title: DASH for asthma: a pilot study of the DASH diet in not-well-controlled adult asthma.
abstract: This pilot study aims to provide effect size confidence intervals, clinical trial and intervention feasibility data, and procedural materials for a full-scale randomized controlled trial that will determine the efficacy of Dietary Approaches to Stop Hypertension (DASH) as adjunct therapy to standard care for adults with uncontrolled asthma. The DASH diet encompasses foods (e.g., fresh fruit, vegetables, and nuts) and antioxidant nutrients (e.g., vitamins A, C, E, and zinc) with potential benefits for persons with asthma, but it is unknown whether the whole diet is beneficial. Participants (n = 90) will be randomized to receive usual care alone or combined with a DASH intervention consisting of 8 group and 3 individual sessions during the first 3 months, followed by at least monthly phone consultations for another 3 months. Follow-up assessments will occur at 3 and 6 months. The primary outcome measure is the 7-item Juniper Asthma Control Questionnaire, a validated composite measure of daytime and nocturnal symptoms, activity limitations, rescue medication use, and percentage predicted forced expiratory volume in 1 second. We will explore changes in inflammatory markers important to asthma pathophysiology (e.g., fractional exhaled nitric oxide) and their potential to mediate the intervention effect on disease control. We will also conduct pre-specified subgroup analyses by genotype (e.g., polymorphisms on the glutathione S transferase gene) and phenotype (e.g., atopy, obesity). By evaluating a dietary pattern approach to improving asthma control, this study could advance the evidence base for refining clinical guidelines and public health recommendations regarding the role of dietary modifications in asthma management.
authors: Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA. maj@pamfri.org
authors: Jun
authors: J
authors: Ma
authors: Peg
authors: P
authors: Strub
authors: Phillip W
authors: PW
authors: Lavori
authors: A Sonia
authors: AS
authors: Buist
authors: Carlos A
authors: CA
authors: Camargo
authors: Kari C
authors: KC
authors: Nadeau
authors: Sandra R
authors: SR
authors: Wilson
authors: Lan
authors: L
authors: Xiao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000178:diet therapy* / Q000276:immunology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000178:diet therapy / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013147:Spirometry; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACQ; Asthma; Asthma Control Questionnaire; CI; DASH; Dietary Approaches to Stop Hypertension; Dietary pattern; FEV1; FeNO; KP; Kaiser Permanente; Lung function; PCP; confidence interval; forced expiratory volume in one second; fractional exhaled nitric oxide; primary care provider.
references: Addiction. 1993 Jun;88(6):791-804
references: 8329970
references: Free Radic Res. 2008 Jan;42(1):94-102
references: 18324527
references: J Asthma. 2006 Dec;43(10):731-4
references: 17169823
references: Am J Hypertens. 2009 Apr;22(4):409-16
references: 19197247
references: Am J Epidemiol. 2001 Dec 15;154(12):1143-9
references: 11744520
references: J Am Diet Assoc. 2007 Sep;107(9):1541-51
references: 17761231
references: Allergy. 2004 May;59(5):469-78
references: 15080825
references: Med Care. 1996 Mar;34(3):220-33
references: 8628042
references: Respir Med. 2006 Apr;100(4):616-21
references: 16226443
