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Sue K. Gao, MPH, PhD; Annette L. Fitzpatrick, PhD; Bruce Psaty, MD, PhD; Rui Jiang, MD, DrPH; Wendy Post, MD, MS; Jeffrey Cutler, MD; Matthew L. Maciejewski, PhD

Arch Intern Med. 2009;169(7):702-707.

Background  This study compared intake of specific nutrients based on the Dietary Approaches to Stop Hypertension (DASH) guidelines for hypertension management among multiethnic middle-aged and older adults.

Methods  We conducted quantitative analysis using baseline data of a prospective cohort study of 5972 adults aged 45 to 84 years recruited between July 2000 and August 2002 who participated in the Multi-Ethnic Study of Atherosclerosis (MESA). Diet information was collected using a 120-item food frequency questionnaire. Bivariate and multivariate methods were used to evaluate associations between DASH-accordant intake of each nutrient (fat, saturated fat, cholesterol, protein, fiber, calcium, magnesium, and potassium) with ethnicity and hypertension status.

Results  Less than 30% of MESA participants met any DASH nutrient target. DASH accordance was lowest in saturated fat intake and highest in cholesterol intake (5.3% and 29.5% of the participants, respectively). Multivariate analyses showed significant ethnic differences in DASH accordance in all nutrients but saturated fat. Compared with white participants, Chinese American participants had greater DASH accordance in cholesterol (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.13-1.67) and protein intake (2.32; 1.55-3.49) but less in total fat (0.47; 0.30-0.74), magnesium (0.58; 0.51-0.67), and potassium intake (0.40; 0.20-0.81); African Americans and Hispanics had greater DASH accordance in fiber intake (1.36; 1.13-1.62; and 2.23; 1.53-3.23, respectively) but less in calcium intake (0.44; 0.37-0.52; and 0.79; 0.68-0.91, respectively). Diagnosed and uncontrolled hypertension was associated with less DASH accordance in saturated fat (OR, 0.80; 95% CI, 0.70-0.91) and magnesium (0.80; 0.71-0.91). DASH accordance differed significantly with and without inclusion of dietary supplements in the analysis.

Conclusions  There is significant variation in DASH goal attainment among different ethnic groups. Assessments of nutrient intake that exclude dietary supplements may be underestimating DASH accordance.

Author Affiliations: Departments of Health Services (Dr Gao) and Epidemiology (Drs Fitzpatrick and Psaty), University of Washington, Seattle; Amgen Inc, Thousand Oaks, California (Dr Gao); Department of Medicine, Columbia University, New York, New York (Dr Jiang); Division of Cardiology, The Johns Hopkins University, Baltimore, Maryland (Dr Post); Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland (Dr Cutler); and Center for Health Services Research in Primary Care, Durham VA Medical Center, and Department of Medicine, Duke University Medical Center, Durham, North Carolina (Dr Maciejewski).

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