1. 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

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. 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

8. Blood Pressure Categories - Adults Systolic (mm Hg)Diastolic (mm Hg) Optimal<120 and<80 Normal<130 and<85 High-Normal130-139 or85-90 High Stage 1 Stage 2 Stage 3 140-159 or 160-179 or >180 or 90-99 100-109 >110

9. Untreated Hypertension Target Organ Damage Includes: Hypertensive heart disease Cerebrovascular disease Renal disease Large vessel disease

10. 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

11. 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 diet JAMA, Oct 16, 2002

12. Mineral Intake and Hypertension Calcium 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)

13. Mineral Intake and Hypertension Potassium 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

14. Mineral Intake and Hypertension Magnesium 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

15. 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

16. 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

17. DASH Diet Pattern based on a 2,000 calorie diet Food GroupServings* Grains7-8 Vegetables4-5 Fruits4-5 Low-fat or fat free dairy2-3 Meats, poultry, fishless than 2 Nuts, seeds, dry beans and peas4-5/week Fats and oils2-3 Sweets5/ week

18. DASH: Dietary Recommendations DASH meets multiple dietary recommendations NIH-NHLBI-ATP III AHA USDA/DHHS Dietary Guidelines NCI and AICR Surgeon General Recommendations

19. Dietary recommendations includes Therapeutic 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

20. 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

21. Take Time for Some TLC (cont) Choose foods low in cholesterol –Plant-based foods Grains Fruits Vegetables Dried beans

22. 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

26. 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 –Morgan@rce.rutgers.edu