references: J Am Coll Nutr. 1994 Jun;13(3):285-91
references: 8077578
references: Thorax. 2010 Jun;65(6):516-22
references: 20522849
references: J Allergy Clin Immunol. 2004 Jan;113(1):59-65
references: 14713908
references: Allergy. 2010 May;65(5):606-15
references: 19845575
references: Ann Intern Med. 2002  Feb 5;136(3):201-9
references: 11827496
references: Thorax. 2009 Jul;64(7):610-9
references: 19406861
references: Health Educ Res. 2005 Aug;20(4):439-47
references: 15598664
references: Respir Res. 2009 Aug 24;10:78
references: 19703285
references: Psychiatry Res. 1989 May;28(2):193-213
references: 2748771
references: Am J Clin Nutr. 2003 May;77(5):1171-8
references: 12716668
references: J Allergy Clin Immunol. 2005 Jun;115(6):1109-17; quiz 1118
references: 15940119
references: Int Arch Allergy Immunol. 2006;141(2):189-98
references: 16899987
references: Am J Clin Nutr. 2010 Aug;92(2):408-15
references: 20554789
references: JAMA Intern Med. 2013 Jan 28;173(2):113-21
references: 23229846
references: BMC Fam Pract. 2009 Nov 12;10:71
references: 19909549
references: BMC Pulm Med. 2010 Mar 24;10:16
references: 20334686
references: Obesity (Silver Spring). 2012 Apr;20(4):756-64
references: 21996661
references: J Allergy Clin Immunol. 2012 Mar;129(3 Suppl):S24-33
references: 22386507
references: Dig Dis Sci. 2001 Jul;46(7):1540-9
references: 11478508
references: J Am Diet Assoc. 1999 Aug;99(8 Suppl):S19-27
references: 10450290
references: Thorax. 2007 Dec;62(12):1050-7
references: 17711870
references: Thorax. 2007 Sep;62(9):786-91
references: 17504819
references: Am J Clin Nutr. 2007 Aug;86(2):488-95
references: 17684223
references: Am J Respir Crit Care Med. 2005 Apr 15;171(8):912-30
references: 15817806
references: Thorax. 2007 Jun;62(6):503-8
references: 17251311
references: Cochrane Database Syst Rev. 2001;(4):CD000436
references: 11687080
references: BMC Pulm Med. 2009 May 19;9:24
references: 19454036
references: Res Nurs Health. 1989 Dec;12(6):347-54
references: 2602575
references: J Am Diet Assoc. 2004 Apr;104(4):595-603
references: 15054345
references: Pediatr Allergy Immunol. 2010 Nov;21(7):1021-7
references: 20561232
references: MMWR Morb Mortal Wkly Rep. 2011 May 6;60(17):547-52
references: 21544044
references: Cochrane Database Syst Rev. 2009 Jan 21;(1):CD000993
references: 19160185
references: Am J Respir Crit Care Med. 2004 Oct 1;170(7):725-9
references: 15256393
references: Eur Respir J. 2005 Nov;26(5):948-68
references: 16264058
references: Lancet. 2006 Aug 26;368(9537):804-13
references: 16935691
references: Eur Respir J. 1999 Oct;14(4):902-7
references: 10573240
references: Eur Respir J. 1997 Mar;10(3):646-51
references: 9072999
references: J Consult Clin Psychol. 1983 Jun;51(3):390-5
references: 6863699
references: Behav Res Methods. 2007 Aug;39(3):384-9
references: 17958149
references: Int J Obes (Lond). 2006 Aug;30(8):1240-9
references: 16491107
references: Allergy. 2008 Jul;63(7):917-23
references: 18588559
references: Respir Res. 2006 Apr 20;7:67
references: 16626491
references: J Allergy Clin Immunol. 2012 Mar;129(3 Suppl):S88-123
references: 22386511
references: Thorax. 2007 Aug;62(8):677-83
references: 17412780
references: Respir Res. 2009 Dec 10;10:122
references: 20003306
references: Eur Respir J. 2005 Aug;26(2):319-38
references: 16055882
references: Cochrane Database Syst Rev. 2004;(2):CD003538
references: 15106206
references: Arch Intern Med. 2010 Jan 25;170(2):126-35
