Higher DASH Scores Linked to Fewer Depressive Symptoms in Chinese Adults

A cross-sectional study of 3,465 adults attending health examinations at First Hospital of Qinhuangdao in China found that higher Dietary Approaches to Stop Hypertension, or DASH, scores were associated with lower odds of depressive symptoms. The association remained statistically significant after adjustment for demographic, lifestyle and health-related factors, while spline and piecewise analyses suggested that the relationship was nonlinear and most evident below an exploratory DASH score of 4.124. Because the study measured diet and mood at one point in time and used a screening scale rather than psychiatric interviews, its findings show an association rather than establishing that eating patterns prevent depression or that raising a DASH score will improve mental health.

Among the 3,465 participants included in the analysis, 460, or 13.3%, met the study’s definition of depressive symptoms. Their mean DASH score was 4.29, compared with 4.38 among the 3,005 participants classified as not having depressive symptoms; the difference was statistically significant. People without depressive symptoms also reported more physical activity and were less likely to live alone or report a history of physical illness, while the two groups did not differ significantly in age, sex, body mass index, energy intake, marital status, education, smoking or drinking status. These baseline comparisons describe an observational sample and do not show that any of these characteristics caused the mood difference.

The researchers calculated the DASH score from a validated semiquantitative food-frequency questionnaire covering 81 food items. Participants reported how frequently they had consumed each item during the preceding month, and the investigators converted those responses into daily equivalents using the China Food Composition Table. The score was based on nine nutrient targets: total fat, saturated fat, protein, dietary fiber, cholesterol, calcium, magnesium, sodium and potassium. Nutrient intakes were standardized per 1,000 kilocalories to account for differences in total energy intake. Each component contributed one point for meeting its target, 0.5 points for reaching an intermediate goal or zero for meeting neither, producing a total score from 0 to 9. In practice, the DASH pattern emphasizes fruits, vegetables, whole grains, low-fat dairy and lean protein while limiting sodium, saturated fat and cholesterol.

Depressive symptoms were assessed with the Chinese version of the 20-item Zung Self-Rating Depression Scale, on which each item is rated from 1 to 4 and total scores range from 20 to 80. Higher scores indicate more severe symptoms. The scale’s internal consistency in this sample was good, with a Cronbach’s alpha of 0.81, and the researchers used a score of 45 or higher to identify depressive symptoms. A previously reported evaluation of this cutoff in a Chinese population found sensitivity of 83.6% and specificity of 96.4% against a DSM diagnosis of depressive symptoms. Even so, the SDS is a screening instrument rather than a diagnostic interview, so the study outcome represents symptom severity as classified by the scale rather than confirmed clinical depression in every participant.

When the DASH score was analyzed as a continuous variable, each additional point was associated with lower odds of depressive symptoms in the unadjusted model, with an odds ratio of 0.87 and a 95% confidence interval of 0.77 to 0.99. The estimate was unchanged after adjustment for age and remained significant in a model adding sex, body mass index, educational level and marital status. In the fully adjusted model, which also included living arrangements, employment, physical illness, smoking, drinking, energy intake and physical activity, the odds ratio was 0.84, with a 95% confidence interval of 0.72 to 0.99 and a p-value of 0.034. The p-value for trend across categorical quintiles was 0.045 in the primary analysis. These estimates are consistent with a modest inverse association, but they do not reveal whether diet itself produced the difference.

The association was also visible when participants were divided into DASH-score quintiles. Using the lowest group, with scores of 3 or less, as the reference, participants in the second quintile had lower odds of depressive symptoms in the fully adjusted model, with an odds ratio of 0.58 and a 95% confidence interval of 0.34 to 0.98. The corresponding odds ratios were 0.39 for scores of 4 to less than 4.5, 0.46 for scores of 4.5 to less than 5 and 0.46 for scores of 5 or higher, with all three confidence intervals excluding one. The group sizes were unequal, ranging from 166 participants in the lowest quintile to 978 in the third, and the cross-sectional design does not establish a temporal sequence between dietary pattern and depressive symptoms.

