Fruit and vegetable diet, cooking classes may lower community CVD, CKD risk
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Key takeaways:
- High-risk African Americans offered a fruit and vegetable diet saw improved kidney outcomes and CVD risk factors.
- Greater improvement was seen in participants who also received cooking classes.
A community-based strategy to screen lower-income African Americans for elevated risk for chronic kidney disease and CVD and intervene with a fruit and vegetable diet, was feasible, according to results of a recently published study.
Some participants were also instructed on cooking meals with provided fruits and vegetables. At 6 months, those participants had a lower albumin-to-creatinine ratio (ACR) than those not given cooking instructions.
The findings support “more focused” CKD screening in high-risk, under-resourced African American communities, Heather E. Kitzman, PhD, and colleagues wrote in Kidney Medicine.
“Targeted screening of communities at high CKD/CVD risk permits execution of ‘precision public health,’” researchers wrote. “Hence, whether to screen individuals for CKD should instead be whether to screen high-risk communities for CKD.”
The randomized, parallel, two-arm trial enrolled 142 African American adults from a southern Dallas community described as “under-resourced” and “historically ‘red-lined.’” Participants had to have an ACR of more than 10 mg/g and no history of dialysis or kidney transplant.
For 6 months, participants were provided 2 cups per day of fruits and vegetables via weekly pick-up or delivery. In a 1:1 ratio, they were randomly assigned to either attend six weekly 90-minute group nutrition and cooking classes or receive no cooking instruction. Participants reported dietary data through ASA24 at baseline, 6 weeks and 6 months.
Classes adhered to a curriculum developed for under-resourced populations, were delivered by community health workers and offered “culturally relevant adaptations to recipes for African Americans.”
At 6 months, 71% of participants (n = 101) remained in the protocol. The group that received cooking instructions had 31% lower ACR at 6 months than those who did not.
The finding suggests that cooking instructions, with an “added logistics and costs,” may be necessary for the fruit and vegetable intervention to achieve community-wide cardiovascular and kidney health benefits, researchers wrote. However, they added that participants saw improvement in chronic disease risk factors by the end of the study “regardless of cooking instruction.”
Fruit and vegetable intake had a significant net increase across the combined group (P < .02). Researchers observed no harms related to study interventions.
Researchers concluded that the community-based intervention was “highly utilized” and the trial showed “promise for identifying effective, easily accessible and scalable strategies to reduce CVD outcomes and CKD incidence in communities at high risk for both.”
Study limitations included its small sample size, low ACR levels at baseline and the loss of 29% of participants over follow-up, researchers wrote. They also highlighted potential for nonresponse bias in the 6-month ASA24 analysis.
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