references: 20101007
references: Curr Opin Lipidol. 2002 Feb;13(1):3-9
references: 11790957
references: N Engl J Med. 1997 Apr 17;336(16):1117-24
references: 9099655
references: Am J Epidemiol. 1985 Jan;121(1):91-106
references: 3964995
references: J Am Acad Child Adolesc Psychiatry. 2003 Dec;42(12):1524-9
references: 14627890
references: Nature. 2008 Jul 24;454(7203):445-54
references: 18650915
references: Am J Respir Crit Care Med. 2010 Mar 15;181(6):566-77
references: 20019345
references: Hypertension. 2010 May;55(5):1199-205
references: 20212264
references: BMC Complement Altern Med. 2006 Jul 19;6:26
references: 16854238
references: Respir Res. 2009 Jun 12;10:49
references: 19519921
references: Am J Clin Nutr. 2000 Oct;72(4):912-21
references: 11010931
references: Stat Med. 1989 Jul;8(7):803-11
references: 2772440
references: J Allergy Clin Immunol. 2008 Sep;122(3):456-68; quiz 469-70
references: 18774381
references: Pharmacol Ther. 2009 Jul;123(1):37-53
references: 19375453
references: Eur Respir J. 1999 Jul;14(1):32-8
references: 10489826
references: Clin Exp Allergy. 2008 Apr;38(4):557-65
references: 18352973
references: Nat Rev Immunol. 2008 Mar;8(3):169-82
references: 18301422
references: Hypertension. 2003 Mar;41(3):422-30
references: 12623938
references: N Engl J Med. 2001 Jan 4;344(1):3-10
references: 11136953
references: J Pediatr. 2008 Jun;152(6):823-8, 828.e1-2
references: 18492525
references: J Allergy Clin Immunol. 2011 May;127(5):1133-40
references: 21377715
references: J Pediatr (Rio J). 2008 Aug;84(4 Suppl):S68-75
references: 18690379
references: Allergy. 2008 Oct;63(10):1310-6
references: 18782109
references: Biometrics. 1989 Sep;45(3):969-77
references: 2790131
references: Eur Respir J. 2005 Jul;26(1):153-61
references: 15994402
references: J Allergy Clin Immunol. 2011 Mar;127(3):724-33.e1-30
references: 21185068
references: Am J Clin Nutr. 2003 Sep;78(3 Suppl):508S-513S
references: 12936941
references: Psychosom Med. 2013 Feb;75(2):137-43
references: 23197844
references: Eur Respir J. 2008 Jan;31(1):179-97
references: 18166596
references: Biometrics. 1975 Mar;31(1):103-15
references: 1100130
references: Am J Respir Crit Care Med. 2009 Jul 1;180(1):59-99
references: 19535666
references: Stat Med. 2009 Jan 15;28(1):65-74
references: 18937226
references: Psychol Methods. 2002 Mar;7(1):83-104
references: 11928892
references: Respir Med. 2010 Jul;104(7):972-80
references: 20171076
references: Science. 2003 Feb 7;299(5608):853-5
references: 12574618
references: Am J Epidemiol. 1985 Nov;122(5):794-804
references: 3876763
references: Chest. 2007 Feb;131(2):410-4
references: 17296641
references: Eur Respir J. 2009 Jan;33(1):33-41
references: 18829673
references: J Nutr. 2003 Oct;133(10):3130-6
references: 14519796
references: Arch Intern Med. 2008 Feb 11;168(3):308-14
references: 18268173
references: Pediatr Allergy Immunol. 2011 May;22(3):283-9
references: 21457335
references: Adv Immunol. 2009;104:51-113
references: 20457116
references: Ann Intern Med. 1999 Oct 5;131(7):485-91
references: 10507956
references: Redox Rep. 2005;10(5):247-55
references: 16354413
references: Am J Clin Nutr. 2012 Sep;96(3):534-43
references: 22854412
references: Health Psychol. 2004 Sep;23(5):443-51
references: 15367063
references: Eur Respir J. 2005 Sep;26(3):523-48
references: 16135737
references: Respir Med. 2008 Nov;102(11):1667-71
references: 18694637
references: Allergy. 2007 Oct;62(10):1171-4
references: 17845587