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. 2019 Sep 29;11(10):2311.
doi: 10.3390/nu11102311.

Mediating-Moderating Effect of Allostatic Load on the Association between Dietary Approaches to Stop Hypertension Diet and All-Cause and Cause-Specific Mortality: 2001-2010 National Health and Nutrition Examination Surveys

Hind A Beydoun  1 , Shuyan Huang  2 , May A Beydoun  3 , Sharmin Hossain  4 , Alan B Zonderman  5
Affiliations

Mediating-Moderating Effect of Allostatic Load on the Association between Dietary Approaches to Stop Hypertension Diet and All-Cause and Cause-Specific Mortality: 2001-2010 National Health and Nutrition Examination Surveys

Hind A Beydoun et al. Nutrients. .

Abstract

This secondary analysis of survey data examined mediating-moderating effects of allostatic load score (calculated using the Rodriquez method) on the association between nutrient-based Dietary Approaches to Stop Hypertension (DASH) diet score (Mellen Index) and the all-cause and cause-specific mortality risks among 11,630 adults ≥ 30 years of age from the 2001-2010 National Health and Nutrition Examination Surveys with no history of cardiovascular disease or cancer at baseline, and who were followed-up for ~9.35 years. Multivariable models were adjusted for demographic, socioeconomic, lifestyle, and health characteristics. All-cause, cardiovascular disease, and cancer-specific mortality rates were estimated at 6.5%, 1.1%, and 1.9%, respectively. The median DASH total score was 3.0 (range: 1-8) (with 78.3% scoring < 4.5), whereas the median allostatic load score was 3 (range: 0-9). The DASH diet, fiber, and magnesium were negatively correlated with allostatic load, whereas allostatic load predicted higher all-cause mortality, irrespective of the DASH diet. Whereas protein was protective, potassium increased all-cause mortality risk, irrespective of allostatic load. Potassium was protective against cardiovascular disease-specific mortality but was a risk factor for cancer-specific mortality. Although no moderating effects were observed, mediation by the allostatic load on cardiovascular disease-specific mortality was observed for DASH total score and selected component scores. Direct (but not indirect) effects of DASH through the allostatic load were observed for all-cause mortality, and no direct or indirect effects were observed for cancer-specific mortality. From a public health standpoint, the allostatic load may be a surrogate for the preventive effects of the DASH diet and its components on cardiovascular disease-specific mortality risk.

Keywords: allostatic load; diet; hypertension; mortality; survey.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study Flowchart.
See this image and copyright information in PMC

References

    1. Oste M.C.J., Gomes-Neto A.W., Corpeleijn E., Gans R.O.B., de Borst M.H., van den Berg E., Soedamah-Muthu S.S., Kromhout D., Navis G.J., Bakker S.J.L. Dietary Approach to Stop Hypertension (DASH) diet and risk of renal function decline and all-cause mortality in renal transplant recipients. Am. J. Transplant. 2018;18:2523–2533. doi: 10.1111/ajt.14707. - DOI - PMC - PubMed
    1. Biesbroek S., Verschuren W.M.M., Boer J.M.A., van de Kamp M.E., van der Schouw Y.T., Geelen A., Looman M., Temme E.H.M. Does a better adherence to dietary guidelines reduce mortality risk and environmental impact in the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition? Br. J. Nutr. 2017;118:69–80. doi: 10.1017/S0007114517001878. - DOI - PMC - PubMed
    1. Schwingshackl L., Bogensberger B., Hoffmann G. Diet quality as assessed by the healthy eating index, alternate healthy eating index, dietary approaches to stop hypertension score, and health outcomes: An updated systematic review and meta-analysis of cohort studies. J. Acad. Nutr. Diet. 2018;118:74–100. doi: 10.1016/j.jand.2017.08.024. - DOI - PubMed
    1. Park Y.M., Fung T.T., Steck S.E., Zhang J., Hazlett L.J., Han K., Lee S.H., Merchant A.T. Diet quality and mortality risk in metabolically obese normal-weight adults. Clin. Proc. 2016;91:1372–1383. doi: 10.1016/j.mayocp.2016.06.022. - DOI - PubMed
    1. Saglimbene V.M., Wong G., Craig J.C., Ruospo M., Palmer S.C., Campbell K., Garcia-Larsen V., Natale P., Teixeira-Pinto A., Carrero J.J., et al. The Association of Mediterranean and DASH diets with mortality in adults on hemodialysis: The DIET-HD multinational cohort study. J. Am. Soc. Nephrol. 2018;29:1741–1751. doi: 10.1681/ASN.2018010008. - DOI - PMC - PubMed