Associations between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and six glucose homeostasis traits in the Microbiome and Insulin Longitudinal Evaluation Study (MILES)

Authors: RAMESH, GAUTAM - University Of California, San Diego; WOOD, ALEXIS - Children'S Nutrition Research Center (CNRC); ALLISON, MATTHEW - University Of California, San Diego; RICH, STEPHEN - University Of Virginia; JENSEN, ELIZABETH - Wake Forest School Of Medicine; ROTTER, JEROME - Harbor-Ucla Medical Center; BERTONI, ALAIN - Wake Forest School Of Medicine; GOODARZI, MARK - Cedars-Sinai Medical Center

Submitted to: Nutrition Metabolism and Cardiovascular Disease
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/10/2022
Publication Date: 3/19/2022
Citation: Ramesh, G., Wood, A.C., Allison, M.A., Rich, S.S., Jensen, E.T., Rotter, J.I., Bertoni, A.G., Goodarzi, M.O. 2022. Associations between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and six glucose homeostasis traits in the Microbiome and Insulin Longitudinal Evaluation Study (MILES). Nutrition Metabolism and Cardiovascular Disease. https://doi.org/10.1016/j.numecd.2022.03.014.
DOI: https://doi.org/10.1016/j.numecd.2022.03.014

Interpretive Summary: Type 2 Diabetes (T2D) is a complex condition that develops over time, with perturbations across multiple metabolic pathways arising at different times during disease progression. While there is robust evidence that the Dietary Approaches to Stop Hypertension (DASH) diet conveys protection from type 2 diabetes (T2D) via lower fasting insulin levels, there are little data on whether DASH improves other metabolic pathways that reflect T2D development. This study examined cross-sectional associations between adherence to a DASH diet and six traits that, at various times in disease progression, indicate the development of T2D. Consuming a DASH diet was associated fasting plasma glucose, insulin sensitivity, and disposition index, but not fasting insulin nor insulin resistance. As fasting plasma glucose, insulin sensitivity, and disposition index are some of the first metabolic difficulties experienced during the development of T2D, these analyses suggestt that DASH provides protection during the early, but not later, stages of the pathology preceding T2D presentation. Such findings, if replicated, may contribute to dietary approaches for disease prevention that are personalized to an individual's metabolic health.

Technical Abstract: The DASH diet conveys protection against type 2 diabetes mellitus (T2D) via plant-based and non-plant-based recommendations. Research has not identified which glucose homeostasis pathways are improved. We examined associations between adherence to a DASH diet and six glucose homeostasis traits, probing whether associations could be attributed to the plant-based (DASH-P) and/or non-plant based (DASH-NP) components. We included data from 295 adults without T2D (age 59.3+/-9.00 years; 63.46% non-Hispanic White and 36.54% African American, self-reported race ancestry) participating in the Microbiome and Insulin Longitudinal Evaluation Study (MILES). An oral glucose tolerance test (OGTT) yielded fasting plasma glucose, insulin, C-peptide, and insulin secretion, sensitivity, and disposition index. Habitual dietary intake was assessed by food frequency questionnaire (FFQ). Associations between DASH components and glucose homeostasis traits were examined, controlling for demographics, body mass index (BMI), physical activity, and energy intake. For significant associations, the models were repeated with scores for DASH-P and DASH-NP as predictors in the same model. DASH and DASH-P scores were inversely associated with fasting plasma glucose (DASH:Beta=-0.036+/-0.012,P=0.005; DASH-P: Beta=-0.04+/-0.017,P=0.002), and positively associated with insulin sensitivity (DASH:Beta=0.022+/-0.012,P=.042; DASH-P:=0.036+/-0.015,P=0.014). The DASH score was also associated with disposition index (Beta=0.026+/-0.013,P=0.038), but this association did not reach significance with DASH-P (Beta=0.035+/-0.018,P=0.051). No associations were observed with DASH-NP score (all P>.05). DASH diet is associated with improvement in specific glucose homeostasis traits, likely arising from increased plant-based foods. Such research may help tailor future dietary advice to specific metabolic risk, and to food groups most effective at improving these.