterns in the REasons for Geographic and Racial Differences in Stroke study. This prospective, observational cohort study enrolled Black and White adults in the United States from 2003 to 2007. The NOVA system was used to categorize items from a baseline food frequency questionnaire according to the level of processing. Participants with incomplete or implausible self-reported dietary data were excluded. Consumption for each category (grams) was normalized to total grams consumed. Scores quantifying adherence to a Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet were also calculated. Incident cognitive impairment was defined using performance relative to a normative sample on memory and fluency assessments. Incident stroke was identified through adjudicated review of medical records. The cognitive impairment cohort (n = 14,175) included participants without evidence of impairment at baseline who underwent follow-up testing. The stroke cohort (n = 20,243) included participants without a history of stroke. In multivariable Cox proportional hazards models, a 10% increase in relative intake of UPFs was associated with higher risk of cognitive impairment (hazard ratio [HR] = 1.16, 95% CI 1.09-1.24, p = 1.01 × 10-5) and intake of unprocessed or minimally processed foods with lower risk of cognitive impairment (HR = 0.88, 95% CI 0.83-0.94, p = 1.83 × 10-4). Greater intake of UPFs (HR = 1.08, 95% CI 1.02-1.14, p = 1.12 × 10-2) and unprocessed or minimally processed foods (HR = 0.91, 95% CI 0.86-0.95, p = 2.13 × 10-4) were also associated with risk of stroke in multivariable Cox models. The effect of UPFs on stroke risk was greater among Black than White participants (UPF-by-race interaction HR = 1.15, 95% CI 1.03-1.29, p = 1.50 × 10-2). Associations between UPFs and both cognitive impairment and stroke were independent of adherence to the Mediterranean, DASH, and MIND diets. Food processing may be important to brain health in older adults independent of known risk factors and adherence to recommended dietary patterns.

A qualitative study of patients’ perceptions of DASH diet apps for dietary self- management of hypertension in Saudi Arabia

Nutrition smartphone apps have become a popular and readily accessible approach to improving dietary behaviour. Hypertension is often associated with a poor diet, and its prevalence is increasing in Saudi Arabia(1). The Dietary Approaches to Stop Hypertension (DASH) eating plan has been shown to reduce blood pressure in people with hypertension(2). A previous study identified two high-quality, safe, and potentially effective smartphone apps for managing hypertension: NOOM and DASH To TEN(3). This study aimed to explore the potential of these two DASH diet self- management apps for controlling blood pressure in the Saudi Arabian context.Fifteen patients were recruited at King Abdullah bin Abdulaziz University Hospital in Riyadh, Saudi Arabia. Ten patients had hypertension, and five had prehypertension (mean age = 45). Patients were given the two apps and asked to try each for one week. Focus groups (n=4) were held at the end of the trial to understand the patient perceptions of the apps. Discussions were recorded, and the transcriptions were analysed using a thematic framework analysis(4).The following four themes emerged:1.Managing hypertension through diet was perceived as important. Most patients reported thatadhering to the DASH diet was challenging due to a lack of motivation and willpower,inadequate support from household members, and high prices for healthy food.2.The potential and current reach of dietary apps emerged as a main theme, and manycomments related to patients’ belief that dietary apps could increase their motivation and awareness about the DASH diet. Barriers to the use of apps were also identified including their difficulty of use, a preference for dietetic monitoring, and cost.3.Interactive app functionality was identified as a key theme, as evidenced by comments about a straightforward sign-up process, an extensive food database for dietary self-monitoring, feedback, goal setting, and reminders, considered essential for diet adherence.4.A preference for the NOOM app emerged. Patients perceived the NOOM app more suitable in the Saudi context. Noom was deemed to support DASH self-management because it supports weight reduction, which helps lower blood pressure. NOOM was perceived as highly interactive, offering motivational reminders, feedback, realistic dietary plans, and a comprehensive food database. Patients made several recommendations for app improvement; these included Arabic language support, automatic calculation of sodium and potassium consumption, and lower cost. Patients also expressed a desire for training in the use of the app.This qualitative analysis suggests that the NOOM app could be suitable for use with hypertensive patients in Saudi Arabia. Further research is needed to determine the feasibility and efficacy of long- term use of the NOOM app with a Saudi Arabia population.

Effect of the DASH diet on the sodium-chloride cotransporter and aquaporin-2 in urinary extracellular vesicles.

