A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure

Appel, Lawrence J.; Moore, Thomas B.; Obarzanek, Eva; Vollmer, William M.; Svetkey, Laura P.; Sacks, Frank M.; Bray, George A.; Vogt, Thomas; Cutler, Jeffrey A.; Windhauser, Marlene M.; Lin, Pao‐Hwa; Karanja, Njeri; Simons‐Morton, Denise G.; McCullough, Marjorie L.; Swain, JaBaris D.; Steele, P.; Evans, Marguerite; Miller, Edgar R.; Harsha, David W.

doi:10.1056/nejm199704173361601

Cited by 5,070 publications

(3,458 citation statements)

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“…This highlights the potential role of probiotic fermented milk in the control and treatment of hypertension. The Dietary Approaches to Stop Hypertension trial demonstrated that a dietary pattern abundant in fruits, vegetables and low-fat dairy products can considerably reduce BP (25) . Data from Study Net change 95% CI Weight (%) Hata (1996) (6) Agerholm-Larsen (2000) (7) Kawase (2000) (8) Inoue (2003) (9) Seppo (2003) (10) Mizushima (2004) (11) Tuomilehto (2004) (12) Aihara (2005) (normotensive) (13) Aihara (2005) (hypertensive) (13) Jauhiainen (2005) (14) Engberink (2008) (15) van der Zander (2008) (16) Jauhiainen (2010) (17) Usinger ( Study Net change 95% CI Weight (%) Hata (1996) (6) Agerholm-Larsen (2000) (7) Inoue (2003) (9) Seppo (2003) (10) Mizushima (2004) (11) Tuomilehto (2004) (12) Aihara (2005) (normotensive) (13) Aihara (2005) (hypertensive) (13) Jauhiainen (2005) (14) Jauhiainen (2010) (17) Usinger (2010 Fig .…”

Section: Discussionmentioning

confidence: 99%

Effect of probiotic fermented milk on blood pressure: a meta-analysis of randomised controlled trials

et al. 2013

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Previous studies have suggested that probiotic fermented milk may possess blood pressure (BP)-lowering properties. In the present study, we aimed to systematically examine the effect of probiotic fermented milk on BP by conducting a meta-analysis of randomised controlled trials. PubMed, Cochrane library and the ClinicalTrials.gov databases were searched up to March 2012 to identify eligible studies. The reference lists of the obtained articles were also reviewed. Either a fixed-effects or a random-effects model was used to calculate the combined treatment effect. Meta-analysis of fourteen randomised placebo-controlled trials involving 702 participants showed that probiotic fermented milk, compared with placebo, produced a significant reduction of 3·10 mmHg (95 % CI 24·64, 2 1·56) in systolic BP and 1·09 mmHg (95 % CI 22·11, 2 0·06) in diastolic BP. Subgroup analyses suggested a slightly greater effect on systolic BP in hypertensive participants than in normotensive ones (23·98 v. 2 2·09 mmHg). Analysis of trials conducted in Japan showed a greater reduction than those conducted in European countries for both systolic BP (26·12 v. 2 2·08 mmHg) and diastolic BP (23·45 v. 20·52 mmHg). Some evidence of publication bias was present, but sensitivity analysis excluding small trials that reported extreme results only affected the pooled effect size minimally. In summary, the present meta-analysis suggested that probiotic fermented milk has BP-lowering effects in pre-hypertensive and hypertensive subjects.

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Section: Discussionmentioning

confidence: 99%

Effect of probiotic fermented milk on blood pressure: a meta-analysis of randomised controlled trials

et al. 2013

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“…In Western diets meats, cheeses and cereal grains yield high potential renal acid loads (Remer & Manz, 1995) and hence may promote osteoporosis by producing a net metabolic acidosis (Barzel, 1995). In contrast, fruit and vegetables yield a net alkaline renal load (Remer & Manz, 1995), and high fruit and vegetable diets have been shown to improve urinary calcium excretion rates (Appel et al, 1997). Consequently, in hunter-gatherer populations consuming high protein diets, a concomitant consumption of high levels of fruit and vegetables may have countered the calciuretic effects of a high-protein diet.…”

