Dash for health presentation
- 1. DASH for HealthShruti SharmaNTR 5502: Nutritional AssessmentMarch 2011
- 2. TopicsPurpose of the toolExplanation to patientsHistory or development of the toolPlausible or purported mechanismSafety of useWho is it for?Case studies, testimonials and methods of marketingLiterature reviewPatient SelectionConclusion
- 3. Purpose of the ToolTo improve your eating and exercise habitsIt allows people with busy lifestyles to learn information about food, food preparation, eating out, losing weight and getting fit Information is posted on a weekly basisYou can create your own page to track your progress in such areas as weight, blood pressure and exerciseYou have to subscribe to the site for either 3 or 6 month increments ranging from $39-69http://www.dashforhealth.com/pages/public/dashforhealthbasics.php
- 4. Explanation to PatientsThe site does a good job of letting patients know that it simply offers guidelines and ways to monitor personal progressFor specific medical concerns, such as interactions of certain foods with medications, referral to a pharmacist or medical doctor is suggested“our nutrition advice is based on the DASH diet, which is a well-balanced way of eating that is consistent with general nutrition guidelines”Based on your height, weight, gender, age and activity level you can find suggestions that will help you achieve your goalshttp://www.dashforhealth.com/pages/public/exerciseadvice.php
- 5. Explanation to Patients (contd.)Weekly articles written by the staff are posted for viewing once you log inSome of the services provided include a “your stuff” page where participants can track their progress, create shopping lists, or even listen to a servings tutorialArchives are available to look up previous articles “DASHified” Recipes are also providedhttp://www.dashforhealth.com/pages/public/exerciseadvice.php
- 6. History of the ToolBased on the DASH Diet “Dietary Approaches to Stop Hypertension”Originally designed to prevent and/or treat hypertension It is now recommended for all American adults (USDA Dietary Guidelines, 2005)Moore, T.J., et al. 2008.
- 7. Plausible MechanismAn algorithm uses the person’s gender, age, and activity level to calculate the number of servings from each of the eight DASH food groups the person should consume dailyThe goal being that patients will practice the suggestions made and consume the recommended servings of each food group and incorporate these changes until goals are metThus, weight loss, changes in blood pressure and learning to make healthier food choices occursMoore, T.J., et al. 2008.
- 8. Plausible MechanismEight food groups are used to guide individuals’ eating habits:FruitsVegetablesLow-fat dairyMeat/fish/poultryGrainsNuts/legumesSweetsAdded fatsMoore, T.J., et al. 2008.
- 9. Safety of UseSafety concerns for the long term use of the DASH Diet is not an issue for most.The diet is more of a guideline for how to eat for your activity level and offers a way for individuals to live healthier lifestyles.However, as with any diet and exercise routine participants should seek counsel with their health care provider to ensure that contraindications do not exist with any of their medications or health conditionsMoore, T.J., et al. 2008.
- 10. Who is the DASH Diet for?It is applicable to the general population, not only overweight, obese or hypertensive individuals. It was originally designed for hypertensive patients as a means for treatment but has now become more of a guideline for how individuals can become healthier while achieving decreases in their blood pressure and weight.Moore, T.J., et al. 2008.
- 11. Marketing MethodsThe site is littered with comments indicating who has profiled the DASH diet plan and user testimonials“The Archives of Internal Medicine shows that the DASH diet helps prevent heart attack and strokes in women.”“recommended by the American Heart Association, in the USDA Dietary Guidelines”“featured in the U.S. High Blood Pressure Guidelines.”http://www.dashforhealth.com/pages/public/testimonials.php
- 12. Marketing MethodsOn the website, 8 testimonials are published, including one by Dr. Henry Domke (Missouri)“I'm renewing my membership with DASH for HealthTM because it works. The DASH diet is without a doubt the best diet for people (like me) who have high blood pressure. I suggest it to all my patients who have high blood pressure, and even many of those who don't. The DASH for HealthTM website has practical suggestions for how to fit this diet into your busy life. This is not a passing fad, but the real thing. I also find the "Your Stuff" monitoring features helpful for keeping track of where I have been. It is rewarding to refer to the graphs to monitor my progress.”http://www.dashforhealth.com/pages/public/testimonials.php
- 13. Literature ReviewThere are many articles available discussing the role of the DASH dietSome of the populations studied include:Older adults with or at risk of cardiovascular diseaseIndividuals with metabolic syndromeStudies have also analyzed the response rates and validity of internet based questionnairesApovian, C.M. et al., 2010., Moore, T.J., et al. 2008, and Stopponi, M.A., et al., 2009.
