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Acceptability of Sodium-Reduced Research Diets, Including the Dietary Approaches to Stop Hypertension Diet, among Adults with Prehypertension and Stage 1 Hypertension

https://doi.org/10.1016/j.jada.2007.06.013Get rights and content

Abstract

Objective

Examine the acceptability of sodium-reduced research diets.

Design

Randomized crossover trial of three sodium levels for 30 days each among participants randomly assigned to one of two dietary patterns.

Participants/setting

Three hundred fifty-four adults with prehypertension or stage 1 hypertension who were participants in the Dietary Approaches to Stop Hypertension (DASH-Sodium) outpatient feeding trial.

Intervention

Participants received their assigned diet (control or DASH, rich in fruits, vegetables, and low-fat dairy products), each at three levels of sodium (higher, intermediate, and lower) corresponding to 3,500, 2,300, and 1,200 mg/day (150, 100, and 50 mmol/day) per 2,100 kcal.

Main outcome measures

Nine-item questionnaire on liking and willingness to continue the assigned diet and its level of saltiness using a nine-point scale, ranging from one to nine.

Statistical analyses performed

Generalized estimating equations to test participant ratings as a function of sodium level and diet while adjusting for site, feeding cohort, carryover effects, and ratings during run-in.

Results

Overall, participants rated the saltiness of the intermediate level sodium as most acceptable (DASH group: 5.5 for intermediate vs 4.5 and 4.4 for higher and lower sodium; control group: 5.7 for intermediate vs 4.9 and 4.7 for higher and lower sodium) and rated liking and willing to continue the DASH diet more than the control diet by about one point (ratings range from 5.6 to 6.6 for DASH diet and 5.2 to 6.1 for control diet). Small race differences were observed in sodium and diet acceptability.

Conclusions

Both the intermediate and lower sodium levels of each diet are at least as acceptable as the higher sodium level in persons with or at risk for hypertension.

Section snippets

DASH-Sodium Trial Design and Study Participants

The DASH-Sodium trial was a multicenter, randomized, controlled trial that compared the effects on blood pressure of two diets at three sodium levels in adults with prehypertension or stage 1 hypertension. It was an outpatient feeding study, a design that promotes high adherence and control of dietary intake (17). Clinical centers located in Baltimore, MD; Baton Rouge, LA; Boston, MA; and Durham-Raleigh, NC; a coordinating center located in Portland, OR; and the National Heart, Lung and Blood

Results

The demographic profile of the 354 participants who completed all seven diet acceptability questionnaires was similar to the 412 participants (14) who were enrolled in the trial (data not shown), resulting in an 86% response rate. Incomplete or nonrespondents (n=58) had similar demographic characteristics as complete respondents (n=354) with respect to age, BMI, sex, race, and hypertension status (data not shown), but were less likely to have had some college education (70% of incomplete or

Discussion

This study assessed the acceptability of sodium-reduced research diets by participants in the DASH-Sodium trial (14). Participants on both the DASH and control diets gave relatively high acceptability ratings to all levels of sodium, ranging on average from four to seven points. The intermediate level received somewhat higher ratings than either the lower or higher sodium. The DASH diet and its components received higher scores than the control diet at all sodium levels. Overall diet

Conclusions

This study found that during 30 days of consuming research diets at three levels of sodium, the intermediate sodium level was slightly more acceptable than either the higher or lower level, which generally had similar ratings. Whether or not acceptability was influenced by the sodium levels themselves or by the manner in which the research diets were prepared cannot be determined in this study. Nonetheless, these differences in salt acceptability between sodium levels were small, and the

N. Karanja and W. M. Vollmer are senior investigators, Kaiser Permanente Center for Health Research, Portland, OR.

References (43)

  • N.M. Karanja et al.

    Pre-enrollment diets of Dietary Approaches to Stop Hypertension trial participantsDASH Collaborative Research Group

    J Am Diet Assoc.

    (1999)
  • F.J. He et al.

    Effect of longer-term modest salt reduction on blood pressure (review)

    Cochrane Database Syst Rev.

    (2004)
  • W.M. Vollmer et al.

    Effects of diet and sodium intake on blood pressure: Subgroup analysis of the DASH-sodium trial

    Ann Intern Med.

    (2001)
  • C. Alli et al.

    Feasibility of a long-term low-sodium diet in mild hypertension

    JAMA

    (1992)
  • J. Hashimoto et al.

    Compliance with long-term dietary salt restriction in hypertensive outpatients

    Clin Exp Hypertens.

    (1994)
  • M.H. Korhonen et al.

    Adherence to the salt restriction diet among people with mildly elevated blood pressure

    Eur J Clin Nutr.

    (1999)
  • L.J. Appel et al.

    Effects of comprehensive lifestyle modification on blood pressure control: Main results of the PREMIER clinical trial

    JAMA

    (2003)
  • S.K. Kumanyika et al.

    Feasibility and efficacy of sodium reduction in the Trials of Hypertension Prevention, Phase ITrials of Hypertension Prevention Collaborative Research Group

    Hypertension

    (1993)
  • S.K. Kumanyika et al.

    Sodium reduction for hypertension prevention in overweight adults: further results from the Trials of Hypertension Prevention Phase II

    J Hum Hypertens.

    (2005)
  • G.K. Beauchamp et al.

    High salt intakeSensory and behavioral factors

    Hypertension

    (1991)
  • S. Havas et al.

    Reducing the public health burden from elevated blood pressure levels in the United States by lowering intake of dietary sodium

    Am J Public Health

    (2004)
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    N. Karanja and W. M. Vollmer are senior investigators, Kaiser Permanente Center for Health Research, Portland, OR.

    K. J. Lancaster is an associate professor, Department of Nutrition, Food Studies, and Public Health, New York University, New York.

    P.-H. Lin is an associate research professor, Department of Medicine, Duke Hyptertension Center and the Sarah W. Stedman Center for Nutritional Studies, Duke University Medical Center, Durham, NC.

    M. M. Most is an associate professor, research, Pennington Biomedical Research Center, Baton Rouge, LA.

    J. D. Ard is an assistant professor, Department of Nutrition Sciences, University of Alabama, Birmingham.

    J. F. Swain is a bionutrition manager, National Institutes of Health General Clinical Research Center, Brigham and Women’s Hospital, Boston, MA.

    F. M. Sacks is a professor, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, and Nutrition Department, Harvard School of Public Health, Boston, MA.

    E. Obarzanek is a research nutritionist, National Heart, Lung, and Blood Institute, Bethesda, MD.

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