Does an antihypertensive diet cost more? Analysis from the Chinese Heart-Healthy diet trial.

OBJECTIVE: To determine whether the Chinese heart-healthy diet (Sichuan cuisine version) (CHH diet-SC) was more expensive than the conventional Sichuan diet and explore the food groups and nutrients that mainly affected the cost of CHH diet-SC. DESIGN: Cost analysis of 4-week intervention diets in the Sichuan center representing southwestern China in the CHH diet study. SETTING: A multicentre, parallel-group, single-blind, randomised feeding trial evaluating the efficacy of lowering blood pressure with the cuisine-based CHH diet. PARTICIPANTS: Totally, fifty-three participants with hypertension aged 25-75 years in the Sichuan center were randomised into the control group (n 26) or the CHH diet-SC group (n 27). RESULTS: The CHH diet-SC was more expensive than the control diet (¥27·87 ± 2·41 v. ¥25·18 ± 2·79 equals $3·90 ± 0·34 v. $3·52 ± 0·39, P < 0·001), and the incremental cost-effectiveness ratio for a 1-mm Hg systolic blood pressure reduction was ¥9·12 ($1·28). Intakes and the cost of seafood, dairy products, fruits, soybeans and nuts, whole grains and mixed beans were higher for the CHH diet-SC than for the control diet (P < 0·001). Intakes of vitamin B1, vitamin B6, vitamin C, Mg and phosphorus were positively correlated with the cost (P < 0·05). CONCLUSIONS: The CHH diet-SC costs more than the conventional Sichuan diet, partly due to the high cost of specific food groups. Positive correlations between the intakes of vitamin B1, vitamin B6, vitamin C, Mg, phosphorus and the dietary cost could be a direction to adjust the composition within the food groups to reduce the cost of the CHH diet-SC.

Using Community-Based Participatory Research Methods to Inform the Development of Medically Tailored Food Kits for Hispanic/Latine Adults with Hypertension: A Qualitative Study.

The Dietary Approaches to Stop Hypertension (DASH) eating plan is the most effective dietary intervention for cardiovascular disease (CVD), but it excludes the consideration of culture and cost. The Hispanic/Latine population is disproportionately affected by CVD, with risks increasing if persons are accustomed to a Westernized diet. This research aims to understand the cultural dietary practices aligned with a DASH eating plan and the social determinants of health impacting fruit and vegetable (F/V) consumption among immigrant Hispanic/Latine individuals at a community-based clinic in Minnesota. Utilizing community-based participatory research methods, a community survey informed the development of DASH-focused, medically tailored food kits of varying F/V modalities. Qualitative feedback was sought out regarding the kits when presented to 15 individuals during in-depth interview sessions to validate the cultural appropriateness of food kits for clinical use. Box A was the highest rated kit (66.7%) and consisted of fresh F/V. The average F/V consumption per day was 2.6 ± 1.4 servings. The food insecurity questionnaires showed high/marginal (40%), low (53.3%), and very low (6.7%) food security. The barriers to consuming F/V were money, time, and transportation. Understanding cultural dietary practices related to the DASH eating plan is necessary to mitigate CVD risk and provide inclusive medical nutrition therapy for Hispanic/Latine populations.

The Impact of RDNs on Non-Communicable Diseases: Proceedings from The State of Food and Nutrition Series Forum.