- 14. Literature ReviewTypes of studies:Randomized control trials (RCTs)Retrospective, quasi-experimental designCost analysisProspective studyCross-sectional study
- 15. Methodology problemsMore studies include a predominantly White, educated population with a higher ratio of female participantsPatient selection in order to increase ethnic diversity, such as increasing the number of Hispanics and African Americans being recruitedLanguage barriers; using English only programsStopponi, M.A., et al., 2009.
- 16. Sample and durationIn the literature available, the sample sizes varies from hundreds to thousands of individualsThe duration of studies ranges from 4 weeks to 12 monthsParticipants were recruited in various ways:Based on employment Health insurance carrierMass mail outsSpouses of participants Apovian, C.M. et al., 2010., Moore, T.J., et al. 2008, and Stopponi, M.A., et al., 2009.
- 17. ConclusionOverall, the literature states the further research needs to be conducted to include a more diverse population base; in order to generalize the resultsThe outcomes of the internet-based programs are promising and appear to change the behaviors of patients in order to reach dietary goalsStopponi, M.A., et al., 2009.
- 18. Literature Review – Moore exampleWeight, Blood Pressure, and Dietary Benefits After 12 Months of a Web-based Nutrition Education Program (DASH for Health): Longitudinal Observational Study. Moore, T.J., et al. 2008This study used three outcome measures; change in:WeightSystolic blood pressure (SBP)Consumption of DASH food groupsDiastolic BP (DBP)was a secondary outcomeThe relationship between the changes in outcome measure scores and use of the DASH for Health website was also analyzedMoore, T.J., et al. 2008.
- 19. Moore, T.J. et al., 2008Food consumption was estimated based on the DASH online questionnaire, a 24 hr recall Website use was tracked based on the number of times a person logged onWeight and BP was self enteredGroups were not randomized and no control group was usedThe researchers did not estimate the effects possible on people who failed to enter data onlineBaseline information was collected in the initial 3 weeks and a 12 month follow up during weeks 48-52Analysis was done using SigmaStat 3.5; using confidence intervals of 95%, paired t-tests or Wilcoxon signed rank tests, p-values were considered significant if less than 0.05Moore, T.J., et al. 2008.
- 20. Moore, T.J. et al., 2008Subjects were from 41 states, equal numbers of each gender were used aged 18-73 years3479 subjects initially enrolled88% were White, 74% Married, and 66% had a college or postgraduate degreeMost common reasons to enroll were “weight loss” and “general health information”25% were concerned about BP or cholesterol levels81% consented to their information being used for research; 26% of those remained at 12 months and were:mostly women, either married or widowed with some singles; most were interested in “general health information”Moore, T.J., et al. 2008.
- 21. Moore, T.J. et al., 2008Conclusion of the article:Fruit and vegetable intake increased significantlyConsumption of grain products decreasedWeight and BP decreased by 12 monthsThus, the DASH diet and exercise can result in a healthier lifestyle, weight loss and improved cardiovascular healthOutcomes related to a greater number of log ins:Weight loweredBlood pressure loweredFruit consumption was the only dietary change linked with greater log insMoore, T.J., et al. 2008.
