Key result
Recent survey years linked to ~22% lower odds of DASH diet adherence in hypertensive adults.
Why the study?
National trends in adherence to the DASH diet among US adults with hypertension after 2004 were uncertain despite advances in DASH evidence and dietary guidelines.
Cross-Sectional (n=14,163)
Yes
Odds Ratio: 0.78 (95% CI 0.67–0.91)
Absolute Event Rate: 18.6% vs 22.1%
Absolute Risk Reduction: 3.5%
p-value: p=0.002
Despite updated guidelines and national reduction initiatives, adherence to the DASH diet among US adults with hypertension has significantly declined between 2003 and 2018, highlighting a critical gap in implementation.
Declining DASH adherence among US adults with hypertension signals an implementation gap; leaves open whether targeted interventions can reverse trends in vulnerable subgroups.
Background: Data from National Health and Nutrition Examination Survey (NHANES) cycles 1988-1994 and 1999-2004 show a declining trend in the adherence to Dietary Approaches to Stop Hypertension (DASH) among adults. Since then, DASH evidence, dietary guidelines, and public-facing dietary resources have advanced, but whether national DASH adherence has improved is uncertain. Methods: We extended the Mellen et al. NHANES analysis among 14,163 adults with self-reported hypertension (N=6,914, 2003-2010, N=7,249, 2011-2018). DASH score included 9 nutrient components: total fat, saturated fat, protein, cholesterol, fiber, calcium, magnesium, potassium, and sodium, with adherence defined as a score ≥4.5. Survey-weighted multivariable models compared DASH score, adherence, and nutrient-threshold attainment across periods. Results: In 2011-2018, U.S. adults with self-reported hypertension represented 76.2 million individuals (33.8%). Multivariable-adjusted DASH adherence declined from 22.1% in 2003-2010 to 18.6% in 2011-2018 (p=0.003), and mean DASH score declined from 2.98 to 2.85 (p=0.007). Adjusted odds of adherence were lower in 2011-2018 compared with 2003-2010 (OR, 0.78; 95% CI, 0.67-0.91; p=0.002). Adherence was lower among non-Hispanic Black adults (OR, 0.70; 95% CI, 0.59-0.84), adults with BMI ≥30 kg/m² (OR, 0.61; 95% CI, 0.51- 0.73), and adults with prior stroke (OR, 0.71; 95% CI, 0.56-0.89). Total fat and sodium threshold attainment declined from 20.9% to 18.7% and 13.8% to 11.8%, respectively. Conclusions: DASH adherence among U.S. adults with self-reported hypertension declined from 2003-2011 to 2011-2018. Implementation strategies should identify barriers to adoption and address the full DASH dietary pattern.
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Parameswaran et al. (2026) conducted a cross-sectional in Hypertension (n=14,163). Survey period 2011-2018 vs. Survey period 2003-2010 was evaluated on DASH diet adherence (score ≥4.5) (OR 0.78, 95% CI 0.67-0.91, p=0.002). The 2011-2018 survey period was associated with a decline in DASH diet adherence to 18.6% from 22.1% in 2003-2010 (OR 0.78) among U.S. adults with self-reported hypertension.
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