Abstract
Background
Dietary approaches to stop hypertension (DASH) diet as a balanced dietary pattern is designed to help manage hypertension. The scientific evidence hypothesized that following the DASH diet may lead to reductions in cardiometabolic risk. We aimed to design a clinical trial to assess the impact of the DASH diet on cardiometabolic and atherogenic indices in individuals with metabolic syndrome (MetS).
Methods
Sixty participants diagnosed with MetS were randomly divided into two groups: the intervention group (adhering to DASH diet) or the control group (following a common healthy diet). Key outcomes of the present study including cardiometabolic index (CMI) as our primary outcome, and atherogenic index of plasma (AIP), atherogenic coefficient (AC) and castelli risk index II (CRI-II) as secondary outcomes were evaluated at the baseline and at the end of the study.
Results
While one participant excluded from the trial, 59 subjects completed the study. Baseline values of CMI (p = 0.33), AIP (p = 0.27), AC (p = 0.44) and CRI-II (p = 0.17) showed no significant difference between the intervention group and the control group. After adjusting for confounding factors, the intervention group demonstrated a significant decrease compared to the control group in CMI (−0.38±0.29 vs. −0.02±0.47; p = 0.001), AIP (−0.04±0.04 vs. 0.01 ± 0.07; p = 0.001), AC (−0.31±0.54 vs. 0.01 ± 0.72; p = 0.04) and CRI-II (−0.30±0.37 vs. −0.03±0.39; p = 0.009).
Conclusions
Adherence to the DASH diet appears to be effective in reducing CMI and some atherogenic indices. Further well-designed clinical trials with longer intervention durations are needed.
Trial registration
The trial was registered on 21 October 2022 at Iranian Registry of Clinical Trials (IRCT20180201038585N12, https://irct.behdasht.gov.ir/trial/66161).
Keywords: Metabolic syndrome, DASH diet, Cardiometabolic risk
Introduction
The worldwide prevalence of metabolic syndrome (MetS) is more than 20% [1]. Due to its widespread prevalence and its association with the occurrence of various non-communicable diseases, MetS imposes a significant economic burden on the healthcare system [1, 2]. The number of prevalent cases of cardiovascular diseases (CVDs) has more than doubled from 1990 to 2023, rising from 311 million to 626 million globally [3]. It has been indicated that the probability of cardiovascular risk is higher among individuals suffering from MetS than individuals without MetS [4]. The cardiometabolic index (CMI), derived from anthropometric measurements and lipid profile, serves as a reliable scoring system for assessing cardiovascular risk [5]. In addition, atherogenic index of plasma (AIP), atherogenic coefficient (AC) and castelli risk index (CRI) have been established to predict cardiometabolic risk [6, 7]. Following healthy dietary patterns can be a useful strategy to manage cardiovascular risk and MetS [8, 9].
The dietary approaches to stop hypertension (DASH) diet as a plant-based diet relies on low consumption of fat, red meat, sugar-sweetened beverages, and sodium [10]. Instead, the DASH diet emphasizes consuming healthy food groups such as vegetables, whole grains, fruits, low-fat dairy products and legumes [11]. It has been shown that adherence to healthy diets such as DASH diet could prevent excessive use of antihypertensive drugs, reduce the dose or number of drugs employed, and improve the efficacy of the pharmacological treatment [12]. The study of Siervo et al. [13] suggested that DASH diet may have greater beneficial effects in subjects with an increased cardiometabolic risk. Some clinical trials have evaluated the effect of DASH diet among individuals suffering from non-communicable diseases [14–17]. A few numbers of studies have explored the effect of DASH diet on individuals with MetS, yielding inconsistent findings [18, 19]. The DASH diet is hypothesized to play a significant role in managing CMI and atherogenic indices. We aimed to examine the effect of DASH diet on CMI and atherogenic indices in subjects with MetS.
