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African Americans Less Likely to Adhere to DASH Diet for Lowering Blood Pressure

2012-09-19

Significant Improvement in Blood Pressure Tied to Greater Adherence to DASH Diet, Journal of the Academy of Nutrition and Dietetics Reports

Media Contacts: Ryan O'Malley, Allison MacMunn
800/877-1600, ext. 4769, 4802 media@eatright.org

The Dietary Approaches to Stop Hypertension (DASH) diet, which promotes consumption of more fruits, vegetables, low-fat dairy products, and whole grain, and less meats and sweets, is a proven effective treatment for hypertension. For some individuals, adherence to the diet can be just as effective in lowering blood pressure as taking antihypertensive medication. A new study has found that greater adherence to the diet can lead to significant reductions in blood pressure, but that African Americans are less likely to adopt the diet compared to whites. The study is published online today in the Journal of the Academy of Nutrition and Dietetics.

“After DASH dietary counseling, African Americans increased their consumption of DASH foods, but continued to lag behind whites in overall adherence to the DASH eating plan, consuming considerably more meat, sweets, and fat, and less fruit,” reports lead investigator James A. Blumenthal, PhD, Professor of Behavioral Medicine in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center in Durham, NC.

The study was a new analysis of the ENCORE study, which evaluated the effectiveness of the DASH diet alone and in combination with exercise training and weight reduction. 144 sedentary, overweight, and obese adults with high blood pressure were randomly assigned to three treatment groups. The first group ate the DASH diet and was engaged in weekly education, support, and feedback in group sessions. The second group also ate the DASH diet and received structured support and feedback, and in addition began a weight management program with caloric restriction, behavior modification, and aerobic exercise three times a week. The third group was instructed to maintain their normal diet and activity, but did not receive in instruction in the DASH diet nor were they encouraged to exercise or lose weight.

Researchers evaluated adherence to the diet, clinic and ambulatory blood pressure, and cardiorespiratory fitness. Participants also underwent a number of psychosocial assessments to evaluate their mental and social wellbeing and to identify potential predictors of dietary adherence including depression, anxiety, level of support from family and friends, and their beliefs about health and exercise. Demographic and background variables, including sex, age, ethnicity, income, education, and baseline body mass index were also examined.

After four months, participants in the DASH plus weight management group lost more weight compared to the DASH diet alone and control groups. There was no difference in dietary compliance between the DASH plus weight maintenance and the Dash alone groups. Participants with higher post-treatment DASH adherence scores had lower blood pressure levels, and the more participants adhered to the daily recommendations in the diet, the more their blood pressure decreased. 

While both African-American and white participants in the DASH treatment groups increased their consumption of DASH foods after treatment, African Americans in both treatment groups had lower adherence scores compared to whites. No other demographic, behavioral, or social variable predicted DASH adherence.

“Strong cultural influences on food preferences, food preparation, and perceptions about eating practices might make it more challenging for African Americans to adhere to the DASH diet,” Dr. Blumenthal notes. “In light of the considerable role that food plays in African-American culture, greater cultural sensitivity is likely to be needed to achieve greater adoption of the DASH eating pattern when prescribing dietary modification programs. For example, it might be more effective to modify traditional recipes to meet current nutritional guidelines rather than to recommend that such foods be eliminated altogether.”

In a video accompanying the article, co-investigator Pao-Hwa Lin, PhD, a nutritionist from the Department of Medicine at Duke University Medical Center, discusses the implications of the study and possible reasons for lower adherence to the DASH diet in African Americans.  

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NOTES FOR EDITORS

“Determinants and Consequences of Adherence to the Dietary Approaches to Stop Hypertension Diet in African-American and White Adults with High Blood Pressure: Results from the ENCORE Trial,” Dawn E. Epstein; Andrew Sherwood, PhD; Patrick J. Smith, PhD; Linda Craighead, PhD; Carla Caccia, RD; Pao-Hwa Lin, PhD; Michael A. Babyak, PhD; Julie J. Johnson, PA-C; Alan Hinderliter, MD; James A. Blumenthal, PhD. Journal of the Academy of Nutrition and Dietetics, Volume 112/Issue 11 (November 2012), DOI: 10.1016/j.jand.2012.07.007, published by Elsevier.  The study was funded by a grant to Dr. Blumenthal from the National Heart, Lung and Blood Institute.

Full text of this article is available to credentialed journalists upon request. Contact Eileen Leahy at 732-238-3628 or andjrnlmedia@elsevier.com to obtain copies. Journalists wishing to set up interviews with the authors may contact Rachel Bloch, Media Relations Representative, Duke Medicine News & Communications, at 919-419-5069 or Rachel.bloch@duke.edu.

A video featuring Dr. Lin is located athttp://andjrnl.org/content/mediapodcast. Excerpts from the video may be reproduced by the media; contact Eileen Leahy to obtain permission.

ABOUT THE JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS

The official journal of the Academy of Nutrition and Dietetics (www.eatright.org), the Journal of the Academy of Nutrition and Dietetics (www.andjrnl.org) is the premier source for the practice and science of food, nutrition and dietetics. The monthly, peer-reviewed journal presents original articles prepared by scholars and practitioners and is the most widely read professional publication in the field. The Journal focuses on advancing professional knowledge across the range of research and practice issues such as: nutritional science, medical nutrition therapy, public health nutrition, food science and biotechnology, food service systems, leadership and management and dietetics education.

The Journal has a current Impact Factor of 3.586 in the Nutrition and Dietetics category of the 2011 Journal Citation Reports®, published by Thomson Reuters. It was previously published as the Journal of the American Dietetic Association.

ABOUT THE ACADEMY OF NUTRITION AND DIETETICS

The Academy of Nutrition and Dietetics (www.eatright.org), formerly the American Dietetic Association, is the world’s largest organization of food and nutrition professionals. The Academy is committed to improving the nation’s health and advancing the profession of dietetics through research, education and advocacy.

ABOUT ELSEVIER

Elsevier is a world-leading provider of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including The Lancet (www.thelancet.com) and Cell (www.cell.com), and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier’s online solutions include ScienceDirect (www.sciencedirect.com), Scopus (www.scopus.com), Reaxys (www.reaxys.com), ClinicalKey (www.clinicalkey.com) and Mosby’s Nursing Suite (www.confidenceconnected.com), which enhance the productivity of science and health professionals, and the SciVal suite (www.scival.com) and MEDai’s Pinpoint Review (www.medai.com), which help research and health care institutions deliver better outcomes more cost-effectively.

A global business headquartered in Amsterdam, Elsevier (www.elsevier.com) employs 7,000 people worldwide. The company is part of Reed Elsevier Group PLC (www.reedelsevier.com), a world-leading publisher and information provider, which is jointly owned by Reed Elsevier PLC and Reed Elsevier NV. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).