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A Dash Of Hope

The old adage states ‘you are what you eat’ but these days perhaps it would be more appropriate to say ‘you were what you ate.’

A recent analysis of data from the ongoing NHANES (National Health and Nutrition Examination Surveys) study suggests almost half (45.4%) of the cardiometabolic deaths that occurred in the US in 2012 had an association with dietary factors.

To put it in context, that’s an estimated 318,656 Americans who might still be here if they’d paid closer attention to what they ate. It’s not quite that simple but there is that implication.

The research was in fact quite specific. While most people, these days are debating the merits of the 5-2 diet, whether carbs are the devil-incarnate or whether we should tax all sugary soft-drinks, this study, published in JAMA concentrated on 10 foods and nutrients, known to be associated with cardiometabolic disease.

The researchers retrospectively examined the intake of these dietary factors among more than 700,000 who died with heart disease, stroke or type 2 diabetes in 2012.

Of all the foods and nutrients they looked at, the ones most associated with cardiometabolic death were excess sodium, insufficient nuts and seeds, a high intake of processed meats and a low intake of seafood omega-3 fats. Low vegetable and fruit intake also featured.

None of this should be surprising really. As an accompanying editorial in JAMA points out it has been 20 years since they first published the evidence that the DASH diet lowered blood pressure.

This Dietary Approaches to Stop Hypertension diet emphasised foods that were rich in protein, fibre, potassium, magnesium, and calcium. In essence, it recommended we eat fruit, vegetables, beans, nuts, whole grains and low fat dairy and limit our intake of saturated fat and sugar.

“Since the creation of DASH 20 years ago, numerous trials have demonstrated that it consistently lowers blood pressure across a diverse range of patients with hypertension and prehypertension,” the editorial written by scientists from the Duke Global Health Institute in the US state.

In fact, the evidence of benefit from the DASH diet is so strong it has been included in every blood pressure management and dietary guideline since it was first published 20 years ago, the authors said.

So why are we still not eating the right things? Well that’s the million dollar question – or may be the 300,000 preventable deaths question.

The answer, according to the editorial authors is much the same as the answer to why obesity rates are on the rise – the ready-accessibility of energy-rich, nutrient-deficient food, greater expense of fresh fruit and vegetables, bad habits and poor food environments.

If all this is sounding a bit depressing, there is hope.

The researchers of the recent JAMA study point out that in the decade between 2002 and 2012, the annual rate of cardiometabolic deaths in the States actually fell by 26%. And because they have NHANES data from back in 2002 they could compare diets over the decade.

It appears that over the ten years, people in the US (and probably Australia) are eating more polyunsaturated fats (rather than saturated fats), more nuts and seeds, and less sugary drinks. So even though there’s a long way to go at least we’re headed in the right direction.

The editorial authors, in addition to recommending community and policy changes, remind primary care clinicians to include dietary advice, especially DASH advice to all people with high blood pressure, and to all people really.

They also suggest the ubiquity of mobile phones represents a major opportunity, through apps and devices for people to provide data and adopt programs that might be effective in achieving sustainable behavioural change.

Maybe in this digital age, with both the dietary  information and a virtual lifestyle coach at our fingertips the next time this study is conducted in another decade we might see the improvements in population health that we know  a good diet can bring.


  1. Micha R, Penalvo JL, Cudhea F. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA 2017; 317 (9): 912-924 doi:10.1001/jama.2017.0947
  2. Steinberg D, Bennett GG, Svetkey L. The DASH diet, 20 years later. JAMA. Published online March 9, 2017 doi:10.1001/jama.2017.1628