Dietary Approaches To Stop Hypertension Index Research Articles

Association of diet quality and weight increase in adult heart transplant recipients.

Understanding the quality of the diet of heart transplant recipients (HTRs) is essential to developing effective dietary interventions for weight control, but relevant evidence is scarce. We investigated diet quality and its association with post-transplant increase in weight adjusted for height (body mass index [BMI]) in Australian HTRs. We recruited adult HTRs from Queensland's thoracic transplant clinic, 2020-2021. Study participants completed a 3-day food diary using a smart-phone app. Socio-demographic information was collected by self-administered questionnaire, and height, serial weight and clinical information were obtained from medical records. We calculated the Dietary Approaches to Stop Hypertension (DASH) index based on nine food groups and nutrients (index of 90 indicates highest possible quality), and any changes in BMI (≤ 0 kg m-2 or >0 kg m-2) post-transplantation. Median DASH index values were assessed in relation to sex and BMI change using Mann-Whitney U test. Among 49 consented HTRs, 25 (51%) completed the food diary (median age 48 years, 52% females). Median BMI at enrolment was 27.2 kg m-2; median BMI change since transplant was +3.7 kg m-2. Fruit, vegetable, and whole grain intakes were generally lower than recommended, giving a low overall median DASH index of 30 with no sex differences. HTRs for which the BMI increased post-transplant had significantly lower median DASH indices than those whose BMI did not increase (30 vs. 45, p = 0.013). The diet quality of HTRs appears suboptimal overall, with fruit and vegetable intakes especially low. HTRs whose BMI increased post-transplant had substantially lower quality diets than HTRs whose BMI did not increase.

The association between dietary quality scores with C-reactive protein and novel biomarkers of inflammation platelet-activating factor and lipoprotein-associated phospholipase A2: a cross-sectional study

Healthy dietary patterns are associated with lower inflammation and cardiovascular disease (CVD) risk and adherence can be measured using diet quality scores. Inflammation is traditionally measured with C-reactive protein (hsCRP), however there is interest in novel pro-inflammatory markers platelet-activating factor (PAF) and lipoprotein-associated phospholipase A2 (Lp-PLA2) that are specifically involved in endothelial dysfunction and inflammation. This cross-sectional study investigated the association between PAF, Lp-PLA2, hsCRP, and six diet scores. One hundred adults (49 ± 13 years, 31% male) with variable CVD risk were recruited. Fasting PAF, Lp-PLA2 and hsCRP and usual dietary intake were measured. Adherence to Dietary Approaches to Stop Hypertension (DASH), Dairy-adjusted DASH, Vegetarian Lifestyle Index, Healthy Eating Index for Australians (HEIFA), Mediterranean Diet Adherence Screener (MEDAS) and PREDIMED-Plus (erMedDiet) scores were calculated. Correlations and multiple regressions were performed. hsCRP, but not PAF, independently correlated with several diet scores. Lp-PLA2 independently correlated with Vegetarian Lifestyle Index only in unadjusted models. A one-point increase in adherence to the DASH Index, the Dairy-adjusted DASH Index and the Vegetarian Lifestyle Index was associated with a 30%, 30%, and 33% reduction in hsCRP levels, respectively. Smaller effects were seen with the other diet scores with a one-point increase in adherence resulting in a 19%, 22% and 16% reduction in hsCRP with HEIFA, MEDAS, erMedDiet scores, respectively. The lack of stronger associations between the novel markers of inflammation and diet scores may be due to confounding by COVID-19 infection and vaccination programs, which prevents any firm conclusion on the relationship between PAF, Lp-PLA2 and healthy dietary patterns. Future research should aim to examine the relationship with these novel markers and healthy dietary patterns in a non-pandemic setting.

Adherence to a priori dietary patterns in relation to obesity: results from two cycles of the Canadian National Nutrition Survey.

To test whether adherence to the Mediterranean diet, the Dietary Approaches to Stop Hypertension (DASH) or a dietary pattern in-line with the 2015-2020 Dietary Guidelines for Americans (DGA) was associated with obesity. 24-h dietary recall data from the Canadian Community Health Survey (CCHS)-Nutrition, 2004 and 2015 cycles, were analysed. Diet quality index scores were computed for the Mediterranean-Style Dietary Pattern Score (MSDPS), a DASH index and the 2015 Dietary Guidelines for Americans Adherence Index (DGAI). Higher scores indicated greater adherence. Association between scores and obesity was examined using logistic regression, adjusting for age, sex, physical activity, smoking status, sequence of dietary recall and alcohol and energy intake. Canada (excluding territories and the institutionalised population). Canadian adults (≥ 18 years), non-pregnant and non-breast-feeding; 11 748 from CCHS 2004 and 12 110 from CCHS 2015. The percentage of females in each sample was 50 %. Mean MSDPS, DASH and DGAI scores were marginally but significantly higher in CCHS 2015 than in CCHS 2004. Those affected by obesity obtained lower scores for all indexes in CCHS 2004 (OR 10th v. 90th percentile for DASH: 2·23 (95 % CI 1·50, 3·32), DGAI: 3·01 (95 % CI 1·98, 4·57), MSDPS: 2·02 (95 % CI 1·14, 3·58)). Similar results were observed in CCHS 2015; however, results for MSDPS were not significant (OR 10th v. 90th percentile for DASH: 2·45 (95 % CI 1·72, 3·49), DGAI: 2·73 (95 % CI 1·85, 4·03); MSDPS: 1·30 (95 % CI 0·82, 2·06)). Following DASH or the 2015-2020 DGA was associated with a lower likelihood of obesity. Findings do not indicate causation, as the data are cross-sectional.

