Source: CALIFORNIA STATE UNIV. FRESNO FOUNDATION submitted to NRP
THE EFFECT OF COMPREHENSIVE NUTRITION INTERVENTION WITH EMPHASIS ON FRESH FRUIT AND VEGETABLE CONSUMPTION ON REDUCING FOOD INSECURITY AND DIET-RELATED CHRONIC DISEASE AT CSU FRESNO
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
ACTIVE
Funding Source
OTHER GRANTS
Reporting Frequency
Annual
Accession No.
1029418
Grant No.
2022-70424-38538
Cumulative Award Amt.
$500,000.00
Proposal No.
2022-07034
Multistate No.
(N/A)
Project Start Date
Sep 15, 2022
Project End Date
Sep 14, 2025
Grant Year
2022
Program Code
[PPR]- Produce Prescription
Recipient Organization
CALIFORNIA STATE UNIV. FRESNO FOUNDATION
4910 N CHESTNUT AVE
FRESNO,CA 93726-1852
Performing Department
(N/A)
Non Technical Summary
Currently approximately 50% of students at California State University, Fresno suffer from food insecurity. This means that one out of two students are experiencing food insecurity. Likewise, individuals with higher rates of food insecurity consume less fruits and vegetables. In this study we willfocus on providing a comprehensive nutrition intervention program that includes guided grocery store tours focusing on fresh fruits and vegetables, ongoing nutrition education sessions supporting the content learned during the grocery store tours, nutrition prescription and incentive boxes also supporting the content learned during the grocery store tours and nutrition educational programs, as well as genetic tests for Non Alcoholic Fatty Liver, obesity and type two diabetes to investigate the Single Nucleotide Polymorphism (SNP) allele frequency in this community.This will provide an opportunity to identify any existing diet related health problems including cardiometabolic disease conditions (obesity, T2DM, HTN, NAFLD) in this population, prevent further health care costs related to these problems and improve college student's self-awareness and nutrition related knowledge. This in turn will provide a decrease in the impact on medical care costs and economic burden.
Animal Health Component
5%
Research Effort Categories
Basic
90%
Applied
5%
Developmental
5%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
70314991010100%
Knowledge Area
703 - Nutrition Education and Behavior;

Subject Of Investigation
1499 - Vegetables, general/other;

