One of the first studies to examine eating patterns of multiple ethnic groups
has shown that nutritional advice--in this case accordance with the Dietary
Approaches to Stop Hypertension (DASH) diet for hypertension control--should be
customized for different racial/ethnic groups [1].

In their study, published in the April 13, 2009 issue of the Archives of
Internal Medicine, Dr Sue K Gao (Amgen, Thousand Oaks, CA) and colleagues used
baseline data from the Multi-Ethnic Study of Atherosclerosis (MESA) to look
cross-sectionally at the diets of different minorities. "We found that despite
all the publicity surrounding the DASH diet, the accordance level was low; less
than one-third were accordant with this diet. Also, we found huge ethnic
variations and some key insights for the less explored ethnicities," she told
heartwire.

Gao, who is a MESA investigator, says it is vital that advice is tailored: "When
you are doing health-promotion campaigns, it's hard to instruct people
regardless of their background--you can't send a blanket message. You need to
pick up on one or two things that they can really improve upon."

Less Than a Third of Participants Met Any DASH Target

DASH consists of an eating plan low in total fat, saturated fat, and cholesterol
and rich in fruits, vegetables, and low-fat dairy products. The underlying
nutrient targets are reduced fat, saturated-fat, and cholesterol intake and
increased protein, fiber, calcium, magnesium, and potassium intake, which have
been shown to aid hypertension control, Gao and colleagues explain. Although
DASH has been shown to be effective among white and African American patients,
it has not been critically examined in other ethnic groups, they note.

The almost 6000 MESA participants examined for this study were self-identified
as white (n=2391), African American (n=1486), Hispanic (n=1318), or Chinese
American (n=777). The analysis used cross-sectional data on diet from the
baseline visit, which consisted of a 120-item food-frequency questionnaire,
which was specially modified to accommodate ethnic foods and therefore "should
be a better reflection of the real diets of ethnic minorities" than previous
work in this field, the researchers point out.

DASH accordance with intake of each nutrient by ethnicity and hypertension
status was analyzed. The term compliance or adherence was not used, said Gao,
"because we had no information on participant knowledge or attitude toward the
DASH diet" and were unable to determine whether eating behaviors had been
consciously modified.

They found that less than 30% of MESA participants met any DASH nutrient target.
DASH accordance was lowest in saturated-fat intake and highest in cholesterol
intake (5.3% and 29.5% of the participants, respectively). Multivariate analyses
showed significant ethnic differences in DASH accordance in all nutrients but
saturated fat.

Compared with white participants, Chinese Americans were more likely to meet
DASH goals in cholesterol (odds ratio [OR], 1.37) and protein intake (OR 2.32)
but less likely to meet total fat (OR 0.47), magnesium (OR 0.58), and potassium
targets (OR 0.40); African Americans and Hispanics had greater DASH accordance
in fiber intake (OR 1.36 and 2.23, respectively) but less in calcium intake (OR
0.44 and 0.79, respectively).

Gao said they also found, somewhat surprisingly, "that hypertensive people did
not behave differently, whether they knew they had hypertension or not."

Uniquely, the researchers also included intake from dietary supplements,
something Gao said is not often done. "If you don't include them, you're missing
something, because it is a matter of reality that people are taking these." They
found in particular that misclassification would be high among whites if data on
supplement intake were not included.

Findings Should Provide Insight to Customize DASH Messages

"Ours is one of the first studies to examine the nutrient-intake patterns of
multiple ethnicities using the DASH targets," Gao stressed to heartwire. "We
found that DASH accordance in general was quite low even after taking account of
intake from both whole-food and dietary supplements and varied significantly by
ethnicity. Findings from MESA may provide insights as to how to customize DASH
messages for different racial/ethnic groups.

"For the Chinese American group, the core message should be to promote the
intake of micronutrients and fiber or their whole-food equivalents of
fruits/vegetables and dairy products. For Hispanic and African Americans, the
core message should be to promote protein and calcium-rich foods such as
seafood, beans, peas, and lean meat and to consider the use of calcium-fortified
foods," she concluded.


Gao SK, Fitzpatrick AL, Psaty B, et al. Suboptimal nutritional intake for
hypertension control in 4 ethnic groups. Arch Intern Med 2009; 169: 702-707.
Abstract