Nutrition Intervention Optimization to Better Utilize Resources and Support Health (NOURISH)

Optimizing Interventions to Improve Nutrition Security and Reduce Diabetes Risk Among Food Pantry Clients

Not having enough food for each person in a household, also called food insecurity, makes it hard to eat a nutritious diet, maintain a healthy weight, and manage diabetes risk. Food banks and pantries provide direct food assistance that can mitigate food insecurity among people with lower income, however, people that utilize these organizations face time, resource, and physical constraints that limit their ability to consistently select and cook healthier meals and the organizations face budget constraints that limit their bandwidth for implementing nutrition programs. This research will test four innovative nutrition programs (nutritious prepared meals, medically tailored groceries in the form of meal kits, culinary medicine, motivational text messages) to identify which are the most effective for supporting healthy eating and food security and the most cost effective for organizations to implement, as an effort to reduce diabetes risk, improve diabetes self-management, and diminish health disparities.

Study Overview

• Status: Not yet recruiting
• Conditions: Food Insecurity; Diabete Type 2; Nutritional Intervention; Obesity & Overweight
• Intervention / Treatment: Behavioral: Meal kits; Behavioral: No-prep meals; Behavioral: Culinary nutrition classes; Behavioral: Text messages

• Study Type: Interventional
• Enrollment (Estimated): 400
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: NICHE Lab Team; Phone Number: ‪(469) 240-9112‬; Email: niche@tufts.edu

Study Locations

• United States
  • Texas
    • Dallas, Texas, United States, 75236
      • Crossroads Community Services
      • Contact: NICHE Lab Team; Phone Number: ‪(469) 240-9112‬; Email: niche@tufts.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Aged 18+,
• Body mass index (BMI)≥ 25;
• Access to a device with SMS and MMS (picture) text and Wi-Fi capabilities (e.g., phone, tablet, computer) and willingness to use the device regularly during the study;
• Willingness to complete four in-person data collection appointments;
• Willing and able to consent.

Exclusion Criteria:

• Presence of a condition or dietary restriction precluding eating study meals or weight loss (e.g., condition requiring liquid diet, pregnancy);
• Another member of the household participating;
• Planning to move within the next 12 months;
• Unwilling to participate.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Single

