Abstract
Dietary interventions may best be delivered at supermarkets, which offer convenience, accessibility, full food inventories and, increasingly, in-store registered dietitians, online shopping and delivery services. In collaboration with a large retail supermarket chain, we conducted a multisite supermarket and web-based intervention targeting nutrition trial (no. NCT03895580), randomizing participants (n = 247 (139 women and 108 men)) 2:2:1 to two levels of dietary education (Strategy 1 and Strategy 2) or an enhanced control group that included educational components beyond the routine standard of care. Both Strategies 1 and 2 included individualized, in-person, dietitian-led, purchasing data-guided interventions. Strategy 2 also included online tools for shopping, home delivery, selection of healthier purchases, meal planning and healthy recipes. The primary endpoint was change in dietary approaches to stop hypertension (DASH) score (a measure of adherence to the DASH diet) from baseline to 3 months. The primary endpoint was met because, at 3 months, the DASH score increased by 4.7 more for the combined Strategy 1 and Strategy 2 groups than for the control group (95% confidence interval (CI) (0.9, 8.5), P = 0.02). In a prespecified hierarchical test, at 3 months, DASH score increased by 3.8 more for the Strategy 2 group than for the Strategy 1 group (95% CI (0.8, 6.)9, P = 0.01). This trial demonstrates the efficacy of data-guided, supermarket-based, dietary interventions and modern online shopping tools in improving dietary quality in a free-living, community-based population. The trial also demonstrates the opportunity for academic investigators to collaborate with retailers to design and rigorously test comprehensive healthcare interventions.
| Original language | English |
|---|---|
| Pages (from-to) | 2530-2536 |
| Number of pages | 7 |
| Journal | Nature Medicine |
| Volume | 28 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 2022 |
Bibliographical note
Publisher Copyright:© 2022, The Author(s).
Funding
We thank the leadership of The Kroger Company. We also thank the Kroger registered dietitians and analysts, whose professionalism, dedication and skill provided the opportunity to test these interventions. We thank the primary care clinicians of UC Health. Finally, we thank the participants who generously dedicated themselves to this trial. The Kroger Company was not involved in the overall design of the study, the analysis or interpretation of any data, the writing of this manuscript or the decision to submit this manuscript for publication. Personnel effort (including coprincipal investigators, D.L.S. and S.C.C.) commensurate with the study conduct and oversight was funded in part by The Kroger Company. The company also provided the time and effort of the study dietitians, the use of the store and clinic space and the electronic purchasing data for this study. This research was also supported in part by funding from CCHMC, UC (that is, Collaborative Research Advancement Grant, Rehn Family Research Award, College of Medicine Research/Pilot Grant, Strategic and Collaborative Grant, Junior Faculty Pilot Project, as well as nongrant funding) and UC Health (Innovative in Care Delivery Grant). R.N.H. received funding from K01DK128022 and UL1TR001998 during the time period of this work.
| Funders | Funder number |
|---|---|
| CCHMC | |
| Kroger Company | |
| National Institute of Diabetes and Digestive and Kidney Diseases | K01DK128022 |
| UCLA Health System | UL1TR001998 |
ASJC Scopus subject areas
- General Biochemistry, Genetics and Molecular Biology