Dash for health presentation

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A presentation on the DASH for Health Online Nutrition Program

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  • I want to say that the DASH Diet is a good plan; however, I would like to warn anyone who is interested in signing up with Dash for Life company to be VERY careful!! After researching their website, I had question but there is not phone number listed and no one responded to my emails. They do not have any type of test before payment (like so many other websites doe). I did sign up for the $39 (for 3 months plan) based on what the website promised. Within 20 minutes realized that the website really wasn't everything it promised and it would not work for me. I tried contacting them 3 times by email in 3 days (they do not have any phone numbers). I was told they will refund my money, minus a $20 cancellation fee!!! It is a joke and rip off! Do yourself a favor and learn from my mistake...buy the book or find another website to use that doesn't try to rip you off!
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  • Hey Stacy,
    Thanks for the comment. As I've stated in other posts, mypyramid is (in my opinion) useless. I remember we've had a conversation about this in the past, as it is not user friendly and lacks basic nutritional information for foods commonly eaten. For example, the last time I used it hot chocolate was not available; instead, an alcohol based drink with Khlua was an option to select. Is that really something that should be on there? As I have never been able to complete a dietary analysis using mypyramid for an average diet, I'd never recommend it. As for fitday, it has the option for the patient to input their foods that may not be previously listed, making it a better tool for general health purposes. Of the three options, fitday would be a better place to start for a free online service (even if I don't think its the best available).
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  • Sorry for the delayed reply but I wasn't able to login for a while

    Jr03003 - Yes, this program may have a cost but it tracks patients progress better than mypyramid, as it is more convenient and helpful with nutritional guidelines. Personally, I am not a fan of mypyramid. I think it is a ridiculous site to use for information as it lacks basic foods nutritional content and it very tedious to input information. It is more user friendly and better organized for patients to track their progress after they input their information. There are also articles and tips that patients can refer to, such as shopping list ideas. As patients have to take their own BP, and input it they have to purchase a personal monitoring device, such as an Omron machine. These machines are often suggested or given to patients with hypertension to track their daily BP and response to changes in medication.
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  • Hi, Shruti. Great presentation. I see that you stated the DASH diet is based on a well-balanced way of eating that is consistent with general nutrition guidelines. So I was curious if a program like fitday or mypramid may suffice for those who may not want to or be able to pay for the subscription. Thanks, Stacy
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  • Hi Shruti,
    Great job on your presentation. I have heard of the DASH diet... it reminds me of the Zone diet (it was initially created to help type II diabetics manage their weight and blood sugars, but eventually was incorporated by others as a guide to 'healthy eating').
    I think you did a great job at showing the limitations of the trials presented; I agree that a larger segment of the population should be polled and more demographic groups should be encouraged to use the tool.
    Did you find any evidence on the effective of the DASH diet in response to type II diabetics?
    Thanks!
