Associations of Adherence to the DASH Diet and the Mediterranean Diet With All-Cause Mortality in Subjects With Various Glucose Regulation States

Fruit and Vegetable Consumption and Risk of All-Cause and Cause-Specific Mortality in Individuals With Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies

CONTEXT

Controversy exists regarding the association between fruit and vegetable consumption and all-cause and cause-specific mortality among individuals with type 2 diabetes (T2D).

OBJECTIVE

This study aims to inform dietary recommendations and add to the body of evidence by providing a thorough investigation of the association between the consumption of fruits and vegetables and the mortality risk in patients with T2D. The literature on this association was evaluated by a comprehensive systematic review and meta-analysis.

DATA SOURCES

PubMed, Scopus, and Web of Science were searched up to 29 June 2024.

DATA EXTRACTION

Prospective cohort studies involving participants with diabetes aged over 18 years reporting risk estimates for the association between total fruit and vegetable intake and all-cause or cause-specific mortality (including cardiovascular disease [CVD], coronary heart disease, and stroke) were included.

DATA ANALYSIS

A random-effects approach was applied for combining risk estimates, and dose-response relationships were assessed using restricted cubic splines. Overall, 9 studies with 75 082 participants and 7590 deaths were included. Compared with the lowest intake, the highest fruit intake was associated with a decreased risk of all-cause (hazard ratio [HR]: 0.82; 95% CI: 0.75, 0.90; n = 6) and CVD (HR: 0.90; 95% CI: 0.84, 0.97; n = 4) mortality. The highest vegetable intake was also related to reduced all-cause (HR: 0.85; 95% CI: 0.73, 0.98; n = 6) and CVD (HR: 0.97; 95% CI: 0.94, 0.99; n = 2) mortality risk. An additional 200 g/day of fruit and vegetable consumption was associated with a 26% and 14% lower risk of all-cause mortality.

CONCLUSION

This meta-analysis indicates an inverse association between fruit and vegetable intake and mortality from all causes and CVD in T2D patients.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42024571094.

The moderating effect of alternate Mediterranean diet on the association between sedentary behavior and insomnia in postmenopausal women

Aim

The study aimed to explore the moderating role of the alternate Mediterranean diet (aMED) adherence on the association between sedentary behavior and insomnia symptoms in postmenopausal women.

Methods

Data regarding postmenopausal women were obtained for this cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) 2005-2008. Sedentary behavior and insomnia symptoms were assessed using the questionnaire. aMED adherence was evaluated according to 24-h dietary recalls. Weighted univariate logistic regression models were utilized to screen potential covariates. The relationship between sedentary behavior, aMED adherence, and insomnia symptoms was explored using weighted univariate and multivariate logistic regression models. All results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of 1,793 postmenopausal women were included in the final analysis. Of them, 643 (37.56%) reported experiencing insomnia symptoms. Among the postmenopausal women, sedentary time of >8 h was associated with insomnia symptoms (OR = 1.41, 95% CI = 1.01-1.96), prolonged nocturnal awakening (OR = 1.38, 95% CI = 1.06-1.79), and undesired early morning awakening (OR = 1.59, 95% CI = 1.09-2.30). No association was observed between adherence to the aMED and insomnia symptoms (OR = 1.05, 95% CI: 0.77-1.44). Among the postmenopausal women with lower adherence to the aMED, the odds of insomnia symptoms were higher in those with sedentary time ≥8 h (OR = 1.63, 95% CI: 1.02-2.62). Similarly, in the participants with low aMED adherence, sedentary time ≥8 h was also associated with prolonged nocturnal awakening (OR = 1.90, 95% CI = 1.27-2.83) and undesired early morning awakening (OR = 1.85, 95% CI = 1.09-3.16).

Conclusion

Adherence to the aMED modulates the association between sedentary behavior and insomnia symptoms in postmenopausal women. Interventions targeting sedentary behavior and dietary patterns may improve sleep quality and overall health in postmenopausal women.

