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DASH Dietary Accordance, NHANES 1988-1994 and 1999-2004

Philip B. Mellen, MD, MS; Sue K. Gao, PhD, MPH; Mara Z. Vitolins, DrPH, MPH, RD; David C. Goff Jr, MD, PhD

Arch Intern Med. 2008;168(3):308-314.

Background  Although the DASH (Dietary Approaches to Stop Hypertension trial) diet is among the therapeutic lifestyle changes recommended for individuals with hypertension (HTN), accordance with the DASH diet is not known.

Methods  Using data from the National Health and Nutrition Examination Survey (NHANES) from the 1988-1994 and 1999-2004 periods, DASH accordance among individuals with self-reported HTN was estimated based on 9 nutrient targets (fat, saturated fat, protein, cholesterol, fiber, magnesium, calcium, sodium, and potassium) (score range, 0-9). Using data from 1999-2004, we compared the DASH score among demographic groups in age- and energy-adjusted models and modeled the odds of a DASH-accordant dietary pattern (4.5) using multivariable logistic regression. The DASH score, DASH accordance, and percentage of participants achieving individual targets were compared with estimates from NHANES 1988-1994 data.

Results  Based on 4386 participants with known HTN in the recent survey period (1999-2004), the mean (SE) DASH score, after adjustment for age and energy intake, was 2.92 (0.05), with 19.4% (1.2%) classified as DASH accordant. In multivariable logistic regression models, DASH accordance was associated with older age, nonblack ethnicity, higher education, and known diabetes mellitus. Accordance with DASH was 7.3% lower in the recent survey period compared with NHANES 1988-1994 (26.7% [1.1%]) (P < .001), reflecting fewer patients with HTN meeting nutrient targets for total fat, fiber, and magnesium.

Conclusion  The dietary profile of adults with HTN in the United States has a low accordance with the DASH dietary pattern, and the dietary quality of adults with HTN has deteriorated since the introduction of the DASH diet, suggesting that secular trends have minimized the impact of the DASH message.

Author Affiliations: Hypertension Center, Hattiesburg Clinic, Hattiesburg, Mississippi (Dr Mellen); Global Health Economics, Amgen Inc, Thousand Oaks, California (Dr Gao); and Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina (Drs Vitolins and Goff).