the dash diet in treating hypertension & type 2 diabetes
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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 - PowerPoint PPT PresentationTRANSCRIPT
The DASH Diet in treating Hypertension & Type 2
Diabetes
Kathleen T. MorganChair, Family & Community
Health SciencesSpecial 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 <80Normal <130 and <85High-Normal 130-139 or 85-90High
Stage 1Stage 2Stage 3
140-159 or160-179 or
>180 or
90-99100-109
>110
Untreated HypertensionTarget 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 dietJAMA, Oct 16, 2002
Mineral Intake and HypertensionCalcium• 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 HypertensionPotassium• 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 HypertensionMagnesium• 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 Patternbased on a 2,000 calorie diet
Food Group Servings*Grains 7-8Vegetables 4-5Fruits 4-5Low-fat or fat free dairy 2-3Meats, poultry, fish less than 2Nuts, seeds, dry beans and peas 4-5/weekFats and oils 2-3Sweets 5/ week
DASH: Dietary RecommendationsDASH meets multiple dietary recommendations• NIH-NHLBI-ATP III• AHA• USDA/DHHS Dietary Guidelines• NCI and AICR• Surgeon General Recommendations
Dietary recommendations includesTherapeutic Lifestyle Changes (TLC)
• 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]