Determinants and consequences of adherence to the dietary approaches to stop hypertension diet in African-American and white adults with high blood pressure: results from the ENCORE trial. The efficacy of a clinic-based behavioral nutrition intervention emphasizing a DASH-type diet for adolescents with elevated blood pressure. The PREMIER intervention helps participants follow the Dietary Approaches to Stop Hypertension dietary pattern and the current Dietary Reference Intakes recommendations. Blood pressure response to dietary modifications in free-living individuals. Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Low-sodium Dietary Approaches to Stop Hypertension-type diet including lean red meat lowers blood pressure in postmenopausal women. The effects of a low-sodium base-producing diet including red meat compared with a high-carbohydrate, low-fat diet on bone turnover markers in women aged 45-75 years. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. Dietary adherence in the Dietary Approaches to Stop Hypertension trial. DASH Collaborative Research Group. The effect of medical nutrition therapy on changes in dietary knowledge and DASH diet adherence in older adults with cardiovascular disease The effect of home-delivered Dietary Approach to Stop Hypertension (DASH) meals on the diets of older adults with cardiovascular disease.
BACKGROUND Although the Dietary Approaches to Stop Hypertension ( DASH ) diet is an accepted nonpharmacologic treatment for hypertension , little is known about what patient characteristics affect dietary adherence and what level of adherence is needed to reduce blood pressure ( BP ) . OBJECTIVE Our aim was to determine what factors predict dietary adherence and the extent to which dietary adherence is necessary to produce clinical ly meaningful BP reductions . DESIGN Ancillary study of the ENCORE ( Exercise and Nutrition Interventions for Cardiovascular Health ) trial -- a 16-week r and omized clinical trial of diet and exercise . PARTICIPANTS / SETTING Participants included 144 sedentary , overweight , or obese adults ( body mass index 25 to 39.9 ) with high BP ( systolic 130 to 159 mm Hg and /or diastolic 85 to 99 mm Hg ) . INTERVENTION Patients were r and omized to one of three groups : DASH diet alone , DASH diet plus weight management , and Usual Diet Controls . MAIN OUTCOMES MEASURES Our primary outcomes were a composite index of adherence to the DASH diet and clinic BP . STATISTICAL ANALYSES PERFORMED General linear models were used to compare treatment groups on post-treatment adherence to the DASH diet . Linear regression was used to examine potential predictors of post-treatment DASH adherence . Analysis of covariance was used to examine the relation of adherence to the DASH diet and BP . RESULTS Participants in the DASH diet plus weight management ( 16.1 systolic BP [ SBP ] ; 95 % CI 13.0 to 19.2 mm Hg and 9.9 diastolic BP [ DBP ] ; 95 % CI 8.1 to 11.6 mm Hg ) and DASH diet alone ( 11.2 SBP ; 95 % CI 8.1 to 14.3 mm Hg and 7.5 DBP ; 95 % CI 5.8 to 9.3 mm Hg ) groups showed significant reductions in BP in comparison with Usual Diet Controls participants ( 3.4 SBP ; 95 % CI 0.4 to 6.4 mm Hg and DBP 3.8 ; 95 % CI 2.2 to 5.5 mm Hg ) . Greater post-treatment consumption of DASH foods was noted in both the DASH diet alone ( mean = 6.20 ; 95 % CI 5.83 to 6.57 ) and DASH diet plus weight management groups ( mean = 6.23 ; 95 % CI 5.88 to 6.59 ) compared with Usual Diet Controls ( mean = 3.66 ; 95 % CI 3.30 to 4.01 ; P<0.0001 ) , and greater adherence to the DASH diet was associated with larger reductions in clinic SBP and DBP ( P ≤ 0.01 ) . Only ethnicity predicted dietary adherence , with African Americans less adherent to the DASH diet compared with whites ( 4.68 ; 95 % CI 4.34 to 5.03 vs 5.83 ; 95 % CI 5.50 to 6.11 ; P<0.001 ) . CONCLUSIONS Greater adherence to the DASH diet was associated with larger BP reductions independent of weight loss . African Americans were less likely to be adherent to the DASH dietary eating plan compared with whites , suggesting that culturally sensitive dietary strategies might be needed to improve adherence to the DASH diet OBJECTIVE To examine the efficacy of a 3-month clinic-based behavioral nutrition intervention emphasizing a diet high in fruits , vegetables , and low fat dairy ( DASH intervention ) versus routine outpatient hospital-based nutrition care ( RC ) on diet and blood pressure ( BP ) in adolescents with elevated BP . STUDY DESIGN Fifty-seven adolescents with a clinical diagnosis of prehypertension or hypertension ( systolic BP or diastolic BP , 90(th ) to 99(th ) percentile ) were r and omly assigned to  DASH or  RC  .  