The DASH Diet in treating Hypertension Type 2

The DASH Diet in treating Hypertension & Type 2 Diabetes Kathleen T. Morgan Chair, Family & Community Health Sciences Special 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 <80 Normal <130 and <85 130 -139 or 85 -90 140 -159 or 160 -179 or >180 or 90 -99 100 -109 >110 High-Normal High Stage 1 Stage 2 Stage 3

Untreated Hypertension Target 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/m 2 • 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 diet JAMA, Oct 16, 2002

Mineral Intake and Hypertension Calcium • 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 Hypertension Potassium • 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 Hypertension Magnesium • 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 Pattern based on a 2, 000 calorie diet Food Group Grains Vegetables Fruits Low-fat or fat free dairy Meats, poultry, fish Nuts, seeds, dry beans and peas Fats and oils Sweets Servings* 7 -8 4 -5 2 -3 less than 2 4 -5/week 2 -3 5/ week

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

Dietary recommendations includes Therapeutic 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