A Six-Week Cooking Program of Plant-Based Recipes Improves Food Security, Body Weight, and Food Purchases for Food Pantry Clients

Pilot study of a heart-healthy food box intervention for Native Americans with uncontrolled hypertension: methods and results from the Chickasaw Healthy Eating Environments Research Study

We sought to evaluate the acceptability and feasibility of a culturally tailored food box intervention for improving blood pressure (BP), food security and Body Mass Index (BMI) among Chickasaw Nation adults with uncontrolled hypertension. As part of the Chickasaw Healthy Eating Environments Research Study (CHEERS), we administered a group randomized pilot study in four tribal communities (two intervention, two control). Participants in the intervention communities received six heart-healthy food boxes, culturally tailored to traditional Chickasaw diet and current food context. Outcomes were measured over 6 months. We enrolled 262 participants, and 204 with complete data on key variables were included in the analysis. The food boxes were very popular, and we achieved high retention for follow-up data collection. Intervention community participants had 2.6 mmHg lower mean systolic BP and improved diet quality and BMI compared with control participants, although, as expected for a pilot study, the differences were not statistically significant. The culturally tailored diet intervention and randomized trial study design were acceptable and feasible for Chickasaw Nation adults with uncontrolled hypertension. Our findings support the value of tribal-food bank partnerships as a potential approach for reducing food insecurity and hypertension-related disparities in Native American communities.

Trends in Plant-Based Diets and the Associated Health Characteristics among Canadians

In Canada, unhealthy dietary patterns comprise diets with poor nutrient density and are associated with chronic conditions. Plant-based diets have gained popularity due to their ability to provide a nutritionally adequate healthy diet. This study aims to compare sociodemographic, socioeconomic, and health characteristics, and diet quality between Canadian adults following plant-based and omnivore diets as well as assess the extent to which key nutrient intakes are of public health concern among Canadians following plant-based diets. The study used nationally representative nutritional data from the 2015 Canadian Community Health Survey and descriptive statistics were computed. The analysis determined that Canadians following strict plant-based diets (1% of total population) were significantly more likely to be an immigrant to Canada, less likely to meet national physical activity guidelines, and less likely to be overweight, compared to Canadians following omnivore diets. Compared to omnivore diets, plant-based diets were nutritionally superior according to the Nutrient-Rich Food index. Continued knowledge translation on what comprises healthy plant-based diets, public guidance on the intersection between diet and health, and the completion of prospective cohort studies are needed. To conclude, the research suggests well-planned plant-based diets, in comparison to omnivore diets, offer a nutrient-dense diet.

What motivates German consumers to reduce their meat consumption? Identifying relevant beliefs

High levels of meat consumption cause problems related to public health, the environment, and animal welfare. Therefore, it is crucial to improve our understanding of the drivers and barriers involved in reducing meat consumption. Using the Theory of Planned Behavior (TPB), we examined to what extent attitude, subjective norm, and perceived behavioral control (PBC) affect intention and willingness to reduce meat consumption. In line with the TPB and going beyond existing literature, we also explored which specific beliefs determine these three constructs. In 2021, we conducted an online survey with a sample representative of the German population (N = 1093). Hierarchical regression models revealed that after controlling for sociodemographic characteristics, the TPB constructs explained 55% of the variance in intention and 61% of the variance in willingness. Importantly, each of the three TPB constructs affected intention and willingness to reduce meat consumption, with attitude having the largest impact. Habit strength and past behavior in addition to the TPB constructs did not improve prediction. Multiple linear regression models showed that attitude was determined by the beliefs that reducing meat consumption leads to a healthier diet, a reduced risk of developing certain diseases, a more natural diet, and the feeling of missing meat. In contrast, environmental and animal welfare concerns showed no significant effect on attitude. Both family and friends contributed to the perceived social pressure. The beliefs of being able to prepare meat-free meals, having enough time to spend on one's diet, and being able to easily purchase meat substitutes led to higher PBC. Based on these findings, we provide recommendations for intervention strategies and derive implications for future research.

Is Extra Virgin Olive Oil the Critical Ingredient Driving the Health Benefits of a Mediterranean Diet? A Narrative Review

Most chronic diseases are preventable with a healthy diet, although there is debate about the optimal dietary approach. Increasingly more countries are focusing on food-based guidelines rather than the traditional nutrient-based approach. Although there is good agreement on plant foods, controversy remains about the types and amounts of fats and oils. This narrative review aims to systematically summarize and evaluate the latest evidence on the protective effects of extra virgin olive oil (EVOO) on disease risk factors. A systematic search of the relevant literature using PubMed, Cochrane Library, and Embase databases was conducted for the years 2000 through December 2022. A narrative synthesis was then undertaken. Of 281 retrieved articles, 34 articles fulfilled our inclusion criteria and were included. Compared with other dietary fats and low-fat diets, EVOO is superior in the management of clinical biomarkers including lowering blood pressure and LDL-c, increasing protective HDL-c, improving glycemic control, and weight management. The protective effects of EVOO are likely due to its polyphenol content rather than the monounsaturated fat content. It is therefore important to promote the regular use of EVOO in the context of healthy dietary patterns such as the Mediterranean diet for maximal health benefit.

Achieving a healthy home food environment: perspectives on parents' nutrition education needs when living with food insecurity

Purpose

The familial food environment is influenced by many factors, including food insecurity, food accessibility, and foods accepted by the family. These factors can facilitate or hinder caregivers' ability to support a healthy home food environment. The aim of this research was to explore the barriers to, perspectives on, and nutrition education needs identified by food-insecure parents which would then inform a community-based nutrition education program.

Methods

A qualitative study used focus group data that were recorded, transcribed verbatim, and analyzed using a constant comparison approach to categorize the emerging themes.

Results

Emergent themes: (1) Cooking confidence deficit; (2) Healthy meal preparation barriers; (3) Healthy meal acceptance barriers; (4) Meal planning, management, and adaptability. These themes suggest that supporting a healthy home food environment is connected to both food knowledge and competencies, known as food literacy.

Conclusion

Food literacy competency should be assessed before nutrition education program implementation within community settings.

Outcomes of Cooking Matters for Diabetes: A 6-week Randomized, Controlled Cooking and Diabetes Self-Management Education Intervention

BACKGROUND

Diabetes self-management education and support is the cornerstone of diabetes care, yet only 1 in 2 adults with diabetes attain hemoglobin A1c (HbA1c) targets. Food insecurity makes diabetes management and HbA1c control more difficult.

