Abstract
CONTEXTTo date, numerous projects have demonstrated that an ongoing limited access to nutritionally dense food (i.e., “food insecurity”) plays a key role in the overall health and wellbeing of lower income at-risk populations.METHODSFor this 2019-2020 pilot project, the resident physician authors first created and administered a simple five-item questionnaire screening process to systematically identify food insecure patients in their metropolitan Detroit residency clinic. A sample of patients who had been identified as food insecure and pre-diabetic were then provided improved access to healthy foods, supplemented by a six-week program of nutritional education classes using a nationally recognized “Cooking Matters’’ six-week long curriculum with a licensed chef and nutrition educatorRESULTSAfter institutional review board approval, the authors enrolled a sample of 10 adults. The authors successfully measured both pre- and post-program Hemoglobin A1c (HbA1C) levels for all participants who completed the required course and subsequent clinic follow up visits. Using a series of initial non-parametric Wilcoxon Signed Rank matched pair tests, post-program follow-up at three months revealed statistically significant reductions in documented HbA1c levels from baseline for six enrolled patients (W=1, Z = - 2.226, p = 0.026) and six-month follow up (i.e., more than four months after completion of the program) (W = 1, Z = - 2.060, p = 0.039). In post-program surveys, each respondent indicated that they found the class content to be generally beneficial to increase their nutritional knowledge.CONCLUSIONSIn the authors’ setting, this food insecurity program has subsequently led to a more formal screening process to evaluate and identify food insecure patients. The authors discuss the scheduling difficulties they experienced from the COVID-19 pandemic for their sample patients. However, these pilot results suggest that prolonged benefits may require ongoing “virtual” teaching sessions with pre-diabetic patients to address the complex factors influencing food insecurity levels identified in similar inner-city settings.
Highlights
A growing body of evidence has identified the association between dietary factors and mortality in patients with Coronary Artery Disease,[1] Cerebrovascular Accidents (CVA),[2,3] Hypertension,[4,5] Type 2 Diabetes Mellitus,[6,7] and cardio-metabolic disease.[1,2,3,4,5,6,7,8]
The authors concluded with colleagues that many patients at their Michigan primary care residency clinic were consuming poorer-quality diets con
Food insecurity has been shown to be an important health concern that needs to be addressed during clinic office visits to reduce patients’ onset of several major chronic diseases.[1,2,3,4,5,6,7,8]. Through implementation of this program at our Family Medicine residency clinic, we attempted to foster an educational environment to help reduce the perceived stigma frequently associated with food insecurity and address common barriers to preparing healthy meals.[12]
Summary
A growing body of evidence has identified the association between dietary factors and mortality in patients with Coronary Artery Disease,[1] Cerebrovascular Accidents (CVA),[2,3] Hypertension,[4,5] Type 2 Diabetes Mellitus,[6,7] and cardio-metabolic disease.[1,2,3,4,5,6,7,8] The nutritional factors associated with these kinds of adverse health outcomes include high intake of high sodium processed meats, sugar sweetened beverages, and lower intake of fruits, vegetables, nuts/ seeds, and omega 3 fats.[1]Estimated proportional diet-related cardio metabolic mortality (i.e., relationship between certain diet related factors and cardiovascular related death) has been found to be higher among men, individuals with low or medium education levels, and African American and Latino populations.[9,10,11] Several additional factors influencing consumption of suboptimal dietary components as identified by clinic-based providers include perceived time constraints, food taste, impaired access to more nutritional foods and cost.[12,13]During project planning, the authors concluded with colleagues that many patients at their Michigan primary care residency clinic were consuming poorer-quality diets con-. A growing body of evidence has identified the association between dietary factors and mortality in patients with Coronary Artery Disease,[1] Cerebrovascular Accidents (CVA),[2,3] Hypertension,[4,5] Type 2 Diabetes Mellitus,[6,7] and cardio-metabolic disease.[1,2,3,4,5,6,7,8] The nutritional factors associated with these kinds of adverse health outcomes include high intake of high sodium processed meats, sugar sweetened beverages, and lower intake of fruits, vegetables, nuts/ seeds, and omega 3 fats.[1].
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