Effects of the Dietary Approaches to Stop Hypertension (DASH) Eating Plan on Cardiovascular Risks Among Type 2 Diabetic Patients Effects of the Dietary Approaches to Stop Hypertension Diet Alone and in Combination With Exercise and Caloric Restriction on Insulin Sensitivity and Lipids A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance, inflammation, and oxidative stress in gestational diabetes. Determinants and consequences of adherence to the dietary approaches to stop hypertension diet in African-American and white adults with high blood pressure: results from the ENCORE trial. Dietary adherence in the Dietary Approaches to Stop Hypertension trial. DASH Collaborative Research Group. The influence of a physician and patient intervention program on dietary intake. The PREMIER intervention helps participants follow the Dietary Approaches to Stop Hypertension dietary pattern and the current Dietary Reference Intakes recommendations. Favourable effects of the Dietary Approaches to Stop Hypertension diet on glucose tolerance and lipid profiles in gestational diabetes: a randomised clinical trial. Comparison of associations of adherence to a Dietary Approaches to Stop Hypertension (DASH)-style diet with risks of cardiovascular disease and venous thromboembolism. Investigating the effect of DASH diet on blood pressure of patients with type 2 diabetes and prehypertension: Randomized clinical trial. The effect of home-delivered Dietary Approach to Stop Hypertension (DASH) meals on the diets of older adults with cardiovascular disease. Adherence to predefined dietary patterns and incident type 2 diabetes in European populations: EPIC-InterAct Study Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Dietary Patterns, Insulin Resistance, and Incidence of Type 2 Diabetes in the Whitehall II Study Effects of the Dietary Approaches to Stop Hypertension (DASH) Diet on the Pressure-Natriuresis Relationship DASH (Dietary Approaches to Stop Hypertension) Diet and Risk of Subsequent Kidney Disease. Development and evaluation of DASH diet tailored messages for hypertension treatment.
OBJECTIVE To determine the effects of the Dietary Approaches to Stop Hypertension ( DASH ) eating pattern on cardiometabolic risks in type 2 diabetic patients . RESEARCH DESIGN AND METHODS A r and omized crossover clinical trial was undertaken in 31 type 2 diabetic patients . For 8 weeks , participants were r and omly assigned to a control diet or the DASH eating pattern . RESULTS After following the DASH eating pattern , body weight ( P = 0.007 ) and waist circumference ( P = 0.002 ) reduced significantly . Fasting blood glucose levels and A1C decreased after adoption of the DASH diet ( −29.4 ± 6.3 mg/dl ; P = 0.04 and −1.7 ± 0.1 % ; P = 0.04 , respectively ) . After the DASH diet , the mean change for HDL cholesterol levels was higher ( 4.3 ± 0.9 mg/dl ; P = 0.001 ) and LDL cholesterol was reduced ( −17.2 ± 3.5 mg/dl ; P = 0.02 ) . Additionally , DASH had beneficial effects on systolic ( −13.6 ± 3.5 vs. −3.1 ± 2.7 mmHg ; P = 0.02 ) and diastolic blood pressure ( −9.5 ± 2.6 vs. −0.7 ± 3.3 mmHg ; P = 0.04 ) . CONCLUSIONS Among diabetic patients , the DASH diet had beneficial effects on cardiometabolic risks This study examined the effects of the Dietary Approaches to Stop Hypertension ( DASH ) diet on insulin sensitivity and lipids . In a r and omized control trial , 144 overweight ( body mass index : 25 to 40 ) men ( n=47 ) and women ( n=97 ) with high blood pressure ( 130 to 159/85 to 99 mm Hg ) were r and omly assigned to one of the following groups : ( 1 ) DASH diet alone ; ( 2 ) DASH diet with aerobic exercise and caloric restriction ; or ( 3 ) usual diet controls ( UC )  . Body composition , fitness , insulin sensitivity , and fasting lipids were measured before and after 4 months of treatment . Insulin sensitivity was estimated on the basis of glucose and insulin levels in the fasting state and after an oral glucose load . Participants in the DASH diet with aerobic exercise and caloric restriction condition lost weight ( −8.7 kg [ 95 % CI : −2.0 to −9.7 kg ] ) and exhibited a significant increase in aerobic capacity , whereas the DASH diet alone and UC participants maintained their weight ( −0.3 kg [ 95 % CI : −1.2 to 0.5 kg ] and + 0.9 kg [ 95 % CI : 0.0 to 1.7 kg ] , respectively ) and had no improvement in exercise capacity . DASH diet with aerobic exercise and caloric restriction demonstrated lower glucose levels after the oral glucose load , improved insulin sensitivity , and lower total cholesterol