Methods
Participants
We conducted a randomized controlled trial (RCT) for 12 weeks. Recruitment of subjects was performed from October 2022 to November 2022 in Yazd, Iran. Individuals aged between 30 and 60 years, with MetS according to the International Diabetes Federation (IDF) criteria [20], and who signed a written informed consent were included in the study. According to the IDF criteria, MetS is defined by the presence of central obesity (waist circumference (WC) in male ≥ 94 cm and female ≥ 80 cm) plus any two of the following four factors: 1) raised triglycerides (TG) (≥150 mg/dL) or specific treatment for this lipid abnormality; 2) reduced high-density lipoprotein cholesterol (HDL-c) (<40 mg/dL in males, <50 mg/dL in females) or specific treatment for this lipid abnormality; 3) raised blood pressure (systolic/diastolic blood pressure ≥ 130/85 mmHg) or treatment of previously identified hypertension; and 4) raised fasting plasma glucose (≥100 mg/dL) or previously diagnosed type 2 diabetes mellitus (T2DM). Individuals who met the following criteria were excluded from the study: hypothyroidism, Cushing’s syndrome, Wilson disease, kidney diseases, history of hepatitis, hemochromatosis, bypass surgery, pregnancy and lactation, and consuming calcium channel blockers, synthetic estrogens, vitamin D, vitamin E, and omega-3.
Trial design
The present study aimed to assess the impact of adhering DASH diet for 12 weeks on CMI (as primary outcome) and atherogenic indices including AIP, AC and CRI-II (as secondary outcomes) among individuals with MetS. Previously, our research team reported the effect of DASH diet on fatty liver, insulin resistance, lipid accumulation product and cardiovascular risk factors [21, 22]. The research protocol was approved by the ethical committee of Baqiyatallah University of Medical Sciences Tehran, Iran. We registered the study protocol at Iranian Registry of Clinical Trials (IRCT20180201038585N12, URL: https://irct.behdasht.gov.ir/trial/66161).
This study was done in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. A stratified randomization method based on sex (male/female) and age (30–45 and 45–60 years) was used and the subjects were divided into the groups by a computer-generated random numbers table. Opaque sealed envelopes were used to perform allocation concealment. Using a 95% confidence interval with α = 0.05 and β = 0.2 and based on the WC values reported by Razavi Zade et al. [17] a sample size of 60 was determined to be sufficient. A retrospective power analysis was performed for outcomes of the present article, and we observed sufficient power.
Both the intervention group (following DASH diet) and control group (following a common healthy diet) received energy-restricted diet with similar macronutrients distribution (50–55% carbohydrate, 15–20% protein, and 30% total fat). The DASH diet compared to the healthy diet has higher amounts of food groups such as vegetables, fruits, low-fat dairy products, nuts, seeds and legumes. Thus, the participants in the intervention group (DASH diet) receive higher amounts of fibers and micronutrients especially potassium, magnesium, vitamin C, vitamin A and folate. In addition, the DASH diet has lower amounts of meats, fats and oils. In general, we aimed to control the effects of energy restriction and macronutrient distribution to clarify the effects of DASH diet compared to a common healthy diet. The dietary intakes of participants were checked every 4 weeks via phone interviews and the participants were trained to follow the intervention. The participants received text messages twice a week to maintain an appropriate level of adherence to the intervention.
Assessments
Dietary intakes of participants were assessed at baseline and post-intervention utilizing a food record [23]. The collected data were analyzed via Nutritionist IV (N-Squared Computing, Salem, OR, USA) customized for Iranian foods. Physical activity was assessed using metabolic equivalent of task (MET) questionnaire [24, 25].
Participants’ weight was recorded at the baseline and after intervention using a digital Seca scale (Seca, Germany), while height and waist circumference were determined by a stadiometer (Seca, Hamburg, Germany) and a tape measure, respectively. We computed body mass index (BMI) using its equation: weight (kg)/height squared (m2).
