obesity reviews doi: 10.1111/obr.

12391

Obesity Comorbidity/Treatment

The effect of dietary approaches to stop hypertension

(DASH) diet on weight and body composition in adults:
a systematic review and meta-analysis of randomized
controlled clinical trials
Sepideh Soltani,1 Fatemeh Shirani,2 Maryam J Chitsazi3,4 and Amin Salehi-Abargouei3,4

1
Department of Nutrition, School of Public
Health, Iran University of Medical Sciences,
Tehran, Iran, 2 Nutrition and Metabolic Diseases
Research Center, Ahvaz Jundishapur
University of Medical Sciences, Ahvaz, Iran,
3
Nutrition and Food Security Research Center,
Shahid Sadoughi University of Medical
Sciences, Yazd, Iran, and 4 Department of
Nutrition, Faculty of Health, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran
Received 6 November 2015; revised 24
January 2016; accepted 25 January 2016
Address for correspondence: Amin Salehi-
Abargouei, PhD in Nutritional Sciences
Department of Nutrition, Faculty of Health,
Sahid Sadoughi University of Medical
Sciences, Yazd, Iran.
Email: abargouei@hlth.mui.ac.ir;
abargouei@gmail.com
Summary
Background: Dietary approaches to stop hypertension (DASH) diet is rich in
foods that are proposed to be inversely associated with obesity. Therefore, DASH
might better affect body weight; however, published data are conflicting.
Objective: To assess the effect of DASH on body weight and composition in
adults.
Methods: PubMed, EMBASE, Scopus and Google scholar were searched up to
December 2015, for relevant randomized controlled clinical trials. Mean changes
in body weight, body mass index (BMI) and waist circumference (WC) were
extracted.
Results: Thirteen articles (ten for body weight, six for BMI and two for WC)
were eligible. Meta-analysis revealed that adults on DASH diet lose more weight
(weighted mean difference [WMD] = 1.42 kg, 95% confidence interval [95%
CI]: 2.03, 0.82) in 8–24 weeks, BMI (WMD = 0.42 kg m 2, 95%CI: 0.64,
0.20) in 8–52 weeks and WC (WMD = 1.05 cm, 95%CI: 1.61, 0.49) in
24 weeks compared with controls. Low caloric DASH led to even more weight re-
duction when compared with other low-energy diets. In addition, the effect was
greater in overweight/obese participants and when compared with typical (Western
or population’s usual) diets.
Conclusion: DASH diet is a good choice for weight management particularly for
weight reduction in overweight and obese participants. © 2016 World Obesity
Keywords: dietary approaches to stop hypertension, DASH, obesity, body weight.

obesity reviews (2016) 17, 442–454

Introduction cardiovascular diseases (CVDs) (3) has absorbed around

Obesity has become a major public health priority for
global health in recent years. A systematic review of epide-
miological studies showed that about 502 million adults
from 199 countries were obese in 2008 (1), and with its cur-
rent trend of incidence, it is predicted that about 1.12 billion
individuals will be obese by 2030 (2). Treating obesity and
its related complications like diabetes, hypertension and
0.7 to 28% of total annual health care service budgets in
different countries (4).
Low-calorie diets are widely used for weight management
(5). Several energy-restricted approaches with different die-
tary components are suggested to be effective in reducing
weight. For instance, there is a great interest in following
high-fat and low-carbohydrate diets (for example, Atkins
diet) as a strategy for weight loss (6). It seems that diets with

