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The PREMIER Intervention Helps Participants Follow the Dietary Approaches to Stop Hypertension Dietary Pattern and the Current Dietary Reference Intakes Recommendations

https://doi.org/10.1016/j.jada.2007.06.019Get rights and content

Abstract

Objective

To examine the influence of the PREMIER study lifestyle interventions on dietary intakes and adherence to the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and the Dietary Reference Intakes (DRI).

Design

An 18-month multicenter, randomized controlled trial comparing two multicomponent lifestyle intervention programs to an advice only control group.

Subjects/setting

A total of 810 participants were recruited from local communities and randomized into the study. Individuals were eligible if they were aged 25 years or older, had body mass index between 18.5 and 45.0, not taking antihypertensive medication, and had prehypertension or stage 1 hypertension (systolic blood pressure 120 to 159 mm Hg and diastolic blood pressure 80 to 95 mm Hg).

Intervention

The two active intervention programs were a behavioral lifestyle intervention that implements established recommendations, and an established intervention plus the DASH dietary pattern. Both interventions consisted of intensive group and individual counseling sessions. The control group received a brief advice session after randomization and again after 6 months of data collection. Dietary intakes were collected by two random 24-hour recalls at baseline, 6 months, and 18 months.

Main outcome measures

The primary outcome of the PREMIER study was change in systolic blood pressure at 6 months. The main outcomes examined here include dietary variables collected by 24-hour recall at each time point.

Statistical analyses

Nutrient intakes were calculated and compared among the time points and the three intervention groups using mixed models with repeated measures at 6 and 18 months. Proportion of participants who met or achieved the original DASH nutrient intake levels and the DRIs were calculated and compared among the three intervention groups. P<0.01 was considered statistically significant.

Results

Participants in both the established intervention and established intervention plus DASH dietary pattern groups substantially reduced energy, total fat, saturated fat, and sodium intake and these reductions persisted throughout the study. Established intervention plus DASH dietary pattern group participants increased intakes of fruits, vegetables, dairy, and many vitamins and minerals; these increases were significantly greater than that of the control and established intervention groups. A majority of established intervention plus DASH dietary pattern group participants achieved at least two thirds of the DRI recommendations for most nutrients at 6 months, despite their reduction in total energy intake. Some but relatively small recidivism occurred at 18 months.

Conclusions

Both the established intervention and established intervention plus DASH dietary pattern group intervention were effective in helping participants follow established recommendations to control blood pressure. The advice-only control group also made some behavior changes, mainly decreasing energy and sodium intake. Only the established intervention plus DASH dietary pattern group significantly increased intakes of DASH-specific food groups, including fruits, vegetables, and dairy products, and nutrients, including protein, fiber, calcium, potassium, and magnesium. Most of the increases did not reach the levels consumed in the original DASH feeding studies. Whereas the established intervention plus DASH dietary pattern group intervention provides a useful platform to achieve the DASH dietary pattern and current DRI recommendations, intervention enhancements, including a greater emphasis on nutrient-dense foods, would likely improve this intervention.

Section snippets

Study Design

PREMIER was a randomized clinical trial designed to determine the effects of two multicomponent lifestyle interventions on blood pressure. Detailed description of the study design, the intervention programs, and the main results have been published elsewhere (8, 9). Participating institutions included the National Heart, Lung, and Blood Institute Project Office (Bethesda, MD), the Coordinating Center (Kaiser Permanente Center for Health Research, Portland, OR), and four clinical centers (Duke

Results

A total of 764 (94%) randomized participants had at least one dietary recall at the two study time points and were included in the data analysis. These participants averaged 50±8.9 years old and had a mean BMI of 33.0±5.8. Approximately 60% were women and one third were African American. Detailed baseline characteristics of the participants have been published elsewhere (8). Overall, both EST and EST+DASH interventions effectively helped participants reduce systolic/diastolic blood pressures by

Discussion

The results of this study suggest that both EST and EST+DASH interventions were effective in helping participants change eating habits and follow the study guidelines related to energy and total and saturated fat reduction during the 6-month intensive program. In addition, the EST+DASH intervention was more effective than EST in meeting DASH-specific targets and DRI recommendations for many nutrients. Although the control group received only a 30-minute advice session immediately following

Conclusions

Both the EST and the EST+DASH interventions were effective in helping participants follow the established recommendations to control blood pressure. At baseline, more participants did not meet the DRI recommendations for the nutrients that may be related to blood pressure regulation (ie, fat, dietary fiber, calcium, potassium, and magnesium) than for other nutrients. Only the EST+DASH group significantly increased intakes of these DASH-specific nutrients and food groups, including fruits,

P.-H. Lin is an associate research professor, Department of Medicine, Duke University Medical Center, Durham, NC.

References (26)

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      Both groups lost weight and lowered blood pressure, yet there was no significant difference between the two groups.38 The DASH group, however, reported greater consumption of foods consistent with the DASH diet (ie, fruits, vegetables, dairy) compared with the group receiving no DASH recommendations.23 These improvements were not enough to promote full adherence to the DASH nutrient targets and improve blood pressure reduction above and beyond standard lifestyle practices.23

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    P.-H. Lin is an associate research professor, Department of Medicine, Duke University Medical Center, Durham, NC.

    L. J. Appel is a professor, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD.

    K. Funk and S. Craddick are research associates, C. Chen and P. Elmer are senior scientists, and M. McBurnie is an investigator, Kaiser Permanente Center for Health Research, Portland, OR.

    C. Champagne is a research professor, Pennington Biomedical Research Center, Baton Rouge, LA.

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