Association between DASH diet adherence and mortality in non-diabetic adults with and without chronic kidney disease.

Abstract

BACKGROUND: The Dietary Approaches to Stop Hypertension (DASH) diet has been associated with reduced cardiovascular risk, but its impact on mortality in individuals with chronic kidney disease (CKD) remains uncertain. METHODS: We analyzed data from 37,827 adults in the NHANES 1999–2014 cycles (without diabetes). Participants were stratified by CKD status (eGFR < 60 mL/min/1.73 m²) and DASH adherence (above or below median score). Mortality outcomes were assessed via the National Death Index. Multivariable Cox regression models, adjusted for demographics, comorbidities, and diet, were used to evaluate associations with all-cause, cardiovascular (CV), and cancer mortality. RESULTS: High DASH adherence was associated with healthier metabolic profiles and lower blood pressure. Among non-CKD participants, higher DASH scores were linked to significantly lower composite CV or cancer mortality (HR 0.896; 95% CI, 0.806–0.997; p = 0.0431), but not to all-cause, CV, or cancer mortality individually. No significant mortality associations were observed in participants with CKD, and interaction effects between DASH and CKD status were non-significant. Higher intake of dietary fiber, magnesium, and potassium was associated with reduced mortality in the overall and non-CKD populations. However, in CKD participants, high magnesium and potassium intake were paradoxically associated with increased cancer mortality. CONCLUSION: Greater adherence to the DASH diet is associated with lower CV and cancer-related mortality among individuals without CKD. In CKD patients, the benefits are less clear, and some nutrients may have differential effects. Personalized dietary strategies based on kidney function may be warranted.