and triglycerides compared with both DASH diet alone and UC , as well as lower fasting glucose and low-density lipoprotein cholesterol compared with UC . DASH diet alone participants generally did not differ from UC in these measures . Combining the DASH diet with exercise and weight loss result ed in significant improvements in insulin sensitivity and lipids . Despite clinical ly significant reductions in blood pressure , the DASH diet alone , without caloric restriction or exercise , result ed in minimal improvements in insulin sensitivity or lipids OBJECTIVE To our knowledge , no reports are available indicating the effects of the dietary approaches to stop hypertension ( DASH ) eating plan on insulin resistance , inflammation , and oxidative stress among pregnant women with gestational diabetes mellitus ( GDM ) . This study was design ed to investigate the effects of the DASH diet on insulin resistance , serum high-sensitivity C-reactive protein ( hs-CRP ) and biomarkers of oxidative stress among pregnant women with GDM . METHODS This r and omized controlled clinical trial was performed with 32 pregnant women diagnosed with GDM at 24 to 28 wk gestation . Participants were r and omly assigned to consume either the control ( n = 16 ) or DASH diet ( n = 16 ) for 4 wk . The DASH diet was rich in fruits , vegetables , whole grains , and low-fat dairy products and was low in saturated fats , total fats , cholesterol , refined grains , and sweets , with a total of 2400 mg/d of sodium . The control diet contained 40 % to 55 % of its energy as carbohydrates , 10 % to 20 % as proteins , and 25 % to 30 % as total fats . Fasting blood sample s were taken at baseline and after 4 wk of intervention to measure fasting plasma glucose ( FPG ) , serum insulin , and hs-CRP , homeostasis model of assessment -insulin resistance ( HOMA-IR ) , plasma total antioxidant capacity ( TAC ) , and total glutathione levels ( GSH ) . RESULTS Consumption of the DASH diet compared with the control diet result ed in decreased FPG ( -7.62 versus 3.68 mg/dL ; P = 0.02 ) , serum insulin levels ( -2.62 versus 4.32 μIU/mL , P = 0.03 ) , and HOMA-IR score ( -0.8 versus 1.1 ; P = 0.03 ) . Increased concentrations of plasma TAC ( 45.2 versus -159.2 mmol/L ; P < 0.0001 ) and GSH ( 108.1 versus -150.9 μmol/L ; P < 0.0001 ) also were seen in the DASH group compared with control group . We failed to find a significant difference in mean changes of serum hs-CRP levels between the two diets . Within-group comparisons revealed significant reductions in plasma TAC and GSH levels in the control diet , while a significant increase in these biomarkers in the DASH diet . CONCLUSION Consumption of the DASH diet in pregnant women with GDM had beneficial effects on FPG , serum insulin levels , HOMA-IR score , plasma TAC , and total GSH levels . The effects of this dietary pattern on pregnancy outcomes need to be investigated in future studies BACKGROUND Although the Dietary Approaches to Stop Hypertension ( DASH ) diet is an accepted nonpharmacologic treatment for hypertension , little is known about what patient characteristics affect dietary adherence and what level of adherence is needed to reduce blood pressure ( BP ) . OBJECTIVE Our aim was to determine what factors predict dietary adherence and the extent to which dietary adherence is necessary to produce clinical ly meaningful BP reductions . DESIGN Ancillary study of the ENCORE ( Exercise and Nutrition Interventions for Cardiovascular Health ) trial -- a 16-week r and omized clinical trial of diet and exercise . PARTICIPANTS / SETTING Participants included 144 sedentary , overweight , or obese adults ( body mass index 25 to 39.9 ) with high BP ( systolic 130 to 159 mm Hg and /or diastolic 85 to 99 mm Hg ) . INTERVENTION Patients were r and omized to one of three groups : DASH diet alone , DASH diet plus weight management , and Usual Diet Controls . MAIN OUTCOMES MEASURES Our primary outcomes were a composite index of adherence to the DASH diet and clinic BP . STATISTICAL ANALYSES PERFORMED General linear models were used to compare treatment groups on post-treatment adherence to the DASH diet . Linear regression was used to examine potential predictors of post-treatment DASH adherence . Analysis of covariance was used to examine the relation of adherence to the DASH diet and BP . RESULTS Participants in the DASH diet plus weight management ( 16.1 systolic BP [ SBP ] ; 95 % CI 13.0 to 19.2 mm Hg and 9.9 diastolic BP [ DBP ] ; 95 % CI 8.1 to 11.6 mm Hg ) and DASH diet alone ( 