The dietary approach to stop hypertension (DASH) diet combines the antihypertensive effect of a low sodium and high potassium diet. In particular, the potassium component of the diet acts as a switch in the distal convoluted tubule to reduce sodium reabsorption, similar to a diuretic but without the side effects. Previous trials to understand the mechanism of the DASH diet were based on animal models and did not characterize changes in human ion channel protein abundance. More recently, protein cargo of urinary extracellular vesicles (uEVs) has been shown to mirror tissue content and physiological changes within the kidney. We designed an inpatient open label nutritional study transitioning hypertensive volunteers from an American style diet to DASH diet to examine physiological changes in adults with stage 1 hypertension otherwise untreated (Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER 3rd, Simons-Morton DG, Karanja N, Lin PH; DASH-Sodium Collaborative Research Group. N Engl J Med 344: 3-10, 2001). Urine samples from this study were used for proteomic characterization of a large range of pure uEVs (small to large) to reveal kidney epithelium changes in response to the DASH diet. These samples were collected from nine volunteers at three time points, and mass spectrometry identified 1,800 proteins from all 27 samples. We demonstrated an increase in total SLC12A3 [sodium-chloride cotransporter (NCC)] abundance and a decrease in aquaporin-2 (AQP2) in uEVs with this mass spectrometry analysis, immunoblotting revealed a significant increase in the proportion of activated (phosphorylated) NCC to total NCC and a decrease in AQP2 from day 5 to day 11. This data demonstrates that the human kidney's response to nutritional interventions may be captured noninvasively by uEV protein abundance changes. Future studies need to confirm these findings in a larger cohort and focus on which factor drove the changes in NCC and AQP2, to which degree NCC and AQP2 contributed to the antihypertensive effect and address if some uEVs function also as a waste pathway for functionally inactive proteins rather than mirroring protein changes.NEW & NOTEWORTHY Numerous studies link DASH diet to lower blood pressure, but its mechanism is unclear. Urinary extracellular vesicles (uEVs) offer noninvasive insights, potentially replacing tissue sampling. Transitioning to DASH diet alters kidney transporters in our stage 1 hypertension cohort: AQP2 decreases, NCC increases in uEVs. This aligns with increased urine volume, reduced sodium reabsorption, and blood pressure decline. Our data highlight uEV protein changes as diet markers, suggesting some uEVs may function as waste pathways. We analyzed larger EVs alongside small EVs, and NCC in immunoblots across its molecular weight range.

Adherence to the dietary approaches to stop hypertension diet reduces the risk of diabetes mellitus: a systematic review and dose-response meta-analysis.

Despite several epidemiological studies reporting a significant association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and the risk of diabetes mellitus, the results remain controversial. In this systematic review and meta-analysis, we aimed to summarize the existing evidence from published observational studies and evaluate the dose-response relationship between adherence to the DASH diet and diabetes mellitus risk. We performed a systematic search for relevant articles published up to September 2023 using electronic databases of PubMed, Embase, Scopus, and China National Knowledge Infrastructure (CNKI). A random-effects model was applied to calculate the combined relative risks (RR) with 95% confidence intervals (CIs) for the highest compared to the lowest categories of DASH score in relation to diabetes mellitus risk. Heterogeneity among the included studies was assessed using the Cochran's Q test and I-squared (I2) statistic. Literature search, study selection, data extraction, and quality assessment were performed by two independent reviewers. Fifteen studies involving 557,475 participants and 57,064 diabetes mellitus cases were eligible for our analyses. Pooled analyses from included studies showed that high adherence to the DASH diet was significantly associated with a reduced risk of diabetes mellitus (RR: 0.82; 95% CI: 0.76-0.90, P < 0.001). Moreover, the dose-response meta-analysis revealed a linear trend between adherence to the DASH diet and diabetes mellitus (RR:0.99; 95%CI: 0.97-1.02, Pdose-response = 0.546, Pnonlinearity = 0.701). Subgroup analyses further revealed a significant inverse association between adherence to the DASH diet and diabetes mellitus risk in case-control studies (RR: 0.65; 95%CI: 0.29-1.43, P < 0.001), with a marginal inverse association in cohort studies (RR:0.83; 95%CI: 0.76-0.91, P < 0.001). Additionally, we conducted analyses separately by comparison and found a significant inverse association between DASH diet and diabetes mellitus risk in T3 vs T1 comparison studies (RR = 0.74; 95%CI: 0.64-0.86, P = 0.012). The findings of this study demonstrate a protective association between adherence to the DASH diet and risk of diabetes mellitus. However, further prospective cohort studies and randomized controlled trials are needed to validate these findings.

