title: Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. Daily magnesium supplements improve glucose handling in elderly subjects. Effects of the Dietary Approaches to Stop Hypertension Diet Alone and in Combination With Exercise and Caloric Restriction on Insulin Sensitivity and Lipids Effects of the Dietary Approaches to Stop Hypertension (DASH) Eating Plan on Cardiovascular Risks Among Type 2 Diabetic Patients DASH Diet Lowers Blood Pressure and Lipid-Induced Oxidative Stress in Obesity DASH Lowers Blood Pressure in Obese Hypertensives Beyond Potassium, Magnesium and Fiber Oral calcium supplementation reduces intraplatelet free calcium concentration and insulin resistance in essential hypertensive patients. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. Low Sodium DASH Reduces Oxidative Stress and Improves Vascular Function in Salt-Sensitive Humans Dairy consumption and risk of type 2 diabetes mellitus in men: a prospective study. Normotensive Women With Type 2 Diabetes and Microalbuminuria Are at High Risk for Macrovascular Disease A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Effects of potassium supplementation on insulin binding and insulin action in human obesity: protein-modified fast and refeeding. Does the DASH diet lower blood pressure by altering peripheral vascular function? Hypocaloric high-protein diet improves glucose oxidation and spares lean body mass: comparison to hypocaloric high-carbohydrate diet. The Dietary Approaches to Stop Hypertension eating plan affects C-reactive protein, coagulation abnormalities, and hepatic function tests among type 2 diabetic patients.
abstract: BACKGROUND Certain dietary components may play a role in the prevention of type 2 diabetes . OBJECTIVE We examined prospect ively the associations between whole- and refined-grain intake and the risk of type 2 diabetes  in a large cohort of men . DESIGN Men from the Health Professionals Follow-up Study without a history of diabetes or cardiovascular disease in 1986 ( n = 42898 ) were followed for < /=12 y. Intakes of whole and refined grains , measured every 4 y by use of food-frequency question naires , were used to predict subsequent type 2 diabetes risk through multivariate analysis . RESULTS We ascertained 1197 cases of incident type 2 diabetes . After adjustment for age ; physical activity ; cigarette smoking ; alcohol consumption ; family history of diabetes ; and fruit , vegetable , and energy intakes , the relative risk of type 2 diabetes was 0.58 ( 95 % CI : 0.47 , 0.70 ; P for trend < 0.0001 ) comparing the highest with the lowest quintile of whole-grain intake . The association was moderately attenuated when additionally adjusted for body mass index ( relative risk : 0.70 ; 95 % CI : 0.57 , 0.85 ; P for trend = 0.0006 ) . Intake of refined grains was not significantly associated with risk of type 2 diabetes . After further adjustment for magnesium intake , cereal fiber intake , and glycemic load , the association between whole grains and type 2 diabetes was attenuated and the trend no longer significant . CONCLUSIONS In men , a diet high in whole grains is associated with a reduced risk of type 2 diabetes in men that may be mediated by cereal fiber . Efforts should be made to replace refined-grain with whole-grain foods We demonstrated similar plasma concentrations and urinary losses but lower erythrocyte magnesium concentrations ( 2.18 + /- 0.04 vs 1.86 + /- 0.03 mmol/L , P less than 0.01 ) in twelve aged ( 77.8 + /- 2.1 y ) vs 25 young ( 36.1 + /- 0.4 y ) , nonobese subjects . Subsequently , aged subjects were enrolled in a double-blind , r and omized , crossover study in which placebo ( for 4 wk ) and chronic magnesium administration ( CMA ) ( 4.5 g/d for 4 wk ) were provided . At the end of each treatment period an intravenous glucose tolerance test ( 0.33 g/kg body wt ) and a euglycemic glucose clamp with simultaneous [D-3H]glucose infusion and indirect calorimetry were performed . CMA vs placebo significantly increased erythrocyte magnesium concentration