Alcohol Consumption and Adherence to the DASH Diet in Hypertensive Veterans

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.