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Figure. Design of the Dietary Approaches to Stop Hypertension (DASH)-Sodium Trial. 

Figure. Design of the Dietary Approaches to Stop Hypertension (DASH)-Sodium Trial. 

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Article
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Initial findings from the Dietary Approaches to Stop Hypertension (DASH)-Sodium Trial demonstrated that reduction of sodium intake in two different diets decreased blood pressure in participants with and without hypertension. To determine effects on blood pressure of reduced sodium intake and the DASH diet in additional subgroups. Randomized feedin...

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... Of the other priori-defined dietary patterns, the Dietary Approaches to Stop Hypertension (DASH) diet, which recommends higher intakes of whole grains, fruits, vegetables, nuts, seeds, legumes, and low-fat dairy, and lower intakes of processed meat, sodium, and sweetened beverages, was originally developed to manage high blood pressure (16). The other score for evaluating the dietary quality is HEI score. ...
Article
Background: Numerous factors such as nutrition and diet can affect the quality of sleep of people, especially employees. The aim of this study was to investigate the relationship between university employees' sleep quality and their dietary quality scores (HEI, DII and DASH score). Materials and methods: This cross-sectional study was performed on 211 employees with a mean age of 38.75±11.31. Nutritional status of individuals was determined through the Food Frequency Questionnaire (FFQ) and to assess sleep quality, the Pittsburgh Sleep Quality Index (PSQI) was used. The quality of sleep decreases with increasing Pittsburgh index score. The calculated dietary quality scores include DASH Index, Healthy Nutrition Index (HEI) and Diet Inflammation Index (DII). Results: The results of this study after adjusting for confounding showed a significant positive relationship between DASH diet score and sleep duration (p <0.001). There was a significant negative relationship between HEI score and total score of PSQI (P = 0.003). Also, HEI score had a significant positive relationship with sleep duration in the unmodified and modified models (p <0.001), and a significant negative relationship was seen in unadjusted and modified model between DII score and sleep duration (p <0.001). Conclusion: It can be concluded that with increasing the diet quality in employees, the sleep quality also increases. This was the first study in south of Iran that examined the quality of sleep and diet of employees and the result of this study can affect the general health and improve the quality of foods consumed by employees.
... Effective heat dissipation is essential in hot environments and is most efficiently achieved through perspiration, which can lead to loss of large amounts of salt and water 59 . Under these conditions, salt desire and renal sodium conservation are essentials for survival therefore, in the past, humans and nonhuman primates from tropical climates increased their salt avidity [60][61][62][63] . Perspiration also causes a drop in blood volume 64 , under these conditions, compensatory mechanisms involved in increasing arterial tone and cardiac contraction force, maintain regular blood pressure values. ...
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Background: Since the emergence of the genus Homo, hominids have occupied a wide variety of environments, facing different selective pressures. Objectives: The aim this study is to compare genotype frequencies between South-West Europe and Peri-equatorial Africa in genes potentially modulators of blood pressure. Methods: The analyzed sample consisted of 325 individuals from Portugal and 226 individuals from Africa (48 from Mozambique and 178 from São Tomé and Príncipe). The following genetic variants were analyzed: intron 4 VNTR in eNOS, rs1050829 in G6PD, -3.7kb α-thalassemic deletion in HBA, rs1800457 in CYB5R3, Hp 1/2 genotype/phenotype in Hp and intron 16 I/D in ACE. Results: Frequencies of genotypes with the 4a allele in eNOS (p<0.001), the G allele in G6PD (p<0.001), the α-3.7 kb in HBA (p <0.001), the C allele in the CYB5R3 (p<0.001) were higher in Peri-equatorial Africa. The Hp 1.1 genotype of Hp has a higher frequency in Peri-equatorial Africa (p=0.002). ACE shows no significant differences. Conclusion: Results show differences in five genetic variants. Conditions of extreme heat and humidity, characteristic of Peri-equatorial Africa, have been associated with increased sodium loss. This study suggests that selected compensatory mechanisms printed in the genome, are nowadays risk factors for hypertension in Peri-equatorial Africa.