OBJECTIVE

Our aim was to test whether a cooking intervention with food provision and diabetes self-management education and support improves HbA1c and diabetes management.

DESIGN

This was a waitlist-controlled, randomized trial.

PARTICIPANTS/SETTING

Participants were 48 adults with type 1 or type 2 diabetes.

INTERVENTION

Cooking Matters for Diabetes was adapted from Cooking Matters and the American Diabetes Association diabetes self-management education and support intervention into a 6-week program with weekly food provision (4 servings).

MAIN OUTCOME MEASURES

Surveys (ie, Summary of Diabetes Self-Care Activities; Medical Outcomes Study Short Form Health Survey, version 1; Diet History Questionnaire III; 10-item US Adult Food Security Survey Module; and Stanford Diabetes Self-Efficacy Scale) were administered and HbA1c was measured at baseline, post intervention, and 3-month follow-up.

STATISTICAL ANALYSIS

Mixed-effects linear regression models controlling for sex and study wave were used.

RESULTS

Mean (SD) age of participants was 57 (12) years; 65% identified as female, 52% identified as White, 40% identified as Black, and 19 (40%) were food insecure at baseline. Intervention participants improved Summary of Diabetes Self-Care Activities general diet score (0 to 7 scale) immediately post intervention (+1.51; P = .015) and 3 months post intervention (+1.23; P = .05), and improved Medical Outcomes Study Short Form Health Survey, version 1, mental component score (+6.7 points; P = .025) compared with controls. Healthy Eating Index 2015 total vegetable component score improved at 3 months (+0.917; P = .023) compared with controls. At baseline, food insecure participants had lower self-efficacy (5.6 vs 6.9 Stanford Diabetes Self-Efficacy Scale; P = .002) and higher HbA1c (+0.77; P = .025), and demonstrated greater improvements in both post intervention (+1.2 vs +0.4 Stanford Diabetes Self-Efficacy Scale score; P = .002, and -0.12 vs +0.39 HbA1c; P = .25) compared with food secure participants.

CONCLUSIONS

Cooking Matters for Diabetes may be an effective method of improving diet-related self-care and health-related quality of life, especially among food insecure patients, and should be tested in larger randomized controlled trials.

Campus Food Pantry Use Is Linked to Better Health Among Public University Students

OBJECTIVE

To examine retrospectively whether access to a campus food pantry (CFP) is related to improvements in sleep, mental health, and physical health among college students in a public university system.

DESIGN

Retrospective, cross-sectional study of student CFP users who completed an online survey in the summer of 2019.

SETTING

Ten-campus University of California system.

PARTICIPANTS

A total of 1,855 students completed the survey.

MAIN VARIABLES MEASURED

Students reported the number of CFP visits in a usual week or month. Students retrospectively rated their perceived health, depressive symptoms, and sleep sufficiency before and after having food pantry access. The difference between pre- and post-food pantry access responses was calculated.

ANALYSIS

Path analysis was used to examine direct and indirect paths of the relationship between CFP visits with self-reported changes in depressive symptoms and perceived health through positive changes in self-reported sleep sufficiency, controlling for sociodemographic factors.

RESULTS

More monthly CFP visits were directly related to decreased depressive symptoms and improved perceived health (β_depressive = 0.10, P < 0.001; β_health = 0.12, P < 0.001). In addition, more CFP visits were related to improved sleep sufficiency (β = 0.09, P = 0.001), which in turn was related to a decrease in depressive symptoms (β = 0.24, P = 0.001; indirect effect: 0.02, P < 0.01) and improved perceived health (β = 0.23, P < 0.001; indirect effect: 0.02, P < 0.01).

CONCLUSIONS AND IMPLICATIONS

Findings suggest that college campus emergency food access is associated with self-reported improvements in student health outcomes associated with food security. Until more long-term solutions that improve college student nutrition are developed, food pantries may be filling a gap.

Increasing Access to Healthy Foods through Improving Food Environment: A Review of Mixed Methods Intervention Studies with Residents of Low-Income Communities

Food insecurity is a broad and serious public health issue in the United States, where many people are reporting lack of access to healthy foods. The reduced availability of healthy, affordable foods has led to increased consumption of energy-dense and nutrient-poor foods, resulting in increasing the risk for many chronic diseases such as obesity, cardiovascular diseases, and type 2 diabetes mellitus. Thus, identifying promising approaches to increase access to healthy foods through improving the food environment is of importance. The purpose of this review article is to highlight how the food environment affects directly a person’s food choices, and how to increase access to healthy foods through improving environmental approaches. The literature search was focused on finding different approaches to improve food security, primarily those with an impact on food environment. Overall, potential solutions were gathered through multilevel environmental approaches, including nutrition education and peer education, community-based participatory research, and policy changes in supplemental nutrition programs. A recommendation to reduce food insecurity is learning to create meals with a variety of seasonal fruits and vegetables purchased from affordable farmers’ markets.

Nutrition Environment at Food Pantries Improves After Fresh Produce Donation Program

OBJECTIVE

To evaluate the influence of the Growing Together Illinois fresh produce donation program and understand factors that affect produce distribution at participating food pantries.

METHODS

In this intervention at 17 Illinois food pantries, Master Gardeners supported food donation gardens, and Supplemental Nutrition Assistance Program Education provided educational and environmental interventions to increase selection and use of fresh produce. This mixed-methods pre-post study assessed pantry characteristics and program impact via Nutrition Environment Food Pantry Assessment Tool evaluations, interview feedback from pantry staff, and structured pantry observations.

RESULTS

Pantries experienced significant increases from preintervention to postintervention in providing various types of produce, marketing and nudging healthful products, providing additional resources, and total Nutrition Environment Food Pantry Assessment Tool scores. Participants had positive feedback about the program and educational interventions and reported the weekly timing of donations mitigated potential storage and spoilage issues.

CONCLUSIONS AND IMPLICATIONS

Future research could focus on approaches to increase fresh produce in food pantries while supporting clients via nutrition and cooking education.

Impact of Enhanced Food Pantry Services on Food Security among Adults with Diabetes Using a Crossover Study Design

Food banks and pantries provide food to millions of food-insecure households each year. However, there has been limited research to understand the extent to which they improve food security. This is a secondary, prespecified analysis of a randomized controlled trial (ClinicalTrials.gov ID: NCT02569060). We examined whether an enhanced food bank intervention impacted the food security status of adults with diabetes. Using a crossover design, participants (n = 568) were randomly assigned to receive the intervention (usual pantry services plus twice-monthly diabetes-specific food boxes, diabetes self-management education, health care referrals, and glucose monitoring) or 6 mo of usual services. Results demonstrate a statistically significant improvement in food insecurity among participants following the intervention phase compared with the control phase (mean: 0.49-point decrease; 95% CI: 0.21, 0.77; P = 0.0006). This finding adds to evidence that the charitable food system plays an important role in mitigating short-term food insecurity for adults with diabetes.

