Higher Dietary Approaches To Stop Hypertension Scores Research Articles

Racial and Ethnic Disparities in Dietary Intake and Quality Among United States Veterans

BackgroundDietary quality plays an important role in disease development and prognosis, and diet is also a key contributor to disparities in many chronic diseases and health conditions. ObjectivesThis study aimed to assess racial and ethnic disparities experienced by veterans; we examined food intake and dietary quality across different racial and ethnic groups of United States veterans. MethodsThe study included 420,730 males and females aged 19–107 y (91.2% males) enrolled in the Veterans Affairs Million Veteran Program with plausible dietary intake measured by food frequency questionnaire. Dietary quality was evaluated with dietary approaches to stop hypertension (DASH) score. Dietary intakes of various race and ethnicity groups were standardized to the age distribution of non-Hispanic White participants, separately for males and females. Differences across race and ethnicity groups were compared using general linear regression models after adjustment for socioeconomic and lifestyle factors as well as military service. ResultsCompared to non-Hispanic White males, non-Hispanic Black males had a relatively lower DASH score, higher red and processed meats, higher sugar-sweetened beverages (SSBs), and lower low-fat dairy intakes. Non-Hispanic Asian males had a relatively higher DASH score as compared to non-Hispanic White males with relatively higher intakes of fruits and vegetables and relatively lower intakes of sodium, red meat and SSBs. Age-standardized DASH scores of Hispanic males and “Other” race/ethnicity groups were not statistically different from non-Hispanic White males. Similar race and ethnicity dietary patterns were found in females, although not all reached a statistically significant level. ConclusionsA modest difference in overall dietary quality (i.e., DASH score) was observed, but unique differences in food preferences across the different racial/ethnic groups were identified. Findings from our study may provide insight for the potential development of specific interventions to help address nutritional disparities experienced among veterans.

Dietary Approaches to Stop Hypertension (DASH) and mortality risk among patients with liver cirrhosis: a prospective cohort study

Background and purposeThe relationship between dietary patterns and cirrhosis is undeniable. The present study aimed to investigate the association between the Dietary Approaches to Stop Hypertension (DASH) diet and the risk of mortality in patients with cirrhosis prospectively.MethodsIn this cohort study, 121 cirrhotic patients were enrolled and followed up annually for four years. Nutritional status and dietary intakes were assessed initially, and the DASH score was calculated accordingly. Crude and multivariable-adjusted hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox proportional hazard analyses.ResultsDASH components including fruits, vegetables, legumes, nuts and seeds, and low-fat dairy products were significantly associated with lower mortality risk in cirrhotic patients. Also, a higher DASH score was significantly associated with a reduction in the risk of mortality in patients with cirrhosis, so that after adjusting for all confounders, the risk of mortality in the upper tertile was 89% lower than the first tertile (HR = 0.11, 95% CI: 0.03–0.42, P trend < 0.001). The 4-year survival rate among patients across tertiles of DASH was 32%, 37%, and 46%, respectively (P = 0.005).ConclusionIt can be concluded that a higher DASH diet score may be associated with a reduced risk of mortality in cirrhotic patients. However, larger studies are needed to confirm the findings and determine their potential mechanisms.

Public awareness of war on diabetes campaign and its association with behavioural outcomes.

The War on Diabetes campaign was launched in 2016, encouraging Singapore residents to engage in regular exercise, adopt healthy dietary habits and screen for early detection of diabetes. This study aims to examine campaign awareness and its associations with sedentary behaviour, dietary habits and identifying diabetes. Data were obtained from the nationwide Knowledge, Attitudes and Practices study on diabetes in Singapore. A total of 2895 participants responded to a single question assessing campaign awareness. The Dietary Approaches to Stop Hypertension (DASH) diet screener assessed dietary habits, and the Global Physical Activity Questionnaire (GPAQ) measured sedentary behaviour. Recognition of diabetes was established using a vignette depicting a person with diabetes mellitus. Logistic and linear regression models were used to measure the associations. Most participants were 18- to 34-years old (29.9%) and females (51.6%). About 57.4% identified the campaign. Campaign awareness exhibited positive associations with identifying diabetes based on the vignette [odds ratio (OR): 1.5; 95% confidence interval (CI): 1.1-2.2; P = 0.022], lower odds of sedentary behaviour ≥7 h/day (OR: 0.7; CI: 0.5-0.9; P = 0.018) and higher DASH scores (β = 1.3; P < 0.001). The study recognized early significant associations between the behavioural outcomes and the campaign, emphasizing the need for ongoing campaign sustainability and evaluation of its long-term impact on population health.