Body Mass Index mediates the associations between dietary approaches to stop hypertension and obstructive sleep apnea among U.S. adults

Background

The Dietary Approaches to Stop Hypertension (DASH) are associated with reduced cardiovascular, diabetes risk, but the effect on obstructive sleep apnea (OSA) is uncertain.

Methods

This study used data from the National Health and Nutrition Examination Survey (NHANES). DASH score was assessed through 24-h dietary recall interviews, and OSA diagnosis in individuals was based on predefined criteria. Logistic regression analysis was used to assess the association between DASH and OSA. Restricted cubic spline (RCS) analysis was used to investigate the dose-response relationship between DASH score and OSA risk. And comprehensive subgroup and mediation analyses were performed.

Results

Among the 14,978 participants, 27.01% had OSA. DASH scores had a negative association with the risk of OSA (OR = 0.91, 95%CI: 0.88-0.95, p < 0.01). Next, we divided DASH scores into quintiles groups. In comparison to the reference group Q1, groups Q5 had adjusted OR values of 0.63 (95%CI: 0.52-0.76, p < 0.01). Subgroup analyses revealed that this association was consistent across different groups. Further mediation analyses showed that the associations of DASH with OSA risk parallelly mediated by the above Body Mass Index (BMI) 33.4%,95%CI (20.6-46.2%) (all p < 0.05). The restricted cubic spline (RCS) analysis indicated a significant dose-response relationship between DASH diet and OSA risk.

Conclusion

These findings suggested that DASH decreased OSA risk, which was possibly and partly mediated by BMI.

Can nutritional scores improve the WHO calibrated non-laboratory risk prediction model for cardiovascular disease? Golestan Cohort Study

Purpose

Evaluation of the added value of Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diet scores on the prediction model of the World Health Organization (WHO) to predict 10-year cardiovascular disease (CVD) mortality using the Golestan Cohort Study data.

Methods

A total of 44,648 participants (25,268 women and 18,531 men) were included in the final analysis. To assess the external validity of the non-laboratory risk model of WHO, the Area Under the Curve (AUC) and calibration plot methods were used. The multivariate Cox proportional hazards regression analysis was used to evaluate the association of 10-year CVD mortality risk with DASH and Mediterranean scores and their components. The added value of each significant variables was evaluated by the concordance C-statistic and integrated discrimination improvement (IDI). Statistical significance was defined as p-value < 0.05.

Results

DASH and Mediterranean diet scores were not significant predictors of 10-year CVD mortality in both genders (p > 0.05). However, sodium and total vegetable in both genders and added sugar in women were significant predictors for 10-year stroke mortality (p < 0.05). Sodium intake in women and monounsaturated fatty acid (MUFA) to saturated fatty acid (SFA) ratio in men had significant associations with 10-year mortality of myocardial infarction/coronary heart disease (MI/CHD). Calculation of IDI showed that none of the evaluated nutritional indices/variables could significantly improve the WHO model performance and predictive ability.

Conclusion

Inclusion of DASH and Mediterranean diet scores and their components did not improve WHO risk prediction model performance and predictive ability to predict 10-year CVD mortality.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01463-x.

Nutrients, Diet Quality, and Dietary Patterns in Patients with Inflammatory Bowel Disease: A Comparative Analysis