442
17, 442–454, March 2016 © 2016 World Obesity
obesity reviews
high protein content affect food consumption through the
change in satiety (7,8). Moreover, restricting carbohydrate
intake might lead to stimulated ketone body production
that might suppress the appetite (9). Inclusion of healthy
dietary food components like low-fat dairy products, fish,
nuts, fruits and vegetables is also examined for their further
reducing effect on weight and body fat (10–13). For in-
stance, it is proposed that providing high amounts of dairy
might lead to more weight and body fat loss when provided
in the context of energy-restricted diets compared with low-
dairy low-energy diets (12). A systematic review and meta-
analysis of 15 randomized controlled clinical trials (RCTs)
by Bender et al. also revealed that fish or omega-3 fatty
acids derived exclusively from fish consumption signifi-
cantly reduce body weight, fat and waist circumference
(WC) (10). However, two recent meta-analyses could not
show the reducing effect of tree nuts, fruits and vegetable
intake on adiposity indices (11,13) and concluded that at
least these healthy food items do not have any unhealthy
effect on body weight.
Dietary approaches to stop hypertension (DASH) diet, a
healthy diet high in fruits, vegetables, fish, nuts and low-
fat dairy products (14), is shown to be beneficial not only
in reducing blood pressure as its original purpose (15) but
also in reducing risk of CVDs (16), cancer (17), insulin resis-
tance (18) and blood lipid markers (19). It is proposed that
DASH diet might affect body mass index (BMI) (20) and
WC (21), too. In fact, RCTs investigating the effects of
DASH diet as a whole diet on weight and body composition
indices have led to inconsistent results. Some evidences sug-
gest that DASH diet might significantly reduce weight (21–
23), and others have shown that there may not be a signifi-
cant improvement in decreasing body weight compared
with other diets (24–26). Although the effect of the healthy
foods including fruits, vegetables, low-fat dairy, fish and
nuts on body weight and body composition is investigated
in several systematic review and meta-analyses (10–13), to
the best of our knowledge, no study has been published try-
ing to summarize the effect of a diet high in all these healthy
food groups (like DASH diet) on adiposity indices. There-
fore, in the present study, we tried to systematically review
RCTs that investigated the effect of DASH diet on weight,
BMI and WC, and if possible, to conduct a meta-analysis,
quantifying the overall effect and to find the potential
sources of heterogeneity between study results.
Materials and methods
Current systematic review was planned, conducted and
reported following PRISMA guidelines. The study protocol
was registered in the international prospective
register of systematic reviews (PROSPERO) database
(http://www.crd.york.ac.uk/PROSPERO, registration no:
CRD42014015586).
© 2016 World Obesity
Effect of DASH diet on weight and body composition 443
Search strategy
PubMed, EMBASE, Scopus and Google scholar were sys-
tematically searched up to December 2015 by using the fol-
lowing keywords: ‘dietary approaches to stop hypertension’
and ‘DASH’. Reference lists of related articles were also
checked for any additional relevant studies. The objective
was to assess the potential effect of following a DASH diet
on weight, BMI, WC and body composition. No language
restriction was considered while searching the mentioned
databases.
Eligibility criteria
Studies were included in the systematic review if (i) they
assessed the effects of DASH plan on human beings, (ii)
were published as original article and (iii) were RCT in de-
sign. Articles were excluded if (i) they were conducted in
children, pregnant or lactating women; (ii) the difference
in lifestyle modification between intervention and control
groups was more than DASH diet (for instance, studies that
compared DASH plus exercise with a control diet without
exercise); (iii) studies with follow-up times less than 8 weeks
because follow-up time would be too short for a weight-
reducing diet and (iv) studies with cross-over design, be-
cause at the cross-over point, the amount of potential
weight loss has changed from baseline and the losses are al-
most always less. Titles and abstracts of the retrieved arti-
cles were independently assessed by two authors (SS and
MJC) for inclusion and exclusion criteria, and any discrep-
ancy was resolved by discussion with the third author
(ASA). Studies that reported the effect of DASH diet on
any of adiposity markers including body weight, body fat
percent, WC and BMI were selected. In case of several re-
ports on the same population, we considered those with
more follow-up time and sample size to be included in the
systematic review and meta-analysis.
Data extraction
Data including number of participants, their age and gen-
der, study design, year of publication, country in which
the study was conducted, length of follow-up time, details
on dietary changes for intervention and control groups, at-
trition and methods used for its management and data on
mean change in outcome variables (including body weight,
BMI, WC and body fat percent) and their corresponding
standard deviation were extracted by two independent au-
thors (SS and FS). If published data were inadequate for
systematic review and/or meta-analysis, needed information
were requested by contacting the corresponding author
of the original studies. Cross-check of all data was per-
formed two times to minimize potential error, and any
disagreement in extracted data was resolved through discus-
sion with ASA.
17, 442–454, March 2016
444 Effect of DASH diet on weight and body composition obesity reviews