Egg consumption and non-alcoholic fatty liver disease: a prospective cohort study

To explore the association between egg consumption and the risk of non-alcoholic fatty liver disease(NAFLD), which will provide epidemiological evidence for NAFLD prevention. A total of 6734 non-NAFLD participants(5500 men and 1234 women, aged(45±14) years old)in the Kailuan cohort followed up in 2014-2015 were enrolled. Semi-quantitative food frequency questionnaires were used to collect the diet frequency, including the consumption of eggs, over the past years. Then the score of dietary approaches to stop hypertension(DASH) was calculated. Abdominal ultrasound was applied for fatty liver diagnosis. The Kaplan-Meier method was used to estimate the cumulative incidences of NAFLD for the three groups(0-4, 5-7 and &gt;7 eggs/week). Furthermore, Cox regression models under various adjusted factors were used to compare the risks of NAFLD. During the median follow-up of 45 months, 1484 NAFLDs were identified among 6734 non-NAFLD participants. The 4-year cumulative incidence rates of NAFLD for the individuals consuming 0-4, 5-7, and &gt;7 eggs/week were 27.1%, 19.9% and 29.6%(P&lt;0.05). The DASH score was significantly higher in those who consumed 5-7 eggs/week than in the other two groups(P&lt;0.001). After adjusting confounders, including DASH score and dietary cholesterol, we found that compared with those consuming 5-7 eggs/week, the individuals with 0-4 and &gt;7 eggs/week had a higher NAFLD hazard, with hazard ratios(95% confidence interval) of 1.20(1.03, 1.41) and 1.25(1.06, 1.47), respectively. The association was more significant in the population with a higher DASH score(P_(interaction)=0.02). Eating 5-7 eggs/week may have the lowest risk of NAFLD, suggesting taking a moderate amount of eggs to prevent NAFLD, even if the overall diet quality is relatively healthy.

Association between dietary approaches to stop hypertension (DASH) diet and hyperuricemia among Chinese adults: findings from a nationwide representative study

BackgroundCertain foods and food groups could positively or negatively impact serum uric acid (SUA) levels. However, evidence on the holistic dietary strategy to prevent and control hyperuricemia (HUA) development remains limited.ObjectiveThe aim of this research work was to explore the association of dietary approaches to stop hypertension (DASH) diet with SUA levels and odds of HUA among Chinese adults.MethodsThis research premise included 66,427 Chinese adults aged 18 and above who were part of the China Adult Chronic Disease and Nutrition Surveillance in 2015. Dietary consumptions were assessed via the household condiment weighing approach and a three-day, 24-hour dietary recall. Total fat, saturated fat, calcium, protein, potassium, cholesterol, magnesium, fiber, and sodium were all adopted to calculate the DASH score (score range, 0–9). The associations of DASH score with SUA levels and odds of HUA were evaluated using multiple linear and logistic regression models, respectively.ResultsWe established that a higher DASH score was linked with a lower SUA levels (β = − 0.11; 95% CI: − 0.12, − 0.1; p < 0.001) and odds of HUA (OR = 0.85; 95% CI: 0.83, 0.87; p < 0.001) after adjustment for age, sex, ethnicity, education status, marital status, health behaviours and health factors. The association of the DASH diet with odds of HUA was stronger among men (p-interaction = 0.009), non-Han Chinese (p-interaction< 0.001) as well as rural residents (p-interaction< 0.001).ConclusionsOur results illustrate that the DASH diet was remarkably negatively with SUA levels and odds of HUA in the Chinese adult population.

A High-Quality Diet, as Measured by the DASH Score, Is Associated with a Lower Risk of Metabolic Syndrome and Visceral Obesity

The current study was designed to examine the relationship between diet quality, as measured by the Dietary Approaches to Stop Hypertension (DASH) score, and the prevalence of metabolic syndrome (MetS) and its components. The study was cross-sectional in design and enrolled 535 people, including 215 with MetS and 320 without MetS. Using a validated food frequency questionnaire, the DASH diet quality score was counted. The mean age of the MetS group and control subjects was 58.48 ± 14.65 and 58.33 ± 9.26 years, respectively. The study showed that the MetS group had a significantly lower mean total DASH score than the control group (23.13 ± 5.44 vs. 24.62 ± 5.07, p = 0.0023). In addition, it was found that an increase in the total DASH score was associated with a lower risk of MetS (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.91-0.99, p = 0.009). In the correlation analysis of the total population, a better-quality diet (higher DASH score) was positively correlated with high-density lipoprotein cholesterol (HDL-c), and negatively correlated with triglyceride (TG) concentration and waist circumference. It was also found that an increase in the total DASH score was associated with a lower risk of abdominal obesity (OR = 0.93, 95% CI = 0.88-0.99, p = 0.017). The results from the analyzed data highlight the potential benefits of following a healthy diet such as DASH.