Barriers and Facilitators in Preparation and Consumption of African Indigenous Vegetables: A Qualitative Exploration From Kenya

Malnutrition and food security continue to be major concerns in sub-Saharan Africa (SSA). In Western Kenya, it is estimated that the double burden of malnutrition impacts 19% of adults and 13–17% of households. One potential solution to help address the concern is increased consumption of nutrient-dense African Indigenous Vegetables (AIVs). The objectives of this study were to: (i) document current methods used for preparation and consumption of AIVs; (ii) identify barriers and facilitators of AIVs consumption and preparation; and (iii) identify a package of interventions to increase the consumption of AIVs to promote healthy diets. This study used qualitative data collected from 145 individual farmers (78 female and 67 male) in 14 focus group discussions (FGDs) using a semi-structured survey instrument. Most farmers reported that they prepared AIVs using the traditional method of boiling and/or pan-cooking with oil, tomato, and onion. However, there were large discrepancies between reported cooking times, with some as little as 1–5 min and others as long as 2 h. This is of importance as longer cooking times may decrease the overall nutritional quality of the final dish. In addition, there were seasonal differences in the reported barriers and facilitators relative to the preparation and consumption of AIVs implying that the barriers are situational and could be modified through context-specific interventions delivered seasonally to help mitigate such barriers. Key barriers were lack of availability and limited affordability, due to an increase cost, of AIVs during the dry season, poor taste and monotonous diets, and perceived negative health outcomes (e.g., ulcers, skin rashes). Key facilitators included availability and affordability during peak-season and particularly when self-produced, ease of preparation, and beneficial health attributes (e.g., build blood, contains vitamins and minerals). To promote healthy diets within at risk-populations in Western Kenya, the findings suggest several interventions to promote the preparation and consumption of AIVs. These include improved household production to subsequently improve affordability and availability of AIVs, improved cooking methods and recipes that excite the family members to consume these dishes with AIVs, and the promotion of the beneficial heath attributes of AIVs while actively dispelling any perceived negative health consequences of their consumption.

Identifying effective interventions to promote consumption of protein-rich foods from lower ecological footprint sources: A systematic literature review

Addressing overconsumption of protein-rich foods from high ecological footprint sources can have positive impacts on health such as reduction of non-communicable disease risk and protecting the natural environment. With the increased attention towards development of ecologically sustainable diets, this systematic review aimed to critically review literature on effectiveness of those interventions aiming to promote protein-rich foods from lower ecological footprint sources. Five electronic databases (Medline, Web of Science, Scopus, Embase and Global Health) were searched for articles published up to January 2021. Quantitative studies were eligible for inclusion if they reported on actual or intended consumption of protein-rich animal-derived and/or plant-based foods; purchase, or selection of meat/plant-based diet in real or virtual environments. We assessed 140 full-text articles for eligibility of which 51 were included in this review. The results were narratively synthesised. Included studies were categorised into individual level behaviour change interventions (n = 33) which included education, counselling and self-monitoring, and micro-environmental/structural behaviour change interventions (n = 18) which included menu manipulation, choice architecture and multicomponent approaches. Half of individual level interventions (52%) aimed to reduce red/processed meat intake among people with current/past chronic conditions which reduced meat intake in the short term. The majority of micro-environmental studies focused on increasing plant-based diet in dining facilities, leading to positive dietary changes. These findings point to a clear gap in the current evidence base for interventions that promote plant-based diet in the general population.

Differences between Vegetarians and Omnivores in Food Choice Motivation and Dietarian Identity

Vegetarianism is on the rise worldwide and its importance is being emphasized in various ways, such as in its sustainability, environmental, food system, and ethical aspects. The purpose of the study is to identify motivations behind food choices and dietarian identity, to investigate the perceptions about plant-based foods, and to identify differences between vegetarians and omnivores. We conducted an online survey of 245 vegetarians and 246 omnivores. There was a significant difference between vegetarians and omnivores. In food choice motivations, vegetarians scored higher in the factors of ‘ethical concern’, ‘health’, and ‘convenience and price’, while omnivores responded higher in ‘sensory appeal’ and ‘weight control’ factors. In the dietarian identity, vegetarians scored higher in the ‘complex motivation’ and ‘strictness’ factors, while on the other hand omnivores scored higher in ‘out-group regard’ and ‘public regard’ factors. Although the reasons can be different, we confirmed that both vegetarians and omnivores are positive toward plant-based foods. Our results suggest that different strategies will be needed to promote plant-based food consumption to vegetarians and to omnivores.

Insights about interventions to address food insecurity in adults with type 2 diabetes: Valuable lessons from the stories of African Americans living in the inner city

OBJECTIVES

This qualitative study aimed to gain insight from the perspectives of food insecure African Americans living in an inner city regarding important diabetes intervention strategies and components.

METHODS

Using a grounded theory approach, two focus groups (totaling 16 individuals) were conducted in Milwaukee, Wisconsin. Purposive, convenience sampling was used to identify food insecure adults with diabetes. Questions were asked using a moderator guide to explore challenges and barriers to managing diabetes within the context of food insecurity, and facilitators or resources that helped participants improve diabetes management. Questions were open ended and followed by probes asking for additional perspectives and personal experiences related to the overarching topic, and questions asking to clarify statements.

RESULTS

Overarching concepts and themes specific to possible interventions discussed during the focus groups included group education, peer support, access to community resources and programs, stress management, and faith-based programs as desired intervention outcomes.

CONCLUSIONS

Key findings from the current study show that inner-city African Americans with diabetes desire interventions that foster social and community support systems.

PRACTICE IMPLICATIONS

Given this insight, more robust and comprehensive interventions are needed to account for the multifaceted experience of food insecurity and diabetes within the inner-city environment.

