Читать книгу Textbook of Lifestyle Medicine - Labros S. Sidossis - Страница 100

The current recommendation for sodium intake is below 2000 mg/d (i.e., 5 g/d salt) to reduce BP and the risk of CVDs, stroke, and coronary heart disease.

Data from epidemiological prospective cohort studies suggest a synergistic effect when the DASH diet is combined with other healthy lifestyle measures. A healthy weight, half an hour or more of moderate‐ to high‐intensity physical activity per day, alcohol intake less than 10 g/d, minimal use of nonnarcotic analgesics, and at least 400 μg/d supplemental intake of folic acid have been associated with lower risk for developing hypertension. In the Nurses’ Health Study of 83,882 adult women aged 27–44 years, the adherence to the DASH diet, combined with improvements in several lifestyle parameters, was associated with lower risk for the development of hypertension.

Findings from the China Health and Nutrition Survey (CHNS) revealed that, after 11 years of follow‐up, three factors were robustly linked to low hypertension prevalence: high adherence to the DASH diet, a healthy body weight, and at least half an hour of daily physical activity of moderate to high intensity. The combination of these lifestyle factors was associated with 38% reduced likelihood of developing hypertension among women and 43% among men.

Several alternatives to the original DASH dietary pattern have been developed to control BP and improve other health parameters. A similar reduction in BP is observed between a high‐fat DASH diet (HF‐DASH) and the original DASH diet; however, plasma triglyceride and very low‐density lipoprotein (VLDL) concentrations decrease more in the HF‐DASH diet, compared to the DASH diet, without any significant changes in LDL cholesterol. An alternative DASH diet, where the main protein source (55% of total proteins) is lean pork (DASH‐P), instead of chicken and fish found in the typical DASH diet (DASH‐CF), shows similar results.

Apart from its positive effect on hypertension, the DASH dietary pattern seems to also have positive effects on several other chronic diseases. This might be due to its high content in some bioactive compounds (such as fiber, vitamins, minerals, trace elements, and phytochemicals) found in whole grains, fruits, and vegetables, combined with its low content in harmful compounds found in processed meat and sugary beverages. The DASH diet has been suggested to have antioxidant, anti‐atherogenic, anti‐inflammatory, antiproliferative, and anti‐tumor properties. Indeed, it has been inversely associated with the risk of CVD, chronic kidney disease (CKD), and several types of cancer. There is also evidence for beneficial effects of the DASH diet on lipid profile, insulin sensitivity, inflammation, and oxidative stress. Most importantly, even modest adherence to the DASH diet has been associated with lower risk of all‐cause mortality, while increasing the adherence to the diet also seems to strengthen this risk‐reducing association.