Wellness Check: Nutrition

Intensive program to support caretaker access to food improves diet of children

1. In this study, a 4-week intensive program to remove barriers in caretaker access to healthy food increased fruit and vegetable intake of children within the household.

2. Gift cards given as part of program did not increase intake of unhealthy food.

Evidence Rating Level: 1 (Excellent)

Nutritious diet is an important component of healthy development. Therefore, measures to remove barriers in accessing healthy food for low-income households are vital. Several different strategies for removing barriers have been tried. However, the effectiveness of wrap-around programs that simultaneously address several barriers has not been directly tested.

This randomized control trial tested whether caregiver access to fresh produce and additional resources for 4 weeks would result in improvement in diet of their children. The trial enrolled 68 low-income households in Texas, United States of America from May to July of 2021. Any family having at least 1 child in grades kindergarten through 5 were included. Any family with children with medical conditions precluding dietary changes were excluded. 31 families were in the intervention group, where they received food preparation tool and weekly boxes of fresh fruits and vegetables and $10.00 grocery gift cards for 4 weeks. The control group received an $80.00 gift card at the end of 8 weeks of data collection. The primary outcome was diet health measured using School Physical Activity and Nutrition (SPAN) Healthy Eating index at end of intervention period and 4 weeks after intervention.

Results demonstrated that compared to children in the control group, children in the intervention group had an average increase in times of eating fruits and vegetables by 2.07 times/day at end of intervention and 2.23 times/day at 4-weeks after intervention. However, this study was limited by the small sample size, which may preclude scaling up for future studies. Nonetheless, the maintenance of positive change in diet post intervention is promising and suggest these interventions should be considered as part of future strategies to improve nutrition in children in low-income households.

Subsidization of supermarkets may help reduce obesity risk in children

1. This study found that subsidization and subsequent access to neighborhood supermarkets may help reduce risk of obesity in children.

2. Changes in risk of obesity was observed when children lived less than 0.5 miles from supermarkets.

Evidence Rating Level: 2 (Good)

Childhood obesity is a rising public health crisis, with a higher prevalence among youth living in neighborhoods with lower socioeconomic status. Previous studies have suggested that among the various possible determinants of this association, proximity to a supermarket and subsequent access to healthy food options may mitigate the risk of obesity. However, the results have not been conclusive.

This study examined the association between placement or renovation of 8 subsidized supermarkets in New York City (NYC), United States, and body mass index (BMI) measures in NYC public school students enrolled in Kindergarten through Grade 12. The study group consisted of 11,356 students residing within 0.5 mile of a subsidized supermarket and the control group consisted of 43,372 students residing in similar neighborhoods but more than 0.5 mile from a supermarket (matched to study group by gender, age, grade, race and ethnicity, and poverty status). Subsidized markets were within neighborhoods with low number of grocery stores per capita and high poverty and unemployment rates. The primary outcome was changes in BMI, which was measured using data from NYC public school’s annual fitness assessment within 12 months before a supermarket opened (pre-intervention) and between 3-12 months after supermarket opened (post-intervention).

Results demonstrated that in the study group, there was a significant decrease in BMI score between pre-intervention and post-intervention period compared to control group (-0.04). A statistically significant decrease in obesity likelihood was also observed. However, this study was limited due to the lack of food and dietary purchasing data, in addition to lack of data relating to fresh food products available at intervention supermarkets. Nonetheless, these results support further strategic work that incorporates subsidized establishment or renovation of supermarkets as a more comprehensive plan to decrease risk of obesity in children living in socio-economically disadvantaged neighborhoods.

Improved diet quality may be associated with increased longevity and better aging in Israeli adults

1. In this study, improved diet quality amongst a cohort of Israeli adults was associated with successful aging and increased longevity. 

Evidence Rating Level: 2 (Good)

There is an expanding aging population in the United States (US) and worldwide, prompting increased attention to identifying determinants of successful aging. Previous studies have shown that healthy lifestyle and nutrition have been associated with longevity and better aging. However, studies that follow participants longitudinally and directly assessed successful aging are still needed.

This cohort study surveyed a random sample of 1770 Israeli citizens (53% women) 65 years or older at two timepoints: 1) between the year 2005 to 2006 (Time 1); 2) Survivors from Time 1 were subsequently contacted for a second interview between May 2017 to June 2019 (Time 2), of which 604 citizens participated. For assessment of nutrition, a 24-hour dietary recall was performed during Time 1 to calculate a Healthy Eating Index (HEI) score. During Time 2, successful aging was defined by preserved physical function, preserved cognitive function, favorable self-rated health, and mental well-being.

Between Time 1 and Time 2, 893 deaths occurred; however, the HEI score was inversely associated with mortality. In Time 2, 242 participants met all criteria for successful aging. After multivariable adjustment, there was a robust association between HEI score and odds ratio for successful aging. To account for further potential confounding, household income, body mass index (BMI) and comorbidities were used as covariates, which did not impact the association. However, this study was limited by the homogeneity of the study population as well as accuracy of nutritional status based on a 24-hour recall of dietary intake. Nonetheless, this study offers insight into the potential long-term benefit of higher quality nutrition in the aging population.

Image: PD

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