Developing and evaluating a culturally-appropriate food kit for increased access to fruits and vegetables and DASH eating plan alignment in immigrant Hispanic/Latine individuals with hypertension: a pilot study.

Abstract

Background: Effective nutrition interventions for hypertension (HTN), including the Dietary Approaches to Stop Hypertension (DASH) Eating Plan, fail to consider cultural preferences and barriers to obtaining and utilizing fruits and vegetables (F/V). A paucity exists in the literature regarding nutrition interventions tailored for Hispanic/Latine communities. This project aims to determine the outcomes associated with improved access to a culturally-appropriate, medically-tailored foods for Hispanic/Latine individuals with HTN via an iterative process: 1) conceptualization of culturally-appropriate F/V for a DASH box using a patient/provider survey, 2) formative DASH box development utilizing individual interviews for food preference feedback, and 3) free-living pilot trial of DASH box intervention to determine impacts on cardiometabolic markers.

Methods: Using community-based participatory research methods, findings from 50 surveys revealed F/V preferences which supported the conceptualization of 6 boxes, including F/V and staple foods to encourage DASH Eating Plan adherence. Boxes were displayed during 15 interviews gathering feedback on acceptability. Themes were assessed using the Framework Method and finalized via consensus building. A 28-day open trial enrolling 21 participants collected pre- and post- measurements of blood pressure (BP), weight, waist circumference (WC), and skin carotenoid levels. Weekly DASH boxes and diet education were provided. Pre-to post-changes in cardiometabolic markers were calculated via t-tests.

Results: Thematic analysis determined participants prefer fresh F/V, use staple items to compliment F/V, and experience barriers (time, money, transportation) to accessing or using F/V. Post intervention, there was a significant improvement in systolic BP (mean difference of -4.17.8 mmHg, p = 0.01), diastolic BP (-3.76.4 mmHg, p = 0.004), and WC (-0.81.1 inches, p = 0.003). While mean difference in weight (-1.24.8 pounds, p = 0.26) and skin carotenoid levels (26.774.1, p = 0.06) changed, results were not significant.

Conclusions: This pilot study provides formative contributions regarding culturally-appropriate interventions for chronic disease management, suggesting a medically-tailored DASH box may be effective in lowering BP and other cardiometabolic risk factors for Hispanic/Latine individuals with HTN.

Clinical trial registration: ClinicalTrials.gov, Identifier NCT05802134, Registered 3/24/2023, https://clinicaltrials.gov/study/NCT05802134 .