In the United States, nutrition-related morbidities are rising steadily at rates corresponding to increasing overweight and obesity in the population. Such morbidities take huge tolls on personal health and impose high costs on health care systems. In 2019, the Academy of Nutrition and Dietetics (Academy) and the Academy of Nutrition and Dietetics Foundation (Academy Foundation) embarked on a new project titled "The State of Food and Nutrition Series" to demonstrate the value of nutrition interventions led by registered dietitian nutritionists for individuals with the following 3 high-priority non-communicable diseases that affect many in the United States and globally: type 2 diabetes mellitus, chronic kidney disease, and hypertension. Poor nutritional status contributes to disease onset and progression in these non-communicable diseases, and appropriate medical nutrition therapy can prevent or delay worsening and ameliorate poor health outcomes. However, many people who have these conditions do not have access to an registered dietitian nutritionist, and consequently do not receive the nutrition care they need. On February 19-20, 2020 in Arlington, VA, as the first stage in The State of Food and Nutrition Series, the Academy and the Academy Foundation gathered health care policymakers, clinicians, and researchers from across the country for the State of Food and Nutrition Series Forum, where Academy leaders sought input to build a comprehensive research strategy that will quantify the impact of patient access to registered dietitian nutritionist-led nutrition interventions for type 2 diabetes mellitus, chronic kidney disease, and hypertension. This article summarizes the findings of that forum.

Development, Validation, and Reproducibility of Food Group-Based Frequency Questionnaires for Clinical Use in Brazil: A Pre-Hypertension and Hypertension Diet Assessment.

The Blood pressure control diet is well described; however, it has not been implemented in clinical care, possibly due to the impracticability of the diet assessment in these contexts. In order to facilitate the dietary assessment, we developed and assessed the validity and reproducibility of two food group-based food frequency questionnaires (FG-FFQs), with a one-week (7-day FG-FFQ) and a one-month (30-day FG-FFQ) period of coverage for patients with pre-hypertension or hypertension. In 2010, 155 men and women, 30-70 years old, were invited to participate in a prospective study in two outpatient clinics in Porto Alegre, southern Brazil. The participants responded to two 30-day, two 7-day FG-FFQ, four 24-h dietary recalls, and underwent demographic, anthropometric, and blood pressure assessments. The validity and reproducibility were assessed using partial correlation coefficients adjusted for sex and age, and the internal validity was tested using the intra-class correlation coefficient. The participants were aged 61 (±10) years and 60% were women. The validity correlation coefficient was higher than r = 0.80 in the 30-day FG-FFQ for whole bread (r = 0.81) and the 7-day FG-FFQ for diet/light/zero soda and industrialized juices (r = 0.84) in comparison to the 24-h dietary recalls. The global internal validity was α = 0.59, but it increased to α = 0.76 when 19 redundant food groups were excluded. The reproducibility was higher than r = 0.80 for pasta, potatoes and manioc, bakery goods, sugar and cocoa, and beans for both versions. The 30-day had a slightly higher validity, both had good internal validity, and the 7-day FG-FFQ had a higher reproducibility.

Psychometric Testing of the Czech Version of the Rapid Eating Assessment for Patients Questionnaire.

BACKGROUND AND PURPOSE: The quantitative study focuses on the psychometric properties of the Rapid Eating Assessment for Patients (REAP) tool for assessing dietary habits. The aim of the study was to validate REAP and its factor structure, reliability, and validity. REAP was used for the first in patients with hypertension. METHODS: Language validation of REAP measurements into Czech language, test, retest, and pilot testing were performed. In addition, 420 patients were investigated, and exploratory confirmation factor analysis and Cronbach's alpha and Split-half coefficients were used. RESULTS: Five models with different number of items and identified factors were created. Reliability coefficients are satisfactory. The best results were achieved through the model created for a group of patients with hypertension. There were five factors extracted and described in words: Factor F1 was named "Meat consumption," factor F2 "Inappropriate food and activities for with hypertension (WH) patients," factor F3 "Consumption of dairy and fatty foods, "factor F4 "Consumption of sweet foods," and factor F5 "Appropriate food and activities for WH patients." CONCLUSION: The REAP questionnaire is a suitable tool for clinical practice use when assessing dietary habits in patients with hypertension.

Self-monitoring networks for personal and societal health: Dietary patterns, activities, blood pressure and Covid-19.

