The Effect of a Digital Behavioral Weight Loss Intervention on Adherence to the Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern in Medically Vulnerable Primary Care Patients: Results from a Randomized Controlled Trial

Abstract

Author Contributions Dr. Steinberg (DS) had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. DS drafted the manuscript for publication. GB conceived of the study, acquired study funding, led study design and supervised its coordination. DS coordinated intervention design. LS participated in study conceptualization and design. MK conducted statistical analysis. MK, JB and LS contributed to the drafting of the manuscript. No writing assistance other than copy editing was provided in the preparation of the manuscript. All authors read and approved the final manuscript. Declaration of conflicting interests and financial disclosure Dr. Steinberg is a consultant with Omada Health. Gary Bennett holds equity in Coeus Health and serves on the scientific advisory boards of Nutrisystem and Interactive Health. These organizations had no role in study design, data collection, data analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication. The remaining authors declare that they have no conflicting interests. Research Snapshot: Research Question: Can a behavioral weight loss intervention, as compared to usual care, influence DASH diet adherence? Key Findings: Within a randomized controlled trial examining a digital health weight loss intervention (Track) among patients with obesity-related comorbidities (e.g., diabetes and hypertension), the intervention produced weight loss and significant, but small, improvements in DASH adherence as compared to usual care. Although Track led to small unintended improvements in DASH adherence, to reduce chronic disease burden, weight loss interventions should emphasize both caloric restriction and diet quality.

Effects of the Modified DASH Diet on Adults With Elevated Blood Pressure or Hypertension: A Systematic Review and Meta-Analysis

“…A study showed that more than 30% of hypertension cases were caused by excessive salt intake ( 38 ); thus, BP decreased with sodium intake decreased ( 33 ). However, contradictory to other studies ( 31 ), we found a lower sodium supplication could not lead to better BP reduction. This might because the modified DASH diet was strict sodium restriction, which was generally as low as 3,000 mg. That also suggested that too low sodium intake did not reduce BP further but might reduce adherence to dietary treatment.…”

“…The modified DASH diet might have greater positive or negative effects in combination with antihypertensive treatment or have higher accordance or provision of different interventions, such as dietary advice or food supplements, however, we did not have sufficient data for these analysis. Like previous studies (31)(32)(33), we found that the modified DASH diet was significantly associated with reductions in SBP, DBP, and cardiovascular risk factors. However, some discrepancies in the degree of BP and cardiovascular risk factor reduction were found.…”

“…Like previous studies ( 31 – 33 ), we found that the modified DASH diet was significantly associated with reductions in SBP, DBP, and cardiovascular risk factors. However, some discrepancies in the degree of BP and cardiovascular risk factor reduction were found.…”

“…A previous meta-analysis showed that the DASH diet was associated with an increased HDL concentration ( 17 ), and a reduction in waist circumference ( 32 ), BMI ( 31 , 32 ), and TG, TC, and LDL concentrations ( 17 ). That was different from our findings, which did not show a reduction in waist circumference or TG concentration, and might be a consequence of the small sample size.…”

Dietary Strategies for Metabolic Syndrome: A Comprehensive Review

“…Nonetheless, Pickering et al suggested that the potential health effects of the DASH diet are dependent on eating pattern adherence, with subjects with lower adherence to the DASH diet showing greater benefit from DASH dietary interventions in BP control than those with higher adherence before the dietary intervention [ 85 ]. Nonetheless, the commitment and implication of the patient are critical in all life-style interventions based on dietary modifications [ 86 , 87 ].…”