Maternal Adherence to a Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern and the Relationship to Breast Milk Nutrient Content

BACKGROUND

Maternal lifestyle factors, such as diet and nutritional status are likely to affect the composition of breast milk (BM). This study aimed to investigate the association between adherence to a Dietary Approaches to Stop Hypertension (DASH) dietary pattern (DP) and BM nutrient content.

METHOD

A total of 700 milk samples were obtained from 350 lactating women. The dietary intakes of the women in the study were estimated using a validated food frequency questionnaire, which included 65 food items. The total antioxidant activity (TAC) of BM samples was evaluated using the Ferric reducing antioxidant power (FRAP), 2,2'-diphenyl-1-picrylhydrazyl (DPPH), thiobarbituric acid reactive substances (TBARS), and Ellman's assay. Also using commercially available kits, the total protein, calcium, and triglyceride contents in milk were determined.

RESULTS

Individuals in the 3rd tertile of adherence to the DASH diet (highest adherence) consumed more dietary fiber, fruits, vegetables, nuts, legumes, and seeds, low-fat dairy, whole grain, less red and processed meat, sweetened beverages, and sodium than those in the first tertile (lowest adherence). Subjects in the 3rd tertile of DASH DP had higher values of milk DPPH and calcium compared to those in the first tertile (P < 0.05). Milk MDA and triglyceride were significantly lower in the 3rd tertile of DASH diet versus the first tertile (P < 0.05).

CONCLUSION

Our study showed that high adherence to the DASH DP was associated with higher BM DPPH and calcium levels and lower amounts of BM MDA and triglyceride. The adherence to the healthy DPs such as the DASH can improve the quality of BM in lactating women.

Dietary Approaches to Stop Hypertension (DASH)-Style Dietary Pattern and 24-Hour Ambulatory Blood Pressure in Elderly Chinese with or without Hypertension

BACKGROUND

It is unknown whether the Dietary Approaches to Stop Hypertension (DASH) dietary pattern is associated with other blood pressure (BP) variables, beyond mean systolic blood pressure (SBP) and diastolic blood pressure (DBP).

OBJECTIVES

The study aimed to study the associations between the DASH dietary pattern and daytime and nighttime mean BPs and BP variance independent of the mean (VIM).

METHODS

A sample of 324 Chinese adults aged ≥ 60 y who were not on BP-lowering medications were included in the analysis. The DASH score was calculated using data collected by a validated FFQ. The 24-h ambulatory BP was measured and the mean and VIM SBP and DBP were calculated for both the daytime (06:00-21:59) and nighttime periods (22:00-05:59). Multivariable linear models were constructed to assess associations between the DASH dietary pattern and daytime and nighttime BP outcomes, adjusting for sociodemographic factors, lifestyle, BMI, and hypertension (clinic SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg), and sleep parameters (only for nighttime BP outcomes). An interaction term between DASH score and hypertension status was added to explore the potential differential association in normotensive and hypertensive individuals.

RESULTS

Every 1-unit increase in the DASH score was associated with a 0.18-unit (95% CI: -0.34, -0.01 unit) and a 0.22-unit (95% CI: -0.36, -0.09 unit) decrease in nighttime VIM SBP and nighttime VIM DBP, respectively. DASH score was not associated with any daytime BP outcomes, nighttime mean SBP, or nighttime mean DBP. A significant interaction (DASH score × hypertension status) was detected for VIM SBP (P-interaction = 0.04), indicating a differential association between DASH score and nighttime VIM SBP by hypertension status.

CONCLUSIONS

Independently of sleep parameters and other factors, the DASH dietary pattern is associated with lower nighttime BP variability in elderly adults.

Blood pressure interactions with the DASH dietary pattern, sodium, and potassium: The International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP)

BACKGROUND

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet enhances potassium intake and reduces sodium intake and blood pressure (BP), but the underlying metabolic pathways are unclear.

OBJECTIVES

Among free-living populations, we delineated metabolic signatures associated with the DASH diet adherence, 24-hour urinary sodium and potassium excretions, and the potential metabolic pathways involved.