Laboratory analysis
After an overnight fasting, 10 cc of blood was drawn from each participant at baseline and post-intervention for laboratory analyses. We evaluated total cholesterol (TC), TG, low-density lipoprotein cholesterol (LDL-c) and HDL-c using Pars Azmoon kits (manufactured in Iran) and an autoanalyzer (Siemens, United Kingdom).
We computed the CMI [5], AIP [26], AC [7] and CRI-II [27] using following equations:
CMI = (TG/HDL-c) × waist-to-height ratio (WHtR)
AIP = log (TG/HDL-c)
AC = (TC – HDL-c)/HDL-c
CRI-II = LDL-c/HDL-c
Statistical analysis
Statistical analysis was conducted utilizing the statistical package for social science (SPSS) software version 24 and an intention-to-treat (ITT) approach was used for analyses. The normality of indices was assessed with the Kolmogorov-Smirnov test. An independent t-test (for continuous variables) was used to compare the differences between groups, while categorical variables were analyzed using chi-square test. Within-group changes from baseline to post-intervention were analyzed utilizing paired t-tests. Analysis of Covariance (ANCOVA) was employed to control confounding factors such as physical activity and energy intake. A p-value equal to or less than 0.05 was deemed statistically significant.
Results
Characteristics and dietary intakes
After excluding one subject (non-referral) from the control group, 59 participants completed the study (Fig. 1). Characteristics of groups were represented at Table 1.
Fig. 1.
Eligibility, screening, and follow-up
Table 1.
Characteristics of subjects with MetS
| Variables | Intervention group (n = 30) |
Control group (n = 30) |
P | |
|---|---|---|---|---|
| Age, y | 44.43 ± 6.06 | 45.60 ± 7.07 | 0.49 | |
| Height, cm | 165.33 ± 9.12 | 163.70 ± 10.57 | 0.52 | |
| Sex | Male, n (%) | 15 (50.0) | 15 (50.0) | 0.99 |
| Female, n (%) | 15 (50.0) | 15 (50.0) | ||
| Smoking | No, n (%) | 21 (70.0) | 22 (73.3) | 0.77 |
| Yes, n (%) | 9 (30.0) | 8 (26.7) | ||
| Education | Under diploma, n (%) | 5 (16.7) | 7 (23.4) | 0.87 |
| Diploma, n (%) | 9 (30.0) | 10 (33.3) | ||
| Bachelor’s degree, n (%) | 11 (36.6) | 9 (30.0) | ||
| Master’s degree, n (%) | 5 (16.7) | 4 (13.3) | ||
| Physical activity | Low, n (%) | 21 (70.0) | 22 (73.3) | 0.95 |
| Moderate, n (%) | 8 (26.7) | 7 (23.4) | ||
| High, n (%) | 1 (3.3) | 1 (3.3) | ||
| Frequency of MetS components | WC, n | 30 | 30 | |
| DBP/SBP, n | 19 | 23 | ||
| TG, n | 18 | 27 | ||
| HDL-c, n | 21 | 16 | ||
| FPG, n | 25 | 26 | ||
| DBP | Baseline | 86.26 ± 6.53 | 86.43 ± 10.02 | 0.93 |
| After intervention | 81.10 ± 7.22 | 84.93 ± 7.83 | 0.06 | |
| Mean change of DBP | −5.16 ± 3.92 | −1.50 ± 7.04 | 0.01 | |
| SBP | Baseline | 125.13 ± 10.42 | 130.56 ± 10.96 | 0.06 |
| After intervention | 118.16 ± 11.30 | 129.20 ± 13.74 | 0.001 | |
| Mean change of SBP | −6.97 ± 8.21 | −1.36 ± 6.83 | 0.006 | |
