Nutritional Considerations Reduction of Sodium Intake
Sodium reduction typically results in lower blood pressure in industrialized societies. Current guidelines in the United States suggest reducing the daily intake of sodium to approximately 100mmol, or approximately 2.4 g of sodium or less per day.
The DASH-Sodium trial demonstrated that reduction of sodium intake from 100 to 50mmolperday (approximately 1.5 g) significantly reduced blood pressure in individuals following either the common US diet or the DASH diet. In addition, TOHP2 (phase 2 of the Trials of Hypertension Prevention) and TONE (Trials of Nonpharmacologic Interventions in the Elderly) documented that reducing sodium can either prevent hypertension or facilitate hypertension control. It should also be noted that salt sensitivity increases with age, so those who demonstrate this sensitivity should maintain a reduced salt diet.
Consumers should either eliminate or limit salt added to foods in cooking and at the table as a means of reducing sodium intake. Nutrition facts labels require sodium content to be listed so that consumers can be more prudent about their diets. The amount of sodium in processed food, such as convenience foods (e.g., boxed products one would prepare at home), soups, and processed meats (e.g., sausage, ham, and other meat products), is often alarming. If there is not a nutrition label on a processed food product, one should assume sodium content is high. Canned products generally contain more sodium than fresh or frozen items, unless a product is specifically labeled as 'no salt added.' The consumption of fresh, unprocessed foods should be promoted.
Moderation of Alcohol Intake
The relationship between high consumption of alcohol (typically three or more drinks per day) and elevated blood pressure has been shown in numerous epidemiologic studies. A drink is defined as 12 oz. of beer, 5 oz. of wine, or 1.5 oz. of distilled spirits. Most evidence indicates that alcohol should be limited to two drinks per day for men and one drink per day for women. Ideally, daily alcohol consumption should be avoided. Whenever possible, alcohol, if consumed, should be done so with meals.
Consumption of a DASH Diet (Increasing Potassium, Magnesium, Calcium, and Fiber Intakes by Increasing Intakes of Fruits, Vegetables, and Low-Fat Dairy Foods)
The contribution of minerals, particularly potassium, magnesium, and calcium, and fiber was identified by contributions from fruits, vegetables, low-fat dairy products, whole grains, and nuts in the DASH eating plan. The DASH diet effectively used these components through an ideal dietary pattern to lower blood pressure.
Increased intakes of potassium have been associated with lower blood pressure. A meta-analy-sis of several trials suggested that 60-120 mmol per day of supplemental potassium reduces systolic and diastolic blood pressure by 4.4 and 2.5 mmHg, respectively, in hypertensive individuals. In normo-tensive individuals, systolic and diastolic blood pressure was reduced by 1.8 and 1.0 mmHg, respectively. Dietary intake of potassium can be easily achieved through consumption of various foods.
The DASH diet, while promoting dietary patterns, was developed very carefully with particular attention paid to the use of specific foods within categories that contribute more to the intakes of desired nutrients. As an example, consider the rank-ordered listing of potassium content of fruits and fruit juices presented in Tables 2 and 3. Dried fruits typically have the highest potassium content, followed by raw fruits and frozen fruits. Canned fruit products generally do not contain as high potassium content as other forms. There is less potassium contained in fruit juices and generally the
Table 2 Fruits, ranked by potassium content (mg/100g)
Dried
Apricots, dehydrated (low moisture) 1850
Bananas, dehydrated, or banana powder 1491
Peaches (low moisture) 1351
Apricots 1162
Litchis 1110
Prunes (low moisture) 1058
Peaches 996
Currants, zante 892
Persimmons, Japanese 802
Raisins 746-825
Plums (prunes) 732
Dates, medjool 696
Figs 680
Longans 658
Dates, deglet noor 656
Apples (low moisture) 640
Pears 533
Jujube 531
Apples 450 Raw
Tamarinds 628
Plantains 499
Breadfruit 490
Avocados 485
Durian, raw or frozen 436
Custardapple (bullock's heart) 382
Bananas 358
Passion-fruit, (granadilla), purple 348
Sapotes (marmalade plum) 344
Currants, European black 322
Kiwi fruit, (Chinese gooseberries) 312
Persimmons, native 310
Abiyuch 304
Jackfruit 303
Rhubarb 288
Guavas, common 284
Elderberries 280
Soursop 278
Currants, red and white 275
Cherimoya 269
Melons, cantaloupe 267
Longans 266
Loquats 266
Carissa (natal-plum) 260
Apricots 259
Pomegranates 259
Papayas 257
Jujube 250
Sugar apples (sweetsop) 247
Figs 232
Melons, honeydew 228
Cherries, sweet 222
Prickly pears 220
Pummelo 216
Roselle 208
Nectarines 201
Gooseberries 198
Quinces 197
Crabapples 194
Mulberries 194
Sapodilla 193
Grapes 191
Peaches 190
Kumquats 186
Melons, casaba 182
Cherries, sour, red 173
Litchis 171
Oranges 166-196
Carambola (starfruit) 163
Blackberries 162
Persimmons, Japanese 161
Plums 157
Tangerines (mandarin oranges) 157
Mangos 156
Feijoa 155
Strawberries 153
Raspberries 151
Acerola, (West Indian cherry) 146
Lemons 138-145
Rowal 131
Grapefruit 127-150
Rose apples 123
Pears, asian 121
Pears 119
Limes 117
Pineapple 115-125
Watermelon 112
Apples, with skin 107
Pitanga, (surinam cherry) 103
Apples, without skin 90
Cranberries 85
Java plum (jambolan) 79
Blueberries 77
Mammy apple (mamey) 47
Oheloberries 38
Fruits, frozen
Strawberries 148
Loganberries 145
Boysenberries 139
Cherries, sour, red 124
Raspberries, red 114
Rhubarb 108
From U.S. Department of Agriculture, Agricultural Research Service (2003) USDA National Nutrient Database for Standard Reference, Release 16. Available atwww.nal.usda.gov/fnic/foodcomp.