Section: Dietary Proteinmentioning

confidence: 99%

The paradoxical nature of hunter-gatherer diets: meat-based, yet non-atherogenic

et al. 2002

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Objective: Field studies of twentieth century hunter-gathers (HG) showed them to be generally free of the signs and symptoms of cardiovascular disease (CVD). Consequently, the characterization of HG diets may have important implications in designing therapeutic diets that reduce the risk for CVD in Westernized societies. Based upon limited ethnographic data (n ¼ 58 HG societies) and a single quantitative dietary study, it has been commonly inferred that gathered plant foods provided the dominant energy source in HG diets. Method and Results: In this review we have analyzed the 13 known quantitative dietary studies of HG and demonstrate that animal food actually provided the dominant (65%) energy source, while gathered plant foods comprised the remainder (35%). This data is consistent with a more recent, comprehensive review of the entire ethnographic data (n ¼ 229 HG societies) that showed the mean subsistence dependence upon gathered plant foods was 32%, whereas it was 68% for animal foods. Other evidence, including isotopic analyses of Paleolithic hominid collagen tissue, reductions in hominid gut size, low activity levels of certain enzymes, and optimal foraging data all point toward a long history of meat-based diets in our species. Because increasing meat consumption in Western diets is frequently associated with increased risk for CVD mortality, it is seemingly paradoxical that HG societies, who consume the majority of their energy from animal food, have been shown to be relatively free of the signs and symptoms of CVD. Conclusion: The high reliance upon animal-based foods would not have necessarily elicited unfavorable blood lipid profiles because of the hypolipidemic effects of high dietary protein (19 -35% energy) and the relatively low level of dietary carbohydrate (22 -40% energy). Although fat intake (28 -58% energy) would have been similar to or higher than that found in Western diets, it is likely that important qualitative differences in fat intake, including relatively high levels of MUFA and PUFA and a lower o-6=o-3 fatty acid ratio, would have served to inhibit the development of CVD. Other dietary characteristics including high intakes of antioxidants, fiber, vitamins and phytochemicals along with a low salt intake may have operated synergistically with lifestyle characteristics (more exercise, less stress and no smoking) to further deter the development of CVD.

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“…It has been observed that there is a protective effect of fruit and vegetables for cardiovascular disease (Appel et al, 1997;Ness and Powles, 1997;Liu et al, 2000). The WHO/FAO international expert group has recently recommended an adequate (400-500 g) daily intake of fresh fruit and vegetables (including berries, green leafy and cruciferous vegetables and legumes) to reduce the risk of coronary heart disease, stroke and high blood pressure (WHO, 2003).…”

Section: Introductionmentioning

confidence: 99%

Longitudinal trends in consumption of vegetables and fruit in Finnish children in an atherosclerosis prevention study (STRIP)

et al. 2005

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Objective: To assess prospectively the consumption of fruit and vegetables and its' correlation to the parental consumption in boys and girls taking part in an atherosclerosis prevention study (Special Turku Coronary Risk Factor Intervention Project for Children (STRIP) study). Hypothesis: Nutrition counselling focused on cardiovascular health effects vegetable and fruit consumption. Design: A prospective, randomised, clinical trial. Subjects: Children were recruited to the STRIP study between 1989 and 1992. At the age of 7 months, children were randomised to the intervention (n ¼ 540) or the control group (n ¼ 522) and were followed up until the age of 11 years. Intervention: Families in the intervention group have, since randomisation, received biannual individualised dietary counselling aimed at reduction of cardiovascular risk factors, especially saturated fat intake. Food records were used to assess fruit and vegetable consumption of children and parents. Results: The percentage of total energy intake provided by fruit and vegetables decreased when the children grew older (P for age o0.001). The 1-to 10-year-old intervention boys consumed more vegetables (mean difference 3.18 g/day; CI 1.48-4.86; Po0.001) and fruit (mean difference 10.1 g/day; CI 5.28-14.94; Po0.001) than did the control. Mother's consumption correlated with the consumption of their daughters and sons, whereas father's consumption correlated only with the consumption of their sons. Conclusions: Finnish children taking part in the atherosclerosis prevention study had a remarkably low fruit and vegetable consumption, which furthermore decreased with age. The children's consumption correlated with the parental consumption, except between boys and mothers. A slight intervention effect was present only among boys.

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A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure

Cited by 5,070 publications

References 25 publications

Effect of probiotic fermented milk on blood pressure: a meta-analysis of randomised controlled trials

Effect of probiotic fermented milk on blood pressure: a meta-analysis of randomised controlled trials

The paradoxical nature of hunter-gatherer diets: meat-based, yet non-atherogenic

Longitudinal trends in consumption of vegetables and fruit in Finnish children in an atherosclerosis prevention study (STRIP)

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