Quality assessment comparison of overall estimates to explore the extent to

Quality of included investigations was also assessed inde- which the summary estimates might depend on a study
pendently by two investigators (SS, ASA) according to the (41). Publication bias was assessed by visual examination of
Cochrane Collaboration’s tool for assessment of risk of bias funnel plots. Egger’s regression asymmetry test and Begg’s
(27). Selection bias (random sequence generation and allo- adjusted rank correlation test were also used for statistical as-
cation concealment), attrition bias (incomplete data out- sessment of publication bias (42). All statistical analyses were
come) and reporting bias (selective outcome reporting) performed using STATA, version 11.2 (Stata Corp., College
were evaluated as the key domains. As blinding is almost Station, TX). P values less than 0.05 were considered as sta-
impossible for dietary intervention trials, we did not con- tistically significant.
sider the blinding of participants and investigators as a
key domain to assess the risk of bias. We classified these do- Results
mains as yes (low risk of bias), no (high risk of bias) or un-
clear. The overall quality of included studies was considered Included studies
as weak if they were low risk for less than two of domains.
Database search led to 3625 potentially relevant articles, and
They were classified as fair if they were low risk for two do-
74 publications were eligible according to inclusion criteria
mains and good if they were low risk in more than two of
and were carefully reviewed for further assessment. After read-
domains.
ing full text of eligible articles, 61 studies were excluded (22–
24,43–93) because ten studies compared combination of
Statistical analysis DASH diet along with other lifestyle modifications such as ex-
ercise program, and therefore, the independent effects of
The difference in mean change (MD) for weight, BMI and
DASH diet could not be assessed (24,48–
WC and their corresponding standard deviations (SDs) be-
50,57,60,61,71,77,80); two were conducted in pregnant
tween intervention (DASH diet) and control groups were ex-
women (46,47); seven publications compared the effect of
tracted from each study to be used as effect size for meta-
different types of the DASH diet (51,62,82,87–90); six
analysis. Ten studies readily reported the mean change values
studies were cross-over in design (21,25,94–97), and the
for intervention and group (20,28–36); however, three stud-
duration of one study was less than 8 weeks (98). In a
ies only reported baseline and follow-up values (26,37,38);
study that was named as DASH trial, it was mentioned by
therefore, we calculated the mean changes and also estimated
authors that weight was actively maintained by changing the
SD for mean change using correlation r using studies that re-
energy intake during the study period (44); therefore,
ported baseline, after intervention and change values
we excluded this study and 14 publications that used its data
[r = 0.95 for weight (20,21,32), r = 0.96 for BMI (20) and
(52–56,59,63,64,69,72,81,83,85,93). Sixteen studies were
0.90 for WC (21)]. The weighted mean difference (WMD)
also excluded because they were conducted on the data
and its corresponding SD were calculated by DerSimonian
from bigger studies [Exercise and Nutrition Interventions
and Laird method (39) using random effects model, which
for Cardiovascular Health (23,58,65), sodium
takes the between-study variation into account. Statistical
DASH trial (66,76,84,92) and PREMIER
heterogeneity between studies was evaluated by using
(22,43,45,67,68,70,78,79,86)]. Four other studies (73–75,91)
Cochran’s Q test and I-squared (I2) (40). We conducted a
were also excluded because of duplicate reports (Fig. 1).
subgroup analysis, separating studies in which DASH diet
In total, 13 clinical trials were eligible to be included in the
was administered as a low-calorie diet in comparison with
present systematic review, and out of these, ten articles had re-
other low-calorie diets (studies with energy restriction) from
ported the effect of DASH diet on weight (20,28–
studies that assessed the effect of DASH diets compared with
32,34,35,37,38), six on BMI (20,26,33–36) and two on WC
other diets without energy restriction. Other subgroup analy-
(33,38) and therefore included in the meta-analysis. There
ses based on participants’ gender (male, female or both gen-
was only one of eligible studies that examined the effect of
ders), study duration (8 to 12 weeks as short-term studies
DASH on body fat percent, lean body mass and trunk fat
and longer than 12 weeks as long-term studies), being a feed-
(28). Six studies were conducted in USA (26,28,29,33,35,37),
ing or non-feeding trial, diet administered for control groups
two were carried out in Australia (31,32), three in Iran
(healthy [including other healthy dietary patterns like Medi-
(20,34,38), one study in Brazil (30) and one study in China
terranean diet, high fruits and vegetable diets, dietary recom-
(36). The characteristics of studies included in the systematic
mendations for heart disease management] and typical diets
review are summarized in Table 1.
[including Western diet and diets usually consumed by the
population]), subjects’ BMI status (normal weight, over-
Assessment of risk of bias
weight or obese) were carried out to check for specific
sources of heterogeneity. Sensitivity analysis was performed Twelve studies included in the systematic review had a good
by excluding studies from the meta-analysis one by one and quality based on the key domains selected for quality

