Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988-1994 and 1999-2004.
ABSTRACT Although the DASH (Dietary Approaches to Stop Hypertension trial) diet is among the therapeutic lifestyle changes recommended for individuals with hypertension (HTN), accordance with the DASH diet is not known.
Using data from the National Health and Nutrition Examination Survey (NHANES) from the 1988-1994 and 1999-2004 periods, DASH accordance among individuals with self-reported HTN was estimated based on 9 nutrient targets (fat, saturated fat, protein, cholesterol, fiber, magnesium, calcium, sodium, and potassium) (score range, 0-9). Using data from 1999-2004, we compared the DASH score among demographic groups in age- and energy-adjusted models and modeled the odds of a DASH-accordant dietary pattern (>or=4.5) using multivariable logistic regression. The DASH score, DASH accordance, and percentage of participants achieving individual targets were compared with estimates from NHANES 1988-1994 data.
Based on 4386 participants with known HTN in the recent survey period (1999-2004), the mean (SE) DASH score, after adjustment for age and energy intake, was 2.92 (0.05), with 19.4% (1.2%) classified as DASH accordant. In multivariable logistic regression models, DASH accordance was associated with older age, nonblack ethnicity, higher education, and known diabetes mellitus. Accordance with DASH was 7.3% lower in the recent survey period compared with NHANES 1988-1994 (26.7% [1.1%]) (P < .001), reflecting fewer patients with HTN meeting nutrient targets for total fat, fiber, and magnesium.
The dietary profile of adults with HTN in the United States has a low accordance with the DASH dietary pattern, and the dietary quality of adults with HTN has deteriorated since the introduction of the DASH diet, suggesting that secular trends have minimized the impact of the DASH message.
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ABSTRACT: Hypertension increases the risk for a variety of cardiovascular diseases, including stroke, coronary artery disease, heart failure, and peripheral vascular disease. The increase in oxidative stress has been associated with the pathogenesis of hypertension. Increase of blood pressure is due to an imbalance between antioxidants defence mechanisms and free radical productions. Excessive production of reactive oxygen species reduces nitric oxide bioavailability leading to an endothelial dysfunction and a subsequent increase in total peripheral resistance. Hypertension can cause few symptoms until it reaches the advanced stage and poses serious health problems with lifelong consequences. Hypertensive patients are required to take drugs for life to control the hypertension and prevent complications. Some of these drugs are expensive and may have adverse reactions. Hence, it is timely to examine scientifically, complimentary therapies that are more effective and with minimal undesirable effects. Nigella sativa (NS) and its active constituents have been documented to exhibit antioxidant, hypotensive, calcium channel blockade and diuretic properties which may contribute to reduce blood pressure. This suggests a potential role of NS in the management of hypertension, and thus more studies should be conducted to evaluate its effectiveness.Evidence-based Complementary and Alternative Medicine 01/2013; 2013(120732):9. DOI:10.1155/2013/120732 · 1.88 Impact Factor
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ABSTRACT: This dissertation evaluated the contribution of the geographic context to black-white disparities in hypertension. Few studies of area-level factors and hypertension disparities have focused on geographic variation both within and between race groups. Uncovering the mechanisms underlying within-group variation may help elucidate the particular environmental factors that contribute to hypertension disparities and highlight potential targets for interventions. Understanding how the distribution of high blood pressure compares for Blacks versus Whites across different environments helps shed light on the mutability of the disparity and potential ways in which it can be reduced. The studies in this dissertation investigated (1) regional geographic factors related to hypertension differences among and between Blacks and Whites; (2) the association between metropolitan-level racial residential segregation and hypertension and neighborhood poverty as a mediating pathway; and (3) the link between neighborhood-level racial residential segregation and hypertension and interactions with area- and individual-level factors. The key finding was that race differences are not invariant. Hypertension prevalence varied significantly within race groups and race differences in hypertension were modified by context. Blacks and Whites born in the South and those living in metropolitan areas located in the South were more likely to be hypertensive than those born or living in other parts of the country. Blacks living in more segregated metropolitan areas had significantly higher odds of hypertension than those in less segregated areas, and the impact of segregation varied by metropolitan area and neighborhood poverty. Race differences in hypertension prevalence ranged from 82% higher for Blacks versus Whites to a low of 13% higher depending on which geographic groups were compared. Race differences also varied significantly by metropolitan-level segregation and neighborhood poverty; in high segregation, low poverty areas Blacks had over 4 times higher odds of hypertension versus Whites whereas Blacks in low segregation, high poverty areas had just 1.2 times higher odds. These findings suggest that race differences in hypertension result not from innate differences but from contextual factors. Specifically, eliminating the processes that lead to residential segregation and the resultant inequitable distribution of neighborhood resources could reduce the unequal burden of hypertension in Blacks versus Whites.
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ABSTRACT: BackgroundDietary quality may impact heart failure outcomes. However, the current status of the dietary quality of persons with heart failure has not been previously reported. ObjectiveTo describe sodium intake, patient factors associated with sodium intake and overall dietary quality in a national sample of persons with heart failure. DesignAnalysis of repeated cross-sectional probability sample surveys using data from National Health and Nutrition Examination Surveys (NHANES) of 1999–2000, 2001–2002, 2003–2004 and 2005–2006. ParticipantsThe study sample consisted of 574 persons with self-reported heart failure (mean age = 70years; 52% women). MeasurementsDiet of each survey participant was assessed using single 24 hour recall. Dietary nutrients of interest included sodium, the mainstay of heart failure dietary recommendations, and additionally potassium, calcium, magnesium, fish oils, saturated fat and fiber. Specific dietary goals were based on established guidelines. ResultsMean sodium intake was 2,719mg, with 34% consuming less than 2,000mg per day. Patient factors associated with greater sodium intake included male gender, lower education, lower income and no reported diagnosis of hypertension. Mean potassium intake was 2,367mg/day, with no differences by type of diuretic used or renal disease status. Adherence rates to established guidelines for other nutrients were 13% for calcium, 10% for magnesium, 2% for fish oils, 13% for saturated fat and 4% for fiber. ConclusionsDietary quality of persons with self-reported heart failure was poor. Public health approaches and clinical dietary interventions are needed for persons with this increasingly prevalent clinical syndrome. KEY WORDSdietary quality-heart failure-clinical dietary interventions-sodium intakeJournal of General Internal Medicine 02/2009; 25(2):135-140. DOI:10.1007/s11606-009-1139-x · 3.42 Impact Factor