Mississippi Communities for Healthy Living: Results of a 6-month nutrition education comparative effectiveness trial

Authors: LANDRY, ALICIA - University Of Southern Mississippi; Thomson, Jessica; HUYE, HOLLY - University Of Southern Mississippi; YADRICK, KATHY - University Of Southern Mississippi; CONNELL, CAROL - University Of Southern Mississippi

Submitted to: Health Education and Behavior
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/7/2016
Publication Date: 7/13/2016
Citation: Landry, A.S., Thomson, J.L., Huye, H., Yadrick, K., Connell, C. 2016. Mississippi Communities for Healthy Living: Results of a 6-month nutrition education comparative effectiveness trial. Health Education and Behavior. doi: 10.117/1090198116657807.

Interpretive Summary: The Lower Mississippi Delta (LMD) region suffers from high rates of chronic health conditions at least partially due to poor nutrition, including obesity, high cholesterol, high blood pressure, and diabetes. Responding to the need for effective nutrition interventions in this region, the Mississippi Communities for Healthy Living (MCHL) study was conducted with LMD African-American adults. This 6-month educational intervention used two approaches to address the low diet quality of LMD residents – single message targeting discretionary calories and multiple messages targeting discretionary calories, fruits, vegetables, whole grains, and lean protein. Food frequency questionnaires were used to measure participants’ diet, while the Healthy Eating Index-2005 was used to generate diet quality scores. The majority of participants in both message groups were female (88% and 96%), African American (90% and 98%), overweight or obese (92% and 87%), and 41-60 years of age (57% and 43%). For 3 of the 12 diet quality components – whole fruit, total grains, and saturated fat – no changes were observed at the end of the intervention. For an additional 3 components – total fruit, milk, and sodium – diet quality had worsened at intervention end. For the remaining 6 components – total vegetables, dark green and orange vegetables and legumes, whole grains, meat and beans, oils, and solid fats, alcoholic beverages and added sugars (i.e. discretionary calories) – as well as total diet quality improvements were observed at intervention end. No differences in diet quality changes were observed between the two approaches. Results from this study suggest that focusing nutrition education on the discretionary calories component of the diet may be as effective as focusing on multiple components for improving diet quality.

Technical Abstract: The United States Lower Mississippi Delta (LMD) region suffers from high prevalence of chronic health conditions with nutritional etiologies, including obesity, high cholesterol, hypertension, and diabetes. Responding to the need for effective nutrition interventions in the LMD, a 2-arm, 6-month, nutrition education, comparative effectiveness trial, Mississippi Communities for Healthy Living (MCHL) was conducted in LMD African-American adults. The single-message approach targeted discretionary calories while the multi-message approach also targeted vegetables, fruits, whole grains, and lean protein. Delta food frequency questionnaires were used to measure participants’ diet, while the Healthy Eating Index-2005 was used to generate diet quality scores. Generalized linear mixed model regression was used to test for significant time, treatment, and time x treatment interaction effects in HEI-2005 component and total score changes. The majority of participants in both treatment arms were female (88% and 96%), African American (90% and 98%), overweight or obese (92% and 87%), and 41-60 years of age (57% and 43%). Significant time effects were present for HEI-2005 total and component scores, with three exceptions – whole fruit, total grains, and saturated fat. Significant treatment effects were present for two components – total and whole fruit; scores were higher in the multiple message approach arm as compared to the single message approach arm across time points. No interaction effects were significant for any of the HEI-2005 scores. Focusing nutrition education on the discretionary calories component of the diet may be as effective as focusing on multiple components for improving diet quality.