Comparing Very Low-Carbohydrate vs DASH Diets for Overweight or Obese Adults With Hypertension and Prediabetes or Type 2 Diabetes: A Randomized Trial

Abstract

PURPOSE Adults with a triple multimorbidity (hypertension, prediabetes or type 2 diabetes, and overweight or obesity), are at increased risk of serious health complications, but experts disagree on which dietary patterns and support strategies should be recommended. METHODSWe randomized 94 adults from southeast Michigan with this triple multimorbidity using a 2 × 2 diet-by-support factorial design, comparing a very low-carbohydrate (VLC) diet vs a Dietary Approaches to Stop Hypertension (DASH) diet, as well as comparing results with and without multicomponent extra support (mindful eating, positive emotion regulation, social support, and cooking). RESULTSUsing intention-to-treat analyses, compared with the DASH diet, the VLC diet led to greater improvement in estimated mean systolic blood pressure (-9.77 mm Hg vs -5.18 mm Hg; P = .046), greater improvement in glycated hemoglobin (-0.35% vs -0.14%; P = .034), and greater improvement in weight (-19.14 lb vs -10.34 lb; P = .0003). The addition of extra support did not have a statistically significant effect on outcomes.CONCLUSIONS For adults with hypertension, prediabetes or type 2 diabetes, and overweight or obesity, the VLC diet resulted in greater improvements in systolic blood pressure, glycemic control, and weight over a 4-month period compared with the DASH diet. These findings suggest that larger trials with longer follow-up are warranted to determine whether the VLC diet might be more beneficial for disease management than the DASH diet for these high-risk adults.

Dietary Patterns and New-Onset Diabetes Mellitus in Southwest China: A Prospective Cohort Study in the China Multi-Ethnic Cohort (CMEC)

“…Recently, a national prospective cohort study in the USA has proved the DASH pattern (high intake of fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains and low intake of sodium, sweetened beverages, and red and processed meats) was statistically significantly associated with increased risk of type 2 diabetes (Q1 vs. Q5) [ 22 ], which was similar to our findings. A clinical trial shows adults with overweight or obesity, hypertension, and prediabetes or type 2 diabetes had improvements in SBP, glycemic control, and weight over a 4-month period combined with DASH pattern, which means the potential in preventing diabetes [ 23 ]. The evidence from RCTs examining the effect of the DASH diet on glycemic control is limited to GDM [ 7 ].…”

“…This prospective cohort study was conducted from September 2018 to October 2023 in Chongqing, a municipality in southwestern China. After multi-stage, stratified, communitybased cluster sampling from 13 main districts and counties (districts and counties of the same grade), 23,308 Chinese adults of Han nationality, aged 30-79 years old, who had lived in the local area for half a year or more participated. Ethical approval was obtained from the Medical Ethics Review Committee of Sichuan University (K2016038) on 9 November 2016.…”

Study of various dietary interventions in patients with hypertension and metabolic syndrome

“…Было обнаружено, что диета VLC снижает АД [31] и она рекомендована Американской диабетической ассоциацией в качестве варианта для контроля гликемии и снижения веса [32]. В рамках рандомизированного исследования MHERO [33] было установлено, что у взрослых с ожирением, АГ и предиабетом или СД 2 типа диета VLC показала большее снижение САД, улучшение гликемического контроля и веса в течение 4-месячного периода по сравнению с диетой DASH, хотя оба диетических подхода показали хорошие результаты.…”