DASH Dietary Pattern for Weight Loss: Hypertension Prevention and Treatment, Evidence for Fat Reduction, and Implementation Strategies

III. DASH Dietary Approach and Weight Loss 1. Definition of DASH Diet The DASH diet (dietary approaches to stop hypertension) is a dietary approach developed by a large-scale hypertension prevention and control program in the United States in 1997. This program found that if the diet contains enough vegetables, fruits, and low-fat (or skim) milk to maintain sufficient intake of potassium, magnesium, calcium and other ions, and the amount of fat in the diet (especially animal fats rich in saturated fatty acids) is minimized, blood pressure can be effectively lowered. Therefore, the DASH diet is now often used as a dietary approach for the prevention and control of hypertension. 2. Implementation and Evidence of DASH Dietary Approach (1) Evidence: Participants in the DASH diet group and the fruit and vegetable group showed significant blood pressure reduction on average. In the following 20 years, in the design of studies with blood pressure reduction as the main goal, there were reports of significant weight loss, weight loss but not significant weight loss, and no weight loss. (2) Suitable population: Obese people with hypertension and diabetes. Because of its balanced nutrition, safety, good compliance, and benefits to cardiovascular health, it can also be used for ordinary simple obesity patients (including adults and the elderly) to prevent the occurrence of cardiovascular diseases. (3) Recommendations: 1) For non-severely obese patients with hypertension/diabetes who do not aim for weight loss, the DASH diet may result in significant or insignificant weight loss. 2) For obese or severely obese patients with or without hypertension or diabetes, if they want to achieve a more significant weight loss effect, they should combine the DASH diet with energy restriction and aerobic exercise. 3) The DASH diet combined with a low-fat diet (WELL diet) can effectively reduce weight. 3. Development of the DASH Diet Plan (1) Principles for developing the diet plan: It does not emphasize excessive control of salt and energy intake. Energy should be at or slightly lower than the average intake or recommended dietary intake of various population groups. The daily macronutrient energy ratio can refer to the initial design of the DASH experimental diet, namely, carbohydrate energy ratio of 45%-56%, protein energy ratio of 15%, and a variety of vegetables and fruits. Dairy: Use skim or low-fat milk (avoid whole milk). Protein: Use white meat (lean meat) such as fish and chicken, avoid red meat, fatty meat and offal. Nuts and seeds: Eat dried fruit or beans in moderation. Oils: Reduce oily foods and cooking oil, and replace animal oil with vegetable oil. Reduce sugar and sugary soft drinks. (3) Example of a diet plan: The diet plan should be adjusted according to the patient's height, weight, race and different eating habits. Example of a diet plan for 2000 kcal per day: 78 servings of cereals and cereal products per day (1 slice of bread or 1 cup of ready-to-eat cereal); 45 servings of vegetables per day (1 cup of raw leafy green vegetables or 1/2 cup of cooked vegetables); 45 servings of fruit per day; 23 servings of low-fat and skim dairy products per day; 2 servings or less of lean meat, poultry and fish (85g cooked); 45 servings of nuts, seeds and dried beans per week; 2-3 servings of fats and oils per day. (4) Nutritional monitoring: Nutritional monitoring is conducted using methods described by nutritional assessment to evaluate the effectiveness of the DASH diet for weight loss and to monitor the possibility of preventing malnutrition in patients. 4. DASH Dietary Precautions (1) Ethnicity, religion, food allergy history, etc.: First, it is necessary to understand the dietary habits of patients of different ethnicities, or religious beliefs and other special dietary restrictions, whether there is a need for fasting, and whether there are special food allergies such as dairy products, bran, fish and seafood. (2) Compliance: It is necessary to comprehensively consider the patient's compliance, such as ethnicity, lifestyle, culture, acceptance of plant-based foods, satisfaction of food diversity, seasonality and price, patient income and other comprehensive factors, and consider the taste and texture of food and the taste preferences of the subjects. (3) Holidays: Special instructions need to be given for diet on holidays. If necessary, takeaway food can be prepared and how to prepare it.

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