17, 442–454, March 2016 © 2016 World Obesity

obesity reviews
Figure 1 Flow diagram for study selection process.
assessment (20,26,28–34,36–38), and one was classified as
fair (35). Three studies did not report using any method to
conceal the allocation of participants (32,35,38), and three
did not mention incomplete outcome data (30,31,35). For
the blinding of assessors or analysts, 11 of the studies tried
to address this potential source of bias (20,26,28–
31,33,34,36–38); however, as all included studies were die-
tary trials, they could not blind the intervention protocols.
There was no evidence of selective outcome reporting in
the included studies (Table 2).
Meta-analysis
Body weight
In total, ten studies (1291 participants) (20,28–
32,34,35,37,38) assessed the effect of DASH diet on body
weight (Table 1). The individuals adhered to DASH diet
© 2016 World Obesity
Effect of DASH diet on weight and body composition 445
achieved a significantly greater weight loss compared
with the individuals assigned to control group
(WMD = 1.42 kg, 95%CI: 2.03, 0.82, P < 0.001).
The heterogeneity among the included studies was high
(Q statistic = 34.67, Cochrane Q test, P ≤ 0.001,
I2 = 71.2%). Subgroup analysis showed that both studies
that examined the effect of DASH diet with energy restric-
tion (WMD = 2.27 kg, 95%CI: 1.65, 1.88, P < 0.001)
and without energy restriction (WMD = 0.85 kg, 95%CI:
1.27, 0.43, P < 0.001) could significantly reduce body
weight. This subgroup analysis could largely describe the
between-study heterogeneity, because the heterogeneity dis-
appeared both in studies with (Q statistic = 2.99, Cochrane
Q test, P = 0.392, I2 = 0%) and without (Q statistic = 6.41,
Cochrane Q test, P = 0.379, I2 = 6.4%) energy restriction,
and the between-group heterogeneity was significant
(Cochrane Q test, P < 0.001). The effect of DASH diet on
17, 442–454, March 2016
446 Effect of DASH diet on weight and body composition obesity reviews

Table 1 Characteristic of randomized controlled trials that evaluated the effect of the DASH diet on body weight, body mass index (BMI) or waist
circumference (WC) and were eligible to be included in systematic review

First author Publication No. of Gender Design Study Subjects Intervention diet Control diet Outcome
year participants duration characteristic measured
(week)