Towards reduced meat consumption: A systematic literature review of intervention effectiveness, 2001-2019

A reduction of meat consumption and shift to plant-based diets, especially in industrialized countries, is acknowledged as crucial for reaching climate targets, addressing public health problems, and protecting animal welfare. While scholarly research distilled drivers of meat consumption and barriers to its reduction, insights into the effectiveness of measures to initiate such a profound change in consumer behaviour are relatively scarce. This paper presents a systematic literature review on consumption-side interventions in the context of meat consumption across scholarly disciplines. Our analysis confirms that existing research predominantly assessed interventions addressing personal factors of behavioural change such as knowledge and emotions. Whether these interventions are effective depends on whether information (i) is provided on health, animal welfare or environmental effects, (ii) is emotionally or cognitively framed, and (iii) is aligned with consumers' information needs. Moreover, linking meat to living animals or to the humanness of animals activates negative emotions and, thus, reduces meat consumption. Further, increasing the visibility and variety of vegetarian dishes in food environments decreases meat-eating. Also, educational courses on how to shop and cook vegetarian food are effective in reducing meat consumption. There is less evidence on the effectiveness of interventions addressing socio-cultural factors such as social norms. Regarding future research directions, existing research mainly investigated the influence of interventions on attitudes and behavioural intentions. Hence, there is still a need for studies to assess more long-term effects of intervention measures on actual meat consumption and their potential to initiate fundamental changes in dietary habits.

Protocol for the Rhode Island CORD 3.0 Study: Adapting, Testing, and Packaging the JOIN for ME Family-Based Childhood Obesity Program in Low-Income Communities

Background: Overweight and obesity in children is a public health crisis in the United States. Although evidence-based interventions have been developed, such programs are difficult to access. Dissemination of evidence-based pediatric weight management interventions (PWMIs) to families from diverse low-income communities is the primary objective of the CDC Childhood Obesity Research Demonstration (CORD) projects. Methods: The goal of the Rhode Island CORD 3.0 project is to adapt the evidence-based PWMI, JOIN for ME, for delivery among diverse families from low-income backgrounds and to test it in a hybrid effectiveness-implementation trial design in which the aims are to examine implementation and patient-centered outcomes. Children between the ages of 6 and 12 years with BMI ≥85th percentile and a caregiver will be recruited through two settings, a federally qualified health center, which serves as a patient-centered medical home, or low-income housing. Dyads will receive a remotely delivered group-based intervention that is 10 months in duration and includes 16 weekly sessions, followed by 4 biweekly and 4 monthly meetings. Assessments of child and caregiver weight status and child health-related quality of life will be conducted at baseline, and at 4 and 10 months after the start of intervention. Implementation outcomes assessing intervention acceptability, adoption, feasibility, fidelity, and penetration/reach will be collected to inform subsequent dissemination. Conclusions: If the adapted version of the JOIN for ME intervention can be successfully implemented and is shown to be effective, this project will provide a model for a scalable PWMI for families from low-income backgrounds. ClinicalTrials.gov no. NCT04647760.

Objectively measured chronic disease risk among food pantry patrons

OBJECTIVES AND DESIGN

This cross-sectional, observational study examined the prevalence of objectively measured chronic disease risk factors among a diverse group of food pantry patrons.

SAMPLE AND MEASUREMENT

Public health nurses performed biometric screenings in community settings for 1,685 unduplicated adults attending food pantries.

RESULTS

Over three fourths of participants (81.1%) were overweight or obese. High cholesterol and high blood pressure were detected in 38.4% and 37.7% of participants, respectively. Over half (58%) of the participants were referred to a local community health clinic for follow-up services.

CONCLUSION

Interventions should target food pantry patrons to reduce the prevalence of chronic disease conditions among this vulnerable population.

Food Bank Donations in the United States: A Landscape Review of Federal Policies

Rates of food insecurity have increased substantially in the United States (US), and more families are turning to the charitable food system to help meet their needs. Prior studies have examined the nutritional quality of foods offered through food banks, but little is known about what government policies may shape the healthy food donation landscape. The purpose of this study was to review US federal policies that impact food and beverage donations to food banks and assess whether policies encourage healthy food donations. In spring 2020, two researchers independently reviewed federal food and beverage donation policies using predefined search terms in two legal databases. We identified six categories of policies based on the existing food donation literature and themes that emerged in the policy review. We identified 42 federal policies spanning six categories that addressed food and beverage donations to food banks. The largest category was "government programs," with 19 (45%) policies. The next largest category was "donation via schools," with 12 (29%) policies. However, no policies specifically addressed the nutritional quality of food donations. There is an opportunity for the federal government to strengthen food bank donation policies and improve the nutritional quality of donated foods and beverages.

The hunger-obesity paradox: Exploring food banking system characteristics and obesity inequities among food-insecure pantry clients

Purpose

Heightened obesity risk among food-insecure food pantry clients is a health equity issue because the co-occurrence of obesity and hunger is deeply-rooted in systematic social disadvantage and historical oppression. This qualitative study examined key stakeholders’ perspectives of the relationship between the U.S. food banking system and obesity disparities among food insecure clients.

Methods

We conducted in-depth, semi-structured interviews with 10 key stakeholders (e.g., food bank director, food bank board member, advocate) who are familiar with food bank operations. Data were transcribed verbatim, coded in NVivo [v11], and analyzed using thematic analysis.

Results

Multiple themes emerged drawing linkages between structural characteristics of the food banking system and disparities in the dual burden of food insecurity and obesity: [a] access to unhealthy food from donors; [b] federal emergency food policy and programming; [c] state-level emergency food policy and programming; [d] geography-based risk profiles; and [e] inadequate food supply versus client need. Interviewees also identified social challenges between system leaders and clients that maintain disparities in obesity risk among individuals with very low food security including: [a] media representation and stereotypes about food pantry clients; [b] mistrust in communities of color; [c] lack of inclusion/representation among food bank system leaders; and [d] access to information.

Conclusion

Future efforts to alleviate obesity inequities among clients chronically burdened by food insecurity, especially among certain subpopulations of clients, should prioritize policy, systems, and environmental strategies to overcome these structural and social challenges within the food banking system.

Policy Progress in Reducing Sodium in the American Diet, 2010–2019

Most Americans consume dietary sodium exceeding age-specific government-recommended targets of 1,500–2,300 mg/day per person. The majority (71%) of US dietary sodium comes from restaurant and packaged foods. Excess sodium intake contributes to hypertension and cardiovascular disease, which is the leading cause of death in the United States. This review summarizes evidence for policy progress to reduce sodium in the US food supply and the American diet. We provide a historical overview of US sodium-reduction policy (1969–2010), then examine progress toward implementing the 2010 National Academy of Medicine (NAM) sodium report's recommendations (2010–2019). Results suggest that the US Food and Drug Administration made no progress in setting mandatory sodium-reduction standards, industry made some progress in meeting voluntary targets, and other stakeholders made some progress on sodium-reduction actions. Insights from countries that have significantly reduced population sodium intake offer strategies to accelerate US progress toward implementing the NAM sodium-reduction recommendations in the future.

