Why the study?
Although the DASH diet lowers blood pressure and LDL cholesterol, its effects and those of diets rich in fruits and vegetables on cardiovascular injury in middle-aged adults without preexisting CVD remained to be determined.
Does a diet rich in fruits and vegetables or the DASH diet reduce markers of subclinical cardiac injury compared to a typical American diet in adults without preexisting CVD?
RCT (n=326)
3-group, parallel-design
Yes
Does a diet rich in fruits and vegetables or the DASH diet reduce markers of subclinical cardiac injury compared to a typical American diet in adults without preexisting CVD?
Effect estimate: Difference -0.5 ng/L (95% CI -0.9 to -0.2)
Diets rich in fruits and vegetables, including the DASH diet, lower biomarkers of subclinical cardiac damage and strain over 8 weeks in adults without preexisting CVD.
Fruit- and vegetable-rich diets were associated with lower cardiac biomarkers; hypothesis-generating for subclinical protection, needs RCTs before practice change.
BACKGROUND: The DASH diet has been found to lower blood pressure (BP) and low-density lipoprotein cholesterol levels. OBJECTIVE: To compare diets rich in fruits and vegetables with a typical American diet in their effects on cardiovascular injury in middle-aged adults without known preexisting cardiovascular disease (CVD). DESIGN: Observational study based on a 3-group, parallel-design, randomized trial conducted in the United States from 1994 to 1996. (ClinicalTrials.gov: NCT00000544). SETTING: 3 of the 4 original clinical trial centers. PARTICIPANTS: 326 of the original 459 trial participants with available stored specimens. INTERVENTION: Participants were randomly assigned to 8 weeks of monitored feeding with a control diet typical of what many Americans eat; a diet rich in fruits and vegetables but otherwise similar to the control diet; or the DASH diet, which is rich in fruits, vegetables, low-fat dairy, and fiber and has low levels of saturated fat and cholesterol. Weight was kept constant throughout feeding. MEASUREMENTS: -terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP). RESULTS: The mean age of participants was 45.2 years, 48% were women, 49% were black, and mean baseline BP was 131/85 mm Hg. Compared with the control diet, the fruit-and-vegetable diet reduced hs-cTnI levels by 0.5 ng/L (95% CI, -0.9 to -0.2 ng/L) and NT-proBNP levels by 0.3 pg/mL (CI, -0.5 to -0.1 pg/mL). Compared with the control diet, the DASH diet reduced hs-cTnI levels by 0.5 ng/L (CI, -0.9 to -0.1 ng/L) and NT-proBNP levels by 0.3 pg/mL (CI, -0.5 to -0.04 pg/mL). Levels of hs-CRP did not differ among diets. None of the markers differed between the fruit-and-vegetable and DASH diets. LIMITATION: Short duration, missing specimens, and an inability to isolate the effects of specific foods or micronutrients. CONCLUSION: Diets rich in fruits and vegetables given over 8 weeks were associated with lower levels of markers for subclinical cardiac damage and strain in adults without preexisting CVD. PRIMARY FUNDING SOURCE: National Institutes of Health, National Heart, Lung, and Blood Institute.
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Juraschek et al. (2020) conducted an RCT in Without preexisting cardiovascular disease (n=326). Fruit-and-vegetable diet and DASH diet vs. Control diet (typical American diet) was evaluated on Subclinical cardiac injury markers (hs-cTnI, NT-proBNP, hs-CRP) (Difference -0.5 ng/L, 95% CI -0.9 to -0.2).
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