Influence of the DASH Diet on Gestational Weight Gain and Perinatal Outcomes in Women with Pre-Existing Diabetes Mellitus: A Randomized, Single-Blind, Controlled Clinical Trial.

BACKGROUND: This study aimed to investigate the influence of the dietary approaches to stop hypertension (DASH) diet on gestational weight gain and perinatal outcomes in pregnant women with pre-existing diabetes mellitus (PDM). METHODS: A randomized, single-blind, controlled clinical trial was conducted with 68 pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital in Rio de Janeiro, Brazil (2016-2020). The standard diet adopted by the control group (standard diet group-SDG) contained 45-55% carbohydrates, 15-20% protein, and 25-30% lipids of the total energy intake. An adapted DASH diet, with a similar macronutrient composition, but with higher calcium, potassium, magnesium, fiber, and reduced saturated fat, was prescribed for the intervention group (DASH diet group-DDG). Student's t- or Mann-Whitney U tests were used to compare outcomes between groups. To assess the trajectory of gestational weight gain throughout the intervention between the study groups, linear mixed-effects regression models were used. RESULTS: The DDG had lower gestational weight gain at the fifth (p = 0.03) and seventh appointment (p = 0.04), with no difference in average total gestational weight gain (SDG: 10 kg [SD = 4]; DDG: 9 kg [SD = 5], p = 0.23). There was a trend for a lower length of stay of the newborns (p = 0.08) in the DDG without differences for other perinatal outcomes. CONCLUSIONS: The DASH diet promoted less variation in gestational weight gain without promoting a difference in total gestational weight gain, and there was no difference between the study groups for perinatal outcomes.

Effect of the Dietary Approaches to Stop Hypertension (DASH) diet on the development of preeclampsia and metabolic outcomes in pregnant women with pre-existing diabetes mellitus: a randomised, controlled, single-blind trial.

Preeclampsia (PE) affects up to five times more women with pre-existing diabetes mellitus (PDM) than women without it. The present study aimed to identify the effect of the DASH diet on PE incidence (primary outcome) and blood pressure, glycated haemoglobin (GH), serum lipids, glutathione peroxidase (GP), C-reactive protein (CRP - secondary outcomes) in pregnant with PDM. This randomised, controlled, single-blind trial studied sixty-eight pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital, Brazil. The standard diet group (SDG) received a diet containing 45-65 % carbohydrates, 15-20 % protein and 25-30 % lipids. The DASH diet group (DDG) received the adapted DASH diet with a similar macronutrient distribution, but with a higher concentration of fibres, unsaturated fats, calcium, magnesium and potassium as well as lower saturated fat. Student's t, Mann-Whitney U and the Chi-square tests were used to compare outcomes. PE incidence was 22⋅9 % in the SDG and 12⋅1 % in the DDG (P = 0⋅25). GP levels significantly increased in the DDG (intra-group analysis; mean difference = 1588 [CI 181, 2994], P = 0⋅03) and tended to be different from the variation in the SDG (mean difference = -29⋅5 [CI -1305; 1⋅365]; v. DDG: 1588 [CI 181; 2994], P = 0⋅09). GH levels decreased significantly and similarly between groups (SDG: -0⋅61 [CI -0⋅26, -0⋅96], P = 0⋅00) v. DDG: -1⋅1 [CI -0⋅57, -1⋅62], P = 0⋅00). There was no evidence of a difference in PE incidence at the end of the intervention between the two diets. The DASH diet seems to favour PE-related biochemical markers.

