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Dietary Approaches to Stop Hypertension Diet, Weight Status, and Blood Pressure among Children and Adolescents: National Health and Nutrition Examination Surveys 2003-2012



      The Dietary Approaches to Stop Hypertension (DASH) diet is associated with lower blood pressure and reduced risk of cardiovascular disease among adults, but little is known about accordance with this dietary pattern or health benefits among children and adolescents.


      The objectives were to evaluate accordance with the DASH diet, differences over time, and the association with health attributes among a nationally representative sample of US children and adolescents.


      Cross-sectional data from the 2003-2012 National Health and Nutrition Examination Surveys (NHANES) were analyzed.


      Data from 9,793 individuals aged 8 to 18 years were examined.

      Main outcome measures

      DASH accordance was estimated based on nine nutrient targets: total fat, saturated fat, protein, cholesterol, fiber, calcium, magnesium, potassium, and sodium; possible score range is 0 to 9.

      Statistical analyses performed

      Accordance with the DASH diet across time was examined comparing the 2011-2012 to 2003-2004 NHANES surveys. The association between DASH score and weight status was examined using multinomial logistic regression, and the associations with waist circumference, systolic blood pressure, and diastolic blood pressure were examined using multivariable linear regression.


      Accordance with the DASH diet was low across the age groups, with a range of mean DASH scores from 1.48 to 2.14. There were no significant changes across time. DASH score was inversely associated with systolic blood pressure (mm Hg) among 14- to 18-year-olds (β=−.46; 95% CI −.83 to −.09) among the larger sample of participants who completed at least one dietary recall, but no significant differences were seen in other age categories. In the subsample of participants with both dietary recalls, a significant inverse association was seen between DASH score and systolic blood pressure for 11- to 13-year-olds (β=−.57; 95% CI −1.02 to −.12). There were no significant associations between this dietary pattern and weight status, waist circumference, or diastolic blood pressure.


      Few US children and adolescents have diets that are in alignment with the DASH diet. Future research should explore strategies to encourage fruit, vegetable, and whole-grain consumption, as well as sodium reductions to help meet DASH nutrient targets in children and adolescents, as well as examine the potential benefits of this eating pattern on health in this population group.


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      J. F. W. Cohen is an assistant professor, Department of Health Sciences, Merrimack College, North Andover, MA, and adjunct assistant professor, Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.


      M. E. Lehnerd is a doctoral candidate, School of Nutrition Science and Policy, Tufts University, Boston, MA.


      R. F. Houser is an assistant professor, School of Nutrition Science and Policy, Tufts University, Boston, MA.


      E. B. Rimm is a professor, Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, and a professor, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.