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Identifying DASH Adherence Patterns and Their Association With Dietary Behaviors Among Adults With Hypertension
Youran Lee1, Melissa C Kay2, Anushka Palipana1
1Duke University School of Nursing, Durham, NC, USA (Currently in University of Michigan School of Nursing, Ann Arbor, Michigan, USA.
Research in Nursing & Health
|May 4, 2026
Summary
Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is low. This study identified distinct DASH adherence subgroups, revealing that intuitive eating behaviors are linked to different adherence patterns in adults with hypertension.
Area of Science:
- Nutritional Science
- Cardiovascular Health
- Behavioral Science
Background:
- The Dietary Approaches to Stop Hypertension (DASH) diet effectively lowers blood pressure but faces low adherence.
- Intuitive eating, focusing on internal hunger and satiety cues, may impact DASH diet adherence, particularly in hypertensive adults.
- Limited research exists on the association between intuitive eating behaviors and DASH adherence patterns in this population.
Purpose of the Study:
- To identify subgroups based on DASH diet adherence among adults with hypertension.
- To examine the association between these DASH adherence subgroups and intuitive eating behaviors.
- To explore how different dietary behavior patterns relate to clinical outcomes.
Main Methods:
- Secondary analysis of baseline data from 301 adults with hypertension in the Nourish U.S. randomized controlled trial.
- DASH adherence assessed using the Mellen Index; intuitive eating behaviors measured with the Intuitive Eating Scale-2 (IES-2).
- Latent class analysis (LCA) used to identify DASH adherence subgroups; differences analyzed via ANOVA and chi-square tests.
Main Results:
- Overall DASH adherence was low (mean = 3.13 ± 1.35).
- Latent class analysis identified three subgroups: low adherence (44.2%), high adherence (41.2%), and mixed-pattern adherence (14.6%).
- Significant differences were found in IES-2 subscales across subgroups, including unconditional permission to eat, reliance on hunger/satiety cues, and body-food choice congruence.
Conclusions:
- Examining DASH adherence patterns, not just overall scores, reveals distinct dietary behaviors and potential for tailored interventions.
- The low-adherence group showed higher reliance on hunger cues, while the high-adherence group demonstrated greater body-food choice congruence.
- Tailored guidance based on identified subgroups and their unique behavioral characteristics may improve adherence and cardiovascular outcomes.
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