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

DASH 杂货对城市食物沙漠黑人居民血压的影响

基本信息

批准号：
10362888
负责人：
STEPHEN P JURASCHEK
金额：
$ 88.26万
依托单位：
BETH ISRAEL DEACONESS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-06-18 至 2027-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10362888
关键词：
Address Adherence Adult Affect Behavior Behavioral Black race Blood Pressure Boston Calories Cardiovascular Diseases Cessation of life Cholesterol Clinical Clinical Trials Collaborations Communities Consultations Consumption Coupling Custom DASH diet Diet Dietary Intervention Dietitian Drops Eating Enrollment Ethnic group Fatty acid glycerol esters Food Food Selections Frequencies Goals Health Health Food Healthy Eating Home Hypertension Income Individual Inequality Intake Intervention Knowledge LDL Cholesterol Lipoproteins Low income Meat Methods National Institute on Minority Health and Health Disparities Outcome Palate Participant Patient Self-Report Pattern Pharmaceutical Preparations Pilot Projects Policies Potassium Preparation Qualitative Methods Race Randomized Randomized Controlled Trials Recommendation Reduce health disparities Research Research Personnel Risk Factors S-nitro-N-acetylpenicillamine Self-Direction Sodium Source Strategic Planning Stroke Supermarket Taste Perception Technology Testing Thinness Translations Unhealthy Diet United States Urban Community Urine Vulnerable Populations base blood pressure elevation blood pressure reduction cardiovascular disorder prevention cardiovascular disorder risk community based participatory research community clinic cost dietary disparity elimination efficacy trial feeding feeding plan food desert food preparation fruits and vegetables geographic barrier health disparity high risk population hypertension control improved income disparities innovation low socioeconomic status novel nutrition optimism patient oriented post intervention premature prevent primary outcome randomized trial saturated fat skills socioeconomics sugar sweetened beverage trend uptake urban dwelling virtual vulnerable community

项目摘要

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.”

血压升高 (BP) 和高血压在美国十分猖獗，影响了一半以上的人降低血压的干预措施可降低黑人成人患心血管疾病 (CVD)、中风和早产的风险。 DASH 饮食是一种均衡饮食计划，强调水果、蔬菜、低脂乳制品和瘦肉，可有效降低患有高血压的黑人成年人的血压，但黑人成年人的摄入量却很差。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尽管有许多教育举措鼓励成年人每天吃 7-9 份水果和食物。蔬菜，社会经济地位较低的成年人水果和蔬菜的平均消费量停滞不前每天 1.3 份，城市“食物荒漠”中的获取、成本和文化失调被认为是非常重要的。因此，迫切需要创新研究来制定改善健康饮食的策略。消费健康食品并减少生活在城市食物荒漠中的黑人成年人的健康差距。杂货配送方面的创新有可能大规模克服健康饮食的障碍随着大型技术公司的出现，它们拥有前所未有的采购和交付能力。能力，可以克服传统障碍并促进美味健康食品的选择然而，虚拟超市是否可以送货上门。在城市食物荒漠中有效改善饮食和血压的方法从未经过测试。我们将进行为期 12 周的个体水平随机试验，以确定完整饮食对健康的影响替换为通过营养师虚拟订购的送货上门、低钠、DASH 模式食品杂货我们的提案代表了与为城市社区提供服务的社区诊所的合作。与具有文化敏感性的膳食准备和基于社区的参与性研究的领导者进行协商，招募居住在当地城市食物荒漠中、血压升高或患有高血压的黑人成年人。每周通过 AmazonFresh 自主选择自己的食品杂货，遵循分配食物的模式 12 周后，我们根据 DASH 喂养计划，摄入超出其卡路里需求的量。将评估食品杂货对收缩压（主要结果）的影响，其次评估对 CVD 危险因素的影响（胆固醇）。我们的建议还包括 8 周的专门观察，以表征促进者和通过混合方法持续坚持 DASH 的障碍。该试验将建立一个可扩展的、以患者为导向的解决方案，克服难以获得健康食品和药物的问题从该提案中获得的知识与不断发展的美国食品直接相关。印记（SNAP）针对电子商务杂货的政策，并将为干预措施的迭代创新提供信息最终，我们的提案实现了一项主要战略重点： NIMHD 的科学研究旨在“开发和测试减少健康差距的干预措施”。