In-store nutrition education enhances adherence to DASH diet

Personalized nutrition advice conducted at grocery stores led to significant improvements in DASH* diet adherence, according to findings from the SuperWIN** trial.

“We have real public health challenges, and it is not clear if we have great solutions to address them,” said lead author Dr Dylan Steen from the University of Cincinnati College of Medicine, Cincinnati, Ohio, US, at ACC.22. “We need to think about how we can extend the reach of modern healthcare systems into communities and better deliver services right where people are.”

A collaboration between a diverse academic team and the grocery retailer Kroger, SuperWIN included 247 adults (mean age 56 years, 69 percent female) who had at least one cardiovascular risk factor***, were regular physical (not online) Kroger shoppers and willing to follow the DASH diet. All participants received an enhanced, single in-store session of medical nutrition therapy. Following which, they were randomized 1:2:2 to receive no further dietary education (control arm), strategy (S)1^#, or S2^# intervention. [ACC.22, Late-Breaking Clinical Trials II]

All arms demonstrated DASH change at 3 months, with the greatest seen in the S2 arm (12.4 points), followed by the S1 and control arms (8.6 and 5.8 points, respectively). When comparing the pooled S1/S2 cohort with the control arm, DASH score was higher in the former vs the latter arm by 4.7 points (p=0.02). Compared with S1, S2 increased DASH score by 3.8 points (p=0.01). In a prespecified analysis, S1/S2 increased DASH score by 8.3 points (p=0.001) vs the control arm prior to the COVID-19 pandemic.

The interventions allowed individualization of the DASH diet, with dietitians teaching participants on how to eat better – right within the aisles of their home grocery store, said Steen. “[Apart from being] registered dietitians … their expertise extends to the store’s inventory of products and brands and products preferred by customers.” Each participant’s dietary and purchasing information were instrumental in incorporating healthy changes into their lifestyle and budget.

Bridging the gap

“Despite guideline recommendations, 75 percent of Americans have poor dietary quality,” said Steen. “SuperWIN may help address the gap between current dietary guidelines and poor public adherence to these recommendations … [Our] results are timely given the rapid expansion and consumer adoption of online shopping, as well as retail-based care.”

“Small changes in diet actually have enormous health impacts, especially if sustained over time … If you just changed the environment where care was delivered, you could already make a difference,” Steen continued. “[While] it is a small step … SuperWIN highlights the potential of research partnerships beyond the pharmaceutical, biotech, and medical device industries to design and test new healthcare approaches and reach patients in their communities.”

A win-win, a call-out to groceries

From a primary prevention standpoint, you can change the behaviour from children on up, as little kids shop with their parents, said discussant Dr Eileen Handberg, past Chair, ACC Cardiovascular Care Team Council. “If we can change the dynamic of the choices they make at the grocery store – it is a super win, a win-win.”

“I hope [groceries consider] meaningful partnerships with researchers to [identify] the right strategy in different populations [and] to try and get us to lead a healthier life,” Handberg said. “[With] better purchases for our daily dietary consumption, we [may] not need all of these lipid therapies … [While] it is going to take a village, I think this is fabulous. I can’t wait to see what they do.”

“There are a lot of opportunities to cut the fat and add the intervention. We will do the deep digging to figure out how we can make this even better, a ‘super win 2.0’,” Steen concluded.