| TG | Baseline | 180.03 ± 65.42 | 207.16 ± 81.23 | 0.16 |
| After intervention | 161.53 ± 64.78 | 207.76 ± 89.06 | 0.02 | |
| Mean change of TG | −18.50 ± 14.32 | 0.60 ± 23.81 | <0.001 | |
| HDL-c | Baseline | 43.23 ± 7.51 | 45.06 ± 9.93 | 0.42 |
| After intervention | 42.33 ± 6.88 | 43.66 ± 7.93 | 0.48 | |
| Mean change of HDL-c | −0.90 ± 3.40 | −1.40 ± 5.46 | 0.67 | |
| FPG | Baseline | 114.26 ± 18.90 | 129.13 ± 31.58 | 0.03 |
| After intervention | 106.40 ± 17.85 | 130.10 ± 24.73 | <0.001 | |
| Mean change of FPG | −7.86 ± 10.08 | 0.97 ± 15.51 | 0.01 | |
| WC | Baseline | 105.53 ± 7.94 | 105.0 ± 9.80 | 0.81 |
| After intervention | 99.51 ± 7.85 | 102.76 ± 8.62 | 0.13 | |
| Mean change of WC | −6.02 ± 4.24 | −2.24 ± 4.28 | 0.001 | |
| Weight | Baseline | 83.37 ± 11.22 | 80.46 ± 11.90 | 0.33 |
| After intervention | 79.98 ± 11.19 | 78.95 ± 11.87 | 0.72 | |
| Mean change of weight | −3.39 ± 2.53 | −1.51 ± 2.72 | 0.008 | |
| BMI | Baseline | 30.49 ± 3.12 | 29.98 ± 3.11 | 0.52 |
| After intervention | 29.24 ± 3.11 | 29.42 ± 3.15 | 0.82 | |
| Mean change of BMI | −1.25 ± 0.93 | −0.56 ± 1.01 | 0.008 | |
P values of age, height, DBP, SBP, TG, HDL-c, FPG, WC, weight and BMI are computed by independent t-test and data are expressed as mean ± standard deviation (SD), while p values of sex, smoking, education and physical activity are computed by chi-square and data are expressed as numbers (percentage)
MetS: metabolic syndrome; PA: physical activity; DBP: diastolic blood pressure; SBP: systolic blood pressure; TG: triglyceride; HDL-c: high-density lipoprotein cholesterol; FPG: fasting plasma glucose; WC: waist circumference; BMI: body mass index
We demonstrated the intake of energy, macronutrients, food groups and micronutrients of two groups at the baseline and after intervention in Table 2. The intervention group received higher amounts of vegetables, fruits, nuts, seeds and legumes, dairy products, fibers, potassium, magnesium, vitamin C, vitamin A and folate, and also lower amounts of meats as well as fats and oils (p ≤ 0.05 for all). There was no side effect related to the intervention.
Table 2.
Dietary intakes in subjects with MetS
| Variables | Intervention group (n = 30) | Control group (n = 30) | P |
|---|---|---|---|
| Energy intake, kcal/d | |||
| Baseline | 2117.50 ± 130.54 | 2093.16 ± 118.67 | 0.45 |
| After intervention | 1540.16 ± 283.92 | 1481.16 ± 284.84 | 0.42 |
| Carbohydrate, g/d | |||
| Baseline | 293.96 ± 24.36 | 289.26 ± 25.26 | 0.46 |
| After intervention | 199.31 ± 36.48 | 193.07 ± 37.13 | 0.51 |
| Protein, g/d | |||
| Baseline | 65.74 ± 10.78 | 66.92 ± 9.91 | 0.66 |
| After intervention | 69.37 ± 12.79 | 64.60 ± 12.42 | 0.14 |
| Fat, g/d | |||
| Baseline | 75.40 ± 17.48 | 74.25 ± 15.18 | 0.78 |
| After intervention | 51.77 ± 9.54 | 50.04 ± 9.62 | 0.48 |
| Potassium, g/d | |||
