(P22-063-25) The Impact of Diet Quality During Long-Term Caloric Restriction on Blood Pressure: An Analysis of CALERIE™ 2

Objectives: Blood pressure is the leading modifiable risk factor for cardiovascular disease. High-quality diets emphasizing whole, nutrient-dense foods have beneficial effects on blood pressure. In CALERIE^TM 2, long-term caloric restriction (CR) improved diet quality and blood pressure, but with considerable variability in participants' responses. This analysis aimed to determine whether changes in diet quality could explain the changes in blood pressure beyond CR.

Methods: Healthy adults without obesity (N=143) achieved ~13% CR from baseline to 12 months. Participants were educated on portion sizes and incorporating more nutrient-dense foods. At baseline and 12 months, systolic and diastolic blood pressure (SBP, DBP) were measured, and 6-day food records were collected to assess diet quality (healthy eating index (0-100); HEI). HEI change from baseline to 12 months was categorized into tertiles: low (Δ -25 to 0), moderate (Δ 0 to 9), and high improvements (Δ 9 to 37).

Results: Without adjustment for CR, SBP and DBP decreased (-3 mmHg; 95% CI: -5, -1; P=0.01 and -2 mmHg; 95% CI: -4, -1; P=0.01, respectively) and HEI increased (8; 95% CI: 6, 10; P< 0.001) from baseline to 12 months; however, those differences were no longer evident after adjusting for %CR and weight loss. At baseline, the HEI of the low, moderate, and high tertiles was 65±9, 60±10, and 53±9, and the respective change in HEI at 12 months was -8±5, 4±3, and18±6. The change in SBP and DBP from baseline to 12 months was not different between the HEI tertiles. Participants that reduced DBP by ≥ 5 mmHg (~90%) showed more improvement in HEI (Δ 8±11) compared to those (~10%) who increased DBP ≥ 5 mmHg (Δ 4±6), but the change in HEI did not significantly differ between these blood pressure groups. On the other hand, HEI was changed similarly between those participants who reduced SBP by ≥ 5 mmHg (~83%) to those (~17%) who increased SBP ≥ 5 mmHg (Δ 7±11 and Δ 7±7, respectively).

Conclusions: One year of CR improved blood pressure and diet quality in healthy individuals without obesity. However, blood pressure changes were attributable to CR without additional benefits from diet quality. Other factors (e.g., health status, family history) may contribute to variability observed in blood pressure responses with long-term CR.

Funding Sources: National Heart, Lung, and Blood Institute