    Anna-Marie
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  • Apovian, C.M. et al., 2010., Moore, T.J., et al. 2008, and Stopponi, M.A., et al., 2009,
  • Dash for health presentation

    1. 1. DASH for Health<br />Shruti Sharma<br />NTR 5502: Nutritional Assessment<br />March 2011<br />
    2. 2. Topics<br />Purpose of the tool<br />Explanation to patients<br />History or development of the tool<br />Plausible or purported mechanism<br />Safety of use<br />Who is it for?<br />Case studies, testimonials and methods of marketing<br />Literature review<br />Patient Selection<br />Conclusion <br />
    3. 3. Purpose of the Tool<br />To improve your eating and exercise habits<br />It allows people with busy lifestyles to learn information about food, food preparation, eating out, losing weight and getting fit <br />Information is posted on a weekly basis<br />You can create your own page to track your progress in such areas as weight, blood pressure and exercise<br />You have to subscribe to the site for either 3 or 6 month increments ranging from $39-69<br />http://www.dashforhealth.com/pages/public/dashforhealthbasics.php<br />
    4. 4. Explanation to Patients<br />The site does a good job of letting patients know that it simply offers guidelines and ways to monitor personal progress<br />For specific medical concerns, such as interactions of certain foods with medications, referral to a pharmacist or medical doctor is suggested<br />“our nutrition advice is based on the DASH diet, which is a well-balanced way of eating that is consistent with general nutrition guidelines”<br />Based on your height, weight, gender, age and activity level you can find suggestions that will help you achieve your goals<br />http://www.dashforhealth.com/pages/public/exerciseadvice.php<br />
    5. 5. Explanation to Patients (contd.)<br />Weekly articles written by the staff are posted for viewing once you log in<br />Some of the services provided include a “your stuff” page where participants can track their progress, create shopping lists, or even listen to a servings tutorial<br />Archives are available to look up previous articles <br />“DASHified” Recipes are also provided<br />http://www.dashforhealth.com/pages/public/exerciseadvice.php<br />
    6. 6. History of the Tool<br />Based on the DASH Diet <br />“Dietary Approaches to Stop Hypertension”<br />Originally designed to prevent and/or treat hypertension <br />It is now recommended for all American adults (USDA Dietary Guidelines, 2005)<br />Moore, T.J., et al. 2008.<br />
    7. 7. Plausible Mechanism<br />An algorithm uses the person’s gender, age, and activity level to calculate the number of servings from each of the eight DASH food groups the person should consume daily<br />The goal being that patients will practice the suggestions made and consume the recommended servings of each food group and incorporate these changes until goals are met<br />Thus, weight loss, changes in blood pressure and learning to make healthier food choices occurs<br />Moore, T.J., et al. 2008.<br />
    8. 8. Plausible Mechanism<br />Eight food groups are used to guide individuals’ eating habits:<br />Fruits<br />Vegetables<br />Low-fat dairy<br />Meat/fish/poultry<br />Grains<br />Nuts/legumes<br />Sweets<br />Added fats<br />Moore, T.J., et al. 2008.<br />
    9. 9. Safety of Use<br />Safety concerns for the long term use of the DASH Diet is not an issue for most.<br />The diet is more of a guideline for how to eat for your activity level and offers a way for individuals to live healthier lifestyles.<br />However, as with any diet and exercise routine participants should seek counsel with their health care provider to ensure that contraindications do not exist with any of their medications or health conditions<br />Moore, T.J., et al. 2008.<br />
    10. 10. Who is the DASH Diet for?<br />It is applicable to the general population, not only overweight, obese or hypertensive individuals.<br /> It was originally designed for hypertensive patients as a means for treatment but has now become more of a guideline for how individuals can become healthier while achieving decreases in their blood pressure and weight.<br />Moore, T.J., et al. 2008.<br />
    11. 11. Marketing Methods<br />The site is littered with comments indicating who has profiled the DASH diet plan and user testimonials<br />“The Archives of Internal Medicine shows that the DASH diet helps prevent heart attack and strokes in women.”<br />“recommended by the American Heart Association, in the USDA Dietary Guidelines”<br />“featured in the U.S. High Blood Pressure Guidelines.”<br />http://www.dashforhealth.com/pages/public/testimonials.php<br />