| Baseline | 1845.55 ± 357.04 | 1982.91 ± 360.65 | 0.14 |
| After intervention | 3376.62 ± 562.29 | 2634.73 ± 748.65 | <0.001 |
| Sodium, g/d | |||
| Baseline | 2279.67 ± 426.55 | 2147.75 ± 279.76 | 0.16 |
| After intervention | 1622.37 ± 550.83 | 1752.78 ± 623.25 | 0.39 |
| Magnesium, g/d | |||
| Baseline | 317.60 ± 71.53 | 311.33 ± 54.09 | 0.70 |
| After intervention | 407.73 ± 79.56 | 344.82 ± 92.38 | 0.006 |
| Vitamin C, g/d | |||
| Baseline | 44.90 ± 5.62 | 46.33 ± 4.19 | 0.26 |
| After intervention | 65.32 ± 5.06 | 53.78 ± 7.17 | <0.001 |
| Vitamin A, g/d | |||
| Baseline | 331.09 ± 69.35 | 348.87 ± 70.74 | 0.33 |
| After intervention | 525.62 ± 44.23 | 460.14 ± 69.24 | <0.001 |
| Folate, g/d | |||
| Baseline | 202.78 ± 40.76 | 207.36 ± 31.30 | 0.62 |
| After intervention | 347.07 ± 61.43 | 277.97 ± 74.71 | <0.001 |
| Fiber, g/d | |||
| Baseline | 16.54 ± 5.91 | 16.90 ± 4.34 | 0.78 |
| After intervention | 31.85 ± 8.45 | 21.67 ± 10.06 | <0.001 |
| Vegetables, serving/d | |||
| Baseline | 1.26 ± 0.64 | 1.23 ± 0.67 | 0.69 |
| After intervention | 3.73 ± 0.44 | 2.73 ± 0.73 | <0.001 |
| Fruits, serving/d | |||
| Baseline | 2.06 ± 0.76 | 1.93 ± 0.69 | 0.33 |
| After intervention | 4.06 ± 0.63 | 2.73 ± 0.74 | <0.001 |
| Grains, serving/d | |||
| Baseline | 13.03 ± 0.55 | 12.30 ± 0.74 | <0.001 |
| After intervention | 6.36 ± 1.40 | 6.96 ± 1.47 | 0.11 |
| Nuts, seeds and legumes, serving/d | |||
| Baseline | 0.23 ± 0.50 | 0.26 ± 0.52 | 0.80 |
| After intervention | 1.46 ± 0.51 | 0.53 ± 0.50 | <0.001 |
| Dairy products, serving/d | |||
| Baseline | 1.33 ± 0.60 | 1.66 ± 0.47 | 0.02 |
| After intervention | 2.10 ± 0.30 | 1.70 ± 0.46 | <0.001 |
| Meats, serving/d | |||
| Baseline | 4.96 ± 0.85 | 4.93 ± 0.82 | 0.87 |
| After intervention | 2.73 ± 0.44 | 4.10 ± 0.30 | <0.001 |
| Fats and oils, serving/d | |||
| Baseline | 5.96 ± 0.66 | 6.03 ± 0.61 | 0.68 |
| After intervention | 2.63 ± 1.03 | 4.26 ± 0.44 | <0.001 |
| Simple sugars, serving/d | |||
| Baseline | 4.90 ± 0.71 | 4.63 ± 1.06 | 0.25 |
| After intervention | 1.10 ± 0.30 | 1.16 ± 0.37 | 0.45 |
Values are presented as mean ± standard deviation (SD)
presulted from comparisons between two groups by independent t-test
MetS: metabolic syndrome
Outcomes
At the baseline, we found no significant difference between groups in CMI (2.74 ± 1.17 vs. 3.06 ± 1.33; p = 0.33), AIP (0.23 ± 0.17 vs. 0.28 ± 0.17; p = 0.27), AC (3.97 ± 0.96 vs. 3.74 ± 1.37; p = 0.44) and CRI-II (3.31 ± 0.74 vs. 3.0 ± 0.98; p = 0.17). At the end of the trial, the values of CMI (2.36 ± 1.08 vs. 3.04 ± 1.27; p = 0.03) and AIP (0.19 ± 0.18 vs. 0.29 ± 0.16; p = 0.02) were significantly lower in the group receiving DASH diet than the control group; however, the values of AC (3.66 ± 0.99 vs. 3.75 ± 1.52; p = 0.79) and CRI-II (3.01 ± 0.61 vs. 2.97 ± 1.05; p = 0.84) were statistically similar (Table 3).