Number of Arms

16

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Condition 1: Pantry, MTG, No-prep meals, Culinary classes, and SMS; Pantry provisions, meal kits, no-prep meals, culinary nutrition classes, and text messages	Behavioral: Meal kits; Meal kits combine ingredients (e.g., chicken, tomatillo salsa verde, peppers, sweet potatoes) in a bag with a recipe that instructs how to make a healthier meal (e.g., Chicken Tomatillo Salsa Verde with Peppers and Sweet Potatoes).; Other Names: medically tailored groceries; MTGs; Behavioral: No-prep meals; The meals were created to meet nutrition standards for people with or at-risk for cardiometabolic diseases. Each entree has at least one serving of proteins, whole grains, and two vegetables. Entrees are low in sodium and sugar and meet carbohydrate recommendations for people with diabetes.; Other Names: ready-to-eat meals; no prep, ready to eat meals; Behavioral: Culinary nutrition classes; Participants randomly assigned to receive culinary nutrition classes will receive six-weeks of hybrid instruction from the Health Meets Food™ curriculum. Health Meets Food™ improves adherence to a nutritious diet, reduces food costs by encouraging more home food preparation, and reduces blood pressure and cholesterol among people with diabetes.; Behavioral: Text messages; Participants will receive four culturally tailored SMS and MMS texts per week with motivational messages and nutrition education developed and tested by Dr. Leng as part of the SANOS trial (R01MD012819) and slightly adapted to our community's food preferences identified through extensive preliminary research. Texts will be delivered in the participants preferred language (English/Spanish) and scheduled for their preferred time (e.g., AM/PM).
Experimental: Condition 2: Pantry, MTG, No-prep meals, and Culinary classes; Pantry provisions, meal kits, no-prep meals, and culinary nutrition classes	Behavioral: Meal kits; Meal kits combine ingredients (e.g., chicken, tomatillo salsa verde, peppers, sweet potatoes) in a bag with a recipe that instructs how to make a healthier meal (e.g., Chicken Tomatillo Salsa Verde with Peppers and Sweet Potatoes).; Other Names: medically tailored groceries; MTGs; Behavioral: No-prep meals; The meals were created to meet nutrition standards for people with or at-risk for cardiometabolic diseases. Each entree has at least one serving of proteins, whole grains, and two vegetables. Entrees are low in sodium and sugar and meet carbohydrate recommendations for people with diabetes.; Other Names: ready-to-eat meals; no prep, ready to eat meals; Behavioral: Culinary nutrition classes; Participants randomly assigned to receive culinary nutrition classes will receive six-weeks of hybrid instruction from the Health Meets Food™ curriculum. Health Meets Food™ improves adherence to a nutritious diet, reduces food costs by encouraging more home food preparation, and reduces blood pressure and cholesterol among people with diabetes.
Experimental: Condition 3: Pantry, MTG, No-prep meals, and SMS; Pantry provisions, meal kits, no-prep meals, and text messages	Behavioral: Meal kits; Meal kits combine ingredients (e.g., chicken, tomatillo salsa verde, peppers, sweet potatoes) in a bag with a recipe that instructs how to make a healthier meal (e.g., Chicken Tomatillo Salsa Verde with Peppers and Sweet Potatoes).; Other Names: medically tailored groceries; MTGs; Behavioral: No-prep meals; The meals were created to meet nutrition standards for people with or at-risk for cardiometabolic diseases. Each entree has at least one serving of proteins, whole grains, and two vegetables. Entrees are low in sodium and sugar and meet carbohydrate recommendations for people with diabetes.; Other Names: ready-to-eat meals; no prep, ready to eat meals; Behavioral: Text messages; Participants will receive four culturally tailored SMS and MMS texts per week with motivational messages and nutrition education developed and tested by Dr. Leng as part of the SANOS trial (R01MD012819) and slightly adapted to our community's food preferences identified through extensive preliminary research. Texts will be delivered in the participants preferred language (English/Spanish) and scheduled for their preferred time (e.g., AM/PM).
Experimental: Condition 4: Pantry, MTG, and No-prep meals; Pantry provisions, meal kits, and no-prep meals	Behavioral: Meal kits; Meal kits combine ingredients (e.g., chicken, tomatillo salsa verde, peppers, sweet potatoes) in a bag with a recipe that instructs how to make a healthier meal (e.g., Chicken Tomatillo Salsa Verde with Peppers and Sweet Potatoes).; Other Names: medically tailored groceries; MTGs; Behavioral: No-prep meals; The meals were created to meet nutrition standards for people with or at-risk for cardiometabolic diseases. Each entree has at least one serving of proteins, whole grains, and two vegetables. Entrees are low in sodium and sugar and meet carbohydrate recommendations for people with diabetes.; Other Names: ready-to-eat meals; no prep, ready to eat meals
Experimental: Condition 5: Pantry, MTG, Culinary classes, and SMS; Pantry provisions, meal kits, culinary nutrition classes, and text messages	Behavioral: Meal kits; Meal kits combine ingredients (e.g., chicken, tomatillo salsa verde, peppers, sweet potatoes) in a bag with a recipe that instructs how to make a healthier meal (e.g., Chicken Tomatillo Salsa Verde with Peppers and Sweet Potatoes).; Other Names: medically tailored groceries; MTGs; Behavioral: Culinary nutrition classes; Participants randomly assigned to receive culinary nutrition classes will receive six-weeks of hybrid instruction from the Health Meets Food™ curriculum. Health Meets Food™ improves adherence to a nutritious diet, reduces food costs by encouraging more home food preparation, and reduces blood pressure and cholesterol among people with diabetes.; Behavioral: Text messages; Participants will receive four culturally tailored SMS and MMS texts per week with motivational messages and nutrition education developed and tested by Dr. Leng as part of the SANOS trial (R01MD012819) and slightly adapted to our community's food preferences identified through extensive preliminary research. Texts will be delivered in the participants preferred language (English/Spanish) and scheduled for their preferred time (e.g., AM/PM).
Experimental: Condition 6: Pantry, MTG, and Culinary classes; Pantry provisions, meal kits, and culinary nutrition classes	Behavioral: Meal kits; Meal kits combine ingredients (e.g., chicken, tomatillo salsa verde, peppers, sweet potatoes) in a bag with a recipe that instructs how to make a healthier meal (e.g., Chicken Tomatillo Salsa Verde with Peppers and Sweet Potatoes).; Other Names: medically tailored groceries; MTGs; Behavioral: Culinary nutrition classes; Participants randomly assigned to receive culinary nutrition classes will receive six-weeks of hybrid instruction from the Health Meets Food™ curriculum. Health Meets Food™ improves adherence to a nutritious diet, reduces food costs by encouraging more home food preparation, and reduces blood pressure and cholesterol among people with diabetes.