The contributors to and consequences of disordered health are increasingly complex with sociodemographic, ecological, economic and food system change. But there are opportunities for any adversity to be mitigated by advances in the understanding of human, especially nutritional, ecobiology and in its more accessible and affordable evaluation and monitoring. Viral pandemics are on the rise with climate change and loss of ecosystems. They threaten human civilisation and planetary habitability. Human security is dependent on sustainable livelihoods of which food and water systems are a vital part. We are socioecological beings and depend for our health on biodiversity and the food diversity that ensures; and on connectedness and communication, made more difficult in pandemics. Rapid and accessible point-of-care (POC) tools are now becoming available to compliment other selfmonitoring network approaches, whether checklist or questionnaire, physical, chemical, or biological, for healthcare and nutritional health. They can provide information as several complimentary and interdependent health indices to facilitate personal, group and community action and management plans. This applies to indices of both communicable and non-communicable disease which problems separately and together are compromising health prospects. These indices include ones of physical and mental activities, dietary patterns, metabolites, blood pressure and now the presence and severity of viruses like Covid-19.Of imminent relevance and promise are optically- readable biosensor based strips for nasal, pharyngeal or salivary samples to check viral presence or finger prick blood for immunoglobulins and interleukins. These should allow less socially prohibitive measures to curb viral transmission and promote personal and societal wellbeing.

Low-Sodium Dietary Perceptions and Experiences of African-American Women with Hypertension.

African-Americans are disproportionately affected by hypertension with lower rates of blood pressure control in comparison to the general population (Brennan et al., 2010). Low-sodium dietary intake is one of the most important lifestyle changes that can help control hypertension (Zhang et al., 2013). This qualitative study aimed to explore and describe the perceptions and experiences of low-sodium dietary practices among African-American women with hypertension. The study used a single-category focus group design. The findings suggest that African-American women are attempting to follow a low-sodium diet; however, they are influenced by personal and environmental factors and lack a clear understanding of what a low-sodium diet entails. Therefore, nurses must understand the factors that influence African-American women's ability to follow a low-sodium diet so that effective interventions can be implemented to improve adherence in this population.

[Self-care management practices for arterial hypertension and diabetes mellitus among elderly people in Campinas, Brazil, in three periods]. / Prácticas autoreferidas para controlar la hipertensión y la diabetes mellitus en adultos mayores de Campinas, Brasil, en tres períodos.

The objective of this study was to estimate the prevalence of self-care management practices - both with and without medication - in elderly hypertensive and diabetic patients in Campinas, Brazil, in three periods. Data from health surveys conducted in three periods 2001-2002, 2008-2009 and 2014-2015 were analyzed. The prevalence of hypertension, diabetes, the continuous use of medication, and all behavioral practices showed an overall increase in the period analyzed, with a significant drop in both the non-regular use of medications and routine doctor visits on the part of individuals without a private health plan. The results evidenced advances in diet-related practices among individuals without health plans as well as those who reported having healthcare coverage, highlighting improvements in drug treatment and physical activity. Adherence to medication and health behaviors for the management of morbidities was shown to be consistent in the period evaluated. These indicators reinforce the need to maintain and expand policies directed at health education and pharmaceutical assistance in the country.

El objetivo fue estimar la prevalencia de las prácticas autoreferidas para controlar la hipertensión y la diabetes, con y sin medicamentos, en adultos mayores de Campinas, Brasil, en tres períodos. Se analizaron los datos de las encuestas de salud realizadas en tres períodos: 2001-2002, 2008-2009 y 2014-2015. La prevalencia de hipertensión, de diabetes, del uso de medicación continua y las prácticas comportamentales aumentaron durante el período analizado, con una caída significativa en el uso no regular de medicamentos y las consultas médicas de rutina en individuos sin plan de salud privado. Los resultados evidenciaron avances en las prácticas relacionadas con la dieta en aquellas personas sin plan de salud y en quienes declararon contar con plan de salud, destacando mejoras en el tratamiento con medicamentos y la práctica de actividad física. La adherencia al uso de medicamentos y a prácticas comportamentales para controlar las morbilidades se mostró consistente en el período evaluado. Estos indicadores refuerzan la necesidad de mantener y ampliar las políticas dirigidas a la educación sanitaria y la asistencia farmacéutica en el país.

