Background: The Dietary Approaches to Stop Hypertension (DASH) diet is being advocated by leading health experts to treat high blood pressure in youth. The optimal intervention delivery format to promote DASH adherence in adolescents has not been ascertained.
Objective: The purpose of this thesis is to evaluate the effectiveness of the DASH-4-Teens intervention for changing diet quality, as assessed by the DASH Score and DASH Components Scores.
Methods: Sixty adolescents, ages 11-18 years, with pre-hypertension or hypertension were randomized to DASH (n=31) or RC (n=29). All participants were counseled twice by a registered dietitian on standard guidelines for blood pressure management, including the DASH diet. In addition, DASH participants received a DASH-4-Teens manual that included 10 modules describing DASH food servings, lists, tips and behavioral strategies, 15 behavioral counseling phone calls by a trained interventionist, and bi-weekly mailings. Dietary intake was assessed by 3 random 24-hour dietary recalls at baseline and 6 months. Adherence to the DASH diet was determined with an index that included 11 DASH food groups and sodium. A maximum score of 10 or 5 was assigned when a DASH component goal was met; less desirable intakes were scored proportionately. DASH component scores were summed to arrive at an overall DASH Score (0-90).
Results: In mixed effects models, DASH was a significant positive predictor of change for overall DASH score (p<0.05); for total grains, fruit, and sodium (p<0.05); and for low-fat dairy in unadjusted and adjusted models (p<0.0001). Change in DASH components scores for fruit, low-fat dairy and sodium were greater in DASH than RC (p<0.05). Post-treatment DASH component scores for fruit, low-fat dairy, and sodium were greater for DASH compared to RC (p<.01).
Conclusion: These findings suggest that the greater efficacy of the DASH-4-Teens intervention over the RC currently prescribed for the treatment of adolescents with pre-hypertension and hypertension is likely related to the intensive behavioral component of the intervention. The DASH Score is a valuable tool for assessing overall dietary change and for honing in on specific dietary component challenges in hypertensive adolescents following a DASH dietary pattern.