Experimental: Condition 7: Pantry, MTG, and SMS; Pantry provisions, meal kits, and text messages	Behavioral: Meal kits; Meal kits combine ingredients (e.g., chicken, tomatillo salsa verde, peppers, sweet potatoes) in a bag with a recipe that instructs how to make a healthier meal (e.g., Chicken Tomatillo Salsa Verde with Peppers and Sweet Potatoes).; Other Names: medically tailored groceries; MTGs; Behavioral: Text messages; Participants will receive four culturally tailored SMS and MMS texts per week with motivational messages and nutrition education developed and tested by Dr. Leng as part of the SANOS trial (R01MD012819) and slightly adapted to our community's food preferences identified through extensive preliminary research. Texts will be delivered in the participants preferred language (English/Spanish) and scheduled for their preferred time (e.g., AM/PM).
Experimental: Condition 8: Pantry and MTG; Pantry provisions and meal kits	Behavioral: Meal kits; Meal kits combine ingredients (e.g., chicken, tomatillo salsa verde, peppers, sweet potatoes) in a bag with a recipe that instructs how to make a healthier meal (e.g., Chicken Tomatillo Salsa Verde with Peppers and Sweet Potatoes).; Other Names: medically tailored groceries; MTGs
Experimental: Condition 9: Pantry, No-prep meals, Culinary classes, and SMS; Pantry provisions, no-prep meals, culinary nutrition classes and text messages	Behavioral: No-prep meals; The meals were created to meet nutrition standards for people with or at-risk for cardiometabolic diseases. Each entree has at least one serving of proteins, whole grains, and two vegetables. Entrees are low in sodium and sugar and meet carbohydrate recommendations for people with diabetes.; Other Names: ready-to-eat meals; no prep, ready to eat meals; Behavioral: Culinary nutrition classes; Participants randomly assigned to receive culinary nutrition classes will receive six-weeks of hybrid instruction from the Health Meets Food™ curriculum. Health Meets Food™ improves adherence to a nutritious diet, reduces food costs by encouraging more home food preparation, and reduces blood pressure and cholesterol among people with diabetes.; Behavioral: Text messages; Participants will receive four culturally tailored SMS and MMS texts per week with motivational messages and nutrition education developed and tested by Dr. Leng as part of the SANOS trial (R01MD012819) and slightly adapted to our community's food preferences identified through extensive preliminary research. Texts will be delivered in the participants preferred language (English/Spanish) and scheduled for their preferred time (e.g., AM/PM).
Experimental: Condition 10: Pantry, No-prep meals, and Culinary classes; Pantry provisions, no-prep meals, and culinary nutrition classes	Behavioral: No-prep meals; The meals were created to meet nutrition standards for people with or at-risk for cardiometabolic diseases. Each entree has at least one serving of proteins, whole grains, and two vegetables. Entrees are low in sodium and sugar and meet carbohydrate recommendations for people with diabetes.; Other Names: ready-to-eat meals; no prep, ready to eat meals; Behavioral: Culinary nutrition classes; Participants randomly assigned to receive culinary nutrition classes will receive six-weeks of hybrid instruction from the Health Meets Food™ curriculum. Health Meets Food™ improves adherence to a nutritious diet, reduces food costs by encouraging more home food preparation, and reduces blood pressure and cholesterol among people with diabetes.
Experimental: Condition 11: Pantry, No-prep meals, and SMS; Pantry provisions, no-prep meals, and text messages	Behavioral: No-prep meals; The meals were created to meet nutrition standards for people with or at-risk for cardiometabolic diseases. Each entree has at least one serving of proteins, whole grains, and two vegetables. Entrees are low in sodium and sugar and meet carbohydrate recommendations for people with diabetes.; Other Names: ready-to-eat meals; no prep, ready to eat meals; Behavioral: Text messages; Participants will receive four culturally tailored SMS and MMS texts per week with motivational messages and nutrition education developed and tested by Dr. Leng as part of the SANOS trial (R01MD012819) and slightly adapted to our community's food preferences identified through extensive preliminary research. Texts will be delivered in the participants preferred language (English/Spanish) and scheduled for their preferred time (e.g., AM/PM).
Experimental: Condition 12: Pantry and No-prep meals; Pantry provisions and no-prep meals	Behavioral: No-prep meals; The meals were created to meet nutrition standards for people with or at-risk for cardiometabolic diseases. Each entree has at least one serving of proteins, whole grains, and two vegetables. Entrees are low in sodium and sugar and meet carbohydrate recommendations for people with diabetes.; Other Names: ready-to-eat meals; no prep, ready to eat meals
Experimental: Condition 13: Pantry, Culinary classes, and SMS; Pantry provisions, culinary nutrition classes, and text messages	Behavioral: Culinary nutrition classes; Participants randomly assigned to receive culinary nutrition classes will receive six-weeks of hybrid instruction from the Health Meets Food™ curriculum. Health Meets Food™ improves adherence to a nutritious diet, reduces food costs by encouraging more home food preparation, and reduces blood pressure and cholesterol among people with diabetes.; Behavioral: Text messages; Participants will receive four culturally tailored SMS and MMS texts per week with motivational messages and nutrition education developed and tested by Dr. Leng as part of the SANOS trial (R01MD012819) and slightly adapted to our community's food preferences identified through extensive preliminary research. Texts will be delivered in the participants preferred language (English/Spanish) and scheduled for their preferred time (e.g., AM/PM).
Experimental: Condition 14: Pantry and Culinary classes; Pantry provisions and culinary nutrition classes	Behavioral: Culinary nutrition classes; Participants randomly assigned to receive culinary nutrition classes will receive six-weeks of hybrid instruction from the Health Meets Food™ curriculum. Health Meets Food™ improves adherence to a nutritious diet, reduces food costs by encouraging more home food preparation, and reduces blood pressure and cholesterol among people with diabetes.
Experimental: Condition 15: Pantry and SMS; Pantry provisions and text messages	Behavioral: Text messages; Participants will receive four culturally tailored SMS and MMS texts per week with motivational messages and nutrition education developed and tested by Dr. Leng as part of the SANOS trial (R01MD012819) and slightly adapted to our community's food preferences identified through extensive preliminary research. Texts will be delivered in the participants preferred language (English/Spanish) and scheduled for their preferred time (e.g., AM/PM).
No Intervention: Condition 16: Pantry only; Pantry provisions

