J Acad Nutr Diet. 2019 Apr;119(4):574-584. doi: 10.1016/j.jand.2018.12.011.
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.
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.
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).
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.
肥胖症的治疗主要侧重于减少总热量摄入，而对改善饮食质量的关注有限。饮食方法防治高血压（DASH）饮食模式在管理高血压和其他慢性疾病方面非常有效，但目前尚不清楚行为体重控制干预是否会提高 DASH 的依从性。我们对一项没有强调饮食质量的行为减肥干预进行了事后分析，并研究了该干预是否会影响医疗脆弱社区卫生中心患者对 DASH 的依从性。
参与者（n=306）被纳入 Track 研究，这是一项针对心血管风险升高患者的随机对照减肥干预研究。该试验比较了常规护理与每周自我监测、针对饮食和运动目标的个性化反馈、以及社区卫生中心的营养师和医生咨询相结合的干预措施。膳食摄入量通过基线和 12 个月时收集的 Block 食物频率问卷进行测量。采用先前验证的评分指数来确定 DASH 的依从性，该指数根据推荐的营养素或食物组目标来评估依从性。两个指数的总分范围均为 0 至 9，分数越高表示 DASH 的依从性越高。
参与者的平均（标准差 [SD]）年龄为 51.1（SD=8.8）岁，平均体重指数为 35.9（SD=3.9）。大多数为女性（69%）和黑人（51%）；13%为西班牙裔。一半（51%）的人年收入<$25,000，33%的人同时患有糖尿病和高血压。基线时，DASH 营养素评分的平均值为 1.81（SD=1.42），其中 6%的人至少达到 4.5 分。DASH 食物指数也有类似的评分。干预组的 DASH 营养素评分有显著的改善，虽然幅度较小（干预组：1.28[SD=1.5]，对照组：0.20[SD=1.3]；P<0.001），但两组 DASH 食物评分没有差异。DASH 评分的变化没有显著的预测因素，DASH 依从性与血压变化之间也没有关联。在干预组中，DASH 营养素评分的改善与体重减轻有关（r=-0.28；P=0.003）。
尽管该干预措施并非旨在提高 DASH 的采用率，但 Track 干预措施确实产生了显著的体重减轻和 DASH 依从性的微小改善。尽管有这些微小的改善，但在参与 Track 研究的医疗脆弱患者中，总体上 DASH 的采用率仍然很低。为了进一步降低慢性病负担，体重减轻干预措施应同时关注热量限制和增加饮食质量。