11.2 SBP ; 95 % CI 8.1 to 14.3 mm Hg and 7.5 DBP ; 95 % CI 5.8 to 9.3 mm Hg ) groups showed significant reductions in BP in comparison with Usual Diet Controls participants ( 3.4 SBP ; 95 % CI 0.4 to 6.4 mm Hg and DBP 3.8 ; 95 % CI 2.2 to 5.5 mm Hg ) . Greater post-treatment consumption of DASH foods was noted in both the DASH diet alone ( mean = 6.20 ; 95 % CI 5.83 to 6.57 ) and DASH diet plus weight management groups ( mean = 6.23 ; 95 % CI 5.88 to 6.59 ) compared with Usual Diet Controls ( mean = 3.66 ; 95 % CI 3.30 to 4.01 ; P<0.0001 ) , and greater adherence to the DASH diet was associated with larger reductions in clinic SBP and DBP ( P ≤ 0.01 ) . Only ethnicity predicted dietary adherence , with African Americans less adherent to the DASH diet compared with whites ( 4.68 ; 95 % CI 4.34 to 5.03 vs 5.83 ; 95 % CI 5.50 to 6.11 ; P<0.001 ) . CONCLUSIONS Greater adherence to the DASH diet was associated with larger BP reductions independent of weight loss . African Americans were less likely to be adherent to the DASH dietary eating plan compared with whites , suggesting that culturally sensitive dietary strategies might be needed to improve adherence to the DASH diet Participants in controlled feeding studies must consume all study foods and abstain from all other foods . In outpatient studies in which adherence may be compromised by free-living conditions , promoting , documenting , and monitoring dietary adherence are necessary . In the Dietary Approaches to Stop Hypertension ( DASH ) trial , a thorough participant screening process , an orientation session , and a run-in feeding period before r and omization aided in the selection of participants who would most likely adhere to the dem and s of the study protocol . Throughout the feeding period , various educational and motivational techniques were used to encourage DASH participants to adhere to the dietary protocol . Both objective and subjective methods documented excellent participant adherence . Daily monitoring of individual adherence was based on meal attendance , body weight measurements , and daily diaries . Urinary sodium , potassium , phosphorus , and urea nitrogen values and an anonymous post study survey were used to evaluate adherence at the end of the study . Most DASH participants adhered to the feeding regimen by consuming only study foods and no other foods . When adherence lapsed , participants generally cited the lack of menu variety as a reason . Successful participant adherence to the constraints of an outpatient controlled feeding study is possible with carefully selected participants and a variety of adherence-promoting strategies incorporated into the study protocol BACKGROUND Efficient dietary interventions for patients with hypertension in clinical setting s are needed . OBJECTIVE To assess the separate and combined influence of a physician intervention ( MD-I ) and a patient intervention ( PT-I ) on dietary intakes of patients with hypertension . DESIGN A nested 2 × 2 design , r and omized controlled trial conducted over 18 months . PARTICIPANTS A total of 32 physicians and 574 out patients with hypertension . INTERVENTION MD-I included training modules addressing the Seventh Report of the Joint National Committee on Prevention , Detection , Evaluation , and Treatment of High Blood Pressure hypertension management guidelines and lifestyle modification . PT-I included lifestyle coaching to adopt the Dietary Approaches to Stop Hypertension ( DASH ) eating pattern , reduce sodium intake , manage weight , increase exercise , and moderate alcohol intake . MAIN OUTCOME MEASURES Dietary intakes were measured by the Block Food Frequency Question naire . Concordance with the DASH dietary pattern was estimated by a DASH score . STATISTICAL ANALYSES The main effects of MD-I and PT-I , and their interaction , were evaluated using analysis of covariance . RESULTS After 6 months of intervention , MD-I participants significantly increased intakes of potassium , fruits , juices , and carbohydrate ; decreased intake of fat ; and improved overall dietary quality as measured by the Healthy Eating Index . PT-I intervention result ed in increased intakes of carbohydrate , protein , fiber , calcium , potassium , fruits and fruit juices , vegetables , dairy and Healthy Eating Index score , and decreased intakes in fat , saturated fat , cholesterol , sodium , sweets , and added fats/oils/sweets . In addition , PT-I improved overall DASH concordance score . The change in DASH score was significantly associated with the changes