226107 Alcohol Consumption and Adherence to the DASH Diet in Hypertensive Veterans

Sunday, November 7, 2010

Jennifer P. Friedberg, PhD , Research & Development Service (151), VA New York Harbor Healthcare System/New York University School of Medicine, New York, NY
Michelle Ulmer, BA , Research and Development Service, Department of Veterans Affairs New York Harbor Healthcare System & New York University, New York, NY
Iris Lin, MPA , VA New York Harbor Healthcare System/NYU Robert F. Wagner Graduate School of Public Service, New York, NY
Elizabeth Grand , VA New York Harbor Healthcare System/New York University, New York, NY
Stuart R. Lipsitz, ScD , Brigham and Women's Hospital/Harvard Medical School, Boston, MA
Sundar Natarajan, MD, MSc , Research and Development Service, Department of Veterans Affairs New York Harbor Healthcare System & New York University, New York, NY
Guidelines for treating hypertension suggest that reducing alcohol intake can lower blood pressure (BP), particularly among those who drink more than two drinks per day. Some studies indicate that alcohol consumption may have an inverse relationship with healthy eating habits. However, little is known about the association between alcohol consumption and specified dietary advice in chronic conditions. In the current study, we examined the relationship between alcohol consumption and adherence to specific components of the Dietary Approaches to Stop Hypertension (DASH) diet in patients with hypertension.

We analyzed baseline data from 383 veterans (mean age=65.8 years; 42.6% Caucasian, 37.6% African American, 13.1% Hispanic) with hypertension participating in a randomized controlled trial to lower BP. Consumption of specific DASH components was obtained using the Willet Food Frequency Questionnaire. Robust regressions were used to determine the relationship between alcohol consumption and each DASH component while controlling for age and race.

Alcohol had a linear relationship with sodium, saturated fat, fiber, fruits and vegetables, low-fat dairy, and potassium. An increase in 1 (0 to 1, 1 to 2, etc) alcoholic beverage per day was associated with a 104.72 mg reduction in sodium (p<.0001) and a 980 mg reduction in saturated fat consumed (p<.0001). An increase in 1 alcoholic beverage was also associated with a 1,820 mg reduction in fiber consumption (p<.0001), a 0.42 serving reduction in fruits and vegetables (p<.0006), a 0.14 serving reduction in consumption of low-fat dairy products, and a 144.76 mg reduction in potassium consumption (p<.0001). There was a quadratic relationship between alcohol and both fat and whole grains such that: a) when alcohol intake increased from 0 to 1 drink, fat decreased by 2,140 mg and whole grain consumption decreased by 0.18 servings, while b) an increase from 1 to 2 drinks decreased consumption of fat by 3,240 mg and whole grains by 0.10 servings.

The association between alcohol and DASH diet adherence is mixed. Although alcohol consumption was associated with reduced sodium, fat, and saturated fat intake, it was also associated with an overall pattern of unhealthy eating. Hypertensive patients who consume excessive alcohol should be encouraged to not only reduce their alcohol consumption but to also improve their overall eating habits in order to lower their BP. Interventions to improve adherence to dietary recommendations in hypertensive patients who consume alcohol should focus on increasing consumption of fruits, vegetables, whole grains, fiber, low-fat dairy, and potassium-rich foods.

Learning Areas:
Administer health education strategies, interventions and programs
Assessment of individual and community needs for health education
Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
1. Identify the DASH diet components that are associated with alcohol consumption in veterans with hypertension. 2. Discuss ways in which interventions to improve dietary adherence in hypertensive patients can be tailored to target patients who consume excessive amounts of alcohol.

Keywords: Hypertension, Adherence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a staff physician at the VA New York Harbor Healthcare System and the principal investigator of the project discussed in this poster, A Behavioral Intervention to Improve Hypertension Control in Veterans
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.