The Dash Diet Pattern and Blood Pressure Changes in US Veterans With Type 2 Diabetes – a Post-hoc Analysis of the Blueberry Consumption and Type 2 Diabetes Study

ObjectivesThe goals of nutrition therapy for adults with type 2 diabetes include promoting healthful eating patterns and supporting improvements in cardiometabolic risk factors. Hypertension, which is a risk factor for stroke, myocardial infarction and heart failure, is common in persons with diabetes. There is limited data on the relationship between the Dietary Approaches to Stop Hypertension (DASH) diet and blood pressure in US veterans with type 2 diabetes. The primary objective of the study is to determine the effect of the DASH diet pattern on blood pressure in US veterans. MethodsA secondary analysis from the Blueberry Consumption and Type 2 Diabetes study (NCT02972996, clinicaltrials.gov) was conducted in fifty-two men (mean ± SD baseline characteristics: 67 ± 6 years; weight, 102 ± 14 kg; body mass index, 34 ± 4 kg/m2; systolic blood pressure, 129 ± 17 mmHg; diastolic blood pressure, 76 ± 8 mmHg; hemoglobin A1c, 7.3 ± 0.8%) with type 2 diabetes. DASH diet patterns for six nutrients (protein, total fat, calcium, potassium, sodium and fiber) were collected by three-day food records. DASH diet scores were created by summing the scores for the six nutrients. Baseline blood pressure was collected according to standard protocol and used for the analysis. Multiple linear regression was used to determine the association between the DASH diet score and blood pressure. ResultsIn multiple linear regression analysis, adjusted for age, body mass index and comorbid conditions, a higher DASH score was associated with a decrease in systolic blood pressure (β = –5.96; P = 0.026) but not diastolic blood pressure (β = –1.65; P = 0.169). For every one unit increase in the DASH score, the estimated mean systolic blood pressure decreased by approximately 6.0 mmHg. ConclusionsThese findings suggest that adherence to the DASH diet pattern is associated with a decrease in systolic blood pressure in men who are US veterans with type 2 diabetes. The results should be verified by randomized clinical trials evaluating the effects of the DASH diet on blood pressure in adults with type 2 diabetes. Funding SourcesThe U.S. Highbush Blueberry Council; the study is the result of work supported with resources and the use of facilities at the Stratton VA Medical Center, Albany, NY, USA.

Health Literacy, Numeracy, and Dietary Approaches to Stop Hypertension Accordance Among Hypertensive Adults.

Health literacy (HL) and health numeracy (HN), the ability to interpret and act on quantitative health information, are important for hypertension self-management such as limiting sodium intake. We examined associations of HL, HN, and Dietary Approaches to Stop Hypertension (DASH) diet accordance. Among 1,073 hypertensive adults enrolled in a Baltimore, Maryland-based cohort study, we performed a cross-sectional analysis. Rapid Estimate of Adult Literacy in Medicine (REALM) measured HL and Test of Functional Health Literacy in Adults (TOFHLA) numeracy score measured HN. DASH accordance was based on nine key nutrients. Linear regression models estimated associations of HL and HN with DASH total and sodium score, inclusive of dietary supplement data. In our sample, 39% of participants were male, 66% were Black, 40.2% lived in poverty, and 29.5% reported food insecurity. Fully, 32.5% had limited HL and 14.5% had limited HN. Mean DASH score overall was 2 (range = 0-7.5); only 6.9% were DASH accordant (score ≥4.5). In age and sex adjusted models, higher REALM was associated with a higher DASH score in the overall sample; the relationship of HN with DASH was statistically significant among White but not Black participants. Educational attainment appeared to explain both findings. There were no significant associations between HL or HN and DASH sodium scores. Differences in educational attainment explained the relation of higher HL and greater accordance to the DASH diet in a population of hypertensive adults. Understanding these factors is vital to reducing disparities in hypertension and its sequelae.

Diet Quality Scores Are Positively Associated with Whole Blood–Derived Mitochondrial DNA Copy Number in the Framingham Heart Study