The blood pressure control effect of the sodium-restricted dietary approaches to stop hypertension diet: a systematic review.

The Dietary Approaches to Stop Hypertension (DASH) diet is highly effective in controlling blood pressure (BP). Although Na restriction is not a primary focus within the DASH diet, it is recommended that it be added to control BP. Therefore, we aimed to systematically review the characteristics and BP-lowering effects of Na-restricted DASH diet interventions. We searched thirteen databases, namely, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, KoreaMed, KISS, KMbase, RISS, CINAHL, Scopus, ClinicalTrials.gov, Grey Literature Report, OpenGrey and PQDT Global, for articles published through May 2023. The randomised controlled trials assessing the BP-lowering effect of the Na-restricted DASH diet in adults aged 18 years and older were included. The study protocol was registered in the PROSPERO registry (CRD42023409996). The risk of bias in the included studies was also assessed. Nine articles were included in this review. Interventions were categorised into three types: feeding, provision and education, and the study results were compared by intervention type. BP was significantly reduced in two of the three feeding studies, one of the three provisional studies and none of the educational studies. In eight studies, effect sizes varied among both systolic BP (-7·7 to -2·4) and diastolic BP (-8·3 to 0·1). Six studies showed an overall high risk of bias. In conclusion, Na-restricted DASH may have beneficial effects on BP control. Additionally, compared with control interventions, feeding interventions appeared to have a greater BP-lowering effect. Further high-quality studies are needed to improve the quality of the evidence.

A Narrative Review of the Association Between Healthy Dietary Patterns and Depression.

The purpose of the present review is the investigation of healthy dietary patterns and diet quality in relation to depression risk. Nutritional psychiatry is to develop scientifically based research that defines the role of nutrition and nutrients in various aspects of mental health. Growing evidence from the field suggests that diet may play an important role in the prevention and/or treatment of depression. In contrast, there is evidence that unhealthy diets may increase the risk of depression. This emerging research suggests that dietary interventions could help prevent depression or be an alternative or adjunctive therapy for depression. The Mediterranean diet (MedDiet), the Dietary Approaches to Stop Hypertension (DASH) diet, and the vegetarian diet are examined in this review.The electronic databases PubMed, Scopus, and Google Scholar were searched for relevant studies published during the last five years. We found many results that support that healthy eating patterns (high in vegetables, fruits, whole grains, nuts, seeds, and fish, low in processed foods) are related to a reduction in the risk of depression. The most robust findings are related to MedDiet, where we also found several positive results for the DASH diet. Regarding the vegetarian diet, there are inconsistent reports. Furthermore, a consistent finding refers to a lower Dietary Inflammatory Index (DII) as associated with a lower depression risk. It has been observed that people suffering from depression have poorer nutritional quality, with lower fruit and vegetable intake. This observation may strengthen the argument that nutritional interventions should be incorporated as an important "pillar" in the multifactorial treatment of patients. However, more well-designed studies are needed to establish the relationship between dietary patterns and mental health. In particular, interventional, longitudinal studies could be more enlightening.

Effect of DASH vs. mediterranean diet accompanied by a salt restriction on metabolic syndrome and cardiometabolic risk factors in adults with high normal blood pressure or grade 1 hypertension: secondary analyses of a randomized controlled trial