Potassium Intake-(Un)Expected Non-Predictor of Higher Serum Potassium Levels in Hemodialysis DASH Diet Consumers.

As high serum potassium levels can lead to adverse outcomes in hemodialysis (HD) patients, dietary potassium is frequently restricted in these patients. However, recent studies have questioned whether dietary potassium really affects serum potassium levels. The dietary approaches to stop hypertension (DASH) diet is considered a healthy dietary pattern that has been related to lower risk of developing end-stage kidney disease. The aim of this study was to analyze the association between a dietary pattern with high content of potassium-rich foods and serum potassium levels in HD patients. This was an observational, cross-sectional, multicenter study with 582 HD patients from 37 dialysis centers. Clinical and biochemical data were registered. Dietary intake was obtained using the Food Frequency Questionnaire. Adherence to the DASH dietary pattern was obtained from Fung’s DASH index. All statistical tests were performed using SPSS 26.0 software. A p-value lower than 0.05 was considered statistically significant. Patients’ mean age was 67.8 ± 17.7 years and median HD vintage was 65 (43–104) months. Mean serum potassium was 5.3 ± 0.67 mEq/L, dietary potassium intake was 2465 ± 1005 mg/day and mean Fung´s Dash Index was 23.9 ± 3.9. Compared to the lower adherence to the DASH dietary pattern, patients with a higher adherence to the DASH dietary pattern were older (p < 0.001); presented lower serum potassium (p = 0.021), serum sodium (p = 0.028), total fat intake (p = 0.001) and sodium intake (p < 0.001); and had higher carbohydrate intake (p < 0.001), fiber intake (p < 0.001), potassium intake (p < 0.001), phosphorus intake (p < 0.001) and body mass index (p = 0.002). A higher adherence to this dietary pattern was a predictor of lower serum potassium levels (p = 0.004), even in the adjusted model (p = 0.016). Following the DASH dietary pattern, which is rich in potassium, is not associated with increased serum potassium levels in HD patients. Furthermore, a higher adherence to the DASH dietary pattern predicts lower serum potassium levels. Therefore, generalized dietary potassium restrictions may not be adequate, at least for those with a DASH diet plan.

MO904: Potassium Intake Does Not Predict High Serum Potassium Levels in Haemodialysis Dash Diet Consumers

Abstract BACKGROUND AND AIMS As high serum potassium levels can lead to adverse outcomes in haemodialysis (HD) patients, dietary potassium is frequently restricted in these patients. However, recent studies have questioned whether dietary potassium really affects serum potassium levels. Dietary approaches to stop hypertension (DASH) emphasizes the consumption of potassium rich foods, specially from plant sources, such as: fruits, vegetables, whole grains, nuts and seeds. The aim of this study was to analyze the association between the DASH dietary pattern and serum potassium levels. METHOD This was an observational cross-sectional multicentre study with 582 HD patients from 37 dialysis centers. Clinical and biochemical data were registered. Dietary intake was obtained using the Food Frequency Questionnaire. Adherence to DASH dietary pattern was obtained from Fung´s DASH index (8–40 points). For the statistical analysis, Fung´s DASH index was categorized into terciles and mean differences were analyzed with one-way ANOVA. Linear regression was used to analyze the relationship between serum potassium and adherence to the Dash dietary pattern. The multivariate model was adjusted to age, gender, presence of diabetes mellitus, energy intake, dietary potassium intake, residual diuresis, dialysis adequacy (Kt/V), dialysis vintage and intake of potassium binders. All statistical tests were performed using SPSS 26.0 software. A P-value lower than 0.05, was considered statistically significant. RESULTS Patients’ mean age was 67.8 ± 17.7 years and median HD vintage was 65 (43–104) months. Mean serum potassium was 5.3 ± 0.67 mEq/L, dietary potassium intake was 2465 ± 1005 mg/day and mean Fung´s Dash Index was 23.9 ± 3.9. Of the whole sample, 36.4% of the patients presented low adherence to the DASH dietary pattern (0–22 points), 39.0% presented a moderate adherence (23–26 points) whereas 24.6% a high adherence (≥27 points). Comparing to the lower adherence, patients with a higher adherence to the DASH dietary pattern were older (P &amp;lt; 0.005), presented lower serum potassium (P = 0.021), serum sodium (P = 0.028), albumin (P = 0.030), creatinine (P &amp;lt; 0.005), energy intake (P = 0.006), protein intake (P = 0.010), total fat intake (P = 0.001), sodium intake (P &amp;lt; 0.005), lean tissue index (P = 0.006) and higher carbohydrates intake (P = 0.007), fiber intake (P &amp;lt; 0.005), potassium intake (P &amp;lt; 0.005), body mass index (P = 0.002) and fat tissue index (P &amp;lt; 0.005). No differences were observed in potassium binders, Kt/V, C-reactive protein nor haemoglobin. A higher adherence to this dietary pattern was a predictor of lower serum potassium levels (P = 0.004), even in the adjusted model (P = 0.016). CONCLUSION Most of the patients presented a moderate adherence to the DASH dietary pattern. Following this dietary pattern, which is rich in potassium, is not associated with increased serum potassium levels in HD patients. What is more, a higher adherence to the DASH dietary pattern predicts lower serum potassium levels. Therefore, tight dietary potassium restrictions may not be adequate, at least for those with a DASH diet plan as a more flexible diet, especially regarding plant-based foods rich in potassium, may promote other health benefits and reduce patient´s dietary plan limitations.