and improved insulin response and action . Net increase in erythrocyte magnesium significantly and positively correlated with the decrease in erythrocyte membrane microviscosity and with the net increase in both insulin secretion and action . In aged patients , correction of a low erythrocyte magnesium concentration may allow an improvement of glucose h and ling This study examined the effects of the Dietary Approaches to Stop Hypertension ( DASH ) diet on insulin sensitivity and lipids . In a r and omized control trial , 144 overweight ( body mass index : 25 to 40 ) men ( n=47 ) and women ( n=97 ) with high blood pressure ( 130 to 159/85 to 99 mm Hg ) were r and omly assigned to one of the following groups : ( 1 ) DASH diet alone ; ( 2 ) DASH diet with aerobic exercise and caloric restriction ; or ( 3 ) usual diet controls ( UC )  . Body composition , fitness , insulin sensitivity , and fasting lipids were measured before and after 4 months of treatment . Insulin sensitivity was estimated on the basis of glucose and insulin levels in the fasting state and after an oral glucose load . Participants in the DASH diet with aerobic exercise and caloric restriction condition lost weight ( −8.7 kg [ 95 % CI : −2.0 to −9.7 kg ] ) and exhibited a significant increase in aerobic capacity , whereas the DASH diet alone and UC participants maintained their weight ( −0.3 kg [ 95 % CI : −1.2 to 0.5 kg ] and + 0.9 kg [ 95 % CI : 0.0 to 1.7 kg ] , respectively ) and had no improvement in exercise capacity . DASH diet with aerobic exercise and caloric restriction demonstrated lower glucose levels after the oral glucose load , improved insulin sensitivity , and lower total cholesterol and triglycerides compared with both DASH diet alone and UC , as well as lower fasting glucose and low-density lipoprotein cholesterol compared with UC . DASH diet alone participants generally did not differ from UC in these measures . Combining the DASH diet with exercise and weight loss result ed in significant improvements in insulin sensitivity and lipids . Despite clinical ly significant reductions in blood pressure , the DASH diet alone , without caloric restriction or exercise , result ed in minimal improvements in insulin sensitivity or lipids OBJECTIVE To determine the effects of the Dietary Approaches to Stop Hypertension ( DASH ) eating pattern on cardiometabolic risks in type 2 diabetic patients . RESEARCH DESIGN AND METHODS A r and omized crossover clinical trial was undertaken in 31 type 2 diabetic patients . For 8 weeks , participants were r and omly assigned to a control diet or the DASH eating pattern . RESULTS After following the DASH eating pattern , body weight ( P = 0.007 ) and waist circumference ( P = 0.002 ) reduced significantly . Fasting blood glucose levels and A1C decreased after adoption of the DASH diet ( −29.4 ± 6.3 mg/dl ; P = 0.04 and −1.7 ± 0.1 % ; P = 0.04 , respectively ) . After the DASH diet , the mean change for HDL cholesterol levels was higher ( 4.3 ± 0.9 mg/dl ; P = 0.001 ) and LDL cholesterol was reduced ( −17.2 ± 3.5 mg/dl ; P = 0.02 ) . Additionally , DASH had beneficial effects on systolic ( −13.6 ± 3.5 vs. −3.1 ± 2.7 mmHg ; P = 0.02 ) and diastolic blood pressure ( −9.5 ± 2.6 vs. −0.7 ± 3.3 mmHg ; P = 0.04 ) . CONCLUSIONS Among diabetic patients , the DASH diet had beneficial effects on cardiometabolic risks Abstract — Evidence suggests that obesity may raise blood pressure ( BP ) through oxidative stress – sensitive mechanisms and that the Dietary Approaches to Stop Hypertension combination diet ( DASH-CD ) may decrease BP by enhancing antioxidant capacity . To address this question , 12 obese patients with high-normal – to – stage 1 hypertension ( hypertensives ) and 12 lean normotensives were studied on their usual diets and after following the DASH-CD and a low-antioxidant diet in r and om sequence for 4 weeks each . Acute oxidative stress was induced by a 4-hour infusion of intralipid and heparin  . Ferric-reducing activity of plasma ( FRAP ) and plasma