Presence of Hypertension Is Reduced by Mediterranean Diet Adherence in All Individuals with a More Pronounced Effect in the Obese: The Hellenic National Nutrition and Health Survey (HNNHS).

Hypertension is a major risk of cardiovascular diseases. This study's aim was to examine associations between hypertension and a priori known lifestyle risk factors, including weight status and Mediterranean diet adherence. The study included a representative sample of the adult population (N = 3775 (40.8% males)), from the Hellenic National Nutrition and Health Survey (HNNHS), which took place from September 2013 to May 2015. Demographic and anthropometric data were collected using validated questionnaires, and blood pressure (BP) measurements were performed for the two main metropolitan areas (N = 1040; 41.1%). Hypertension diagnosis was according to the International Classification of Diseases (ICD-10) guidelines. Weighted proportions, extended Mantel-Haenszel (M-H) analyses, and multiple logistic regressions (for the survey data) were performed. Mean systolic BP (SBP) and diastolic BP (DBP) were 118.6 mmHg and 72.2 mmHg respectively, with both values being higher in males compared to females in all age groups (p < 0.001). Study participants with hyperlipidemia or diabetes, and those overweight, were almost twice as likely to be hypertensives, with the odds increasing to 4 for those obese (p for all, < 0.05). Stricter Mediterranean diet adherence significantly decreased the likelihood of hypertension by 36% (OR: 0.64; 95% CI: 0.439, 0.943), and a significant interaction was found between Mediterranean diet adherence and weight status on hypertension. The presence of hypertension is clustered with comorbidities, but is significantly associated with modifiable risk factors, including Mediterranean diet and weight status, underlining the need for personalized medical nutritional treatment.

Long-Term Effects in the EXERDIET-HTA Study: Supervised Exercise Training vs. Physical Activity Advice.

Purpose: To determine whether improvements in cardiorespiratory fitness (CRF), blood pressure (BP) and body composition previously seen after a 16-week exercise intervention (POST) with hypocaloric diet are maintained following six months (6M) of unsupervised exercise time. Methods: Overweight/obese, physically inactive participants with primary hypertension (HTN) (n = 190) were randomly assigned into an attention control group (physical activity recommendations) or one of three supervised exercise groups. After POST, all participants received diet and physical activity advice for the following 6M but no supervision. All anthropometric and physiological measurements were taken pre and post the 16-week supervised intervention period, as well as after 6M of no supervision. Results: After 6M: 1) body mass (BM) (Δ = 2.5%) and waist circumference (Δ = 1.8%) were higher (P < .005) than POST, but lower (P < .005) than pre-intervention (BM, Δ = -5.1%; waist circumference, Δ = -4.7%), with high-volume and high-intensity interval training group revealing a higher BM reduction (Δ = -6.4 kg) compared to control group (Δ = -3.5 kg); 2) BP variables were higher (P < .001) compared to POST with no change from pre-intervention; and 3) CRF was higher compared to pre-intervention (Δ = 17.1%, P < .001) but lower than POST (Δ = -5.7%, P < .001). Conclusions: When an overweight/obese population with HTN attains significant improvements in cardiometabolic health POST intervention with diet restriction, there is a significant reduction following 6M when exercise and diet supervision is removed, and only recommendations were applied. These results suggest the need for a regular, systematic and supervised diet and exercise programs to avoid subsequent declines in cardiometabolic health.

"The coupons and stuff just made it possible": economic constraints and patient experiences of a produce prescription program.

