Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
Nutrients. 2019 Feb 5;11(2):338. doi: 10.3390/nu11020338.
The Dietary Approaches to Stop Hypertension (DASH) dietary pattern, which emphasizes fruit, vegetables, fat-free/low-fat dairy, whole grains, nuts and legumes, and limits saturated fat, cholesterol, red and processed meats, sweets, added sugars, salt and sugar-sweetened beverages, is widely recommended by international diabetes and heart association guidelines.
To summarize the available evidence for the update of the European Association of the Study of Diabetes (EASD) guidelines, we conducted an umbrella review of existing systematic reviews and meta-analyses using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach of the relation of the DASH dietary pattern with cardiovascular disease and other cardiometabolic outcomes in prospective cohort studies and its effect on blood pressure and other cardiometabolic risk factors in controlled trials in individuals with and without diabetes.
MEDLINE and EMBASE were searched through 3 January 2019. We included systematic reviews and meta-analyses assessing the relation of the DASH dietary pattern with cardiometabolic disease outcomes in prospective cohort studies and the effect on cardiometabolic risk factors in randomized and non-randomized controlled trials. Two independent reviewers extracted relevant data and assessed the risk of bias of individual studies. The primary outcome was incident cardiovascular disease (CVD) in the prospective cohort studies and systolic blood pressure in the controlled trials. Secondary outcomes included incident coronary heart disease, stroke, and diabetes in prospective cohort studies and other established cardiometabolic risk factors in controlled trials. If the search did not identify an existing systematic review and meta-analysis on a pre-specified outcome, then we conducted our own systematic review and meta-analysis. The evidence was summarized as risk ratios (RR) for disease incidence outcomes and mean differences (MDs) for risk factor outcomes with 95% confidence intervals (95% CIs). The certainty of the evidence was assessed using GRADE.
We identified three systematic reviews and meta-analyses of 15 unique prospective cohort studies ( = 942,140) and four systematic reviews and meta-analyses of 31 unique controlled trials ( = 4,414) across outcomes. We conducted our own systematic review and meta-analysis of 2 controlled trials ( = 65) for HbA1c. The DASH dietary pattern was associated with decreased incident cardiovascular disease (RR, 0.80 (0.76⁻0.85)), coronary heart disease (0.79 (0.71⁻0.88)), stroke (0.81 (0.72⁻0.92)), and diabetes (0.82 (0.74⁻0.92)) in prospective cohort studies and decreased systolic (MD, -5.2 mmHg (95% CI, -7.0 to -3.4)) and diastolic (-2.60 mmHg (-3.50 to -1.70)) blood pressure, Total-C (-0.20 mmol/L (-0.31 to -0.10)), LDL-C (-0.10 mmol/L (-0.20 to -0.01)), HbA1c (-0.53% (-0.62, -0.43)), fasting blood insulin (-0.15 μU/mL (-0.22 to -0.08)), and body weight (-1.42 kg (-2.03 to -0.82)) in controlled trials. There was no effect on HDL-C, triglycerides, fasting blood glucose, HOMA-IR, or CRP. The certainty of the evidence was moderate for SBP and low for CVD incidence and ranged from very low to moderate for the secondary outcomes.
Current evidence allows for the conclusion that the DASH dietary pattern is associated with decreased incidence of cardiovascular disease and improves blood pressure with evidence of other cardiometabolic advantages in people with and without diabetes. More research is needed to improve the certainty of the estimates.
强调水果、蔬菜、无脂/低脂奶制品、全谷物、坚果和豆类，限制饱和脂肪、胆固醇、红色和加工肉类、甜食、添加糖、盐和含糖饮料的膳食方法来停止高血压（DASH）饮食模式，被国际糖尿病和心脏协会的指南广泛推荐。
为了总结现有证据，更新欧洲糖尿病研究协会（EASD）的指南，我们使用 GRADE 方法对现有的系统评价和荟萃分析进行了伞式综述，该方法评估了 DASH 饮食模式与前瞻性队列研究中心血管疾病和其他心血管代谢结局的关系，以及其对伴有和不伴有糖尿病的个体中对照试验中血压和其他心血管代谢风险因素的影响。
通过 2019 年 1 月 3 日检索 MEDLINE 和 EMBASE。我们纳入了评估 DASH 饮食模式与前瞻性队列研究中心血管代谢疾病结局关系的系统评价和荟萃分析，以及评估其对随机和非随机对照试验中心血管代谢风险因素影响的荟萃分析。两位独立的评审员提取了相关数据，并评估了个体研究的偏倚风险。主要结局是前瞻性队列研究中的心血管疾病（CVD）发生率，对照试验中的收缩压。次要结局包括前瞻性队列研究中的冠心病、中风和糖尿病发生率和对照试验中的其他已确立的心血管代谢风险因素。如果检索没有发现预先指定的结局的现有系统评价和荟萃分析，则我们进行了自己的系统评价和荟萃分析。证据总结为疾病发生率结局的风险比（RR）和风险因素结局的均数差异（MD），置信区间（95%CI）为 95%。使用 GRADE 评估证据的确定性。
我们确定了三项关于 15 项独特前瞻性队列研究（n = 942,140）的系统评价和荟萃分析，以及四项关于 31 项独特对照试验（n = 4,414）的系统评价和荟萃分析。我们对 2 项对照试验（n = 65）进行了自己的 HbA1c 系统评价和荟萃分析。DASH 饮食模式与心血管疾病的发生率降低相关（RR，0.80（0.76-0.85））、冠心病（0.79（0.71-0.88））、中风（0.81（0.72-0.92））和糖尿病（0.82（0.74-0.92）），在对照试验中收缩压（MD，-5.2mmHg（95%CI，-7.0 至-3.4））和舒张压（-2.60mmHg（-3.50 至-1.70））、总胆固醇（-0.20mmol/L（-0.31 至-0.10））、LDL-C（-0.10mmol/L（-0.20 至-0.01））、HbA1c（-0.53%（-0.62，-0.43））、空腹胰岛素（-0.15μU/mL（-0.22 至-0.08））和体重（-1.42kg（-2.03 至-0.82））。对 HDL-C、甘油三酯、空腹血糖、HOMA-IR 或 CRP 没有影响。SBP 的证据确定性为中度，CVD 发生率的证据确定性为低，次要结局的证据确定性从非常低到中度不等。
目前的证据允许得出结论，DASH 饮食模式与心血管疾病的发生率降低有关，并改善了伴有和不伴有糖尿病的个体的血压，同时还有其他心血管代谢优势的证据。需要更多的研究来提高估计的确定性。