in blood pressure and weight at 6 months . At 18 months , most changes reversed back toward baseline levels , including the DASH score . CONCLUSIONS Both MD-I and PT-I  improved eating patterns at 6 months with some sustained effects at 18 months . Even though all dietary changes observed were consistent with the DASH nutrient targets or food group guidelines , only the PT-I intervention was effective in improving the overall DASH concordance score . This finding affirms the role of medical nutrition therapy in long-term intensive interventions for hypertension risk reduction and weight management and underlines the need for development of maintenance strategies . Furthermore , this study emphasizes the importance of collaborations among physicians , registered dietitians and other dietetics practitioners , and lay health advisors while assisting patients to make healthy behavior changes OBJECTIVE To examine the influence of the PREMIER study lifestyle interventions on dietary intakes and adherence to the Dietary Approaches to Stop Hypertension ( DASH ) dietary pattern and the Dietary Reference Intakes ( DRI ) . DESIGN An 18-month multicenter , r and omized controlled trial comparing two multicomponent lifestyle intervention programs to an advice only control group . SUBJECTS/ SETTING A total of 810 participants were recruited from local communities and r and omized into the study . Individuals were eligible if they were aged 25 years or older , had body mass index between 18.5 and 45.0 , not taking antihypertensive medication , and had prehypertension or stage 1 hypertension ( systolic blood pressure 120 to 159 mm Hg and diastolic blood pressure 80 to 95 mm Hg ) . INTERVENTION The two active intervention programs were a behavioral lifestyle intervention that implements established recommendations , and an established intervention plus the DASH dietary pattern . Both interventions consisted of intensive group and individual counseling sessions . The control group received a brief advice session after r and omization and again after 6 months of data collection . Dietary intakes were collected by two r and om 24-hour recalls at baseline , 6 months , and 18 months . MAIN OUTCOME MEASURES The primary outcome of the PREMIER study was change in systolic blood pressure at 6 months . The main outcomes examined here include dietary variables collected by 24-hour recall at each time point . STATISTICAL ANALYSES Nutrient intakes were calculated and compared among the time points and the three intervention groups using mixed models with repeated measures at 6 and 18 months . Proportion of participants who met or achieved the original DASH nutrient intake levels and the DRIs were calculated and compared among the three intervention groups . P<0.01 was considered statistically significant . RESULTS Participants in both the established intervention and established intervention plus DASH dietary pattern groups substantially reduced energy , total fat , saturated fat , and sodium intake and these reductions persisted throughout the study . Established intervention plus DASH dietary pattern group participants increased intakes of fruits , vegetables , dairy , and many vitamins and minerals ; these increases were significantly greater than that of the control and established intervention groups . A majority of established intervention plus DASH dietary pattern group participants achieved at least two thirds of the DRI recommendations for most nutrients at 6 months , despite their reduction in total energy intake . Some but relatively small recidivism occurred at 18 months . CONCLUSIONS Both the established intervention and established intervention plus DASH dietary pattern group intervention were effective in helping participants follow established recommendations to control blood pressure . The advice-only control group also made some behavior changes , mainly decreasing energy and sodium intake . Only the established intervention plus DASH dietary pattern group significantly increased intakes of DASH-specific food groups , including fruits , vegetables , and dairy products , and nutrients , including protein , fiber , calcium , potassium , and magnesium . Most of the increases did not reach the levels consumed in the original DASH feeding studies . Whereas the established intervention plus DASH dietary pattern group intervention provides a useful platform to achieve the DASH dietary pattern and current DRI recommendations , intervention enhancements , including a greater emphasis on nutrient-dense