SBP , DBP , 3-day diet recall , weight , and height were assessed at pretreatment , post-treatment , and 3 months later ( follow-up ) . RESULTS In completer analysis , DASH versus RC had a greater decrease in SBP z scores from baseline to post-treatment ( P < 0.01 ) and a trend for a greater decrease in SBP z scores from baseline through follow-up ( P = .07 ) . DBP z scores changed similarly for conditions from baseline through follow-up . Relative to RC , DASH had a greater increase in intake of fruits ( P < .001 ) , potassium and magnesium ( P < .01 ) , and a greater decrease in total fat ( P < .05 ) from baseline to post-treatment . From baseline through follow-up , DASH versus RC had a greater increase in low fat dairy ( P < .001 ) . CONCLUSIONS The DASH intervention proved more effective than RC in improving SBP and diet quality in adolescents with elevated BP OBJECTIVE To examine the influence of the PREMIER study lifestyle interventions on dietary intakes and adherence to the Dietary Approaches to Stop Hypertension ( DASH ) dietary pattern and the Dietary Reference Intakes ( DRI ) . DESIGN An 18-month multicenter , r and omized controlled trial comparing two multicomponent lifestyle intervention programs to an advice only control group . SUBJECTS/ SETTING A total of 810 participants were recruited from local communities and r and omized into the study . Individuals were eligible if they were aged 25 years or older , had body mass index between 18.5 and 45.0 , not taking antihypertensive medication , and had prehypertension or stage 1 hypertension ( systolic blood pressure 120 to 159 mm Hg and diastolic blood pressure 80 to 95 mm Hg ) . INTERVENTION The two active intervention programs were a behavioral lifestyle intervention that implements established recommendations , and an established intervention plus the DASH dietary pattern . Both interventions consisted of intensive group and individual counseling sessions . The control group received a brief advice session after r and omization and again after 6 months of data collection . Dietary intakes were collected by two r and om 24-hour recalls at baseline , 6 months , and 18 months . MAIN OUTCOME MEASURES The primary outcome of the PREMIER study was change in systolic blood pressure at 6 months . The main outcomes examined here include dietary variables collected by 24-hour recall at each time point . STATISTICAL ANALYSES Nutrient intakes were calculated and compared among the time points and the three intervention groups using mixed models with repeated measures at 6 and 18 months . Proportion of participants who met or achieved the original DASH nutrient intake levels and the DRIs were calculated and compared among the three intervention groups . P<0.01 was considered statistically significant . RESULTS Participants in both the established intervention and established intervention plus DASH dietary pattern groups substantially reduced energy , total fat , saturated fat , and sodium intake and these reductions persisted throughout the study . Established intervention plus DASH dietary pattern group participants increased intakes of fruits , vegetables , dairy , and many vitamins and minerals ; these increases were significantly greater than that of the control and established intervention groups . A majority of established intervention plus DASH dietary pattern group participants achieved at least two thirds of the DRI recommendations for most nutrients at 6 months , despite their reduction in total energy intake . Some but relatively small recidivism occurred at 18 months . CONCLUSIONS Both the established intervention and established intervention plus DASH dietary pattern group intervention were effective in helping participants follow established recommendations to control blood pressure . The advice-only control group also made some behavior changes , mainly decreasing energy and sodium intake . Only the established intervention plus DASH dietary pattern group significantly