F2-isoprostanes were measured as biomarkers of antioxidant capacity and oxidative stress , respectively . BP was lower in obese hypertensives on the DASH-CD than on the usual and low-antioxidant diets ( −8.1±1.5/−7.4±1.6 mm Hg , P < 0.05 ) . BP did not change significantly in lean normotensives after 4 weeks on the DASH-CD but tended to rise on the low-antioxidant diet  . FRAP on usual diets was higher in lean subjects than in obese subjects . FRAP increased in obese but not lean volunteers on the DASH-CD compared with usual diet , and the group difference disappeared . F2-isoprostanes increased from baseline during intralipid and heparin in both groups on the low-antioxidant diet but not in obese hypertensives on the DASH-CD . Among free-living obese hypertensives , the DASH-CD  raises antioxidant capacity , lowers BP , and reduces oxidative stress induced by acute hyperlipidemia . The findings are consistent with evidence that elevated BP in obese subjects may reflect an imbalance between antioxidant capacity and oxidative stress that is improved by the DASH-CD The mechanism underlying blood pressure ( BP ) reduction in the high fruits and vegetables arm of the Dietary Approaches to Stop Hypertension ( DASH ) study is unknown but may include potassium , magnesium and fibre . This study was design ed to separate minerals and fibre from other components of DASH on BP in abdominally obese individuals with metabolic syndrome with pre-hypertension to stage 1 hypertension ( obese hypertensives ) . A total of 15 obese hypertensives and 15 lean normotensives were studied on a st and ardized usual diet , r and omized to DASH or usual diet supplemented with potassium , magnesium and fibre to match DASH , then crossed over to the complementary diet . All diets were 3 weeks long , isocaloric and matched for sodium and calcium . In obese hypertensives , BP was lower after 3 weeks on DASH than usual diet ( −7.6±1.4/−5.3±1.4 mm Hg , P<0.001/0.02 ) and usual diet supplemented ( −6.2±1.4/−3.7±1.4 P<0.005/0.06 ) , whereas BP was not significantly different on usual and supplemented diets . BP values were not different among the three diets in lean normotensives . Small artery elasticity was lower in obese hypertensives than in lean normotensives on the usual and supplemented diets ( P<0.02 ) . This index of endothelial function improved in obese hypertensives ( P<0.02 ) but not lean normotensives on DASH , and was no longer different from values in lean normotensives ( P>0.50 ) . DASH is more effective than potassium , magnesium and fibre supplements for lowering BP in obese hypertensives , which suggest that high fruits and vegetables DASH  lowers BP and improves endothelial function in this group by nutritional factors in addition to potassium , magnesium and fibre We evaluated the effect of oral calcium supplementation on blood pressure , calcium metabolism , and insulin resistance in essential hypertension . After receiving a st and ard diet with 500 mg of calcium per day during a 4-week period , 20 nondiabetic , essential hypertensive patients were r and omized in a double-blind fashion to receive oral calcium supplementation ( 1500 mg of calcium per day ) or placebo for 8 weeks . At the end of the 4-week period of low-calcium diet and after the 8-week period of intervention , we measured blood pressure ( by both office and 24-hour ambulatory blood pressure monitoring ) , calcium-regulating hormones [ urinary hydroxyproline and serum osteocalcin , parathormone , and 1,25(OH)2-vitamin D3 ] , intraplatelet free calcium concentration , fasting plasma glucose and insulin levels , and the insulin-sensitivity index ( euglycemic-hyperinsulinemic clamp ) . Compared with patients maintained at low calcium intake , essential hypertensive patients under oral calcium supplementation significantly reduced serum osteocalcin ( from 22.2 + /- 1.9 to 17.9 + /- 2.0 micrograms/L ; P = .0015 ) , parathormone ( from 4.20 + /- 0.38 to 3.30 + /- 0.36 pmol/L ; P = .0003 ) , and 1,25(OH)2-vitamin D3 ( from 98.0 + /- 