foods , would likely improve this intervention Although gestational diabetes mellitus ( GDM ) is associated with an increased risk of maternal and neonatal morbidity , there is no consensus as to the optimal approach of nutritional management in these patients . The present study was design ed to assess the effect of the Dietary Approaches to Stop Hypertension ( DASH ) eating plan on glucose tolerance and lipid profiles of pregnant women with GDM . The present r and omised controlled clinical trial was performed among thirty-four women diagnosed with GDM at 24 - 28 weeks of gestation . Subjects were r and omly assigned to consume either the control diet ( n 17 ) or the DASH eating pattern ( n 17 ) for 4 weeks . The control diet was design ed to contain 45 - 55 % carbohydrates , 15 - 20 % protein and 25 - 30 % total fat . The macronutrient composition of the DASH diet was similar to the control diet ; however , the DASH diet was rich in fruits , vegetables , whole grains and low-fat dairy products , and contained lower amounts of saturated fats , cholesterol and refined grains with a total of 2400 mg Na/d . Fasting blood sample s were taken at baseline and after 4 weeks of intervention to measure fasting plasma glucose , glycated Hb ( HbA1c ) and lipid profiles . Participants underwent a 3 h oral glucose tolerance tests and blood sample s were collected at 60 , 120 and 180 min to measure plasma glucose levels . Adherence to the DASH eating pattern , compared with the control diet , result ed in improved glucose tolerance such that plasma glucose levels reduced at 60 ( 21·86 v. 20·45 mmol/l , Pgroup = 0·02 ) , 120 ( 22·3 v. 0·2 mmol/l , Pgroup = 0·001 ) and 180 min ( 21·7 v. 0·22 mmol/l , Pgroup = 0·002 ) after the glucose load . Decreased HbA1c levels ( 20·2 v. 0·05 % , Pgroup = 0·001 ) was also seen in the DASH group compared with the control group . Mean changes for serum total ( 20·42 v. 0·31 mmol/l , Pgroup = 0·01 ) and LDL-cholesterol ( 20·47 v. 0·22 mmol/l , Pgroup = 0·005 ) , TAG ( 20·17 v. 0·34 mmol/l , Pgroup = 0·01 ) and total : HDL-cholesterol ratio ( 20·6 ( SD 0·9 ) v. 0·3 ( SD 0·8 ) , Pgroup = 0·008 ) were significantly different between the two diets . Additionally , consumption of the DASH diet favourably influenced systolic blood pressure ( 22·6 v. 1·7 mmHg , Pgroup = 0·001 ) . Mean changes of fasting plasma glucose ( 20·29 v. 0·15 mmol/l , Pgroup = 0·09 ) were nonsignificant comparing the DASH diet with the control diet . In conclusion , consumption of the DASH eating pattern for 4 weeks among pregnant women with GDM result ed in beneficial effects on glucose tolerance and lipid profiles compared with the control diet BACKGROUND Venous thromboembolism ( VTE ) and cardiovascular disease ( CVD ) share some risk factors , including obesity , but it is unclear how dietary patterns associated with reduced risk of CVD relate to risk of VTE . OBJECTIVE To compare the relationships of adherence to a Dietary Approaches to Stop Hypertension (DASH)-style diet with the risks of CVD and VTE . PATIENTS / METHODS We confirmed by medical record review 1094 incident cases of CVD and 675 incident VTEs during a mean follow-up of 14.6 years in 34 827 initially healthy participants in the Women 's Health Study who completed at baseline a 133-item food frequency question naire scored for adherence to a DASH diet .  We compared estimated associations of dietary patterns with CVD and VTE from proportional hazards models in a competing risk framework . RESULTS Initial analyses adjusted for age , energy intake and r and omized treatments showed 36 - 41 % reduced hazards of CVD among women in the top two quintiles of DASH score relative to those in the bottom quintile ( P(trend ) < 0.001 ) . In multivariate analysis , women in the top two quintiles had 12 - 23 % reduced hazards of CVD relative to women in the bottom quintile ( P(trend ) = 0.04 ) . Analyses restricted to coronary events showed more variable 10 - 33 % reduced hazards in the top two quintiles ( P(trend ) = 0.09 ) . In contrast , higher DASH scores were unrelated to risk of VTE , with a 1 % reduced hazard for the top vs. bottom quintile ( P(trend ) = 0.95 ) . CONCLUSION An apparently strong association of adherence to the DASH diet with incidence of CVD was attenuated upon control for confounding variables . Adherence to the DASH diet was not associated with risk of VTE in women BACKGROUND AND OBJECTIVES Prehypertension in people with type 2 diabetes is associated with increased risk of cardiovascular disease and lower extremity