BackgroundThe association between diet quality and mitochondrial DNA copy number (mtDNA-CN) remains to be examined. ObjectivesWe aimed to study the relation between diet quality and mtDNA-CN. MethodsWe analyzed data from 2931 Framingham Heart Study (FHS) participants (mean age of 57 y, 55% females). Whole-genome sequencing was used to calculate mtDNA-CN from whole-blood samples. We examined the cross-sectional associations between 3 diet quality scores, the Dietary Approaches to Stop Hypertension (DASH) score, the Alternative Healthy Eating Index (AHEI), and the Mediterranean diet score (MDS), and mtDNA-CN. Linear mixed models were used to account for maternal lineage. ResultsWe observed that a higher DASH score was positively associated with mtDNA-CN after adjusting for sex, age, energy intake, smoking status, alcohol intake, and physical activity level. A 1-SD increase in the DASH score was associated with a 0.042-SD greater mtDNA-CN (95% CI: 0.007, 0.077; P= 0.02). Similarly, for each SD increase in AHEI and MDS, the mtDNA-CN SD increased by 0.056 (95% CI: 0.019, 0.092; P= 0.003) and 0.047 (95% CI: 0.01, 0.083; P= 0.01), respectively. Diet quality scores were associated with neutrophil and lymphocyte counts but not platelet counts, e.g., for a 1-SD increase in the DASH, neutrophils decreased by 0.8% (95% CI: 0.5%, 1.1%; P= 4.1 × 10–6), lymphocytes increased by 0.7% (95% CI: 0.4%, 1%, P= 1.2 × 10–5), and there was no significant change in platelet number (0.1 × 1000/μL; 95% CI: –1.6, 1.9; P= 0.89). Further adjustment for neutrophil, lymphocyte, and platelet counts and the associations between diet quality scores and mtDNA-CN were completely attenuated to nonsignificant (P= 0.95, 0.54, and 0.91, respectively). ConclusionsWe observed that higher diet quality is associated with a greater whole-blood derived mtDNA-CN in middle-aged to older adult FHS participants, and that blood cell composition, particularly neutrophil counts, attenuated the association between diet quality and mtDNA-CN.

Higher diet quality relates to decelerated epigenetic aging

DNA methylation-based epigenetic age measures have been used as biological aging markers and are associated with a healthy lifespan. Few population-based studies have examined the relation between diet and epigenetic age acceleration. We aimed to investigate the relation between diet quality and epigenetic age acceleration. We analyzed data from 1995 participants (mean age, 67 years; 55% women) of the Framingham Heart Study Offspring Cohort. Cross-sectional associations between the Dietary Approaches to Stop Hypertension (DASH) score and 3 whole-blood DNA methylation-derived epigenetic age acceleration measures-Dunedin Pace of Aging Methylation (DunedinPoAm), GrimAge acceleration (GrimAA), and PhenoAge acceleration (PhenoAA)-were examined. A mediation analysis was conducted to assess the mediating role of epigenetic age acceleration in relation to DASH and all-cause mortality. A higher DASH score was associated with lower levels of DunedinPoAm (β = -0.05; SE=0.02; P=0.007), GrimAA (β = -0.09; SE=0.02; P<0.001), and PhenoAA (β = -0.07; SE=0.02; P=0.001). All 3 epigenetic measures mediated the association between the DASH score and all-cause mortality, with mean proportions of 22.1% for DunedinPoAm (Pmediation=0.04), 45.1% for GrimAA (Pmediation=0.001), and 22.9% for PhenoAA (Pmediation=0.03). An interaction was observed between the DASH score and smoking status in relation to the epigenetic aging markers. The association between the DASH score and epigenetic aging markers tended to be stronger in "ever-smokers" (former and current smokers) compared to "never-smokers." The proportions of mediation were 31.3% for DunedinPoAm, 46.8% for GrimAA, and 10.3% for PhenoAA in ever-smokers, whereas no significant mediation was observed in never-smokers. Higher diet quality is associated with slower epigenetic age acceleration, which partially explains the beneficial effect of diet quality on the lifespan. Our findings emphasize that adopting a healthy diet is crucial for maintaining healthy aging.

Abstract 12649: Associations Between Diet Adherence Scores and Cardiac Structure and Function in the Hispanic Community Health Study/Study of Latinos

Introduction: The Alternative Healthy Eating Index (AHEI) and Dietary Approaches to Stop Hypertension (DASH) diets are associated with improved cardiovascular outcomes. We assessed associations between adherence to these diets and measures of left ventricular (LV) structure and function from the Echocardiographic Study of Latinos (Echo-SOL) ancillary study. Hypothesis: We hypothesized that increased adherence to AHEI or DASH diets would be associated with better cardiac structure and function. Methods: Cross-sectional baseline data from two 24-hour dietary recalls were used to calculate AHEI and DASH adherence scores among 1818 adults (57% female, mean age 56 ± 0.17) with complete echocardiographic assessments. Adherence scores were calculated based on decile of each food group for each score, with higher scores signifying higher adherence (AHEI: 0-110, DASH: 0-80). Associations between adherence scores and echo outcomes were analyzed via simple linear regression as well as ANOVA across quintiles of each score. All analyses were weighted to account for complex survey design. Results: Mean ± SE diet scores were 49.9 ± 0.32 for AHEI and 43.2 ± 0.33 for DASH. Higher AHEI scores were associated with better ejection fraction (EF) (1.1% per 10-point increase, p &lt; 0.01) and higher left atrial volume index (1.6 ml/m 2 per 10-point increase, p &lt; 0.01). Higher DASH scores were directly associated with EF (0.3% per 10-point increase, p &lt; 0.01) and inversely associated with LV mass (-4.4g per 10-point increase, p &lt; 0.01). In quintile analysis, better global longitudinal strain was seen across increasing quintiles of AHEI score (Figure). Conclusions: Adherence to AHEI and DASH diets was associated with more favorable cardiac structure and function. Pre-heart failure (HF) is an independent risk factor for incident clinical HF development. These findings have important implications for HF prevention.