The Role of a Food Literacy Intervention in Promoting Food Security and Food Literacy-OzHarvest's NEST Program

Food literacy interventions are widely implemented to improve the food security and health of low-socioeconomic adults. The purpose of this study was to conduct an inquiry into the value of OzHarvest's six-week NEST (Nutrition Education and Skills Training) program in promoting food security and food literacy, and to identify the barriers and enablers that participants experienced in sustaining food security, and in utilising their food literacy skills beyond the program. A descriptive evaluation study with pre-post surveys (n = 21) and post-program interviews (n = 17) was conducted, with a convenience sample of NEST program participants living in Sydney, Newcastle, and Melbourne, Australia. Participants demonstrated improvements in food security status (p = 0.030), cooking confidence (p = 0.001), food preparation behaviours (p = 0.006), nutrition knowledge (p = 0.033), vegetable consumption (p = 0.043), and a reduction in intake of sugar-sweetened beverages (p = 0.017), and salty snack foods (p = 0.011). The interviews revealed that participants learned to stretch their food budgets and make meaningful changes to their food utilisation (a key dimension of food security). Interviews also identified enablers (e.g., social support) and barriers (e.g., health conditions) to achieving food security. Acknowledging the need for a multi-faceted approach that also addresses upstream determinants, interventions like NEST may play a role in promoting food security and food literacy.

Identifying Who Improves or Maintains Their Food Literacy Behaviours after Completing an Adult Program

Food Sensations for Adults is a free four-week nutrition and cooking program that teaches low- to middle-income individuals food literacy. This research aimed to compare demographic characteristics of participants who completed the program’s follow-up questionnaire three months after program completion and assess whether food literacy and dietary behaviour changes were improved or maintained. Statistical analysis methods used factor scores of the plan and manage, selection, and preparation domains to examine mean self-reported changes in food literacy. Tertile stratification methods calculated changes in participants who had low, middle, and high end-of-program food literacy scores, and multivariable regression analysis explored the associations. The follow-up results (n = 621) demonstrated a statistically significant factor score increase in plan and manage (3%) and selection (7.2%) domain scores, and a decrease in the preparation score (3.1%), and serves of consumed vegetables (7.9%), but were still significantly higher than at the start of the program. At follow-up, participants with low food literacy at the program end significantly improved their follow-up domain scores for plan and manage (60%) and selection (73.3%), and participants with moderate or high food literacy at the program end maintained their follow-up scores. A food literacy program can support adults to improve and maintain their food literacy behaviours and maintain dietary behaviour change; therefore, strategies to support this continued change must be considered.

How to transition to reduced-meat diets that benefit people and the planet

Overwhelming evidence shows that overconsumption of meat is bad for human and environmental health and that moving towards a more plant-based diet is more sustainable. For instance, replacing beef with beans in the US could free up 42% of US cropland and reduce greenhouse gas emissions by 334 mmt, accomplishing 75% of the 2020 carbon reduction target. We summarise the evidence on how overconsumption of meat affects social, environmental and economic sustainability. We highlight the social, environmental and economic effectiveness of a range of dietary interventions that have been tested to date. Because meat eating is embedded within complex cultural, economic, and political systems, dietary shifts to reduce overconsumption are unlikely to happen quickly and a suite of sustained, context-specific interventions is likely to work better than brief, one-dimensional approaches. We conclude with key actions needed by global leaders in politics, industry and the health sector that could help aide this dietary transformation to benefit people and the planet.

Availability of Food Options and Nutrition Education in Local Food Pantries

OBJECTIVE

Explore the availability of food options and nutrition education at food pantries and identify the barriers to offering them to pantry clients.

DESIGN

Cross-sectional, mixed-methods study.

SETTING

Food pantry, Cincinnati, OH.

PARTICIPANTS

A total of 41 food pantry coordinators (aged 63.4 ± 9.1 years), recruited by e-mail/phone in an urban area.

PHENOMENON OF INTEREST

Availability of food options and nutrition education and barriers to improving food options and providing nutrition education at food pantries.

ANALYSIS

Survey data were collected using Qualtrics and analyzed using SPSS software. In-depth interviews were transcribed verbatim, transcripts were independently coded, and codes and themes were discussed until a consensus was reached.

RESULTS

The availability of fresh produce, dairy, low-sodium canned vegetables, and whole grains were limited, and 10 food pantries (24%) offered nutrition education to their clients. Challenges to improving food options were lack of space and equipment for storage and transportation. Identified barriers to providing nutrition education included the lack of space, funding, personnel with nutrition expertise, and clients' low interest in nutrition education.

CONCLUSIONS AND IMPLICATIONS

The availability of healthy food choices and nutrition education were limited at local food pantries. Collaborative efforts with community partners and nutrition experts may be necessary to overcome those barriers.

A review of the food security, diet and health outcomes of food pantry clients and the potential for their improvement through food pantry interventions in the United States

Food pantries are community-based organizations that provide food to prevalently low and very low food secure households, presenting an opportune point of contact and potential site for interventions. This review evaluates the food security, dietary quality, dietary intake and health outcomes of U.S. adults served by food pantries and the potential for interventions based in food pantries to improve these outcomes. Results from the 15 included studies showed the prevalence of food insecurity and very low food security among food pantry clients was higher than national estimates at up to 89% and 52%, respectively; dietary quality was up to 20 points lower on the Healthy Eating Index compared with U.S. adults; intake for 16 nutrients did not meet the Estimated Average Requirement or exceed the Average Intake for 30% to 100% of clients; and a strikingly high prevalence of obesity, diabetes, heart disease and related conditions, and depressive symptoms were present among U.S. food pantry users. Interventions in food pantries have been successful in improving food security, weight and diabetic control but not dietary quality or intake. However, these few interventions hold promise and present a need for further research investment to address food security, dietary intake and health outcomes among food pantry clients.

An evaluation of SecondBite® 's FoodMate® , a nutrition education and skill-building program aimed at reducing food insecurity

ISSUE ADDRESSED

Enhancing food skills and nutrition knowledge may help promote healthy eating among people who are food insecure. FoodMate^® by SecondBite^® , an 8-week nutrition education and food hamper program, focuses on developing food skills and independence among Australians at risk of/experiencing food insecurity. This study aimed to explore participants' perceptions of and experiences with FoodMate^® over a long-term (up to 2 years) follow-up.

