The DASH Diet in treating Hypertension & Type 2

Diabetes

Kathleen T. MorganChair, Family & Community

Health SciencesSpecial Thanks to Colorado State Univ and Western Dairy Council

Hypertension & Type 2 Diabetes• 72 million people in the US age 20 and older have high

blood pressure• 20.8 million – 7 % of the US population have diabetes• 13.3 % of all non-Hispanic blacks aged 20 and older have

diabetes• After adjusting for population age differences, Mexican

Americans, the largest Hispanic/Latino subgroup, are 1.7 times as likely to have diabetes as non-Hispanic whites.

Hypertension & Type 2 Diabetes• The prevalence of hypertension is about twice as high

among patients diagnosed with type 2 diabetes as it is among patients without diabetes

• The current obesity epidemic contributes to hypertension and type 2 diabetes

• Losing as little as 10 pounds can contribute to reducing hypertension and improving glucose sensitivity.

Diabetes & HTN & Disparities• African American men develop diabetes and high

blood pressure earlier in life than other men and are more likely to suffer serious side-effects from these diseases

• Within the African-American community, those with the highest rates of hypertension, are likely to be middle aged or older, less educated, overweight or obese, physically inactive and to have diabetes

Diabetes & HTN & Disparities• Remediable factors:

– Worse access to high-quality healthcare– Socioeconomic barriers to buying healthy food and

necessary medications– Lack of culturally appropriate care

Dietary Approaches to High Blood Pressure

• DASH Diet– Dietary Approaches to Stop Hypertension– Promotes fruits, vegetables, whole grains and low fat

dairy products– Adequate Calcium, Potassium, Magnesium– Low in red meat, sweets and sugar beverages

Hypertension Prevalence• 50 million hypertensive US adults • One-third of people are unaware• Less than half of American adults have optimal blood

pressure• Increases in prevalence and severity in African

Americans

Blood Pressure Categories - Adults

Systolic (mm Hg) Diastolic (mm Hg)

Optimal <120 and <80Normal <130 and <85High-Normal 130-139 or 85-90High

Stage 1Stage 2Stage 3

140-159 or160-179 or

>180 or

90-99100-109

>110

Untreated HypertensionTarget Organ Damage Includes:• Hypertensive heart disease• Cerebrovascular disease• Renal disease• Large vessel disease

Public Health Challenge of Hypertension• Prevent BP rise with age• Decrease existing prevalence

– Healthy People 2010 goal – 16%• Increase awareness and detection

– Has no symptoms, called the “silent killer”• Improve control• Reduce cardiovascular risks• Increase recognition of importance of controlling systolic

hypertension

National High Blood Pressure Education Program

Updated Recommendations to Prevent Hypertension• Maintain normal body weight for adults

– BMI 18.5-24.9 kg/m2• Reduce sodium intake to no more than 100 mmol/day• Regular physical activity – at least 30 minutes most days of the

week• Limit alcohol consumption• Maintain adequate potassium intake• Consume a diet rich in fruits, vegetables and low-fat dairy

products• Reduce saturated fat and total fat in dietJAMA, Oct 16, 2002

Mineral Intake and HypertensionCalcium• American Heart Association Statement

– Increasing calcium intake may preferentially lower blood pressure in salt-sensitive people

– Benefits more evident with low initial calcium intakes (300-600 mg/day)

Mineral Intake and HypertensionPotassium• Clinical trials and meta-analyses indicate potassium

(K) supplementation lowers BP• Adequate K intake, preferably from food sources,

should be maintained• Evidence is strong enough to support a health claim

on high potassium foods

Mineral Intake and HypertensionMagnesium• Evidence suggests an association between lower

dietary magnesium intake and high blood pressure• Not enough evidence exists to justify a

recommendation of increased Mg intake

DASH is Unique• Tested dietary patterns rather than single nutrients• Experimental diets used common foods that can be

incorporated into recommendations for the public• Investigators planned the DASH diet to be fully

compatible with dietary recommendations for reducing risk of CVD, osteoporosis and cancer

DASH Reduces Homocysteine Levels• Effect a result of diet high in vitamin B-rich milk and

milk products, fruits and vegetables

• Lowering homocysteine with DASH may reduce CVD risk an additional 7%-9%

-Appel, et al. Circulation, 102:852, 2000

DASH Diet Patternbased on a 2,000 calorie diet

Food Group Servings*Grains 7-8Vegetables 4-5Fruits 4-5Low-fat or fat free dairy 2-3Meats, poultry, fish less than 2Nuts, seeds, dry beans and peas 4-5/weekFats and oils 2-3Sweets 5/ week

DASH: Dietary RecommendationsDASH meets multiple dietary recommendations• NIH-NHLBI-ATP III• AHA• USDA/DHHS Dietary Guidelines• NCI and AICR• Surgeon General Recommendations

Dietary recommendations includesTherapeutic Lifestyle Changes (TLC)

• Saturated fat: 7% of total calories• Cholesterol: < 200 mg/day• Weight reduction• Increased physical activity • Viscous (soluble) fiber: 10-25 g/day• Plant stanols/sterols: 2 g/day

Take Time for Some TLC

• Choose foods low in saturated fat– Whole grains– Fruits– Vegetables– Fat free or 1% dairy products– Lean meats, fish, skinless poultry– Dried peas/beans

Take Time for Some TLC (cont)

• Choose foods low in cholesterol– Plant-based foods

• Grains• Fruits• Vegetables• Dried beans

Easily implemented suggestions:

• Make connections between dietary practices and health concerns very concrete, address options for reducing sodium

• De-emphasize the “low-income” designation of the audience for whom the program is intended

• Encourage participants to attend classes in “teams” to support each other

• Emphasize food demonstrations• Encourage participants to visit supermarkets, read labels

or conduct an informal survey of friends or family

Rutgers Cooperative Extension Programs• Encourage participation in Rutgers Essex County’s

Cooperative Extension’s:– Food Stamp Nutrition Education Program (FSNEP)– Expanded Food and Nutrition Education Program

(EFNEP)

–Thank you–Morgan@rce.rutgers.edu