DASH膳食干预模式在体重管理中的应用

DASH 的独到之处
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
Subjects: 412 randomized 57% women 57% ethnic minority Systolic BP of 120‐159 mmHg Diastolic BP of 80‐95 mmHg 41% hypertensive
DASH‐Sodium Trial: Study Design
DASH II Sodium
134 132 130 Systolic 128 Blood 126 Pressure (mmHg) 124 122 120 118 High 3300 Intermediate 2400 Low 1500
Control DASH
Sodium Levels (mgNa)
DA 干预期（8周）： 1/3受试者继续美国饮食 1/3 受试者“蔬果膳食” 1/3 受试者吃设计的“降压降脂膳食”
DASH研究结果
收缩压平均下降5.5mmHg 舒张压平均下降3 mmHg 高血压者： 收缩压平均下降11.4 mmHg 舒张压平均下降5.5 mmHg 血总胆固醇平均下降14单位 （7%） LDL平均下降10.7 单位（9%） 尿钙流失减少，骨代谢改善
DASH Study Test Diets
2. Fruit and vegetable diet Similar to control diet in fat and protein content Included 8‐10 servings fruits and vegetables Calcium – 534 mg/day Potassium – 4101 mg/day Magnesium – 423 mg/day
DASH 研究设计
3‐week run‐in on control diet 8‐week randomization to one of three diets: Control Fruits and vegetables Combination: fruits, vegetables and low fat dairy products Energy intake adjusted to ensure constant weight Sodium content of all three diets was approximately 3000 mg/daily
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如何预防慢病、保持健康？
原则：管住嘴，迈开腿 具体如何实现？
管住嘴 •如何吃? 吃什么？ 不吃什么？ 为什么？
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对营养学家及临床医生提出的问题
Is there an optimal dietary pattern for individuals with the chronic conditions？ 是否能有一种膳食模式能够帮助预防和 控制慢性病？
DASH 研究者结论
Blood pressure reduction is rapid Blood pressure is comparable to drugs BP effect can be generalized to all Americans Dietary Ca/F&V effect independent of Sodium intake and weight change DASH has public health implications Preventive measure against hypertension Reduce stroke by 27% and CHD by 15%
Sodium levels: Lower: 1500 mg/day; Intermediate: 2400 mg/day; Higher: 3,300 mg/day
Lower Sodium Intermediate Sodium Control Diet, N = 204 Higher Sodium
北京
（健康白皮书, 2012) Age：18‐79
上海
超重 肥胖 高血压 > 15岁 > 45岁 糖尿病
36.5% 21% 33% 25% 50%
46%死因与 39.5% （男性） 高血压有关
11.2% （男性） 23.6% （成年人）
8.9% (18‐79 岁） 10% （成年人）
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体重增加与死亡率有直接关系
DASH膳食干预模式在体重 管理中的应用
王燕芳， MD, PhD, MHSc 教授 北京大学临床研究所
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主要内容
1. DASH 研究介绍：DASH膳食对高血压及其 他慢性病的有益作用 2. 如何应用DASH膳食模式改善健康 3. 介绍美国2010膳食指南：“我的盘子”
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慢性病流行状况：北京vs.上海
“DASH” 饮食介绍
Dietary Approaches to Stop Hypertension
（DASH) 采用饮食的方法来预防及控制高血压 台湾翻译为“得舒饮食”
The DASH Study
Part I Dietary Approaches to Stop Hypertension
L.J. Appel et al, New England Journal of Medicine; 366:1117‐1124, 1997
DASH Study Test Diets
3. Combination diet Similar to fruit and vegetable diet Low fat and cholesterol At least 3 servings of dairy foods Calcium – 1265 mg/day Potassium – 4415 mg/day Magnesium – 480 mg/day
Randomization
Control Diet DASH Diet, N = 208 Lower Sodium Run‐in: 11‐14 days Intermediate Sodium Higher Sodium
Intervention (Three 30‐day periods, random order)
DASH 受试者的基线特征特征
Systolic bp < 160 mm Hg Average was 132 mm Hg Diastolic bp 80‐95 mm Hg Average was 85 mm Hg 459 randomized 133 hypertensive 326 normotensive 22 years and older 50% women 29% untreated hypertensive Not currently taking hypertensive meds
DASH Study Test Diets
1. Control diet Modeled after the typical American diet 37% fat, 15% protein Calcium deficient – 443 mg/day Potassium – 1700 mg/day Magnesium – 165 mg/day
DASH 研究检验膳食设计
Designed to achieve distinct differences in the intakes of: Fiber Minerals Ca, K, and Mg Protein Total fat, saturated, poly and monounsaturated fat Cholesterol intake targeted to be lower in the combination diet.
Part II：DASH‐Sodium
Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet
Sacks, F.M., et al. New England Journal of Medicine. Jan 4, 2001
Part II Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet
Sacks, F.M., et al. New England Journal of Medicine; Jan 4, 2001
DASH饮食研究历史
DASH饮食研究项目是由美国NIH赞助，于1992‐1997年间由 多个研究单位联合执行的一项大型临床研究计划 主要目的是要研究如何使用饮食的方法来有效地降低血压 参加的单位： 1. Johns Hopkins University, MD 2. Duke University Medical Center, NC 3. Kaiser Permanente Center for Health Research, ON 4. Brigham and Women’s Hospital, Massachusetts 5. Pennington Biomedical Research Center, Louisiana