Efeito dos padrões alimentares no tratamento e prevenção da hipertensão arterial: uma atualização / Effect of dietary patterns on the treatment and prevention of high blood pressure: an update

A hipertensão arterial (HA) é uma condição clínica caracterizada por elevação sustentada dos níveis pressóricos maior ou igual a 140 e/ou 90 mmHg. As diretrizes atuais têm apontado cada vez mais estudos que verificam a influência dos diferentes padrões alimentares e seus efeitos benéficos no controle da HA, como: Dietary Approach to Stop Hypertension (DASH) que preconiza o consumo de frutas, hortaliças, fibras, minerais e laticínios com baixos teores de gordura; DASH-Sodium a qual combina três níveis diferentes de ingestão de sódio; Dieta Mediterrânea (MedDiet) caracterizada pela ingestão reduzida de carne vermelha e processada, ovos, doces e bebidas açucaradas, somada ao consumo moderado de peixes, vinho tinto e laticínios com baixo teor de gordura e alta ingestão de azeite de oliva; Plant based cujo escopo é consumir principalmente proteínas de origem vegetal, com um padrão alimentar rico em fibras, que inclua cereais integrais, frutas, legumes, leguminosas e nozes, com uma ingestão regular de peixes e frutos do mar, laticínios com baixo teor de gordura. Todas essas intervenções mostraram benefícios nos níveis pressóricos, porém a DASH é o padrão alimentar mais frequentemente recomendado e com maior nível de evidência para a prevenção primária e o controle da HA (AU).

Arterial hypertension (AH) is a clinical condition characterized by a sustained increase in blood pressure levels higher than or equal to 140 and or 90 mmHg. Present guidelines have increasingly pointed to studies that show the influence of different dietary patterns and their beneficial effects on the control of AH, just as: Dietary Approach to Stop Hypertension (DASH), which advocates the consumption of fruits, vegetables, fiber, minerals and dairy products low in fat; DASH-Sodium which associate three different levels of sodium intake; Mediterranean Diet (MedDiet) characterized by reduced intake of red and processed meat, eggs, sweets, and sugary drinks, besides, moderate consumption of fish, red wine and low-fat dairy products and high intake of olive oil; Plant-based whose scope is to consume mainly plant-based proteins, with a dietary pattern rich in fiber, which includes whole grains, fruits, vegetables, legumes, and nuts, with a regular intake of fish and seafood, low-fat dairy products. All these interventions showed benefits in blood pressure levels, however DASH is the most frequently recommended dietary pattern with the highest level of evidence for primary prevention and AH control (AU).

Efeitos do sal de ervas sobre a pressão arterial e a excreção de sódio urinário de pessoas com hipertensão / Effects of herbal salt on blood pressure and urinary sodium excretion in people with hypertension

A presente pesquisa teve por objetivo analisar os efeitos da substituição do sal de cozinha por sal de ervas sobre os valores de pressão arterial e excreção de sódio urinário de pessoas com hipertensão arterial. Trata-se de um estudo de abordagem quantitativa e delineamento quasi-experimental, tipo "cross-over", com amostra de hipertensos cadastrados em três unidades públicas de saúde de um município do estado de Mato Grosso. A coleta de dados foi realizada no período de maio de 2020 a maio de 2022. Por meio de entrevista, foi aplicado o questionário para identificação das variáveis sociodemográficas e o "Questionário de Adesão a Medicamentos - Qualiaids" (QAM-Q). Posteriormente, foi realizada a avaliação antropométrica e a medida casual da pressão arterial. A pesquisa foi dividida em três etapas: Etapa 1 - os participantes permaneceram em uso habitual do sal de cozinha, durante sete dias; Etapa 2 - os participantes fizeram uso exclusivo de cinco gramas de sal por dia, durante 10 dias; Etapa 3 - os participantes usaram exclusivamente o sal de ervas para o preparo das refeições, durante 10 dias. Em todas as etapas, foi realizada a Monitorização Residencial da Pressão Arterial (MRPA) e a dosagem de sódio urinário. As análises descritivas foram realizadas por meio do pacote estatístico IBM Statistical Package for Social Science - SPSS®, versão 25.0. O teste ANOVA foi utilizado para comparações entre as médias pareadas. Os resultados foram expressos como valores médios, desvio padrão (dp), mínimo, máximo e mediana. Para diferença estatística foi considerado p<0,05. Participaram do estudo 24 indivíduos, com idade média de 63,2 ± 10 anos, a maioria mulheres (54,2%), que convivem com companheiro (70,8%), de cor da pele autodeclarada branca (54,2%), com média de 7,6 anos de estudo e aposentados (45,8%). Em relação às variáveis clínicas, houve predomínio de participantes com pressão arterial ótima (45,8%), na categoria sobrepeso (45,8%), com risco cardiovascular elevado segundo relação cintura-estatura (87,5%) e risco muito elevado de acordo com a medida da circunferência da cintura (54,1%); 62,5% se mostraram aderentes ao tratamento. Na comparação entre as três etapas, observou-se redução significante nos valores de Pressão Arterial Sistólica (p=0,003) e Pressão Arterial Diastólica (p=0,001), sem diferença nas variáveis consumo de sal (p=0,66) e excreção de sódio urinário (p=0,66). Ainda que o uso do sal de ervas seja uma estratégia não medicamentosa interessante e inovadora para o controle da pressão arterial, os participantes não aderiram de forma expressiva à intervenção proposta. De qualquer forma, salienta-se que a monitorização do consumo de sódio é primordial para a avaliação do uso do sal pela população, tendo em vista a implementação de medidas visando a redução da pressão arterial e a prevenção de eventos cardiovasculares.

