Understanding the Gaps: DASH Diet Awareness and Hypertension-Related Behaviours in Young Adults

Hypertension, a leading risk factor for cardiovascular diseases, has seen a rising prevalence among young adults globally. In India, studies indicate that 12.4% of men and 8.2% of women aged 18–39 years are hypertensive [1].

Eating patterns play a crucial role in modulating blood pressure (BP). High sodium consumption is a recognized contributor to the development of hypertension [2,3]. whereas dietary regimens abundant in fruits, vegetables, and low-fat dairy—such as the Dietary Approaches to Stop Hypertension (DASH) diet—have been proven effective in lowering BP levels [4]. The Dietary Approaches to Stop Hypertension (DASH) diet is a scientifically backed nutritional approach designed to prevent and manage hypertension. It emphasizes the consumption of nutrient-dense foods rich in potassium, calcium, magnesium, and fiber while reducing sodium, saturated fats, and added sugars. Developed in the 1990s by the National Heart, Lung, and Blood Institute (NHLBI), the DASH diet was shown to effectively lower blood pressure levels, even without weight loss interventions [5]. Despite the proven benefits of the DASH diet, awareness and adherence among young adults remain suboptimal. A study among university students found that only a minority adhered to the DASH dietary pattern, which was associated with lower BP and reduced visceral fat (3). Furthermore, eating behaviours, including the consumption of latenight snacks and preference for certain tastes, have been linked to elevated BP levels in college students [6].

In the Indian context, dietary patterns are diverse, with a significant portion of the population following vegetarian diets. However, the consumption of processed foods high in sodium is increasing, contributing to the hypertension burden [1]. Additionally, lifestyle factors such as physical inactivity and stress are prevalent among young adults, further exacerbating the risk of hypertension. [7,8] Given the escalating prevalence of hypertension and the critical role of diet in its management, it is imperative to assess the awareness and adherence to dietary patterns like the DASH diet among young adults. Understanding the knowledge gaps and barriers to adherence can inform targeted interventions aimed at promoting healthy eating behaviours and, consequently, reducing the risk of hypertension and related complications in this demographic. This study aims to evaluate the awareness, knowledge, and adherence to the DASH diet among young adults, alongside their dietary habits and lifestyle factors, to provide insights into potential strategies for hypertension prevention and management in this population.

Study Design

A cross-sectional study was conducted to evaluate the awareness, knowledge, and adherence to the DASH diet among young adults aged 18-25 years.

Inclusion Criteria

● Participants aged 18-25 years.

● Individuals willing to provide informed consent.

● Both genders, irrespective of dietary habits.

Exclusion Criteria

● Participants with pre-existing diagnosed chronic diseases such as diabetes or hypertension.

● Individuals on specific dietary restrictions or regimens not related to DASH.

Number of Participants

The study included 263 participants, predominantly first-year undergraduate students, with a demographic distribution of 65% females and 35% males.

Questionnaire Formation: A structured questionnaire was designed and validated based on:

• Awareness and knowledge of the DASH diet.

• Dietary patterns and habits (e.g., salt intake, caffeine consumption).

• Lifestyle factors (e.g., physical activity, stress levels).

• Sources of dietary information and willingness to follow the DASH diet.

• Anthropometric measures such as BMI.

Literature Search and Data Sources

● MESH Terms: Relevant medical subject headings included “DASH diet,” “hypertension,” “dietary adherence,” “young adults,” and “nutritional interventions.”

● Databases Used:

• PubMed: For peer-reviewed articles related to DASH and hypertension.

• Scopus: For cross-disciplinary studies on diet and lifestyle.

Statistical Analysis

● Chi-square tests for analyzing associations between gender and dietary habits.

● P-values less than 0.05 were considered statistically significant.

Ethical Considerations

The study received approval from the institutional ethics committee. Participants provided written informed consent before inclusion.

Table 1: Demographic Distribution of Study Population

The study consisted of 263 participants, predominantly females (65.0%) compared to males (35.0%). The majority of participants (71.5%) were aged 18–20 years, followed by 27.4% in the 20–24 years range, with only 1.1% aged above 25 years. In terms of academic year distribution, an overwhelming 91.6% were firstyear students, while only 7.2% were third-year students, and the remaining were evenly distributed among second-year students, fourth-years, and interns (0.4% each). This demographic structure reflects a youthful and predominantly female population, with a large proportion at the beginning of their academic journey.

