‘Harnessing the supermarket’: Grocery store-led intervention improved diet quality
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WASHINGTON — Personalized nutrition interventions led by grocery store dietitians and guided by food purchasing data were associated with improved adherence to the Dietary Approaches to Stop Hypertension eating plan, researchers reported.
The Supermarket and Web-based Intervention Targeting Nutrition (SuperWIN) trial was designed as a partnership between academic researchers and the grocery retailer Kroger; it is the first to deliver a nutritional intervention in each participant’s home grocery store guided by their food purchasing decisions.
‘Harnessing the supermarket’
“SuperWIN has demonstrated the efficacy of dietary interventions harnessing the supermarket’s physical environment, the retail-based dietitian working within the store, as well as the purchasing data captured on the store’s loyalty cards,” Dylan L. Steen, MD, MS, adjunct associate professor of medicine at the University of Cincinnati College of Medicine and director of Clinical Trials and Population Health Research at the University of Cincinnati Heart, Lung and Vascular Institute, said at the American College of Cardiology Scientific Session. “SuperWIN now also demonstrates the efficacy of online shopping and other technologies to support health.”
Despite guideline recommendations, 75% of Americans have poor dietary quality, Steen said during the late-breaking clinical trial presentation.
Dietary interventions delivered at grocery stores offer convenience, accessibility, full food inventories and increasingly, in-store registered dietitians, online shopping and delivery services, electronic food purchasing data-guided support tools, and other health care services, Steen said.
DASH diet scores improved
The researchers analyzed data from 247 adults with at least one CV risk factor, including obesity, hypercholesterolemia and/or hypertension, who enrolled via a primary care network via each participant’s home grocery store and retail clinic.
All participants received medical nutrition therapy in a single, 30-minute session and were then randomly assigned to one of two individualized, in-person, dietitian-led interventions focused on the DASH diet or usual care (n = 46). The first intervention used only the in-store environment for education, demonstration and practice (n = 100). The second intervention harnessed the in-store and online environments (n = 101). The trial was stopped March 13, 2020, during the COVID-19 pandemic and resumed in June 2020.
Researchers assessed change in DASH score from baseline to 3 months after intervention, analyzing strategies one and two together compared with standard care and strategy two compared with strategy one.
Compared with standard care, the interventions increased DASH score by a mean of 4.7 points (95% CI, 0.9-8.5; P = .02). The in-store and online intervention increased DASH score by a mean of 3.8 points (95% CI, 0.8-6.9; P = .01) vs. the in-store only intervention.
“Adherence to the DASH diet increased in all three groups and the interventions remained increased at 6 months,” Steen said.
A prespecified analysis demonstrated that prior to the COVID-19 pandemic the interventions increased DASH score by a mean of 8.3 points (95% CI, 3.4-13.3; P = .001) compared with usual care.
“The pre-COVID metrics are very exciting because of the near-perfect visit attendance,” Steen said. “This, to me, suggests that if we want to add on more educational sessions, we could go ahead and do so, because the visit attendance was so good.”
A ‘new era of research’
The SuperWIN researchers said analyses on food literacy, purchases, biometrics and participant experience are pending.
In 2019, an American Heart Association scientific advisory called for immediate action regarding sponsored research with retailers like supermarkets, studies of online shopping to promote healthier purchases and studies of nutrition applications.
“SuperWIN was only made possible by this unique, first-of-its-kind research collaboration between our academic team and a large retailer,” Steen said. “My callout to everyone is we need to spark a new era of research in this field so we can extend the reach of traditional health care systems out into the communities, promote access and convenience and better outcomes.”
During a discussion following the presentation, a question was asked how the intervention would work in underserved communities.
Steen, who noted total household income was above $125,000 for about 30% of the cohort, said enhancements in online or home delivery may reduce some of the barriers to improving dietary intake, especially for communities with the most challenges.
“We need bigger studies in more communities,” Steen said. “This was conducted at 13 Kroger stores in Ohio and Kentucky. The opportunity is certainly there.”
Perspective
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Eileen M. Handberg, PhD, ARNP, FACC
What are the things that put us most at risk for CVD? It is how we eat, how we exercise and how we live. These habits start when we are young. Taking an intervention to where people live is very helpful. Asking people to come into the doctor’s office to learn about nutrition is not helpful when there is no relationship between that visit and what you are doing at the local grocery store.
Grocery chains may take this type of intervention up as an opportunity to help. Ultimately, what they want is more people coming into the stores. That is what the pharmacies and minute clinics do. If you have a program that is considered healthy in your grocery store, that is appealing to customers. This program also provides direct feedback on what you purchased. What consumers think they buy what we actually buy are completely different things. How do we make better choices? If there is some accountability for that, it is a win-win for everyone.
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Steen D, et al. Joint American College of Cardiology/Journal of the American Medical Association Late-Breaking Clinical Trials. Presented at: American College of Cardiology Scientific Session; April 2-4, 2022; Washington, D.C. (hybrid meeting).
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