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Native Youth Participating in the Together on Diabetes 12-Month Home-Visiting Program Reported Improvements in Alternative Healthy Eating Index-2010 Diet Quality Domains Likely to Be Associated With Blood Pressure and Glycemic Control

Published:February 03, 2021DOI:https://doi.org/10.1016/j.jand.2020.12.017

      Abstract

      Background

      The Together on Diabetes (TOD) intervention was a home-visiting diabetes prevention and management program for Native youth.

      Objectives

      (1) Examine the impact of the TOD program on diet quality using the Alternative Healthy Eating Index (AHEI-2010); (2) determine association between diet quality and cardiometabolic health.

      Design

      The TOD program was conducted from October 2012 to June 2014 and was evaluated using a pretest-posttest study design from baseline to 12 months. Dietary intake was assessed using a food frequency questionnaire.

      Participants/setting

      There were 240 participants between 10 and 19 years of age from 4 reservation-based, rural tribal communities in the southwestern United States that had been diagnosed with T2DM or prediabetes or were identified as at risk based on body mass index and a qualifying laboratory test.

      Intervention

      Youth were taught a 12-lesson curriculum on goal setting, nutrition, and life skills education.

      Main outcome measures

      Behavioral and physiologic outcomes related to diabetes.

      Statistical analysis

      Changes in AHEI-2010 score and associations with cardiometabolic measures were tested, over time, using adjusted longitudinal linear mixed-effects models.

      Results

      The study sample reported an average energy intake of 2016 kcal/d (±1260) and AHEI-2010 score of 47.4 (±7.4) (range: 0-110, higher = better diet quality), indicating low diet quality at baseline. At 12 months’ follow-up, there was a reduction in kilocalories (mean = −346 kcal/d; P < .001), sugar-sweetened beverages (mean = −2 fluid oz/d; P = .032), red/processed meat (mean = −1.5 oz/d; P = .008), and sodium (mean = −650 mg/d; P < .001) but no change in AHEI-2010 score (P = .600). The change in systolic blood pressure from baseline to 12 months for participants within the highest AHEI-2010 quartile group was significantly larger than the change in participants within the lowest quartile group (mean = −5.90 mm Hg; P = .036).

      Conclusions

      Despite stable AHEI-2010 scores during follow-up, there were improvements in diet quality domains likely to be associated with cardiometabolic health. Home-visiting programs like TOD are promising interventions for decreasing dietary intake of poor-quality foods.

      Keywords

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      Biography

      K. Ducharme-Smith is a doctoral candidate, Program in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      R. Chambers is a senior research associate, Center for American Indian Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      V. Garcia-Larsen is an assistant professor, Program in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      F. Larzelere is a research associate, Center for American Indian Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      A. Kenney is a senior research associate, Center for American Indian Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      R. Reid is a study physician, Center for American Indian Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      L. Nelson is a research program assistant, Center for American Indian Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      J. Richards is a senior research associate, Center for American Indian Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      M. Begay is a research program assistant, Center for American Indian Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      A. Barlow is a program director, Center for American Indian Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      S. Rosenstock is an assistant scientist, Center for American Indian Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.