11.0 to 61.6 + /- 5.7 pmol/L ; P = .0062 ) . Likewise , we found a significant reduction in intraplatelet free calcium concentration ( from 35.9 + /- 1.2 to 26.5 + /- 0.8 nmol/L ; P = .0005 ) and fasting plasma insulin levels ( from 71.8 + /- 5.9 to 64.6 + /- 6.2 pmol/L ; P = .05 ) and a significant increase in the insulin-sensitivity index ( from 2.89 + /- 0.77 to 4.00 + /- 0.95 mg.kg-1.min-1 ; P = .0007 ) . None of these parameters were significantly modified in patients maintained at low calcium intake . Office and 24-hour mean values of systolic and diastolic blood pressure did not change after 8 weeks of oral calcium supplementation or placebo BACKGROUND It is known that obesity , sodium intake , and alcohol consumption factors influence blood pressure . In this clinical trial , Dietary Approaches to Stop Hypertension , we assessed the effects of dietary patterns on blood pressure . METHODS We enrolled 459 adults with systolic blood pressures of less than 160 mm Hg and diastolic blood pressures of 80 to 95 mm Hg . For three weeks , the subjects were fed a control diet that was low in fruits , vegetables , and dairy products , with a fat content typical of the average diet in the United States . They were then r and omly assigned to receive for eight weeks the control diet , a diet rich in fruits and vegetables , or a " combination " diet rich in fruits , vegetables , and low-fat dairy products and with reduced saturated and total fat . Sodium intake and body weight were maintained at constant levels . RESULTS At base line , the mean ( + /-SD ) systolic and diastolic blood pressures were 131.3+/-10.8 mm Hg and 84.7+/-4.7 mm Hg , respectively . The combination diet reduced systolic and diastolic blood pressure by 5.5 and 3.0 mm Hg more , respectively , than the control diet ( P<0.001 for each ) ; the fruits- and -vegetables diet reduced systolic blood pressure by 2.8 mm Hg more ( P<0.001 ) and diastolic blood pressure by 1.1 mm Hg more than the control diet ( P=0.07 ) . Among the 133 subjects with hypertension ( systolic pressure , > or = 140 mm Hg ; diastolic pressure , > or = 90 mm Hg ; or both ) , the combination diet reduced systolic and diastolic blood pressure by 11.4 and 5.5 mm Hg more , respectively , than the control diet ( P<0.001 for each ) ; among the 326 subjects without hypertension , the corresponding reductions were 3.5 mm Hg ( P<0.001 ) and 2.1 mm Hg ( P=0.003 ) . CONCLUSIONS A diet rich in fruits , vegetables , and low-fat dairy foods and with reduced saturated and total fat can substantially lower blood pressure . This diet offers an additional nutritional approach to preventing and treating hypertension Salt induces oxidative stress in salt-sensitive ( SS ) animals and man . It is not known whether in SS subjects the low-sodium dietary approaches to stop hypertension ( LS-DASH ) reduces oxidative stress more than DASH , which is high in antioxidants . To assess the effects of DASH and LS-DASH on oxidative stress , 19 volunteers were studied after 3 weeks of a st and ardized usual low fruits and vegetables diet ( ULFV ) , followed by 3 weeks on DASH ( both diets ∼120 mmol Na+ per day ) , then 3 weeks on LS-DASH ( 60 mmol Na+ per day ) . SS was defined as systolic blood pressure ⩾5 mm Hg lower on LS-DASH than DASH . In SS subjects ( N=9 ) , systolic blood pressure was lower on LS-DASH ( 111.0±2.0 mm Hg ) than DASH ( 118.0±2.2 , P<0.01 ) and ULFV ( 122.3±2.7 , P=0.002 ) . In salt-resistant ( SR ) volunteers ( N=10 ) , systolic blood pressure was lower on DASH ( 113.0±1.6 ) than ULFV ( 119.0±1.8 , P<0.05 ) but not LS-DASH ( 115.7±1.8 ) . Urine F2-isoprostanes , a marker of oxidative stress , were lower in SS subjects on LS-DASH ( 1.69±0.24 ) than ULFV ( 3.09±0.50 , P<0.05 ) and marginally lower than DASH ( 2.46±0.44 , P<0.20 ) . F2-isoprostanes were not different among the three diets in SR volunteers ( 2.18±0.29 , 2.06±0.29 , 2.27±0.53 , respectively ) . Aortic augmentation index , a measure of vascular stiffness , was lower in SS subjects on LS-DASH than