Lifestyle counseling including the DASH diet improves multiple metabolomic profiles

Lifestyle interventions improve cardiometabolic risk factors, but data from randomized trials on their impact on detailed metabolomic profiles remain limited.

Our aim was to evaluate the effects of lifestyle counseling with and without the Dietary Approaches to Stop Hypertension (DASH) diet on changes in metabolomic patterns.

We analyzed data from 690 adult participants of the randomized PREMIER trial. The trial compared three lifestyle interventions: 'Advice-only', 'Established', and 'Established plus DASH'. Fasting plasma metabolites were quantified by NMR spectroscopy at baseline and 6 months, and principal component (PC) analysis was used to identify metabolomic patterns. Multiple linear regression examined the interventions and changes in BMI and heart rate in relation to changes in PC scores and individual metabolites.

Thirteen PCs representing lipoprotein, triglyceride-rich, amino acid, fatty acid, inflammatory, and ketone-related patterns were identified. Compared with Advice-only, the Established intervention reduced PC4 (β = -0.50, P = 0.04), VLDL cholesterol, and saturated fatty acids. Established plus DASH had broader effects, reducing PC9 (β = -0.33, P = 0.01), PC11 (β = -0.28 P = 0.004), and PC12 (β = -0.23, P = 0.02), increasing omega-3 fatty acids, and lowering branched-chain and aromatic amino acids, lactate, citrate, and GlycA. BMI change was associated with multiple PCs, whereas heart rate change showed fewer independent associations.

Lifestyle interventions induce coordinated metabolomic changes across lipid, amino acid, and inflammatory pathways. Weight loss appears to be the primary driver, while adding DASH provides broader metabolomic benefits than standard lifestyle counseling.

ClinicalTrials.gov NCT00000616 (PREMIER: Lifestyle Interventions for Blood Pressure Control - Full Text View - ClinicalTrials.gov).