People who adhered to the DASH diet have a significantly lower risk of developing heart failure


The Dietary Approaches to Stop Hypertension (DASH) diet started in 1993 as a research study funded by the National Heart, Lung and Blood Institute (NHLBI) to determine if a specific diet could lower blood pressure and reduce its complications.

The DASH diet study, which lasted four years, examined the effects of three dietary patterns on a group of healthy Caucasian and African American and other minority men and women with an average age of 46 years and average blood pressure of less than 160/80–95 mm Hg.

African Americans and other minorities were to comprise about two-thirds of the study sample, and about 50 percent of the sample were to be female.

The three diets included a typical American diet, a typical American diet plus additional fruits and vegetables, and the DASH diet (see Tables 9-5 and Table 9-6) [54].

Table 9-5. The DASH Diet

Food GroupsDaily Servings and Serving SizesNutrients
Grains and grain products6 to 8 servings:Carbohydrates, fiber
1 slice bread, 1 ounce dry cereal, ½ cup cooked rice, pasta or cereal
Vegetables4 to 5 servings:Calcium, potassium, magnesium, fiber
1 cup raw leafy green vegetable, ½ cup cut-up raw or cooked vegetable, ½ cup vegetable juice
Fruits4 to 5 servings:Calcium, potassium, magnesium, fiber
1 medium fruit, ¼ cup dried fruit, ½ cup fresh, frozen or canned fruit, ½ cup fruit juice
Legumes, nuts, seeds4 to 5 servings per week:Protein, calcium, potassium, magnesium, fiber
⅓ cup or ½ ounce nuts, 2 tablespoons peanut butter, 2 tablespoons (½ ounce) seeds, ½ cup cooked legumes (dry beans), lentils, peas
Fat-free or low-fat dairy products2 to 3 servings:Protein, calcium, potassium, magnesium
1 cup dairy milk or yogurt, 1½ ounces cheese
Lean Meats, poultry, fishServing of 6 ounces or less:Protein, magnesium
1 ounce cooked lean meats, poultry or fish, 1 egg
Fats and oils2 to 3 servings:
1 teaspoon soft margarine, 1 teaspoon vegetable oil, 1 tablespoon mayonnaise, 2 tablespoons salad dressing
Mono- and polyunsaturated fats


Table 9-6. A Typical DASH Diet Daily Meal Plan

2 slices whole grain bread
1 tablespoon unsalted peanut butter
1 tablespoon all-fruit preserves
1 cup dairy skim milk
½ medium grapefruit
Salad3 ounces baked halibut
1 cup cooked brown rice
½ cup steamed broccoli
1 whole-grain roll
1 tablespoon reduced-fat butter
1 cup fresh berries
1 cup plain low-fat yogurt
3 gingersnaps
½ cup pineapple in own juice
3 cups fresh spinach leaves
1 medium tomato
½ cup reduced low-sodium garbanzo beans
Salad dressing
1 tablespoon olive oil
½ to 1 tablespoon lemon juice
12 unsalted whole-grain crackers
1 medium orange
1 cup dairy skim milk
DASH Diet ComponentsDASH Diet Servings
Grains and grain products9 (2 slices whole-grain bread, 12 whole-grain crackers, 1 cup cooked brown rice, 1 whole-grain roll, 3 gingersnaps)
Vegetables5 (3 cups fresh spinach, 1 medium tomato, ½ cup steamed broccoli)
Fruits5 (½ medium grapefruit, 1 medium orange, ½ cup pineapple in own juice, 1½ cups fresh berries)
Dairy foods (low-fat or fat-free)3 (2 cups dairy skim milk, 1 cup plain low-fat yogurt)
Meats, poultry, and fish1 (4 ounces baked halibut)
Legumes, nuts, and seeds2 (1 tablespoon peanut butter, ½ cup garbanzos)
Fats and oils2 (1 tablespoons olive oil, 1 tablespoon reduced-fat butter)
Sweets0 servings
Nutrition Facts:
1,947 total calories, 52% carbohydrates, 17% protein, 30% fat, 7% saturated fat, 5% polyunsaturated fat, 16% monounsaturated fat, 30.4 grams fiber, 94.8 milligrams cholesterol, 4,308 milligrams potassium, 2,054.1 milligrams sodium


All three groups consumed about 3,000 milligrams of salt daily, which was slightly less than the average US daily intake at the time of 3,600 to 4,000 milligrams. 