- 22. Moore, T.J. et al., 2008 - Study LimitationsParticipants were not randomizedA control group was not usedThe selection of patients in the study by Moore, et al. (2008) was based on interested individuals working at the EMC Corporation and their spousesParticipation was voluntaryInformation was self-entered by participants12 month outcomes could only be calculated for those who were still using the site at the timeReasons for dropping out were not recorded, biasing the outcomes to appear more favorablePeople who did not lose weight or lower their BP may not have continued for the 12 monthsFood selection and exercise routines were not standardized for all participantsMoore, T.J., et al. 2008.
- 23. Patient SelectionIt is applicable to the general population, not only overweight, obese or hypertensive individuals.Limitations to the use of online programs:Ease of access to the internetLogging onto the site regularlyLevel of educationSocioeconomic statusAgeStandardized serving sizesApovian, C.M. et al., 2010., Moore, T.J., et al. 2008, and Stopponi, M.A., et al., 2009.
- 24. ConclusionThus, the DASH Diet, which includes an increased intake of fruits and vegetables, a reduction in sodium intake and regular exercise can benefit those with, and at risk of cardiovascular concerns, such as hypertension and overweight individuals.“For overweight or obese persons with above-normal BP, the addition of exercise and weight loss to the DASH diet resulted in even larger BP reductions, greater improvements in vascular and autonomic function, and reduced left ventricular mass.” (Blumenthal, J.A., et al., 2010)Apovian, C.M. et al., 2010., Blumenthal, J.A., et al., 2010, Moore, T.J., et al. 2008, Shenoy, S.F., et al., 2010, and Stopponi, M.A., et al., 2009.
- 25. ConclusionIt is a simple online tool to guide and modify the food consumption behaviors of patients.Patients can be guided to its use in the office and then requested to bring print outs of their information for follow up visits. This allows the clinician to track the patient’s progress.
- 26. ReferencesApovian, C.M., Murphy, M.C., Cullum-Dugan, D., Lin, P.H., Gilbert, K.M., Coffman, G., Jenkins, M., Bakun, P., Tucker, K.L. and Moore, T.J. (2010). Validation of a web-based dietary questionnaire designed for the DASH (Dietary Approaches to Stop Hypertension) diet: the DASH Online Questionnaire. Public Health Nutr; 13(5):615-622. Doi: 10.1017/S1368980009991996.Blumenthal, J.A., Babyak, M.A., Hinderliter, A., Watkins, L.L., Craighead, L., Lin, P.H., Caccia, C., Johnson, J., Waugh, R., and Sherwood, A. (2010). Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Arch Intern Med; 170(2):126-35. Retrieved from: http://archinte.ama-assn.org/cgi/content/full/170/2/126Dash For Health. Retrieved from: http://www.dashforhealth.com/Moore, T.J. Alsabeeh, N., Apovian, C.M., Murphy, M.C., Coffman, G.A., Cullum-Dugan, D., Jenkins, M. and Cabral, H. (2008). Weight, Blood Pressure, and Dietary Benefits After 12 Months of a Web-based Nutrition Education Program (DASH for Health): Longitudinal Observational Study. J Med Internet Res; 10(4):e52. Doi: 10.2196/jmir.1114. Shenoy, S.F., Poston, W.S.C., Reeves, R.S., Kazaks, A., Holt, R.R>, Keen, C.L., Chen, H.J., Haddock, C.K., Winters, B.L., Khoo, C.S.H., and Foreyt, J.P. (2010). Weight loss in individuals with metabolic syndrome given DASH diet counseling when provided a low sodium vegetable juice: a randomized controlled trial. Nutr. J; 9:8. Doi: 10.1186/1475-2891-9-8. Stopponi, M.A., Alexander, G.L., McClure, J.B., Carroll, N.M., Divine, G.W., Calvi, J.H., Rolnick, S.J., Strecher, V.J., Johnson, C.C., and Ritzwoller, D.P. (2009). Recruitment to a randomized web-based nutritional intervention trial: characteristics of participants compared to non-participants. J.Med Internet Res; 11(3):e38.Doi: 10.2196./jmir.1086.
Editor's Notes
- #17: Apovian, C.M. et al., 2010., Moore, T.J., et al. 2008, and Stopponi, M.A., et al., 2009,