Ard (37) 2004 56 M/F Parallel 12 Hypertension DASH diet Typical diet Body
CHO: 45% CHO: 46% weight
Fat: 36% Fat: 35%
Pro: 16% Pro: 17%
Azadbakht 2005 76 M/F Parallel 24 Overweight and DASH diet 500 kcal Healthy diet Body weight,
(38) obese with less than 500 kcal less waist
metabolic participants’ needs than participants’ circumference
syndrome needs
CHO: 55% CHO: 55%
Fat: <30% Fat: <30%
Pro: 15% Pro: 15%
Nowson 2005 54 M Parallel 12 Overweight and WELL diet Low-fat diet Body weight
(32) obese with (modified DASH diet)
hypertension CHO: 59.1% CHO: 53.5%
Fat: 18.5% Fat: 23.8%
Pro: 19.8% Pro: 19.5%
Elmer (29) 2006 537 M/F Parallel 24 Healthy adults with Established plus Established diet Body weight
prehypertension DASH
CHO: 50.9% CHO: 50.4%
Fat: 33.2% Fat: 33.5%
Pro: 16% Pro: 16.2%
Ledikwe 2007 435 M/F Parallel 24 Prehypertensive Established plus Established diet Waist
(33) and hypertensive DASH circumference,
persons CHO: 50.9% CHO: 50.4% body mass
Fat: 33.2% Fat: 33.5% index
Pro: 16% Pro: 16.2%
Nowson 2009 111 F Parallel 14 Overweight and Vitality diet (VD), a Higher acid load Body
(31) obese low-sodium DASH- reference healthy weight
postmenopausal type diet with a low- diet (RHD)
women with dietary acid load
hypertension CHO: 45.4% CHO: 46.7%
Fat: 32.9% Fat: 31.7%
Pro: 20% Pro: 20%
Blumenthal 2010 95 M/F Parallel 16 Healthy overweight DASH diet Iso-caloric Body
(28) with hypertension typical weight
diet
CHO: 53.8% CHO: 46.4% Body fat
percent
Fat: 27.8% Fat: 36.8% Lean body
mass
Pro: 19.4% Pro: 16.7% Total trunk fat
Smith (26) 2010 81 M/F Parallel 16 Overweight or obese DASH diet Iso-caloric Body mass
with hypertension typical index
diet
CHO: 53.8% CHO: 46.4%
Fat: 27.8% Fat: 36.8%
Pro: 19.4% Pro: 16.7%
Lima (30) 2013 206 M/F Parallel 24 Hypertension Nutritional counselling Counselling was Body
provided by a based on weight
nutritionist, which was standard care
based on the and mainly
principles of the focused on salt
DASH intake reduction.
Asemi (20) 2014 48 F Parallel 8 Overweight and Calorie-restricted Calorie-restricted Body mass
obese with PCOS DASH diet diet index, body
CHO: 52% CHO: 52% weight
Fat: 30% Fat: 30%
Pro: 18% Pro: 18%

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obesity reviews Effect of DASH diet on weight and body composition 447

Table 1. (Continued)
First author Publication No. of Gender Design Study Subjects Intervention diet Control diet Outcome
year participants duration characteristic measured
(week)

Razavi 2015 60 M/F Parallel 8 Overweight and Calorie-restricted Calorie-restricted Body mass
Zade (34) obese patients with DASH diet diet index, body
non-alcoholic fatty CHO: 52% CHO: 52% weight
liver disease Fat: 30% Fat: 30%
Pro: 18% Pro: 18%
Rifai (35) 2015 48 M/F Parallel 12 Patients with DASH diet Dietary Body mass
heart failure recommendation for index, body
heart failure weight
Wong (36) 2015 485 M/F Parallel 52 Grade 1 hypertensive DASH diet fruits Advice for Body mass
patients (4–5 serves/day), hypertensive index
vegetables (4–5 patients
serves/day), low-fat
dairy products (2–3
serves/day), lean
meats, poultry and
fish (≤6 serves/day)

Established diet: attending weight loss sessions and were educated for weight loss, reduced sodium intake, increased physical activity and moderate
alcohol intake.
M, male; F, female; HAD, healthy American diet; CHO, carbohydrate; Pro, protein.