Field Of Science
1010 - Nutrition and metabolism;
Goals / Objectives
At the end of the program, the participants will increase their consumption of fruits and vegetables by eating one more serving per day as measured by their HealthWatch 360 score. The HealthWatch 360 Research Portal is designed for academics and research institutes to collect diet, lifestyle and health data using mobile app technology. The portal allows researchers to interact with their study participants and view, download and analyze data collected with the HealthWatch 360 mobile app. This HIPAA-compliant platform consists of three major components: (1) Mobile app for study participants to report food intake, physical activity, health symptoms and other health-related parameters. (2) Online-based research portal for researchers to recruit participants and manage data collection. (3) Large database of food and supplements that provides accurate and comprehensive nutritional analysis. https://www.gbhealthwatch.com/organization/research.phpAt the end of the nutrition education program, the participants will be able to select fruits and vegetables that are good sources of vitamin C, fiber, folate, calcium, phytonutrients - anthocyanins, resveratrol, carotenoids, flavonoids as indicated by the post test evaluation HealthWatch 360 score of 80% or better.At the end of the program, the participants will be able to observe and demonstrate the step by step cooking process highlighting fruits and vegetables.At the end of the program, participants will continue to improve or maintain their anthropometric measurements at the 3month, 6month and 1year marks.?
Project Methods
Cost and Economic Analysis: This analysis utilizes primary data generated from the survey of the participants and secondary data from agencies like USDA ERS food access atlas, and Medical Expenditure Panel Survey (MEPS) of the US Department of Health & Human Services. Data generated from the survey and the secondary sources pertaining to food accessibility, SNAP participation and benefit levels, health care costs/expenditures, etc., will be utilized to understand the economic implications of inadequate consumption of fruits and vegetables. The economic impact analysis will include the estimation of direct and indirect health-care costs that can be avoided if inadequate consumption of fruits and vegetables is reduced among the participants. This study follows population-attributable fraction (PAF) approach wherein the risk that inadequate consumption poses for chronic diseases and the direct and indirect costs for the treatment and management of these diseases is considered. The PAF approach is used to understand the proportional reduction in chronic disease that would occur if the respondents consume the recommended number of servings of fruits and vegetables. In addition, the study will examine the possibility of analyzing the alternative scenarios when there is a 5 and 10 percent improvement in the fresh produce consumption among the respondents and thereby extrapolating the findings for the Fresno State students.Upon enrollment, all participants will be randomly assigned to one of two groups: treatment group or control groupFruit and Vegetables frequency questionnaire, medical history, Anthropometric Measurements (AD) testing - (Height (HT) /Weight (WT) / Body Mass Index (BMI) / Waist Circumference (WC) /Body Fat (BF) / Skeletal Muscle (SM) / Visceral Adipose Tissue (VAT) (measurements will take place upon initial visit, 3 months, 6months, 1year)Genetic test: Genetic testing will be done through GBinsight (San Diego, California USA) via cheek swab. The genomic DNA will be sequencing by using next generation sequencing (NGS) at targeted regions for specific SNPs on an Illumina HiSeq instrument and analyzed with a bioinformatics pipeline developed by GBinsight. NGS is performed at a CLIA-certified and CAP-accredited licensed medical genetic testing laboratory.Treatment (experimental) group will receive intensive nutrition educational training - grocery store tours, nutrition education, cooking classes + fruits/vegetables prescription box (once a week for six months) - prescription (disease specific (Obesity (BMI >30, Cardiovascular Disease (Hypertension), Non-Alcoholic Fatty Liver Disease (NAFLD), Type 2 Diabetes Mellitus (T2DM)Control group will receive passive nutrition educational training - handouts + 20$ SaveMart gift card and cooking classesAll participants will have access to the website designated for this project - will include all handouts, links to other evidence based information, videos and email contact information.Upon arrival and completion of all pre-assessment documents and measurements, participants will be assigned a date/time to attend the program. Initial visits, 3 months f/up and 6months f/up and 1 year. (final visit to assess results)Comprehensive Nutrition Intervention - treatment groupPart I: Nutrition Educational SessionsThree nutrition education sessions: Initial, 3 months, 6monthsThere will be an initial nutrition education session that will detail the connection between the disease conditions (heart disease, diabetes, obesity) and nutrition. A workbook will be provided for each participant detailing the information provided for each of the three steps of the nutrition education program.The workbook will allow the participants to interact during the programPart 2: Grocery Store ToursThree grocery store tours: Initial, 3months, 6 monthsMeet at grocery store (SaveMart Grocery Store)Complete pre assessment test about their knowledge regarding grocery store shoppingRecipe books (follow the fruits/vegetables discussed during the grocery store tours)Grocery Store Tours will focus on distinguishing between different types of fruits and vegetables available within the grocery store (seasonal fruits and vegetables will be highlighted to focus on carbon foot reduction)Upon completing the grocery tour each students will receive a prescription box containing fresh fruits and vegetables (Assorted apples, bananas, berries, tomatoes, nectarines, peaches, kale, broccoli, asparagus, carrots, green leafy vegetables, green peas, green beans, corn, bell peppers, citrus fruits, sweet potato, eggplants, onion, garlic, zucchini, squash, cauliflower, brussel sprouts and more (Items may vary based on the availability).One fruit and vegetable prescription box will be prepared for each student every week for the duration of six months in order to increase intake of fresh fruits and vegetables daily.Part 3: Cooking DemonstrationsThree cooking demonstrations: Initial, 3 months, 6monthsCooking demonstrations will be the third level of nutrition education. This will allow the participants to take the information learned during Step 1 and Step 2. Participants will be able to learn simple cooking techniques that will support ease and confidence in the kitchen. Furthermore, recipes will be created that are simple to make, budget friendly and incorporate the fruits and vegetables highlighted during the grocery store tours as well as the produce prescription boxes received. The cooking demonstrations will provide them with the confidence to navigate the kitchen successfully.Collateral materialsStudent Nutritional Educational Workbook - each student will receive a workbook that provides all materials for the nutrition educational sessions, grocery store tours and cooking demonstrations. This is an interactive workbook that will include the nutrition education content, activities, pre/post tests, and evaluations. The workbook will focus on incorporating more fruits and vegetables into their daily intake.Statistical analysisData analysis will be done using IBM SPSS Statistics 28 package. All sociodemographic variables will be converted to contingency tables and descriptive statistics will be summarized for all the variables. A Multi-level variable of food security will be developed based upon USDA's methodology of categorizing food security. The analysis will put more emphasis on 'low' and 'very low' food security populations. Correlation coefficients will be calculated to demonstrate the interrelationships among different variables impacting food security. In addition, Multiple linear regression and ANOVA tests will be used for analyzing the association between different socio demographic characteristics and the level of food security. The study will also analyze the differences between pre and post nutrition intervention for respondents using parametric tests like student's t-test, etc.

Progress 09/15/23 to 09/14/24

Outputs
Target Audience: Nothing Reported Changes/Problems:Same as last year, our principal challenges revolved around suboptimal enrollment rates and reduced participant retention within our study. What opportunities for training and professional development has the project provided?We trained seven undergraduate students and three graduate students to be part of the reseach team for this project with very specific job discription. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Continue recruitment to completed the requreid sample size.

Impacts
What was accomplished under these goals? The pre-intervention and student recruitment assessments are completed for part of the study.

Publications

  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2024 Citation: Phase 1 of Impact of Nutritional Intervention on The Prevention of Metabolic Associated Steatotic Liver Disease in Central Valley College Students Bilal Fazal Mehmood, MD1, Katherine Jones, DO1, Ernesto Rodriguez, MD1, Serhat Asci, Ph.D2, Srinivasa Konduru, Ph.D2, Shabnam Pooya, Ph.D2, Lisa Herzig, Ph.D2, Marina Roytman, MD3 1 Department of Internal Medicine, University of California San Francisco, Fresno, CA 2 Jordan College of Agricultural Sciences and Technology, California State University, Fresno, Fresno, CA 3 Division of Gastroenterology and Hepatology, University of San Francisco, Fresno, CA Background The Central Valley is considered an agricultural haven, yet its residents are disproportionately affected by metabolic disorders. Despite being a major supplier of fresh produce to the nation, its communities are marginalized by high concentrations of food deserts. In the Central Valley an estimated 45% of children and 38% of adults are classified as obese. This study aims to assess the efficacy of a prescriptive nutritional intervention program to reduce obesity and prevent metabolic associated steatotic liver disease (MASLD) in students at the California State University, Fresno (CSUF). Methods Participants included freshman to junior level college students from CSUF. Inclusion criteria consisted of eligibility for Supplemental Nutrition Assistance Program (SNAP), body mass index (>25 kg/m2), and waist circumference (>35 inches in males, >40 inches in females). Baseline vibration controlled transient elastography (VCTE) established pre-intervention liver fibrosis and steatosis. Phase 2 will utilize nutritional interventions, with VCTE as a primary endpoint for fibrosis and steatosis post-intervention. Results Our study identified 274 subjects, of which 105 were included due to incomplete data or withdrawal. Participants consisted of 78 (75%) females, 26 males, and 1 subject did not identify as either male or female. The average age was 25 years. Half of participants (53) had severe steatosis (S3) and 12% had a fibrosis score above the minimal value (F0-1). Subgroup analysis revealed that Hispanic ethnicity among men was a significant predictor of higher fibrosis grade (p = 0.025) and steatosis score (p = 0.027). Among women, Black ethnicity was found to be a significant predictor of higher fibrosis grade (p = 0.034). Conclusion Food insecurity among college students results in obesity and metabolic disorders driven by high energy intake and unhealthy food choices. Our study revealed that half of the college students at CSUF had severe steatosis with a concerning proportion of them already developing fibrosis at a young age. Men of hispanic ethnicity and women of black ethnicity were at high risk for advanced steatosis and fibrosis. Students of ethnic minorities were found to be at a higher risk for advanced steatosis and fibrosis. These findings present an opportunity for non-invasive intervention to prevent fibrosis, which will be the second phase of our study.
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2024 Citation: Comprehensive Nutrition Intervention Program emphasizing fruit and vegetable consumption to reduce food insecurity in Central Valley of California Serhat Asci1, Srini Konduru1, Shabnam Pooya2, Lisa Herzig2 and Bilal Fazal Mehmood, MD3