either DASH or ULFV , and lower on DASH than ULFV in SR volunteers . In SS but not SR subjects , LS-DASH is associated with lower values for F2-isoprostanes and the aortic augmentation index . The results suggest that LS-DASH  decreases oxidative stress , improves vascular function and lowers blood pressure in SS but not SR volunteers BACKGROUND Diet and lifestyle modifications can substantially reduce the risk of type 2 diabetes . While a strong inverse association has been reported between dairy consumption and the insulin resistance syndrome among young obese adults , the relation between dairy intake and type 2 diabetes is unknown . METHODS We prospect ively examined the relation between  dairy intake and incident cases of  type 2 diabetes in 41,254 male participants with no history of diabetes , cardiovascular disease , and cancer at baseline in the Health Professionals Follow-up Study . RESULTS During 12 years of follow-up , we documented 1243 incident cases of type 2 diabetes . Dairy intake was associated with a modestly lower risk of type 2 diabetes . After adjusting for potential confounders , including body mass index , physical activity , and dietary factors , the relative risk for type 2 diabetes in men in the top quintile of dairy intake was 0.77 ( 95 % confidence interval [ CI ] , 0.62 - 0.95 ; P for trend , .003 ) compared with those in the lowest quintile . Each serving-per-day increase in total dairy intake was associated with a 9 % lower risk for type 2 diabetes ( multivariate relative risk , 0.91 ; 95 % CI , 0.85 - 0.97 ) . The corresponding relative risk was 0.88 ( 95 % CI , 0.81 - 0.94 ) for low-fat dairy intake and 0.99 ( 95 % CI , 0.91 - 1.07 ) for high-fat dairy intake . The association did not vary significantly according to body mass index ( < 25 vs > or = 25 kg/m(2 ) ; P for interaction , .57 ) . CONCLUSION Dietary patterns characterized by higher dairy intake , especially low-fat dairy intake , may lower the risk of type 2 diabetes in men OBJECTIVE —The excess risk of macrovascular disease and death associated with diabetes seems higher in women than in men . The pathogenesis for this risk difference has not been fully eluci date d. We investigated whether female sex was associated with macrovascular disease and death , independently of known risk factors related to type 2 diabetes , nephropathy , or retinopathy in normotensive patients with type 2 diabetes and microalbuminuria . RESEARCH DESIGN AND METHODS —We conducted a prospect i ve , prolonged follow-up study of a subgroup of 67 diabetic patients ( 46 men and 21 women ) without established cardiovascular disease who participated in a larger clinical trial . Data were collected on current and past health , medication use , blood pressure , renal function , and HbA1c  during the follow-up period of 4.7 ± 0.8 ( means ± SE ) years . The end point was a composite of death , cardiovascular disease , cerebrovascular events , and peripheral artery disease . RESULTS —Of the women , eight ( 38.1 % ) met the end point compared with six ( 13.4 % ) of the men ( P = 0.02 for difference in event-free survival ) . The hazard ratio of women relative to men was 3.19 ( 95 % CI 1.11–9.21 ) , which further increased after adjusting for age , systolic blood pressure , BMI , smoking , total-to-HDL cholesterol ratio , urinary albumin excretion , and retinopathy . CONCLUSIONS —In our study population of normotensive patients with type 2 diabetes and microalbuminuria , female sex was associated with increased risk of fatal and nonfatal cardiovascular disease , independent of the classical cardiovascular risk factors , the severity of nephropathy or presence of retinopathy , or health care utilization BACKGROUND Type 2 diabetes mellitus is increasingly common , primarily because of increases in the prevalence of a sedentary lifestyle and obesity . Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known . METHODS We r and omly assigned 522 middle-aged , overweight subjects ( 172 men and 350 women ; mean age , 55 years ; mean body-mass index [ weight in kilograms divided by the square of the height in meters ] , 31 ) with impaired glucose tolerance to either the intervention group or the control group . Each subject in the intervention group received individualized counseling aim ed at reducing weight , total intake of fat , and intake of saturated fat and increasing intake of fiber and physical activity . An oral glucose-tolerance test was performed annually ; the diagnosis of diabetes was confirmed by a second test . The mean duration of follow-up was 3.2 years . RESULTS The mean ( + /-SD ) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group ; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group ( P<0.001 for both comparisons between the groups ) . The cumulative incidence of diabetes after four years was 11 percent ( 95 percent confidence interval , 6 to 15 percent ) in the intervention group and 23 percent ( 95 percent confidence interval , 17 to 29 percent ) in the control group . During the trial , the risk of diabetes was reduced by 58 percent ( P<0.001 ) in the intervention group . The reduction in the incidence of diabetes was directly associated with changes in lifestyle . CONCLUSIONS Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects To investigate the role of potassium deficiency in the development of glucose intolerance during caloric deprivation , potassium balance was maintained within normality with oral potassium supplementation in a group of obese subjects who underwent protein-modified fast and the results of the study of carbohydrate metabolism ( oral glucose test , insulin receptors on monocytes and peripheral glucose utilization as assessed by euglycaemic clamp ) were compared with those obtained in a group of obese subjects admitted to protein-modified fast without potassium supplementation . Caloric deprivation without oral potassium supplementation was followed by a negative potassium balance and a decrease of serum potassium levels ; a decrease of the peripheral levels of insulin along with an increase in insulin receptors and a striking reduction of peripheral glucose utilization were also observed . The maintenance of normal potassium balance and normal serum potassium levels with oral potassium-chloride supplementation was associated with higher peripheral levels of insulin ( P less than 0.01 ) and improvement of peripheral glucose utilization ( P less than 0.01 ) whereas the binding of insulin to monocytes was unchanged . The data suggest that potassium depletion during protein-modified fast causes a decrease of the peripheral levels of insulin and a resistance to insulin action at the postreceptors sites which is reversed by potassium supply We tested whether lowering of blood pressure ( BP ) on the dietary approaches to stop hypertension ( DASH ) diet was associated with changes in peripheral vascular function : endothelial function , assessed by flow-mediated vasodilatation ( FMD ) of the brachial artery , and subcutaneous adipose tissue blood flow ( ATBF ) . We also assessed effects on heart rate variability ( HRV ) as a measure of autonomic control of the heart . We allocated 27 men and women to DASH diet and control groups .  We measured FMD , ATBF and HRV on fasting and after ingestion of 75 g glucose , before and after 30 days on dietary intervention , aim ing for weight maintenance . The control group did not change their diet . The DASH-diet group complied with the diet as shown by significant reductions in systolic ( P<0.001 ) and diastolic ( P=0.005 ) BP , and in plasma C-reactive protein ( P<0.01 ) , LDL-cholesterol ( P<0.01 ) and apolipoprotein B ( P=0.001 ) , a novel finding . Body weight changed by < 1 kg . There were no changes in the control group . We found no changes in FMD , or in ATBF , in the DASH-diet group , although heart rate fell ( P<0.05 ) . Glucose and insulin concentrations did not change . In this small-scale study , the DASH diet lowered BP independently of peripheral mechanisms The aim of the study was to