(1) Background: Diet plays an important role in the development of inflammatory bowel disease (IBD). There are a number of methods available to assess the diets of patients with IBD, including nutrients, dietary patterns, and various appraisal tools of diet quality. However, research on diet quality and dietary patterns in IBD populations is limited, and comparative evaluations of dietary intake in patients with IBD have not been performed. (2) Objectives: The aim of this study was to assess nutrients, the dietary patterns, and diet quality of patients with IBD and to investigate the relationship between dietary patterns, diet quality, and the adequacy of nutrient intake. (3) Methods: Three-day food records of 268 patients with ulcerative colitis (UC) and 126 patients with Crohn's disease (CD) were collected to estimate nutrients and food groups, while dietary quality was assessed using the Dietary Inflammation Index (DII) and Mediterranean Diet Score (MDS). Dietary patterns were derived using principal component analysis (PCA). Participants' nutrient intake, diet quality, and dietary patterns were compared. We used binary logistic regression to assess the relationship between dietary patterns (independent variable) and nutritional adequacy (dependent variable). (4) Results: In our sample, patients had inadequate energy, protein, and dietary fiber intake compared with Reference Nutrient Intake (RNI). Regarding micronutrients, intakes of potassium, zinc, selenium, vitamin A, vitamin C, vitamin E, sodium, calcium, iron, niacin, thiamin, and riboflavin were inadequate. Regarding food groups, the highest intakes were fruits, legumes, dairy products, and nuts. PCA revealed four dietary patterns, namely DP1, DP2, DP3, and DP4. Among UC patients, 96, 55, 69, and 48 patients adhered to DP1, DP2, DP3, and DP4 dietary patterns, respectively. Among CD patients, 41, 31, 34, and 20 patients complied with the dietary patterns of DP1, DP2, DP3, and DP4, respectively. There was no significant difference in dietary patterns between UC and CD patients. Compared with DP4 (high intake of mixed legumes and low intake of tubers), DP1 (high intake of cereals, tubers, vegetables and eggs) was more likely to ensure adequate intake of energy (OR, 2.96; 95% CI, 1.55, 5.62), protein (OR, 2.05; 95% CI, 1.06, 3.96), carbohydrates (OR, 3.55; 95% CI, 1.51, 6.59), thiamine (OR, 2.59; 95% CI, 1.36,4.93), niacin (OR, 2.75; 95% CI, 1.39, 5.42), phosphorus (OR, 2.04; 95% CI, 1.08, 3.85), zinc (OR, 2.43; 95% CI, 1.28, 4.63), and manganese (OR, 3.10; 95% CI, 1.60, 5.90), and DP2 (high intake of fruits, poultry, aquatic products, and nuts) was more likely to meet niacin requirements than DP4 (OR, 2.65; 95% CI, 1.28, 5.48). (5) Conclusion: This study clarifies our understanding of dietary intake, diet quality, and dietary patterns in adult patients with IBD. Future attention is needed to improve diet quality, emphasizing the importance of assessing and understanding patient dietary habits and increasing understanding of the factors that influence dietary intake in IBD in order to achieve optimal outcomes for patients with IBD.

Impact of fundamental components of the Mediterranean diet on the microbiota composition in blood pressure regulation

BACKGROUND

The Mediterranean diet (MedDiet) is a widely studied dietary pattern reflecting the culinary traditions of Mediterranean regions. High adherence to MedDiet correlates with reduced blood pressure and lower cardiovascular disease (CVD) incidence and mortality. Furthermore, microbiota, influenced by diet, plays a crucial role in cardiovascular health, and dysbiosis in CVD patients suggests the possible beneficial effects of microbiota modulation on blood pressure. The MedDiet, rich in fiber and polyphenols, shapes a distinct microbiota, associated with higher biodiversity and positive health effects. The review aims to describe how various Mediterranean diet components impact gut microbiota, influencing blood pressure dynamics.

MAIN BODY

The MedDiet promotes gut health and blood pressure regulation through its various components. For instance, whole grains promote a healthy gut microbiota given that they act as substrates leading to the production of short-chain fatty acids (SCFAs) that can modulate the immune response, preserve gut barrier integrity, and regulate energy metabolism. Other components of the MedDiet, including olive oil, fuits, vegetables, red wine, fish, and lean proteins, have also been associated with blood pressure and gut microbiota regulation.

CONCLUSION

The MedDiet is a dietary approach that offers several health benefits in terms of cardiovascular disease management and its associated risk factors, including hypertension. Furthermore, the intake of MedDiet components promote a favorable gut microbiota environment, which, in turn, has been shown that aids in other physiological processes like blood pressure regulation.

