10 min readConcept sheetVery common 10-mark case; DASH and the 'below 5 g salt' rule are standard viva points

Diet in hypertension and atherosclerosis

For hypertension and atherosclerosis, plan a low-salt, DASH-style diet with little saturated fat, more fibre and potassium, and weight loss if overweight.

SaltBelow 5 g a day, i.e. under 2 g sodium (WHO; ICMR-NIN 2024); the lower DASH target is 1.5 g sodium

FatSaturated fat below 7% of energy, no trans fat, cholesterol below 200 mg a day (NCEP ATP III TLC diet)

FibreAbout 25-40 g a day (ICMR-NIN 2020: about 40 g per 2000 kcal; TLC: 20-30 g), with 10-25 g soluble fibre from oats, pulses, fruits and methi seeds (TLC)

DASH patternPlenty of fruits, vegetables, low-fat dairy, whole grains, pulses and nuts; little red meat, sugar and salt

Aim and principles of the diet

Aim: To plan, prepare and calculate a diet for an overweight man with hypertension and high LDL cholesterol (early atherosclerosis). Principles: Hypertension (BP 140/90 mmHg or above) and atherosclerosis (fatty, fibrous plaques narrowing the arteries) share causes: too much salt, saturated and trans fat, obesity, inactivity, smoking and alcohol. The diet follows the DASH (Dietary Approaches to Stop Hypertension) and TLC (therapeutic lifestyle changes) patterns. Energy is reduced if overweight, because weight loss lowers both BP and LDL. Sodium is kept below 2 g (salt below 5 g): no salt at the table and no pickles, papad or salted snacks. Potassium, calcium and magnesium are raised through fruits, vegetables, low-fat milk and pulses, as they help lower BP (unless kidney function is poor). Total fat is moderate (20-30% of energy) with saturated fat below 7%, no trans fat (no vanaspati or reused frying oil) and cholesterol below 200 mg a day. Unsaturated and omega-3 fats come from groundnut, mustard and rice bran oils used in rotation, fish and flaxseed. Fibre, especially soluble fibre (oats, barley, pulses, methi seeds, fruits), lowers LDL. Alcohol is avoided and sugar kept low.

Nutrient prescription: Mr. H, 52 y, 170 cm, 78 kg, BP 150/95, LDL raised

Nutrient	Prescription	Basis and source
Ideal body weight	63 kg	(170 − 100) × 0.9; BMI now 27.0
Energy	About 1600 kcal	25 kcal/kg IBW × 63 = 1575, for slow weight loss (Indian texts use about 20-25 kcal/kg IBW)
Protein	About 63 g	1.0 g/kg IBW
Fat	20-25% of energy (about 35-45 g); saturated fat below 7% (below 12 g); cholesterol below 200 mg	Saturated fat and cholesterol: NCEP ATP III TLC diet (TLC allows total fat 25-35%; kept lower here for weight loss)
Sodium	Below 2 g (salt below 5 g)	WHO; ICMR-NIN Dietary Guidelines 2024; DASH lower target 1.5 g
Potassium	At least 3.5 g	WHO (about 90 mmol a day), from fruits, vegetables and pulses, if kidneys are normal
Fibre	25-40 g, with 10-25 g soluble	Total: ICMR-NIN 2020 about 40 g per 2000 kcal, TLC 20-30 g; soluble 10-25 g: TLC

Foods to include and avoid

Food group	Choose	Avoid
Cereals	Whole wheat, oats, barley, ragi, hand-pounded or parboiled rice	Maida bakery items, bread and biscuits (salt and baking soda)
Pulses and protein foods	All dals, sprouts, fish twice a week, egg white, low-fat paneer, skinless chicken	Red meat, organ meats, egg yolk in excess, salted dried fish, processed meats
Milk	Double-toned or skimmed milk, low-fat curd, unsalted buttermilk	Whole milk, cream, butter, cheese, khoa sweets
Vegetables and fruits	Five or more servings: greens, gourds, guava, orange, papaya, banana	Pickled vegetables, fruit canned in syrup
Fats and nuts	Groundnut, mustard, rice bran and sesame oils in rotation; a few nuts; flaxseed	Vanaspati, reused frying oil, much ghee, butter or coconut oil
Others	Lemon, herbs, garlic, spices for flavour; plain water	Salt at the table, papad, pickles, chips, sauces, instant noodles, alcohol

Sample one-day menu: hypertension with high LDL (Mr. H)

Time	Menu	Approx. amount (raw)
6.00 am	Tea without sugar	Double-toned milk 100 mL
8.00 am	Oats vegetable upma	Oats 40 g, vegetables 50 g, oil 4 g
11.00 am	Guava	100 g
1.00 pm	Phulka (2), rice, unsalted tur dal with lemon, greens poriyal, salad, low-fat curd	Atta 50 g; rice 80 g; tur dal 25 g; greens 100 g, oil 4 g; vegetables 100 g; low-fat curd 100 g
4.00 pm	Tea with sprouted green gram salad	Double-toned milk 100 mL; whole green gram 25 g, groundnuts 10 g, vegetables 25 g
7.30 pm	Phulka (2), fish curry (or low-fat paneer), vegetable	Atta 50 g; fish 60 g, oil 5 g; vegetables 100 g, oil 5 g
9.00 pm	Fruit	Papaya 150 g, orange 100 g

Worked calculation: Mr. H's DASH-style diet

Problem

Mr. H, 52 years, 170 cm, 78 kg (BMI 27.0), sedentary, has BP 150/95 mmHg and a raised LDL cholesterol. Find his IBW, energy and protein needs and check the menu, including fibre.