Restricted cubic spline analysis indicated a significant nonlinear relationship, with a p-value for non-linearity of 0.001. A two-piecewise logistic model identified an exploratory inflection point at a DASH score of 4.124, with a 95% confidence interval of 2.050 to 6.450. Below that value, a one-point increase in the score was associated with lower odds of prevalent depressive symptoms, with an adjusted odds ratio of 0.397, a 95% confidence interval of 0.261 to 0.605 and a p-value below 0.001. At scores of 4.124 or higher, the association was not statistically significant, with an odds ratio of 0.953 and a 95% confidence interval of 0.705 to 1.288. The researchers emphasized that this sample-specific breakpoint should not be treated as a minimum effective dose, an intervention threshold or a clinical target. It has not been externally validated, and relatively few participants occupied the extremes of the score distribution, producing wide confidence intervals in those regions.

Exploratory subgroup analyses suggested inverse associations among men, participants aged 45 or older, those with a body mass index of at least 24 kilograms per square meter and people with a college education or higher. The fully adjusted odds ratios were 0.78 for men, 0.78 for participants aged 45 or older, 0.83 for those with a body mass index of at least 24 kilograms per square meter and 0.86 for those with college education or higher. However, no significant interaction effects were detected for any subgroup, with all interaction p-values above 0.05. Some confidence intervals crossed the null value, and statistical power varied across strata. The authors therefore cautioned that differences in statistical significance should not be interpreted as evidence that the association is stronger in one group than another. The subgroup results require confirmation in larger, appropriately powered studies.

Several biological and behavioral pathways could plausibly connect a DASH-style diet with depressive symptoms, but the study did not measure these mechanisms. The authors cited potential roles for fiber, unsaturated fatty acids and antioxidant-rich foods in relation to inflammation and oxidative stress, along with possible effects on neurotransmitter metabolism, the hypothalamic-pituitary-adrenal axis and the gut-brain axis. Dietary patterns rich in vegetables, fruits, whole grains and fish have also been associated with lower depression risk in previous meta-analysis, whereas higher intake of added sugars and ultra-processed foods has been linked to a greater risk. Such pathways remain hypotheses for this dataset. Health behaviors may matter as well: people who follow healthier diets may also differ in self-regulation, health literacy and activity levels, while depressive symptoms can themselves influence eating habits. Reverse causation therefore cannot be excluded.

The study’s main strengths are its sample size, detailed adjustment and effort to characterize the dose-response pattern in Chinese adults, a population for which evidence on DASH adherence and depressive symptoms had been limited. Its limitations are substantial. Participants came from a single-center health-examination sample in Qinhuangdao, limiting generalizability. The self-administered food-frequency questionnaire covered only the preceding month and may have introduced measurement error, while the study lacked information on psychiatric history, antidepressant use, sleep characteristics, household income and other dimensions of socioeconomic status. Excluding people with incomplete data could have introduced selection bias, although included and excluded participants did not differ significantly in baseline characteristics. Most importantly, the cross-sectional design, exploratory threshold and screening-based outcome preclude causal or clinical conclusions. Prospective studies in independent Chinese cohorts, ideally with repeated dietary measurements, psychiatric assessment and richer psychosocial data, are needed to determine whether a sustained DASH-style eating pattern predicts fewer depressive symptoms over time.

Subject of Research: Association between DASH dietary adherence and depressive symptoms among Chinese adults

Article Title: Dietary Approaches to Stop Hypertension score is associated with depressive symptoms among Chinese adults: a cross-sectional study

Article References: Li, P., Li, Y., Zhao, Y., Fan, X., Liu, L., Zhang, R., Gong, T., Zhang, J., Li, X., Li, C., & Zhang, L. (2026). Dietary Approaches to Stop Hypertension score is associated with depressive symptoms among Chinese adults: a cross-sectional study. Frontiers in Nutrition, 13, 1913667. https://doi.org/10.3389/fnut.2026.1913667

Image Credits: AI Generated

DOI: 10.3389/fnut.2026.1913667

Keywords: DASH diet, depressive symptoms, Chinese adults, cross-sectional study, dietary patterns, dose-response relationship, nutritional epidemiology, mental health, Dietary, Approaches, Stop, Hypertension