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JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION

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JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION

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  1. The PREMIER intervention helps participants meet the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and the current Dietary Reference Intakes recommendationsPao-Hwa Lin, PhD, Larry Appel, MD, Kristine Funk, MS, RD, Shirley Craddick, MS, RD, Chuhe Chen, PhD, Patricia Elmer, PhD, MaryAnn McBurnie, PhD, Catherine Champagne, PhD, RD JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Lin P, et al. J Am Diet Assoc. 107, Sept. 2007

  2. Objective • To examine the impact of the PREMIERstudy lifestyle interventions on dietary intakes and adherence to the DASH dietary pattern and the Dietary Reference Intakes (DRI). JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Lin P, et al. J Am Diet Assoc. 107, Sept. 2007

  3. Overview of the PREMIER trial • An 18-month multi-center, randomized controlled trial. • Comparing two multi-component lifestyle intervention programs to an advice only control group. • A total of 810 participants were randomized into the study. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Lin P, et al. J Am Diet Assoc. 107, Sept. 2007

  4. Eligibility criteria Individuals were eligible if they were: • age 25 or older • Body Mass Index between 18.5 and 45.0 kg/m2 • not taking anti-hypertensive medication • pre-hypertensive or stage 1 hypertensive (systolic blood pressure 120-159 mmHg and diastolic blood pressure 80-95 mmHg). JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Lin P, et al. J Am Diet Assoc. 107, Sept. 2007

  5. PREMIER Intervention • There were three randomized groups:1) a behavioral lifestyle intervention that implements established recommendations (EST), 2) an EST intervention plus the DASH dietary pattern (EST+DASH),3) a control group receiving a brief advice only. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Lin P, et al. J Am Diet Assoc. 107, Sept. 2007

  6. Outcome measurement • Dietary intakes collected by two random 24 hour recalls at baseline, 6 and 18 months, respectively. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Lin P, et al. J Am Diet Assoc. 107, Sept. 2007

  7. Table 1. DASH dietary pattern nutrient targets at 2000 kcal/day JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Lin P, et al. J Am Diet Assoc. 107, Sept. 2007

  8. Table 2. Dietary guidelines for the EST and EST+DASH groups JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Lin P, et al. J Am Diet Assoc. 107, Sept. 2007

  9. Figure 1 Proportion of EST+DASH participants not meeting the DRI recommendations from baseline to 6 and 18 months* *Data represent proportion of EST+DASH participants who did not meet the DRI recommendations. For total fat, polyunsaturated fat and sodium, the data represent those whose intakes were above the targets. Data for other nutrients represent those whose intakes were below 2/3 of the DRI targets. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Lin P, et al. J Am Diet Assoc. 107, Sept. 2007

  10. Summary • Baseline intakes of all nutrients were within the DRI recommended ranges or at least met 2/3 of the targets except for dietary fiber, vitamin E, calcium and potassium. • Average sodium intakes were much higher than both the DASH and DRI recommendations. • Both total servings and selection of foods may be important to meet DASH specific targets for micronutrients. • Only the EST+DASH group significantly increased intakes of DASH specific food groups including fruits, vegetables and dairy products, and nutrients including protein, fiber, calcium, potassium, and magnesium. However, most of the increases did not reach the levels consumed in the original DASHfeeding studies. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Lin P, et al. J Am Diet Assoc. 107, Sept. 2007

  11. Conclusions • Both EST and EST+DASH interventions were effective in helping participants follow established recommendations to control blood pressure. • When multiple lifestyle guidelines were implemented in the same intervention program, the level of adherence achieved was less than when only a single guideline was implemented. • The Advice Only control group also made some behavioral changes, mainly decreasing energy and sodium intakes. • The EST+DASH intervention program provided a useful strategy to achieve both the DASH dietary pattern and current DRI recommendations. Intervention enhancements, including a greater emphasis on nutrient dense foods, would likely result in improved nutrient density. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Lin P, et al. J Am Diet Assoc. 107, Sept. 2007

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