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.

Abstract MP56: Specific Nutrients Associate Better Than Dietary Approaches To Stop Hypertension Score With Adult Cardiovascular Risk Factors Over 25 Years: The Princeton Lipid Study

Introduction: Diet is a contributing factor to cardiovascular disease risk and is the basis for dietary guidelines such as the Dietary Approaches to Stop Hypertension (DASH) eating plan. However, little is known about how childhood dietary habits are maintained into adulthood or how child to adult, or adult to adult changes in diet may influence disease risk. Hypothesis: Our goal was to examine the relationship between diet quality, cardiovascular disease risk, and changes in diet quality over time. We hypothesized that diets lacking in nutrients for ideal cardiovascular health would be conserved from childhood to adulthood. This would be reflected as increased rates of hypertension, diabetes, dyslipidemia, and obesity. Methods: Diet data was analyzed from the Princeton Lipid Research study (24 hour recall in the 70’s; Block Food Frequency Questionnaire in 1998). Diet quality at each visit was assessed as a ranking of 15 different macro/micronutrients and by a modified DASH index based on 9 nutrient targets and adapted for children. Outcomes in both childhood and adulthood included: glucose intolerance/diabetes, high blood pressure/hypertension, dyslipidemia/hyperlipidemia, and obesity. Linear and logistic regression models were performed with adjustment for age, race, sex, BMI, occupation and education of self or head of household, and marital status. Results: Analysis included 221 total individuals in Generation 1 (parents at initial visit; 39% (86 of 221) male, mean age 38.9 ± 6.5 followed up at 66.6 ± 6.6 years) and 606 individuals in Generation 2 (45% (271 of 606) male, mean age 11.9 ± 3.23 at initial visit and 38.5 ± 3.6 years at follow up). Generation 1 increased in total DASH score from initial visit to follow-up (1.74 ± 0.95 → 2.11 ± 1.33) while Generation 2 decreased (1.91 ± 0.80 → 1.64 ± 1.13). Overall DASH score was not significantly associated with baseline or follow up outcomes in childhood or adulthood. However, in Generation 2 at follow-up, fiber, potassium, iron, niacin, and vitamin A were associated with hypertension; fiber and sugar with hyperlipidemia; cholesterol with obesity; and saturated fat with diabetes in Generation 1. Conclusions: Overall diet quality was poor in both generations and changed little over time. In conclusion, no relationship was detected between DASH diet accordance and disease outcomes, however certain nutrients are associated with higher cardiovascular disease risk.