fresh forms of the juices have incrementally more than the processed forms. Fruits and juices in general contain some magnesium, another mineral of interest to the DASH investigators. Most fruits contain 2-30 mg of magnesium per 100 grams, but dried fruits contain much more (30-90 mg) and the amounts vary greatly. Fruit juices contain less than 20 mg of magnesium per 100 grams, with most containing less than 10 mg. Fiber content of fruit ranges from approximately 7 to 14 g of fiber for dried fruits on a per 100 gram basis and between 1 and 5g for other fruits per 100 grams. Generally, fruit juices contribute less than 1 g of dietary fiber per 100 grams, but high-pulp varieties of juices provide slightly more dietary fiber.
Table 3 Fruit juices, ranked by potassium content |
(mg/100 g) |
Fruit juice |
K (mg) |
Passion fruit juice, fresh |
278 |
Prune juice, canned |
276 |
Orange juice, fresh |
200 |
Orange juice, from concentrate |
190 |
Tangerine juice, fresh or canned |
178 |
Orange juice, canned |
175 |
Grapefruit juice, white or pink, fresh or canned |
162 |
Pineapple juice, canned or from concentrate |
134 |
Grape juice, canned or bottled, unsweetened |
132 |
Apple juice, from frozen concentrate, unsweetened |
126 |
Lemon juice, fresh |
124 |
Apple juice, canned or bottled, unsweetened |
119 |
Apricot nectar |
114 |
Lime juice, fresh |
109 |
Lemon juice, canned or bottled |
102 |
Acerola juice, fresh |
97 |
Cranberry juice, unsweetened |
77 |
Lime juice, canned or bottled |
75 |
Peach nectar |
40 |
Papaya nectar |
31 |
Grape juice, from frozen concentrate, sweetened |
21 |
Pear nectar |
13 |
From U.S. Department of Agriculture, Agricultural Research Service (2003) USDA National Nutrient Database for Standard Reference, Release 16. Available at www.nal.usda.gov/fnic/ foodcomp.
Table 4 contains a rank-ordered listing of vegetables (including beans) by content of potassium. Magnesium content is also shown. The data are presented for vegetables and beans in the raw form generally. It is important to remember that many fresh forms are concentrated in terms of weight when cooked, especially spinach and other greens, and it is thus possible to obtain a higher mineral content from cooked vegetables (especially in the case of potassium). The magnesium content differs less from the fresh to the cooked state for most vegetables and beans. Most vegetables contain approximately 1-3 g of dietary fiber per
Vegetable |
K (mg) |
Mg (mg) |
Tomatoes, sun-dried |
3427 |
194 |
Palm hearts |
1806 |
10 |
Arrowhead |
922 |
51 |
Yam |
816 |
21 |
Beet greens |
762 |
70 |
Lemon grass (citronella) |
723 |
60 |
Butterbur (fuki) |
655 |
14 |
Taro leaves |
648 |
45 |
Epazote |
633 |
121 |
Soybeans, green |
620 |
65 |
Amaranth leaves |
611 |
55 |
Cress, garden |
606 |
38 |
Taro, tahitian |
606 |
47 |
Yautia (tannier) |
598 |
24 |
Taro |
591 |
33 |
Winged bean tuber |
586 |
24 |
Waterchestnuts, Chinese (matai) |
584 |
22 |
Wasabi, root |
568 |
69 |
Chrysanthemum, garland |
567 |
32 |
Chrysanthemum leaves |
567 |
32 |
Jute, potherb |
559 |
64 |
Spinach |
558 |
79 |
Lotus root |
556 |
23 |
Parsley |
554 |
50 |
Pigeonpeas, immature seeds |
552 |
68 |
Bamboo shoots |
533 |
3 |
Coriander (cilantro) leaves |
521 |
26 |
Sweetpotato leaves |
518 |
61 |
Mushroom, oyster |
516 |
20 |
Vinespinach (basella) |
510 |
65 |
Purslane |
494 |
68 |
Fireweed, leaves |
494 |
156 |
Mushrooms, portabella |
484 |
11 |
Soybeans, mature seeds |
484 |
72 |
Borage |
470 |
52 |
Lima beans, immature seeds |
467 |
58 |
Horseradish tree, pods |
461 |
45 |
Corn salad |
459 |
13 |
Squash, zucchini, baby |
459 |
33 |
Cowpeas, leafy tips |
455 |
43 |
Potatoes, red, flesh and skin |
455 |
22 |
Arrowroot |
454 |
25 |
Lambsquarters |