The present research aimed to analyze the effects of replacing table salt with herbal salt on blood pressure values and urinary sodium excretion in people with hypertension. This study has a quantitative approach and quasi-experimental design, "cross-over" type, with a sample of hypertensive patients registered in three public health units in a municipality in the state of Mato Grosso. Data collection was carried out from May 2020 to May 2022. Through an interview, the questionnaire to identify sociodemographic variables and the "Medication Adherence Questionnaire - Qualiaids" (QAM-Q) were applied. Subsequently, anthropometric assessment and casual blood pressure measurements were performed. The research was divided into three stages: Stage 1 - the participants kept the usual use of table salt for seven days; Stage 2 - participants made exclusive use of five grams of salt per day for ten days; Stage 3 - participants used only herbal salt to prepare meals for 10 days. Residential blood pressure monitoring and urinary sodium measurement were performed at all stages. Descriptive analyzes were performed using the IBM Statistical Package for Social Science - SPSS® program, version 25.0. The One Way test was used for comparisons between the paired mean values. Results were expressed as mean values, standard deviation (sd), minimum, maximum, and median. For statistical difference, p<0.05 was considered. Participated in the research 24 individuals, with a mean age of 63.2 ± 10 years, most of them was women (54.2%), who live with a partner (70.8%), self-declared white skin color (54.2%), with an average of 7.6 years of formal education and retired (45.8%). Regarding clinical variables, it was observed a predominance of participants with optimal blood pressure (45.8%), in the overweight category (45.8%), with high cardiovascular risk according to the waist-to-height ratio (87.5%), and very high risk according to waist circumference measurement (54.1%), 62.5% were adherent to the treatment. When comparing the three stages, there was a significant reduction in the values of systolic blood pressure (p=0.003) and diastolic blood pressure (p=0.001), with no difference in the variables salt consumption (p=0.66) and urinary sodium excretion (p=0.66). Although the use of herbal salt is an interesting and innovative non-drug strategy for blood pressure control, participants did not significantly adhere to the proposed intervention. Nevertheless, it should be noted that the monitoring of sodium consumption is essential for the evaluation of the use of salt by the population and to implement measures aimed at reducing blood pressure and preventing cardiovascular events.