increased intakes of DASH-specific food groups , including fruits , vegetables , and dairy products , and nutrients , including protein , fiber , calcium , potassium , and magnesium . Most of the increases did not reach the levels consumed in the original DASH feeding studies . Whereas the established intervention plus DASH dietary pattern group intervention provides a useful platform to achieve the DASH dietary pattern and current DRI recommendations , intervention enhancements , including a greater emphasis on nutrient-dense foods , would likely improve this intervention A diet rich in fruits , vegetables , and low-fat dairy foods has been shown to lower blood pressure ( BP ) when all foods are provided . We compared the effect on BP ( measured at home ) of 2 different self-selected diets : a low-sodium , high-potassium diet , rich in fruit and vegetables ( LNAHK ) and a high-calcium diet rich in low-fat dairy foods ( HC ) with a moderate-sodium , high-potassium , high-calcium DASH-type diet , high in fruits , vegetables and low-fat dairy foods ( OD ) . Subjects were r and omly allocated to 2 test diets for 4 wk , the OD and either LNAHK or HC diet , each preceded by a 2 wk control diet ( CD ) . The changes in BP between the preceding CD period and the test diet period ( LNAHK or HC ) were compared with the change between the CD and the OD periods . Of the 56 men and 38 women that completed the OD period , 43 completed the LNAHK diet period and 48 the HC diet period . The mean age was 55.6 + /- 9.9 ( + /-SD ) years . There was a fall in systolic pressure between and the CD and OD [ -1.8 + /- 0.5 mm Hg ( P < 0.001 ) ] . Compared with OD , systolic and diastolic BPs fell during the LNAHK diet period [ -3.5 + /- 1.0 ( P < 0.001 ) and -1.9 + /- 0.7 ( P < 0.05 ) mmHg , respectively ] and increased during the HC diet period [ + 3.1 + /- 0.9 ( P < 0.01 ) and + 0.8 + /- 0.6 ( P = 0.15 ) mm Hg , respectively ] . A self-selected low-sodium , high-potassium diet result ed in a greater fall in BP than a multifaceted OD , confirming the beneficial effect of dietary intervention on BP in a community setting BACKGROUND The Dietary Approaches to Stop Hypertension ( DASH ) diet has been shown to lower blood pressure , but little is known about its long-term effect on cardiovascular end points . Our objective was to assess the association between a DASH-style diet adherence score and risk of coronary heart disease ( CHD ) and stroke in women . METHODS In this prospect i ve cohort study , diet was assessed 7 times during 24 years of follow-up ( 1980 - 2004 ) with vali date d food frequency question naires . A DASH score based on 8 food and nutrient components ( fruits , vegetables , whole grains , nuts and legumes , low-fat dairy , red and processed meats , sweetened beverages , and sodium ) was calculated . Lifestyle and medical information was collected biennially with a question naire . The Cox proportional hazard model was used to adjust for potential confounders . The study population comprised 88,517 female nurses aged 34 to 59 years without a history of cardiovascular disease or diabetes in 1980 . The main outcome measures were the numbers of confirmed incident cases of nonfatal myocardial infa rct ion , CHD death , and stroke . RESULTS We documented 2129 cases of incident nonfatal myocardial infa rct ion , 976 CHD deaths , and 2317 [ corrected ] cases of stroke . After adjustment for age , smoking , and other cardiovascular risk factors , the relative risks of CHD across quintiles of the DASH score were 1.0 , 0.99 , 0.86 , 0.87 , and 0.76 ( 95 % confidence interval , 0.67 - 0.85 ) ( P<.001 for trend ) . The magnitude of risk difference was similar for nonfatal myocardial infa rct ion and fatal CHD . The DASH score was also significantly associated with lower risk of stroke ( multivariate relative risks across quintiles of the DASH score were 1.0 , 0.92 , 0.91 , 0.89 , and 0.82 ) ( P=.002 for trend ) . Cross-sectional analysis in a subgroup of women with blood sample s showed that the DASH score was significantly associated with lower plasma levels of C-reactive protein ( P=.008 for trend ) and interleukin 6 ( P=.04 for trend ) . CONCLUSION Adherence to the DASH-style diet is associated with a lower risk of CHD and stroke among middle-aged women during 24 years of follow-up Low-sodium