Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis

Abstract

The Dietary Approach to Stop Hypertension (DASH) is recommended to lower blood pressure (BP), but its effects on cardiometabolic biomarkers are unclear. A systematic review and meta-analysis of randomised controlled trials (RCT) was conducted to determine the effects of the DASH diet on cardiovascular risk factors. Medline, Embase and Scopus databases were searched from inception to December 2013. Inclusion criteria were as follows: (1) DASH diet; (2) RCT; (3) risk factors including systolic and diastolic BP and glucose, HDL, LDL, TAG and total cholesterol concentrations; (4) control group. Random-effects models were used to determine the pooled effect sizes. Meta-regression analyses were carried out to examine the association between effect sizes, baseline values of the risk factors, BMI, age, quality of trials, salt intake and study duration. A total of twenty articles reporting data for 1917 participants were included in the meta-analysis. The duration of interventions ranged from 2 to 24 weeks. The DASH diet was found to result in significant decreases in systolic BP (2 5·2 mmHg, 95 % CI 2 7·0, 2 3·4; P,0·001) and diastolic BP (2 2·6 mmHg, 95 % CI 23·5, 2 1·7; P,0·001) and in the concentrations of total cholesterol (2 0·20 mmol/l, 95 % CI 2 0·31, 20·10; P,0·001) and LDL (20·10 mmol/l, 95 % CI 2 0·20, 20·01; P¼ 0·03). Changes in both systolic and diastolic BP were greater in participants with higher baseline BP or BMI. These changes predicted a reduction of approximately 13 % in the 10-year Framingham risk score for CVD. The DASH diet improved cardiovascular risk factors and appeared to have greater beneficial effects in subjects with an increased cardiometabolic risk. The DASH diet is an effective nutritional strategy to prevent CVD.Key words: Dietary Approach to Stop Hypertension diet: Meta-analyses: Hypertension: Dyslipidaemia: Diabetes: Cardiovascular risk CVD are the leading cause of mortality worldwide, accounting for 30 % of all global deaths (1) . Haemodynamic (elevated blood pressure (BP)) and metabolic (hyperlipidaemia and hyperglycaemia) stressors are important cardiovascular risk factors and linked to the onset and progression of atherosclerosis (2) . Models incorporating risk factors such as age, smoking status, sex, diabetes, BP, and total cholesterol and HDL-cholesterol concentrations have been developed for predicting the risk of cardiovascular events and mortality (3,4) . Dietary and lifestyle interventions are important behavioural strategies for cardiovascular risk reduction (5,6) . The Dietary Approach to Stop Hypertension (DASH) is a dietary pattern that promotes the consumption of fruits, vegetables, and low-fat dairy products; includes whole grains, poultry, fish, and nuts; and attempts to reduce the intakes of red meat, sweets, sugar-containing beverages, total fat, saturated fat and cholesterol (7) . Thus, the DASH dietary pattern promotes a higher intake of protective nutrients such as K, Ca, Mg, fibre and vegetable proteins and, at the same time, a lower intake of refined ca...

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