Autocuidado para hipertensos: desenvolvimento de um e-book como material educativo / Self-care to hipertensives: development of an e-book as an educative material

Objetivo: apresentar o desenvolvimento do material educativo intitulado "Auto-cuidado para Hipertensos: um guia para cuidar da sua saúde". Métodos: este material foi desenvolvido com base nas orientações para construção de materiais de orientação para o cuidado em saúde, teve como ponto de partida o estudo multicêntrico: "Efetividade de uma estratégia NUtricional para controle PRESSórico em pacientes com hipertensão arterial sistêmica usuários do Sistema Único de Saúde: estudo NUPRESS". Para a elaboração do material foi feito um levantamento bibliográfico. Em seguida, foi realizada a escrita dos temas abordados em forma de capítulos e, por último, foi montada a parte gráfica. Quando finalizado, o e-book foi enviado a 10 juízes que o avaliaram e validaram conforme a sua organização, estilo da escrita, aparência e apelo do material. Foram aceitas as sugestões dos juízes e realizadas as alterações. Resultados: os juízes (n=10), com média de idade de 43,7±17,6 anos e sendo 70% do sexo feminino, avaliaram em sua maioria, com concordância que o conteúdo do e-book possuía boa organização e aparência. Já os domínios de estilo de escrita e apelo foram os que apresentaram menor percentual de concordância entre os juízes, embora tenham obtido uma aprovação de 83,3% em cada dimensão. Conclusões: o e-book desenvolvido pode ser utilizado tanto por profissionais da saúde quanto por pessoas com hipertensão com o propósito de educação sobre a doença, saúde e autocuidado. O material tem linguagem objetiva e de fácil compreendimento, sem usar termos técnicos, além disso foram utilizados recursos gráficos para cativar e facilitar a leitura.

Aims: to present the development of the educational material entitled: "Autocuidado para Hipertensos: um guia para cuidar da sua saúde". Methods: this material was developed based on the guidelines for the construction of orientation materials for health care, taking as its starting point the multicenter study: "Effectiveness of a NUTRITION strategy for PRESSURE control in patients with systemic arterial hypertension users of the Unified Health System: NUPRESS study". For the elaboration of the material, a bibliographical surveywas made, then the themes were written in chapters, and finally, the graphic part was assembled. When finished, the e-book was sent to 10 judges who evaluated and validated it according to its organization, writing style, appearance, and appeal. The judges' suggestions were accepted, and the changes were made. Results: the judges (n=10), with a mean age of 43.7±17. 6 years and wich 70% were female, mostly agreed that the E-book content had good organization and appearance. The domains of writing style and appeal, on the other hand, presented the lowest percentage of agreement among the judges, although they obtained 83.3% approval in each dimension. Conclusions: the e-book developed can be used both by health professionals and people with hypertension for the purpose of education about the disease, health and self-care. The material has an objective and easy-to-understand language, without using technical terms, and graphic resources were used to captivate and facilitate reading.

Building capacity in reducing population dietary sodium intake in the Americas / Creación de capacidad para reducir la ingesta de sodio en los alimentos a nivel de la población en la Región de las Américas / Desenvolvimento de capacidade para a redução da ingestão alimentar de sódio pela população das Américas

ABSTRACT Objective. To present some resources developed as part of the technical support of the Pan American Health Organization (PAHO) to Member States to reduce population dietary sodium intake, and to discuss the main challenges and opportunities to accelerate action toward sodium intake reduction in the Americas. Methods. Sources of information include a mapping of salt reduction policies conducted in 2019, reports from working group meetings, interviews conducted in 2020 and 2021 in seven countries, and technical documents developed around the Updated PAHO Regional Sodium Reduction Targets. Results. These tools show that, despite progress, challenges to succeed in this agenda persist. Priority given to sodium reduction is low in most countries, with insufficient resource allocation. There is a lack of intersectoral coordinated action, and a systemic approach to food systems is commonly missing. Surveillance mechanisms of sodium intake are insufficient, and industry interference in policy processes is commonly identified, undermining policy progress and success. There are also important regional opportunities to address these challenges. These include common ground for future collaborations by updating, strengthening, and complementing these existing tools, and technical and financial support for data generation. Conclusions. PAHO is committed to continue to support countries in the process of promoting, implementing, and monitoring cost-effective sodium reduction interventions. One key policy priority in this agenda is the adoption of the Updated PAHO Regional Sodium Reduction Targets with a mandatory approach, together with the comprehensive and complementary implementation of other strategies. Strong political will and commitment of countries will be critical to translate goals into concrete achievements in the Americas.