Although produce prescription (PRx) programs have been shown to improve fruit and vegetable (FV) consumption, few studies have examined how economic constraints influence participant experience. We conducted a qualitative study of patient experience of a 3-month PRx program for hypertension (PRxHTN) including 3 safety-net clinics and 20 farmers' markets (FMs). We interviewed 23 PRxHTN participants using semistructured guides to understand their program experiences. Interviews were audio-taped, transcribed, and analyzed to identify a priori and emergent themes. PRxHTN participants completing qualitative interviews were mostly middle-aged (mean: 62 years) African American (100%) women (78%). Economic hardship as a barrier to maximum program participation and sustainability was a main theme identified, with three subthemes: (i) transportation issues shaped shopping and eating patterns and limited participant ability to access FMs to utilize PRxHTN vouchers; (ii) limited and unstable income shaped participant shopping and eating behavior before, during, and after PRxHTN; and (iii) participants emphasized individual-level influences like personal or perceived motivations for program participation, despite significant structural constraints, such as economic hardship, shaping their program engagement. Future PRx programs should bolster economic and institutional supports beyond FM vouchers such as transportation assistance, partnering with local food banks and expansion to local grocery stores offering year-round FV access to support sustained behavior change. Additionally, structural competency tools for providers may be warranted to reorient focus on structural influences on program engagement and away from potentially stigmatizing individual-level explanations for program success. These efforts have potential to enhance the translation of PRx programs to the needs of economically vulnerable patients who struggle to manage chronic illness and access basic nutrition.

Dietary Impact of Produce Prescriptions for Patients With Hypertension.

INTRODUCTION: Little is known regarding the impact of produce prescriptions within the context of hypertension visits at safety net clinics. We evaluated intervention effectiveness on patient usage of farmers markets and dietary change related to fruit and vegetable consumption. METHODS: Health Improvement Partnership - Cuyahoga worked with 3 clinics to integrate, implement, and evaluated a produce prescription for hypertension (PRxHTN) program. PRxHTN involves 3 monthly, nonphysician provider visits, comprising blood pressure measurement, nutrition counseling, and four $10 farmers market produce vouchers, for hypertensive adult patients screening positive for food insecurity. Dietary measures were collected at visits 1 and 3. Voucher use was tracked via farmers market redemption logs. RESULTS: Of the 224 participants from 3 clinics, most were middle-aged (mean age, 62 y), female (72%), and African American (97%) and had a high school education or less (62%). Eighty-six percent visited a farmers market to use their produce vouchers, with one-third reporting it was their first farmers market visit ever. Median number of farmers market visits was 2 (range: 0-6), and median number of vouchers redeemed was 8 (range: 0-12). Among the subsample with follow-up survey data (n = 137), significant improvement in fruit and vegetable consumption was observed as well as a decline in fast food consumption. CONCLUSION: PRxHTN participants visited at least 1 farmers market, reported increases in provider communication related to diet, and exhibited significant changes in dietary behavior. PRxHTN can serve as a strong model for linking safety net clinics with farmers markets to promote community resource use and improve fruit and vegetable consumption among food-insecure patients with hypertension.

Effects on Cardiovascular Risk Scores and Vascular Age After Aerobic Exercise and Nutritional Intervention in Sedentary and Overweight/Obese Adults with Primary Hypertension: The EXERDIET-HTA Randomized Trial Study.