Table 1: Demographic distribution of study population

Table 2: Knowledge about the DASH Diet

Knowledge and awareness of the DASH diet were limited among participants. A small proportion (25.1%) had heard of the DASH diet, but 35.7% expressed willingness to follow it. Dietary habits revealed that 38.4% consumed caffeine often, while 51.0% consumed sugar-sweetened beverages frequently. The participants’ dietary patterns showed that 53.6% followed a vegetarian diet, while 39.9% opted for a mixed diet. In terms of fatty meals, 50.6% reported consuming them often, and 65.0% had an average daily salt intake of 5 grams, exceeding the recommended limits. Regarding dietary health awareness, 68.4% reported consuming a balanced diet, while 45.6% actively monitored their salt intake. Awareness of the normal blood pressure range was high, with 93.2% identifying it correctly. Furthermore, 78.3% recognized that excessive salt intake could lead to hypertension, while 66.2% associated it with heart diseases

Table 2:Knowledge about DASH diet

Table 3: Knowledge According to Gender

The analysis revealed significant gender differences in several parameters. Females were more likely to consume fatty meals less often, with only 34.6% consuming them very often compared to 65.4% of males (p=0.002). Regarding physical activity, males demonstrated higher exercise levels, with 60.3% exercising daily compared to 39.7% of females (p=0.0001). In contrast, females were more aware of the relationship between salt intake and hypertension (p=0.015) and the association between salt and heart diseases (p=0.037). However, both genders showed low awareness of the DASH diet, with no significant difference between them. Stress levels were slightly higher among females, but this difference was not statistically significant (p=0.298). Headaches were reported more frequently among females (77.8%) than males (22.2%), with a significant p-value of 0.005. These findings highlight gender-specific trends in dietary habits, physical activity, and health awareness.

Table 3: Knowledge according to gender

This study, which primarily included young adults, mostly female participants at the early stages of their undergraduate education, demonstrated a limited level of knowledge and awareness regarding the DASH diet. However, a substantial number of respondents acknowledged the association between high salt intake and the risk of hypertension and heart failure. Previous research has indicated that sustained adherence to the DASH dietary pattern is linked to a decreased incidence of heart failure among middle-aged and older adults in Sweden [9]. Furthermore, following the DASH diet has been associated with a lower risk of developing heart failure in individuals under the age of 75, reinforcing its potential for primary prevention in younger populations [10]. Diet plays a crucial role in the primary prevention of cardiovascular diseases such as hypertension and ischemic heart conditions [11,12,13]. Research from Sweden demonstrated that adherence to the DASH diet was associated with a 37% lower occurrence of heart failure in women [14,15] and a 22% lower rate in men [16,17] when comparing individuals in the highest adherence group to those in the lowest. It is important to note, however, that these findings were based on a largely homogeneous White population. Additionally, studies following healthy individuals have found that daily intake of wholegrain breakfast cereals may reduce obesity risk by 30% [18]. Conversely, consuming eggs more than twice daily was linked to a 64% increase in heart failure risk [19] and a sodium intake of 100 mmol/day or more was tied to a 26% higher risk [20]. Interestingly, nut consumption showed no significant relationship with heart failure prevalence [21].

Therefore, assessing compliance with the DASH diet, recommended for both the prevention and management of hypertension, can be a beneficial approach in clinical settings. The DASH dietary model has demonstrated efficacy in reducing the risk of multiple conditions, including cardiovascular diseases [22,23,24,25,26]. Its principles are consistent with nutritional strategies widely endorsed for addressing other cardiovascular risk factors, such as elevated lipid levels [27] and type 2 diabetes mellitus [28] Additionally, this dietary approach aligns with guidelines aimed at cancer prevention [29] and is supportive in managing chronic conditions like osteoporosis [30,31].

The survey revealed that a significant proportion of respondents (78.3%) acknowledged the link between excessive sodium consumption and the development of hypertension, while 66.2% recognized its association with cardiovascular diseases. These findings underscore the critical need to promote adherence to evidence-based dietary patterns, such as the DASH diet, as a preventative strategy against hypertension within the general population. Moreover, the study highlights notable gender-specific variations in dietary behaviours, physical activity levels, and healthrelated awareness, emphasizing the necessity for tailored public health interventions.

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