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Dietary Patterns (Poster Session)

(P13-065-25) A Modified Dietary Approaches to Stop Hypertension (mDASH) Index Is Associated With Reduced Risks of Selected Cardiometabolic Outcomes

Sunday, June 1, 2025
11:45 AM - 12:45 PM ET
Location: Poster Board C-62

    Presenting Author(s)

  • Ioanna Yiannakou, PhD, RD, MS

    Postdoctoral Associate
    Boston University School of Medicine
    Boston, Massachusetts, United States

    • Co-Author(s)

  • ML

    Michelle T. Long, MD, MSc

    Clinical Drug Development, Medicine and Science, NASH, Novo Nordisk, Bagsværd, Denmark & Department of Medicine, Section of Gastroenterology, Boston University School of Medicine

  • PJ

    Paul F. Jacques, DSc

    Professor
    Tufts University
    Boston, Massachusetts, United States

  • AB

    Alexa Beiser, PhD

    Boston University
    Boston, Massachusetts, United States

  • RP

    R. Taylor Pickering, PhD

    Post-Doctoral Fellow
    Boston University School of Medicine
    Boston, Massachusetts, United States

  • Lynn L. Moore, DSc, MPH

    Department of Medicine/Preventive Medicine and Epidemiology, Boston University Chobanian & Avedisian School of Medicine
    Boston, Massachusetts, United States

Disclosure(s):
Ioanna Yiannakou, PhD, RD, MS: No relevant financial relationship(s) with ineligible companies to disclose.


Objectives: We recently developed a modified Dietary Approaches to Stop Hypertension (mDASH) index that incorporates updated dietary evidence such as the consumption of total dairy irrespective of fat content and total vegetables (including white and sweet potatoes) as opposed to the typical low-fat DASH diet. Here, we compared the predictive validity of mDASH for selected cardiometabolic outcomes (hypertension (HTN), atherosclerotic cardiovascular disease (ASCVD), and nonalcoholic fatty liver disease (NAFLD)) compared with earlier low-fat DASH indexes in the prospective Framingham Offspring cohort.

Methods: We included participants with valid food frequency questionnaire data who were free of prevalent disease for each outcome (n=1714 HTN analyses; n=2700 ASCVD; n=1406 NAFLD). We calculated two previous DASH indexes: DASH Index I by Fung and DASH Index II by Günther. Predictive validity was assessed by comparing the ability of mDASH vs. other DASH indexes at baseline to predict incident HTN, ASCVD, and NAFLD risks over 11, 24.5, and 6 years (median), respectively. Cox regression models were used to estimate hazard ratios (HRs) for HTN and ASCVD in survival analyses. Modified Poisson regression models were used to estimate NAFLD risk. Models were adjusted for confounding by age, sex, energy, sodium intake, cigarette smoking, education, multivitamin use, hypertension (ASCVD and NAFLD analyses), and alcohol intake (NAFLD).

Results: There were 712 HTN, 597 ASCVD, and 268 NAFLD cases. Higher adherence to mDASH was associated with the largest decrease in HTN risk. The HR (95% CI) for quintile 5 vs. 1 for the three indexes were as follows: (mDASH: HR=0.67 (0.51-0.89); DASH Index I: HR=0.74 (0.58-0.94); DASH Index II: HR=0.84 (0.68-1.04). High adherence (vs. low) to mDASH and DASH Index I (but not DASH Index II) was associated with a statistically significant 29-30% lower ASCVD risk. Lastly, high adherence to mDASH and DASH Index II was associated with a statistically significant 29% lower NAFLD risk while DASH Index I showed no association.

Conclusions: A modified DASH pattern that encourages higher consumption of total fruits and vegetables and total dairy, irrespective of fat content, is an equally strong or stronger predictor of HTN, ASCVD, and NAFLD risk than previous DASH indexes.

Funding Sources: National Dairy Council