Association between Dietary Patterns and Frailty Prevalence in Shanghai Suburban Elders: A Cross-Sectional Study.

Objective: To investigate the association between dietary patterns with frailty phenotypes in an elderly Chinese population. Methods: A cross-sectional study was performed in 780 Shanghai suburban elders aged 65–74 in 2019. Dietary data were collected using a food frequency questionnaire. Adherence to a priori dietary patterns, including the Chinese Healthy Eating Index (CHEI), Dietary Approaches to Stop Hypertension (DASH) diet and Mediterranean Diet (MD) were calculated. Three a posteriori dietary patterns were identified by factor analysis, namely, “protein-rich”; “vegetables”; and “sugar, oil, and condiments”. Frailty was defined using the Fried frailty phenotype scale. Ordinal multiple logistic regression was applied to examine the associations between dietary patterns and frailty prevalence. Results: The prevalences of pre-frailty and frailty were 47.69% and 3.85%, respectively. Participants with a higher DASH score had a lower frailty prevalence in the sex- and age-adjusted models of the 780 subjects (OR = 0.97 (95% CI: 0.94–0.99), p < 0.05). The association slightly strengthened in the multivariate adjusted model of the 555 subjects after excluding the participants with chronic diseases may influence frailty (OR = 0.96 (95% CI: 0.92–1.00), p < 0.05). High “protein-rich” dietary pattern scores were negatively associated with frailty prevalence in the multivariate adjusted model of the 780 subjects (OR = 0.82 (95% CI: 0.69–0.98), p < 0.05). The association attenuated in the sex- and age-adjusted model of the 555 subjects (OR = 0.84 (95% CI: 0.69–1.00, p = 0.056). Conclusion: A better diet quality as characterized by DASH and “protein-rich” was associated with a reduced prevalence of frailty in Shanghai suburban elders. The correlation of CHEI, MD or a posteriori dietary patterns with the development of frailty in Chinese older people remains to be explored.

A case-control study of Dietary Approaches to Stop Hypertension (DASH) diets, colorectal cancer and adenomas among Iranian population

Background and aimsColorectal cancer (CRC) is the third most common cancer, worldwide. Recently, much attention has been given to the association between Dietary Approaches to Stop Hypertension (DASH) and CRC, however, data on colorectal adenomas (CRAs) as its precursor are scarce. Thus, the purpose of this case-control study was to investigate the association of DASH score with the risk of CRC and CRA in Iranian adults.MethodA total of 499 participants, including 129 CRC and 130 CRA cases, along with 240 controls, were asked about their dietary intake via a validated questionnaire. The DASH score was then calculated based on a priori methods and categorized in quartiles. Multivariate logistic regression was performed to assess the association of DASH score and the risk of CRC and CRA.ResultsAfter adjusting for confounding variables, adherence to the DASH diet was associated with a reduction in the risk of CRC and CRA, respectively (OR of 4th versus 1st quartile = 0.04, 95% CI: 0.01–0.11, OR = 0.10, 95% CI: 0.04–0.22). Also, subgroup analysis based on gender showed that women and men with a higher DASH score had a significantly lower risk of CRC and CRAs.ConclusionThe results of this study demonstrated that adherence to a DASH dietary pattern could reduce the risk of CRC and CRA in men and women. Promoting a DASH eating plan can be helpful in reducing the risk of CRC.

Associations of the Dietary Approaches to Stop Hypertension dietary pattern with cardiac structure and function

Background and aimsVarious food groups have been associated with measures of left ventricular geometry and function. Whether the Dietary Approaches to Stop Hypertension (DASH) dietary pattern in mid-life is associated with a favorable cardiac structure and function later in life is unknown. Methods and resultsThe study population consisted of the Atherosclerosis Risk in Communities study participants free of cardiovascular disease at study visit 3 in 1993–1995. Dietary intake was assessed by food frequency questionnaire at study visits 1 (1987–1989) and 3 (1993–1995). Participants who underwent transthoracic echocardiograms at the Jackson field center at visit 3 (n = 1974) and at all field centers at study visit 5 (2011–2013; n = 4651) were included in this study. General linear regression was used to evaluate associations between dietary intake and markers of cardiac structure and function adjusting for potential confounders. Higher DASH score was associated with lower left ventricle mean wall thickness and higher absolute value of longitudinal strain at visit 5 (ptrend = 0.004 and < 0.001, respectively). ConclusionThe DASH dietary pattern in midlife was favorably associated with left ventricle structure and systolic function later in life. These results emphasize the importance of adhering to a healthy eating plan as one lifestyle measure to preserve cardiac structure and function.