Optimal Medical Therapy for Stable Ischemic Heart Disease in 2024: Focus on Exercise and Cardiac Rehabilitation

Given the prevalence of chronic coronary disease, efforts should be made toward risk factor modification. Cardiac rehabilitation is a secondary prevention program consisting of tailored exercise and lifestyle counseling and has been shown to not only reduce cardiovascular morbidity and mortality but also improve quality of life and exercise capacity. Despite the benefits, it remains underutilized. Efforts should be made to increase referral for patients with chronic coronary disease to aid in symptom management and reduction of cardiovascular risk factors.

Age and sex differences in the association between Dietary Inflammatory Index and severe headache or migraine: a nationwide cross-sectional study

BACKGROUND

Migraine and severe headaches are extremely prevalent neurological disorders that plague humans and society. Prior research has revealed that DII may affect the occurrence of migraines, but there are too few relevant studies and more are required. This study aimed to determine the association between severe headache or migraine and the Dietary Inflammatory Index (DII), with particular attention to age and gender differences.

METHODS

Using data from the National Health and Nutrition Examination Survey (NHANES), we performed a cross-sectional study. In addition, we investigated the association between DII and severe headache or migraine using weighted multivariate logistic regression models, and restricted cubic splines models were plotted to explore their linear correlation.

RESULTS

There were a total of 13,439 people participating in the study, and of those, 2745 experienced a severe headache or migraine within the previous three months. The DII was linearly and positively correlated with severe headache or migraine (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 1.01-1.08, p = 0.0051). Stratified analysis showed that this relationship persisted among women and those aged < 60 years, with ORs of 1.08 (95% CI = 1.04-1.13, p = 0.0004) and 1.05 (95% CI = 1.01-1.09, p = 0.0071), respectively.

CONCLUSIONS

We found that greater levels of DII were significantly related to an increased likelihood of migraine onset, especially among women and young and middle-aged populations. Further research is required to validate and expand upon our results.

The Impact of a Nutritional Intervention on Glycemic Control and Cardiovascular Risk Markers in Type 2 Diabetes

INTRODUCTION

Nutritional management plays a crucial role in treating patients with type 2 diabetes (T2D), working to prevent and control the progression of chronic non-communicable diseases.

OBJECTIVES

To evaluate the effects of individualized nutritional interventions on weight, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), fasting blood glucose (FBG), hemoglobin A1c (HbA1c), total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), triglycerides (TGs), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR)} over 12 months and subsequently at follow-up (15 months).

METHODS

This longitudinal experimental study (without randomization and blinding) enrolled 84 sedentary participants with T2D (both sexes, aged 18-80 years). They were divided into a control group of 40 participants who received only medical consultations, and an intervention group of 44 participants who received the same medical care along with a nutritional assessment. Consultations occurred quarterly from August 2020 to November 2022 (first-twelfth month), with six to nine patients per session. Subsequently, a follow-up was conducted from December 2022 to November 2023, during which the intervention group had only medical care (during the 12th-15th months). Personalized dietary planning was inspired by the Mediterranean/DASH diets adapted to Brazilian foods and socioeconomic cultures.

STATISTICAL ANALYSIS

Normal variables were compared between groups for each time point and also within each group across different time points using a two-way ANOVA (repeated measures for intragroup) followed by the Šídák post hoc test. Non-normal variables were compared between groups for each time point using Kruskal-Wallis followed by the Dunn post hoc test, and within each group across different time points using Friedman followed by the Dunn post hoc test. Data with a Gaussian distribution were presented as mean ± standard deviation (SD), and data with a non-Gaussian distribution were presented as median ± interquartile range (IQR). For all cases, α < 0.05 and p < 0.05 were adopted.