METHODS

For evaluation purposes, SecondBite^® previously collected data from participants prior to (T1) and following completion (T2) of FoodMate^® . This paper reports results from semi-structured telephone interviews conducted in a follow-up study (2016/2017, T3) among 19 adults enrolled in FoodMate^® programs delivered in Victoria and New South Wales within the previous two years. Data were analysed using inductive thematic analysis of responses to T3 open-ended questions, and descriptive analysis of closed-ended question responses (T1 vs T2 vs T3).

RESULTS

Major qualitative themes included program enjoyment; perceived positive long-term program impact on participants' eating and related attitudes and skills; barriers to cooking; suggested program modifications; and impact on others. In descriptive quantitative analyses, participants' diet; confidence to cook using basic ingredients, follow simple recipes and try new foods; cooking and food-related skills; social engagement and life satisfaction all improved between T1 and T3.

CONCLUSIONS

Overall, FoodMate^® was well-received and associated with long-term positive changes in a range of outcomes. Wider implementation among vulnerable groups should be considered. SO WHAT?: Future health promotion initiatives could adopt FoodMate^® to increase food skills and knowledge among adults experiencing food insecurity.

Impact of increasing vegetarian availability on meal selection and sales in cafeterias

Shifting people in higher income countries toward more plant-based diets would protect the natural environment and improve population health. Research in other domains suggests altering the physical environments in which people make decisions ("nudging") holds promise for achieving socially desirable behavior change. Here, we examine the impact of attempting to nudge meal selection by increasing the proportion of vegetarian meals offered in a year-long large-scale series of observational and experimental field studies. Anonymized individual-level data from 94,644 meals purchased in 2017 were collected from 3 cafeterias at an English university. Doubling the proportion of vegetarian meals available from 25 to 50% (e.g., from 1 in 4 to 2 in 4 options) increased vegetarian meal sales (and decreased meat meal sales) by 14.9 and 14.5 percentage points in the observational study (2 cafeterias) and by 7.8 percentage points in the experimental study (1 cafeteria), equivalent to proportional increases in vegetarian meal sales of 61.8%, 78.8%, and 40.8%, respectively. Linking sales data to participants' previous meal purchases revealed that the largest effects were found in the quartile of diners with the lowest prior levels of vegetarian meal selection. Moreover, serving more vegetarian options had little impact on overall sales and did not lead to detectable rebound effects: Vegetarian sales were not lower at other mealtimes. These results provide robust evidence to support the potential for simple changes to catering practices to make an important contribution to achieving more sustainable diets at the population level.

Outcomes of disease prevention and management interventions in food pantries and food banks: a scoping review

OBJECTIVE

Food insecurity affects millions of Americans and is associated with a range of adverse health outcomes. Food insecure individuals often obtain food from food pantries/banks, prompting health researchers to implement disease prevention/management interventions at these sites. This review examined the existing peer-reviewed research on disease prevention/management interventions implemented in food pantries/banks.

DESIGN

Scoping review.

DATA SOURCES

Databases searched included MEDLINE, Web of Science, CINAHL and Cochrane. Search strategies included Medical Subject Headings and key terms, including food pantry, food bank, food shelf, food aid and related concepts.

ELIGIBILITY CRITERIA

Studies were included if they described an intervention involving food pantries/banks where at least one biometric indicator was included as an outcome variable. Articles focused solely on the quality of foods distributed, the diet quality of food pantry/bank clients or government food aid programmes were excluded.

DATA EXTRACTION AND SYNTHESIS

Extracted data included publication details, intervention type, study design, participant characteristics, study outcomes, and barriers and facilitators of intervention implementation.

RESULTS

A total of 3317 articles were assessed for eligibility. Six studies met the predefined inclusion criteria. The studies employed a range of intervention approaches to manage or prevent a number of chronic diseases, including obesity, type 2 diabetes and HIV. The studies examined a range of biometric outcomes, including body mass index, glycated haemoglobin and blood pressure. Information about the food pantries/banks where the interventions were conducted was lacking. The studies documented multiple barriers and facilitators related to costs, sustainability and organisational capacity.

CONCLUSIONS

To our knowledge, this is the first review to examine disease prevention and management interventions conducted in food pantries and food banks. Given the high number of households who obtain food from food pantries/banks and the chronic health conditions associated with food insecurity, this review highlights the need for more high-quality research in this setting.

The effect of culinary interventions (cooking classes) on dietary intake and behavioral change: a systematic review and evidence map

Background

Culinary interventions (cooking classes) have been used to improve the quality of dietary intake and change behavior. The aim of this systematic review is to investigate the effects of culinary interventions on dietary intake and behavioral and cardiometabolic outcomes.

Methods

We conducted a systematic review of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus for comparative studies that evaluated culinary interventions to a control group or baseline values. The intervention was defined as a cooking class regardless of its length or delivery approach. Studies included populations of children, healthy adults or adults with morbidities. The risk of bias was assessed using the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale. Outcomes were pooled using the random-effects model and descriptive statistics and depicted in an evidence map. Simple logistic regression was used to evaluate factors associated with intervention success.

Results

We included 30 studies (6 were randomized, 7381 patients, average follow up 25 weeks). Culinary interventions were not associated with a significant change in body mass index (− 0.07 kg/m², 95% CI: -1.53, 1.40), systolic (− 5.31 mmHg, 95% CI: -34.2, 23.58) or diastolic blood pressure (− 3.1 mmHg, 95% CI: -23.82, 17.62) or LDL cholesterol (− 8.09 mg/dL, 95% CI: -84.43, 68.25). Culinary interventions were associated with improved attitudes, self-efficacy and healthy dietary intake in adults and children. We were unable to demonstrate whether the effect of a culinary intervention was modified by various characteristics of the intervention such as its delivery or intensity. Interventions with additional components such as education on nutrition, physical activity or gardening were particularly effective.

Conclusions

Culinary interventions were not associated with a significant change in cardiometabolic risk factors, but were associated with improved attitudes, self-efficacy and a healthier dietary intake in adults and children.

Electronic supplementary material

The online version of this article (10.1186/s40795-019-0293-8) contains supplementary material, which is available to authorized users.

