Fiber-rich foods delivered to Low-Income Households: A feasibility study of children with prediabetes and spillover effect on their caregivers

Abstract

Introduction: The incidence of pediatric prediabetes and type 2 diabetes mellitus (T2DM) is increasing, with those from low socioeconomic status (SES) households at increased risk. Dietary fiber (e.g., whole grains) is shown to improve glucose control and there is need for innovative strategies that address barriers to consumption (e.g., limited availability).

Methods: Food Overcoming our Diabetes Risk (FoodRx) was a pre-post study (N = 47) that provided 16 weeks of home-delivered whole grains, vegetables, and beans/legumes to households of low-income children in [blinded for submission] who had obesity and prediabetes. Child liking and intake (24-hour diet recalls) was evaluated. Anthropometrics and T2DM-related laboratory measurements (e.g. glycated hemoglobin) were measured for children, and for caregivers to evaluate potential spillover effect.

Results: Post-intervention, children increased liking of whole grains, vegetables, and beans/legumes (P < 0.05 for all). Child whole grain intake increased from 1.7 to 2.5 oz-equivalent servings/day (P < 0.001), and the percent of total grain intake that were whole increased from 30% to 44% (P < 0.001). Children's body mass index, blood pressure, and serum triglyceride levels increased (+14.6 mg/dl, P = 0.04). Caregivers fasting glucose (-7.5 mg/dl; P = 0.03), fasting insulin (-2.5 μIU/ml, P = 0.0009) and homeostatic model assessment for insulin resistance (HOMA-IR) decreased (-0.8, P = 0.01).

Conclusions: Home deliveries of fiber rich foods improved liking and intake among children at risk for T2DM. There was spillover effect on caregivers, who demonstrated improvement in T2DM-related laboratory measurements instead of the children.

Keywords: CSA, community-supported agriculture; Endocrinology; HOMA-IR, homeostatic model assessment for insulin resistance; HbA1c, Hemoglobin A1c; Metabolic disorders; Prediabetes; Preventive medicine; SES, socioeconomic status; T2DM, type 2 diabetes mellitus.

Fig. 1

Deliveries to participant households consisted of weekly deliveries of vegetables from a local farm which were accompanied by whole grain foods delivered from the Food Bank to the participating farm.