RESUMEN Objetivo. Presentar algunos recursos elaborados como parte del apoyo técnico brindado por la Organización Panamericana de la Salud (OPS) a los Estados Miembros para reducir la ingesta de sodio en los alimentos a nivel de la población y abordar los principales desafíos y oportunidades para acelerar las medidas de reducción de la ingesta de sodio en la Región de las Américas. Métodos. Entre las fuentes de información se encontraron un mapeo de las políticas de reducción de la sal realizado en el 2019, varios informes de reuniones de grupos de trabajo, entrevistas realizadas en siete países entre el 2020 y el 2021, y documentos técnicos acerca de las metas regionales actualizadas de la OPS para la reducción del sodio. Resultados. Estas herramientas muestran que, a pesar de los avances, persisten los desafíos en el logro de esta agenda. La prioridad dada a la reducción del sodio en la mayoría de los países es baja y la asignación de recursos es insuficiente. No hay coordinación intersectorial y por lo general no se adopta un enfoque sistémico para los sistemas alimentarios. Los mecanismos de vigilancia de la ingesta de sodio son insuficientes y es común que haya interferencia de la industria en los procesos que siguen las políticas, lo que socava su progreso y éxito. Hay importantes oportunidades regionales para abordar estos desafíos, como un terreno común para futuras colaboraciones mediante la actualización, el fortalecimiento y la complementación de las herramientas existentes, y el apoyo técnico y financiero para la generación de datos. Conclusiones. La OPS mantiene su compromiso de seguir apoyando a los países en el proceso de promoción, ejecución y seguimiento de intervenciones costo-eficaces para la reducción del sodio. Una prioridad política clave en esta agenda es la adopción con carácter obligatorio de las metas regionales actualizadas de la OPS para la reducción del sodio, junto a la ejecución integral y complementaria de otras estrategias. Una fuerte voluntad política y el compromiso de los países serán fundamentales para traducir estos objetivos en logros concretos en la Región de las Américas.

RESUMO Objetivo. Apresentar alguns recursos desenvolvidos como parte do apoio técnico da Organização Pan-Americana da Saúde (OPAS) aos Estados Membros para reduzir a ingestão alimentar de sódio pela população e discutir os principais desafios e oportunidades para acelerar as ações em prol da redução da ingestão de sódio nas Américas. Métodos. As fontes de informação incluem um mapeamento das políticas de redução de sal realizado em 2019, relatórios de reuniões do grupo de trabalho, entrevistas realizadas em 2020 e 2021 em sete países e documentos técnicos relativos às Metas regionais atualizadas da OPAS para a redução do sódio. Resultados. Essas ferramentas mostram que, apesar dos progressos, os desafios para o êxito dessa agenda persistem. Na maioria dos países, a prioridade dada à redução do sódio é baixa, com alocação insuficiente de recursos. Não há ação coordenada intersetorial e, em geral, nem abordagem sistêmica dos sistemas alimentares. Os mecanismos de vigilância da ingestão de sódio são insuficientes e é comum haver interferência da indústria nos processos políticos, o que prejudica o avanço e o êxito das políticas. Há também importantes oportunidades regionais para enfrentar esses desafios, como um consenso para futuras colaborações por meio da atualização, do fortalecimento e da complementação das ferramentas existentes, além de apoio técnico e financeiro para a geração de dados. Conclusões. A OPAS está empenhada em continuar apoiando os países no processo de promoção, implementação e monitoramento de intervenções de redução do sódio com boa relação custo-benefício. Uma prioridade política decisiva nessa agenda é a adoção das Metas regionais atualizadas da OPAS para a redução do sódio, com aplicação obrigatória, associada à implementação ampla e complementar de outras estratégias. A firmeza de vontade e o compromisso político dos países será crucial para materializar os objetivos nas Américas.