Dietary Approaches to Stop Hypertension (DASH) diets and breast cancer among women: a case control study

BackgroundStudying entire dietary patterns is a promising alternative approach to overcome limitations of the single food or nutrient approach. We evaluated the relationship between the scores of 4 established Dietary Approaches to Stop Hypertension (DASH) diet indexes and breast cancer risk among Iranian women.MethodsThis case-control study was carried out on 408 eligible women (136 cases and 272 hospital-based controls). A validated 168 item semi-quantitative food frequency questionnaire was used for assessing usual dietary intakes. DASH index scores were generated based on predefined algorithms for each of the 4 previously described indexes (Dixon’s, Mellen’s, Fung’s and Günther’s DASH diet index). Unconditional logistic regression analysis was performed to estimate odds ratio (OR) and 95% confidence intervals (CIs) for score categories or quintiles of DASH diet indexes and breast cancer risk in multivariate adjusted models.ResultsWomen in the highest categories of the Mellen’s and Günther’s scores had lower odds of breast cancer than those in the lowest quintiles (Mellen’s OR:0.50; 95% CI:0.62–0.97; P-trend:0.02; Günther’s OR:0.48; 95% CI:0.25–0.93; P-trend:0.05). However, no significant associations were found between Dixon’s and Fung’s DASH score and breast cancer risk. Modification by menopausal status revealed that breast cancer risk was only reduced in postmenopausal women with higher scores on Mellen’s index (OR:0.24; 95% CI:0.08–0.68; P-trend:0.04).ConclusionA greater adherence to 2 of the 4 DASH indexes (Mellen’s and Günther’s indexes) was associated with decreased risk of breast cancer.

Associations Between a Priori-Defined Diet Quality Indices and Survival in a Longitudinal Cohort Study of Head and Neck Squamous Cell Carcinoma Patients

Abstract Objectives Use of diet quality indices has become increasingly common. However, there are no studies, to date, that have examined the relationship of a priori indices with prognostic outcomes in the head and neck squamous cell carcinoma (HNSCC) population. The purpose of this analysis was to examine associations between diet quality in the first two years after diagnosis and mortality in a sample of HNSCC patients. Methods This was a secondary analysis of 396 newly diagnosed HNSCC patients recruited from the University of Michigan Head and Neck Specialized Programs of Research Excellence longitudinal cohort study. Participants completed food frequency questionnaires (FFQs) and health surveys at the time of diagnosis, 1-year post-diagnosis (n = 341), and 2-years post-diagnosis (n = 217). Cox Proportional Hazards models assessed associations between diet quality index score (categorized as quintiles and modeled as a time-varying covariate), all-cause-, and cancer-specific mortality. The indices chosen for examination included the Alternative Mediterranean Diet Index (aMED), Alternate Healthy Eating Index-2010 (AHEI-2010), Dietary Approaches to Stop Hypertension (DASH), and a ketogenic diet index. All models adjusted for age, sex, BMI, HPV-status, tumor site, stage, education, smoking, drinking, and total calorie intake (modeled as time-varying). Results There were 105 total deaths and 67 cancer-related deaths, during a median follow-up time of 3 years. Higher aMED and AHEI-2010 scores were significantly inversely associated with all-cause (HRaMED 0.33, 95% CI: 0.18–0.59, ptrend &amp;lt; 0.0001; HRaHEI 0.34, 95% CI: 0.20–0.58, ptrend &amp;lt; 0.001) and cancer-related mortality (HRaMED 0.28, 95% CI: 0.13–0.59, ptrend = 0.001; HRaHEI 0.35, 95% CI: 0.18–0.71, ptrend &amp;lt; 0.0001). There were no significant associations found with the DASH index. The ketogenic diet index showed an attenuated significant inverse association for the fifth quintile, but there was a lack of linear trend. Conclusions Developing and testing interventions that follow food and quantity guidelines emphasized by the aMED and AHEI-2010 diet quality indices among HNSCC survivors, is warranted. Funding Sources NIH/NCI and a USDA/NIFA Hatch Project.

Dietary Pattern Indices and Incident Peripheral Arterial Disease in Women: A Prospective Cohort Study

Abstract Objectives We aimed to evaluate diet quality as reflected by multiple a priori dietary pattern indices in relation to incident PAD. Methods We included 138,506 US postmenopausal women aged 50–79 years without known PAD at baseline (1993–1998) of the Women's Health Initiative. Score of 4 dietary pattern indices, including the alternate Mediterranean diet (aMED) index, the alternate Healthy Eating Index (AHEI)-2010, the Dietary Approaches to Stop Hypertension (DASH) diet index, and the Healthy Eating Index (HEI)-2015, were derived using data collected by a validated food frequency questionnaire. Incident cases of symptomatic PAD in the lower extremities were ascertained and adjudicated through March 2019 by reviewing medical record. Hazard ratios (HR) and 95% confidence interval (CI) were estimated using Cox proportional hazards models, with adjustment for multiple potential confounders including known risk factors for PAD (i.e., smoking, high blood pressure, dyslipidemia, and diabetes). Results During a median 18.6 years of follow-up, 1036 incident cases of PAD were identified. All 4 dietary pattern indices were inversely associated with risk of PAD. The multivariable-adjusted HRs (95% CI) comparing the highest with the lowest score quartiles were 0.74 (0.61–0.91) for aMED index (P-trend across quartile = 0.010), 0.79 (0.65–0.95) for AHEI-2010 (P-trend &amp;lt; 0.001), 0.66 (0.55–0.80) for DASH index (P-trend &amp;lt; 0.001), and 0.68 (0.56–0.82) for HEI-2015 (P-trend &amp;lt; 0.001). Among major foods/nutrients contributing to these dietary patterns, intakes of whole grains (top vs. bottom quartile, HR = 0.81; P-trend = 0.01), legumes (HR = 0.77; P-trend = 0.004), dietary fiber (HR = 0.78; P-trend = 0.01), and vegetable protein (HR = 0.76; P-trend = 0.006) were associated with lower risk of PAD, whereas intakes of red meat (HR = 1.38; P-trend = 0.003), processed meat (HR = 1.36; P-trend = 0.004), and regular soft drinks (HR = 1.26; P-trend = 0.01) were associated with higher risk. Conclusions Adherence to various recommended dietary patterns is associated with lower risk of PAD in a nationwide cohort of US postmenopausal women. Our findings may extend the range of cardiovascular diseases that are potentially preventable by adopting a healthy dietary pattern. Funding Sources National Heart, Lung, and Blood Institute; and National Institute of Diabetes and Digestive and Kidney Diseases.