METHODS

We used 24-hour urinary metabolic profiling by proton nuclear magnetic resonance spectroscopy to characterize the metabolic signatures associated with the DASH dietary pattern score (DASH score) and 24-hour excretion of sodium and potassium among participants in the United States (n = 2164) and United Kingdom (n = 496) enrolled in the International Study of Macro- and Micronutrients and Blood Pressure (INTERMAP). Multiple linear regression and cross-tabulation analyses were used to investigate the DASH-BP relation and its modulation by sodium and potassium. Potential pathways associated with DASH adherence, sodium and potassium excretion, and BP were identified using mediation analyses and metabolic reaction networks.

RESULTS

Adherence to the DASH diet was associated with urinary potassium excretion (correlation coefficient, r = 0.42; P < 0.0001). In multivariable regression analyses, a 5-point higher DASH score (range, 7 to 35) was associated with a lower systolic BP by 1.35 mmHg (95% CI, -1.95 to -0.80 mmHg; P = 1.2 × 10-5); control of the model for potassium but not sodium attenuated the DASH-BP relation. Two common metabolites (hippurate and citrate) mediated the potassium-BP and DASH-BP relationships, while 5 metabolites (succinate, alanine, S-methyl cysteine sulfoxide, 4-hydroxyhippurate, and phenylacetylglutamine) were found to be specific to the DASH-BP relation.

CONCLUSIONS

Greater adherence to the DASH diet is associated with lower BP and higher potassium intake across levels of sodium intake. The DASH diet recommends greater intake of fruits, vegetables, and other potassium-rich foods that may replace sodium-rich processed foods and thereby influence BP through overlapping metabolic pathways. Possible DASH-specific pathways are speculated but confirmation requires further study. INTERMAP is registered as NCT00005271 at www.clinicaltrials.gov.

Feasibility of a Digital Health Intervention to Improve Diet Quality Among Women With High Blood Pressure: Randomized Controlled Feasibility Trial

BACKGROUND

Over 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a proven lifestyle approach to lower blood pressure, yet population-level adherence is poor. Innovative strategies that promote DASH are needed.

OBJECTIVE

This paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension.

METHODS

We conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) to app-based diet tracking plus feedback on DASH adherence via text message (intervention). The intervention platform extracted nutrient data from the app, compared it to DASH recommendations, and sent tailored feedback text messages. Outcomes included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure.

RESULTS

The women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69%) and college educated (49/59, 83%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: -2.8 mmHg, 95% CI -1.8 to 7.4; P=.23) and diastolic (mean difference: -3.6 mmHg, 95% CI -0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34% (10/59) indicated that the feedback text messages helped them reach their diet goals.

CONCLUSIONS

A digital health intervention to improve DASH adherence is feasible and produces moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03215472; https://clinicaltrials.gov/ct2/show/study/NCT03215472.

Effects of the Dietary Approaches to Stop Hypertension (DASH) Eating Plan on the Metabolic Side Effects of Corticosteroid Medications

OBJECTIVE

We aimed to determine the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on the metabolic side effects of corticosteroid medication use.

DESIGN

A randomized clinical trial was undertaken in 60 patients on corticosteroid therapy for 10 weeks. Patients were randomly assigned to a DASH or control diet. Carbohydrate, protein, and fat in both groups were 50-60%, 15-20%, 30%, respectively. DASH diet was a diet rich in fruits, vegetables, whole grains, low-fat dairy products, and low in total and saturated fat and cholesterol, refined grains, and also sweets. Fasting blood samples were collected to determine blood glucose and lipid profile. Blood pressure and anthropometric measurements were measured based on the standard guidelines.

RESULTS

The mean age and body mass index (BMI) were 31.1 ± 3.6 year and 26.9 ± 2.6 kg/m(2), respectively. There were no significant differences between age and BMI in two groups at baseline. No significant difference was observed in body weight and waist circumference following the DASH diet compared to control diet. Systolic and diastolic blood pressures were significantly different following the DASH eating pattern (P = 0.04). Serum total cholesterol and fasting blood glucose significantly decreased in those following the DASH diet after adjustment for potential confounders.

CONCLUSION

The DASH diet had beneficial effects on several metabolic side effects among patients using corticosteroid medications.