The DASH Diet and Other Dietary Patterns

The Dietary Approaches to Stop Hypertension (DASH) diet refers to a dietary pattern that aims to control hypertension. This pattern is rich in fruit, vegetables, and low-fat dairy products, includes whole grains, poultry, fish, and nuts, and limits saturated fat, red meat, sweets, and sugar-containing beverages (Conlin et al. 2000). The DASH score, which exists in several versions, is used in order to assess adherence to the DASH dietary pattern. The DASH score version most commonly found in the literature with U.S. populations includes eight components (whole grains, vegetables, fruit, nuts and legumes, low-fat dairy, red and processed meat, sugar-sweetened beverages, sodium), each of which scores 5 points for a total of 40 points, while the scoring system is based on sex-specific quintile rankings (Fung et al. 2008).

Other dietary patterns include (1) very low carbohydrate diets (V-LCDs), (2) low- fat diets, (3) hypothesis-driven dietary patterns, and (4) empirically derived dietary patterns.

The V-LCD or ketogenic dietary patterns are considered to have a carbohydrate intake of 20-50 g/day (equivalent to 20% or less of the daily calorie intake from carbohydrates) (Stradling et al. 2014). There are a lot of popular examples of carbohydrate-restricted diets, such as the South Beach, Zone, and Atkins diets. Of these, the Atkins diet is the only ketogenic diet, although it is non-energy restricted, having less than 20% of the daily calorie intake from carbohydrates (Stradling et al. 2014). The South Beach diet is energy restricted and limits carbohydrate intake to approximately 40% of total energy intake, while it encourages the consumption of lower glycemic index carbohydrate foods. The Zone diet, despite the carbohydrate restriction, promotes a balanced intake of carbohydrate, protein, and fat (40:30:30) (Stradling et al. 2014).

Low-fat diets are those in which the energy from fat consumption does not exceed 30% of total energy consumption.

The hypothesis-driven dietary patterns are usually determined by applying an index that assesses adherence to certain guidelines. Specifically, the HEI was developed to quantify adherence to the Dietary Guidelines for Americans (Guenther et al. 2013). It includes 12 components (total vegetables, “greens and beans,” total fruit, whole fruit, seafood and plant proteins, total protein foods, whole grains, low- fat dairy, fatty acid ratio [{PUFA+MUFA}:SFA], refined grains, sodium, “empty calories”) and it scores for a total out of 100 points (Reedy et al. 2014). The AHEI was developed based on foods and nutrients associated with chronic disease risk and includes 11 components (whole grains, vegetables, fruit, nuts and legumes, trans fat, EPA and DHA, PUFAs, alcohol, red and processed meat, sugar-sweetened beverages and fruit juices, sodium), while it scores for a total out of 110 points (Chiuve et al. 2012a). Dietary patterns can be also derived empirically in order to explore the structure of dietary patterns in the population, either by principal component analysis (PCA) or cluster analysis (Bhupathiraju and Tucker 2011).

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