investigate the effects of two hypocaloric ( 800-kcal ) diets on body weight reduction and composition , insulin sensitivity , and proteolysis in 25 normal glucose-tolerant obese women . The two diets had the following composition : 45 % protein , 35 % carbohydrate ( CHO ) , and 20 % fat ( HP diet , 10 subjects ) , and 60 % CHO , 20 % protein , and 20 % fat ( HC diet , 15 subjects ) ; both lasted 21 days . A euglycemic hyperinsulinemic ( 25 mU/kg/h ) clamp lasting 150 minutes combined with indirect calorimetry was performed before and after the diet . Both diets induced a similar decrease in body weight and fat mass ( FM ) , whereas fat-free mass ( FFM ) decreased only after the HC diet .  3-Methylhistidine ( 3-CH3-HIS ) excretion was reduced by 48 % after the HP diet and remained unchanged after the HC diet ( P < .05 ) . A significant correlation was found between the changes in FFM and in 3-CH3-HIS excretion after the diet ( rs = .50 , P < .02 ) . Blood glucose remained unchanged , while insulin decreased in both diets . Free fatty acids ( FFA ) significantly increased only after the HC diet ( P < .05 ) . During the clamp period , glucose disposal and glucose oxidation significantly increased after the HP diet and significantly decreased after the HC diet . Opposite results were found when measuring lipid oxidation . In conclusion , our experience suggests that ( 1 ) a hypocaloric diet providing a high percentage of natural protein can improve insulin sensitivity ; and ( 2 ) conversely , a hypocaloric high-polysaccharide-CHO diet decreases insulin sensitivity and is unable to spare muscle tissue Few studies exist regarding the effects of the Dietary Approaches to Stop Hypertension ( DASH ) diet on novel cardiovascular risk factors among type 2 diabetic patients . We evaluated the effects of the DASH eating pattern on C-reactive protein ( CRP ) level , coagulation abnormalities , and hepatic function tests in type 2 diabetic patients . In this r and omized , crossover clinical trial , 31 type 2 diabetic patients consumed a control diet or the DASH diet  for 8 wk . The DASH diet was rich in fruits , vegetables , whole grains , and low-fat dairy products and low in saturated fat , total fat , cholesterol , refined grains , and sweets , with a total of 2400 mg/d sodium . The control diet was a st and ard diet for diabetic patients .  There was a 4-wk washout between the 2 trial phases . The main outcome measures were CRP level , coagulation indices , and hepatic function tests . The mean percent change for plasma CRP level was -26.9 ± 3.5 % after the DASH diet period and -5.1 ± 3.8 % after the control diet period ( P = 0.02 ) . Decreases in both alanine aminotransferase and aspartate aminotransferase levels were greater after consuming the DASH diet compared with the control diet ( -14.8 ± 3.0 % vs -6.6 ± 3.4 % ; P = 0.001 ; -29.4 ± 3.7 % vs -5.9 ± 1.4 % ; P = 0.001 , respectively ) . The decrease in the plasma fibrinogen level during the DASH diet period ( -11.4 ± 3.6 % ) was greater than that during the control diet ( 0.5 ± 3.4 % ) ( P = 0.03 ) . Among diabetic patients , the DASH diet can play an important role in reducing inflammation , plasma levels of fibrinogen , and liver aminotransferases . Future longer term studies are recommended
target: The DASH dietary pattern may lead to an improvement in insulin sensitivity independent of weight loss .
  The DASH diet may play an important role in glycemic control in long- term interventions .
background: OBJECTIVE Type 2 diabetes is a major public health problem .
  The Dietary Approaches to Stop Hypertension ( DASH ) eating pattern may contribute to managing risk factors of type 2 diabetes .
  The objective of this study was to conduct a systematic review and meta- analysis on r and omized controlled trials ( RCTs ) that examine the effects of DASH diet consumption on the indices of glycemic control such as fasting blood glucose ( FBG ) , serum fasting insulin level , and Homeostatic Model Assessment insulin resistance ( HOMA-IR ) .