RESULTS

In the intervention group, significant reductions were observed between the first and twelfth month for all parameters (p < 0.05), (except for TC), along with an increase in HDL-C (p = 0.0105). Conversely, in the control group, there was a significant increase in HbA1c, weight, BMI, FBG, and WHR (p < 0.05) between the first and twelfth months. Regarding the comparison between groups, there was a significant difference for all analyzed parameters (p < 0.05) from the first to the twelfth month. In the follow-up, differences were also observed (p < 0.05), except for BMI (p > 0.05).

CONCLUSION

The individualized nutritional intervention improved eating habits, anthropometric, biochemical, and cardiovascular markers in T2D over 12 months, with sustained results during follow-up. The dietary plan inspired by the Mediterranean and DASH diets demonstrated good adaptation to the Brazilian food culture and the patients' socioeconomic contexts. Consistent monitoring and personalized nutritional management are essential for optimizing long-term outcomes. However, more clinical trials are necessary in order to optimize the level of evidence for longitudinal interventions.

The Role of the Glycemic Index and Glycemic Load in the Dietary Approach of Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is a common metabolic disorder that often develops during pregnancy, characterized by glucose intolerance and insulin resistance (IR). To ensure the well-being of both the mother and the fetus, the body undergoes multiple metabolic and immunological changes that result in peripheral IR and, under certain hereditary or acquired abnormalities, GDM in predisposed women. The adverse short- and long-term effects of GDM impact both the mother and the fetus. Nutrition seems to play an important role to prevent GDM or improve its evolution. An emphasis has been given to the proportion of carbohydrates (CHO) relative to protein and lipids, as well as dietary patterns, in GDM. The effects of CHO on postprandial glucose concentrations are reflected in the glycemic index (GI) and glycemic load (GL). Diets rich in GI and GL may induce or exacerbate IR, whereas diets low in GI and GL appear to enhance insulin sensitivity and improve glycemic control. These positive outcomes may be attributed to direct interactions with insulin and glucose homeostasis or indirect effects through improved body composition and weight management. This comprehensive narrative review aims to explore the significance of nutrition, with a focus on the critical evaluation of GI and GL in the dietary management of women with GDM.

The association between dietary approaches to stop hypertension diet and bone mineral density in US adults: evidence from the National Health and Nutrition Examination Survey (2011-2018)

This study aimed to investigate the relationship between the dietary approaches to stop hypertension (DASH) dietary patterns and bone mineral density (BMD) in adults residing in the United States. To achieve this, data from the National Health and Nutrition Examination Survey (NHANES) database for 2011-2018 were utilized. This study utilized the NHANES database from 2011 to 2018, with a sample size of 8,486 US adults, to investigate the relationship between the DASH diet and BMD. The DASH diet was assessed based on nine target nutrients: total fat, saturated fat, protein, fiber, cholesterol, calcium, magnesium, sodium and potassium. The primary outcome measures were BMD values at the total BMD, thoracic spine, lumbar spine, and pelvis. Multivariable linear models were employed to analyze the association between the DASH diet and BMD. Interaction tests, subgroup, and sensitivity analysis were also followed. A negative correlation was observed between the DASH diet and total BMD (OR: - 0.003 [95%CI: - 0.005, - 0.001), pelvic (OR: - 0.005 [95%CI: - 0.007, - 0.002]), and thoracic BMD (OR: - 0.003 [95%CI: - 0.005, - 0.001]). However, the DASH diet does not appear to have a particular effect on lumbar spine BMD (OR: - 0.002 [95%CI: - 0.004, 0.001]). Similarly, when the DASH diet was categorized into tertiles groups, the relationship with total BMD, pelvic BMD, thoracic BMD, and lumbar spine BMD remained consistent. Furthermore, we performed a sensitivity analysis by converting BMD to Z-scores, and the results remained unchanged. Subgroup analyses and interaction tests indicated no significant dependence of BMI, gender, smoking, hypertension, and diabetes on the observed association (all p for interactions > 0.05). The DASH diet has been identified as potentially reducing total BMD, while specifically impacting thoracic and pelvic BMD. However, it appears to have no significant effect on lumbar spine BMD.