... The results suggest the significant increase in systemic arterial blood pressure and PWV but not pulse pressure may lead to the existence of accommodating circumstance in the circulatory system of females on high salt diet that circumvents ventricular hypertrophy. Evidence from several studies indicate a direct relationship between sodium intake and changes in systemic arterial blood pressure [34,53,54]. Accordingly, chronic consumption of high salt has been found to result in a significant increase in systemic arterial blood pressure linked to the onset of hypertension and increase morbidity and mortality [55][56][57]. ...
... Accordingly, chronic consumption of high salt has been found to result in a significant increase in systemic arterial blood pressure linked to the onset of hypertension and increase morbidity and mortality [55][56][57]. In contrast, a decrease in salt consumption has been shown to decrease blood pressure, lower incidence of cardiovascular complications and better health outcomes [53,58,59]. Further, blood pressure responses to salt intake have also been reported to vary with sex and age [60][61][62]. ...
Article
Background: Increase in vascular stiffness is associated with a higher risk of cardiovascular morbidity and mortality and is likely sex-specific. Method: Our objectives were to compare structural and functional alterations in small resistance arteries as related to vascular stiffness from Dahl salt-sensitive male and female rats (n = 8, mean ± s.e.m.). Results: Arterial blood pressure and pulse wave velocity were significantly (P < 0.05) elevated in males (161 ± 3 mmHg; 6.4 ± 0.2 m/s) and females (147 ± 2 mmHg; 5.5 ± 0.1 m/s) on a high (H) salt compared with regular (R) diets but were significantly higher in males (H) than in all others. Significant increases in collagen and smooth muscle cell areas were evident in ultrastructure of mesenteric arteries of hypertensive males compared to normotensive or corresponding females. There were no significant differences in composite Young's modulus (CYM) between groups. Vasoconstriction resulted in significantly higher CYM in male (H: 8.6 ± 1 KPa) than R (4.5 ± 0.8 KPa), and the corresponding females (H: 5.6 ± 0.6 KPa and R: 5 ± 0.9 KPa). In contrast, vasodilation significantly reduced CYM in the male groups (H: 2.5 ± 0.4 KPa and R: 2.7 ± 0.5 KPa) compared with the corresponding values in females (H: 4.2 ± 0.6 KPa and R: 5 ± 0.5 KPa). Moreover, the slope of pressure-volume curves revealed significantly greater distended vascular compliance in male H than R, and the corresponding females. Conclusion: Our findings are supportive of a link between high salt intake and elevated blood pressure as being sex specific, likely involving sex-dependent changes in ultrastructure of the vessels, which ultimately may alter the biomechanics, and thus, the haemodynamic functions of both macro-circulation and micro-circulations.
... regardless of age or hypertension status (117). In the DASH-Sodium trial, reduction of Na+ intake produced a greater depressor response in women than in men (133). A Brazilian study of 12,813 subjects, 35 to 64 years old demonstrated that the slope of the pressor effect of salt was steeper in women than men, after adjustment for confounders and independent from having hypertension or using antihypertensive drugs (82). ...
Article
Significance: Salt-sensitivity of blood pressure (SSBP) is an independent risk factor for mortality and morbidity due to cardiovascular disease, and disproportionately affects blacks and women. Several mechanisms have been proposed including exaggerated activation of sodium transporters in the kidney leading to salt retention and water. Recent advances: Recent studies have found that in addition to the renal epithelium, myeloid immune cells can sense sodium via the epithelial Na+ channel (ENaC), which leads to activation of the NADPH oxidase enzyme complex, increased fatty acid oxidation, and production of isolevuglandins (IsoLGs). IsoLGs are immunogenic and contribute to salt-induced hypertension. In addition, aldosterone mediated activation of ENaC has been attributed to the increased SSBP in women. The goal of this review is to highlight mechanisms contributing to SSBP in blacks and women, including, but not limited to increased activation of ENaC, fatty acid oxidation, and inflammation. Critical issues: A critical barrier to progress in management of SSBP is that its diagnosis is not feasible in the clinic and is limited to expensive and laborious research protocols, which makes it difficult to investigate. Yet without understanding the underlying mechanisms, this important risk factor remains without treatment. Future directions: Further studies are needed to understand the mechanisms which contribute to differential blood pressure responses to dietary salt and find feasible diagnostic tools. This is extremely important and may go a long way in mitigating the racial and sex disparities in cardiovascular outcomes.
