• Embed Doc
  • Copy Link
  • Readcast
  • Collections
  • CommentGo Back
Download
 
10/22/20091
DASH: an Eating Plan forLifelong Health
Lynn L. Moore, DSc, MPH
Preventive Medicine & Epidemiology Boston University School of Medicine
2
DASH eating plan recommended by:Primary Goals of Today’s Talk 
Re-assess the evidence for DASH
Examine effects of DASH on health outcomesin adults (in addition to BP)
Look at new data on DASH and healthoutcomes in children and adolescents
Secondary Goals
Raise question of what constitutes a “DASHeating plan”.
Identify some unanswered questions
3
 
DASH Eating Plan
(Adults)
based on a 2,000 calorie diet 
U.S. Department of Health and Human Services. Your Guide to Lowering Your BloodPressure with DASH. 2nd Edition, April 2006
Food GroupDaily ServingsVegetables4-5Fruits4-5Low-fat or fat-free dairy products 2-3
Grains (esp. whole grains)6-8Meats (lean), poultry, fish6 or lessNuts, seeds, dry beans, peas4-5/weekFats and oils2-3Sweets5 or less/week
4
 
10/22/20092
 Vegetables
:
broccoli ( 
 vit A 
 ), soy ( 
Ca, potassium
 ), beets, mushrooms, potatoes(B6), green leafy/spinach ( 
 vit A, Mg, Ca
 ),tomatoes, ( 
 potassium, Mg
 ) ( 
fiber
 )
Fruit
:
melons, bananas, papaya, prunes,oranges ( 
Mg, potassium, vit C, fiber
 ),fortified juices ( 
Ca
 )
Dairy
:
milk, yogurt, cheese
( 
Ca, Potassium, Mg
, vit D, phos,
 protein
 )
Major DASH Food Groups
5
 
Original DASH Clinical Trial
 Three diets
Control (typical American)
Fruits and vegetables (K, mg, fiber)
Combination: fruits, vegetables, low-fatdairy (K, mg, fiber, ca, pro)
Isocaloric (no wt loss)
459 adults
50% women
60% African-American
Elevated BP:
SBP < 160 mm Hg 
DBP 80 –95 mm Hg 
Intervention Period –8 wks
6
 Appel LJ
 N Engl JMed 1997;336:1117-1124
1201221241261281301321340 1 2 3 4 5 6 7 8
Follow-up Time (wks)
   S   B   P   (  m  m   H  g   )
ControlFruit & VegDASH
DASH and Mean SBP Change
7
 Appel L.
 N Engl J Med 1997;336:1117-1124
•
Effects in African-Americans were nearly double those of Caucasians
Other Findings Related to DASH & BP
In DASH-sodium trial, DASH lowered BP at alllevels of sodium intake but DASH + low sodium led to greatest reductions in BP
(Sacks F, N Engl J Med 2001)
 African-Americans particularly vulnerable toadverse BP effects of low potassium diet
(Morris RC, Hypertension 1999)
In IWHS, concordance with DASH (using score) was not associated with lower risk of Htn
(Folsom AR, AJH 2007)
 WHI emphasizing fruits, veg & whole grains ledto modest reductions in SBP & DBP
(Howard BV, JAMA 2006)
8
 
10/22/20093
-6.8-6.2-8.4-12-9.8-11.2
-14.0-12.0-10.0-8.0-6.0-4.0-2.00.0
   M  e  a  n   C   h  a  n  g  e   i  n   S   B   P   (  m  m   H  g   )
Advice onlyESTEST+DASH
Met. SyndromeNo Met. Syndrome
SBP Change in Setting of MetabolicSyndrome: (PREMIER Study)
Lien LF et al.
Hypertension 2007;50:609-616 
9
6-month follow up
•In setting of MetS,DASH diet enhancedbeneficial effect of ESTintervention•In those without MetS,the EST intervention &EST + DASH wereequally effective
No added benefit of DASH compared with EST alone for lipids, insulin resistance or glucose
 Why the Inconsistent Results?
Original RCT, well-controlled feeding study-demonstrated efficacy of DASH approach insubjects with low intakes of key nutrients.
Baseline intakes key nutrients higher in somesubsequent studies so effects may be weaker.
 WHI did not emphasize dairy intake. Review (Kris-Etherton) concludes: there is growing evidence that dairy is involved in BP regulation.
DASH scoring systems equally weight all dietary components and may wash out importantdietary effects.
10
Long-term Health Effects of ElevatedBlood Pressure Begin Early
-12-11-10-9-8-7-6-5-4-3-2-1012
End of Rx3-mo. f/uEnd of Rx3-mo. f/uEnd of Rx3-mo. f/u
DASHRoutine Care
Post-treatment completersDASH = 24; RC = 22
3-Month follow-up completersDASH = 18; RC = 18
   C   h  a  n  g  e
DASH vs. Routine Care
Change in BP & BMI in Adolescents with HBP
Couch et al,
 J Pediatr 2008;152:494-501
12
Change in DBP Change in SBP Change in BMI 
of 00

Leave a Comment

You must be to leave a comment.
Submit
Characters: ...
You must be to leave a comment.
Submit
Characters: ...