Associations of adherence to the DASH diet and the Mediterranean diet with chronic obstructive pulmonary disease among US adults

Background

The Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet are associated with reduced cardiovascular, tumor, and diabetes risk, but the effect on chronic obstructive pulmonary disease (COPD) is uncertain.

Objective

To investigate the association of the DASH diet and the Mediterranean diet with the risk of COPD in American adults.

Methods

This cross-sectional study included 28,605 participants from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 survey cycle who had complete dietary and other questionnaire data. The scores of healthy eating patterns (the DASH diet and the Mediterranean diet) were derived from a 24-h dietary recall interview [individual food and total nutrient data from NHANES and food pattern equivalents data from the United States Department of Agriculture (USDA)]. The primary outcome was the prevalence of COPD. COPD was defined based on participants self-reported whether or not a doctor or health professional had diagnosed chronic bronchitis or emphysema. Secondary outcomes were lung function and respiratory symptoms. All analyses were adjusted for demographics and standard COPD risk factors (primary tobacco exposure, secondhand smoke exposure, and asthma).

Results

This study included 2,488 COPD participants and 25,607 non-COPD participants. We found that a higher DASH diet score was associated with a lower risk of COPD [odds ratio (OR): 0.83; 95% confidence interval (CI): 0.71-0.97; P = 0.021]. This association persisted in several subgroups [men (OR: 0.73; 95% CI: 0.58-0.93; P = 0.010), relatively young (OR: 0.74; 95% CI: 0.55-1.01; P = 0.050), and smoker (OR: 0.82; 95% CI: 0.67-0.99; P = 0.038)]. In contrast, the Mediterranean diet score was not significantly associated with COPD prevalence in this large cross-sectional analysis representative of the US adult population (OR: 1.03; 95% CI: 0.88-1.20; P = 0.697). In addition, we found a correlation between DASH diet adherence and lung function [β: -0.01; 95% CI: -0.01-0.00; P = 0.003 (FEV1: FVC)] or respiratory symptoms [OR: 0.80; 95% CI: 0.73-0.89; P < 0.001 (dyspnea); OR: 0.80; 95% CI: 0.70-0.91; P = 0.002 (cough); OR: 0.86; 95% CI: 0.74-0.99; P = 0.042 (expectoration)], especially in non-COPD populations.

Conclusion

A higher DASH diet score was associated with improved COPD prevalence, lung function and respiratory symptoms. This new finding supports the importance of diet in the pathogenesis of COPD and expands the scope of the association of the DASH diet score with major chronic diseases.

Dietary Factors and All-Cause Mortality in Individuals With Type 2 Diabetes: A Systematic Review and Meta-analysis of Prospective Observational Studies

BACKGROUND

Type 2 diabetes is a major health concern associated with mortality. Diet may influence the progression of diabetes; however, systematic reviews are lacking.

PURPOSE

This study systematically summarized the evidence on diet and all-cause mortality in individuals with type 2 diabetes.

DATA SOURCES

PubMed and Web of Science were searched until June 2022.

STUDY SELECTION

Prospective observational studies investigating dietary factors in association with all-cause mortality in individuals with type 2 diabetes were selected.

DATA SYNTHESIS

We identified 107 studies. Moderate certainty of evidence was found for inverse associations of higher intakes of fish (summary risk ratios per serving/week: 0.95; 95% CI 0.92, 0.99; n = 6 studies), whole grain (per 20 g/day: 0.84; 95% CI 0.71, 0.99; n = 2), fiber (per 5 g/day: 0.86; 95% CI 0.81, 0.91; n = 3), and n-3 polyunsaturated fatty acids (per 0.1 g/day: 0.87; 95% CI 0.82, 0.92; n = 2) and mortality. There was low certainty of evidence for inverse associations of vegetable consumption (per 100 g/day: 0.88; 95% CI 0.82, 0.94; n = 2), plant protein (per 10 g/day: 0.91; 95% CI 0.87, 0.96; n = 3), and for positive associations of egg consumption (per 10 g/day: 1.05; 95% CI 1.03, 1.08; n = 7) and cholesterol intake (per 300 mg/day: 1.19; 95% CI 1.13, 1.26; n = 2). For other dietary factors, evidence was uncertain or no association was observed.

