Abstract
Objective
To examine the influence of the PREMIER study lifestyle interventions on dietary intakes
and adherence to the Dietary Approaches to Stop Hypertension (DASH) dietary pattern
and the Dietary Reference Intakes (DRI).
Design
An 18-month multicenter, randomized controlled trial comparing two multicomponent
lifestyle intervention programs to an advice only control group.
Subjects/setting
A total of 810 participants were recruited from local communities and randomized into
the study. Individuals were eligible if they were aged 25 years or older, had body
mass index between 18.5 and 45.0, not taking antihypertensive medication, and had
prehypertension or stage 1 hypertension (systolic blood pressure 120 to 159 mm Hg
and diastolic blood pressure 80 to 95 mm Hg).
Intervention
The two active intervention programs were a behavioral lifestyle intervention that
implements established recommendations, and an established intervention plus the DASH
dietary pattern. Both interventions consisted of intensive group and individual counseling
sessions. The control group received a brief advice session after randomization and
again after 6 months of data collection. Dietary intakes were collected by two random
24-hour recalls at baseline, 6 months, and 18 months.
Main outcome measures
The primary outcome of the PREMIER study was change in systolic blood pressure at
6 months. The main outcomes examined here include dietary variables collected by 24-hour
recall at each time point.
Statistical analyses
Nutrient intakes were calculated and compared among the time points and the three
intervention groups using mixed models with repeated measures at 6 and 18 months.
Proportion of participants who met or achieved the original DASH nutrient intake levels
and the DRIs were calculated and compared among the three intervention groups. P<0.01 was considered statistically significant.
Results
Participants in both the established intervention and established intervention plus
DASH dietary pattern groups substantially reduced energy, total fat, saturated fat,
and sodium intake and these reductions persisted throughout the study. Established
intervention plus DASH dietary pattern group participants increased intakes of fruits,
vegetables, dairy, and many vitamins and minerals; these increases were significantly
greater than that of the control and established intervention groups. A majority of
established intervention plus DASH dietary pattern group participants achieved at
least two thirds of the DRI recommendations for most nutrients at 6 months, despite
their reduction in total energy intake. Some but relatively small recidivism occurred
at 18 months.
Conclusions
Both the established intervention and established intervention plus DASH dietary pattern
group intervention were effective in helping participants follow established recommendations
to control blood pressure. The advice-only control group also made some behavior changes,
mainly decreasing energy and sodium intake. Only the established intervention plus
DASH dietary pattern group significantly increased intakes of DASH-specific food groups,
including fruits, vegetables, and dairy products, and nutrients, including protein,
fiber, calcium, potassium, and magnesium. Most of the increases did not reach the
levels consumed in the original DASH feeding studies. Whereas the established intervention
plus DASH dietary pattern group intervention provides a useful platform to achieve
the DASH dietary pattern and current DRI recommendations, intervention enhancements,
including a greater emphasis on nutrient-dense foods, would likely improve this intervention.
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References
- A clinical trial of the effects of dietary patterns on blood pressure.N Engl J Med. 1997; 336: 1117-1124
- National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report.JAMA. 2003; 289: 2560-2572
Brief summary: Dietary Guidelines for Americans, 2005. Available at: http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=6417. Accessed June 18, 2007.
- Descriptive characteristics of the dietary patterns used in the Dietary Approaches to Stop Hypertension Trial.J Am Diet Assoc. 1999; 99: S19-S27
US Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. Your Guide to Lowering Your Blood Pressure with DASH. Available at: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf. Accessed June 18, 2007.
- Premier: A clinical trial of comprehensive lifestyle modification for blood pressure control: Rationale, design and baseline characteristics.Ann Epidemiol. 2003; 13: 462-471
- Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline.National Academies Press, Washington, DC1998
- Effects of comprehensive lifestyle modification on blood pressure control: Main results of the PREMIER clinical trial.JAMA. 2003; 289: 2083-2093
- PREMIER—A trial of lifestyle interventions for blood pressure control: Intervention design and rationale.Health Promot Pract. 2006; (June 27)
- The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.Arch Intern Med. 1997; 157: 2413-2446
- Social Foundations of Thought and Action: A Social Cognitive Theory.Prendice-Hall, Englewood Cliffs, NJ1986
- Self-Directed Behavior: Self-Modification for Personal Adjustment.5th ed. Brooks/Cole, Pacific Grove, CA1989
- Motivational Interviewing, Preparing People for Change.2nd ed. The Guilford Press, New York, NY2002
- Stages and processes of self-change of smoking: Toward an integrative model of change.J Consult Clin Psychol. 1983; 51: 390-395
- The treatment and prevention of obesity: A systematic review of the literature.Int J Obes Relat Metab Disord. 1997; 21: 715-737
- Compliance with cardiovascular disease prevention strategies: A review of the research.Ann Behav Med. 1997; 19: 239-263
- How effective are traditional dietary and exercise interventions for weight loss?.Med Sci Sports Exerc. 1999; 31: 1129-1134
- Dietary intake of selected minerals for the United States population: 1999-2000.Adv Data. 2004; (April 27): 1-5
- Food group sources of nutrients in the dietary patterns of the DASH-Sodium trial.J Am Diet Assoc. 2003; 103: 488-496
- Intake of alpha-tocopherol is limited among US adults.J Am Diet Assoc. 2004; 104: 567-575
- Dietary variety increases the probability of nutrient adequacy among adults.J Nutr. 2004; 134: 1779-1785
- Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and the Carotenoids.National Academies Press, Washington, DC1997
- Increasing vegetable and fruit intake: Randomized intervention and monitoring in an at-risk population.Cancer Epidemiol Biomarkers Prev. 2000; 9: 307-317
- The 2005 Dietary Guidelines Advisory Committee: Developing a key message.J Am Diet Assoc. 2005; 105: 1418-1424
- Nutritional Epidemiology.Oxford University Press, New York, NY1998
- Comparison of multiple-pass 24-hour recall estimates of energy intake with total energy expenditure determined by the doubly labeled water method in young children.J Am Diet Assoc. 1996; 96: 1140-1144
Biography
P.-H. Lin is an associate research professor, Department of Medicine, Duke University Medical Center, Durham, NC.
Biography
L. J. Appel is a professor, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD.
Biography
K. Funk and S. Craddick are research associates, C. Chen and P. Elmer are senior scientists, and M. McBurnie is an investigator, Kaiser Permanente Center for Health Research, Portland, OR.
Biography
C. Champagne is a research professor, Pennington Biomedical Research Center, Baton Rouge, LA.
Article info
Publication history
Published online: July 28, 2007
Identification
Copyright
© 2007 American Dietetic Association. Published by Elsevier Inc. All rights reserved.
