Adherence to the dietary approaches to stop hypertension (DASH) diet in relation to all-cause and cause-specific mortality: A systematic review and dose-response meta-analysis of prospective cohort studies

Background: Although previous investigations have proposed an association between Dietary Approaches to Stop Hypertension (DASH)-style diet and lower mortality from chronic diseases, the exposure-response relationship is not clear. The present systematic review and meta-analysis aimed to explore the linear and non-linear dose-response association between adherence to the DASH diet and all-cause and cause-specific mortality. Methods: Database search was performed in PubMed, Scopus, and EMBASE for prospective cohort studies investigating the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and risk of mortality. Summary hazard ratios (HRs) and 95 confidence intervals (CI) were estimated with the use of a random-effects model for the linear and nonlinear relationships. The two-stage hierarchical regression model was applied to test the potential non-linear dose-response associations. Results: The inclusion criteria were met by 17 studies (13 publications). The scores reported for adherence to the DASH diet in different studies were converted to a conventional scoring method in which the adherence score might range between 8 to 40. The linear analysis revealed that summary HRs were 0.95 (95 CI: 0.94-0.96, I2 = 91.6, n = 14) for all-cause, 0.96 (95 CI: 0.95-0.98, I2 = 82.4, n = 12) for CVD, 0.97 (95 CI: 0.96-0.98, I2 = 0.00, n = 2) for stroke, and 0.97 (95 CI: 0.95-0.98, I2 = 63.7, n = 12) for cancer mortality per each 5-point increment of adherence to the DASH diet. There was also evidence of non-linear associations between the DASH diet and all-cause and cause-specific mortality as the associations became even more evident when the adherence scores were more than 20 points (P < 0.005). Conclusion: Even the modest adherence to the DASH diet is associated with a lower risk of all-cause and cause-specific mortality. The higher adherence to the diet also strengthens the risk-reducing association. Registration: This review was registered in the international prospective register of systematic reviews (PROSPERO) database (registration ID: CRD42018086500). © 2020 The Author(s)

Association between dietary behaviors and depression in adolescent girls

Background: The growing prevalence of depression has become a major public health problem. There is limited evidence regarding the relationship between dietary behaviors and depression. The present study was designed to evaluate the association between dietary behaviors and depression score. Methods: A total of 933 Iranian adolescent girls aged 12 to 18 years were included in this cross-sectional study. Depression severity score was assessed using a validated Persian version of Beck’s depression inventory. Dietary behaviors were pre-defined and assessed in ten domains using a standard questionnaire. To investigate the association between dietary behaviors and depression score, the linear regression analysis in crude and adjusted models was used. Results: 67.7% of participants had no or minimal depression symptoms and 32.3% of participants were categorized with mild-to-severe depression symptoms. There were significant inverse relationships between main meal consumption (Beta: -0.141; 95% CI: − 3.644 to − 1.000; P = 0.001), snack consumption (Beta: -0.100; 95% CI: − 2.400 to − 0.317; P = 0.002), regular meal consumption (Beta: 0.23; 95% CI: 0.13–0.42; P = 0.001) and food chewing (Beta: -0.152; 95% CI: − 2.279 to − 0.753; P = 0.03) with depression score. These associations remained significant after adjustment for confounding variables. In addition, frequency of intra-meal fluid intake (Beta: 0.096; 95% CI: 0.288 to 1.535; P = 0.004) and spicy foods consumption (Beta: 0.076; 95% CI: 0.098 to 1.508; P = 0.02) were directly associated with depression score in the crude model. These significant relations were disappeared in full adjusted model. No significant association was found between breakfast consumption, intake of fried foods, chewing ability, and tooth loss with depression score (P > 0.05). Conclusions: Significant associations were observed between specific eating behaviors with depression score. Prospective studies are needed to confirm these findings

Treatment of Diabetes with Lifestyle Changes: Diet

The present chapter critically reviews scientific evidence on the impact of the diet and its components on the metabolic control, cardiovascular risk factors, and morbidity/mortality in diabetic patients. Three main topics are included in this chapter: (1) the effects of dietary treatment on body weight control in diabetic patients; (2) the optimal dietary composition in order to achieve blood glucose control and reduce other cardiovascular risk factors associated with type 2 diabetes; (3) the effects of lifestyle modifications and dietary changes on the risk to develop type 2 diabetes. The overall body of evidence seems to confirm the efficacy of current recommendations for diabetes management. However, although dietary strategies based on structured interventions are often successful, particularly in relation to body weight control, they are not easily applicable in clinical practice and, therefore, more feasible strategies should be identified. In addition, further intervention studies focused on the effects of lifestyle on hard endpoints in diabetic subjects are needed to definitively prove the role of diet in the prevention of both cardiovascular and microvascular complications in these patients over and above their impact on weight reduction

Perspective: The Application of A Priori Diet Quality Scores to Cardiovascular Disease Risk-A Critical Evaluation of Current Scoring Systems.