Effectiveness of an Adult Food Literacy Program

Nutrition education programs aim to improve food literacy domains covering the planning and management, selection, preparation and cooking and eating of healthy food. Reviews indicate programs are effective but acknowledge challenges with evaluation of community focused delivery. Food Sensations^® for Adults (FSA) is a free four-week nutrition and cooking program targeted at low-to-middle income Western Australians who would like to improve their food literacy. The aim of this research was assess how effective FSA is in changing food literacy and selected dietary behaviours. Statistical analysis identified a significant increase in postprogram scores for domains of planning and management, selection and preparation using factor scores (n = 1092). The proportion of the score increase in the postprogram scores compared to the preprogram scores was 10–25%. There was also a significant increase in self-reported fruit and vegetable serve intake, equating to an average increase of ¼ serve/day of fruit and ½ serve/day of vegetables. Of those classified as low food literacy, 61–74% improved postprogram scores in the three domains. FSA is effective in improving food literacy and dietary behaviours and the results add to the evidence base as to how effective these programs can be and for whom they should be targeted for future success.

A systematic review of food pantry-based interventions in the USA

Objective

Food pantries play a critical role in combating food insecurity. The objective of the present work was to systematically review and synthesize scientific evidence regarding the effectiveness of food pantry-based interventions in the USA.

Design

Keyword/reference search was conducted in PubMed, Web of Science, Scopus, Cochrane Library and CINAHL for peer-reviewed articles published until May 2018 that met the following criteria. Setting: food pantry and/or food bank in the USA; study design: randomized controlled trial (RCT) or pre–post study; outcomes: diet-related outcomes (e.g. nutrition knowledge, food choice, food security, diet quality); study subjects: food pantry/bank clients.

Results

Fourteen articles evaluating twelve distinct interventions identified from the keyword/reference search met the eligibility criteria and were included in the review. Five were RCT and the remaining seven were pre–post studies. All studies found that food pantry-based interventions were effective in improving participants’ diet-related outcomes. In particular, the nutrition education interventions and the client-choice intervention enhanced participants’ nutrition knowledge, cooking skills, food security status and fresh produce intake. The food display intervention helped pantry clients select healthier food items. The diabetes management intervention reduced participants’ glycaemic level.

Conclusions

Food pantry-based interventions were found to be effective in improving participants’ diet-related outcomes. Interventions were modest in scale and usually short in follow-up duration. Future studies are warranted to address the challenges of conducting interventions in food pantries, such as shortage in personnel and resources, to ensure intervention sustainability and long-term effectiveness.

Food Is Medicine: Using a 4-Week Cooking Program of Plant-Based, Olive oil Recipes to Improve Diet and Nutrition Knowledge in Medical Students

Diet can be used to treat chronic diseases, yet nutrition education is not sufficiently included in most medical school curriculum. Providing practical nutrition information that could lead to improvements in clinical measures could improve patient outcomes and physician clinical skills; it might also improve the diet and eating behavior of the medical student. This study used a 4-week cooking program of plant-based recipes that included extra virgin olive oil to provide medical students with practical cooking skills and nutrition education. The results indicate that the program can improve both the diet and eating behavior of the student and their nutrition knowledge.

Examining the Association between Food Literacy and Food Insecurity

Poor food literacy behaviours may contribute to food insecurity in developed countries. The aim of this research was to describe the apparent prevalence of food insecurity in adults at enrolment in a food literacy program and to examine the relationship between food insecurity and a range of independent variables. Individuals attending the Food Sensations^® for Adults program in Western Australia from May 2016 to April 2018 completed a pre-program questionnaire (n = 1433) indicating if they had run out of money for food in the past month (food insecurity indicator), frequency of food literacy behaviours, selected dietary behaviours, and demographic characteristics. The level of food insecurity reported by participants (n = 1379) was 40.5%. Results from multiple logistic regression demonstrated that behaviours related to planning and management, shopping, preparation, and cooking were all statistically independently associated with food insecurity, in addition to soft/soda drink consumption, education, employment status, and being born in Australia. The results are salient as they indicate an association between food literacy and food insecurity. The implications are that food insecure participants may respond differently to food literacy programs. It may be necessary to screen people enrolling in programs, tailor program content, and include comprehensive measures in evaluation to determine effect on the impact of food literacy programs on different subgroups.

Restructuring physical micro-environments to reduce the demand for meat: a systematic review and qualitative comparative analysis

BACKGROUND

Reducing meat consumption could help to protect the natural environment and promote population health. Interventions restructuring physical micro-environments might help to change habitual behaviour. We synthesised the scientific evidence pertaining to whether, and which, interventions restructuring physical micro-environments effectively reduce the demand for meat.

METHODS

We did a systematic review of quantitative studies evaluating the effectiveness of interventions restructuring physical micro-environments to reduce the demand for meat. We identified relevant records by searching six electronic databases (CAB Abstracts, Embase, PsycINFO, Science Citation Index, MEDLINE, and Dissertations & Theses) on Aug 31, 2017, contacting experts, screening publicly accessible online resources, and searching references. We included studies that evaluated the effectiveness of interventions restructuring physical micro-environments to reduce the demand for meat, defined as the actual or intended consumption, purchase, or selection of meat in real or virtual environments. We extracted data pertaining to the study samples, the interventions, and meat demand at the follow-up closest to intervention completion and at the longest follow-up, with the former representing our primary outcome. We synthesised data narratively and did a qualitative comparative analysis to identify configurations of intervention characteristics associated with, and those not found to be associated with, significant reductions in meat demand. Our Systematic Review is registered with PROSPERO, number CRD42017081532.

RESULTS

Of 10 733 titles and abstracts screened for eligibility, we assessed 60 full papers and included 14 papers reporting on 18 studies with 22 intervention conditions. Three interventions reducing the portion size of meat servings reduced meat consumption in randomised trials. Three interventions providing meat alternatives with supporting educational material were associated with reduced meat demand in pre-post design studies. Three of four interventions altering the sensory properties (eg, visual presentation) of meat or meat alternatives at point of purchase reduced meat demand in randomised trials. Four interventions repositioning meat products to be less prominent at point of purchase were associated with lower meat demand, but only two such interventions reached statistical significance in a randomised trial and a multiple treatment reversal design. Only one of five interventions manipulating the description of meat or meat alternatives at point of purchase was associated with lower meat demand in a multiple treatment reversal design. Evidence from randomised trials evaluating a pricing intervention or interventions restructuring several aspects of micro-environments was too scarce or inconsistent to be conclusive. The results from our qualitative comparative analysis supported the findings of this narrative synthesis.

INTERPRETATION

Some interventions restructuring physical micro-environments could help to promote lower demand for meat. Interventions reducing portion sizes of meat servings, providing meat alternatives, or changing the sensory properties of meat and meat alternatives at point of purchase offered the most promise in the context of experimental studies.

FUNDING

None.

Impact of Cooking and Home Food Preparation Interventions Among Adults: A Systematic Review (2011-2016)

OBJECTIVE

To update a review of the impact of interventions for adults that included a cooking component on diet, health, and psychosocial outcomes.

