Blood pressure interactions with the DASH dietary pattern, sodium, and potassium: The International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP)
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet enhances potassium intake and reduces sodium intake and blood pressure (BP), but the underlying metabolic pathways are unclear.
Objective
Among free-living populations, delineate metabolic signatures associated with the DASH diet adherence, 24-hr urinary sodium and potassium excretions and the potential metabolic pathways involved.
Design
24-hr urinary metabolic profiling by proton nuclear magnetic resonance spectroscopy was used to characterize the metabolic signatures associated with the DASH dietary pattern score (DASH score) and 24-hr excretion of sodium and potassium among participants in the United States (n=2,164) and United Kingdom (n= 496) enrolled in the International Study of Macro- and Micronutrients and Blood Pressure (INTERMAP). Multiple linear regression and cross-tabulation analyses were used to investigate the DASH-BP relation and its modulation by sodium and potassium. Potential pathways associated with DASH adherence, sodium and potassium excretion, and BP were identified using mediation analyses and metabolic reaction networks.
Results
Adherence to DASH diet was associated with urinary potassium excretion (correlation coefficient, r = 0.42, P<0.0001). In multivariable regression analyses, a five-point higher DASH score (range 7 to 35) was associated with a lower systolic BP by 1.35 mmHg (95% confidence interval: -1.95, -0.80, P=1.2 × 10−5); control of the model for potassium but not sodium attenuated the DASH-BP relation. Two common metabolites (hippurate and citrate) mediated the potassium-BP and DASH-BP relationships, while five metabolites (succinate, alanine, S-methyl cysteine sulfoxide, 4-hydroxyhippurate, phenylacetylglutamine) were found specific to the DASH-BP relation.
Conclusions
Greater adherence to DASH diet is associated with lower BP and higher potassium intake across levels of sodium intake. The DASH diet recommends greater intake of fruits, vegetables, and other potassium rich foods that may replace sodium-rich processed foods and thereby influence BP through overlapping metabolic pathways. Possible DASH-specific pathways are speculated but confirmation requires further study.
Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet enhances potassium intake and reduces sodium intake and blood pressure (BP), but the underlying metabolic pathways are unclear.
Objective
Among free-living populations, delineate metabolic signatures associated with the DASH diet adherence, 24-hr urinary sodium and potassium excretions and the potential metabolic pathways involved.
Design
24-hr urinary metabolic profiling by proton nuclear magnetic resonance spectroscopy was used to characterize the metabolic signatures associated with the DASH dietary pattern score (DASH score) and 24-hr excretion of sodium and potassium among participants in the United States (n=2,164) and United Kingdom (n= 496) enrolled in the International Study of Macro- and Micronutrients and Blood Pressure (INTERMAP). Multiple linear regression and cross-tabulation analyses were used to investigate the DASH-BP relation and its modulation by sodium and potassium. Potential pathways associated with DASH adherence, sodium and potassium excretion, and BP were identified using mediation analyses and metabolic reaction networks.
Results
Adherence to DASH diet was associated with urinary potassium excretion (correlation coefficient, r = 0.42, P<0.0001). In multivariable regression analyses, a five-point higher DASH score (range 7 to 35) was associated with a lower systolic BP by 1.35 mmHg (95% confidence interval: -1.95, -0.80, P=1.2 × 10−5); control of the model for potassium but not sodium attenuated the DASH-BP relation. Two common metabolites (hippurate and citrate) mediated the potassium-BP and DASH-BP relationships, while five metabolites (succinate, alanine, S-methyl cysteine sulfoxide, 4-hydroxyhippurate, phenylacetylglutamine) were found specific to the DASH-BP relation.
Conclusions
Greater adherence to DASH diet is associated with lower BP and higher potassium intake across levels of sodium intake. The DASH diet recommends greater intake of fruits, vegetables, and other potassium rich foods that may replace sodium-rich processed foods and thereby influence BP through overlapping metabolic pathways. Possible DASH-specific pathways are speculated but confirmation requires further study.
Date Issued
2022-07
Date Acceptance
2022-03-09
Citation
The American Journal of Clinical Nutrition, 2022, 116 (1), pp.216-229
ISSN
1938-3207
Publisher
Oxford University Press
Start Page
216
End Page
229
Journal / Book Title
The American Journal of Clinical Nutrition
Volume
116
Issue
1
Copyright Statement
© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
License URL
Sponsor
National Institutes of Health
National Institutes of Health
National Institute for Health Research
National Institutes of Health
Japan Society for the Promotion of Science
Medical Research Council (MRC)
Medical Research Council
Identifier
https://academic.oup.com/ajcn/advance-article/doi/10.1093/ajcn/nqac067/6548184
Grant Number
0600 370 D330 1362
60045948 ICSTM
3R01HL135486-02S1
IMTERMAP Subaward No. 60024563
20171002 & 20180913
MR/S004033/1
MR/S004033/1
Subjects
Science & Technology
Life Sciences & Biomedicine
Nutrition & Dietetics
biomarkers
blood pressure
DASH dietary pattern
24-hour dietary recalls
hypertension
metabolic pathways
potassium
sodium
urinary metabolites
MACRONUTRIENT INTAKE TRIAL
AMINO-ACID-METABOLISM
ASSOCIATION
SPECTROSCOPY
PREVENTION
DIVERSITY
BIOMARKER
RESPONSES
INSIGHTS
ALANINE
24-hour dietary recalls
DASH dietary pattern
biomarkers
blood pressure
hypertension
metabolic pathways
potassium
sodium
urinary metabolites
Blood Pressure
Dietary Approaches To Stop Hypertension
Humans
Hypertension
Micronutrients
Potassium
Sodium
Sodium, Dietary
Humans
Hypertension
Potassium
Sodium
Sodium, Dietary
Micronutrients
Blood Pressure
Dietary Approaches To Stop Hypertension
09 Engineering
11 Medical and Health Sciences
Nutrition & Dietetics
Publication Status
Published
Date Publish Online
2022-03-14