452 |
34 |
Kale, scotch |
450 |
88 |
Mustard spinach (tendergreen) |
449 |
11 |
Mushrooms, brown, Italian or Crimini |
448 |
9 |
Kale |
447 |
34 |
Pumpkin leaves |
436 |
38 |
Cowpeas (blackeyes), immature seeds |
431 |
51 |
Jerusalem artichokes |
429 |
17 |
Potato, flesh and skin |
421 |
23 |
Chicory greens |
420 |
30 |
Mountain yam, Hawaii |
418 |
12 |
Potatoes, russet, flesh and skin |
417 |
23 |
Ginger root, raw |
415 |
43 |
Fennel, bulb, raw |
414 |
17 |
Potatoes, skin |
413 |
23 |
Potatoes, white, flesh and skin |
407 |
21 |
Garlic |
401 |
25 |
Cardoon |
400 |
42 |
Dandelion greens |
397 |
36 |
Dock |
390 |
103 |
Brussels sprouts |
389 |
23 |
Peas, mature seeds, sprouted |
381 |
56 |
Mushrooms, enoki |
381 |
16 |
Salsify (vegetable oyster) |
380 |
23 |
Chard, Swiss |
379 |
81 |
Parsnips |
375 |
29 |
Artichokes (globe or French) |
370 |
60 |
Fiddlehead ferns |
370 |
34 |
Arugula |
369 |
47 |
Seaweed, laver |
356 |
2 |
Mustard greens |
354 |
32 |
Squash, winter, butternut |
352 |
34 |
Vegetable |
K(mg) |
Mg |
Kohlrabi |
350 |
19 |
Squash, winter, all varieties |
350 |
14 |
Pumpkin |
340 |
12 |
Eppaw |
340 |
32 |
Peppers, hot chili, green |
340 |
25 |
Horseradish tree leafy tips |
337 |
147 |
Rutabagas |
337 |
23 |
Sweet potato |
337 |
25 |
Shallots |
334 |
21 |
Taro shoots |
332 |
8 |
Beans, fava, in pod |
332 |
33 |
Celtuce |
330 |
28 |
Watercress |
330 |
21 |
Beets |
325 |
23 |
Broccoli, leaves |
325 |
25 |
Broccoli, flower clusters |
325 |
25 |
Broccoli, stalks |
325 |
25 |
Lentils, sprouted |
322 |
37 |
Peppers, hot chili, red |
322 |
23 |
Carrots |
320 |
12 |
Squash, winter, hubbard |
320 |
19 |
Broccoli |
316 |
21 |
Endive |
314 |
15 |
Mushrooms |
314 |
9 |
Swamp cabbage (skunk cabbage) |
312 |
71 |
Burdock root |
308 |
38 |
Beans, navy, mature seeds |
307 |
101 |
Beans, pinto, mature seeds |
307 |
53 |
Pepper, Serrano |
305 |
22 |
Cauliflower |
303 |
15 |
Okra |
303 |
57 |
Radicchio |
302 |
13 |
Celeriac |
300 |
20 |
Cauliflower, green |
300 |
20 |
Balsam pear (bitter gourd), pods |
296 |
17 |
Chives |
296 |
42 |
Turnip greens |
296 |
31 |
Chicory roots |
290 |
22 |
Radishes, white icicle |
280 |
9 |
Onions, spring or scallions |
276 |
20 |
Grape leaves |
272 |
95 |
Cassava |
271 |
21 |
Corn, sweet, yellow or white |
270 |
37 |
Tomatillos |
268 |
20 |
Squash, summer, all varieties |
262 |
17 |
Celery |
260 |
11 |
Tomatoes, yellow |
258 |
12 |
Nopales |
257 |
52 |
Pepper, banana |
256 |
17 |
Cabbage, Chinese (pak-choi) |
252 |
19 |
Hyacinth beans, immature seeds |
252 |
40 |
Broadbeans, immature seeds |
250 |
38 |
Broccoli, frozen |
250 |
16 |
Lettuce, cos or romaine |
247 |
14 |
Cabbage |
246 |
15 |
Peas, green |
244 |
33 |
Cabbage, red |
243 |
16 |
Pokeberry shoots (poke) |
242 |
18 |
Yardlong bean |
240 |
44 |
Cabbage, Chinese (pe-tsai) |
238 |
13 |
Lettuce, butterhead |
238 |
13 |
Tomatoes, red, ripe |
237 |
11 |
Carrots, baby |
237 |
10 |
Radishes |
233 |
10 |
Cabbage, savoy |
230 |
28 |
Eggplant |
230 |
14 |
Radishes, oriental |
227 |
16 |
Seaweed, agar |
226 |
67 |
Winged beans, immature seeds |
223 |
34 |
Cowpeas, young pods with seeds |
215 |
58 |
Peppers, jalapeno |
215 |
19 |
Onions, welsh |
212 |
23 |
Squash, summer |
212 |
21 |
Tomatoes, orange |
212 |
8 |
Peppers, sweet, yellow |
212 |
12 |
Chicory, witloof |
211 |
10 |
Peppers, sweet, red |
211 |
12 |
Beans, snap, green |
209 |
25 |
Beans, snap, yellow |
209 |
25 |
Tomatoes, green |
204 |
10 |
Asparagus |
202 |
14 |
Peppers, Hungarian |
202 |
16 |
Peas, edible, podded |
200 |
24 |
Broccoli raab |
196 |
22 |
Turnips |
191 |
11 |
Beans, kidney, mature seeds |
187 |
21 |
Lettuce, red leaf |
187 |
12 |
Sesbania flower |
184 |
12 |
Poi |
183 |
24 |
Squash, summer, scallop |
182 |
23 |