body weight as well as subgroup analysis based on energy
restriction is illustrated in Fig. 2. Other subgroup analyses
are summarized in Table 3. It was revealed that the DASH
diet reduces body weight regardless of gender. DASH diet
also resulted in greater body weight reduction than control
diet when it was prescribed in non-feeding trials. Our anal-
yses also indicated that participants in DASH group lost less
weight in longer period of time (more than 12 weeks), com-
pared with short-term (8–12 weeks) trials in comparison
with control groups. Furthermore, body weight was signifi-
cantly reduced by following DASH diet when compared
with a typical diet in control group; however, the difference
was not significant when other healthy diets were prescribed
for control group. Only studies with overweight and obese
participants showed significant weight reduction following
DASH diet (Table 3). The results of meta-regression indi-
cated that neither the year of study (β = 0.001; P = 0.995)
nor the number of participants (β = 0.002; P = 0.569) associ-
ated with between-study heterogeneity.
Body mass index
Six studies (1157 participants) had data on BMI change and
were included in the meta-analysis (20,26,33–36). Table 4
shows the effect of DASH diet on BMI as well as several
subgroup analyses. DASH diet resulted in reduced BMI
compared with control group (WMD = 0.42 kg m 2;
95%CI: 0.64, 0.20, P < 0.001); between-study heteroge-
neity was significantly high (Q statistic = 28.05, Cochrane Q
test, P < 0.001, I2 = 82.2%). This result was also shown
across almost all subgroups.
Waist circumference and body fat percent
Totally, two studies (511 subjects) were included in the anal-
ysis (33,38). In overall, our analysis revealed that DASH
diet decreases more 1.05 cm in WC than other iso-caloric di-
ets (95%CI: 1.61, 0.49, P < 0.001). The heterogeneity
was also high between included studies (Cochrane Q
test = 9.83, P < 0.001, I2 = 79.7%). We could find only one
eligible study by Blumenthal et al. that could not find a sig-
nificant effect of DASH diet on body fat percent, lean body
mass or trunk fat (28).
Sensitivity analysis and publication bias
Sensitivity analysis revealed that the effect of DASH diet on
body weight and BMI was not substantially modified by ex-
cluding a certain study.
Although a slight asymmetry was seen in funnel plots
(Supporting information Figure S1), there was no evidence
for publication bias in the selected studies assessing the ef-
fect of DASH diet on weight (Begg’s test, P = 0.815; Egger’s
test, P = 0.564) and BMI (Begg’s test, P = 0.573; Egger’s test,
P = 0.518).
Discussion
The present systematic review and meta-analysis revealed
that adherence to DASH diet significantly decreases body
weight, BMI and WC. Our finding in overall analysis indi-
cated that mean weight reduction was about 1.42 kg for
study periods ranging between 8 and 24 weeks; however,
the influence of the DASH diet on body weight was greater
when administered along with energy-restricted diets

© 2016 World Obesity 17, 442–454, March 2016

448 Effect of DASH diet on weight and body composition obesity reviews

Table 2 Study quality and risk of bias assessment using Cochrane Collaboration’s tool (27)

First author (year) Random sequence Allocation Blinding Blinding of outcome Incomplete Selective Score Overall
generation concealment assessment outcome data reporting quality

Ard (2004) (37) 4 Good

Azadbakht (2005) (38) 4 Good

Nowson (2005) (32) 3 Good

Elmer (2006) (29) 5 Good

Ledikwe (2007) (33) 5 Good

Nowson (2009) (31) 3 Good

Blumenthal (2010) (28) 5 Good

Smith (2010) (26) 5 Good

Lima (2013) (30) 4 Good

Asemi (2014) (20) 4 Good

Razavi Zade (34) 4 Good

Rifai (35) 2 Fair

Wong (36) 5 Good

( 2.27 kg), for short-term periods ( 1.64 kg) and in over-
weight and obese participants ( 1.63 kg).
The DASH diet is a healthy eating dietary pattern, and
studies have shown that this dietary pattern not only lowers
blood pressure (15) but also is contributed to better
glycaemic control (18), lower risk of CVDs (16) and cancer
(17). Obesity is also a risk factor for all these mentioned dis-
eases (99). To our knowledge, this is the first systematic re-
view and meta-analysis that has reviewed the effect of
adherence to DASH diet on weight and body composition.
It is mentioned that the positive effect of DASH diet on
hypertension (15) might be attributed to its reducing effect
on weight (96). It has been suggested that every kilogram
of weight reduction might result in 1 mm Hg decrease in sys-
tolic and diastolic blood pressure (100).
Our results showed that adherence to DASH diet reduced
more body weight when compared with typical diets, but
the same effect was not seen when DASH diet was com-
pared with other healthy diets. This result suggests that
the healthier food choices might influence on body weight.
The energy density of this dietary pattern is low, so people
can consume less energy without necessarily decreasing the
total weight of foods ingested, and this makes the DASH
diet a good choice to reduce body weight in long term with-
out feeling hungry (101). An increased consumption of
fruits, vegetables and whole grain products is also widely
recommended in DASH dietary guideline. Findings from a
prospective cohort study showed that women in the highest
quintile of whole grain intake had 23% lower risk of weight
gain than did women in the lowest quintile (102). Fruit and

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obesity reviews Effect of DASH diet on weight and body composition 449

Figure 2 Forest plot of randomized controlled clinical trials illustrating weighted mean difference in weight change (kg) between the DASH and control
groups for all eligible studies as well as subgroup analysis based on energy restriction. Analysis was conducted using random effects model.

