Associations of Adherence to the DASH Diet and the Mediterranean Diet With All-Cause Mortality in Subjects With Various Glucose Regulation States

Abstract

Background and AimsA dietary pattern concordant with either the Dietary Approaches to Stop Hypertension (DASH) diet or the Mediterranean diet has been associated with a lower risk of all-cause mortality in general population. We investigated the associations of adherence to the DASH diet and the Mediterranean diet with all-cause mortality across three glucose regulation states (normal glucose tolerance, prediabetes, and diabetes) using data from the National Health and Nutrition Examination Survey (NHANES).MethodsData from the NHANES participants from 1999 to 2010, including their vital status linked to the National Death Index through the end of 2011, were analyzed. Adherence to the DASH diet and the Mediterranean diet was assessed using the DASH score and the alternative Mediterranean Diet Index (aMED), respectively. Weighted Cox proportional hazards regression models were used to compare the hazard ratios for the associations of adherence (diet score >median vs. ≤ median) to the DASH diet and the Mediterranean diet with all-cause mortality.ResultsA total of 28,905 participants were analyzed, and 2,598 of them had died after a median follow-up of 6.3 years. The median DASH score and aMED were 2 and 3, respectively. Adherence to the Mediterranean diet (aMED >3 vs. ≤ 3), but not the DASH diet, was associated with a lower risk of all-cause mortality (adjusted HR 0.74, 95% CI 0.66–0.83, p < 0.001) in the overall population. The findings were consistent across the three glucose regulation states. A joint effect of aMED >3 and DASH score >2 (adjusted HR 0.71, 95% CI 0.52–0.99, p = 0.042) was noted in participants with diabetes.ConclusionsAdherence to the Mediterranean diet (aMED >median) was associated with reduced all-cause mortality in a general population. For people with diabetes, a dietary pattern concordant with both the DASH diet and the Mediterranean diet (DASH score >median and aMED >median) was associated with a lower risk of mortality.

Adherence to the dietary approaches to stop hypertension diet and all-cause mortality in patients with a history of heart failure

“…A computer-assisted software program, and measurement aids and visuals including charts and drawings were used to facilitate the 24-h dietary recall interview. Data from the 24-h dietary recall interview were translated for analyses according to the Food Patterns Equivalents Database (developed by the United States Department of Agriculture ( https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/food-surveys-research-group/docs/fped-databases/ ), which had been applied to the NHANES population ( 21 – 23 ).…”

“…We determined whether the participants' intake met the goal of each target nutrient. This method has been applied to the NHANES population ( 21 – 23 ). One point was assigned to each target nutrient if the study participants' intake met the goal ( 20 , 23 , 24 ), while half (0.5) a point was assigned if only the intermediate goal was met.…”

“…This method has been applied to the NHANES population ( 21 – 23 ). One point was assigned to each target nutrient if the study participants' intake met the goal ( 20 , 23 , 24 ), while half (0.5) a point was assigned if only the intermediate goal was met. The maximum DASH score is 9, and a higher score indicates better concordance with the DASH diet.…”

Dietary Approaches to Stop Hypertension via Indo-Mediterranean Foods, May Be Superior to DASH Diet Intervention

“…Hypertension has become a public health problem, and there are approximately 1.31 billion patients with hypertension, as per WHO estimates [ 1 , 2 ]. In the USA and other developed countries, as well as Mediterranean countries such as Greece and Spain, the prevalence of hypertension (defined as those receiving drug therapy or having a systolic pressure of ≥140 mmHg and/or a diastolic pressure ≥90 mmHg) was approximately 30% which has remained relatively constant since 1999 [ 3 , 4 , 5 ]. The prevalence of hypertension after adjustment of age in Japan is approximately 21% [ 6 ], which is lower than in other developed countries, Mediterranean countries and the prevalence rate in India (25%) and other developing countries [ 1 , 2 , 5 ].…”

“…Of these risk factors, modification of the western type of diet is crucial, because such diets can also predispose obesity, hyperlipidemia, diabetes, coronary artery diseases (CAD) and stroke. One important cause for differences in the rate of hypertension prevalence in various countries may be due to diet quality, in particular salt, vegetable, fruit and fish consumption [ 1 , 2 , 3 , 7 ]. In the United States, dietary approaches to stop hypertension (DASH) diet was designed for the management of hypertension due to its high potassium and lower sodium contents [ 7 , 8 , 9 ].…”