INTRODUCTION: The EXERDIET-HTA study was a multi-arm parallel, a randomized, single-blind controlled experimental trial comparing the effects of 16 weeks of different aerobic exercise programs two days per week, and dietary intervention in a hypertensive, overweight/obese and non-physically active population. AIM: To evaluate the influence of diet and aerobic exercise program intervention on cardiovascular risk (CVR) factors and predicted CVR and vascular age (VA) profiles in overweight/obese people with primary hypertension (HTN), and to analyze the potential sex differences in the ability to predict VA and CVR via different methods. METHODS: The CVR and VA determined (n = 167, 53.7 ± 7.8 years) using the Framingham Risk Score (FRS) and the new equation for the prediction of 10-year atherosclerotic cardiovascular disease (ASCVD) risk, before and after the 16-week intervention period (different aerobic exercise programs + hypocaloric diet). The sex-specific risk factors considered were age, high-density lipoprotein cholesterol (HDL-C), total cholesterol, systolic blood pressure (SBP), diabetes mellitus (DM) and smoking status. RESULTS: From baseline to follow-up, participants reduced (p ≤ 0.001) FRS-CVR score and VA, and SBP. Total cholesterol decreased significantly, but specifically in men (p ≤ 0.001), and antihypertensive medication (%) in women (p = 0.047). No significant differences over time were observed for HDL-C, smoking, DM overall for either sex. For ASCVD-CVR there was no overall change or for either sex. After the intervention, women had a lower CVR score than men (p ≤ 0.001), irrespective of the calculation method. CONCLUSIONS: The improvement in CVR factors after 16-week lifestyle changes reduced the risk of suffering a cardiovascular event in overweight/obese adults with HTN through the FRS estimation tool, but not with the ASCVD score. The risk score algorithms could underestimate CVR in women. In contrast, VA could be a useful and easier tool in the management of individuals with CVR factors.

Pensions and Low Sodium Salt: A Qualitative Evaluation of a New Strategy for Managing Hypertension in Rural South Africa.

BACKGROUND: This paper describes a pilot study to assess the feasibility of a novel intervention to improve the management of hypertension among older people in rural South Africa. Older South Africans have the highest rates of uncontrolled hypertension recorded for any country. Notably, South Africa has a widely-available old age grant (pension), which is delivered on a monthly basis to citizens living in rural villages. METHODS: We assessed the feasibility of engaging with older people at the point of pension delivery in the Agincourt sub-district of Mpumalanga Province. This included providing information about hypertension, measuring blood pressure, referral to primary care services, and providing a monthly supply of low sodium salt. We recruited 20 people aged 60 and over to participate in the pilot intervention, which was conducted over three months in two villages. Towards the end of the intervention, we conducted focus groups with study participants and held a meeting with local stakeholders, including the district health office and the state social security agency. RESULTS: The pilot study demonstrated (i) Sustained engagement with the original 20 participants. Of these, 19 continued to participate in the intervention during subsequent monthly pension days. (ii) A high level of acceptance of the low sodium salt product reflected in repeat usage and comments made in the focus groups. (iii) Strong support for the intervention and a willingness to collaborate with local stakeholders. (iv) A perception among participants that symptoms they associated with hypertension had abated. This is supported by blood pressure readings made over the three months of follow-up. CONCLUSION: Though limited in scope, this pilot study provided evidence of the feasibility of the intervention and justification for it to be tested on a larger and more robust basis.

Eating with others and meal location are differentially associated with nutrient intake by sex: The Diabetes Study of Northern California (DISTANCE).

Though eating with others is often a social behavior, relationships between social contexts of eating and nutrient intake have been underexplored. This study evaluates how social aspects of eating - frequencies of eating meals with others, meals prepared at home, and meals outside the home - are associated with nutrient intake. Because diet improvement can reduce complications of diabetes mellitus, we surveyed a multi-ethnic cohort of persons with type 2 diabetes (n = 770) about social aspects of diet (based on 24-hour recalls). Sex-stratified multiple regression analyses adjusted for confounders assessed the relationship between frequency of eating with others and nutrient intake (total energy, energy from fat, energy from carbohydrates, Healthy Eating Index/HEI, Dietary Approaches to Stop Hypertension/DASH score). Although there was slight variation in men's versus women's propensity to share meals, after adjustment for confounders, there was no consistently significant association between meals with others and the 5 nutrient intake measures for either men or women. The directions of association between categories of eating with others and diet quality (HEI and DASH scores) - albeit not significant - were different for men (positive) and women (mostly negative), which warrants further investigation. The next analyses estimated nutrient intake associated with meals prepared at home, and meals consumed outside the home. Analyses indicated that greater meal frequency at home was associated with significantly better scores on diet quality indices for men (but not women), while meal frequency outside the home was associated with poorer diet quality and energy intake for women (but not men). Better measurement of social dimensions of eating may inform ways to improve nutrition, especially for persons with diabetes for whom diet improvement can result in better disease outcomes.