damages compared to people with normal blood pressure . On the other h and , limited studies have conducted to investigate the effect of DASH diet on blood pressure and prehypertension in patients with type 2 diabetes . Therefore , in this study , we aim ed to evaluate the effect of DASH diet on blood pressure and prehypertension in patients with type 2 diabetes . MATERIAL S AND METHODS In this clinical trial , 80 patients with diabetes type 2 and prehypertension in the age range of 18 - 65 years were r and omly allocated to intervention ( n = 40 ) and control ( n = 40 ) groups for 12 weeks . The intervention group had DASH diet and the control group received diabetic diet in accordance with the recommendations of the American Diabetes Association ( ADA ) with 24-h dietary recall ; systolic and diastolic blood pressures were measured before and after study . RESULTS Taking DASH diet and diabetic diet for 12 weeks caused significant reduction in systolic blood pressure in the intervention group ( P value = 0.003 ) . Diastolic blood pressure showed no significant change in none of the two groups . CONCLUSION Following the DASH diet in patients with prehypertension has beneficial effects in improving systolic blood pressure and can be effective to prevent the development of hypertension . Hence , there are needs for long-term interventions with larger sample size in future studies BACKGROUND Many older adults with hyperlipidemia or hypertension participate in the Older Americans Act Nutrition Program , which serves meals in community setting s and delivers meals to homes . However , there is little information regarding whether therapeutic meals design ed around Dietary Approach to Stop Hypertension ( DASH ) principles have a beneficial effect on the diets of these older adults . OBJECTIVE The objective of this study was to determine the degree to which dietary change is influenced by providing 7 home-delivered therapeutic meals weekly to adults aged > or = 60 y. DESIGN We conducted a 1-y r and omized controlled trial in 298 persons with hyperlipidemia or hypertension , in which 50 % of participants received 7 therapeutic meals per week for 12 mo . Those in need of dietary change at baseline ( n = 210 ) were examined . Changes in intermediate DASH accordance , DASH accordance , and the nutrients that make up the DASH diet were measured by using 24-h food recalls at baseline , 6 mo , and 12 mo . Chi-square tests , t tests , and multiple regression were used to examine the association between receipt of meals and dietary change over time . RESULTS Participants who received meals were 20 % ( P = 0.001 ) more likely to reach intermediate DASH accordance at 6 mo and were 18 % ( P = 0.007 ) more likely to meet saturated fat accordance at 12 mo than were those who did not receive meals . When stratified by race and income , gains were marginally larger for whites and higher-income individuals . CONCLUSION Delivery of 7 DASH meals per week was found to increase compliance with dietary recommendations among noncompliant older adults with cardiovascular disease Few studies have investigated the relationship between predefined dietary patterns and  type 2 diabetes incidence ; little is known about the generalisability of these associations . We aim ed to assess the association between predefined dietary patterns and  type 2 diabetes risk in European population s. From among a case-cohort of 12,403 incident diabetes cases and 16,154 subcohort members nested within the prospect i ve European Prospect i ve Investigation into Cancer and Nutrition study , we used data on 9,682 cases and 12,595 subcohort participants from seven countries .  Habitual dietary intake  was assessed at baseline with country-specific dietary question naires . Two  diet- quality scores ( alternative Healthy Eating Index [ aHEI ]  ,  Dietary Approaches to Stop Hypertension [ DASH ] score )  and three  reduced rank regression (RRR)-derived dietary-pattern scores were constructed . Country-specific HRs were calculated and combined using a r and om-effects meta- analysis . After multivariable adjustment , including body size , the aHEI and DASH scores were not significantly associated with diabetes , although for the aHEI there was a tendency towards an inverse association in countries with higher mean age . We observed inverse associations of the three RRR-derived dietary-pattern scores with diabetes : HRs ( 95 % CIs ) for a 1-SD difference were 0.91 ( 0.86 , 0.96 ) , 0.92 ( 0.84 , 1.01 ) and 0.87 ( 0.82 , 0.92 ) . R and