ObjectiveLifestyle interventions are recommended as the first-line treatment to control metabolic syndrome components and improve cardiometabolic risk factors. However, studies directly comparing the cardiometabolic effects of the Dietary Approaches to Stop Hypertension (DASH) vs. the Mediterranean diet (MedDiet) accompanied by salt restriction are currently lacking. Thus, with the present secondary analyses of a randomized trial, we aimed to assess the cardiometabolic effects of a 3-month intensive dietary intervention implementing salt restriction alone or on top of the DASH and MedDiet compared to no/minimal intervention in never drug-treated adults with high normal blood pressure (BP) or grade 1 hypertension. MethodsWe randomly assigned individuals to the control group (CG, n = 60), salt restriction group (SRG, n = 60), DASH diet with salt restriction group (DDG, n = 60), or MedDiet with salt restriction group (MDG, n = 60). ResultsAccording to the intention-to-treat analysis, the DDG and the MDG had lower odds ratio (OR) (95% CI) of metabolic syndrome [0.29 (0.12, 0.72), and 0.15 (0.06, 0.41), respectively] compared to the CG. Moreover, the MDG had lower odds of metabolic syndrome compared to the SRG and lower odds of elevated BP levels than the DDG and the SRG. Moreover, total and LDL-cholesterol, fasting glucose, HbA1c, and systolic/diastolic BP were reduced in all three intervention groups compared to the CG. ConclusionOn a background of salt restriction, the MedDiet was superior in BP reduction, but the DASH and MedDiet reduced the prevalence of metabolic syndrome to the same extent.

Humanized Diets Define Optimal Pressure Lowering Response to Dietary Potassium in Mice

High potassium (K) diets are known to lower blood pressure (BP) in rodents and humans but can also raise BP when consumed in extreme. Interestingly, this response also appears to be influenced by dietary sodium (Na) such that when Na intake is high, high K lowers BP, whereas when sodium intake is lower, high K increases BP (Little et al, Hypertension, 2023). We recently reported (Little et al, JCI Insight, 2023) that the K-mediated BP lowering response, driven by the inactivation of the thiazide-sensitive sodium chloride cotransporter (NCC), is offset by an increase in ENaC (epithelial sodium channel) when an extremely high K diet is chronically consumed. Here, we define the optimal dietary K level needed to inactivate NCC without activating ENaC in the high Na setting and show this K level approximates the recommended level for humans by the DASH (Dietary Approaches to Stop Hypertension) trials. Mice were fed diets containing 6 different K contents, all with high Na (1.7%), so the effects of the control diet (1% K, 1.7% Na) could be compared to traditional extremes (0.1% and 5% K) and others (0.35%, 0.7%, 1.7%) that mimic typical variation in human diets (30-120 mEq/d) when mouse consumption is normalized for caloric intake relative to body mass. Metabolic cage and renal clearance studies were used to assess electrolyte and aldosterone (aldo) excretion as well as NCC- (hydrochlorothiazide (HCTZ) sensitive) and ENaC- (benzamil sensitive) dependent sodium handling. Blood potassium (PK) was measured using iSTAT. BP was measured hourly for 10 days using DSI telemetry probes in male mice (C57Bl6J). The BP response to the diuretics was also measured. PK levels changed significantly with each diet relative to the control diet from 3.2mM to 4.8mM. Systolic blood pressure (SBP; 12-hour active period average) also changed significantly with the different K diets. Extreme high or low K diets (0.1% and 5%) increased SBP by 7mmHg, 0.35% and 0.7% K diets increased SBP by 6 and 3mmHg, while the 1.7% K diet lowered SBP by 4mmHg relative to control (1% K, 132 mmHg). Thus, the relationship between SBP and PK is ‘U-shaped’. Diuretic studies revealed that HCTZ reduces SBP in the 0.1%, 0.35%, 0.7% K groups but had minimal effect in the 1.7% and 5% K groups. Conversely, inhibiting ENaC activity with benzamil normalized SBP in the 5% K group but had a minimal effect in the 1.7% group and no BP effect in the other groups. The BP-lowering effect of each diuretic correlated with increased natriuresis suggesting dietary K influences blood pressure by affecting distal nephron sodium transport. Lastly, urinary aldo levels increased with increasing dietary K, but compared to the control group, aldo levels were significantly lower in the 0.1%, 0.35%, and 0.7% groups, significantly higher in the 5% group, and not different in the 1.7% group. As previously reported, our results demonstrate that extremes in dietary intake can elevate blood pressure by stimulating distal nephron sodium transport proteins with low K inducing NCC activation and high K stimulating ENaC with elevated aldosterone. An optimal dietary K level (1.7%) that maximally reduces BP in mice was identified, suppressing NCC activity while limiting aldosterone production and ENaC activity. Remarkably, this diet mimics the human DASH diet in K content and further supports its effcacy as a blood pressure-lowering modality. DE (DK054231, DK51496); PW (DK054231, DK093501, DK110375): Leducq Foundation U54 DK137331-01. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Assessing diet quality and associated environmental impacts: A cross-sectional analysis in a middle- to older-aged Irish population

