Integrating Food Security Interventions in Cardiometabolic Prevention Programs: A Systematic Review of the Literature Restricted; Files Only

Acquaah, Nana Esi (Spring 2022)

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 Food insecurity which is estimated to affect over 10% of households in the U.S. continues to be a major factor resulting in the development of cardiometabolic diseases (CMD) such as diabetes and cardiovascular disease. To prevent a further rise in CMDs, disease prevention programs recommend lifestyle and behavior modifications such as increased exercise and improved eating habits through the intake of healthier food items such as fruits, vegetables, and legumes as one of the primary ways to reduce disease risk. These changes prove to be difficult for individuals facing food insecurity due to limitations in the accessibility and affordability of healthy food options. This review examines current cardiometabolic prevention program efforts to address challenges among food-insecure participants and identifies gaps and limitations of current interventions. The electronic database PubMed was searched for published papers after 2000 to identify cardiometabolic prevention programs addressing food insecurity. Handsearching was also performed to find additional publications that met criteria for inclusion. Data abstracted included changes in baseline/endline health and behavior outcomes and program and participant characteristics (e.g., age). Three articles satisfied the inclusion criteria. One was a randomized control trial, one a cluster-randomized design, and the last was a longitudinal study. Reports of improvements in BMI levels, weight loss, and reduced obesity risk with extended program participation were reported in study 1 which was focused on a retail intervention on tribal reservations. Study 2, another retail intervention on Native American reservations reported marginal improvements in fruit and vegetable intake. In study 3, a Diabetes Prevention Program in 2 clinics, there were reports of improvements in food security, weight loss, and increased consumption of healthier foods. There is a lack of evidence documenting improvements in health outcomes based on current program efforts. Future research should involve the collection of health data (weight changes, BMI, HbA1c levels) to increase evidence-based findings, facilitate community engagement, pass policies that connect food insecure clients to nutrition assistance, and adapt existing nutrition programs (medically tailored meals, food incentive programs (vouchers), and digital services) to address the needs of food insecure program participants.

Table of Contents

Chapter 1: Introduction & Rationale 1

1.1 Statement of the Problem 2

1.2 Purpose statement 3

1.3 Research questions 3

1.4 Significance statement 3

Chapter 2: Review of the Literature 4

2.1 Burden of Cardiometabolic Disease 4

2.1.1 Role of a healthy diet in disease prevention  5

2.2 Burden of Food Insecurity 6

2.2.1 Risk factors linked with being food insecure 7

2.2.2 Uniquely at risk: More detailed examples 8

2.2.3 Linkages between food insecurity and cardiometabolic disease in the US 8

2.3 Cardiometabolic Prevention and Program Examples 9

2.3.1 Diabetes Prevention Program 9

2.3.2 Dietary Approaches to Stop Hypertension (DASH) 11

2.3.3 American Heart Association 12

2.3.4 Obesity Prevention Programs 13

2.4 Concluding Remarks: Aim of Review  13

Chapter 3: Methods 15

3.1 Literature Search Strategy (see table in Appendix C)  15

3.1.1 Selection Strategy: Inclusion and Exclusion Criteria 15

3.2 Data Extraction 17

3.3. Quality / Risk-of-Bias Assessment (See tables in Appendix A and B) 17

3.4 Ethical considerations 18

Chapter 4: Results 19

4.1 Article Search Findings 19

4.1.1 How have cardiometabolic prevention programs in the U.S. addressed issues of food insecurity among underserved populations? 23

4.1.2 Different outcomes of cardiometabolic prevention programs 24

4.1.2.a. Diet Outcomes 24

4.1.2.b. Weight Outcomes 24

4.1.2.c. Other Outcomes 25

Chapter 5: Discussion 26

5.1 How Food Insecurity is being addressed among underserved populations 26

5.1.1 Health Outcomes of Prevention Programs 26

5.1.2 Gaps in current program efforts 27

5.2 How Findings Differ from other Literature 29

5.3 Other Findings in the Literature 31

5.4 Strengths and Weaknesses of the Analysis 35

5.5 Public Health Implications 36

5.6 Recommendations 37

5.6.1 Implementing a Community-Based Approach 38

5.6.2 Standardizing Future Research Efforts 38

5.6.3 Medically Tailored Meals 39

5.6.4 Food Incentive Programs (Vouchers) 40

5.6.5 Addressing Infrastructure Challenges 40

5.6.7 Digital Interventions 41

5.6.8 Upscaling Food Pantry Efforts 42

5.7 Conclusions 43

References 45

Appendix A 54

Appendix B 54

Appendix C 55


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