Leeks (bulb and lower leaf portion) |
180 |
28 |
Winged bean leaves |
176 |
8 |
Peppers, sweet, green |
175 |
10 |
Pumpkin flowers |
173 |
24 |
Lettuce, iceberg |
152 |
8 |
Gourd, white flowered (calabash) |
150 |
11 |
Yambean (jicama) |
150 |
12 |
Mung beans, mature seeds |
149 |
21 |
Cucumber, with peel |
147 |
13 |
Onions |
144 |
10 |
Gourd, dishcloth (towelgourd) |
139 |
14 |
Cucumber, peeled |
136 |
12 |
New Zealand spinach |
130 |
39 |
Seaweed, spirulina |
127 |
19 |
Chayote, fruit |
125 |
12 |
Onions, sweet |
119 |
9 |
Squash, winter, spaghetti |
108 |
12 |
Seaweed, kelp, raw |
89 |
121 |
Radish seeds, sprouted, raw |
86 |
44 |
Alfalfa seeds, sprouted, raw |
79 |
27 |
Seaweed, irishmoss, raw |
63 |
144 |
Seaweed, wakame, raw |
50 |
107 |
Jew's ear (pepeao), raw |
43 |
25 |
Data source: U.S. Department of Agriculture, Agricultural Research Service. 2003. USDA National Nutrient Database for Standard Reference, Release 16. Nutrient Data Laboratory Home Page, http://www.nal.usda.gov/fnic/foodcomp.
100 grams; beans and legumes offer approximately 5 g of dietary fiber, and some dried vegetables offer more than double this amount.
Nuts were also an important part of the DASH diet, contributing potassium, magnesium, fiber, and protein. They contain fat, mostly monounsaturated, and thereby contribute energy to the diet. Table 5
Description |
K (mg) |
Mg (mg) |
Fiber (g) |
Nuts | |||
Pistachio nuts, dry roasted |
1042 |
120 |
10.3 |
Pistachio nuts, raw |
1025 |
121 |
10.3 |
Ginkgo nuts, dried |
998 |
53 |
9.3 |
Chestnuts, European, dried, |
986 |
74 |
11.7 |
unpeeled | |||
Almonds, dry roasted |
746 |
286 |
11.8 |
Almonds |
728 |
275 |
11.8 |
Almonds, oil roasted |
699 |
274 |
10.5 |
Almonds, blanched |
687 |
275 |
10.4 |
Hazelnuts or filberts |
680 |
163 |
9.7 |
Cashew nuts, raw |
660 |
292 |
3.3 |
Brazil nuts, dried, |
659 |
376 |
7.5 |
unblanched | |||
Hazelnuts or filberts, blanched |
658 |
160 |
11.0 |
Cashew nuts, oil roasted |
632 |
273 |
3.3 |
Pine nuts, pinyon, dried |
628 |
234 |
10.7 |
Pine nuts, pignolia, dried |
597 |
251 |
3.7 |
Chestnuts, European, roasted |
592 |
33 |
5.1 |
Cashew nuts, dry roasted |
565 |
260 |
3.0 |
Walnuts, black, dried |
523 |
201 |
6.8 |
Chestnuts, European, raw, |
518 |
32 |
8.1 |
unpeeled | |||
Ginkgo nuts, raw |
510 |
27 |
9.3 |
Walnuts, English |
441 |
158 |
6.7 |
Hickorynuts, dried |
436 |
173 |
6.4 |
Pecans, dry roasted |
424 |
132 |
9.4 |
Butternuts, dried |
421 |
237 |
4.7 |
Pecans |
410 |
121 |
9.6 |
Pecans, oil roasted |
392 |
121 |
9.5 |
Macadamia nuts, raw |
368 |
130 |
8.6 |
Macadamia nuts, |
363 |
118 |
8.0 |
dry roasted | |||
Ginkgo nuts, canned |
180 |
16 |
9.3 |
Seeds | |||
Breadnuttree seeds, dried |
2011 |
115 |
14.9 |
Cottonseed kernels, roasted |
1350 |
440 |
5.5 |
(glandless) | |||
Breadfruit seeds, roasted |
1082 |
62 |
6.0 |
Breadfruit seeds, raw |
941 |
54 |
5.2 |
Sunflower seed kernels, dry |
850 |
129 |
9.0 |
roasted | |||
Pumpkin and squash seed |
807 |
535 |
3.9 |
kernels, dried | |||
Pumpkin and squash seed |
806 |
534 |
3.9 |
kernels, roasted | |||
Sunflower seed kernels, dried |
689 |
354 |
10.5 |
Flaxseed |
681 |
362 |
27.9 |
Sunflower seed kernels |
491 |
129 |
11.5 |
Sunflower seed kernels, oil |
483 |
127 |
6.8 |
roasted | |||
Sesame seeds, whole, dried |
468 |
351 |
11.8 |
Sesame seed kernels, dried |
407 |
347 |
12.7 |
(decorticated) | |||
Sesame seed kernels, |
406 |
346 |
16.9 |
toasted |
includes the potassium, magnesium, and fiber content of some common nuts and seeds. Although this is presented based on a rank-ordered content of potassium, it is easy to see that some nuts and seeds are a significant source of magnesium and dietary fiber and their consumption was therefore encouraged in the DASH diet.
