Innovative Nutrition Practices in Pediatric Health Care: Assessment of a Fruit and Vegetable Prescription Program for Children in Need

项目摘要/摘要 水果和蔬菜中的营养物质对正常的生长发育、认知功能和 预防慢性病；然而，大多数美国儿童摄入的水果和蔬菜较少 比建议的要高。有证据表明，新鲜、高质量农产品的有限获得和负担能力 这是适当消费的重大障碍，特别是在低收入青年中。有补贴 由医生开具的水果和蔬菜处方，以换取新鲜农产品，地址访问 和负担能力挑战，同时强调饮食在促进健康方面的重要作用。带着童年 一贯被认为是建立终身饮食模式的关键时期，初级保健 给年轻患者开新鲜水果和蔬菜的医生很可能会影响终生 饮食行为。我们的初步工作表明，其子女长期接触 水果和蔬菜处方计划，为每个办公室的新鲜农产品提供一张15美元的处方 拜访感知到的处方，以有效改善儿童饮食模式和家庭食物 保安。尽管美国儿科学会建议医生对所有患有 对于粮食不安全的儿童，许多人没有筛查，也没有在解决根本问题方面发挥积极作用 由于缺乏资源来支持筛查呈阳性的家庭。我们建议提供一张处方给 在每一次办公室访问中向每一个孩子提供水果和蔬菜超越了传统的营养教育 与新鲜农产品的可获得性和可负担性有关的持续环境挑战。这样做的目的是 应用是解决与儿科水果和蔬菜处方的影响相关的知识空白 关于食品安全、儿童饮食模式和体重状况的计划。要做到这一点，我们将比较 来自低收入城市三家大型诊所的人口学相似的儿科患者群体 他们接受了水果和蔬菜处方计划(FVPP)，该计划为新鲜水果提供一张15美元的处方 在每一次办公室探视时，给每一个孩子提供水果和蔬菜。将根据儿童暴露情况确定三个群组 对于基线时的儿科FVPP：高暴露(24个月)、中等暴露(12-24个月)和无 以前接触过的。然后，我们将向从未暴露过的患者介绍FVPP，并收集、记录和 比较饮食摄入量、食品安全和体重状况随时间的变化。我们将检验这一假设 接触FVPP与更高的水果和蔬菜摄入量、更好的食品安全性和更低的 儿童肥胖率。第一个目标是比较基线饮食摄入量、食物安全和体重 状态介于高暴露、中等暴露、无暴露组之间。第二个目标将衡量 新暴露儿童在6个月、12个月、18个月和24个月时的饮食、食物安全和体重状况的变化 敬自由人民党。第三个目标是比较饮食摄入量、食品安全和体重状况的后续指标。 在初始无暴露组中测量基线，在高暴露组。

Project Summary/Abstract Nutrients in fruits and vegetables are critical for proper growth and development, cognitive function, and prevention of chronic disease; however, most US children consume fewer servings of fruits and vegetables than recommended. Evidence suggests that limited access to and affordability of fresh, high-quality produce are significant barriers to adequate consumption, particularly among low-income youth. Subsidized prescriptions for fruits and vegetables, written by physicians in exchange for fresh produce, address access and affordability challenges while emphasizing the vital role of diet in health promotion. With childhood consistently identified as a critical period for the establishment of lifelong dietary patterns, primary care physicians who prescribe fresh fruits and vegetables to their young patients are likely to influence lifelong dietary behaviors. Our preliminary work suggests that caregivers whose children were exposed to a year-round fruit and vegetable prescription program that provided one $15 prescription for fresh produce at every office visit perceived prescriptions to be effective in improving child dietary patterns as well as household food security. Although American Academy of Pediatrics recommends that physicians screen all households with children for food insecurity, many do not screen nor play an active role in addressing the underlying problem due to lack of resources to support families who screen positive. We suggest that providing a prescription for fruits and vegetables to every child at every office visit goes beyond traditional nutrition education to address persistent environmental challenges related to access and affordability of fresh produce. The objective of this application is to address gaps in knowledge related to the influence of pediatric fruit and vegetable prescription programs on food security, child dietary patterns, and weight status. To do this, we will compare demographically similar pediatric patient groups from three large clinics in a low-income urban city based on their exposure to a fruit and vegetable prescription program (FVPP) that provides one $15 prescription for fresh fruits and vegetable to every child at every office visit. Three clusters will be identified based on child exposure to the pediatric FVPP at baseline: high exposure (>24 months), moderate exposure (12-24 months), and no previous exposure. We will then introduce the FVPP to never exposed patients and collect, record, and compare changes in dietary intake, food security, and weight status over time. We will test the hypothesis that exposure to the FVPP is associated with higher intake of fruits and vegetables, better food security, and lower rates of obesity among children.The first aim will compare baseline dietary intake, food security, and weight status between high exposure, moderate exposure, no exposure groups. The second aim will measure changes in diet, food security, and weight status at 6-, 12-, 18-, and 24-months among children newly exposed to the FVPP. The third aim will compare follow-up measures of dietary intake, food security, and weight status in the initial no exposure group to baseline measures in the high exposure group.