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The Effect of DASH Dietary Adherence and Participant Characteristics on CVD Risk Factor Response to a DASH Dietary Intervention in Adolescents with Elevated Blood Pressure

Goins, Laura K.
http://orcid.org/0000-0002-8338-696X
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1504871786313111

Abstract Details

2017, MS, University of Cincinnati, Allied Health Sciences: Nutrition.
Abstract: Background: Hypertension (HTN) is a growing problem among youth. Recommendations to manage pediatric HTN include dietary modification as first-line treatment. The Dietary Approaches to Stop Hypertension (DASH) diet has been effective in managing elevated blood pressure (BP) in adults, and evidence supports its utility in children with HTN. Although greater adherence to the DASH diet is assumed to mediate these changes, few studies have analyzed whether this is so. The goal of the present study is to determine the contribution of DASH dietary adherence in mediating BP and vascular function responses to a dietary intervention emphasizing the DASH diet (DASH-4-Teens program) in adolescents with elevated BP. Dietary interventions in adults have found differential BP and vascular function responses to diet therapy according to pre-treatment HTN status, race, and baseline sodium and potassium intakes. However, these relationships have remained largely unexplored in youth and will be also examined in the present investigation. Methods: A total of 159 children between the ages of 11-18 with a clinical diagnosis of pre-HTN or stage 1 HTN were randomized to either the DASH-4-Teens dietary intervention or usual care (UC) for pediatric BP management. BP, vascular function, diet, anthropometrics, and demographics were collected/measured. Statistical analyses evaluated DASH adherence as a mediator for BP and vascular function response to dietary intervention and potential interaction with race, pre-intervention HTN status, and sodium and potassium intake and dietary intervention on BP and vascular function measures. Results: Based on mediation analysis using UC as the reference, the DASH-4-Teens intervention was effective in reducing SBP (ß = -3.9; 95% CI = -6.6;-0.1.2) and SBP z-score (ß = -0.4; 95% CI = -0.6;-0.1), but not DBP, DBP z-score or vascular function outcomes. The favorable effect of the DASH-4-Teens intervention was not mediated by DASH dietary adherence, as measured by the DASH score, on SBP (ß = 0.6; 95% CI = -0.4;2.0) or SBP z-score (ß = 0.1; 95% CI = -0.1;0.2). Favorable response on SBP and SBP z-score to the DASH-4-Teens program did not differ based on race, pre-intervention HTN status, or pre-intervention sodium and potassium intake. Conclusion: The behaviorally-based DASH-4-Teens intervention was efficacious in modifying SBP (and related z-scores), but not DBP or vascular function measures in teens with elevated BP. These results were generalizable across racial groups, pre-treatment HTN status groups, and teens with different pre-treatment sodium and potassium intake levels. Unexpectedly, DASH dietary adherence was not a significant mediator of the favorable changes of DASH-4-Teens on SBP. Further characterization of the components of the DASH-4-Teens intervention, dietary and otherwise, that mediate SBP changes will be important to inform future lifestyle interventions targeting youth with CVD risk.
Sarah Couch, Ph.D. (Committee Chair)
Abigail Peairs, Ph.D. (Committee Chair)
53 p.
Nutrition
DASH diet; hypertension; adolescents; blood pressure; vascular function; characterisitcs

Recommended Citations

Citations

  • Goins, L. K. (2017). The Effect of DASH Dietary Adherence and Participant Characteristics on CVD Risk Factor Response to a DASH Dietary Intervention in Adolescents with Elevated Blood Pressure [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1504871786313111

    APA Style (7th edition)

  • Goins, Laura. The Effect of DASH Dietary Adherence and Participant Characteristics on CVD Risk Factor Response to a DASH Dietary Intervention in Adolescents with Elevated Blood Pressure. 2017. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1504871786313111.

    MLA Style (8th edition)

  • Goins, Laura. "The Effect of DASH Dietary Adherence and Participant Characteristics on CVD Risk Factor Response to a DASH Dietary Intervention in Adolescents with Elevated Blood Pressure." Master's thesis, University of Cincinnati, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1504871786313111

    Chicago Manual of Style (17th edition)

ucin1504871786313111
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This open access ETD is published by University of Cincinnati and OhioLINK.