Table 3.
Effect of DASH diet on cardiometabolic and atherogenic indices in subjects with MetS
| Variables | Intervention group (n = 30) |
Control group (n = 30) |
P † | P †† |
|---|---|---|---|---|
| CMI | ||||
| Baseline | 2.74 ± 1.17 | 3.06 ± 1.33 | 0.33 | 0.001 |
| After intervention | 2.36 ± 1.08 | 3.04 ± 1.27 | 0.03 | |
| P | <0.001 | 0.82 | ||
| Mean change of CMI | −0.38 ± 0.29 | −0.02 ± 0.47 | 0.001 | |
| Mean change of EMM (95%CI) | −0.38 (−0.52, −0.23) | −0.02 (−0.16, 0.12) | ||
| AIP | ||||
| Baseline | 0.23 ± 0.17 | 0.28 ± 0.17 | 0.27 | 0.001 |
| After intervention | 0.19 ± 0.18 | 0.29 ± 0.16 | 0.02 | |
| P | <0.001 | 0.46 | ||
| Mean change of AIP | −0.04 ± 0.04 | 0.01 ± 0.07 | 0.001 | |
| Mean change of EMM (95%CI) | −0.04 (−0.06, −0.02) | 0.01 (−0.01, 0.03) | ||
| AC | ||||
| Baseline | 3.97 ± 0.96 | 3.74 ± 1.37 | 0.44 | 0.04 |
| After intervention | 3.66 ± 0.99 | 3.75 ± 1.52 | 0.79 | |
| P | 0.004 | 0.94 | ||
| Mean change of AC | −0.31 ± 0.54 | 0.01 ± 0.72 | 0.06 | |
| Mean change of EMM (95%CI) | −0.31 (−0.54, −0.08) | 0.01 (−0.21, 0.24) | ||
| CRI-II | ||||
| Baseline | 3.31 ± 0.74 | 3.0 ± 0.98 | 0.17 | 0.009 |
| After intervention | 3.01 ± 0.61 | 2.97 ± 1.05 | 0.84 | |
| P | <0.001 | 0.66 | ||
| Mean change of CRI-II | −0.30 ± 0.37 | −0.03 ± 0.39 | 0.01 | |
| Mean change of EMM (95%CI) | −0.30 (−0.43, −0.15) | 0.03 (−0.17, −0.11) | ||
Values are presented as mean ± standard deviation (SD)
P: resulted from comparisons within groups by paired t-test. P†: resulted from comparisons between two groups by independent t-test. P††: resulted from comparisons between two groups by Univariate analysis of covariance after adjusting for physical activity and energy intake. We reported the results as estimated marginal means with 95% confidence intervals, lower bound and upper bound
DASH: dietary approaches to stop hypertension; MetS: metabolic syndrome; EMM: estimated marginal means; CMI: cardiometabolic index; AIP: atherogenic index of plasma; AC: Atherogenic coefficient; CRI: castelli risk index
After adjusting for confounding factors, the group receiving DASH diet showed a significant reduction in CMI (−0.38 ± 0.29 vs. −0.02 ± 0.47; p = 0.001), AIP (−0.04 ± 0.04 vs. 0.01 ± 0.07; p = 0.001), AC (−0.31 ± 0.54 vs. 0.01 ± 0.72; p = 0.04) and CRI-II (−0.30 ± 0.37 vs. −0.03 ± 0.39; p = 0.009) (Table 3).
