适应性正念训练对体内感知及坚持终止高血压饮食疗法（DASH饮食）的影响：MB-BP随机临床试验

Effects of Adapted Mindfulness Training on Interoception and Adherence to the Dietary Approaches to Stop Hypertension (DASH) Diet: The MB-BP Randomized Clinical Trial.

作者信息

Loucks Eric B, Kronish Ian M, Saadeh Frances B, Scarpaci Matthew M, Proulx Jeffrey A, Gutman Roee, Britton Willoughby B, Schuman-Olivier Zev

机构信息

Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.

Department of Behavioral Sciences, Brown University School of Public Health, Providence, RI, USA.

出版信息

medRxiv. 2023 May 15:2023.05.10.23289818. doi: 10.1101/2023.05.10.23289818.

DOI:10.1101/2023.05.10.23289818

PMID:37292774

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10246061/

Abstract

BACKGROUND

Hypertension is a major cause of cardiovascular disease. The Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure (BP). However, adherence is typically low. Mindfulness training adapted to improving health behaviors that lower BP could improve DASH adherence, in part through improved interoceptive awareness relevant to dietary consumption. The primary objective of the MB-BP trial was to evaluate effects of the Mindfulness-Based Blood Pressure Reduction (MB-BP) program on interoceptive awareness. Secondary objectives assessed whether MB-BP impacts DASH adherence, and explored whether interoceptive awareness mediates DASH dietary changes.

METHODS

Parallel-group phase 2 randomized clinical trial conducted from June 2017-November 2020 with 6 months follow-up. Data analyst was blinded to group allocation. Participants had elevated unattended office BP (≥120/80 mmHg). We randomized 201 participants to MB-BP (n=101) or enhanced usual care control (n=100). Loss-to-follow-up was 11.9%. Outcomes were the Multidimensional Assessment of Interoceptive Awareness (MAIA; range 0-5) score, and the DASH adherence score (range 0-11) assessed via a 163-item Food Frequency Questionnaire.

RESULTS

Participants were 58.7% female, 81.1% non-Hispanic white, with mean age 59.5 years. Regression analyses demonstrated that MB-BP increased the MAIA score by 0.54 (95% CI: 0.35,0.74; p<.0001) at 6 months follow-up vs. control. MB-BP increased the DASH score by 0.62 (95% CI: 0.13,1.11; p=0.01) at 6 months vs. control, in participants with poor DASH adherence at baseline.

CONCLUSIONS

A mindfulness training program adapted to improving health behaviors that lower BP improved interoceptive awareness and DASH adherence. MB-BP could support DASH dietary adherence in adults with elevated BP.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov identifier NCT03859076 (https://clinicaltrials.gov/ct2/show/NCT03859076; MAIA) and NCT03256890 (https://clinicaltrials.gov/ct2/show/NCT03256890; DASH diet adherence).

摘要

背景

高血压是心血管疾病的主要病因。终止高血压膳食疗法（DASH）饮食可降低血压（BP）。然而，依从性通常较低。适用于改善降低血压的健康行为的正念训练可以提高DASH饮食的依从性，部分原因是通过提高与饮食摄入相关的内感受性意识。基于正念的血压降低（MB-BP）试验的主要目的是评估基于正念的血压降低计划对内感受性意识的影响。次要目标评估MB-BP是否会影响DASH饮食的依从性，并探讨内感受性意识是否介导了DASH饮食的变化。

方法

2017年6月至2020年11月进行的平行组2期随机临床试验，随访6个月。数据分析师对分组情况不知情。参与者的诊室外血压升高（≥120/80 mmHg）。我们将201名参与者随机分为MB-BP组（n = 101）或强化常规护理对照组（n = 100）。失访率为11.9%。结局指标为内感受性意识多维评估（MAIA；范围0 - 5）得分，以及通过163项食物频率问卷评估的DASH饮食依从性得分（范围0 - 11）。

结果

参与者中58.7%为女性，81.1%为非西班牙裔白人，平均年龄59.5岁。回归分析表明，与对照组相比，在6个月随访时，MB-BP组的MAIA得分提高了0.54（95%CI：0.35,0.74；p <.0001）。在基线时DASH饮食依从性较差的参与者中，与对照组相比，MB-BP组在6个月时的DASH得分提高了0.62（95%CI：0.13,1.11；p = 0.01）。