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

拉美裔家庭受肥胖、2型糖尿病、非酒精性脂肪肝的影响不成比例 疾病和血脂异常。饮食是一个主要的因素，糟糕的饮食在很大程度上是由环境因素驱动的 暗示，包括餐厅的大量食物以及对低营养、深加工和高营养食品的积极营销 甜食。在低收入社区尤其如此，那里的营销和不健康的可获得性 食物是更突出的。此外，超市的营销、折扣和促销策略往往 敦促购物者购买低营养的非必需食品或过量购买。一种很有希望的方法 解决这些导致慢性病风险差异的营养、社会和经济因素的概念是 食品处方，其中包括菜单规划和负担得起的营养食品的送货上门。这 这种方法的前提是修改家庭环境中的上下文线索，而不是依赖于自我 监管控制。项目3将测试对文化敏感的饮食计划和负担得起的食品杂货的效果。 一项随机对照试验的分娩服务，以改善饮食质量、体重控制和慢性病风险 在多代拉美裔家庭中。食品处方将满足Eat-Lancet的可持续性 指导方针，并为所有家庭提供至少90%的23种关键营养素的推荐膳食摄入量 会员，费用不超过680美元/月，加州SNAP(加州SNAP)目前对一个家庭的预算 四。我们将包括基于年龄、性别、活动水平和体重目标的量身定做的指导。我们 将开发和验证我们的菜单，并与超重或肥胖的拉丁裔成年人的重点小组一起测试物流 肥胖。此后，我们将从Kaiser Permanente招收180个3-5人的拉丁裔家庭(n=720) 会员至少有两名超重或肥胖人士，以及至少一名5-10岁儿童，至 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，a 将生成杂货清单，并将物品送货上门。人体测量，血压， 饮食摄入量和HbA1c、肝酶和血脂的血样将在基线、6和12收集 月份。预计每个家庭每周将贡献100美元，超过这一数额的家庭将作为 参与激励。具体目标是：1)制定负担得起和对文化敏感的餐饮计划和 为拉丁裔家庭提供食品杂货送货干预。2)确定食品处方和食品杂货的影响 分娩对父母肥胖、饮食质量和慢性病风险的影响。3)确定食品处方的影响 和杂货店送货对儿童肥胖、饮食质量和慢性病风险的影响。在跨中心的AIM中，来自此的数据 项目将与项目1和项目2相结合，以审查：1)慢性病的多层次决定因素 2)不同类型的以家庭为基础的干预措施的影响，以及社会和 环境因素影响对干预的反应。如果这种方法被证明是有效的，那么食物处方 可以为改善拉美裔家庭的饮食、健康和福祉提供一个可扩展和可持续的模式。

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.