Hyerang Kim, PhD Postdoctoral Fellow, School of Nursing, Johns Hopkins University, Baltimore, Maryland. Hee-Jung Song, PhD Assistant Scientist, School of Nursing, Johns Hopkins University, Baltimore, Maryland. Hae-Ra Han, PhD, RN, FAAN Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland. Kim B. Kim, PhD CEO/President, Korean Resource Center, Ellicott City, Maryland. Miyong T. Kim, PhD, RN, FAAN Professor, School of Nursing, Bloomberg School of Public Health, and School of Medicine, Johns Hopkins University, Baltimore, Maryland.
J Cardiovasc Nurs. 2013 Nov-Dec;28(6):514-23. doi: 10.1097/JCN.0b013e318262c0c1.
Lifestyle modification strategies such as adoption of the Dietary Approaches to Stop Hypertension (DASH) diet are now recognized as an integral part of high blood pressure (HBP) management. Although the high prevalence of HBP among Korean Americans (KAs) is well documented, few dietary interventions have been implemented in this population, in part because of a lack of culturally relevant nutrition education guidelines. Translating and testing the efficacy of culturally relevant dietary recommendations using a well-established dietary guideline such as DASH are imperative for promoting better cardiovascular health for this high-risk cultural group.
The aims of this study were to systematically translate and validate a culturally modified DASH for Koreans (K-DASH) and obtain preliminary evidence of efficacy.
A 2-step approach of intervention translation and efficacy testing, together with close adherence to principles of community-based participatory research, was used to maximize community input. A 1-group pre-post design with 24-hour urine and 24-hour ambulatory blood pressure monitoring comparisons was used to test the initial feasibility and efficacy of the K-DASH intervention.
A total of 28 KAs with HBP participated in a 10-week dietary intervention consisting of group education sessions and individual counseling. Both systolic blood pressure and diastolic blood pressure, as measured by ambulatory blood pressure monitoring, were significantly decreased at postintervention evaluation (systolic blood pressure, -4.5 mm Hg; diastolic blood pressure, -2.6 mm Hg; P < .05). Serum low-density lipoprotein cholesterol was significantly decreased (-7.3 mg/dL; P < .05). Serum potassium and ascorbic acid levels were also improved in the reference range. Urine potassium level was significantly increased, supporting increased fruit and vegetable consumption.
This pilot study has (a) demonstrated that a cultural adaptation of DASH using community-based participatory research methodology produced a culturally relevant and efficacious dietary intervention for the KAs with HBP and (b) provided strong preliminary evidence for the efficacy of the K-DASH intervention in reducing HBP in hypertensive KAs.
生活方式的改变策略，如采用膳食方法来停止高血压（DASH）饮食，现在被认为是高血压（HBP）管理的一个组成部分。尽管韩裔美国人（KAs）中 HBP 的高患病率已有充分记录，但在该人群中很少实施饮食干预，部分原因是缺乏与文化相关的营养教育指南。使用 DASH 等成熟的饮食指南来翻译和测试与文化相关的饮食建议的疗效，对于促进这个高风险文化群体的心血管健康至关重要。
本研究的目的是系统地翻译和验证一种针对韩国人的文化改良 DASH（K-DASH）饮食，并获得初步的疗效证据。
采用两步干预翻译和疗效测试方法，并紧密遵循社区参与式研究原则，以最大限度地获得社区投入。采用 1 组前后设计，进行 24 小时尿液和 24 小时动态血压监测比较，以测试 K-DASH 干预的初步可行性和疗效。
共有 28 名患有 HBP 的 KAs 参加了为期 10 周的饮食干预，包括小组教育课程和个人咨询。通过动态血压监测测量的收缩压和舒张压均在干预后评估时显著降低（收缩压下降 4.5mmHg；舒张压下降 2.6mmHg；P<.05）。血清低密度脂蛋白胆固醇也显著降低（-7.3mg/dL；P<.05）。血清钾和抗坏血酸水平也在参考范围内得到改善。尿钾水平显著增加，支持增加水果和蔬菜的摄入。
这项初步研究表明，（a）使用基于社区的参与式研究方法对 DASH 进行文化改编，为 HBP 的 KAs 提供了一种与文化相关且有效的饮食干预措施，（b）为 K-DASH 干预在降低 HBP 方面的疗效提供了有力的初步证据。