... 9 As such, moderate reductions in sodium intake can effectively reduce blood pressure. 10,11 Excessive sodium intake, insufficient potassium intake, and a low sodium/potassium intake ratio are important risk factors for hypertension in China. 15 The INTERSALT 3 study found that every Our study suggested an excessive sodium but insufficient potassium consumption and a consequent high sodium/potassium intake ratio in Chinese hypertensive patients. ...
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Sodium and potassium intake in hypertensive patients in China is not clear. The authors aimed to investigate the distribution of sodium and potassium intake in hypertensive patients in China, and to analyze the relationship between sodium and potassium intake and blood pressure. The study was performed in 130 hospitals from 23 provinces across China from 2016 to 2019. Finally, 9501 hypertensive patients average aged 54 years were included. 24 h urinary sodium and potassium excretion were measured. Distribution of urinary electrolytes were described according to age, gender and region. The association between urinary electrolytes and blood pressure was analyzed by multivariate linear regression. Hypertensive patients exhibited an average 24 h urinary sodium and potassium excretion of 156.7 ± 81.5 mmol/d and 39.2 ± 20.2 mmol/d (equivalent to sodium chloride of 9.2 g/d, potassium chloride of 2.9 g/d), sodium/potassium ratio (median) of 4.14 (2.92,5.73). Urinary electrolytes were lower in women than men (sodium: 171.1 vs 138.7, p < .05; potassium: 40.3 vs 37.7, p < .05), in the elderly than in the younger (sodium: 168.7 vs 139.9, p < .05; potassium: 39.5 vs. 37.5, p < .05). For every 1 unit of Na/K ratio increase, blood pressure increased by 0.46/0.24 mmHg. Blood pressure was 2.75/1.27 mmHg higher in quartile 4 than quartile 1 of Na/K. It remains high sodium and low potassium for hypertensive patients in China. Decreased sodium, Na/K ratio and increased potassium may help for blood pressure management.
... Moreover, limited data from RCTs were available and the metanalysis conducted lead to inconclusive findings [23]. Indeed, despite the large body of evidence on RCTs comparing the effect of different levels of dietary Na on BP [79,[91][92][93][94][95][96], data for cardiovascular events and all-cause mortality remain limited and insufficient to address the specific question of the optimal daily Na intake range. ...
Article
The last decade, a growing number of evidence support J-shape or inverse - instead of positive linear -- associations between dietary sodium intake and cardiovascular morbidity/mortality. A careful evaluation of these studies leads to the following observations: less accurate methods for dietary sodium assessment are usually used; most studies included high-risk participants, enhancing the possibility of a 'reverse causality' phenomenon. However, these limitations do not explain all the findings. Few carefully designed randomized clinical trials comparing different levels of sodium intake that address the issue of the optimal and safe range exist; therefore, current guidelines recommend a higher cut-off instead of a safe range of intake. Given the demonstrated harmful effects of very low sodium diets leading to subclinical vascular damage in animal studies, the 'J-shape hypothesis' cannot yet be either neglected or verified. There is a great need of well-designed general population-based prospective randomized clinical trials to address the issue.
... The DASH diet emphasizes fruit, vegetables, fat-free or low-fat dairy products, whole grains, nuts, and legumes. It limits total and saturated fat, cholesterol, red and processed meats, sweets, added sugars, and sugar-sweetened beverages and is rich in magnesium, potassium, calcium, and ber [17]. Although this diet was originally developed to prevent or treat hypertension [18], the effects of the DASH diet on patients with metabolic syndrome [19] and other populations [20,21] can be generalized to patients with diabetes. ...
