{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:53:42Z","timestamp":1791251622504,"version":"4.1.0"},"posted":{"date-parts":[[2026,10,1]]},"group-title":"Nutrition","reference-count":31,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,30]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Data from National Health and Nutrition Examination Survey (NHANES) cycles 1988\u20131994 and 1999\u20132004 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.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We extended the Mellen et al. NHANES analysis among 14,163 adults with self-reported hypertension (N=6,914, 2003\u20132010, N=7,249, 2011\u20132018). DASH score included 9 nutrient components: total fat, saturated fat, protein, cholesterol, fiber, calcium, magnesium, potassium, and sodium, with adherence defined as a score \u22654.5. Survey-weighted multivariable models compared DASH score, adherence, and nutrient-threshold attainment across periods.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In 2011\u20132018, 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\u20132018 compared with 2003\u20132010 (OR, 0.78; 95% CI, 0.67\u20130.91; p=0.002). Adherence was lower among non-Hispanic Black adults (OR, 0.70; 95% CI, 0.59\u20130.84), adults with BMI \u226530 kg\/m\u00b2 (OR, 0.61; 95% CI, 0.51\u2013 0.73), and adults with prior stroke (OR, 0.71; 95% CI, 0.56\u20130.89). Total fat and sodium threshold attainment declined from 20.9% to 18.7% and 13.8% to 11.8%, respectively.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.09.28.26364241","type":"posted-content","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:05:15Z","timestamp":1790885115000},"source":"Crossref","is-referenced-by-count":0,"title":["Declining Adherence to Dietary Approaches to Stop Hypertension (DASH) Diet Among US Adults with Hypertension: NHANES 2003\u20132018"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0984-9938","authenticated-orcid":false,"given":"Vijaya","family":"Parameswaran","sequence":"first","affiliation":[{"name":"Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjali","family":"Phalke","sequence":"additional","affiliation":[{"name":"School of Global Public Health, New York University, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Gardner","sequence":"additional","affiliation":[{"name":"Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4867-8588","authenticated-orcid":false,"given":"David J.","family":"Maron","sequence":"additional","affiliation":[{"name":"Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026100518251482000_2026.09.28.26364241v1.1","unstructured":"Centers for Disease Control and Prevention. Heart Disease Facts. Atlanta, GA: Centers for Disease Control and Prevention; 2024. Accessed July 5, 2026. https:\/\/www.cdc.gov\/heart-disease\/data-research\/facts-stats\/index.html"},{"key":"2026100518251482000_2026.09.28.26364241v1.2","unstructured":"Centers for Disease Control and Prevention. High Blood Pressure Facts. Atlanta, GA: Centers for Disease Control and Prevention; 2026. 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Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: U.S. Government Printing Office; 2010."},{"key":"2026100518251482000_2026.09.28.26364241v1.14","unstructured":"U.S. Department of Health and Human Services; U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 8th ed. Washington, DC: U.S. Department of Health and Human Services and U.S. Department of Agriculture; 2015."},{"key":"2026100518251482000_2026.09.28.26364241v1.15","unstructured":"U.S. Department of Agriculture; U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th ed. Washington, DC: U.S. Department of Agriculture and U.S. Department of Health and Human Services; 2020."},{"key":"2026100518251482000_2026.09.28.26364241v1.16","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001146"},{"key":"2026100518251482000_2026.09.28.26364241v1.17","unstructured":"U.S. Food and Drug Administration. 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