Efeitos do sal de ervas sobre a pressão arterial e a excreção de sódio urinário de pessoas com hipertensão / Effects of herbal salt on blood pressure and urinary sodium excretion in people with hypertension

A presente pesquisa teve por objetivo analisar os efeitos da substituição do sal de cozinha por sal de ervas sobre os valores de pressão arterial e excreção de sódio urinário de pessoas com hipertensão arterial. Trata-se de um estudo de abordagem quantitativa e delineamento quasi-experimental, tipo "cross-over", com amostra de hipertensos cadastrados em três unidades públicas de saúde de um município do estado de Mato Grosso. A coleta de dados foi realizada no período de maio de 2020 a maio de 2022. Por meio de entrevista, foi aplicado o questionário para identificação das variáveis sociodemográficas e o "Questionário de Adesão a Medicamentos - Qualiaids" (QAM-Q). Posteriormente, foi realizada a avaliação antropométrica e a medida casual da pressão arterial. A pesquisa foi dividida em três etapas: Etapa 1 - os participantes permaneceram em uso habitual do sal de cozinha, durante sete dias; Etapa 2 - os participantes fizeram uso exclusivo de cinco gramas de sal por dia, durante 10 dias; Etapa 3 - os participantes usaram exclusivamente o sal de ervas para o preparo das refeições, durante 10 dias. Em todas as etapas, foi realizada a Monitorização Residencial da Pressão Arterial (MRPA) e a dosagem de sódio urinário. As análises descritivas foram realizadas por meio do pacote estatístico IBM Statistical Package for Social Science - SPSS®, versão 25.0. O teste ANOVA foi utilizado para comparações entre as médias pareadas. Os resultados foram expressos como valores médios, desvio padrão (dp), mínimo, máximo e mediana. Para diferença estatística foi considerado p<0,05. Participaram do estudo 24 indivíduos, com idade média de 63,2 ± 10 anos, a maioria mulheres (54,2%), que convivem com companheiro (70,8%), de cor da pele autodeclarada branca (54,2%), com média de 7,6 anos de estudo e aposentados (45,8%). Em relação às variáveis clínicas, houve predomínio de participantes com pressão arterial ótima (45,8%), na categoria sobrepeso (45,8%), com risco cardiovascular elevado segundo relação cintura-estatura (87,5%) e risco muito elevado de acordo com a medida da circunferência da cintura (54,1%); 62,5% se mostraram aderentes ao tratamento. Na comparação entre as três etapas, observou-se redução significante nos valores de Pressão Arterial Sistólica (p=0,003) e Pressão Arterial Diastólica (p=0,001), sem diferença nas variáveis consumo de sal (p=0,66) e excreção de sódio urinário (p=0,66). Ainda que o uso do sal de ervas seja uma estratégia não medicamentosa interessante e inovadora para o controle da pressão arterial, os participantes não aderiram de forma expressiva à intervenção proposta. De qualquer forma, salienta-se que a monitorização do consumo de sódio é primordial para a avaliação do uso do sal pela população, tendo em vista a implementação de medidas visando a redução da pressão arterial e a prevenção de eventos cardiovasculares

