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The DASH Diet in treating Hypertension & Type 2 Diabetes

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Title: The DASH Diet in treating Hypertension & Type 2 Diabetes


1
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

2
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.

3
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.

4
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

5
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

6
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

7
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

8
Blood Pressure Categories - Adults
9
Untreated Hypertension
  • Target Organ Damage Includes
  • Hypertensive heart disease
  • Cerebrovascular disease
  • Renal disease
  • Large vessel disease

10
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

11
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 diet
  • JAMA, Oct 16, 2002

12
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)

13
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

14
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

15
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

16
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, 102852, 2000

17
DASH Diet Patternbased on a 2,000 calorie diet
  • Food Group Servings
  • Grains 7-8
  • Vegetables 4-5
  • Fruits 4-5
  • Low-fat or fat free dairy 2-3
  • Meats, poultry, fish less than 2
  • Nuts, seeds, dry beans and peas 4-5/week
  • Fats and oils 2-3
  • Sweets 5/ week

18
DASH Dietary Recommendations
  • DASH meets multiple dietary recommendations
  • NIH-NHLBI-ATP III
  • AHA
  • USDA/DHHS Dietary Guidelines
  • NCI and AICR
  • Surgeon General Recommendations

19
Dietary recommendations includesTherapeutic
Lifestyle Changes (TLC)
  • Saturated fat ??7 of total calories
  • Cholesterol lt 200 mg/day
  • Weight reduction
  • Increased physical activity
  • Viscous (soluble) fiber 10-25 g/day
  • Plant stanols/sterols 2 g/day

20
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

21
Take Time for Some TLC (cont)
  • Choose foods low in cholesterol
  • Plant-based foods
  • Grains
  • Fruits
  • Vegetables
  • Dried beans

22
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

23
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24
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26
Rutgers Cooperative Extension Programs
  • Encourage participation in Rutgers Essex Countys
    Cooperative Extensions
  • Food Stamp Nutrition Education Program (FSNEP)
  • Expanded Food and Nutrition Education Program
    (EFNEP)
  • Thank you
  • Morgan_at_rce.rutgers.edu
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