Dietary Approaches to Stop Hypertension ( DASH ) diets are base producing but restrict red meat without clear justification . We hypothesized that a vitality diet ( VD ) , a low-sodium DASH-type diet with a low dietary acid load containing 6 servings of 100 g cooked lean red meat per week , would be more effective in reducing blood pressure ( BP ) compared with a higher acid load reference healthy diet ( RHD ) based on general dietary guidelines to reduce fat intake and increase intake of breads and cereals . A r and omized , parallel dietary intervention study was conducted to compare the BP-lowering effect of these 2 diets in postmenopausal women with high/normal BP . Women were r and omly assigned to follow either VD or RHD for 14 weeks . Home BP was measured daily with an automated BP monitor under st and ard conditions . Of 111 women commencing the study , 95 completed ( 46 VD , 49 RHD ) . Systolic BP ( SBP ) throughout the intervention was lower in the VD group compared to the RHD group ( repeated- measures analysis of variance time by diet , P = .04 ) , such that at the end of the study , the VD had a fall of SBP by 5.6 + /- 1.3 mm Hg ( mean + /- SEM ) compared with a fall of 2.7 + /- 1.0 mm Hg in the RHD ( group difference , P = .08 ) . When only those taking antihypertensive medications were assessed , the VD ( n = 17 ) had a significant fall of 6.5 + /- 2.5 mm Hg SBP ( P = .02 ) and 4.6 + /- 1.4 mm Hg diastolic BP ( P = .005 ) after 14 weeks , and their BP was lower than that of the RHD group ( n = 18 ) throughout the study ( P < .05 ) . We concluded that a low-sodium DASH diet with a low dietary acid load , which also included lean red meat on most days of the week , was effective in reducing  BP in older women , particularly in those taking antihypertensive medications A r and omised , parallel- design dietary intervention study was conducted in women ( aged 45 - 75 years ) with prehypertension or stage 1 hypertension . The aim was to compare the effects on bone turnover of a low-Na base-producing ( LNAB ) Dietary Approaches to Stop Hypertension (DASH)-type diet ( including six serves lean red meat/week ) with a high-carbohydrate low-fat ( HCLF ) diet with a higher acid load ( both > 800 mg dietary Ca/d ) . Fasting serum bone markers ( baseline and week 14 ) and 24 h urinary electrolyte excretion ( baseline , weeks 4 , 8 , 12 and 14 ) were measured . After the intervention period , the LNAB group ( n 46 ) had a fall of 26 ( sem 6 ) % ( P < 0.0001 ) in urinary Na , an increase in K excretion ( 6.8 ( sem 3.6 ) mmol/d ; P = 0.07 ) and , compared with the HCLF group ( n 49 ) , a greater reduction in urinary Ca excretion by 0.7 ( sem 0.3 ) mmol/d . Serum 25-hydroxyvitamin D , intact parathyroid hormone and osteocalcin did not change , and both groups had a similar increase of 23 ( sem 5 ) % ( P < 0.0001 ) in C-terminal telopeptide of type I collagen . The HCLF group had an 11 ( sem 4 ) % increase ( P = 0.003 ) in N-terminal propeptide , type I procollagen , which could indicate an increased rate of bone turnover . The fall in urinary Ca with the lower-Na lower-acid load diet is likely to have long-term beneficial effects on bone . As bone resorption was not different between the two dietary patterns with relatively high Ca intake , the effect on bone health of a dietary pattern with a lower acid load warrants further study on a lower Ca intake OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND Although the DASH ( Dietary Approaches to Stop Hypertension ) diet has been shown to lower blood pressure ( BP ) in short-term feeding studies , it has not been shown to lower BP among free-living individuals , nor has it been shown to alter cardiovascular biomarkers of risk . OBJECTIVE To compare the DASH diet alone or combined with a weight management program with usual diet controls among participants with prehypertension or stage 1 hypertension ( systolic BP , 130 - 159 mm Hg ; or diastolic BP , 85 - 99 mm Hg ) . DESIGN AND SETTING R and omized , controlled trial in a tertiary care medical center with assessment s at baseline and 4 months . Enrollment began October 29 , 2003 , and ended July 28 , 2008 . PARTICIPANTS Overweight or obese , unmedicated out patients with high BP ( N = 144 ) . INTERVENTIONS Usual diet controls , DASH diet alone , and DASH diet plus weight