DESIGN

A total of 3,047 records were identified by searching MEDLINE, Agricola, Web of Science, and the Cochrane Central Register of Controlled Trials (January, 2011 to March, 2016). A total of 34 articles met inclusion and exclusion criteria for analysis. Study description and outcomes were extracted and synthesized to generate conclusions regarding impact.

RESULTS

Less than half of the studies included a control group. The most common intended outcomes were improvements in fruit and/or vegetable intake and weight. The majority of studies showed positive dietary behavior changes and improvements in cooking confidence and knowledge. Limitations included the lack of a control group, no follow-up past after intervention, the use of nonvalidated assessment instruments, and small convenience samples.

DISCUSSION

Findings were similar to a previous review regarding positive impact on dietary and cooking confidence outcomes. Clinical and weight outcomes were addressed in more studies included in the current review than in the previous 1; however, limitations were similar.

CONCLUSIONS AND IMPLICATIONS

Intervention design and assessment tools need to be strengthened in intervention studies with cooking components.

Critical review of behaviour change techniques applied in intervention studies to improve cooking skills and food skills among adults

BACKGROUND

Cooking and food skills interventions have grown in popularity; however, there is a lack of transparency as to how these interventions were designed, highlighting a need to identify and understand the mechanisms of behavior change so that effective components may be introduced in future work. This study critiques cooking and food skills interventions in relation to their design, behavior change techniques (BCTs), theoretical underpinnings, and outcomes.

METHODS

A 40-item CALO-RE taxonomy was used to examine the components of 59 cooking and food skills interventions identified by two systematic reviews. Studies were coded by three independent coders.

RESULTS

The three most frequently occurring BCTs identified were #1 Provide information on consequences of behavior in general; #21 Provide instruction on how to perform the behavior; and #26 Prompt Practice. Fifty-six interventions reported positive short-term outcomes. Only 14 interventions reported long-term outcomes containing BCTs relating to information provision.

CONCLUSION

This study reviewed cooking and food skills interventions highlighting the most commonly used BCTs, and those associated with long-term positive outcomes for cooking skills and diet. This study indicates the potential for using the BCT CALO-RE taxonomy to inform the design, planning, delivery and evaluation of future interventions.

Adults' food skills and use of gardens are not associated with household food insecurity in Canada

OBJECTIVES

To determine the extent to which Canadian adults' food preparation and cooking skills and use of home or community gardens relate to their household food insecurity status; and to compare the food shopping and cooking behaviours of adults in food-secure and food-insecure households.

METHODS

Data were drawn from two Rapid Response Modules appended to the Canadian Community Health Survey in 2012 and 2013. The analytic sample comprised 16,496 respondents 18 years and older. Multivariable logistic regression analyses were conducted to determine the association between food insecurity and adults' self-rated cooking abilities, food preparation skills score, use of gardens, food shopping behaviours, and cooking behaviours, while adjusting for socio-demographic characteristics.

RESULTS

Adults in food-insecure households did not differ significantly from others with respect to their food preparation skills or cooking ability, and neither variable predicted the odds of household food insecurity when socio-demographic characteristics were taken into account. Adults in food-insecure households were less likely to use a garden for food, but gardening was unrelated to the odds of food insecurity. Shopping with a budget was more common among adults in food-insecure households, but no other differences in food shopping behaviours were observed after adjustment for socio-demographic characteristics. Adults in food-insecure households were as likely as others to adjust recipes to make them healthier, but they had higher odds of adjusting recipes to reduce their fat content.

CONCLUSION

Our findings suggest that household food insecurity in Canada is not a problem of insufficient food skills.

Results of a Pilot Intervention in Food Shelves to Improve Healthy Eating and Cooking Skills Among Adults Experiencing Food Insecurity

Since the start of the 2007 economic downturn, reliance on emergency food assistance suppliers (e.g., food pantries, also known as food shelves) has increased. Many food shelves strive to provide effective nutrition programs to serve their clients, even while they are faced with a scarcity of resources. Rigorous evaluation of the impact of such programming on dietary outcomes is, therefore, warranted. The aim of this study was to evaluate the effectiveness of a pilot cooking and nutrition education intervention among food shelf clients. A six-session class was conducted with 63 participants in four food shelves in Minneapolis and St. Paul, MN. Diet was assessed through a 24-hour recall from which a Healthy Eating Index (HEI) score was created. Cooking skills were assessed by survey. Average HEI scores increased from 50.9 at baseline to 58.5 post-intervention (p = 0.01, n = 43). Participants demonstrated improved cooking skills scores post-intervention (35.9 vs. 33.1 at baseline, p = 0.002, n = 45). Future research is needed to advance our understanding of how best to improve client nutrition knowledge and cooking skills. This study provides some evidence that improvements in diet and skills can be demonstrated with minimal intervention.

Fruit and vegetable consumption and food values: National patterns in the United States by Supplemental Nutrition Assistance Program eligibility and cooking frequency

BACKGROUND

More frequent cooking at home may help improve diet quality and be associated with food values, particularly for individuals participating in the Supplemental Nutrition Assistance Program (SNAP).

OBJECTIVE

To examine patterns of fruit and vegetable consumption and food values among adults (aged 20 and older) in the United States, by SNAP participation and household cooking frequency.

METHODS

Analysis of cross-sectional 24-hour dietary recall data obtained from the National Health and Nutrition Examination Survey 2007-2010 (N=9560).

RESULTS

A lower percentage of SNAP participants consumed fruit (total: 35% vs. 46%, p=0.001; fresh: 30% vs. 41%, p<0.001) and vegetables (total: 49% vs. 58%, p=0.004; fresh: 35% vs. 47%, p<0.001) than those ineligible for SNAP. Among SNAP participants, cooking >6times/week was associated with greater vegetable consumption compared to cooking <2times/week (175g vs. 98g, p=0.003). SNAP-eligible individuals who cooked ≥2times/week were more to report price (medium cookers: 47% vs. 33%, p=0.001; high cookers: 52% vs. 40%, p<0.001), ease of preparation (medium cookers: 36% vs. 28%, p=0.002; high cookers: 36% vs. 24%, p<0.001) and how long food keeps (medium cookers: 57% vs. 45%, p<0.001; high cookers: 61% vs. 50%, p<0.001) as important compared to SNAP-ineligible individuals.

CONCLUSIONS

Fruit and vegetable consumption in the United States is low regardless of cooking frequency. Efforts to improve diet quality should consider values on which food purchases are based.