Table 3 Meta-analysis showing the effect of DASH diet on body weight (kg) based on several subgroups (all analyses were conducted using random
effects model)

Meta-analysis Heterogeneity
2
Study group Number of participant WMD (95%CI) P effect Q statistic P within group I (%) P between group

Overall 1291 1.42 ( 2.03, 0.82) <0.001 34.67 <0.001 71.2 —

Gender
Female 213 1.45 ( 3.08, 0.18) 0.082 17.34 <0.001 88.5 0.01
Male 76 1.54 ( 3.68, 0.59) 0.157 6.06 0.014 83.5
Both 1002 1.26 ( 1.71, 0.8) <0.001 2.08 0.838 0
Duration
Short period (8–12 weeks) 266 1.64 ( 2.54, 0.74) <0.001 6.72 0.151 40.5 0.153
Long period (>12 weeks) 1025 1.35 ( 2.17, 0.52) 0.001 25.91 <0.001 80.7
Feeding
Feeding 221 0.33 ( 0.96, 0.31) 0.313 1.17 0.558 0 <0.001
Non-feeding 1070 1.73 ( 2.25, 1.22) <0.001 15.12 0.035 53.7
Control diet
Healthy 289 1.20 ( 2.67, 0.27) 0.11 26.41 <0.001 84.9 0.838
Typical 1002 1.55 ( 2.07, 1.03) <0.001 8.23 0.144 39.2
Subjects’ BMI status
Overweight and obese (BMI ≥ 25) 870 1.63 ( 2.23, 1.03) <0.001 17.55 0.007 65.8 <0.001
Normal and overweight 421 0.82 ( 1.83, 0.18) 0.109 4.5 0.213 33.3 <0.001

WMD, weighted mean difference; BMI, body mass index.

vegetables are also rich in water and fibre, therefore consid-
ered as low in energy density. Increases in fruit and vegeta-
ble consumption are proposed to reduce the risk of obesity
(103,104).
The results of two large, prospective cohort studies
showed an inverse association between the frequency of
nut intake and BMI (105,106). Nuts are rich in unsaturated
fatty acids, and it is suggested that these fatty acids have
thermogenic effects and in return might contribute to
reduced fat accumulation (107). Furthermore, nuts might
increase the satiety because they are high in fibre and pro-
tein (108). Other components of DASH dietary pattern in-
cluding low-fat dairy might also have role in reducing the
appetite and body weight as a result (12). Fish consumption
as part of a DASH is also associated with low body weight
(109). A recent meta-analysis of randomized controlled tri-
als revealed that consumption of fish or fish oil capsules re-
sults in 0.59-kg reduction in body weight, 0.24-kg m 2

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450 Effect of DASH diet on weight and body composition obesity reviews

2
Table 4 Meta-analysis showing the effect of DASH diet on body mass index (BMI) (kg m ) based on several subgroups (all analyses were conducted
using random effects model)

Meta-analysis Heterogeneity
2
Study group Number of WMD (95%CI) P effect Q statistic P within group I (%) P between group
participant

Overall 1157 0.42 ( 0.64, 0.20) <0.001 28.05 <0.001 82.2 —

Gender
Female 48 0.9 ( 1.16, 0.64) <0.001 0 — — <0.001
Both 1109 0.28 ( 0.41, 0.16) <0.001 6.9 0.142 42
Duration
Short period (8–12 weeks) 156 0.7 ( 1.07, 0.34) <0.001 4.08 0.130 50.9 <0.001
Long period (>12 weeks) 1001 0.28 ( 0.39, 0.12) <0.001 4.83 0.089 58.6
Control diet
Healthy 48 0.7 ( 3.11, 4.51) 0.719 0 — — 0.6
Typical 1109 0.42 ( 0.64, 0.21) <0.001 27.78 <0.001 85.6
Subjects’ BMI status
Overweight and obese (BMI > 25) 624 0.51 ( 0.80, 0.23) <0.001 19.82 <0.001 84.9 0.005
Normal and overweight 533 0.13 ( 0.28, 0.02) 0.086 0.18 0.67 0
Calorie restriction
With calorie restriction 543 0.61 ( 0.93, 0.29) <0.001 7.54 0.023 73.5 <0.001
Without calorie restriction 614 0.42 ( 0.64, 0.20) 0.002 4.13 0.127 51.6