The present research aimed to analyze the effects of replacing table salt with herbal salt on blood pressure values and urinary sodium excretion in people with hypertension. This study has a quantitative approach and quasi-experimental design, "cross-over" type, with a sample of hypertensive patients registered in three public health units in a municipality in the state of Mato Grosso. Data collection was carried out from May 2020 to May 2022. Through an interview, the questionnaire to identify sociodemographic variables and the "Medication Adherence Questionnaire - Qualiaids" (QAM-Q) were applied. Subsequently, anthropometric assessment and casual blood pressure measurements were performed. The research was divided into three stages: Stage 1 - the participants kept the usual use of table salt for seven days; Stage 2 - participants made exclusive use of five grams of salt per day for ten days; Stage 3 - participants used only herbal salt to prepare meals for 10 days. Residential blood pressure monitoring and urinary sodium measurement were performed at all stages. Descriptive analyzes were performed using the IBM Statistical Package for Social Science - SPSS® program, version 25.0. The One Way test was used for comparisons between the paired mean values. Results were expressed as mean values, standard deviation (sd), minimum, maximum, and median. For statistical difference, p<0.05 was considered. Participated in the research 24 individuals, with a mean age of 63.2 ± 10 years, most of them was women (54.2%), who live with a partner (70.8%), self-declared white skin color (54.2%), with an average of 7.6 years of formal education and retired (45.8%). Regarding clinical variables, it was observed a predominance of participants with optimal blood pressure (45.8%), in the overweight category (45.8%), with high cardiovascular risk according to the waist-to-height ratio (87.5%), and very high risk according to waist circumference measurement (54.1%), 62.5% were adherent to the treatment. When comparing the three stages, there was a significant reduction in the values of systolic blood pressure (p=0.003) and diastolic blood pressure (p=0.001), with no difference in the variables salt consumption (p=0.66) and urinary sodium excretion (p=0.66). Although the use of herbal salt is an interesting and innovative non-drug strategy for blood pressure control, participants did not significantly adhere to the proposed intervention. Nevertheless, it should be noted that the monitoring of sodium consumption is essential for the evaluation of the use of salt by the population and to implement measures aimed at reducing blood pressure and preventing cardiovascular events

Impact of the Dietary Approaches to Stop Hypertension (DASH) diet on glycaemic control and consumption of processed and ultraprocessed foods in pregnant women with pre-gestational diabetes mellitus: a randomised clinical trial.

The aim of this study was to evaluate the impact of the Dietary Approaches to Stop Hypertension (DASH) diet on glycaemic control and consumption of processed (PF) and ultraprocessed (UPF) foods in pregnant women with pre-gestational diabetes mellitus (PGDM). This is a randomised, controlled, single-blind clinical trial with forty-nine adult women with PGDM, followed at a public maternity hospital in Rio de Janeiro, Brazil. The control group (CG) received a standard diet consisting of 45-55 % of the total energy intake of carbohydrates, 15-20 % of proteins and 25-30 % of lipids. The DASH group (DG) received an adapted DASH diet, which did not differ from the standard diet in the percentage of macronutrients, but had higher contents of fibre, unsaturated fats and minerals such as Ca, Mg and K; and lower contents of Na and saturated fats than the standard diet. In the analysis by protocol, the DG presented a higher incidence of glycaemic control after 12 weeks of intervention (57·1 v. 8·3 %, P = 0·01, moderate effect size) and a lower mean consumption of UPF (-9·9 %, P = 0·01) compared with the CG. There was no statistically significant difference in fasting and postprandial blood glucose concentrations, or in the consumption of PF between the groups (P > 0·05). The DASH diet may be a strategy for glycaemic control in pregnant women with PGDM, favouring the adoption of a nutritionally adequate diet with lower consumption of UPF. Further studies are needed to investigate the effect of the DASH diet on glycaemic profile, and maternal and perinatal outcomes in women with PGDM.

Association between DASH diet (Dietary Approaches to Stop Hypertension) and hypertension in adolescents: A cross-sectional school-based study.

BACKGROUND & AIMS: The DASH diet (Dietary Approaches to Stop Hypertension) is considered a healthy dietary pattern, and is recommended for the control of arterial hypertension (AH). However, its role in the adolescent population needs to be better investigated and clarified. The aim of this study is to identify the association between AH and the DASH diet score in a representative sample of Brazilian adolescents. METHODS: A cross-sectional study using data from a national, multicenter and schoolbased probabilistic sample of 71,553 Brazilian adolescents who had their blood pressure (BP) measured and completed a 24-hour dietary recall (2013-2014). The components of the DASH score were assessed. Logistic regression models were used to evaluate the association between AH, anthropometric and sociodemographic variables, and the tertile of the DASH score. RESULTS: Approximately 11% of the adolescents who were in the 3rd tertile of the DASH score presented AH, 18% were overweight and 9% were obese. Among the components of the score, the highest intake was sugar-sweetened beverages (92.1%), legumes and oilseeds (68.2%), red and processed meat (64.5%) and the lowest were low-fat dairy (2.2%), whole grains (11.6%) and fruits (18.1%). Sodium intake was above the maximum recommended in all tertiles. CONCLUSIONS: A small proportion of Brazilian adolescents consume foods from the DASH diet. No associations were found between this dietary pattern and AH. Strategies to increase the intake of protective foods in adolescents must be investigated as well as the potential health benefits of the standard DASH diet for this age group over time.

