Title: The DASH Diet in treating Hypertension & Type 2 Diabetes
1The 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
2Hypertension 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.
3Hypertension 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.
4Diabetes 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
5Diabetes HTN Disparities
- Remediable factors
- Worse access to high-quality healthcare
- Socioeconomic barriers to buying healthy food and
necessary medications - Lack of culturally appropriate care
6Dietary 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
7Hypertension 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
8Blood Pressure Categories - Adults
9Untreated Hypertension
- Target Organ Damage Includes
- Hypertensive heart disease
- Cerebrovascular disease
- Renal disease
- Large vessel disease
10Public 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
11National 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
12Mineral 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)
13Mineral 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
14Mineral 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
15DASH 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
16DASH 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
17DASH 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
18DASH Dietary Recommendations
- DASH meets multiple dietary recommendations
- NIH-NHLBI-ATP III
- AHA
- USDA/DHHS Dietary Guidelines
- NCI and AICR
- Surgeon General Recommendations
19Dietary 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
20Take 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
21Take Time for Some TLC (cont)
- Choose foods low in cholesterol
- Plant-based foods
- Grains
- Fruits
- Vegetables
- Dried beans
22Easily 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
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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