Healthy dietary habits are the cornerstone of cardiovascular disease (CVD) prevention. Numerous researchers have developed diet quality indices to help evaluate and compare diet quality across and within various populations. The availability of these new indices raises questions regarding the best selection relevant to a given population. In this perspective, we critically evaluate a priori-defined dietary indices commonly applied in epidemiological studies of CVD risk and mortality. A systematic literature search identified 59 observational studies that applied a priori-defined diet quality indices to CVD risk factors and/or CVD incidence and/or CVD mortality. Among 31 different indices, these scores were categorized as follows: 1) those based on country-specific dietary patterns, 2) those adapted from distinct dietary guidelines, and 3) novel scores specific to key diet-related factors associated with CVD risk. The strengths and limitations of these indices are described according to index components, calculation methods, and the application of these indices to different population groups. Also, the importance of identifying methodological challenges faced by researchers when applying an index are considered, such as selection and weighting of food groups within a score, since food groups are not necessarily equivalent in their associations with CVD. The lack of absolute cutoff values, emphasis on increasing healthy food without limiting unhealthy food intake, and absence of validation of scores with biomarkers or other objective diet assessment methods further complicate decisions regarding the best indices to use. Future research should address these limitations, consider cross-cultural and other differences between population groups, and identify translational challenges inherent in attempting to apply a relevant diet quality index for use in CVD prevention at a population level

The effect of dietary approaches to stop hypertension (DASH) on serum inflammatory markers: A systematic review and meta-analysis of randomized trials

Background & aims: Dietary approaches to stop hypertension (DASH) diet is associated with improved blood pressure and risk of cardiovascular diseases. It is proposed that DASH might also improve systemic inflammatory markers like highly sensitive C-reactive protein (hs-CRP); however, interventional studies have led to conflicting results. The aim of current systematic review was to summarize results of randomized clinical trials examining the effect of DASH on inflammatory biomarkers. Methods: Randomized trials which assessed the effect of adherence to DASH diet on the circulating inflammatory biomarkers in adults were identified through searching PubMed, EMBASE, Scopus and Google Scholar up to December 2016. Difference in Mean change and its corresponding standard deviation in inflammatory markers between intervention and control groups were calculated to be used as effect size. Random effects model was used to calculate the summary effects. Results: Seven trials were eligible and six studies with 451 participants were included in the meta-analysis which measured hs-CRP as the biomarker of systemic inflammation. The DASH diet significantly decreased serum hs-CRP levels mean difference (MD) = �1.01, 95% confidence interval (CI): �1.64, �0.38; I-squared (I2) = 67.7% compared to usual diets; however, the effect was not significant when it was compared with healthy diets (MD = 0.10 mg/L; 95%CI: �0.16, 0.37; I2 = 94.0%). The reduction in serum hs-CRP levels was greater in trials lasted eight weeks or more. Conclusion: Adherence to DASH diet is effective in improving circulating serum inflammatory biomarkers in adults, compared with usual diet; therefore, it could be a valuable strategy to suppress inflammation process. © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolis

The effect of dietary approaches to stop hypertension (DASH) on serum inflammatory markers: A systematic review and meta-analysis of randomized trials

Background & aims: Dietary approaches to stop hypertension (DASH) diet is associated with improved blood pressure and risk of cardiovascular diseases. It is proposed that DASH might also improve systemic inflammatory markers like highly sensitive C-reactive protein (hs-CRP); however, interventional studies have led to conflicting results. The aim of current systematic review was to summarize results of randomized clinical trials examining the effect of DASH on inflammatory biomarkers. Methods: Randomized trials which assessed the effect of adherence to DASH diet on the circulating inflammatory biomarkers in adults were identified through searching PubMed, EMBASE, Scopus and Google Scholar up to December 2016. Difference in Mean change and its corresponding standard deviation in inflammatory markers between intervention and control groups were calculated to be used as effect size. Random effects model was used to calculate the summary effects. Results: Seven trials were eligible and six studies with 451 participants were included in the meta-analysis which measured hs-CRP as the biomarker of systemic inflammation. The DASH diet significantly decreased serum hs-CRP levels mean difference (MD) = �1.01, 95% confidence interval (CI): �1.64, �0.38; I-squared (I2) = 67.7% compared to usual diets; however, the effect was not significant when it was compared with healthy diets (MD = 0.10 mg/L; 95%CI: �0.16, 0.37; I2 = 94.0%). The reduction in serum hs-CRP levels was greater in trials lasted eight weeks or more. Conclusion: Adherence to DASH diet is effective in improving circulating serum inflammatory biomarkers in adults, compared with usual diet; therefore, it could be a valuable strategy to suppress inflammation process. © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolis