Key Points:
- The GOFRESH trial, a parallel-group randomized study, was conducted to determine the effects of low sodium-DASH groceries on systolic BP.
- Home-delivered groceries selected to follow a DASH diet (Dietary Approaches to Stop Hypertension) pattern plus dietitian counselling significantly reduced systolic blood pressure (SBP) at 3 months compared to a self-directed grocery stipend.
- The DASH-grocery intervention also achieved modest reductions in diastolic blood pressure (DBP), urinary sodium excretion and LDL cholesterol, but the beneficial effects were not sustained at 6 months once the intervention ceased.
- The study population was Black adults living in urban “food-desert” communities, highlighting both dietary access disparities and the potential of grocery-based intervention.
The DASH diet is an evidence-based eating pattern shown to lower blood pressure in controlled settings. However, translating this into real-world food access, especially for communities with limited grocery options, has been a challenge. The GOFRESH trial (Groceries for Black Residents of Boston to Stop Hypertension (NCT05121337) simultaneously published in JAMA, was designed to test whether providing DASH-patterned, low-sodium groceries to Black adults living in urban neighborhoods with few grocery stores could reduce blood pressure.
This was a parallel-group, randomized clinical trial that enrolled 180 self-identified Black adults (mean age 46 years, 57% female) living in Boston-area communities with limited grocery access, having SBP 120 to less than 150 mmHg, DBP < 100 mmHg, and not on HTN treatment. Participants were randomized to either 12 weeks of home-delivered, online-ordered DASH-patterned groceries plus weekly dietitian calls, or three monetary stipends of $500 every 4 weeks for self-directed grocery shopping. The primary outcome was the change in office SBP from baseline to 3 months. Secondary outcomes included DBP, urinary sodium/potassium, LDL-cholesterol, BMI and HbA1c with maintenance assessed at 6 months.
At 3 months, SBP fell by a mean of 5.7 mmHg (95% CI -7.4 to -3.9) in the DASH-grocery group versus 2.3 mmHg (95% CI -4.1 to -0.4) in the stipend group; the between-group difference was -3.4 mmHg (95% CI -5.9 to -0.8; P = 0.009). DBP decreased by 2.4 mmHg (95% CI -4.2 to -0.5) greater in the intervention arm. Urinary sodium excretion decreased by 545 mg/24 h (95% CI -1041 to -50) more in the intervention group, and LDL-cholesterol dropped by 8.0 mg/dL (95% CI -13.7 to -2.3). However, by 6 months (three months post-intervention), the BP reductions were not maintained: BP returned toward baseline in both arms. No significant changes in BMI or HbA1c were observed.
In this study, home-delivered, DASH-patterned groceries and dietitian counseling meaningfully decreased blood pressure among Black adults, but effects were not maintained after the intervention ended.
It provides real-world evidence supporting dietary interventions directed at the grocery environment. However, the lack of sustained effect post-intervention underscores the need for ongoing access, affordability, and structural supports to maintain change. As lead investigator Stephen P. Juraschek, MD, PhD, noted: “We thought that some of the benefits of the nutrition changes would be maintained after the groceries were discontinued; however, the study did not address other important barriers, such as the cost of nutritious foods or access to grocery stores.” Future work should explore scalable, cost-effective models and assess long-term sustainability of grocery-based dietary interventions.