Adherence to the Dietary Approaches to Stop Hypertension (DASH) and hypertension risk: results of the Longitudinal Study of Adult Health (ELSA-Brasil).

We investigated whether high adherence to the Dietary Approaches to Stop Hypertension (DASH) diet was independently associated with lower risk of incident hypertension. Participants included 5632 adults, without hypertension at the baseline (2008-2010) of the Longitudinal Study of Adult Health, who took part in the second follow-up visit (2012-2014). Adherence to the DASH diet was estimated at baseline using a score based on eight food items (final scores from 8 to 40 points) and was categorised as high adherence (≥30 points, or ≥75 %) and low adherence (<75 %; reference). Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥90 mmHg, or use of antihypertensive drugs. The association between adherence to the DASH diet and the risk of incident hypertension was estimated using Cox regression models adjusted by covariates. In total, 780 new cases of hypertension (13·8 %) were identified in about 3·8-year follow-up. Participants with high adherence to the DASH diet had 26 % lower risk of hypertension (hazard ratio (HR) 0·74; 95 % CI 0·57, 0·95) after adjustment for socio-demographic characteristics, health-related behaviours, diabetes and family history of hypertension. The HR reduced to 0·81 (95 % CI 0·63, 1·04) and was of borderline statistical significance after adjustment for BMI, suggesting that lower body weight explains about 10 % of the association between high adherence to the DASH diet and hypertension risk reduction. The results indicate that high adherence to the DASH diet lowered the risk of hypertension by one-fourth over a relatively short follow-up period.

Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern Is Associated with Reduced Incidence of Metabolic Syndrome in Children and Adolescents.

OBJECTIVE: To assess the association of adherence to Dietary Approaches to Stop Hypertension (DASH)-style diet with development of metabolic syndrome (MetS) in children and adolescents. STUDY DESIGN: Dietary data were collected using a valid and reliable food frequency questionnaire among 425 healthy subjects, aged 6-18 years. MetS was defined as the presence of at least 3 of the following according to the Cook criteria: waist circumference ≥90th percentile for sex and age according to national reference curves; systolic blood pressure and/or diastolic blood pressure ≥90th percentile for sex, age, and height; fasting plasma glucose ≥100 mg/dL; triglycerides ≥110 mg/dL; and high-density lipoprotein cholesterol <40 mg/dL. The DASH-style diet score was assessed based on 8 components: high intakes of whole grain, vegetables, fruits, nuts, legumes; moderate amounts of low-fat dairy products; and low intake of red and processed meat, sweetened beverages, and sodium. Multivariable logistic regression models were used to estimate the OR and 95% CI after 3.6 years of follow-up for developing MetS in each quartile of DASH score after adjustment for baseline confounders. RESULTS: Mean ± SD for age and DASH score were 13.6 ± 3.7 years and 24.1 ± 4.3, respectively, at baseline. The OR (95% CI) of developing MetS in the highest, compared with the lowest, quartile of DASH score was 0.36 (0.14-0.94) with a linear decreasing trend (P for trend = .023). Also, incidence of hypertension, high fasting plasma glucose, and abdominal obesity decreased with higher adherence to DASH diet (P < .05 for all). CONCLUSIONS: Our findings indicate the relationship of adherence to DASH-style diet with MetS and some of its components in both children and adolescents.