Association of dietary patterns with obesity and metabolically healthy obesity phenotype in Chinese population: a cross-sectional analysis of China Multi-Ethnic Cohort Study

Metabolically healthy obesity (MHO) might be an alternative valuable target in obesity treatment. We aimed to assess whether alternative Mediterranean (aMED) diet and Dietary Approaches to Stop Hypertension (DASH) diet were favorably associated with obesity and MHO phenotype in a Chinese Multi-Ethnic population. We conducted this cross-sectional analysis using the baseline data of the China Multi-Ethnic Cohort (CMEC) study that enrolled 99 556 participants from seven diverse ethnic groups. Participants with self-reported cardiometabolic diseases were excluded to eliminate possible reverse causality. Marginal structural logistic models were used to estimate the associations, with confounders determined by directed acyclic graph (DAG). Among 65 699 included participants, 11.2% were with obesity. MHO phenotype was present in 5.7% of total population and 52.7% of population with obesity. Compared with the lowest quintile, the highest quintile of DASH diet score had 23% decreased odds of obesity (OR = 0.77, 95% CI: 0.71-0.83, Ptrend <0.001), and 27% increased odds of MHO (OR = 1.27, 95% CI: 1.10-1.48, Ptrend =0.001) in population with obesity. However, aMED diet showed no obvious favorable associations. Further adjusting for BMI did not change the associations between diet scores and MHO. Results were robust to various sensitivity analyses. In conclusion, DASH diet rather than aMED diet is associated with reduced risk of obesity and presents BMI-independent metabolic benefits in this large population-based study. Recommendation for adhering to DASH diet may benefit the prevention of obesity and related metabolic disorders in Chinese population.

The Effectiveness of Dietary Approaches to Stop Hypertension (DASH) Mobile Applications in Supporting a Healthy Diet and Controlling Hypertension in Adults: Systematic Review (Preprint)

BACKGROUND Uncontrolled hypertension is a public health issue, with increasing prevalence worldwide. The Dietary Approach to Stop Hypertension (DASH) diet is one of the most effective dietary approaches for lowering blood pressure (BP). Dietary mobile applications (apps) have gained popularity and are being used to support DASH diet self-management, aiming to improve DASH diet adherence and thus lower BP OBJECTIVE This systematic review aimed to assess the effectiveness of smartphone apps that support self-management to improve DASH diet adherence and, consequently, reduce BP. A secondary aim was to assess user engagement, satisfaction and acceptance, and usability related to DASH mobile app use. METHODS EMBASE (OVID), Cochrane Library, CINAHL, Web of Science, Scopus, and Google Scholar electronic databases were used to conduct systematic searches for studies conducted between 2008 and 2021 that used DASH smartphone apps to support self-management. The included articles’ reference lists were also checked. RESULTS Five studies (three RCTs and two pre-post studies) including 334 participants altogether examined DASH mobile apps. All studies found a positive trend related to the use of DASH smartphone apps, but the three RCTs had a high risk of bias. One pre-post study had a high risk of bias, the other had a low risk. As a consequence, no firm conclusions can be drawn regarding DASH smartphone apps’ effectiveness in increasing DASH diet adherence and lowering blood pressure. All the apps appeared to be accepted and easy to use. CONCLUSIONS There is weak emerging evidence of a positive effect of using DASH smartphone apps supporting self-management to improve DASH diet adherence and, consequently, lower BP. Further research is needed to provide high-quality evidence that can determine the effectiveness of DASH smartphone apps. CLINICALTRIAL Review article

The Dietary Approach to Stop Hypertension (DASH) diet is associated with a lower risk of heart failure: A cohort study

Aims Trials demonstrate that following the DASH diet lowers blood pressure, which may prevent development of heart failure (HF). We investigated the association between long-term adherence to the DASH diet and food substitutions within the DASH diet on the risk of HF. Methods Men and women aged 45-83 years without previous HF, ischemic heart disease or cancer at baseline in 1998 from the Cohort of Swedish Men (n = 41,118) and the Swedish Mammography Cohort (n = 35,004) were studied. The DASH diet emphasizes intake of fruit, vegetables, whole grains, nuts and legumes and low-fat dairy and deemphasizes red and processed meat, sugar-sweetened beverages and sodium. DASH diet scores were calculated based on diet assessed by food frequency questionnaires in late 1997 and 2009. Incidence of HF was ascertained using the Swedish Patient Register. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Results During the median 22 years of follow-up (1998-2019) 12,164 participants developed HF. Those with the greatest adherence to the DASH diet had a lower risk of HF compared to those with the lowest adherence (HR 0.85, 95% CI 0.80, 0.91 for baseline diet and HR 0.83, 95% CI 0.78, 0.89 for long-term diet, comparing quintiles). Replacing 1 serving/day of red and processed meat with emphasized DASH diet foods was associated with an 8-12% lower risk of HF. Conclusion Long-term adherence to the DASH diet and relevant food substitutions within the DASH diet were associated with a lower risk of HF.