management . OUTCOME MEASURES The main outcome measure is BP measured in the clinic and by ambulatory BP monitoring . Secondary outcomes included pulse wave velocity , flow-mediated dilation of the brachial artery , baroreflex sensitivity , and left ventricular mass . RESULTS Clinic-measured BP was reduced by 16.1/9.9 mm Hg ( DASH plus weight management ) ; 11.2/7.5 mm ( DASH alone ) ; and 3.4/3.8 mm ( usual diet controls ) ( P < .001 ) . A similar pattern was observed for ambulatory BP ( P < .05 ) . Greater improvement was noted for DASH plus weight management compared with DASH alone for pulse wave velocity , baroreflex sensitivity , and left ventricular mass ( all P < .05 ) . CONCLUSION For overweight or obese persons with above-normal BP , the addition of exercise and weight loss to the DASH diet result ed in even larger BP reductions , greater improvements in vascular and autonomic function , and reduced left ventricular mass . CLINICAL TRIAL REGISTRATION clinical trials.gov Identifier : NCT00571844 CONTEXT Weight loss , sodium reduction , increased physical activity , and limited alcohol intake are established recommendations that reduce blood pressure ( BP ) . The Dietary Approaches to Stop Hypertension ( DASH ) diet also lowers BP . To date , no trial has evaluated the effects of simultaneously implementing these lifestyle recommendations . OBJECTIVE To determine the effect on BP of 2 multicomponent , behavioral interventions . DESIGN , SETTING , AND PARTICIPANTS R and omized trial with enrollment at 4 clinical centers ( January 2000-June 2001 ) among 810 adults ( mean [ SD ] age , 50 [ 8.9 ] years ; 62 % women ; 34 % African American ) with above-optimal BP , including stage 1 hypertension ( 120 - 159 mm Hg systolic and 80 - 95 mm Hg diastolic ) , and who were not taking antihypertensive medications . INTERVENTION Participants were r and omized to one of 3 intervention groups : ( 1 ) " established , " a behavioral intervention that implemented established recommendations ( n = 268 ) ; ( 2 ) " established plus DASH,"which also implemented the DASH diet ( n = 269 ) ; and ( 3 ) an " advice only " comparison group ( n = 273 ) . MAIN OUTCOME MEASURES Blood pressure measurement and hypertension status at 6 months . RESULTS Both behavioral interventions significantly reduced weight , improved fitness , and lowered sodium intake . The established plus DASH intervention also increased fruit , vegetable , and dairy intake . Across the groups , gradients in BP and hypertensive status were evident . After subtracting change in advice only , the mean net reduction in systolic BP was 3.7 mm Hg ( P<.001 ) in the established group and 4.3 mm Hg ( P<.001 ) in the established plus DASH group ; the systolic BP difference between the established and established plus DASH groups was 0.6 mm Hg ( P = .43 ) . Compared with the baseline hypertension prevalence of 38 % , the prevalence at 6 months was 26 % in the advice only group , 17 % in the established group ( P = .01 compared with the advice only group ) , and 12 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .12 compared with the established group ) . The prevalence of optimal BP ( < 120 mm Hg systolic and < 80 mm Hg diastolic ) was 19 % in the advice only group , 30 % in the established group ( P = .005 compared with the advice only group ) , and 35 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .24 compared with the established group ) . CONCLUSION Individuals with above-optimal BP , including stage 1 hypertension , can make multiple lifestyle changes that lower BP and reduce their cardiovascular disease risk Participants in controlled feeding studies must consume all study foods and abstain from all other foods . In outpatient studies in which adherence may be compromised by free-living conditions , promoting , documenting , and monitoring dietary adherence are necessary . In the Dietary Approaches to Stop Hypertension ( DASH ) trial , a thorough participant screening process , an orientation session , and a run-in feeding period before r and omization aided in the selection of participants who would most likely adhere to the dem and s of the study protocol . Throughout the feeding period , various educational and motivational techniques were used to encourage DASH participants to adhere to the dietary protocol . Both