om-effects meta-analyses revealed heterogeneity between countries that was explainable by differences in the age of participants or the distribution of dietary intake . Adherence to specific RRR-derived dietary patterns , commonly characterised by high intake of fruits or vegetables and low intake of processed meat , sugar-sweetened beverages and refined grains , may lower type 2 diabetes risk BACKGROUND Although the DASH ( Dietary Approaches to Stop Hypertension ) diet has been shown to lower blood pressure ( BP ) in short-term feeding studies , it has not been shown to lower BP among free-living individuals , nor has it been shown to alter cardiovascular biomarkers of risk . OBJECTIVE To compare the DASH diet alone or combined with a weight management program with usual diet controls among participants with prehypertension or stage 1 hypertension ( systolic BP , 130 - 159 mm Hg ; or diastolic BP , 85 - 99 mm Hg ) . DESIGN AND SETTING R and omized , controlled trial in a tertiary care medical center with assessment s at baseline and 4 months . Enrollment began October 29 , 2003 , and ended July 28 , 2008 . PARTICIPANTS Overweight or obese , unmedicated out patients with high BP ( N = 144 ) . INTERVENTIONS Usual diet controls , DASH diet alone , and DASH diet plus weight management . OUTCOME MEASURES The main outcome measure is BP measured in the clinic and by ambulatory BP monitoring . Secondary outcomes included pulse wave velocity , flow-mediated dilation of the brachial artery , baroreflex sensitivity , and left ventricular mass . RESULTS Clinic-measured BP was reduced by 16.1/9.9 mm Hg ( DASH plus weight management ) ; 11.2/7.5 mm ( DASH alone ) ; and 3.4/3.8 mm ( usual diet controls ) ( P < .001 ) . A similar pattern was observed for ambulatory BP ( P < .05 ) . Greater improvement was noted for DASH plus weight management compared with DASH alone for pulse wave velocity , baroreflex sensitivity , and left ventricular mass ( all P < .05 ) . CONCLUSION For overweight or obese persons with above-normal BP , the addition of exercise and weight loss to the DASH diet result ed in even larger BP reductions , greater improvements in vascular and autonomic function , and reduced left ventricular mass . CLINICAL TRIAL REGISTRATION clinical trials.gov Identifier : NCT00571844 OBJECTIVE —The aim of this study was to identify a dietary pattern associated with insulin resistance and investigate whether this pattern was prospect ively associated with type 2 diabetes . RESEARCH DESIGN AND METHODS — Analysis was based on 7,339 participants of the Whitehall II study .  Dietary intake  was measured using a 127-item food frequency question naire . We used the reduced rank regression method to determine dietary patterns using the homeostasis model assessment of insulin resistance as the intermediate or response variable . The association between the dietary pattern identified and incidence of type 2 diabetes was investigated using Cox proportional hazard regression models . RESULTS —We identified a dietary pattern characterized by high consumption of low-calorie/diet soft drinks , onions , sugar-sweetened beverages , burgers and sausages , crisps and other snacks , and white bread and low consumption of medium-/high-fiber breakfast cereals , jam , French dressing/vinaigrette , and wholemeal bread . Higher dietary pattern scores were associated with increased risk of type 2 diabetes ( hazard ratio for top quartile 2.95 [ 95 % CI 2.19–3.97 ] ; adjusted for age , sex , and energy misreporting ) . This relationship was attenuated after adjustment for ethnicity , employment grade , health behaviors ( smoking , alcohol use , and physical activity ) but remained significant after further adjustment for blood pressure and BMI ( 1.51 [ 1.10–2.09 ] ) . CONCLUSIONS —A dietary pattern associated with insulin resistance predicts type 2 diabetes risk after adjustment for a range of confounders . This study adds to the evidence that dietary patterns are an important risk factor for type 2 diabetes Abstract —Blood pressure-lowering mechanisms of the Dietary Approaches to Stop Hypertension ( DASH ) diet , rich in fruits , vegetables , and low-fat dairy foods , were analyzed based on the pressure-natriuresis relationship . Participants ( n=375 ) were r and omly assigned to control or DASH diet groups by using a parallel-group design . They then ate their assigned diet for 3 consecutive 30-day intervention feeding periods , during which sodium intake varied among 3 levels by a r and omly assigned sequence . Urinary