Association of Dietary Pattern, Lifestyle and Chronotype with Metabolic Syndrome in Elderly—Lessons from the Population-Based Hamburg City Health Study

In aging populations, the increasing prevalence of metabolic syndrome and the resulting elevated risk of developing non-communicable diseases is a major challenge for worldwide health care. The elderly population-based Hamburg City Health Study (HCHS) allows investigating the association in the relevant age group 45–74 years. For 3513 of 10,000 participants, self-reported information on dietary patterns (DASH, MEDAS), chronotype, lifestyle, and data on metabolic syndrome parameters was available. Overall, having a “low” DASH score was a statistically significant risk factor (OR 1.23; 95% CI 1.01–1.48). Only for “late” chronotype, a slightly elevated OR (1.06) was found, but no statistically significant effect on the outcome of metabolic syndrome. Still, considering chronotype vastly improved the model. However, a trend of an increasing predicted probability from early to late chronotype was found for participants with low adherence to the DASH diet. Future research should focus on options for prevention in persons with late chronotype, so they can be supported better in adherence to, e.g., DASH diet to lower their risk.

Dietary Management of Heart Failure: DASH Diet and Precision Nutrition Perspectives

Heart failure (HF) is a major health care burden increasing in prevalence over time. Effective, evidence-based interventions for HF prevention and management are needed to improve patient longevity, symptom control, and quality of life. Dietary Approaches to Stop Hypertension (DASH) diet interventions can have a positive impact for HF patients. However, the absence of a consensus for comprehensive dietary guidelines and for pragmatic evidence limits the ability of health care providers to implement clinical recommendations. The refinement of medical nutrition therapy through precision nutrition approaches has the potential to reduce the burden of HF, improve clinical care, and meet the needs of diverse patients. The aim of this review is to summarize current evidence related to HF dietary recommendations including DASH diet nutritional interventions and to develop initial recommendations for DASH diet implementation in outpatient HF management. Articles involving human studies were obtained using the following search terms: Dietary Approaches to Stop Hypertension (DASH diet), diet pattern, diet, metabolism, and heart failure. Only full-text articles written in English were included in this review. As DASH nutritional interventions have been proposed, limitations of these studies are the small sample size and non-randomization of interventions, leading to less reliable evidence. Randomized controlled interventions are needed to offer definitive evidence related to the use of the DASH diet in HF management.

The effect of the Dietary Approaches to Stop Hypertension (DASH) diet on body composition, complete blood count, prothrombin time, inflammation, and liver function in hemophilic adolescents

There is no dietary strategy that has yet been specifically advocated for hemophilia. Therefore, we sought to assess the effect of the Dietary Approaches to Stop Hypertension (DASH) diet in adolescents with hemophilia. In this parallel trial, 40 male adolescents with hemophilia were dichotomized into the DASH group or control group for 10 weeks. The serum high sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), complete blood count (CBC), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), partial thromboplastin time (PTT), waist circumference (WC), percentage of body fat, fat-free mass (FFM), and liver steatosis were measured at the beginning and end of the study. Serum vitamin C was measured as a biomarker of compliance with the DASH diet. The DASH diet was designed to include high amounts of whole grains, fruits, vegetables, and low-fat dairy products, as well as low amounts of saturated fats, cholesterol, refined grains, sweets and red meat. Serum vitamin C in the DASH group was significantly increased compared to the control (P=0.001). There was a significant reduction in WC (P=0.005), fat mass (P=0.006), hepatic fibrosis (P=0.02), and PTT (P=0.008) in the DASH group, compared with the control. However, there were no significant differences regarding other selected outcomes between groups. Patients in the DASH group had significantly greater increase in the levels of red blood cell, hemoglobin, and hematocrit, as compared to control. Adherence to the DASH diet in children with hemophilia yielded significant beneficial effects on body composition, complete blood count, inflammation, and liver function.

Community-Academic Partnership to Improve Nutrition and Blood Pressure in Seniors: Outcomes & Impact of COVID-19

The Dietary Approaches to Stop Hypertension (“DASH diet”) has been proven in research settings to lower blood pressure, but its implementation is untested among seniors in congregate meals settings. We report the planning, implementation, impact of COVID-19, and results of an Administration of Community Living-funded study to test whether two evidence-based interventions - DASH-alignment of congregate meals, and home blood pressure self-monitoring, can lower systolic blood pressure and increase blood pressure control among community-dwelling seniors.. Congregate meal menus were aligned with the DASH eating plan, through collaboration of Bionutrition professionals on the research team, CBN food services leadership, and the NYC Department for the Aging. Seniors provided feedback on the DASH-modified meal options. The intervention began on October 15, 2019 (Site 1) and February 3, 2020 (Site 2). The study was interrupted by the COVID-19 pandemic in March 2020, when congregate meals ceased, and when approximately 75% of primary outcome data were collected. Modified implementation permitted completion of modified study outcomes. Preliminary analyses suggest that some participants were able to lower their blood pressure in this program. The DASH diet implemented in the congregate meal setting, along with programs to support BP self-efficacy through modification of existing programs, may be a valuable and scalable model to reduce cardiovascular risk among community-living seniors.