    12. 12. Marketing Methods<br />On the website, 8 testimonials are published, including one by Dr. Henry Domke (Missouri)<br />“I'm renewing my membership with DASH for HealthTM because it works. The DASH diet is without a doubt the best diet for people (like me) who have high blood pressure. I suggest it to all my patients who have high blood pressure, and even many of those who don't. The DASH for HealthTM website has practical suggestions for how to fit this diet into your busy life. This is not a passing fad, but the real thing. I also find the "Your Stuff" monitoring features helpful for keeping track of where I have been. It is rewarding to refer to the graphs to monitor my progress.”<br />http://www.dashforhealth.com/pages/public/testimonials.php<br />
    13. 13. Literature Review<br />There are many articles available discussing the role of the DASH diet<br />Some of the populations studied include:<br />Older adults with or at risk of cardiovascular disease<br />Individuals with metabolic syndrome<br />Studies have also analyzed the response rates and validity of internet based questionnaires<br />Apovian, C.M. et al., 2010., Moore, T.J., et al. 2008, and Stopponi, M.A., et al., 2009.<br />
    14. 14. Literature Review<br />Types of studies:<br />Randomized control trials (RCTs)<br />Retrospective, quasi-experimental design<br />Cost analysis<br />Prospective study<br />Cross-sectional study<br />
    15. 15. Methodology problems<br />More studies include a predominantly White, educated population with a higher ratio of female participants<br />Patient selection in order to increase ethnic diversity, such as increasing the number of Hispanics and African Americans being recruited<br />Language barriers; using English only programs<br />Stopponi, M.A., et al., 2009.<br />
    16. 16. Sample and duration<br />In the literature available, the sample sizes varies from hundreds to thousands of individuals<br />The duration of studies ranges from 4 weeks to 12 months<br />Participants were recruited in various ways:<br />Based on employment <br />Health insurance carrier<br />Mass mail outs<br />Spouses of participants <br />Apovian, C.M. et al., 2010., Moore, T.J., et al. 2008, and Stopponi, M.A., et al., 2009. <br />
    17. 17. Conclusion<br />Overall, the literature states the further research needs to be conducted to include a more diverse population base; in order to generalize the results<br />The outcomes of the internet-based programs are promising and appear to change the behaviors of patients in order to reach dietary goals<br />Stopponi, M.A., et al., 2009.<br />
    18. 18. Literature Review – Moore example<br />Weight, Blood Pressure, and Dietary Benefits After 12 Months of a Web-based Nutrition Education Program (DASH for Health): Longitudinal Observational Study. Moore, T.J., et al. 2008<br />This study used three outcome measures; change in:<br />Weight<br />Systolic blood pressure (SBP)<br />Consumption of DASH food groups<br />Diastolic BP (DBP)was a secondary outcome<br />The relationship between the changes in outcome measure scores and use of the DASH for Health website was also analyzed<br />Moore, T.J., et al. 2008.<br />
    19. 19. Moore, T.J. et al., 2008<br />Food consumption was estimated based on the DASH online questionnaire, a 24 hr recall <br />Website use was tracked based on the number of times a person logged on<br />Weight and BP was self entered<br />Groups were not randomized and no control group was used<br />The researchers did not estimate the effects possible on people who failed to enter data online<br />Baseline information was collected in the initial 3 weeks and a 12 month follow up during weeks 48-52<br />Analysis was done using SigmaStat 3.5; using confidence intervals of 95%, paired t-tests or Wilcoxon signed rank tests, p-values were considered significant if less than 0.05<br />Moore, T.J., et al. 2008.<br />
    20. 20. Moore, T.J. et al., 2008<br />Subjects were from 41 states, equal numbers of each gender were used aged 18-73 years<br />3479 subjects initially enrolled<br />88% were White, 74% Married, and 66% had a college or postgraduate degree<br />Most common reasons to enroll were “weight loss” and “general health information”<br />25% were concerned about BP or cholesterol levels<br />81% consented to their information being used for research; 26% of those remained at 12 months and were:<br />mostly women, either married or widowed with some singles; most were interested in “general health information”<br />Moore, T.J., et al. 2008.<br />