Low-fat dairy products were also an important part of the DASH diets. These were used primarily to increase the calcium content of the diets from a low content of approximately 450 mg on the control and fruit and vegetable diets to approximately 1250 mg on the DASH diet at the 2000 kcal (8368 kJ) level. Calcium has frequently been reported to have an inverse relationship with blood pressure, but studies utilizing supplemental calcium have been inconsistent. With supplements, effects on blood pressure reduction have been negligible. Nonetheless, the blood pressure lowering effect of the DASH diet has been suggested to be in part related to the calcium content of the diet. It should be noted that the DASH diet also was lower in fat and higher in protein, and therefore it is not easily attributable to one factor alone but rather a combination of several factors, as depicted in Figure 1.
The final point regarding composition of the DASH diet is that it included specific food choices. The diet contained whole grains, poultry, and fish (in addition to the fruits, vegetables, low-fat dairy, and nuts previously mentioned). Although it was reduced in total and saturated fat, it was also reduced in meats, sweets, and sugar-containing beverages. Food was consumed as an overall pattern in which it is quite possible that the interaction between food items is as important as the specific foods in reducing blood pressure. Thus, the DASH diet contained dietary patterns promoted by the National Institutes of Health, National Heart, Lung, and Blood Institute. The dietary patterns of DASH are presented at three energy levels in Table 6.

From U.S. Department of Agriculture, Agricultural Research Service (2003) USDA National Nutrient Database for Standard Reference, Release 16. Available at www.nal.usda.gov/fnic/ foodcomp.
T Fruits T Vegetables I Sodium I Fat T Protein T Dairy products ? Other nutrients _ ? Nutrient interactions
Figure 1 Assessing the effects of the DASH-Sodium diet on blood pressure. The figure depicts the fact that there is some certainty associated with the increases in fruits and vegetables and reduction in sodium. The gray areas represent the other components of the diet and the possible contribution of each, alone or in combination with other factors.
Table 6 Food group servings for the DASH diet at three energy levels
Food group Daily servings (except as noted)
1600 kcal or 2000kcal or 3100 kcal or
Table 6 Food group servings for the DASH diet at three energy levels
Food group Daily servings (except as noted)
1600 kcal or 2000kcal or 3100 kcal or
6694 kJ |
8368kJ |
12970 kJ | |
Grains and grain |
6 |
7-8 |
12-13 |
products | |||
Vegetables |
3-4 |
4-5 |
6 |
Fruits |
4 |
4-5 |
6 |
Low-fat or fat-free |
2-3 |
2-3 |
3-4 |
dairy foods | |||
Meats, poultry, |
1-2 |
2 or less |
2-3 |
fish | |||
Nuts, seeds, dry |
3perweek |
4-5 |
1 |
beans |
per week | ||
Fats and oils |
2 |
2-3 |
4 |
Sweets |
0 |
5 per week |
2 |
Dietary Protein Consumption
Results of meta-analyses from several investigators indicate an inverse association between dietary protein and blood pressure levels. However, data have not been conclusive. The DASH diet contained approximately 18% of energy from protein compared to 15% of energy from protein in the other diets tested. Because of the addition of low-fat dairy foods and the reduced emphasis on high-fat meats, it can be assumed that this elevation in protein was brought about by foods that contributed protein from perceived beneficial sources. This is an area of dietary intake that requires more research.
Fish Oil Supplementation
Studies suggest that an intake of fish oil at a level of approximately 4 g per day reduces systolic blood pressure by approximately 1.7-2.1 mmHg and diastolic blood pressure by 1.5-1.6 mmHg. These effects tend to be larger in individuals older than 45 years of age and in populations with blood pressure readings greater than 140/90 mmHg. Generally, there have been differences associated with fish oil capsules compared to naturally occurring sources of EPA and DHA from fatty fish, again indicating dietary pattern rather than consumption of individual items may be crucial. The DASH diet had a relatively high fish content (compared to animal meats) and this may be yet one more factor contributing to the lowering of blood pressure in individuals on the DASH diet.
