Effects of DASH Groceries on Blood Pressure in Black Residents of Urban Food Deserts

高血压和高血压在美国很猖獗，超过一半的人受到不成比例的影响 黑人成年人。降低血压的干预措施可降低心血管疾病(CVD)、中风和早产的风险 死亡。DASH饮食，强调水果、蔬菜、低脂乳制品和瘦肉的平衡饮食计划， 能有效降低患有高血压的黑人成年人的血压。然而，黑人成年人的吸烟率很低。 事实上，不健康的饮食是黑人高血压管理差异的最重要决定因素。 成年人。尽管许多教育倡议鼓励成年人每天吃7-9份水果和 蔬菜，社会经济地位较低的成年人对水果和蔬菜的平均消费停滞不前 每天1.3份。可获得性、成本和城市“食物沙漠”中的文化不和谐被认为是显著的。 健康饮食的障碍。因此，迫切需要创新研究来制定改进战略。 减少健康食品的消费，减少生活在城市食品沙漠的黑人成年人之间的健康差距。 食品杂货递送方面的新创新有可能克服大规模健康饮食的障碍 比例。随着大型科技型公司的出现，这些公司拥有前所未有的采购和交付 能力，有可能克服传统障碍，并促进美味的健康食品的选择 遍布城市黑人社区。然而，提供送货上门的虚拟超市是否可以 在城市食品沙漠中有效改善饮食和BP的杠杆作用从未经过测试。 我们将进行为期12周的个人水平的随机试验，以确定完全饮食对健康的影响 取而代之的是由营养师虚拟订购的自制、低钠、精致的杂货 援助。我们的提案代表了与服务于城市社区的社区诊所的合作伙伴关系 与文化敏感的餐饮准备和基于社区的参与性研究的领导人进行磋商，以 招募生活在当地城市食物沙漠中、血压升高或高血压的黑人成年人。参与者将拥有 自主通过AmazonFresh每周选择自己的食品杂货，遵循一种分配食物的模式 按DASH喂养计划分组，摄入的热量超过他们的卡路里需求。12周后，我们 将评估食品对收缩压(主要结局)和次要心血管疾病危险因素的影响 (胆固醇)。我们的提案还包括为期8周的专门观察，以确定促进者和 通过混合方法持续坚持冲刺的障碍。 这项试验将建立一个可扩展的、以患者为中心的解决方案，以克服难以获得健康食品的问题，并 解决健康差距问题。从这项提议中获得的知识与美国食品的进化直接相关 印花(SNAP)电子商务杂货政策，并将在干预措施方面提供迭代创新信息， 减少黑人成年人的饮食差异。最终，我们的建议实现了以下重大战略优先事项 NIMHD用于科学研究，以“开发和测试干预措施，以减少健康差距。”

Elevated blood pressure (BP) and hypertension are rampant in the US, disproportionately affecting over half of black adults. Interventions that lower BP reduce risk of cardiovascular disease (CVD), stroke, and premature death. The DASH diet, a balanced eating plan that emphasizes fruits, vegetables, low fat dairy, and lean meats, is efficacious in lowering BP among black adults with hypertension. However, uptake among black adults is poor. In fact, unhealthy diet is the most significant determinant of disparities in hypertension management among black adults. Despite numerous educational initiatives encouraging adults to eat 7-9 daily servings of fruits and vegetables, average consumption of fruits and vegetables by adults of lower socioeconomic status has stagnated at 1.3 servings daily. Access, cost, and cultural dissonance in urban "food deserts" have been cited as significant barriers to healthier eating. Thus, innovative research is urgently needed to devise strategies that improve consumption of healthy foods and reduce health disparities among black adults living in urban food deserts. Novel innovations in grocery delivery have the potential to overcome barriers to healthy eating on a massive scale. With the advent of large technology-based companies, which have unprecedented sourcing and delivery capabilities, it is possible to overcome traditional barriers and facilitate choice of palatable healthy foods throughout urban black communities. However, whether virtual supermarkets with home delivery can be leveraged to meaningfully improve diet and BP in an urban food desert has never been tested. We will perform a 12-week individual-level, randomized trial to determine the health effects of complete dietary replacement with home-delivered, low-sodium, DASH-pattern groceries ordered virtually with dietitian assistance. Our proposal represents a partnership with community clinics serving urban communities in consultation with leaders in culturally sensitive meal preparation and community-based participatory research to enroll black adults living in local urban food deserts with elevated BP or hypertension. Participants will have autonomy to choose their own groceries weekly through AmazonFresh, following a pattern that portions food groups according to the DASH feeding plan at an amount that exceeds their Calorie needs. After 12 weeks, we will assess the effects of the groceries on systolic BP (primary outcome) and secondarily on CVD risk factors (cholesterol). Our proposal also includes 8 weeks of dedicated observation to characterize facilitators and barriers of sustained DASH adherence via mixed methods. This trial will establish a scalable, patient-oriented solution that overcomes poor access to healthful foods and addresses health disparities. Knowledge to be gained from this proposal is directly relevant to evolving U.S. food stamp (SNAP) policy toward e-commence groceries and will inform iterative innovation on interventions that reduce dietary disparities among black adults. Ultimately, our proposal accomplishes a major strategic priority of the NIMHD for scientific research to “develop and test interventions to reduce health disparities.”