objective and subjective methods documented excellent participant adherence . Daily monitoring of individual adherence was based on meal attendance , body weight measurements , and daily diaries . Urinary sodium , potassium , phosphorus , and urea nitrogen values and an anonymous post study survey were used to evaluate adherence at the end of the study . Most DASH participants adhered to the feeding regimen by consuming only study foods and no other foods . When adherence lapsed , participants generally cited the lack of menu variety as a reason . Successful participant adherence to the constraints of an outpatient controlled feeding study is possible with carefully selected participants and a variety of adherence-promoting strategies incorporated into the study protocol Objective To examine the effect of MNT on dietary knowledge of older adults at baseline , 6 months and 12 months and to assess the effect of dietary knowledge on change in DASH diet adherence from baseline to 12 months . Design Data for the analysis come from a controlled , r and omized prospect i ve design conducted from 2003–2005 with the outcome measures taken pre- , mid- , and post-intervention . Setting Data were collected from participants in their homes in an urban community in North Carolina . Participants Participants ( N=147 ) were adults aged 60 + with a diagnosis of hypertension and /or hyperlipidemia . InterventionIntervention recipients received three sessions of MNT throughout the 1 year study period . The control group received nutrition information at enrollment . Measurements Participants completed a dietary knowledge question naire and a 24 dietary recall at baseline , 6 months , and 12 months . Instrumental variables models with participant fixed effects were used to determine the impact of MNT on dietary knowledge and dietary knowledge on DASH diet adherence . Results Among those who received MNT  , dietary knowledge increased from baseline to twelve months ( p<.01 ) . Changes in dietary knowledge were not associated with changes in DASH adherence from baseline to 12 months ( p=0.44 ) . Conclusions The MNT administered was effective at improving dietary knowledge , but not at improving DASH adherence . Three MNT sessions may be insufficient to change behavior . Integrating behavioral change theory and cultural sensitivity to MNT may improve diet adherence among diverse older adults BACKGROUND Many older adults with hyperlipidemia or hypertension participate in the Older Americans Act Nutrition Program , which serves meals in community setting s and delivers meals to homes . However , there is little information regarding whether therapeutic meals design ed around Dietary Approach to Stop Hypertension ( DASH ) principles have a beneficial effect on the diets of these older adults . OBJECTIVE The objective of this study was to determine the degree to which dietary change is influenced by providing 7 home-delivered therapeutic meals weekly to adults aged > or = 60 y. DESIGN We conducted a 1-y r and omized controlled trial in 298 persons with hyperlipidemia or hypertension , in which 50 % of participants received 7 therapeutic meals per week for 12 mo . Those in need of dietary change at baseline ( n = 210 ) were examined . Changes in intermediate DASH accordance , DASH accordance , and the nutrients that make up the DASH diet were measured by using 24-h food recalls at baseline , 6 mo , and 12 mo . Chi-square tests , t tests , and multiple regression were used to examine the association between receipt of meals and dietary change over time . RESULTS Participants who received meals were 20 % ( P = 0.001 ) more likely to reach intermediate DASH accordance at 6 mo and were 18 % ( P = 0.007 ) more likely to meet saturated fat accordance at 12 mo than were those who did not receive meals . When stratified by race and income , gains were marginally larger for whites and higher-income individuals . CONCLUSION Delivery of 7 DASH meals per week was found to increase compliance with dietary recommendations among noncompliant older adults with cardiovascular disease
Background The Dietary Approaches to Stop Hypertension ( DASH ) diet has been recognized as effective to lower blood pressure in feeding trials , but compliance with the diet must be persistent to maximize health benefits in clinical practice .