Suboptimal Nutritional Intake for Hypertension Control in 4 Ethnic Groups

Amgen Inc, 1 Amgen Center Dr, MS28-3A, Thousand Oaks, CA 91320-1799, USA.
Archives of internal medicine (Impact Factor: 17.33). 05/2009; 169(7):702-7. DOI: 10.1001/archinternmed.2009.17
Source: PubMed


This study compared intake of specific nutrients based on the Dietary Approaches to Stop Hypertension (DASH) guidelines for hypertension management among multiethnic middle-aged and older adults.
We conducted quantitative analysis using baseline data of a prospective cohort study of 5972 adults aged 45 to 84 years recruited between July 2000 and August 2002 who participated in the Multi-Ethnic Study of Atherosclerosis (MESA). Diet information was collected using a 120-item food frequency questionnaire. Bivariate and multivariate methods were used to evaluate associations between DASH-accordant intake of each nutrient (fat, saturated fat, cholesterol, protein, fiber, calcium, magnesium, and potassium) with ethnicity and hypertension status.
Less than 30% of MESA participants met any DASH nutrient target. DASH accordance was lowest in saturated fat intake and highest in cholesterol intake (5.3% and 29.5% of the participants, respectively). Multivariate analyses showed significant ethnic differences in DASH accordance in all nutrients but saturated fat. Compared with white participants, Chinese American participants had greater DASH accordance in cholesterol (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.13-1.67) and protein intake (2.32; 1.55-3.49) but less in total fat (0.47; 0.30-0.74), magnesium (0.58; 0.51-0.67), and potassium intake (0.40; 0.20-0.81); African Americans and Hispanics had greater DASH accordance in fiber intake (1.36; 1.13-1.62; and 2.23; 1.53-3.23, respectively) but less in calcium intake (0.44; 0.37-0.52; and 0.79; 0.68-0.91, respectively). Diagnosed and uncontrolled hypertension was associated with less DASH accordance in saturated fat (OR, 0.80; 95% CI, 0.70-0.91) and magnesium (0.80; 0.71-0.91). DASH accordance differed significantly with and without inclusion of dietary supplements in the analysis.
There is significant variation in DASH goal attainment among different ethnic groups. Assessments of nutrient intake that exclude dietary supplements may be underestimating DASH accordance.

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    • "The wide range of prevalence of hypokalemia may depend on dietary consumption of potassium according to the study population or ethnicity. Compared with Caucasians, Asians and African Americans tend to have lower daily potassium intake (Gao et al., 2009; Kant et al., 2007; Szeto et al., 2005). In a group of 266 Chinese PD patients, prevalence was reported as 20.3%, and hypokalemia was found to be an independent predictor of mortality, although causes of death in the hypokalemic group did not differ from those in the normokalemic group (Szeto et al., 2005). "

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    • "The underlying nutrient targets are reduced dietary fat, saturated fat and cholesterol intake and increased protein, fiber, Ca, Mg and K intake. The literature suggests that these nutrients are associated with BP control (Engberink et al., 2009; Gao et al., 2009). "
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