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

项目概要/摘要 水果和蔬菜中的营养素对正常的生长和发育、认知功能和 预防慢性疾病;然而，大多数美国儿童消耗较少的水果和蔬菜 比推荐的。有证据表明，获得新鲜、优质农产品的机会有限， 是充分消费的重大障碍，特别是在低收入青年中。补贴 医生为换取新鲜农产品而开的水果和蔬菜处方， 和负担能力的挑战，同时强调饮食在促进健康方面的重要作用。与童年 一直被认为是建立终身饮食模式的关键时期，初级保健 给年轻病人开新鲜水果和蔬菜处方的医生可能会影响他们的终身健康。 饮食行为我们的初步研究表明，孩子们全年都暴露在 水果和蔬菜处方计划，在每个办公室提供一个15美元的新鲜农产品处方 访问被认为对改善儿童饮食模式和家庭食品有效的处方 安全尽管美国儿科学会建议医生对所有患有 在儿童面临粮食不安全问题时，许多人既不进行筛查，也不积极解决根本问题。 因为缺乏资源来支持筛查呈阳性的家庭。我们建议，提供处方， 在每次办公室访问时向每个孩子提供水果和蔬菜，这超出了传统的营养教育， 与新鲜农产品的获取和可负担性有关的持续环境挑战。的目的 应用是为了解决与儿科水果和蔬菜处方的影响有关的知识空白 食品安全，儿童饮食模式和体重状况的计划。为此，我们将比较 来自一个低收入城市的三个大型诊所的人口统计学相似的儿科患者群体， 他们接触水果和蔬菜处方计划（FVPP），提供一个15美元的新鲜处方， 水果和蔬菜在每个孩子每次办公室访问。将根据儿童接触情况确定三个集群 基线时的儿童FVPP：高暴露（>24个月）、中等暴露（12-24个月）和无 以前的曝光。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、食物安全和体重状况随时间的变化。我们将检验这个假设， 暴露于FVPP与水果和蔬菜的摄入量较高，食品安全性较好， 儿童肥胖率。第一个目标是比较基线饮食摄入量，食品安全和体重 高暴露组、中等暴露组和无暴露组之间的状态。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、食品安全和体重状况变化 到FVPP。第三个目标将比较饮食摄入、食品安全和体重状况的后续措施 从最初的无接触组到高接触组的基线测量。

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.