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Invited Commentary
November 11, 2013

DASH for Less Cash?

Author Affiliations
  • 1Maya Angelou Center for Health Equity, Winston-Salem, North Carolina
  • 2Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
  • 3Gramercy Research Group, Winston-Salem, North Carolina
JAMA Intern Med. 2013;173(20):1924-1925. doi:10.1001/jamainternmed.2013.9163

It is well established that the Dietary Approaches to Stop Hypertension (DASH) eating plan, which emphasizes increased consumption of fruits, vegetables, and reduced dietary saturated fat, cholesterol, and sodium, improves blood pressure.1 Intervention studies, for example the Exercise and Nutrition Interventions for Cardiovascular Health (ENCORE) studies, have demonstrated have demonstrated that DASH can be implemented with other lifestyle changes including weight loss and physical activity, which also addresses other ongoing epidemics in our society, including obesity and diabetes. DASH was formally adopted into the Dietary Guidelines for Americans, 2010.2 Despite recommendations, widespread adoption of and long-term adherence to DASH has been limited, particularly among low-income and racial/ethnic minority groups, who are also at greatest risk for hypertension and the resulting poor health consequences. In this issue, Monsivais and colleagues3 highlight the relationship of the DASH eating pattern to food costs using data from the 2001-2002 National Health and Nutrition Examination Survey (NHANES). The authors scored diets reported by 4744 adults based on accordance with DASH and determined estimated retail costs for reported foods per 2000 kilocalories. DASH accordance was positively related to diet cost; specifically, the foods reported by those in the top 20% of adherence to the DASH dietary pattern cost 19% more to obtain than foods reported by those in the lowest DASH adherence category. The mean diet cost for the healthiest quintile was 34% higher for white adults and 21% for black adults, both statistically significantly higher than the cost for the lowest quintile in either race/ethnic group. In marked contrast, Hispanic adults (predominantly Mexican American in this sample) in the top DASH accordance quintile were consuming foods costing only 6% more than the lowest quintile.

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