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一项来自护士建康研究（NHS）的数据分析显示，在24年的后续追踪，持续使用DASH（Dietary Approaches to Stop Hypertension）型态饮食与降低中年女性冠状动脉心脏疾病（CHD）和中风风险有关。麻州波士顿Simmons大学Teresa Fung与其哈佛大学公卫学院的同事发现，对于这种饮食型态顺从性较高的女性，其CHD事件发生率下降了24%、中风下降了18%；这种型态的饮食富含水果、蔬菜、豆子、坚果、谷粒、与低脂日常饮食，并且仅食用少量红肉与加工肉品、甜味饮料以及钠。
Fung医师向Medscape神经学与神经外科学表示，这项分析的主要目的在于透过详细的营养谘询、以及NHS研究中长期的预后，发展一种评估DASH型态饮食的顺从性。
她指出，我们发现，对于这种型态饮食顺从性高的个体，长期来说发生冠状动脉心脏疾病与中风的风险较低。
【吃的健康】
DASH饮食，特别是同时限制钠的摄取量，已经在随机分派临床研究中被证实可以降低血压，且受到国家心脏、肺脏、与血液机构、美国心脏医学会、与美国农业部的建议，作为健康饮食。
然而，虽然它可以降低血压，但这种饮食对于心脏血管事件终点的影响，例如中风或是冠状动脉心脏及并仍然是未知的。
Fung医师向Medscape神经学与神经外科学表示，为了这项分析，Fung医师与其同事研发了一种评分对DASH饮食顺应性的工具，对收纳在NHS研究、于DASH饮食发明前的88,517位女性，这些女性自1980年起在22年间接受5次的饮食谘询，这些女性填写确效过的食物饮食频率问卷。该评分是根据8种食物与营养成分，包括水果、蔬菜、豆子、坚果、谷粒、与低脂日常饮食，而食用红肉或是加工肉品、甜味饮料、与钠则是扣分。
受试者的年龄在收纳时介于34~59岁之间，且没有心脏血管疾病或是糖尿病；后续期间总共发生了1867件意外非致命性心肌梗塞、883件CHD事件、1977件中风。
在校正年龄、吸烟与其他心血管危险因子，发生CHD的相对风险是对DASH型态饮食顺应性前20%（第5四分位数）、相较于那些顺应性倒数前20%（第1四分位数）是显著下降的，此外，非致命性与致命性事件也有同样的发现。
对DASH型态饮食顺应性第5四分位数相较于第1四分位数发生CHD事件多变项相对风险
|
终点 |
相对风险（ 95% CI ）
|
P
|
|
整体 CHD |
0.76 (0.67 – 0.85)
|
< .0001
|
|
非致命性 CHD |
0.78 (0.67 – 0.90)
|
.002
|
|
致命性 CHD |
0.71 (0.58 – 0.89)
|
.001
|
|
终点 |
相对风险（ 95% CI ）
|
P
|
|
整体中风发生率 |
0.82 (0.71 – 0.94)
|
.002
|
|
缺血性中风 |
0.89 (0.73 – 1.07)
|
.13
|
|
出血性中风 |
0.86 (0.0.62 – 1.18)
|
.56
|
DASH-Style Diet May Reduce Risk for CHD and Stroke
By Susan Jeffrey
Medscape Medical News
A new analysis of data from the Nurses' Health Study (NHS) suggests that adherence to a Dietary Approaches to Stop Hypertension (DASH)-style diet is associated with a lower risk for both coronary heart disease (CHD) and stroke in middle-aged women over 24 years of follow-up.
Teresa Fung, ScD, RD, from Simmons College, in Boston, Massachusetts, and colleagues at the Harvard School of Public Health found a 24% reduction in CHD events and an 18% reduction in stroke among women who appeared to adhere more closely to this pattern of eating, which is high in fruit, vegetables, legumes, nuts, whole grains, and low-fat dairy products and low in red and processed meats, sweetened beverages, and sodium.
The main aim of this analysis was to develop a tool to measure adherence to the DASH pattern of eating, utilizing the detailed nutrition information and long-term outcomes available in the NHS, Dr. Fung told Medscape Neurology & Neurosurgery.
"We found that individuals who do adhere to that score, long term, have a lower risk of coronary heart disease and stroke," she said.
Eating for Lower Risk
The DASH diet, particularly in combination with restricted sodium, has been shown in randomized trials to lower blood pressure and is advocated now by the National Heart, Lung, and Blood Institute; the American Heart Association; and the United States Department of Agriculture as a healthy eating pattern.
However, although it lowers blood pressure, the effect of this dietary pattern on cardiovascular end points such as stroke and coronary heart disease has not been established.
For this analysis, Dr. Fung and colleagues developed a tool that scored adherence to the DASH-style diet among 88,517 women who were enrolled in the NHS prior to the development of the DASH diet per se but who provided dietary information 5 times during 22 years of follow-up beginning in 1980, with validated food frequency questionnaires. The score was based on 8 food and nutrient components: fruits, vegetables, whole grains, nuts and legumes, and low-fat dairy, and a reverse-scoring scheme for consumption of red and processed meats, sweetened beverages, and sodium.
Participants were aged 34 to 59 years at enrollment and were free of cardiovascular disease or diabetes. A total of 1867 cases of incident nonfatal myocardial infarction, 883 CHD deaths, and 1977 strokes were documented over follow-up.
After adjustment for age, smoking, and other cardiovascular risk factors, the relative risk for total CHD for those in the top 20% for adherence to the DASH diet (quintile 5) vs those in the bottom 20% for adherence (quintile 1) was significantly reduced, as well as the risk for nonfatal and fatal events.
Multivariate Relative Risk for CHD Events for Subjects in Quintile 5 vs Quintile 1 for Adherence to DASH-Style Diet
|
End Point |
Relative Risk (95% CI) |
P |
|
Total CHD |
0.76 (0.67 – 0.85) |
< .0001 |
|
Nonfatal CHD |
0.78 (0.67 – 0.90) |
.002 |
|
Fatal CHD |
0.71 (0.58 – 0.89) |
.001 |
The DASH score was also significantly associated with a lower risk for total stroke.
Multivariate Relative Risk for Stroke Events for Subjects in Quintile 5 vs Quintile 1 for Adherence to DASH-Style Diet
|
End Point |
Relative Risk (95% CI) |
P |
|
Total stroke |
0.82 (0.71 – 0.94) |
.002 |
|
Ischemic stroke |
0.89 (0.73 – 1.07) |
.13 |
|
Hemorrhagic stroke |
0.86 (0.0.62 – 1.18) |
.56 |
The benefit of the DASH pattern of eating was greater for women with hypertension than those without hypertension at baseline, Dr. Fung noted.
In the future, they hope to use this type of approach, scoring for adherence to dietary patterns and looking at cardiovascular outcomes, for other diets. For example, she noted, the recent OMNIHEART trial showed that substituting proteins and unsaturated fats for carbohydrates in the diet could reduce blood pressure and improve lipid profiles.
"So if we could come up with something that can measure somebody's adherence to the DASH diet, as well as the characteristics of the OMNIHEART diet, that would be good," she said.
Dr. Fung disclosed that she consults for the UNO Chicago Grill. No other potential conflicts of interest were reported.
American Heart Association 2007 Scientific Sessions: Abstract 2369. Presented Monday, November 5, 2007.