    21. 21. Moore, T.J. et al., 2008<br />Conclusion of the article:<br />Fruit and vegetable intake increased significantly<br />Consumption of grain products decreased<br />Weight and BP decreased by 12 months<br />Thus, the DASH diet and exercise can result in a healthier lifestyle, weight loss and improved cardiovascular health<br />Outcomes related to a greater number of log ins:<br />Weight lowered<br />Blood pressure lowered<br />Fruit consumption was the only dietary change linked with greater log ins<br />Moore, T.J., et al. 2008.<br />
    22. 22. Moore, T.J. et al., 2008 - Study Limitations<br />Participants were not randomized<br />A control group was not used<br />The selection of patients in the study by Moore, et al. (2008) was based on interested individuals working at the EMC Corporation and their spouses<br />Participation was voluntary<br />Information was self-entered by participants<br />12 month outcomes could only be calculated for those who were still using the site at the time<br />Reasons for dropping out were not recorded, biasing the outcomes to appear more favorable<br />People who did not lose weight or lower their BP may not have continued for the 12 months<br />Food selection and exercise routines were not standardized for all participants<br />Moore, T.J., et al. 2008.<br />
    23. 23. Patient Selection<br />It is applicable to the general population, not only overweight, obese or hypertensive individuals.<br />Limitations to the use of online programs:<br />Ease of access to the internet<br />Logging onto the site regularly<br />Level of education<br />Socioeconomic status<br />Age<br />Standardized serving sizes<br />Apovian, C.M. et al., 2010., Moore, T.J., et al. 2008, and Stopponi, M.A., et al., 2009. <br />
    24. 24. Conclusion<br />Thus, the DASH Diet, which includes an increased intake of fruits and vegetables, a reduction in sodium intake and regular exercise can benefit those with, and at risk of cardiovascular concerns, such as hypertension and overweight individuals.<br />“For overweight or obese persons with above-normal BP, the addition of exercise and weight loss to the DASH diet resulted in even larger BP reductions, greater improvements in vascular and autonomic function, and reduced left ventricular mass.” (Blumenthal, J.A., et al., 2010)<br />Apovian, C.M. et al., 2010., Blumenthal, J.A., et al., 2010, Moore, T.J., et al. 2008, Shenoy, S.F., et al., 2010, and Stopponi, M.A., et al., 2009. <br />
    25. 25. Conclusion<br />It is a simple online tool to guide and modify the food consumption behaviors of patients.<br />Patients can be guided to its use in the office and then requested to bring print outs of their information for follow up visits. This allows the clinician to track the patient’s progress.<br />
    26. 26. References<br />Apovian, C.M., Murphy, M.C., Cullum-Dugan, D., Lin, P.H., Gilbert, K.M., Coffman, G., Jenkins, M., Bakun, P., Tucker, K.L. and Moore, T.J. (2010). Validation of a web-based dietary questionnaire designed for the DASH (Dietary Approaches to Stop Hypertension) diet: the DASH Online Questionnaire. Public Health Nutr; 13(5):615-622. Doi: 10.1017/S1368980009991996.<br />Blumenthal, J.A., Babyak, M.A., Hinderliter, A., Watkins, L.L., Craighead, L., Lin, P.H., Caccia, C., Johnson, J., Waugh, R., and Sherwood, A. (2010). Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Arch Intern Med; 170(2):126-35. Retrieved from: http://archinte.ama-assn.org/cgi/content/full/170/2/126<br />Dash For Health. Retrieved from: http://www.dashforhealth.com/<br />Moore, T.J. Alsabeeh, N., Apovian, C.M., Murphy, M.C., Coffman, G.A., Cullum-Dugan, D., Jenkins, M. and Cabral, H. (2008). Weight, Blood Pressure, and Dietary Benefits After 12 Months of a Web-based Nutrition Education Program (DASH for Health): Longitudinal Observational Study. J Med Internet Res; 10(4):e52. Doi: 10.2196/jmir.1114. <br />Shenoy, S.F., Poston, W.S.C., Reeves, R.S., Kazaks, A., Holt, R.R>, Keen, C.L., Chen, H.J., Haddock, C.K., Winters, B.L., Khoo, C.S.H., and Foreyt, J.P. (2010). Weight loss in individuals with metabolic syndrome given DASH diet counseling when provided a low sodium vegetable juice: a randomized controlled trial. Nutr. J; 9:8. Doi: 10.1186/1475-2891-9-8. <br />Stopponi, M.A., Alexander, G.L., McClure, J.B., Carroll, N.M., Divine, G.W., Calvi, J.H., Rolnick, S.J., Strecher, V.J., Johnson, C.C., and Ritzwoller, D.P. (2009). Recruitment to a randomized web-based nutritional intervention trial: characteristics of participants compared to non-participants. J.Med Internet Res; 11(3):e38.Doi: 10.2196./jmir.1086. <br />

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