Transcript Beyond Bones and Blood Pressure: Emerging Functional

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/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
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
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)
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•
•
•
•
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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
–[email protected]