The American Heart Association recommends eating two servings of fish per week and emphasizes that the choice should be a fatty fish (such as salmon, herring, or mackerel). Not all fish have the same content of omega-3 fatty acids. Table 7 provides a listing of amounts of combined EPA/ DHA in fish and other seafood sources and the amount of consumption (in ounces of product) necessary to provide a 4-g intake. Descriptors include common raw and canned products, but the intakes given are rough estimates due to potential variability in oil content within species, season, and diet. Cooking methods and other preparation techniques may affect the final concentrations in raw fish.
Other Fatty Acid Effects
Monounsaturated fatty acids, particularly olive oil, may help lower blood pressure. Olive oil has typically been associated with the popularized Mediterranean diet, which has been promoted as a treatment for cardiovascular disease. Other oils (e.g., canola and peanut oil) have a high monounsa-turated fat content. Nuts, which are part of the DASH diet, contain significant amounts of monounsaturated fats and fit well in the Mediterranean diet.
Caffeine
Although a link between caffeine consumption (particularly coffee) and hypertension may exist, effects of coffee drinking on blood pressure appear to be dependent on the time of consumption and subsequent determination of blood pressure values. Generally, a role for caffeine intake and development of hypertension is not believed to be significant.
Weight Reduction
Obesity and overweight are considered independent risk factors for cardiovascular disease and are closely associated with hypertension. This linkage was demonstrated in the 1960s by the Framingham Heart Study investigators in the United States. Obesity in the industrialized world has been increasing at epidemic proportions. The relationship between increasing body weight and increasing blood pressure has been termed obesity hypertension, and treatment requires consideration of physiologic changes related to this disorder. Although efforts have been under way in the United States to reduce overweight and obesity, it is estimated that the age-adjusted prevalence of overweight and obesity (body mass index (BMI) >25.0) among adults aged 20 or older is 64%; for those considered obese (BMI >30.0) it is 30%. During a 25-year period in the United States, this reflects approximately a 36% increase in the combined levels of overweight and obesity and essentially a doubling of obesity rates.
Table 7 Eicosapentaenoic (EPA, 20:5 n-3) and docosahexaenoic (DHA, 22:6 n-3) acid in fish/seafood (per 100 grams) and the amount of consumption (in ounces) required to provide ~4g of EPA + DHAperday (ranked in order of content)
Fish/seafood |
EPA (g) |
DHA (g) |
EPA + DHA (g) |
Oz. to | |
F |
sh, caviar, black and red, granular |
2.74 |
3.80 |
6.54 |
2.2 |
F |
sh, mackerel, salted |
1.62 |
2.97 |
4.58 |
3.1 |
F |
sh, roe, mixed species, cooked |
1.26 |
1.75 |
3.01 |
4.7 |
F |
sh, shad, American, raw |
1.09 |
1.32 |
2.41 |
5.9 |
F |
sh, roe, mixed species, raw |
0.98 |
1.36 |
2.35 |
6.0 |
F |
sh, mackerel, Atlantic, raw |
0.90 |
1.40 |
2.30 |
6.1 |
F |
sh, anchovy, European, canned in oil |
0.76 |
1.29 |
2.06 |
6.9 |
F |
sh, salmon, chinook, raw |
1.01 |
0.94 |
1.95 |
7.2 |
F |
sh, salmon, Atlantic, farmed, raw |
0.62 |
1.29 |
1.91 |
7.4 |
F |
sh, herring, Pacific, raw |
0.97 |
0.69 |
1.66 |
8.5 |
F |
sh, salmon, pink, canned |
0.85 |
0.81 |
1.65 |
8.5 |
F |
sh, herring, Atlantic, raw |
0.71 |
0.86 |
1.57 |
9.0 |
F |
sh, anchovy, European, raw |
0.54 |
0.91 |
1.45 |
9.7 |
F |
sh, mackerel, Pacific and jack, raw |
0.51 |
0.93 |
1.44 |
9.8 |
F |
sh, salmon, Atlantic, wild, raw |
0.32 |
1.12 |
1.44 |
9.8 |
F |
sh, sablefish, raw |
0.68 |
0.72 |
1.40 |
10.1 |
F |
sh, mackerel, spanish, raw |
0.33 |
1.01 |
1.34 |
10.5 |
F |