sodium excretion rate and mean arterial pressure were measured at the end of each sodium intake level . Mean arterial pressure and urinary sodium excretion were plotted on x and y axes , respectively , for participants eating control and DASH diets and were modeled as linear relationships for simplicity to allow the estimation of the extrapolated x-intercept and slope of the relationships . The DASH diet steepened the slope of the relationship ( 29.5±3.4 vs 64.9±13.1 [mmol/d]/mm Hg , P = 0.0002 ) without significantly shifting the x-intercept ( 94.1±0.5 vs 93.2±0.6 mm Hg , NS ) of the relationship . These data suggest a natriuretic action of the DASH diet BACKGROUND There are established guidelines for recommended dietary intake for hypertension treatment and cardiovascular disease prevention . Evidence is lacking for effective dietary patterns for kidney disease prevention . STUDY DESIGN Prospect i ve cohort study . SETTING & PARTICIPANTS Atherosclerosis Risk in Communities ( ARIC ) Study participants with baseline estimated glomerular filtration rate ( eGFR ) ≥ 60mL/min/1.73m2 ( N=14,882 ) . PREDICTOR The Dietary Approaches to Stop Hypertension ( DASH ) diet score was calculated based on self-reported dietary intake of red and processed meat , sweetened beverages , sodium , fruits , vegetables , whole grains , nuts and legumes , and low-fat dairy products , averaged over 2 visits . OUTCOMES Cases were ascertained based on the development of eGFRs<60mL/min/1.73m2 accompanied by ≥25 % eGFR decline from baseline , an  International Classification of Diseases , Ninth/Tenth Revision code for a kidney disease-related hospitalization or death , or end-stage renal disease from baseline through 2012 . RESULTS 3,720 participants developed kidney disease  during a median follow-up of 23 years . Participants with a DASH diet score in the lowest tertile were 16 % more likely to develop kidney disease than those with the highest score tertile ( HR , 1.16 ; 95 % CI , 1.07 - 1.26 ; P for trend < 0.001 ) , after adjusting for sociodemographics , smoking status , physical activity , total caloric intake , baseline eGFR , overweight/obese status , diabetes status , hypertension status , systolic blood pressure , and antihypertensive medication use . Of the individual components of the DASH diet score , high red and processed meat intake was adversely associated with kidney disease and high nuts , legumes , and low-fat dairy products intake was associated with reduced risk for kidney disease . LIMITATIONS Potential measurement error due to self-reported dietary intake and lack of data for albuminuria . CONCLUSIONS Consuming a DASH-style diet was associated with lower risk for kidney disease independent of demographic characteristics , established kidney risk factors , and baseline kidney function . Healthful dietary patterns such as the DASH diet may be beneficial for kidney disease prevention For this study , the Manage Associated Perceptions ( MAP ) of Dietary Behavior Study , research ers developed , evaluated , and tested messages tailored to improve compliance with the Dietary Approaches to Stop Hypertension ( DASH ) diet by gradually instilling healthy Cognitive Representations of the DASH Diet ( CRDDs ) . The sample consisted of women from diverse background s ( N = 53 ) , r and omly assigned to two experimental groups ( n = 13 and n = 14 ) and to two control groups ( n = 12 and n = 14 ) . The experimental groups performed a version of the intervention for 30 days . Data about dietary compliance and CRDDs were collected at 30 , 60 , and 90 days . Compared to control group members , experimental group members demonstrated greater improvements in CRDD scores and were significantly more compliant with the diet . Another significant finding was that older women were more compliant
The DASH dietary pattern may lead to an improvement in insulin sensitivity independent of weight loss .
The DASH diet may play an important role in glycemic control in long- term interventions .
OBJECTIVE Type 2 diabetes is a major public health problem .
The Dietary Approaches to Stop Hypertension ( DASH ) eating pattern may contribute to managing risk factors of type 2 diabetes .
The objective of this study was to conduct a systematic review and meta- analysis on r and omized controlled trials ( RCTs ) that examine the effects of DASH diet consumption on the indices of glycemic control such as fasting blood glucose ( FBG ) , serum fasting insulin level , and Homeostatic Model Assessment insulin resistance ( HOMA-IR ) .