Poor Dietary Guidelines Compliance among Low-Income Women Eligible for Supplemental Nutrition Assistance Program-Education (SNAP-Ed)

Shinyoung Jun, Sowmyanarayanan V Thuppal, Melissa K Maulding, Heather A Eicher-Miller, Dennis A Savaiano, Regan L Bailey, Shinyoung Jun, Sowmyanarayanan V Thuppal, Melissa K Maulding, Heather A Eicher-Miller, Dennis A Savaiano, Regan L Bailey

Abstract

The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program aims to improve nutritional intakes of low-income individuals (<185% poverty threshold). The objective of this study was to describe the compliance with Dietary Guidelines for Americans (DGA) recommendations for fruits, vegetables, and whole grains among SNAP-Ed eligible (n = 3142) and ineligible (n = 3168) adult women (19-70 years) nationwide and SNAP-Ed participating women in Indiana (n = 2623), using the NHANES 2007-2012 and Indiana SNAP-Ed survey data, respectively. Sensitivity analysis further stratified women by race/ethnicity and by current SNAP participation (<130% poverty threshold). Nationally, lower-income women were less likely to meet the fruit (21% vs. 25%) and vegetable (11% vs. 19%) guidelines than higher-income women, but did not differ on whole grains, which were ~5% regardless of income. The income differences in fruit and vegetable intakes were driven by non-Hispanic whites. Fewer SNAP-Ed-eligible U.S. women met fruit (21% vs. 55%) and whole grain (4% vs. 18%) but did not differ for vegetable recommendations (11% vs. 9%) when compared to Indiana SNAP-Ed women. This same trend was observed among current SNAP participants. Different racial/ethnic group relationships with DGA compliance were found in Indiana compared to the nation. Nevertheless, most low-income women in the U.S. are at risk of not meeting DGA recommendations for fruits (79%), vegetables (89%), and whole grains (96%); SNAP-Ed participants in Indiana had higher compliance with DGA recommendations. Increased consumption of these three critical food groups would improve nutrient density, likely reduce calorie consumption by replacing high calorie choices, and improve fiber intakes.

Keywords: Dietary Guidelines; NHANES; SNAP; SNAP-Education; diet disparities; fruit; low-income; nutrition; vegetable; whole grain.

Conflict of interest statement

The authors declare no conflict of interest. The funding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Figures

Figure 1
Figure 1
The percentage meeting the Dietary Guidelines for American recommendations of SNAP-Ed eligible and SNAP-Ed ineligible women nationwide, NHANES 2007–2012. (a) All (b) White (c) Black (d) Hispanic/Mexican American. Fruit and vegetable intakes are measured in cup equivalents and whole grain intake is measured in ounce equivalents. * Significantly different between SNAP-Ed eligible and SNAP-Ed ineligible women nationwide based on t-tests. Error bars indicate 95% confidence intervals.