How do short-term associations between diet quality and metabolic risk vary with age?

PurposePoor diet quality is one of the key contributors to poor cardiovascular health and associated morbidity and mortality. This study aimed to assess how the short-term associations between diet quality and metabolic risk factors change with age.MethodsThis longitudinal, observational study used data from the National Diet and Nutrition Survey (2008–2016) (n = 2024). Diet quality was measured using the Dietary Approaches to Stop Hypertension (DASH) index, fruit and vegetable (F&V) intake, and a F&V biomarker score. We assessed associations between measures of diet quality and a metabolic risk z score (generated from five metabolic risk factors) among those aged 11–60 years, and then tested effect modification by age group (adolescents 11–18 years, young adults 19–35 years, mid-aged adults 36–60 years).ResultsAnalysis across all age groups showed inverse associations between standardised DASH index and metabolic risk z score of − 0.19 (95% CI − 0.26, − 0.11). These associations were moderated by age group, with strong associations seen in mid-aged adults: − 0.27 (95% CI − 0.39, − 0.16), but associations were significantly attenuated in young adults [− 0.10 (95% CI − 0.22, 0.01)] and adolescents [0.03 (95% CI − 0.05, 0.11)]. Similar results were found for F&V intake and F&V biomarker score.ConclusionsShort-term associations between diet quality and metabolic risk are not consistent across adolescent and young adult age groups, suggesting that mechanisms by which diet impacts on metabolic risk may be acting differently in younger age groups compared to adults. Further research is warranted using longitudinal study designs and replication in different populations to understand changes in determinants of cardiometabolic health with age.

Adherence to diet quality indices in relation to semen quality and reproductive hormones in young men.

Is adherence to an a priori defined diet quality indices [Alternate Healthy Index 2010 (AHEI-2010), relative Mediterranean diet score (rMED) or dietary approaches to stop hypertension (DASH)] associated with semen quality and reproductive hormone levels in young men? Greater adherence to the DASH diet is related to higher sperm counts. Studies assessing the relationship between dietary intake and male reproductive function have mainly been focused on specific nutrients, food groups or data-driven dietary patterns, but the evidence on a priori defined dietary indices is still scarce. Cross-sectional study of 209 male university students recruited from October 2010 to November 2011 in Murcia Region (Southern Spain). Healthy young men aged 18-23years were included in this study. Diet was assessed using a validated food frequency questionnaire and three a priori-defined dietary indices (AHEI-2010, rMED and DASH) were calculated. Linear regression was used to analyze the relation between the three dietary indices and semen quality parameters and reproductive hormone levels accounting for potential confounders and covariates. We found statistically significant positive associations between the DASH index and sperm concentration (P, trend = 0.04), total sperm count (P, trend = 0.04) and total motile sperm count (P, trend = 0.02). No associations were observed for other semen parameters or male reproductive hormones. Even though we adjusted for several known and suspected confounders we cannot exclude the possibility of residual or unmeasured confounding or chance findings. Subjects were blinded to the study outcomes thus reducing the potential influence on their report of diet. Our sample size may be too small to rule out associations with other semen parameters or reproductive hormones. Causal inference is limited, as usual with all observational studies. The results suggest that greater adherence to the DASH may help improve sperm counts. This study was carried out on young men from the general population. However, results may differ among other populations (e.g. infertile men). Therefore, further research is needed to confirm these findings and extend these results to other populations. This work was supported by Fundación Séneca, grants No 08808/PI/08 and No 19443/PI/14; Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III (AES), grants No PI10/00985 and No PI13/01237; and grant P30DK046200 from the National Institutes of Health. Authors have no competing interests to declare.