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.

Associations of maternal dietary inflammatory potential and quality with offspring birth outcomes: An individual participant data pooled analysis of 7 European cohorts in the ALPHABET consortium.

BackgroundAdverse birth outcomes are major causes of morbidity and mortality during childhood and associate with a higher risk of noncommunicable diseases in adult life. Maternal periconception and antenatal nutrition, mostly focusing on single nutrients or foods, has been shown to influence infant birth outcomes. However, evidence on whole diet that considers complex nutrient and food interaction is rare and conflicting. We aim to elucidate the influence of whole-diet maternal dietary inflammatory potential and quality during periconceptional and antenatal periods on birth outcomes.Methods and findingsWe harmonized and pooled individual participant data (IPD) from up to 24,861 mother–child pairs in 7 European mother–offspring cohorts [cohort name, country (recruitment dates): ALSPAC, UK (1 April 1991 to 31 December 1992); EDEN, France (27 January 2003 to 6 March 2006); Generation R, the Netherlands (1 April 2002 to 31 January 2006); Lifeways, Ireland (2 October 2001 to 4 April 2003); REPRO_PL, Poland (18 September 2007 to 16 December 2011); ROLO, Ireland (1 January 2007 to 1 January 2011); SWS, United Kingdom (6 April 1998 to 17 December 2002)]. Maternal diets were assessed preconceptionally (n = 2 cohorts) and antenatally (n = 7 cohorts). Maternal dietary inflammatory potential and quality were ranked using the energy-adjusted Dietary Inflammatory Index (E-DII) and Dietary Approaches to Stop Hypertension (DASH) index, respectively. Primary outcomes were birth weight and gestational age at birth. Adverse birth outcomes, i.e., low birth weight (LBW), macrosomia, small-for-gestational-age (SGA), large-for-gestational-age (LGA), preterm and postterm births were defined according to standard clinical cutoffs. Associations of maternal E-DII and DASH scores with infant birth outcomes were assessed using cohort-specific multivariable regression analyses (adjusted for confounders including maternal education, ethnicity, prepregnancy body mass index (BMI), maternal height, parity, cigarettes smoking, and alcohol consumption), with subsequent random-effects meta-analyses.Overall, the study mothers had a mean ± SD age of 29.5 ± 4.9 y at delivery and a mean BMI of 23.3 ± 4.2 kg/m2. Higher pregnancy DASH score (higher dietary quality) was associated with higher birth weight [β(95% CI) = 18.5(5.7, 31.3) g per 1-SD higher DASH score; P value = 0.005] and head circumference [0.03(0.01, 0.06) cm; P value = 0.004], longer birth length [0.05(0.01, 0.10) cm; P value = 0.010], and lower risk of delivering LBW [odds ratio (OR) (95% CI) = 0.89(0.82, 0.95); P value = 0.001] and SGA [0.87(0.82, 0.94); P value < 0.001] infants. Higher maternal prepregnancy E-DII score (more pro-inflammatory diet) was associated with lower birth weight [β(95% CI) = −18.7(−34.8, −2.6) g per 1-SD higher E-DII score; P value = 0.023] and shorter birth length [−0.07(−0.14, −0.01) cm; P value = 0.031], whereas higher pregnancy E-DII score was associated with a shorter birth length [−0.06(−0.10, −0.01) cm; P value = 0.026] and higher risk of SGA [OR(95% CI) = 1.18(1.11, 1.26); P value < 0.001]. In male, but not female, infants higher maternal prepregnancy E-DII was associated with lower birth weight and head circumference, shorter birth length, and higher risk of SGA (P-for-sex-interaction = 0.029, 0.059, 0.104, and 0.075, respectively). No consistent associations were observed for maternal E-DII and DASH scores with gestational age, preterm and postterm birth, or macrosomia and LGA. Limitations of this study were that self-reported dietary data might have increased nondifferential measurement error and that causality cannot be claimed definitely with observational design.ConclusionsIn this cohort study, we observed that maternal diet that is of low quality and high inflammatory potential is associated with lower offspring birth size and higher risk of offspring being born SGA in this multicenter meta-analysis using harmonized IPD. Improving overall maternal dietary pattern based on predefined criteria may optimize fetal growth and avert substantial healthcare burden associated with adverse birth outcomes.