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Diet	24-hour recall based on recommendations from the National Cancer Institute and prior evidence suggesting feasibility and validity of the measure with Spanish speakers. Diet will be assessed using 24-hour recall administered via the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) in English and Spanish. Will be used to calculate a Healthy Eating Index (HEI) score. The HEI is a scale from 0 to 100.	Recorded at baseline (Appt 1, prior to randomization), midpoint (Appt 2, month 3), immediately following the intervention period (Appt 3, month 6), and three months post-intervention (Appt 4, month 9).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Household food security	Measured using the USDA 6-item household food security survey and will be treated as a continuous variable if normally distributed or a categorical variable if data is non-normal. Categorical scoring will be based on USDA recommendations (0-1 affirmative responses = high or marginal food security, 2-4 = low food security, 5-6 = very low food security).	Recorded at baseline (Appt 1, prior to randomization), midpoint (Appt 2, month 3), immediately following the intervention period (Appt 3, month 6), and three months post-intervention (Appt 4, month 9).
Percent body weight change	Will be calculated as (Baseline weight minus follow-up weight) / (Baseline weight) x 100. Height and weight will be measured using an externally validated and calibrated Tanita DC-240MA scale.	Recorded at baseline (Appt 1, prior to randomization), midpoint (Appt 2, month 3), immediately following the intervention period(Appt 3, month 6), and three months post-intervention (Appt 4, month 9).
Hemoglobin A1C (HbA1c)	Will be measured using the externally validated point-of-care instrument, DCA VantageAnalyzer (1μl finger stick, nonfasting). This method has been implemented in food pantries and is less invasive and more cost effective than a venous blood draw.	Recorded at baseline (Appt 1, prior to randomization), midpoint (Appt 2, month 3), immediately following the intervention period(Appt 3, month 6), and three months post-intervention (Appt 4, month 9).

