Abstract
Background
Obesity treatment focuses primarily on reducing overall caloric intake with limited
focus on improving diet quality. The Dietary Approaches to Stop Hypertension (DASH)
dietary pattern is effective in managing hypertension and other chronic conditions,
yet it is not clear whether behavioral weight control interventions improve DASH adherence.
We conducted a post hoc analysis of a behavioral weight loss intervention that did
not emphasize diet quality and examined whether the intervention impacted DASH adherence
in medically vulnerable community health center patients.
Methods
Participants (n=306) were enrolled in Track, a randomized controlled weight loss intervention
for patients with elevated cardiovascular risk. The trial compared usual care to an
intervention with weekly self-monitoring, tailored feedback on diet and exercise goals,
and dietitian and provider counseling in community health centers. Dietary intake
was measured using the Block Food Frequency Questionnaires collected at baseline and
12 months. DASH adherence was determined using previously validated scoring indices
that assessed adherence based on recommended nutrient or food group targets. Total
scores for both indices ranged from 0 to 9, with higher scores indicating greater
DASH adherence.
Results
The mean (and standard deviation [SD]) age of participants was 51.1 (SD=8.8) years
and the mean body mass index was 35.9 (SD=3.9). Most were female (69%) and black (51%);
13% were Hispanic. Half (51%) had an annual income <$25,000 and 33% had both diabetes
and hypertension. At baseline, the mean DASH nutrient score was 1.81 (SD=1.42) with
6% achieving at least a score of 4.5. Similar scores were seen for the DASH foods
index. The intervention group saw significantly greater, albeit small, improvements
in mean DASH nutrient score (intervention: 1.28 [SD=1.5] vs control: 0.20 [SD=1.3];
P<0.001), and there was no difference in DASH food score between study arms. There
were no significant predictors of change in DASH score and no association between
DASH adherence and changes in blood pressure. Within the intervention arm, improvements
in DASH nutrient score were associated with greater weight loss (r=−0.28; P=0.003).
Conclusion
Although the intervention was not designed to increase adoption of DASH, the Track
intervention produced significant weight loss and small improvements in DASH adherence.
Despite these small improvements, overall adoption of DASH was poor among the medically
vulnerable patients enrolled in Track. To further reduce chronic disease burden, weight
loss interventions should include a focus on both caloric restriction and increasing
diet quality.
Keywords
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Biography
D. Steinberg is an associate professor, Duke University School of Nursing, Durham, NC, and the associate director, Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC.
Biography
M. Kay is a postdoctoral associate, Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC, and the Duke Center for Childhood Obesity Research, Durham, NC.
Biography
J. Burroughs is a registered dietitian and clinical research coordinator, Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC.
Biography
L. P. Svetkey is director of clinical research, Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC, and a professor, Department of Medicine, Division of Nephrology, Duke University Medical Center, Durham, NC.
Biography
G. G. Bennett is director, Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, NC, and the Bishop-MacDermott Professor of Psychology, Global Health and Medicine, and vice provost for undergraduate education, Duke University, Durham, NC.
Article info
Publication history
Published online: March 21, 2019
Accepted:
December 18,
2018
Received:
April 12,
2018
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST D. Steinberg is a consultant with Omada Health. G. G. Bennett holds equity in Coeus Health and serves on the scientific advisory boards of Nutrisystem and Interactive Health. These organizations had no role in study design, data collection, data analysis, interpretation of data, writing of the report, or the decision to submit the article for publication. The remaining authors declare that they have no conflicting interests.
FUNDING/SUPPORT This trial is funded by the National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (R01DK093829). D. Steinberg is supported by the National Institutes of Health Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) Career Development Grant (K12HD043446). The funders had no role in study design, data collection, data analysis, interpretation of data, writing of the report, or the decision to submit the article for publication.
This study was registered at ClinicalTrials.gov, NCT01827800, on April 3, 2013.
All study activities were approved by the Duke University Institutional Review Board on May 20, 2012.
Identification
Copyright
© 2019 by the Academy of Nutrition and Dietetics.
