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

在多代拉丁裔家庭中推广符合 RDA 的负担得起的饮食的食品处方

• 批准号: 10494271
• 负责人: Deborah A Cohen
• 金额: $ 74.95万
• 依托单位: CHILDREN'S HOSPITAL OF LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10494271
• 关键词: 10 year old; Address; Adult; Affect; Age; Blood Pressure; Blood specimen; Body Weight decreased; Body mass index; Budgets; California; Child; Child Health; Chronic; Chronic Disease; Code; Crossover Design; Cues; Data; Development; Diet; Dietary intake; Dyslipidemias; Eating; Economics; Enrollment; Environmental Risk Factor; Enzymes; Family; Family member; Focus Groups; Food; Generations; Glycosylated hemoglobin A; Goals; Guidelines; Health; Home; Home environment; Household; Impulsivity; Incentives; Individual; Intervention; Latino; Latino Population; Link; Lipids; Liver; Logistics; Los Angeles; Low income; Marketing; Measurement; Mental Fatigue; Menu Planning; Modeling; Neighborhoods; New York City; Non-Insulin-Dependent Diabetes Mellitus; Nutrient; Nutritional; Obesity; Overweight; Participant; Personal Satisfaction; Persons; Pilot Projects; Population; Prediabetes syndrome; Process; Randomized Clinical Trials; Randomized Controlled Trials; Recommended Dietary Allowance; Research Personnel; Restaurants; Risk; Risk Reduction; Sex Behavior; Supermarket; Testing; Unhealthy Diet; United States Department of Agriculture; Waiting Lists; Weight; Weight maintenance regimen; aged; base; blood lipid; blood pressure reduction; cognitive function; community engagement; cost; dietary; disorder risk; efficacy testing; health disparity; improved; intervention delivery; liver function; member; negative affect; non-alcoholic fatty liver disease; nutrition; obesity in children; primary outcome; programs; randomized trial; response; secondary outcome; service delivery; social; social factors; sugar; trend; weight maintenance

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.

拉丁裔家庭受肥胖、2 型糖尿病、非酒精性脂肪肝的影响尤为严重 疾病、血脂异常。饮食是一个主要影响因素，不良饮食在很大程度上是由环境造成的 线索，包括餐厅份量大以及低营养、高加工和高品质的积极营销 糖类食品。在低收入社区尤其如此，那里的不健康产品的营销和可用性 食物更为突出。此外，超市的营销、折扣和促销策略往往 促使购物者购买低营养的随意食品或过量购买。一种有前途的方法 解决这些造成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 该方法的前提是修改家庭环境中的上下文线索，而不是依赖自我 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的效果 一项随机对照试验中的送货服务，旨在改善饮食质量、体重控制和慢性病风险 在多代拉丁裔家庭中。食品处方将满足 EAT-Lancet 可持续发展要求 指南并实现所有家庭 23 种关键营养素推荐膳食摄入量的至少 90% 会员，每月费用不超过 680 美元，目前 CalFresh（加利福尼亚州的 SNAP）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定制的份量指示。我们 将开发和验证我们的菜单，并与超重或超重的拉丁裔成年人焦点小组一起测试物流 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) 会员中至少有两名超重或肥胖者，以及至少一名 5 至 10 岁的儿童， 参加一项为期 6 个月的随机试验，采用等待名单交叉设计。根据每周的菜单计划， 将生成购物清单，并将物品运送到家。人体测量、血压、 将在基线、6 点和 12 点收集膳食摄入量以及 HbA1c、肝酶和脂质的血液样本 几个月。每个家庭每周需缴纳 100 美元，高于此金额的部分将作为补贴 参与激励。具体目标是： 1) 制定负担得起且文化敏感的膳食计划和 对拉丁裔家庭的杂货配送干预。 2) 确定食品处方和杂货的影响 提供有关父母肥胖、饮食质量和慢性病风险的信息。 3) 确定食物处方的影响 杂货配送对儿童肥胖、饮食质量和慢性病风险的影响。在跨中心目标中，来自此的数据 项目将与项目1和2结合起来研究：1）慢性病的多层次决定因素 拉丁裔儿童的风险； 2) 不同类型的家庭干预措施的效果以及社会和干预措施如何影响 环境因素影响对干预的反应。如果这种方法被证明有效，食物处方 可以提供一个可扩展且可持续的模式来改善拉丁裔家庭的饮食、健康和福祉。