sh, whitefish, mixed species, raw |
0.32 |
0.94 |
1.26 |
11.2 |
F |
sh, salmon, coho, farmed, raw |
0.39 |
0.82 |
1.21 |
11.7 |
F |
sh, salmon, chum, canned |
0.47 |
0.70 |
1.18 |
12.0 |
F |
sh, tuna, fresh, bluefin, raw |
0.28 |
0.89 |
1.17 |
12.0 |
F |
sh, salmon, sockeye, raw |
0.52 |
0.65 |
1.17 |
12.0 |
F |
sh, salmon, sockeye, canned |
0.49 |
0.66 |
1.16 |
12.2 |
F |
sh, salmon, coho, wild, raw |
0.43 |
0.66 |
1.09 |
13.0 |
F |
sh, salmon, pink, raw |
0.42 |
0.59 |
1.01 |
14.0 |
F |
sh, sardine, Atlantic, canned in oil |
0.47 |
0.51 |
0.98 |
14.4 |
F |
sh, trout, rainbow, farmed, raw |
0.26 |
0.67 |
0.93 |
15.2 |
F |
sh, halibut, Greenland, raw |
0.53 |
0.39 |
0.92 |
15.4 |
F |
sh, tuna, white, canned in water |
0.23 |
0.63 |
0.86 |
16.4 |
F |
sh, shark, mixed species, raw |
0.32 |
0.53 |
0.84 |
16.7 |
F |
sh, bluefish, raw |
0.25 |
0.52 |
0.77 |
18.3 |
F |
sh, bass, striped, raw |
0.17 |
0.59 |
0.75 |
18.7 |
F |
sh, trout, mixed species, raw |
0.20 |
0.53 |
0.73 |
19.3 |
F |
sh, smelt, rainbow, raw |
0.28 |
0.42 |
0.69 |
20.4 |
Mollusks, oyster, Pacific, raw |
0.44 |
0.25 |
0.69 |
20.5 | |
Fish, swordfish, raw |
0.11 |
0.53 |
0.64 |
22.1 | |
Fish, spot, raw |
0.22 |
0.41 |
0.63 |
22.4 | |
Fish, salmon, chum, raw |
0.23 |
0.39 |
0.63 |
22.5 | |
Fish, wolffish, Atlantic, raw |
0.31 |
0.32 |
0.62 |
22.6 | |
Fish, bass, freshwater, mixed species, raw |
0.24 |
0.36 |
0.60 |
23.7 | |
Fish, sea bass, mixed species, raw |
0.16 |
0.43 |
0.60 |
23.7 | |
Fish, trout, rainbow, wild, raw |
0.17 |
0.42 |
0.59 |
24.0 | |
Fish, pompano, florida, raw |
0.18 |
0.39 |
0.57 |
24.8 | |
Mollusks, oyster, eastern, wild, raw |
0.27 |
0.29 |
0.56 |
25.2 | |
Fish, drum, freshwater, raw |
0.23 |
0.29 |
0.52 |
27.3 | |
Mollusks, squid, mixed species, raw |
0.15 |
0.34 |
0.49 |
28.9 | |
Crustaceans, shrimp, mixed species, raw |
0.26 |
0.22 |
0.48 |
29.4 | |
Fish, sucker, white, raw |
0.19 |
0.29 |
0.48 |
29.5 | |
Mollusks, mussel, blue, raw |
0.19 |
0.25 |
0.44 |
32.0 | |
Fish, tilefish, raw |
0.09 |
0.35 |
0.43 |
32.8 | |
Fish, pollock, Atlantic, raw |
0.07 |
0.35 |
0.42 |
33.5 | |
Mollusks, oyster, eastern, farmed, raw |
0.19 |
0.20 |
0.39 |
36.1 | |
Fish, pollock, walleye, raw |
0.15 |
0.22 |
0.37 |
37.9 | |
Fish, seatrout, mixed species, raw |
0.17 |
0.21 |
0.37 |
37.9 | |
Crustaceans, crab, queen, raw |
0.26 |
0.11 |
0.37 |
37.9 | |
Fish, catfish, channel, wild, raw |
0.13 |
0.23 |
0.36 |
38.8 | |
Fish, halibut, Atlantic and Pacific, raw |
0.07 |
0.29 |
0.36 |
38.9 | |
Crustaceans, crab, blue, canned |
0.19 |
0.17 |
0.36 |
38.9 | |
Fish, carp, raw |
0.24 |
0.11 |
0.35 |
40.1 | |
Fish, cisco, raw |
0.10 |
0.26 |
0.35 |
40.1 |
Fish/seafood |
EPA (g) |
DHA (g) |
EPA + DHA (g) |
Oz. to provide ~4 g EPA + DHA |
Fish, rockfish, Pacific, raw |
0.14 |
0.20 |
0.35 |
40.9 |
Fish, mullet, striped, raw |
0.22 |
0.11 |
0.33 |
43.4 |
Crustaceans, crab, blue, raw |
0.17 |
0.15 |
0.32 |
44.1 |
Fish, mackerel, king, raw |
0.14 |
0.18 |
0.31 |
45.1 |
Fish, pike, walleye, raw |
0.09 |
0.23 |
0.31 |
45.4 |
Fish, snapper, mixed species, raw |
0.05 |
0.26 |
0.31 |
45.4 |
Crustaceans, crab, dungeness, raw |
0.22 |
0.09 |
0.31 |
46.0 |
Fish, ocean perch, Atlantic, raw |
0.08 |
0.21 |
0.29 |
48.5 |
Fish, sturgeon, mixed species, raw |
0.19 |
0.09 |
0.29 |
49.2 |
Fish, catfish, channel, farmed, raw |
0.07 |
0.21 |
0.27 |
51.5 |
Fish, tuna, light, canned in water |
0.05 |
0.22 |
0.27 |
52.3 |
Fish, sheepshead, raw |
0.14 |
0.12 |
0.26 |
54.1 |
Fish, tuna, fresh, skipjack, raw |
0.07 |
0.19 |
0.26 |
55.1 |
Fish, perch, mixed species, raw |
0.08 |
0.17 |
0.25 |
55.8 |
Fish, grouper, mixed species, raw |
0.03 |
0.22 |
0.25 |
57.1 |
Fish, whiting, mixed species, raw |
0.09 |
0.13 |
0.22 |
63.0 |
Fish, croaker, Atlantic, raw |
0.12 |
0.10 |
0.22 |
64.1 |
Fish, tuna, fresh, yellowfin, raw |
0.04 |
0.18 |
0.22 |
64.7 |
Fish, cod, Pacific, raw |
0.08 |