Progress 09/15/22 to 09/14/23

Outputs
Target Audience:During the reporting period, the recruitment efforts primarily focused on Fresno State students who met specific inclusion criteria, including: SNAP Recipients: A specific subset of Fresno State students targeted for recruitment were those who were already enrolled in the SNAP benefit program (Bulldog Pantry - Student Cupboard). These individuals were identified as potential participants based on their SNAP enrollment status. Being overweight or obese: Students with a BMI of 25 or higher for non-athlete students andwith a waistline that measured at least 35 inches for women and 40 inches for men. Changes/Problems:Our principal challenges revolved around suboptimal enrollment rates and reduced participant retention within our study: Total Participants Enrolled: While 90 eligible Participants signed up for the orientation session and 30 of them were eligible for the study and signed the consent form only 3 participants continue the study after first educational session. To address these issues, we have undertaken collaborative meetings with key stakeholders, including the Senior Program Marketing Manager from the Fair Food Network, the Produce Prescription Manager from the Nutrition Incentive Hub at the Fair Food Network, and a Product Designer. These interactions aim to enhance our recruitment materials and to gain insights into effective strategies for participant retention. What opportunities for training and professional development has the project provided?Recruitment and Outreach Skills: The project involved extensive recruitment efforts, including the use of flyers, email blasts, social media, on-campus events, and collaborations with different entities at Fresno State. This allowed team members to develop skills in marketing, communication, and outreach to engage potential participants effectively. Informed Consent and Ethical Considerations: Study members were responsible for explaining the study to potential participants, addressing their questions, and obtaining informed consent. This process required an understanding of ethical considerations in research and enhanced their skills in obtaining consent in compliance with Institutional Review Board (IRB) regulations. Health Assessment and Screening: The project required the screening of participants for eligibility based on specific health criteria, including BMI measurements, waist circumference, and other health-related assessments. Team members involved in these screenings specially nutrition students gained valuable experience in health assessment techniques. Randomization and Study Group Assignment: Upon enrollment, participants were randomly assigned to either the treatment or control group. This process introduced team members to the principles of randomization in research and the importance of creating comparable groups for experimentation. Data Collection: The project included the collection of anthropometric measurements, genetic testing, and other health-related data. Study members involved in data collection gained experience in accurately recording and managing data, which is essential in research. Nutrition Education and Program Development: The project offered opportunities for the development and delivery of nutrition education sessions. Team members responsible for these sessions had the chance to design educational content, create workbooks, and use various teaching methods to convey nutrition information effectively. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?In pursuit of our recruitment and retention objectives, our current efforts are focused on enhancing both the design and content of our promotional materials, specifically the flyers and orientation resources. These enhancements are aimed at optimizing student engagement within our program.

Impacts
What was accomplished under these goals? Spring 2023 Semester Progress Report List of activities: Set meetings with project staff for strategic planning among collaborators Developed a plan for dietary recall data and cooking demonstrations Prepared a detailed review of existing literature Trained undergraduate students to lead the grocery tour with an emphasis on fruit and vegetables Trained graduate students on the correct method of conducting nutrition educational sessions cooking demonstrations Trained all of the students/researchers on the process of conducting a USDA Multiple-Pass Createed consent form for participants Secured study approval by the Institutional Review Board (IRB) Approval from California State University, Fresno Initiation research study Created a food security questionnaire (USDA 6 item questionnaire) Created sociodemographic information Created a folate intake questionnaire Updated and modify nutrition education session lesson plans Recieved approval for Core Metrics questionaire for Baseline and Post Participant Surveys from Senior Research Associate, Gretchen Swanson Center forNutrition,TheNutritionIncentiveHub Recruitment study participants recieved signed consent forms from potential participant (18 and older) Started biweekly orientation and introduction classes to recruit students (February 2023 to May 2023 during spring semester) Collected blood sample for lipid profile, Liver function and glucose tests Collected sample saliva for the genetic test Completed pre-assessment core metric, sossioeconomic and folate itake questionaire Total Participants Enrolled in orientation/introduction classes duringSpring 2023 semeste: 90 Eligible Participants: 30 Assessment Completion: Blood Test Completed: 16 participants Genetic Test Completed: 12 participants Completed First Educational Session: 10 participants Signed Up for Grocery Store Tour: 3 participants Participant Details: While the total number of enrolled participants reached 90 during this period, it's important to note that specific assessments and educational sessions have been initiated with varying completion rates. Blood Tests: 16 participants have successfully completed blood tests, which are a crucial component of our study for assessing various health markers. Genetic Tests: Genetic testing, an integral part of our research, has been completed by 12 participants. This involves advanced analysis of genomic DNA through next-generation sequencing. Educational Sessions: Ten participants have attended and completed the first educational session, which covers essential information on nutrition and health. This session serves as the foundation for their participation in the study. Grocery Store Tours: Three participants have signed up for our grocery store tours, which aim to provide practical guidance on making healthy food choices. While these numbers represent the progress made up to this point, the study is ongoing, and we anticipate continued participation and assessment completion as we move forward.

Publications