Diet Quality and Mortality, Stunting and Wasting in Children Aged 6–59 Months: An Ecological Analysis from the Global Dietary Database

Abstract Objectives Empirical evidence on the relationship between diet quality metrics and child growth outcomes is sparse. We investigated the associations between the Infant and Young Child Minimum Dietary Diversity (IYCMDD) and Dietary Approaches to Stop Hypertension (DASH) scores, and under-5 mortality and disability-adjusted life years (DALYs) due to stunting, wasting, underweight and overweight/obesity in children aged 6–59 months. Methods The Global Dietary Database (GDD) uses Bayesian hierarchical modeling methods to combine individual-level dietary intake from national and sub-nationally representative surveys with other country-level data to estimate mean national intakes for 55 dietary factors. Dietary data for children from 185 countries was obtained from the GDD. Data on under-5 mortality rates and disease specific DALYs were obtained from the World Bank's World Development Indicators and the Global Burden of Diseases study, respectively. We assessed country- and sex-stratum level cross-sectional associations between the IYCMDD and DASH scores, and mortality and DALYs using Poisson regression models, adjusting for individual and national-level confounders (sex, education, urbanicity, unemployment rate, poverty rate, income, and geographic region). Results In 2015, a higher IYCMDD score was associated with a lower risk of under-5 mortality (odds ratio [OR] 0.88, 95% CI 0.86–0.90, P-value &amp;lt; 0.001 for a 1-unit increase) and DALYs linked to stunting (0.67, 0.67–0.68, P-value &amp;lt; 0.001), wasting (0.70, 0.69–0.70, P-value &amp;lt; 0.001), and underweight (0.70, 0.70–0.71, P-value &amp;lt; 0.001). No significant association with overweight/obesity (0.99, 0.97–1.01, P-value = 0.479) was observed. A higher DASH score was associated with a decreased risk of DALYs linked to under-5 mortality (0.94, 95% 0.93–0.95, P-value &amp;lt; 0.001), stunting (0.87, 0.87–0.88, P-value &amp;lt; 0.001), wasting (0.89, 0.88–0.89, P-value &amp;lt; 0.001), and underweight (0.88, 0.87–0.89, P-value &amp;lt; 0.001), and an increased risk of overweight/obesity (1.02, 1.01–1.02, P-value &amp;lt; 0.01). Conclusions Higher IYCMDD and DASH scores were protective against the risk of death and stunting and wasting in children, but not overweight/obesity. Our findings suggest a need to prioritize appropriate metrics relevant to the double burden of malnutrition. Funding Sources Gates Foundation.

Maternal dietary quality, inflammatory potential and offspring adiposity throughout childhood: a pooled analysis of 7 European cohorts (ALPHABET consortium)

AbstractIntroductionThe foetal programming hypothesis posits that optimising early life factors e.g. maternal diets can help avert the burden of adverse childhood outcomes e.g. childhood obesity. To improve applicability to public health messaging, we investigated whether maternal whole diet quality and inflammatory potential influence childhood adiposity in a large consortium.MethodsWe harmonized and pooled individual participant data from up to 8,769 mother-child pairs in 7 European mother-offspring cohorts. Maternal early-, late-, and whole-pregnancy dietary quality and inflammatory potential were assessed with Dietary Approaches to Stop Hypertension (DASH) and energy-adjusted Dietary Inflammatory Index (E-DII), respectively. Primary outcome was childhood overweight and obesity (OWOB), defined as age- and sex-specific body-mass-index-z score (BMIz) &gt; 85th percentile based on WHO growth standard. Secondary outcomes were sum-of-skinfold-thickness (SST), fat-mass-index (FMI) and fat-free-mass-index (FFMI) in available cohorts. Outcomes were assessed in early- [mean (SD) age: 2.8 (0.3) y], mid- [6.2 (0.6) y], and late-childhood [10.6 (1.2) y]. We used multivariable regression analyses to assess the associations of maternal E-DII and DASH with offspring adiposity outcomes in cohort-specific analyses, with subsequent random-effects meta-analyses. Analyses were adjusted for maternal age, pre-pregnancy BMI, parity, lifestyle factors, energy intake, educational attainment, offspring age and sex.ResultsA more pro-inflammatory maternal diet, indicated by higher E-DII, was associated with a higher risk of offspring late-childhood OWOB [pooled-OR (95% CI) comparing highest vs. lowest E-DII quartiles: 1.22 (1.01,1.47) for whole-pregnancy and 1.38 (1.05,1.83) for early-pregnancy; both P &lt; 0.05]. Moreover, higher late-pregnancy E-DII was associated with higher mid-childhood FMI [pooled-β (95% CI): 0.11 (0.003,0.22) kg/m2; P &lt; 0.05]; trending association was observed for whole-pregnancy E-DII [0.12 (-0.01,0.25) kg/m2; P = 0.07]. A higher maternal dietary quality, indicated by higher DASH score, showed a trending inverse association with late-childhood OWOB (pooled-OR (95% CI) comparing highest vs. lowest DASH quartiles: 0.58 (0.32,1.02; P = 0.06). Higher early-pregnancy DASH was associated with lower late-childhood SST [pooled-β (95% CI): -1.9 (-3.6,-0.1) cm; P &lt; 0.05] and tended to be associated with lower late-childhood FMI [-0.34 (-0.71,0.04) kg/m2; P = 0.08]. Higher whole-pregnancy DASH tended to associate with lower early-childhood SST [-0.33 (-0.72,0.06) cm; P = 0.10]. Results were similar when modelling DASH and E-DII continuously.DiscussionAnalysis of pooled data suggests that pro-inflammatory, low-quality maternal antenatal diets may influence offspring body composition and obesity risk, especially during mid- or late-childhood. Due to variation of data availability at each timepoint, our results should be interpreted with caution. Because most associations were observed at mid-childhood or later, future studies will benefit from a longer follow-up.

