Can an adapted mindfulness training program improve interoception and adherence to the DASH diet?

By Pooja Toshniwal PahariaNov 6 2023Reviewed by Lily Ramsey, LLM

In a recent study published in JAMA Network Open, researchers investigated whether the Mindfulness-Based Blood Pressure Reduction (MB-BP) adapted mindfulness program improved interoceptive awareness and Dietary Approaches to Stop Hypertension (DASH) adherence.

Study: Adapted Mindfulness Training for Interoception and Adherence to the DASH Diet. Image Credit: Antonina Vlasova/Shutterstock.com

Background

Hypertension, or elevated blood pressure (BP), can lead to cardiovascular disease, which is a leading cause of mortality worldwide.

DASH diets lower blood pressure and have outperformed Mediterranean diets and caloric restriction methods in previous studies; however, adherence to the diet is low.

Mindfulness practice adapted to improve health practices that reduce blood pressure may increase DASH diet adherence through increased interoceptive awareness concerning dietary intake.

About the study

In the present study, researchers evaluated the impact of the adapted mindfulness training program on interoception and adherence to the DASH diet.

The phase two, parallel-group randomized controlled trial included English-speaking adults with unattended hypertension (BP equal to or above 120/80 mm of Hg), recruited from Rhode Island between 1 June 2017 and 30 November 2020 and followed for six months.

Of the 348 initially identified individuals, 67 were ineligible, 17 were unwilling to participate, and 63 failed to register before the trial’s termination. As a result, 201 individuals were randomized to the program (intervention, n=101) and the enhanced regular care (control, n=100) groups, with 24 (12%) lost to follow-up.

The MB-BP program comprised ten sessions, including 2.5-hour weekly group sessions and a 7.5-hour one-day group session. The recommended home mindfulness training was 45 minutes or more daily, six days per week, and included yoga, meditation, self-awareness, emotional regulation, and attention control. 

The eight-week intervention was modified for increased blood pressure, including education, personalized feedback, and mindfulness practices targeting risk factors for hypertension.

The intervention and control group participants were provided home blood pressure monitoring equipment with physician referral options. The regular care recipients also received brochures to control high blood pressure, as the American Heart Association (AHA) recommended.

The outcome evaluators and data analysts were blinded to the group allocation. Intention-to-treat analyses were performed between 1 June 2022 and 30 August 2023.

The primary study outcome was interoceptive awareness, assessed using the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. The secondary study outcome was adherence to the DASH diet, assessed using the Harvard 2007 Grid Food Frequency Questionnaire. The Five-Facet Mindfulness Questionnaire (FFMQ) was used to assess mindfulness.

Regression modeling was performed using generalized estimating equations for analysis. The team excluded individuals who practiced meditation more than once per week, those with a history of psychotic or bipolar disorders and self-injurious behaviors, and those with serious medical conditions, eating disorders, substance use disorders, or suicidal ideation.

Results

The mean participant age was 60 years; 118 (59%) of the participants were women, 163 (81%) were white individuals of non-Hispanic ethnicity, and 146 (73%) had received college-level education.

After six months of follow-up, the Mindfulness-Based Blood Pressure Reduction (MB-BP) mindfulness program significantly improved MAIA and DASH scores by 0.5 and 0.6 points, compared to controls, respectively.

The mindfulness program increased MAIA scores by 0.5 points at six months compared to controls. Among individuals with poor DASH adherence at baseline, mindfulness training also significantly elevated DASH scores by 0.6 points at six months compared to enhanced regular care.

The program showed a 0.3-point elevation in baseline DASH scores among all intervention group participants compared to a change of 0.04 points by enhanced regular care among control group participants in DASH scores six months from baseline.

In the exploratory mediation analysis performed to investigate whether MAIA could mediate MB-BP effects on DASH scores, the findings showed partial (31%) mediation. The adapted mindfulness program mainly affected emotional awareness, body listening, self-regulation, and attention regulation.

With adapted mindfulness being a probable active aspect of the program, the FFMQ scores showed 33% mediation. Eight serious adverse events were reported during six months of follow-up, four in both groups and physical injury-induced adverse events were equivalent in both groups. However, none of the adverse events were related to study involvement.

Self-awareness can affect eating behaviors by noting fullness and hunger, the impact of different meals on an individual's moods, and being aware of eating habits.

Attention control may be applied to dietary behaviors by paying attention to the sensory qualities of food, making deliberate choices for healthy eating habits, and shopping for health-promoting foods. Emotion regulation may be applied to food behaviors by reducing responses to cravings, practicing self-kindness and compassion, and reducing psychological suffering.

Conclusion

Overall, the study findings showed that the adapted mindfulness program improved interoception and adherence to the DASH diet compared to enhanced regular care over six months. The impact of mindfulness training on MAIA scores was in line with previous studies.