WMD, weighted mean difference; BMI, body mass index.

decrease in BMI and loss of 0.81 cm in WC and 0.49% in
body fat percent compared with control groups (10).
It is also mentioned in the previous studies that high salt
intake may induce obesity independent of total energy in-
take (110). The DASH eating plan is a high-potassium,
low-sodium diet, which has been shown to inversely associ-
ate with obesity (111). It is mentioned that high-salt diet
might lead to an increased level of plasma leptin as well as
accumulation of white adipose tissue (112).
ALL RCTs included in our review had tried to administer
diets with similar energy contents for both intervention and
control groups. The meta-analysis indicated that DASH
diet adherence caused weight loss, and therefore, this was
regardless of the energy intake. Furthermore, our subgroup
analysis based on energy restriction revealed that DASH
diet might result in even more weight and BMI loss when
administered in the context of energy-restricted diets com-
pared with the time it was administered without energy re-
striction. This result suggests that including DASH diet
components in low-calorie diets might help participants to
better imitate their weight loss diets, and therefore, it results
in reducing more weight and BMI; therefore, this makes low
caloric DASH a better choice for weight reduction than
other low-energy diets used for control groups.
Our findings also demonstrated that DASH diet adher-
ence lead to body weight loss in non-feeding trials while
the effect was not significant in feeding studies. In feeding
approaches, the foods selected for intervention and control
groups were fixed and adjusted for the caloric needs of
participants. Therefore, participants in both groups can-
not eat extra foods if they feel hungry. Therefore, in these
approaches, the satiety-lowering effect of foods and
therefore differences in weight reduction might not be
expressed.
We investigated the weight-reducing effect of DASH diet
alone without other lifestyle interventions (exercise and
weight management programs) and tried to include well-
controlled randomized clinical trials. Most of included stud-
ies reported body weight and composition as secondary
data (20,29,30,32,37,38,95–97), and we could not find this
number of studies if we tried to search for studies that
targeted these body fat indices as the primary outcome by
using body weight and composition-related keywords in
combination with keywords related to DASH diet.
In this study, we included weight change, BMI change
and WC change in meta-analysis. Although change in BMI
during weight loss is just the weight change because height
does not change in these trials and also weight would be
greater in precision than WC, we decided to extract data
on weight, BMI and WC because different RCTs included
in this review reported the effect of DASH on different
indicators.
It should be kept in mind that although all included stud-
ies mentioned that they had used DASH diet for interven-
tion group, the macronutrient composition of DASH diet
was different between them, and this might explain the high
heterogeneity found between included studies. Therefore,
this limitation should be considered while interpreting our
results. Moreover, a limited number of included studies
assessed the degree of participants’ compliance with inter-
vention diets. Furthermore, only one study assessed the
effect of DASH on body fat or lean body mass.
In conclusion, our systematic review and meta-analysis
on RCTs revealed that the DASH diet might be a better

17, 442–454, March 2016 © 2016 World Obesity

obesity reviews
choice than typical low-calorie diets in reducing weight and
body fat particularly for overweight and obese subjects.
Long-term randomized clinical trials with follow-up time
more than 12 weeks targeting not only weight but also other
indicators of adiposity including body fat mass as their
primary outcome are highly recommended.
Conflict of interest statement
No conflict of interest was declared.
Acknowledgements
The authors thank Dr. Lawrance J. Appel, Dr. Caryl A.
Nowson, Dr. Frank M. Sacks and Dr. Catherine Huggins
for their valuable contribution of additional information
from their studies. The authors would also thank the
research council of Nutrition and Food Security Research
Center, Shahid Sadoughi University of Medical Sciences
for financial support of this study.
Author’s contribution
The authors’ responsibilities were as follows: ASA con-
ceived the study. ASA, SS and FS, MJC carried out the liter-
ature search and data extraction. ASA and SS conducted the
quality of included studies, data analysis and interpretation.
All authors contributed to the study conception, design and
drafting of the manuscript.
ASA: analysis and interpretation of data, ASA and SS:
writing of the manuscript and critical revision of manuscript
drafts for important intellectual content.
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