Diet Quality through Adolescence and Early Adulthood: Cross-Sectional Associations of the Dietary Approaches to Stop Hypertension Diet Index and Component Food Groups with Age.

Late adolescence to early adulthood is the period of life when prevalence of overweight and obesity rises the fastest, and an important time to understand changes in dietary risk factors. In this study we assess the variation in diet quality through analysis of cross-sectional data from 2957 individuals aged 13 to 30 from the National Diet and Nutrition Study (2008–2016). Diet data were self-reported using four-day food diaries and coded to give diet quality using the dietary approaches to stop hypertension (DASH) index (range 0–80) and DASH component food groups (grams/day). The mean DASH index score was low at 34.8 (95% confidence interval (CI) = 34.3–35.4). The regression of diet quality score and food groups on age categories revealed no significant change in diet quality score with age category in males, but an improved diet quality score among females aged 19–21 (β = 2.04, 95% CI = 0.05–4.02), 25–27 (β = 3.77, 95% CI = 1.36–6.18) and 28–30 (β = 2.39, 95% CI = 0.53–4.26), compared to age 13–15. Both sexes showed increased vegetable intake with age. Dairy intake was lower in early adult ages among males, while in females there was an increase in the proportion of low-fat dairy consumed with age. Further research should address the determinants of changes in diet in early adulthood to provide evidence for the targeting of public health policy.

The Effectiveness of Dietary Approaches to Stop Hypertension Diet Intervention in Persons with Arterial Hypertension and Obesity: A Key Role of the Patients’ Personality Profile

Background/Aims: Benefits resulting from weight loss and dietary approaches to stop hypertension (DASH) diet in the treatment of arterial hypertension led to a search for a better therapy that would include psychological factors. The present study aimed to assess the relationship between the personality traits included in the Big Five personality traits and the effectiveness of treatment for weight loss in patients with essential hypertension and excessive body weight. Methods: The study involved 84 patients with essential hypertension, overweight or obesity, managed by a hypertensiologist. All patients underwent a 3-month diet treatment as part of the development process of an individualised eating plan that follows the principles of DASH diet and food education. Body mass index and DASH index were calculated before and after the therapy. NEO Five-Factor Inventory was applied to measure psychological variables. Results: The intervention led to a statistically significant increase of DASH index measured before and after treatment. There was a significant correlation between the increase of DASH index and gender. Patients presented higher intensity of openness to experience, extraversion, conscientiousness and lower levels of neuroticism and agreeableness compared to general population. Conclusion: The influence of psychological variables on the observed difference between men and women in DASH values and weight loss was not demonstrated.

Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH) style diet, and metabolic health in U.S. adults

There is sparse evidence on the relationship between the Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH) style diet, and metabolic health, especially comparing cardiometabolic phenotypes among in normal weight and obese populations. We aimed to investigate the association of the Mediterranean diet scores (MDS) and DASH index with metabolically healthy obese (MHO) and metabolically obese normal weight (MONW) phenotypes in a representative U.S. MDS and DASH index were calculated using dietary data from 2767 adults aged 20-90 years without any prior diagnosis of cancer or cardiovascular disease from the National Health and Nutrition Examination Survey III, 1988-1994. MHO and MONW individuals were identified using fasting glucose, insulin resistance, blood pressure, triglycerides, C-reactive protein, and high-density lipoprotein-cholesterol. Higher MDS was associated with higher odds of MHO phenotype (odds ratio (OR)T3 vs T1, 2.57 [95% confidence interval (CI), 1.04-6.35]; P trend=0.04), and higher DASH index was associated with lower odds of MONW phenotype (ORT3 vs T1, 0.59 [95% CI, 0.38-0.93]; P trend=0.03) only in the younger age group (<45 years for men or premenopausal women). No significant associations of MDS and DASH index with MHO and MONW phenotypes were observed in the older age group (≥45 years for men or postmenopausal women). Adherence to Mediterranean diet or DASH style diet was favorably associated with MHO and MONW phenotypes only in the younger age group, suggesting that potential dietary intervention to prevent cardiometabolic disease differ by age group.