Caloric intake was similar for the three test groups.

Alcohol was limited in all the groups to one to two drinks a week.

The participants who added more fruits and vegetables to their diet and those who followed the DASH diet lowered their blood pressure the most.

Those who exclusively followed the DASH diet had the greatest reduction in blood pressure, especially if they had hypertension before the study.

The results also indicated that reducing sodium intake lowered blood pressure in both the typical American diet and the DASH diet groups.

The more sodium was reduced, the greater the fall in blood pressure. The biggest reduction was found in the group that followed the DASH diet at 1,500 milligrams of sodium daily.

Blood pressure decreased as much or more by dietary sodium restriction than any antihypertensive medication.

The researchers also concluded that the DASH diet may be more effective for African Americans than for Caucasians because they have a greater genetic disposition toward developing hypertension [50,51].

It should be noted that the original DASH diet did not require stringent sodium restriction or weight loss – two traditional dietary tools that may effectively control blood pressure.

Combining the original DASH diet with sodium restriction appears to be more effective than just dietary manipulation.

The DASH diet plan is low in total fat, saturated fats and cholesterol.

It features whole grains, vegetables, fruits and legumes, nuts and seeds, and low-fat dairy products. Meats, poultry and fish are minimized.

Sweets, added sugars and sugar-containing beveragesare lower compared to the typical American diet.

The diet is rich in calcium, magnesium, potassium, fiber, and other minerals and vitamins, and it supplies about 2,000 calories.

It can be adapted according to individualized needs.

The DASH diet daily meal plan in Table 9-6 is based on the DASH diet servings in Table 9-5.

A diet proven to have beneficial effects on high blood pressure also may reduce the risk of heart failure in people under age 75, according to a study led by researchers at Wake Forest School of Medicine, part of Wake Forest Baptist Health.

The observational study of more than 4,500 people showed that those individuals under 75 who most closely adhered to the DASH (Dietary Approaches to Stop Hypertension) diet had a significantly lower risk of developing heart failure than those whose eating habits were least in keeping with the diet.

The research is published in the current online issue of the American Journal of Preventive Medicine.

“Only a few prior studies have examined the effects of the DASH diet on the incidence of heart failure, and they have yielded conflicting results,” said the study’s lead author, Claudia L. Campos, M.D., associate professor of general internal medicine at Wake Forest School of Medicine.

“This research showed that following the DASH diet can reduce the risk of developing heart failure by almost half, which is better than any medicine.”

The DASH diet emphasizes the eating of fruits, vegetables, nuts, whole grains, poultry, fish, and low-fat dairy products while reducing consumption of salt, red meat, sweets and sugar-sweetened beverages.

It is similar to the Mediterranean diet but differs in recommending low-fat dairy products and excluding alcoholic beverages.

For the study the researchers reviewed the cardiovascular health records over 13 years of 4,478 men and women of multiple ethnicities from six U.S. sites who were between ages 45 and 84 with no history of cardiovascular disease when they were enrolled in the Multi-Ethnic Study of Atherosclerosis between 2000 and 2002.

The assessment of their dietary habits was based on their responses to a 120-item questionnaire covering the serving size and frequency of consumption of specific foods and beverages.

Using this data, the study team divided the participants into five groups, each representing 20 percent of the study population, based on how well (or poorly) their eating habits aligned with the DASH diet.

The risk of heart failure did not vary significantly by DASH compliance for the population as a whole, but it did for participants under 75, with those in the group with the highest DASH compliance group having an incidence rate 40 percent lower than those in the lowest compliance group.

“Heart failure is a frequent cause of hospitalization in older adults and is associated with substantial health care costs, so identifying modifiable risk factors for of heart failure is an important public health goal,” Campos said.

“This research provides a framework for further exploration of the DASH diet as an effective element in the primary prevention of heart failure.”

More information: Claudia L. Campos et al, Dietary Approaches to Stop Hypertension Diet Concordance and Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis, American Journal of Preventive Medicine (2019). DOI: 10.1016/j.amepre.2018.11.022
Journal information: American Journal of Preventive Medicine
Provided by Wake Forest University Baptist Medical Center


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