Identifying DASH Adherence Patterns and Their Association With Dietary Behaviors Among Adults With Hypertension.

The Dietary Approaches to Stop Hypertension (DASH) diet is effective in lowering blood pressure yet adherence to DASH remains low. Intuitive eating, a behavior that emphasizes responsiveness to hunger and satiety cues, may influence DASH adherence but has not been well studied among adults with hypertension. This study examined DASH adherence subgroups and their association with dietary behaviors using data from the Nourish U.S. based randomized controlled trial. A cross-sectional secondary analysis of baseline data from 301 participants was conducted. DASH adherence was assessed using the Mellen Index. Dietary behaviors were measured with the Intuitive Eating Scale-2 (IES-2). Latent class analysis (LCA) was used to identify DASH adherence subgroups, and subgroup differences in dietary behaviors and clinical outcomes were analyzed. Overall, DASH adherence was low (mean = 3.13 ± 1.35). LCA identified three DASH adherence subgroups: low adherence (44.2%), high adherence (41.2%), and mixed-pattern adherence (14.6%). Subgroups significantly differed in IES-2 subscales, including unconditional permission to eat (p < 0.0001), reliance on hunger and satiety cues (p = 0.0487), and body-food choice congruence (p < 0.0001). The low-adherence group scored higher on hunger cues, while the high-adherence group scored higher on body-food choice congruence. These findings highlight the value of examining overall dietary patterns rather than a single DASH score, as patterns better capture interactions among foods and nutrients that influence diet quality and health. Each subgroup's distinct demographic and behavioral characteristics further emphasize tailored DASH diet guidance which could lead to better cardiovascular outcomes. PATIENT OR PUBLIC CONTRIBUTION: 301 adults with hypertension contributed to this study by providing baseline data as part of the Nourish randomized controlled trial (ClinicalTrials.gov: NCT03875).

Duke Scholars

Author Gary G. Bennett Psychology & Neuroscience

Author Qing Yang School of Nursing