Current dietary patterns have implications for both population and planetary health, giving dietary shifts the potential to reduce these impacts. However, higher quality diets are not inherently of lower environmental impact. This paper examines the association between diet quality, defined using the Dietary Approaches to Stop Hypertension (DASH) diet, Mediterranean (MED) diet and Healthy Eating Index 2015 (HEI-2015) , and environmental impacts among middle- to older-aged adults. The cross-sectional analysis used a random sample of 1862 males and females aged 46–73 years. Diet quality scores (DQS) were derived from a validated food frequency questionnaire (FFQ). The impact of food production was estimated using greenhouse gas emissions (GHGE) and blue water use (BWU) environmental impact indicators from secondary data sources. Relationships between food groups, DQS and environmental impacts were evaluated via correlation and regression analyses. The food group red meat & offal was found to be the largest contributor to dietary GHGE and caffeinated beverages to BWU for all DQS and across all quartiles of adherence. The cumulative contribution of discretionary foods and beverages requires attention given they are superfluous to human health. In fully adjusted regression analyses, higher diet quality was associated with lower GHGE for all DQS. Conversely, higher diet quality was positively associated with water use (DASH and MED only). Encompassing principles of the DASH and MED diets in future dietary recommendations may reduce diet-related disease in later life and dietary GHGE. However, the increase of BWU as diets become healthier is a concern. Advocating for plant-based diets must be coordinated with sustainable production and supply. National solutions to increase self-sufficiency and reduce impacts and reliance on climate vulnerable countries is warranted. The population dietary shifts required for health and planet can only be realised by multi-level structural changes to food systems through policy, and not through sole expectation of individual change.

Impact of Lifestyle Medicine Interventions on the Management of Systemic Hypertension in Primary Care: A Canadian Randomized Controlled Trial

The study aimed to evaluate the feasibility of implementing lifestyle interventions in primary care settings with hypertensive patients and their effect on blood pressure, body composition, cardiometabolic markers, and antihypertensive drug use. Sixty participants diagnosed with stage 1 hypertension were randomly assigned to 4 groups: (1) Standard medical care (control), (2) Physical activity protocol, (3) Dietary Approach to Stop Hypertension (DASH) diet, and (4) Combination of physical activity protocol and DASH diet. Participants received counseling from family physicians, nurses, kinesiologists, and registered dietitians. Various assessments were conducted before (T0) and after (T6) the interventions, including 24-h ambulatory blood pressure monitoring, blood and urine tests, anthropometric measurements, computed tomography to measure adipose tissue, submaximal exercise test to estimate maximal oxygen consumption and health questionnaires. Fifty-one (51) participants (51/57, 89%) completed the program. All interventions reduced blood pressure indices between T0 and T6, except the combined interventions group. Body composition and cardiometabolic parameters were improved in all groups, except for the control group. In total, 28% of participants (7/23) reduced or stopped their antihypertensive medications at T6. The results suggest that structured lifestyle interventions are feasible in primary care and improve blood pressure and cardiometabolic parameters in patients with stage 1 hypertension.

The Effect of KalDiDASH (DASH Diet Calendar) Usage on Knowledge Level and Diet Adherence Among Hypertension Patients the Kalibagor Village Posbindu

Background:Hypertension is a condition where an individual's systolic blood pressure is 140 mmHg, or higher and diastolic blood pressure is 90 mmHg or higher, occurring in both men and women. One recommended approach to manage hypertension is the DASH (Dietary Approaches to Stop Hypertension) diet. However, in implementing the hypertension diet, patients often lack knowledge about permissible foods and tend to follow the diet only immediately after seeking medical attention, with adherence declining after the first week. Method: This study employed a quantitative method with a pre-experimental design using a one-group pretest-posttest approach. The sample consisted of 27 respondents suffering from hypertension at PosbinduKalibagor Village, selected through the total sampling technique and G*Power software. Data analysis utilized Paired Sample T-Test with a significance level of 0.05. Results:There was a significant difference in the average knowledge level before and after DASH diet health education using the KalDiDASH media, with t(26) = -7.772, p = 0.001. There was also a significant difference in the average diet adherence level before and after using KalDiDASH, with t(26) = -2.993, p = 0.006. There was an effect of using KalDiDASH (DASH Diet Calendar) on the knowledge level and diet adherence of hypertension patients at the Kalibagor Village Posbindu, with p-values of 0.001 and 0.006 (less than 0.05), respectively, and a large effect size. Conclusion:Using KalDiDASH affects hypertension patients' knowledge level and diet adherence at the Kalibagor Village Posbindu.