Discussion
This study has shown that adhering to the DASH diet for 12 weeks can be effective in reducing CMI and some atherogenic indices.
CMI and atherogenic indices, established as valid scoring systems for assessing cardiometabolic risk, are derived from on anthropometric variables and lipid profile [5–7]. To date, no research has specifically examined the effect of DASH diet on these indices. However, some studies have explored the effect of DASH diet on either anthropometric variable or lipid profile. For instance, A study found that adherence to DASH diet for 12 weeks reduced body weight and body fat mass among obese people [28]. Similarly, it has been shown that adhering to the DASH diet for 12 weeks effectively decreased BMI [29]. Contrary to these findings, it has been reported that a 6-week adherence to DASH diet showed no significant effect on anthropometric measurements in individuals suffering from MetS [19]. In line with the results of the present study, the meta-analysis of Lari et al. [15] highlighted the positive impact of DASH diet on several anthropometric parameters such as weight, BMI, and waist circumference (WC).
A clinical trial reported that 6-month adherence to DASH diet is an effective approach for managing lipid profile parameters such as TC, TG and LDL-c, though it showed no effect on HDL-c [16]. A study revealed the beneficial effect of DASH diet on TG [14]. In addition, another meta-analysis reported reductions in TC and LDL-c, though no impact was observed on HDL-c [15]. It’s worth mentioning that the DASH diet is characterized as a low-fat dietary pattern, and some evidence suggest that dietary patterns with low-fat content are ineffective in raising HDL-c levels [30–32].
The health benefits of DASH diet are primarily linked to the its nutrient-rich food groups. Antioxidant compounds like polyphenols, abundantly present in vegetables and fruits, attenuate lipid production and β-oxidation in the liver [33, 34]. Additionally, polyphenols enhance hepatic clearance of lipids while decreasing fat accumulation in the liver [35, 36]. Whole grains can diminish intrahepatic fat production [37, 38]. Fibers content found in whole grains and vegetables play an important role in decreasing both hepatic lipid production and lipid peroxidation [39]. Soluble dietary fiber is effective in absorbing dietary cholesterol, reducing absorption of cholesterol and increasing lipid excretion [39, 40]. Moreover, fibers influences macronutrient absorption, gastric emptying time, satiety and appetite regulation, all of which improve obesity [39]. Furthermore, replacing low-energy food groups like fruits and vegetables with meats and processed foods allows for a reduction in energy intake without altering the overall food volume consumed [40]. In general, DASH diet may be effective in reducing cardiovascular risk factors.
As an important strength, our study investigated the impact of DASH diet on novel cardiometabolic and atherogenic indices. This study had some limitations. An important limitation was the relatively short duration of the intervention. In addition, the effect of the DASH diet was not assessed at the middle of intervention period (week 6). Given the nature of the intervention (diet), there were two other important limitations. 1) There was no possibility of blinding the participants. 2) It was difficult to accurately assess the level of compliance of the participants.
Conclusions
The present study suggests that following DASH diet for 12 weeks may decrease CMI and some atherogenic indices. Further studies with longer intervention durations must be conducted in this area.
Acknowledgements
We acknowledge the contribution of the participants and co-researchers.
Author contributions
K.P and A.S: conducted the study; M.H: provided material and technical support; X.W, A.T and R.R: carried out the statistical analysis, and interpreted the finding; X.W: drafted the manuscript; K.P: critically revised the manuscript and supervised the study. All authors reviewed the final manuscript.
Funding
There is no financial funding for this study.
Data availability
The data and materials of the current study is available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
The ethical committee of Baqiyatallah University of Medical Sciences in Tehran confirmed the study protocol and written informed consent. All participants provided their informed consent prior to the start of the trial.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
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Data Availability Statement
The data and materials of the current study is available from the corresponding author upon reasonable request.