0.14 |
0.22 |
65.6 |
Fish, flatfish (flounder and sole species), raw |
0.09 |
0.11 |
0.20 |
70.9 |
Mollusks, scallop, mixed species, raw |
0.09 |
0.11 |
0.20 |
71.3 |
Fish, haddock, raw |
0.06 |
0.13 |
0.19 |
76.3 |
Fish, cod, Atlantic, raw |
0.06 |
0.12 |
0.18 |
76.7 |
Fish, burbot, raw |
0.07 |
0.10 |
0.17 |
85.0 |
Mollusks, octopus, common, raw |
0.08 |
0.08 |
0.16 |
89.9 |
Fish, eel, mixed species, raw |
0.08 |
0.06 |
0.15 |
96.0 |
Crustaceans, crayfish, farmed, raw |
0.12 |
0.03 |
0.14 |
98.0 |
Mollusks, clam, mixed species, raw |
0.07 |
0.07 |
0.14 |
99.4 |
Crustaceans, crayfish, wild, raw |
0.10 |
0.04 |
0.14 |
99.4 |
Mollusks, snail, raw |
0.12 |
0.00 |
0.12 |
118.6 |
Fish, sunfish, pumpkin seed, raw |
0.04 |
0.07 |
0.11 |
129.4 |
Fish, dolphinfish, raw |
0.02 |
0.09 |
0.11 |
130.6 |
Fish, pike, northern, raw |
0.03 |
0.07 |
0.11 |
131.9 |
Mollusks, cuttlefish, mixed species, raw |
0.04 |
0.07 |
0.11 |
134.4 |
Turtle, green, raw |
0.02 |
0.03 |
0.06 |
252.0 |
Mollusks, abalone, mixed species, raw |
0.05 |
0.00 |
0.05 |
287.9 |
Frog legs, raw |
0.01 |
0.02 |
0.03 |
415.0 |
From U.S. Department of Agriculture, Agricultural Research Service (2003) USDA National Nutrient Database for Standard Reference, Release 16. Available at www.nal.usda.gov/fnic/foodcomp.
The increase in obesity is seen in all ethnic, gender, and age groups. This problem is not confined to the average American; the US military reported that more than 50% of military personnel were overweight and more than 6% were obese in the late 1990s, despite high physical activity levels due to the rigors of basic training and regular field exercises. For the military, this reflects a trend that mirrors what is happening in the general population.
Globally, more than 1 billion adults are classified as overweight and approximately 300 million as clinically obese, ranging from less than 5% in China, Japan, and some African nations to more than 75% in urban Samoa. Alarmingly, this epidemic has spread to children, with 17.6 million children younger than 5 years of age estimated to be overweight worldwide. Data from the United States indicate that 15% of children and adolescents 6-19 years of age are overweight, a figure at least three times higher than that reported in the period from 1960 to 1970. Overweight children are at risk of becoming overweight adults but, more important, are likely to experience chronic health problems (including hypertension) associated typically with only adult obesity.
The World Health Organization has recommended an integrated, multifaceted, population approach be implemented to bring about effective weight management for those at risk of overweight and obesity. The key elements for developing such an environmental support include the following:
• Availability and access to a variety of low-fat, high-fiber foods
• Opportunities for physical activities
• Promotion of healthy behavior to encourage, motivate, and enable individuals to lose weight by
Eating more fruits, vegetables, nuts, and whole grains
Engaging in moderate physical activity for at least 30 minutes a day
Reducing the amounts of fat and sugar in the diet
Changing from a diet containing saturated animal fats to one emphasizing unsaturated vegetable oils
• Proper training of clinical personnel to ensure effective support for those trying to lose weight or avoid further weight gain
Obviously, it is essential to maintain a healthy body weight and thus necessary to keep a focus on energy intake in an effort to prevent overweight. Regarding hypertension, weight reduction appears to be the most promising answer in terms of potential impact on lowering blood pressure. Losing as few as 4.5 kg, or 10 pounds, of body weight can reduce blood pressure. Adopting healthy eating patterns yields additional benefits.

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