Adherence to DASH Dietary Pattern Is Inversely Associated with Osteoarthritis in Americans (P18-012-19)

ObjectivesOsteoarthritis (OA) is a common disease which significantly contributes to disability among older adults. Dietary factors are suggested to play a role in preventing OA, however, studies in this area spare. 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. MethodsThis study included United States (US) adults (≥aged 20 years) who participated NHANES cycles 2007–2016. The Dietary Approaches to Stop Hypertension (DASH) score was calculated from nine food items with a higher DASH score indicating better adherence to the DASH dietary pattern. Multivariable logistic regression models adjusted for age, education, race/ethnicity, household income, smoking, alcohol consumption, and total energy intake were used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CI) of DASH with OA. All analyses accounted for the complex survey design. ResultsAmong the 17,349 participants included in this study, 9.05% reported OA. The DASH score was inversely associated with OA. The aOR (95% CI) were 1.00 (ref), 0.09 (0.70, 1.16), and 0.74 (0.58, 0.94) (Ptrend = 0.01) across the DASH score tertiles. When analyses were stratified by BMI categories (normal, overweight, obese) the magnitude of the association was stronger and remained significant only among obese participants (i.e., BMI ≥ 30 kg/m2). Among participants with an obese BMI, participants with a DASH score in the highest tertile compared to participants with a DASH score in the lowest tertile had a 17% lower likelihood of having OA (P = 0.009). ConclusionsIn a representative sample of American adults, higher adherence to the DASH dietary pattern was associated with lower likelihood of having OA and this association was particularly evident among obese individuals. Funding SourcesN/A. Supporting Tables, Images and/or Graphs▪

Abstract MP37: Diet Quality and Lifetime Risk of Total Cardiovascular Disease in US Adults

Introduction: Suboptimal diet is a leading risk factor for cardiovascular disease (CVD). Yet, the relationship between diet quality and lifetime CVD risk, and whether it differs by age, are unclear. Methods: Diet data from 10 US prospective cohorts were harmonized according to a standard protocol. Three diet quality indices were calculated within each cohort: Dietary Approaches to Stop Hypertension (DASH) diet, alternate Healthy Eating Index 2010 (aHEI-2010), and alternate Mediterranean (aMED) diet. CVD included coronary heart disease, stroke and heart failure. Study sample was divided into younger (&lt;40 years old), middle-aged (40-60) and older (&gt;60) groups based on age at the first dietary assessment. Cumulative CVD risk according to 5-year interval was estimated using modified Kaplan-Meier analysis, adjusting for competing risk of death. Multivariable proportional hazards regression was applied to determine the association between the three diet quality indices and CVD by sex and age. Results: A total of 129,892 participants with 1,603,199 person years of follow-up were analyzed. The adjusted cumulative CVD risk was lower in younger and middle-aged men and all women who had higher DASH score (Figure 1). Age modified the diet-CVD association in both men and women (P &lt;0.0005). Compared to the lowest DASH score quintile (poorest diet), the adjusted hazard ratio (HR) for CVD decreased with increasing quintile of diet quality. The HR for the highest quintile was 0.41 (95% CI: 0.20-0.87) in younger men, 0.97 (0.82-1.16) in middle-aged men, 1.03 (0.89-1.19) in older men, 0.47 (0.21-1.05) in younger women, 0.73 (0.63-0.84) in middle-aged women, and 0.82 (0.76-0.88) in older women. Results were similar for aMED and aHEI-2010 score. Conclusions: Better diet quality is associated with lower lifetime CVD risk in all women and men except older men. Stronger inverse diet quality-CVD association in younger than middle-aged and older adults suggests that relative benefits of a healthy diet for CVD risk reduction may be greater at younger ages.