Working

IBW = (170 − 100) × 0.9 = 63 kg. BMI = 78 ÷ (1.7 × 1.7) = 78 ÷ 2.89 = 27.0, which is obese by the Asian cut-off of 25.
Energy = 63 kg × 25 kcal/kg = 1575, about 1600 kcal, for slow weight loss (Indian texts use about 20-25 kcal/kg IBW).
Protein = 63 kg × 1.0 g/kg = 63 g.
Saturated fat limit = 7% of 1600 kcal = 112 kcal ÷ 9 = about 12 g.
Approximate values used (kcal and g protein per 100 g raw unless stated; rounded from Indian food composition tables, mainly IFCT 2017 and the older Nutritive Value of Indian Foods; a few, such as toned milk, are estimates): double-toned milk 45 and 3 per 100 mL; oats 375 and 13; mixed vegetables 30 and 1.5; oil/ghee 900; guava 50 and 1; atta 320 and 10.5; rice 355 and 8; tur dal 330 and 22; greens 35 and 3; low-fat curd 45 and 3; whole green gram 325 and 23; groundnut 570 and 25; fish 100 and 17; papaya 35 and 0.5; orange 45 and 0.8.
Cereals (oats 40 g, atta 100 g, rice 80 g): 754.0 kcal, 22.1 g protein, 17.4 g fibre.
Pulses (tur dal 25 g, whole green gram 25 g): 163.8 kcal, 11.3 g protein, 6.5 g fibre.
Milk and milk products (double-toned milk 200 mL, low-fat curd 100 g): 135.0 kcal, 9.0 g protein, 0.0 g fibre.
Egg and fish (fish 60 g): 60.0 kcal, 10.2 g protein, 0.0 g fibre.
Vegetables (mixed vegetables 275 g, greens 100 g): 117.5 kcal, 7.1 g protein, 12.3 g fibre.
Fruits (guava 100 g, papaya 150 g, orange 100 g): 147.5 kcal, 2.6 g protein, 11.0 g fibre.
Oil, nuts and coconut (oil/ghee 18 g, groundnut 10 g): 219.0 kcal, 2.5 g protein, 0.9 g fibre.
Energy = 754.0 + 163.8 + 135.0 + 60.0 + 117.5 + 147.5 + 219.0 = 1596.8 kcal.
Protein = 22.1 + 11.3 + 9.0 + 10.2 + 7.1 + 2.6 + 2.5 = 64.8 g.
Fibre = 17.4 + 6.5 + 12.3 + 11.0 + 0.9 = 48.1 g.
Compare with the prescription: energy 1596.8 ÷ 1600 × 100 = 100%; protein 64.8 ÷ 63 × 100 = 103%.
Fibre values used (g per 100 g raw, approximate): atta 11, oats 10, rice 3, dals 9, whole green gram 17, vegetables 3, greens 4, guava 6, papaya and orange 2, groundnut 9. The day's fibre (about 48 g) is above the 25-40 g target, with soluble fibre from oats, pulses and fruit.
Each group is rounded to one decimal and the totals are the sums of those rounded figures; all values are approximate.

Answer

IBW 63 kg; prescription about 1600 kcal and 63 g protein. The menu gives about 1597 kcal (100%), 65 g protein (103%) and about 48 g fibre, with no added salt at the table.

Preparation and serving tips, and result

Cook with about 3 g salt for the whole day (about half a level teaspoon) and none at the table; flavour with lemon, garlic, curry leaves, pepper or kokum.
Read labels: bread, biscuits, sauces and instant soups hide sodium.
Use a combination of oils measured by teaspoon (18 g in this plan) and never reuse frying oil.
Grill, steam or make light curries; remove chicken skin; prefer fish.
Stir a teaspoon of soaked methi seeds or flaxseed powder into dosa batter or curd for extra soluble fibre.
Result: The diet gives about 1597 kcal, 65 g protein and about 48 g fibre with no salt at the table, meeting Mr. H's prescription of 1600 kcal and 63 g protein.

In the diet kitchen

In the diet kitchen, cardiac and hypertensive trays come from a low-salt pot: salt is weighed for the day, and pickles, papad and salted buttermilk stay off the tray. Choosing double-toned milk, rotating oils and sending fruit instead of a sweet are small kitchen habits that cut sodium, saturated fat and sugar for many patients at once.

Exam angle

Short answer: “What is the DASH diet?” Dietary Approaches to Stop Hypertension: a diet rich in fruits, vegetables, low-fat dairy, whole grains, pulses and nuts, and low in salt, saturated fat, red meat and sugar.

Short answer: “How does soluble fibre help in atherosclerosis?” It binds bile acids and cholesterol in the gut so more is excreted, lowering LDL. Sources: oats, barley, pulses, methi seeds, fruits.

Essay: “Plan a diet for an overweight man with hypertension and high LDL cholesterol.” IBW 63 kg; energy 25 kcal/kg ≈ 1600 kcal; protein 1 g/kg = 63 g; salt below 5 g; saturated fat below 7%, cholesterol below 200 mg; fibre 25-40 g; potassium-rich fruits and vegetables; DASH-style Indian menu; calculation and result; low-salt cooking tips.

Remember it

'5, 7, 200': salt under 5 g, saturated fat under 7% of energy, cholesterol under 200 mg, on a DASH plate full of fruit and vegetables.