Food Prescriptions to Promote Affordable Diets that Meet RDAs Among Multi-Generational Latino Households

拉丁裔家庭不成比例地受到肥胖，2型糖尿病，非酒精性脂肪肝的影响 疾病和血脂异常。饮食是一个主要的影响因素，不良的饮食在很大程度上是由环境因素造成的。 线索，包括大的餐厅部分和积极营销的低营养，高度加工和高 含糖食品。在低收入社区尤其如此，在那里，不健康食品的营销和供应 食物更重要。此外，超市的营销、折扣和促销策略往往 促使消费者购买低营养的非必需食品或过量购买。一个有希望的方法是 解决造成慢性病风险差异的营养、社会和经济因素， 食品处方，其中包括菜单规划和负担得起的营养食品的家庭交付。这 这种方法是在家庭环境中修改上下文线索，而不是依赖于自我， 监管控制。项目3将测试文化敏感的膳食计划和负担得起的杂货店的影响 随机对照试验中的分娩服务，以改善饮食质量，体重控制和慢性病风险 多代同堂的拉丁裔家庭食品处方将满足EAT-Lancet可持续性 指南，并达到所有家庭23种关键营养素推荐膳食摄入量的至少90% 成员，在成本不超过680美元/月，目前的CalFresh（加州的SNAP）的家庭预算， 四我们将根据年龄、性别、活动水平和体重目标提供量身定制的份量指示。我们 将开发和验证我们的菜单和测试物流与重点群体的拉丁美洲成年人超重或 肥胖此后，我们将从Kaiser Permanente招募180个3-5人的拉丁裔家庭（n=720） 至少有两个超重或肥胖的人，至少有一个5-10岁的孩子， 参加一项为期6个月的随机试验，采用等待名单交叉设计。根据每周菜单计划， 将生成杂货清单，并将物品送到家中。人体测量血压 将在基线、第6天和第12天采集饮食摄入量和HbA 1c、肝酶和脂质的血液样本 个月每个家庭将被期望贡献$100/周，与金额超过这作为补贴， 鼓励参与。具体目标是：（1）制定负担得起的、对文化敏感的膳食计划， 为拉丁裔家庭提供食品杂货配送干预。2)确定食品处方和杂货的影响 分娩对父母肥胖、饮食质量和慢性病风险的影响。3)确定食物处方的影响 以及食品杂货配送对儿童肥胖、饮食质量和慢性病风险的影响。在一个跨中心的目标，数据从这个 本研究将与研究一、研究二结合，探讨：（1）慢性病的多层次决定因素 拉丁裔儿童的风险;和2）不同类型的家庭为基础的干预措施的影响，以及如何社会和 环境因素影响对干预措施的反应。如果这种方法被证明是有效的， 可以提供一个可扩展的和可持续的模式，以改善饮食，健康和幸福的拉丁美洲家庭。

Latino families are disproportionately affected by obesity, type 2 diabetes, non-alcoholic fatty liver disease, and dyslipidemia. Diet is a major contributing factor and poor diet is heavily driven by environmental cues, including large restaurant portions and aggressive marketing of low-nutrient, highly processed and high sugar foods. This is especially true in low-income neighborhoods where marketing and availability of unhealthy foods is more salient. Furthermore, the marketing, discounts and promotional strategies in supermarkets often nudge shoppers to buy low-nutrient discretionary foods or buy in excessive quantities. One promising approach to address these nutritional, social, and economic contributors to disparities in chronic disease risk is the concept of food prescriptions, which includes menu planning and home-delivery of affordable and nutritious food. This approach is premised on modifying contextual cues in the home environment rather than relying on self- regulatory control. Project 3 will test the effects of a culturally sensitive meal planning and affordable grocery delivery service in a randomized controlled trial to improve diet quality, weight control and chronic disease risk among multi-generational Latino households. Food prescriptions will meet the EAT-Lancet sustainability guidelines and achieve at least 90% of the recommended dietary allowances for 23 critical nutrients for all family members, at a cost not exceeding $680/month, the current CalFresh (California’s SNAP) budget for a family of four. We will include tailored directions on portion size based on age, sex, activity level and weight goals. We will develop and validate our menus and test logistics with focus groups of Latino adults with overweight or obesity. Thereafter, we will enroll 180 Latino households of 3-5 people (n=720) from Kaiser Permanente members with at least two individuals with overweight or obesity, and at least 1 child aged 5-10 years of age, to participate in a 6-month randomized trial with a wait-list cross-over design. Based on the weekly menu plan, a grocery list will be generated, and items delivered to the home. Anthropometric measurements, blood pressure, dietary intake and blood samples for HbA1c, liver enzymes and lipids will be collected at baseline, 6, and 12 months. Each family will be expected to contribute $100/week, with the amount above this subsidized as an incentive for participation. Specific aims are: 1) Develop an affordable and culturally sensitive meal-planning and grocery delivery intervention for Latino households. 2) Determine the impact of food prescriptions and grocery delivery on parental obesity, diet quality and chronic disease risk. 3) Determine the impact of food prescriptions and grocery delivery on child obesity, diet quality and chronic disease risk. In a cross-center aim, data from this Project will be combined with Projects 1 and 2 to examine: 1) The multi-level determinants of chronic disease risk in Latino children; and 2) The effects of different types of family-based interventions and how social and environmental factors affect the response to intervention. If this approach proves effective, food prescriptions could provide a scalable and sustainable model to improve diet, health, and well-being in Latino families.