Abstract MP11: Sodium Reduction in Combination With the Dietary Approaches to Stop Hypertension Diet Lowers 10-year Atherosclerotic Cardiovascular Disease Risk: Results From the Dietary Approaches to Stop Hypertension-Sodium Trial

Introduction: The Dietary Approaches to Stop Hypertension (DASH) diet lowers estimated 10-year ASCVD (atherosclerotic cardiovascular disease) risk. The impact of sodium reduction, alone or in combination with the DASH diet, is not known. Objective: To determine the effects of the sodium reduction alone and when combined with the DASH diet on 10-year ASCVD risk. Methods: The DASH-Sodium trial randomized 412 adults with systolic blood pressure (BP) 120-159 mmHg and diastolic BP 80-95 mmHg to the DASH diet or a typical American diet (control). Within each arm, individuals consumed 3 different levels of sodium in random order: low (50 mmol/day), medium (100 mmol/day), and high (150 mmol/day). Each period lasted 4 weeks. Pooled cohort equation-estimated 10-year ASCVD risk scores were calculated at baseline and at 4, 8, and 12 weeks of feeding. Results: Among the 412 participants (mean [SD] age 48 [10] years; 57% female, 57% Black), sodium reduction decreased ASCVD risk scores in both DASH and control diets ( Figure 1 ). Compared to high sodium intake, low sodium intake changed ASCVD risk by -9.4% (95% CI -11.7, -7.0). Compared to a typical American diet, the DASH diet changed 10-year ASCVD by -5.3% (95% CI -9.3, -1.2). Compared to a high sodium-control diet, the combination of both low sodium intake with DASH changed ASCVD risk by -14.1% (95% CI -18.6, -9.3). Conclusions: Sodium reduction and the DASH diet both independently reduced 10-year ASCVD risk. Moreover, the combined impact was additive. These findings support dietary sodium reduction in addition to the DASH diet for ASCVD prevention.

Abstract P107: The DASH Diet Reduces Markers of Subclinical Cardiac Injury Over an 8-week Period: Results From an Individual Level Meta-Analysis

Introduction: The Dietary Approaches to Stop Hypertension (DASH) diet has previously been shown to reduce blood pressure and low-density lipoprotein (LDL) cholesterol as compared to the typical American diet. However, direct evidence linking the DASH diet with clinical markers of cardiovascular disease (CVD) is limited. Objectives: To perform a systematic review of trials examining the DASH diet and sensitive markers implicated in CVD: high-sensitivity cardiac troponin (hs-cTnl), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high-sensitivity c-reactive protein (hs-CRP) to determine the effects of the DASH diet on subclinical cardiac injury. Methods: We systematically reviewed 1122 abstracts from PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials (date range 1997 to 2022). We retrieved data from two trials (DASH and DASH-Sodium, using 8-week biomarker measurements), and combined data from the trials to determine subgroup effects. We used mixed effects tobit models to determine the effects of the DASH diet (versus an isocaloric typical American diet) on hs-cTnl, NT-proBNP, and hs-CRP. Effects were determined overall and in subgroups of age, sex, race, hypertension status, obesity, and smoking status. Results: Of the 632 participants included, mean age (SD) was 47 (10.5); 54% were female and 55% were Black. Compared to an isocaloric control diet, the DASH diet reduced hs-cTnl (β = -17.7%, 95% CI: -26.3, -8.1), NT-proBNP (β = -8.6%, 95% CI: -16.8, 0.4), and hs-CRP (β = -11.1%, 95% CI: -20.7, 0.2). Effects were consistent across demographic groups, although the DASH diet had a larger effect on hs-CRP among men ( P -interaction = 0.016) ( Figure ). Conclusion: The DASH diet reduced subclinical cardiac damage and inflammation over an 8-week period. These data provide evidence of the direct benefits of the DASH diet on cardiac health.

