title: Weight, blood pressure, and dietary benefits after 12 months of a Web-based Nutrition Education Program (DASH for health): longitudinal observational study.
abstract: BACKGROUND
  The dietary habits of Americans are creating serious health concerns, including obesity, hypertension, diabetes, cardiovascular disease, and even some types of cancer. While considerable attention has been focused on calorie reduction and weight loss, approaches are needed that will not only help the population reduce calorie intake but also consume the type of healthy, well-balanced diet that would prevent this array of medical complications.
  
  
  OBJECTIVE
  To design an Internet-based nutrition education program and to explore its effect on weight, blood pressure, and eating habits after 12 months of participation.
  
  
  METHODS
  We designed the DASH for Health program to provide weekly articles about healthy nutrition via the Internet. Dietary advice was based on the DASH diet (Dietary Approaches to Stop Hypertension). The program was offered as a free benefit to the employees of EMC Corporation, and 2834 employees and spouses enrolled. Enrollees voluntarily entered information about themselves on the website (food intake), and we used these self-entered data to determine if the program had any effect. Analyses were based upon the change in weight, blood pressure, and food intake between the baseline period (before the DASH program began) and the 12th month. To be included in an outcome, a subject had to have provided both a baseline and 12th-month entry.
  
  
  RESULTS
  After 12 months, 735 of 2834 original enrollees (26%) were still actively using the program. For subjects who were overweight/obese (body mass index > 25; n = 151), weight change at 12 months was -4.2 lbs (95% CI: -2.2, -6.2; P < .001). For subjects with hypertension or prehypertension at baseline (n = 62), systolic blood pressure fell 6.8 mmHg at 12 months (CI: -2.6, -11.0; P < .001; n = 62). Diastolic pressure fell 2.1 mmHg (P = .16). Based upon self-entered food surveys, enrollees (n = 181) at 12 months were eating significantly more fruits, more vegetables, and fewer grain products. They also reduced consumption of carbonated beverages. Enrollees who had visited the website more often tended to have greater blood pressure and weight loss effect, suggesting that use of the DASH for Health program was at least partially responsible for the benefits we observed.
  
  
  CONCLUSIONS
  We have found that continued use of a nutrition education program delivered totally via the Internet, with no person-to-person contact with health professionals, is associated with significant weight loss, blood pressure lowering, and dietary improvements after 12 months. Effective programs like DASH for Health, delivered via the Internet, can provide benefit to large numbers of subjects at low cost and may help address the nutritional public health crisis.
authors.affiliation: Boston University Medical Center, Boston, MA 02118, USA. tmoore@bu.edu
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Moore
authors.forename: Nour
authors.initials: N
authors.lastname: Alsabeeh
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Apovian
authors.forename: Megan C
authors.initials: MC
authors.lastname: Murphy
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Coffman
authors.forename: Diana
authors.initials: D
authors.lastname: Cullum-Dugan
authors.forename: Mark
authors.initials: M
authors.lastname: Jenkins
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
mesh_terms: D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D001835:Body Weight; D004032:Diet; D005247:Feeding Behavior / Q000502:physiology; D005638:Fruit; D015438:Health Behavior; D006266:Health Education / Q000379:methods* / Q000592:standards; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D020407:Internet; D008019:Life Style; D010353:Patient Education as Topic; D012648:Self Care; D014675:Vegetables