Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
Section of Bioinformatics, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom.
Am J Clin Nutr. 2022 Jul 6;116(1):216-229. doi: 10.1093/ajcn/nqac067.
Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet enhances potassium intake and reduces sodium intake and blood pressure (BP), but the underlying metabolic pathways are unclear.
Among free-living populations, we delineated metabolic signatures associated with the DASH diet adherence, 24-hour urinary sodium and potassium excretions, and the potential metabolic pathways involved.
We used 24-hour urinary metabolic profiling by proton nuclear magnetic resonance spectroscopy to characterize the metabolic signatures associated with the DASH dietary pattern score (DASH score) and 24-hour excretion of sodium and potassium among participants in the United States (n = 2164) and United Kingdom (n = 496) enrolled in the International Study of Macro- and Micronutrients and Blood Pressure (INTERMAP). Multiple linear regression and cross-tabulation analyses were used to investigate the DASH-BP relation and its modulation by sodium and potassium. Potential pathways associated with DASH adherence, sodium and potassium excretion, and BP were identified using mediation analyses and metabolic reaction networks.
Adherence to the DASH diet was associated with urinary potassium excretion (correlation coefficient, r = 0.42; P < 0.0001). In multivariable regression analyses, a 5-point higher DASH score (range, 7 to 35) was associated with a lower systolic BP by 1.35 mmHg (95% CI, -1.95 to -0.80 mmHg; P = 1.2 × 10-5); control of the model for potassium but not sodium attenuated the DASH-BP relation. Two common metabolites (hippurate and citrate) mediated the potassium-BP and DASH-BP relationships, while 5 metabolites (succinate, alanine, S-methyl cysteine sulfoxide, 4-hydroxyhippurate, and phenylacetylglutamine) were found to be specific to the DASH-BP relation.
Greater adherence to the DASH diet is associated with lower BP and higher potassium intake across levels of sodium intake. The DASH diet recommends greater intake of fruits, vegetables, and other potassium-rich foods that may replace sodium-rich processed foods and thereby influence BP through overlapping metabolic pathways. Possible DASH-specific pathways are speculated but confirmation requires further study. INTERMAP is registered as NCT00005271 at www.clinicaltrials.gov.
遵循 DASH（停止高血压的饮食方法）饮食可增加钾的摄入，减少钠的摄入和血压（BP），但潜在的代谢途径尚不清楚。
在自由生活的人群中，我们描述了与 DASH 饮食依从性、24 小时尿钠和钾排泄以及潜在代谢途径相关的代谢特征。
我们使用质子核磁共振光谱法进行 24 小时尿液代谢谱分析，以确定与 DASH 饮食模式评分（DASH 评分）相关的代谢特征，以及美国（n=2164）和英国（n=496）参与者的 24 小时尿钠和钾排泄，这些参与者参加了国际宏观和微量营养素与血压研究（INTERMAP）。使用多元线性回归和交叉表分析研究 DASH-BP 关系及其对钠和钾的调节。使用中介分析和代谢反应网络确定与 DASH 依从性、钠和钾排泄以及 BP 相关的潜在途径。
DASH 饮食的依从性与尿钾排泄呈正相关（相关系数 r=0.42；P<0.0001）。在多变量回归分析中，DASH 评分每增加 5 分（范围为 7 至 35），收缩压降低 1.35mmHg（95%CI，-1.95 至-0.80mmHg；P=1.2×10-5）；控制钾模型而不是钠模型可减弱 DASH-BP 关系。两种常见代谢物（马尿酸和柠檬酸）介导了钾-BP 和 DASH-BP 之间的关系，而 5 种代谢物（琥珀酸、丙氨酸、S-甲基半胱氨酸亚砜、4-羟基马尿酸和苯乙酰谷氨酰胺）被发现与 DASH-BP 关系特异。
DASH 饮食的依从性越高，钾的摄入量越高，钠的摄入量越低。DASH 饮食建议增加水果、蔬菜和其他富含钾的食物的摄入量，这些食物可能会取代富含钠的加工食品，从而通过重叠的代谢途径影响血压。推测可能存在 DASH 特异性途径，但需要进一步研究证实。INTERMAP 在 www.clinicaltrials.gov 上注册为 NCT00005271。