Among 4 Diet Quality Indexes, Only the Alternate Mediterranean Diet Score Is Associated with Better Colorectal Cancer Survival and Only in African American Women in the Multiethnic Cohort

Background: Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States, with a 5-y survival rate of ∼65%. Therefore, the identification of modifiable health factors to improve CRC survival is crucial.Objective: We investigated the association of 4 prediagnostic a priori diet quality indexes with CRC-specific and all-cause mortality in the Multiethnic Cohort (MEC).Methods: The MEC included >215,000 African-American, Native Hawaiian, Japanese-American, Latino, and white adults living in Hawaii and California who completed a validated quantitative food-frequency questionnaire in 1993–1996. CRC cases and deaths were identified through linkages to cancer registries and to state and national vital registries. Sex-specific HRs and 95% CIs were estimated for the Healthy Eating Index (HEI) 2010, the Alternative HEI (AHEI) 2010, the alternate Mediterranean Diet (aMED) score, and the Dietary Approaches to Stop Hypertension (DASH) index with CRC-specific and overall mortality as the primary outcomes. Ethnicity-specific analyses were the secondary outcomes.Results: Among 4204 MEC participants diagnosed with invasive CRC through 2010, 1976 all-cause and 1095 CRC-specific deaths were identified. A higher aMED score was associated with lower CRC-specific mortality in women [HR continuous pattern score divided by its respective SD (HR1SD): 0.86; 95% CI: 0.77, 0.96] but not in men (HR1SD: 1.01; 95% CI: 0.92, 1.11). A higher aMED score was also associated with lower all-cause mortality in women (HR1SD: 0.88; 95% CI: 0.81, 0.96) but not in men (HR1SD: 1.00; 95% CI: 0.93, 1.07). The HEI-2010, AHEI-2010, and DASH index were not significantly associated with CRC-specific or with all-cause mortality. The inverse relation for the aMED score was limited to African Americans and to colon (compared with rectal) cancer.Conclusions: The aMED score was related to lower mortality only in African-American women (1 of 5 ethnic groups studied). The results should be interpreted with caution due to the small numbers of cases within ethnic groups and the issue of multiple testing.

Diet Quality and Risk of Melanoma in an Italian Population1–3

Background: Some results from laboratory and epidemiologic studies suggest that diet may influence the risk of melanoma, but convincing evidence for a role of single nutrients or food items is lacking. Diet quality, which considers the combined effect of multiple food items, may be superior for examining this relation.Objective: We sought to assess whether diet quality, evaluated with the use of 4 different dietary indexes, is associated with melanoma risk.Methods: In this population-based case-control study, we analyzed the relation between 4 diet quality indexes, the Healthy Eating Index 2010 (HEI-2010), Dietary Approaches to Stop Hypertension (DASH) index, Greek Mediterranean Index (GMI), and Italian Mediterranean Index (IMI), and melanoma risk in a northern Italian community, with the use of data from 380 cases and 719 matched controls who completed a semiquantitative food frequency questionnaire.Results: In the overall sample, we found an inverse association between disease risk and the HEI-2010 and DASH index, but not the Mediterranean indexes, adjusting for potential confounders (skin phototype, body mass index, energy intake, sunburn history, skin sun reaction, and education). However, in sex stratified analyses, the association appeared only in women (P-trend: 0.10 and 0.04 for the HEI-2010 and DASH index, respectively). The inverse relations were stronger in women younger than age 50 y than in older women, for whom the GMI and IMI scores also showed an inverse association with disease risk (P-trend: 0.05 and 0.02, respectively).Conclusions: These results suggest that diet quality may play a role in cutaneous melanoma etiology among women.

A priori-defined diet quality indexes and risk of type 2 diabetes: the Multiethnic Cohort.

Dietary patterns have been associated with the incidence of type 2 diabetes, but little is known about the impact of ethnicity on this relationship. This study evaluated the association between four a priori dietary quality indexes and risk of type 2 diabetes among white individuals, Japanese-Americans and Native Hawaiians in the Hawaii component of the Multiethnic Cohort. After excluding participants with prevalent diabetes and missing values, the analysis included 89,185 participants (11,217 cases of type 2 diabetes). Dietary intake was assessed at baseline with a quantitative food frequency questionnaire designed for use in the relevant ethnic populations. Sex- and ethnicity-specific HRs were calculated for the Healthy Eating Index-2010 (HEI-2010), the Alternative HEI-2010 (AHEI-2010), the Alternate Mediterranean Diet Score (aMED) and the Dietary Approaches to Stop Hypertension (DASH). We observed significant inverse associations between higher DASH index scores and risk of type 2 diabetes in white men and women, as well as in Japanese-American women and Native Hawaiian men, with respective risk reductions of 37%, 31%, 19% and 21% (in the highest compared with the lowest index category). A higher adherence to the AHEI-2010 and aMED diet was related to a 13-28% lower risk of type 2 diabetes in white participants but not in other ethnic groups. No significant associations with risk of type 2 diabetes were observed for the HEI-2010 index. The small ethnic differences in risk of type 2 diabetes associated with scores of a priori-defined dietary patterns may be due to a different consumption pattern of food components and the fact that the original indexes were not based on diets typical for Asians and Pacific Islanders.