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adherence	Number of meal kits eaten by the participant per month divided by number of meal kits selected per month, number of no-prep meals eaten per month divided by number of no-prep meals selected per month, number of culinary nutrition classes completed, and number of texts read.	Through study completion, an average of 6 months (Baseline through 6 months)
Implementation Outcomes	Will measure early-stage implementation outcomes with the follow-up questionnaire (acceptability [intervention satisfaction measures] and through administrative tracking: intervention fidelity (adherence to assigned intervention components [e.g., eating meals, attending classes, etc.] and study protocols [e.g., attending appointments]).	The entirety of the participant being enrolled (6 months)

Collaborators and Investigators

• Sponsor: Tufts University
• Collaborators: University of Texas Southwestern Medical Center
• Investigators: Principal Investigator: Kelseanna Hollis-Hansen, PhD, MPH, Tufts University

Study record dates

Study Major Dates

• Study Start (Estimated): January 1, 2027
• Primary Completion (Estimated): February 1, 2031
• Study Completion (Estimated): February 1, 2031

Study Registration Dates

• First Submitted: July 8, 2026
• First Submitted That Met QC Criteria: July 14, 2026
• First Posted (Actual): July 20, 2026

Study Record Updates

• Last Update Posted (Actual): July 20, 2026
• Last Update Submitted That Met QC Criteria: July 14, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Type 2 Diabetes; Culinary medicine; Medically tailored meals; Food is Medicine; Medically tailored groceries
• Additional Relevant MeSH Terms: Endocrine System Diseases; Nutrition Disorders; Metabolic Diseases; Overnutrition; Body Weight; Glucose Metabolism Disorders; Diabetes Mellitus; Pathological Conditions, Signs and Symptoms; Nutritional and Metabolic Diseases; Signs and Symptoms; Overweight; Obesity; Diabetes Mellitus, Type 2; Food; Diet, Food, and Nutrition; Physiological Phenomena; Food and Beverages; Fast Foods
• Other Study ID Numbers: STUDY00006929; 1R01DK145891-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Sharing Time Frame: June 2027
• IPD Sharing Access Criteria: The study protocol and informed consent sheet will be published along with an open-access peer reviewed protocol manuscript.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No