Abstract P195: Metabolites Mediate the Association of the MIND Diet With Hypertension and Chronic Kidney Disease

The Mediterranean-DASH diet intervention for neurodegenerative delay (MIND), is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. The Mediterranean and DASH diets are associated with decreased risk of cardiometabolic disease; however, less is known regarding the association of the MIND diet with cardiometabolic disease. The objectives of this analysis were (1) to determine if the MIND diet is associated with prevalent hypertension and chronic kidney disease (CKD) and (2) to identify metabolites associated with the MIND diet and if these metabolites mediate the association of the MIND diet with hypertension and CKD. In the REasons for Geographic and Racial Disparities in Stroke (REGARDS) cohort, we examined the association of the MIND diet with prevalent hypertension and CKD. Fully adjusted models included age, sex, race, calories, alcohol, smoking, education, exercise, income, region, BMI, lipidemia, history of coronary artery disease, and diabetes. In the REGARDS stroke case-cohort sub-study, 357 metabolites were measured in baseline plasma. Weighted linear regression models were used to test the association between MIND diet score and metabolites adjusting for age, sex, race, calories, alcohol, and smoking. Weighted logistic regression models were used to test the association between MIND-metabolites and hypertension and CKD adjusting for age, race, sex, BMI, alcohol, and smoking. Mediation analysis was conducted to examine metabolites mediating the association between MIND diet and hypertension and CKD. Sensitivity analyses were conducted in the cohort random controls. A higher MIND diet score was associated with lower odds of hypertension (odds ratio [OR] 0.97, 95% CI 0.96-0.99; p=0.01) and CKD (OR 0.88, 95% CI 0.86-0.91; p&lt;0.0001). Fifty-one metabolites were associated with the MIND diet (MIND-metabolites). Three MIND-metabolites were associated with greater odds of hypertension; however, these associations were attenuated in the fully adjusted models. Twelve MIND-metabolites were associated with greater odds of CKD. Mediation analyses indicated dimethylguanidino valeric acid (DMGV), guanosine, and C7 carnitine to mediate the association between MIND diet and hypertension. DMGV, guanosine, gluconic acid, S-Adenosyl-L-homocysteine, C7 carnitine, and 5 triacylglycerols mediated the association between MIND diet and CKD. Higher adherence to the MIND diet is associated with a lower likelihood of hypertension and CKD. MIND diet-related metabolites were found to be associated with hypertension and CKD and may provide insight to metabolic pathways linking diet and disease.

Association of priori-defined DASH dietary pattern with metabolic health status among Iranian adolescents with overweight and obesity

There was no evidence on the relationship of Dietary Approaches to Stop Hypertension (DASH) with metabolic health condition in adolescents with overweight and obesity. The purpose of this research was to investigate the association of priori-defined DASH dietary pattern with metabolic health status among adolescents with overweight and obesity in Iran. A cross-sectional survey performed on a representative sample of adolescents with overweight and obesity (n = 203). Dietary intakes were collected via a validated food frequency questionnaire and DASH score was characterized according to eight components. Data of anthropometric measures, blood pressure, circulating insulin, fasting blood sugar, and lipid profile were collected. Metabolic health status was defined based on criteria of International Diabetes Federation (IDF) and insulin resistance (IR). Based on IDF and IDF/IR criteria, 38.9% and 33.0% of adolescents suffered from metabolically unhealthy overweight/obesity (MUO). After controlling all confounders, subjects in the highest vs. lowest tertile of DASH diet had respectively 92% and 91% lower odds of MUO based on IDF definition (OR = 0.08; 95%CI 0.03–0.22) and IDF/IR criteria (OR = 0.09; 95%CI 0.03–0.29). Subgroup analysis by sex and body mass index determined that this relationship was more powerful in girls and overweight individuals. Also, in fully adjusted model, highest vs. lowest adherence to DASH diet was linked to decreased odds of hyperglycemia (OR = 0.07; 95% CI 0.03–0.21), hypertriglyceridemia (OR = 0.26; 95% CI 0.09–0.73), low HDL cholesterolemia (OR = 0.30; 95% CI 0.12–0.73) and insulin resistance (OR = 0.07; 95% CI 0.02–0.28), as metabolic health components. Greater compliance to DASH dietary pattern was linked to a remarkable lower odd of metabolic unhealthy condition among Iranian adolescents, especially in overweight subjects and girls. More prospective surveys are required to assert these results.