Abstract
Tribal communities in the United States face disparities to accessing healthy foods including high-quality produce. A six-week fresh fruit and vegetable (FV) dietary intervention, Eat Fresh, was co-designed with a Community Advisory Board of local food and nutrition stakeholders on the Flathead Reservation of the Confederated Salish and Kootenai Tribes in Montana. Eat Fresh was implemented as a pilot study with low-income participants (n = 19) enrolled in the Food Distribution Program on Indian Reservations toward improving dietary quality and perceptions of well-being. We evaluated Eat Fresh at pre- and post-intervention on the basis on food procurement practices, dietary quality using the Healthy Eating Index (HEI), Body Mass Index (BMI), blood pressure, and participant perceptions of health. Participants reported consuming a greater number of types of FVs daily during the intervention (p < 0.005 for fruits and p > 0.19 for vegetables). Overall, participants found Eat Fresh moderately challenging to adhere to with the main barriers being access to ingredients in recipes (39.51% of responses), time constraints to cook (35.80%), and lack of financial resources (33.33%). Dietary quality improved during the intervention from a mean HEI score of 48.82 (± 11.88) out of 100–56.92 (± 11.88; (p > 0.12). HEI scores for fruit consumption significantly increased (p < 0.05) from 1.69 (out of 5 points) during the pre-intervention to 2.96 during the post-intervention. BMI and blood pressure increased for several participants, highlighting an unintended consequence. Most participants responded that FV consumption made them feel either very good (51.16%) or good about their health (43.02%) with the majority (83%) perceiving an improvement in energy. Findings of this pilot study highlight both intended and unintended consequences of a dietary intervention that provide lessons in co-designing community-based programs.
Highlights
Diet-related chronic health challenges are a primary risk factor of disease globally (1) while being a leading preventable cause of death (2)
We evaluated Eat Fresh at pre- and post-intervention on the basis on food procurement practices, dietary quality using the Healthy Eating Index (HEI), Body Mass Index (BMI), blood pressure, and participant perceptions of health
Numerous studies have shown that a notable percentage of diet-related chronic challenges including cardiovascular disease, hypertension, cancer, Type II diabetes, and weight gain are preventable over time with healthy lifestyles that are supported by food environments that provide access to healthy and affordable foods (3–8)
Summary
Diet-related chronic health challenges are a primary risk factor of disease globally (1) while being a leading preventable cause of death (2). Numerous studies have shown that a notable percentage of diet-related chronic challenges including cardiovascular disease, hypertension, cancer, Type II diabetes, and weight gain are preventable over time with healthy lifestyles that are supported by food environments that provide access to healthy and affordable foods (3–8). A growing body of evidence supports that residents of tribal and rural communities face disparities in their food environments to accessing healthy, affordable, convenient, and desirable foods (10–16). Despite global and national efforts to improve dietary quality, diet-related chronic diseases, and food insecurity represent critical health disparities in the United States among Native American, African American, Hispanic, and Asian populations (17–22). Native American adults are twice as likely to be food insecure compared to non-Hispanic whites (22)
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