Associations between change in DASH diet scores and CVD risk factors in the PREMIER Trial (369.1)

OBJECTIVE: To measure associations between changes in the Dietary Approaches to Stop Hypertension (DASH) dietary indices and changes in blood pressure (BP), weight, and waist circumference (CVD risk factors) in PREMIER, a randomized, controlled trial of behavioral intervention for hypertension with and without the DASH dietary pattern.METHODS: DASH diet scores were derived based upon nutrient (9 nutrients, DASH_Nutrient) and food‐based (8 food groups, DASH_Food) targets using two 24‐h recalls administered at baseline, 6 months, and 18 months. Generalized estimating equations (GEE) were used to assess associations between CVD risk factors per SD change in the two DASH indices after accounting for confounders and randomization group.RESULTS: At baseline (n=807), lower DASH scores were associated with higher BMI, African‐American race, and younger age for both indices. Spearman correlations between the indices were 0.36. Mean DASH scores at baseline and 18 months were 2.7 (SD=1.4) and 3.7 (SD 1.4) for DASH_Nutrient (range 0 to 9) and 36.2 (SD=10.5) and 40.0 (SD 11.8) for DASH_Food (range 0‐80). Each SD increase in DASH_Nutrient was associated with a ‐1.26 (95% CI: ‐1.91 to ‐0.61) mmHg decrease in systolic BP versus a ‐0.87 (95% CI: ‐1.44 to ‐0.30) mmHg per SD change in DASH_Food. Each SD increase in DASH_Nutrient score was associated with a ‐0.50 (‐0.95 to ‐0.06) unit decrease in diastolic BP. Changes in the DASH_Food score were not significantly associated with changes in diastolic BP.INTERPRETATION: The DASH dietary pattern defined by nutrient, rather than food, intake is more closely associated with reduction in CVD risk factors.Table. Longitudinal associations (Mean (95% CI)) between changes from baseline in DASH Diet Scores and CVD risk factors CVD Risk Factor DASH_Nutrient (derived based on Mellen’s DASH Index), per SD DASH_Food (derived based on Gunther’s DASH Index), per SD Systolic Blood Pressure, mmHg ‐1.26 (‐1.91 to ‐0.61) ‐0.87 (‐1.44 to ‐0.30) Diastolic Blood Pressure, mmHg ‐0.50 (‐0.95 to ‐0.06) ‐0.32 (‐0.75 to 0.11) Weight, lb ‐1.94 (‐2.80 to ‐1.17) ‐1.10 (‐1.71 to ‐0.49) Waist Circumference, cm ‐0.89 (‐1.29 to ‐0.48) ‐0.75 (‐1.10 to ‐0.40) GEE models with unstructured correlation matrix adjusted for baseline CVD risk factor, baseline DASH score, sex, race, age, education, smoking (current, former, never), physical activity, energy intake, BMI, and randomization assignment.

Association between body composition and conformity to the recommendations of Canada's Food Guide and the Dietary Approaches to Stop Hypertension (DASH) diet in peri-adolescence

The role of following the recommendations of Canada's Food Guide (CFG) and the Dietary Approaches to Stop Hypertension (DASH) diet on body composition in children is unknown. The present study assessed how conformity to the recommendations of these diets was associated with BMI, waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), waist girth (WG), hip girth (HG) and risk of overweight in peri-adolescents. CFG and DASH indices were derived from responses to a food questionnaire, with a higher index representing greater conformity to CFG and DASH diet recommendations. Body composition was assessed by trained research assistants. Schools within the Niagara region (Ontario, Canada). Children (n 1570) aged 12.4 (sd 0.3) years. After adjustment for age to peak height velocity and total physical activity, a higher CFG index was associated with lower WHtR (b = -0.001, 95 % CI -0.002, -0.0004), WHR (b = -0.001, 95 % CI -0.002, -0.001) and WG (b = -0.18, 95 % CI -0.30, -0.07) in girls. No associations were observed in boys. In contrast, a higher DASH index was associated with decreased body composition measures in both genders. Specifically, the DASH index was negatively associated with BMI (girls: b = -0.07, 95 % CI -0.10, -0.04; boys: b = -0.05, 95 % CI -0.08, -0.02), WHtR (girls: b = -0.001, 95 % CI -0.002, -0.001; boys: b = -0.001, 95 % CI -0.002, -0.0004), WHR (girls: b = -0.001, 95 % CI -0.002, -0.001; boys: b = -0.001, 95 % CI -0.001, -0.00004), WG (girls: b = -0.24, 95 % CI -0.31, -0.16; boys: b = -0.15, 95 % CI -0.24, -0.07) and HG (girls: b = -0.15, 95 % CI -0.23, -0.07; boys: b = -0.12, 95 % CI -0.19, -0.04). A higher DASH index was also associated with lower odds of overweight in girls (OR = 0.70, 95 % CI 0.56, 0.87) and boys (OR = 0.76, 95 % CI 0.62, 0.93). The DASH diet may prevent overweight in peri-adolescents.