... As our results revealed, 24hUNa decreased signi cantly after salt intake restriction, whereas it increased after the fourth week; however, the 24hUNa at all stages after the intervention was lower than at baseline. The 24hUK level of the intervention group increased after intervention possibly because of the KCl in the 52% sodium-limited formula salt and the potassium enrichment in the DASH diet [17]. Our study also revealed that the Na + /K + ratio decreased after intervention. ...
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Background Excessive salt intake is currently the foremost universal risk factor for controllable chronic disease. Reducing salt intake has been identified as one of the most cost-effective measures countries can adopt to improve the health outcomes of their populations. This study evaluated the short-term effects of a modest salt intake reduction combined with the Chinese Modified Dietary Approaches to Stop Hypertension (CM-DASH) diet on salt intake, certain biochemical parameters, mean arterial pressure (MAP), and pulse pressure (PP) in hypertensive patients with type II diabetes. Methods Sixty-one participants were randomized to the intervention group (52% low-sodium salt and DASH intervention [n = 30, 11 men]) and control group (normal salt and DASH intervention [n = 31, 14 men]). An 8-week dietary intervention was applied. Daily salt intake, blood pressure, and drug use were recorded every week. Twenty-four-hour urine samples, casual urine samples, and blood samples were measured at baseline, the fourth week, and the end of the intervention. Results Of the 61 participants, 59 patients (25 men and 34 women) completed the entire study. The daily salt intake of all patients significantly decreased compared with at baseline (P < 0.001). The Na⁺/K+ ratio and urine creatinine decreased after the intervention, and the 24-hour urine potassium of the intervention and control groups increased after the intervention and the fourth week, respectively. Additionally, 24-hour UNa, (MAU), and urinary microalbumin-to-creatinine ratio(UACR) decreased significantly after the intervention but increased after the fourth week. Finally, MAP and PP both decreased after the intervention, but the difference between the two groups was not statistically significant. Conclusion A modest salt reduction and the CM-DASH diet for hypertensive patients with type II diabetes can achieve the effect of salt reduction in a short period. Before and after individual comparisons, sodium and potassium intake, MAU, MAP, and PP were improved, but no statistically significant difference was observed between the two groups regardless of the use of 52% sodium limited formula salt or traditional table salt. The salt reduction effect needs to be investigated with an extended follow-up. Trail registration ChiCTR2000029017.Registered on 11/01/2020-Prospective registration, http:// www.chictr.org.cn/
... Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a low-glycemic index and low energydense diet which has rstly been considered for the regulation of blood pressure [19]. This dietary pattern is rich in vegetables, fruits, whole grains, and low-fat dairy with a reduced content of sodium, saturated and total fat [19]. ...
... Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a low-glycemic index and low energydense diet which has rstly been considered for the regulation of blood pressure [19]. This dietary pattern is rich in vegetables, fruits, whole grains, and low-fat dairy with a reduced content of sodium, saturated and total fat [19]. Therefore, due to these useful ingredients, favorable effects of the DASH diet on insulin resistance, lipid pro les, biomarkers of in ammation and oxidative stress, and PCOS women have also been reported repeatedly [20][21][22][23]. ...
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Objective: Polycystic Ovary Syndrome (PCOS) as one of the endocrine and metabolic abnormalities is prevalent in reproductive-aged women. This study aimed to investigate the relevance between adherence to the DASH diet and PCOS. Results: This is an age and BMI-matched case-control study including (n=108) new diagnosis PCOS women as a case group and women without PCOS as a control group (n=108). Also, the validated 168-item food frequency questionnaire was used to determine the usual dietary intake. The method of Fung et al. was used to calculate the DASH score. Moreover, logistic regression was assessed to evaluate the relationship between adherence to the DASH diet and the odds of PCOS. After adjustment for potential confounders, an increase in adherence to the DASH diet significantly reduced the odds of PCOS (OR for the highest vs. lowest quartile = 0.18; 95% CI 0.07, 0.47). There was a significant decreasing trend in the odds of PCOS across increasing quintiles of the DASH diet (p-trend <0.001). The results showed that adherence to the DASH diet could reduce the odds of PCOS by 82 percent. It’s worth noting that more prospective studies are required to confirm the findings of the current study.