CONCLUSIONS

Higher intake of fish, whole grain, fiber, and n-3 polyunsaturated fatty acids were inversely associated with all-cause mortality in individuals with type 2 diabetes. There is limited evidence for other dietary factors, and, thus, more research is needed.

Dietary Approaches to Stop Hypertension via Indo-Mediterranean Foods, May Be Superior to DASH Diet Intervention

Western-type diet with high salt and sugar, sedentary behavior, obesity, tobacco and alcoholism are important risk factors for hypertension. This review aims to highlight the role of western diet-induced oxidative stress and inflammation in the pathogenesis of hypertension and the role of various types of diets in its prevention with reference to dietary approaches to stop hypertension (DASH) diet. It seems that it is crucial to alter the western type of diet because such diets can also predispose all CVDs. Western diet-induced oxidative stress is characterized by excessive production of reactive oxygen species (ROS) with an altered oxidation-reduction (redox) state, leading to a marked increase in inflammation and vascular dysfunction. Apart from genetic and environmental factors, one important cause for differences in the prevalence of hypertension in various countries may be diet quality, deficiency in functional foods, and salt consumption. The role of the DASH diet has been established. However, there are gaps in knowledge about the role of some Indo-Mediterranean foods and Japanese foods, which have been found to decrease blood pressure (BP) by improving vascular function. The notable Indo-Mediterranean foods are pulses, porridge, spices, and millets; fruits such as guava and blackberry and vegetables, which may also decrease BPs. The Japanese diet consists of soya tofu, whole rice, in particular medical rice, vegetables and plenty of fish rich in fish oil, fish peptides and taurine that are known to decrease BPs. Epidemiological studies and randomized, controlled trials have demonstrated the role of these diets in the prevention of hypertension and metabolic diseases. Such evidence is still meager from Japan, although the prevalence of hypertension is lower (15-21%) compared to other developed countries, which may be due to the high quality of the Japanese diet. Interestingly, some foods, such as berries, guava, pumpkin seeds, carrots, soya beans, and spices, have been found to cause a decrease in BPs. Omega-3 fatty acids, fish peptide, taurine, dietary vitamin D, vitamin C, potassium, magnesium, flavonoids, nitrate and l-arginine are potential nutrients that can also decrease BPs. Larger cohort studies and controlled trials are necessary to confirm our views.

Adherence to the dietary approaches to stop hypertension diet and all-cause mortality in patients with a history of heart failure

Background and aims

We investigated the association of adherence to the Dietary Approaches to Stop Hypertension (DASH) diet with all-cause mortality in patients with a history of heart failure.

Methods

We analyzed data from the National Health and Nutrition Examination Survey (NHANES). Dietary information was obtained from a 24-h dietary recall interview. Adherence to the DASH diet was assessed using the DASH score. The primary outcome was all-cause mortality which was confirmed by the end of 2011. Weighted Cox proportional hazards regression models were used to determine the hazard ratios and 95% CI for the association of the DASH score and all-cause mortality with multivariate adjustment.

Results

The median DASH score was 2 among the 832 study participants. There were 319 participants who died after a median follow-up duration of 4.7 years. A higher DASH score (>2 vs. ≤ 2) was not associated with a decrease in the risk of all-cause mortality (adjusted HR 1.003, 95% CI 0.760–1.323, p = 0.983). With respect to the components of the DASH score, a lower sodium intake was not associated with a decreased risk of mortality (adjusted HR 1.045, 95% CI 0.738–1.478, p = 0.803).

Conclusion

A higher DASH score (>2 vs. ≤ 2) was not associated with all-cause mortality in patients with heart failure.