Quantitative assessment of the effects of chitosan intervention on blood pressure control.

BACKGROUND: Chitosan is a popular dietary fiber often used to reduce dietary fat absorption to control weight and blood lipids. However, its effects on blood pressure (BP) have not been fully elucidated. We evaluated the effects of chitosan administration on systolic blood pressure (SBP) and diastolic blood pressure (DBP) through a pooled analysis of available randomized controlled trials (RCTs). MATERIALS AND METHODS: Electronic searches were conducted in Medline, Cochrane Library, Scopus, and EMBASE to identify relevant human placebo-control RCTs. Trials that reported BP changes from baseline to study endpoint in patients receiving treatment of chitosan were included for analysis. Weighted mean difference (WMD) and 95% CIs were pooled using fixed-effects or random-effects models. Statistical heterogeneity, prespecified subgroup, publication bias, sensitivity analysis, and meta-regression assessments were also tested. RESULTS: Six hundred and seventeen participants from eight trials with 10 arms were included. Overall, chitosan administration did not significantly lower SBP (WMD: -1.41 mmHg, 95% CI: -3.29 to 0.47; P=0.14) and DBP (WMD: -0.61 mmHg, 95% CI: -1.75 to 0.52; P=0.29). However, our subgroup analyses indicated that chitosan consumption significantly reduced DBP in shorter-term (<12 weeks) and higher-dose (>2.4 g/day) arms. Funnel plots or Egger's tests analysis (P=0.36 and 0.43 for SBP and DBP, respectively) demonstrated that there was no significant publication bias in this study. CONCLUSION: This meta-analysis indicates that chitosan consumption significantly decreases DBP at higher dosage and in shorter-term interventions, while chitosan has no significant effects on SBP. However, these results should be interpreted cautiously because of the limited eligible RCTs included in this meta-analysis; further large-scale, well-designed RCTs on this topic are urgently needed.

Accessibility and Affordability of Supermarkets: Associations With the DASH Diet.

INTRODUCTION: It is unknown whether there is an interplay of affordability (economic accessibility) and proximity (geographic accessibility) of supermarkets in relation to having a Dietary Approaches to Stop Hypertension (DASH)-accordant diet. METHODS: Data (collected: 2005-2015, analyzed: 2016) were from the cross-sectional, population-based Fenland Study cohort: 9,274 adults aged 29-64 years, living in Cambridgeshire, United Kingdom. Dietary quality was evaluated using an index of DASH dietary accordance, based on recorded consumption of foods and beverages in a validated 130-item, semi-quantitative food frequency questionnaire. DASH accordance was defined as a DASH score in the top quintile. Dietary costs (£/day) were estimated by attributing a food price variable to the foods consumed according to the questionnaire. Individuals were classified as having low-, medium-, or high-cost diets. Supermarket affordability was determined based on the cost of a 101-item market basket. Distances between home address to the nearest supermarket (geographic accessibility) and nearest economically-appropriate supermarket (economic accessibility) were divided into tertiles. RESULTS: Higher-cost diets were more likely to be DASH-accordant. After adjustment for key demographics and exposure to other food outlets, individuals with lowest economic accessibility to supermarkets had lower odds of being DASH-accordant (OR=0.59, 95% CI=0.52, 0.68) than individuals with greatest economic accessibility. This association was stronger than with geographic accessibility alone (OR=0.85, 95% CI=0.74, 0.98). CONCLUSIONS: Results suggest that geographic and economic access to food should be taken into account when considering approaches to promote adherence to healthy diets for the prevention of cardiovascular diseases and other chronic disease.