... In this study, we conducted exploratory untargeted plasma metabolomic and lipidomic profiling on salt-sensitive and saltresistant participants from the Dietary Approaches to Stop Hypertension 2 Sodium (DASH-Sodium) Trial. The DASH-Sodium clinical trial examined the impact of dietary sodium on BP in individuals via a control diet, which models the typical American consumption, or the DASH diet, both delivered at high, intermediate, and low levels of sodium [17,18]. This carefully monitored dietary trial study provided the opportunity to identify salt-sensitive versus salt-resistant individuals by their BP response to dietary sodium intervention. ...
Article
Objective: This study conducted exploratory metabolomic and lipidomic profiling of plasma samples from the DASH (Dietary Approaches to Stop Hypertension) Sodium Trial to identify unique plasma biomarkers to identify salt-sensitive versus salt-resistant participants. Methods: Utilizing plasma samples from the DASH-Sodium Trial, we conducted untargeted metabolomic and lipidomic profiling on plasma from salt-sensitive and salt-resistant DASH-Sodium Trial participants. Study 1 analyzed plasma from 106 salt-sensitive and 85 salt-resistant participants obtained during screening when participants consumed their regular diet. Study 2 examined paired within-participant plasma samples in 20 salt-sensitive and 20 salt-resistant participants during a high-salt and low-salt dietary intervention. To investigate differences in metabolites or lipidomes that could discriminate between salt-sensitive and salt-resistant participants or the response to a dietary sodium intervention Principal Component Analysis and Orthogonal Partial Least Square Discriminant Analysis was conducted. Differential expression analysis was performed to validate observed variance and to determine the statistical significance. Results: Differential expression analysis between salt-sensitive and salt-resistant participants at screening revealed no difference in plasma metabolites or lipidomes. In contrast, three annotated plasma metabolites, tocopherol alpha, 2-ketoisocaproic acid, and citramalic acid, differed significantly between high-sodium and low-sodium dietary interventions in salt-sensitive participants. Conclusion: In DASH-Sodium Trial participants on a regular diet, plasma metabolomic or lipidomic signatures were not different between salt-sensitive and salt-resistant participants. High-sodium intake was associated with changes in specific circulating metabolites in salt-sensitive participants. Further studies are needed to validate the identified metabolites as potential biomarkers that are associated with the salt sensitivity of blood pressure.
... There is great concern about the link between salt intake and high blood pressure leading to cardiovascular disease [1]. Thus, reformulations of processed food products have been made to decrease NaCl content and thus reduce sodium consumption [2]. ...
Article
The objective of this work was to evaluate the sensory characteristics of meat sausages with 4 different salt formulations (Form1: 2% NaCl, Form3: 1.5% NaCl + 0.5% KCl, Form4: 1.5% + 0.5% NaCl, Form 5: 0.5% Sub 4 salt + 1.5% NaCl) and 2 ripening times (7 and 14 days). Attributes of appearance, odor, texture and flavor were evaluated by a qualified taste panel. The data were submitted to Generalized Procrustes Analysis (GPA) and Product Characterization (PC). The GPA results highlight some characteristics in the different formulations of meat sausages. However, only the firmness felt by the thumbs presented a discriminatory power between sausages with less time of maturation. On the other hand, the external color was the only attribute with significant discriminatory capacity in the sausages with longer maturation time. The results indicate that panelists do not detect very significant differences in sensory characteristics when changing salt levels in meat sausage formulations which may be important in the production of healthier products.