References

    1. U.S. Department of Agriculture Food and Nutrition Service. Supplemental Nutrition Assistance Program Education Plan Guidance FY 2018. [(accessed on 20 November 2017)]; Available online: .
    1. Savoie M.R., Mispireta M., Rankin L.L., Neill K., LeBlanc H., Christofferson D. Intention to change nutrition-related behaviors in adult participants of a Supplemental Nutrition Assistance Program-Education. J. Nutr. Educ. Behav. 2015;47:81–85. doi: 10.1016/j.jneb.2014.08.009.
    1. Williams P.A., Cates S.C., Blitstein J.L., Hersey J.C., Kosa K.M., Long V.A., Singh A., Berman D. Evaluating the Impact of Six Supplemental Nutrition Assistance Program Education Interventions on Children’s At-Home Diets. Health Educ. Behav. 2015;42:329–338. doi: 10.1177/1090198114558589.
    1. U.S. Department of Agriculture Dietary Guidelines for Americans 2015–2020. [(accessed on 20 November 2017)]; Available online: .
    1. McGill C.R., Fulgoni V.L., III, Devareddy L. Ten-year trends in fiber and whole grain intakes and food sources for the United States population: National Health and Nutrition Examination Survey 2001–2010. Nutrients. 2015;7:1119–1130. doi: 10.3390/nu7021119.
    1. The Secretary of Health and Human Services and te Secretary of Agriculture Scientific Report of the 2015 Dietary Guidelines Advisory Committee. [(accessed on 25 November 2017)]; Available online: .
    1. McAnulty J.T., Akabas S.R., Thuppal S.V., Paxson E.E., Saklani S., Tucker K.L., Bailey R.L. Fiber Intake Varies by Poverty-Income Ratio and Race/Ethnicity in the US Adults. Nutr. Today. 2017;52:73–79. doi: 10.1097/NT.0000000000000207.
    1. Storey M., Anderson P. Income and race/ethnicity influence dietary fiber intake and vegetable consumption. Nutr. Res. 2014;34:844–850. doi: 10.1016/j.nutres.2014.08.016.
    1. National Center for Health Statistic . National Health and Nutrition Examination Survey: Plan and Operations, 1999–2010. US Department of Health and Human Services; Centers for Disease Control and Prevention; Hyattsville, MD, USA: 2013.
    1. U.S. Department of Health and Human Services Poverty Guidelines. [(accessed on 28 November 2017)]; Available online: .
    1. US Department of Agriculture Food Patterns Equivalents Database (FPED) [(accessed on 12 July 2017)]; Available online: .
    1. Riederer A.M., Pearson M.A., Lu C. Comparison of food consumption frequencies among NHANES and CPES children: Implications for dietary pesticide exposure and risk assessment. J. Expo. Anal. Environ. Epidemiol. 2010;20:602–614. doi: 10.1038/jes.2009.48.
    1. Krebs-Smith S.M., Guenther P.M., Subar A.F., Kirkpatrick S.I., Dodd K.W. Americans do not meet federal dietary recommendations. J. Nutr. 2010;140:1832–1838. doi: 10.3945/jn.110.124826.
    1. Drewnowski A., Rehm C.D. Socioeconomic gradient in consumption of whole fruit and 100% fruit juice among US children and adults. Nutr. J. 2015;14:3. doi: 10.1186/1475-2891-14-3.
    1. Bailey R.L., Akabas S.R., Paxson E.E., Thuppal S.V., Saklani S., Tucker K.L. Total Usual Intake of Shortfall Nutrients Varies With Poverty Among US Adults. J. Nutr. Educ. Behav. 2017;49:639–646. doi: 10.1016/j.jneb.2016.11.008.
    1. Kirkpatrick S.I., Dodd K.W., Reedy J., Krebs-Smith S.M. Income and race/ethnicity are associated with adherence to food-based dietary guidance among US adults and children. J. Acad. Nutr. Diet. 2012;112:624–635. doi: 10.1016/j.jand.2011.11.012.
    1. Hiza H.A., Casavale K.O., Guenther P.M., Davis C.A. Diet quality of Americans differs by age, sex, race/ethnicity, income, and education level. J. Acad. Nutr. Diet. 2013;113:297–306. doi: 10.1016/j.jand.2012.08.011.
    1. United States Department of Agriculture Agricultural Research Service. Food Patterns Equivalent Intakes from Food, 2013–2014. [(accessed on 28 November 2017)]; Available online: .
    1. Liu R.H. Health-promoting components of fruits and vegetables in the diet. Adv. Nutr. 2013;4:S384–S392. doi: 10.3945/an.112.003517.
    1. Park Y., Subar A.F., Hollenbeck A., Schatzkin A. Dietary fiber intake and mortality in the NIH-AARP Diet and Health Study. Arch. Intern. Med. 2011;171:1061–1068. doi: 10.1001/archinternmed.2011.18.
    1. Slavin J.L., Savarino V., Paredes-Diaz A., Fotopoulos G. A review of the role of soluble fiber in health with specific reference to wheat dextrin. J. Int. Med. Res. 2009;37:1–17. doi: 10.1177/147323000903700101.
    1. Papathanasopoulos A., Camilleri M. Dietary Fiber Supplements: Effects in Obesity and Metabolic Syndrome and Relationship to Gastrointestinal Functions. Gastroenterology. 2010;138:65–72. doi: 10.1053/j.gastro.2009.11.045.
    1. Riccioni G., Sblendorio V., Gemello E., Di Bello B., Scotti L., Cusenza S., D’Orazio N. Dietary fibers and cardiometabolic diseases. Int. J. Mol. Sci. 2012;13:1524–1540. doi: 10.3390/ijms13021524.
    1. Threapleton D.E., Greenwood D.C., Evans C.E.L., Cleghorn C.L., Nykjaer C., Woodhead C., Cade J.E., Gale C.P., Burley V.J. Dietary fibre intake and risk of cardiovascular disease: Systematic review and meta-analysis. BMJ. 2013;347 doi: 10.1136/bmj.f6879.
    1. Wannamethee S.G., Whincup P.H., Thomas M.C., Sattar N. Associations between dietary fiber and inflammation, hepatic function, and risk of type 2 diabetes in older men: Potential mechanisms for the benefits of fiber on diabetes risk. Diabetes Care. 2009;32:1823–1825. doi: 10.2337/dc09-0477.
    1. Yao B., Fang H., Xu W., Yan Y., Xu H., Liu Y., Mo M., Zhang H., Zhao Y. Dietary fiber intake and risk of type 2 diabetes: A dose-response analysis of prospective studies. Eur. J. Epidemiol. 2014;29:79–88. doi: 10.1007/s10654-013-9876-x.
    1. Moore L.V., Thompson F.E. Adults Meeting Fruit and Vegetable Intake Recommendations—United States, 2013. Morb. Mortal. Wkly. Rep. 2015;64:709–713.
    1. Centers for Disease Control and Prevention (CDC) State-specific trends in fruit and vegetable consumption among adults—United States, 2000–2009. Morb. Mortal. Wkly. Rep. 2010;59:1125–1130.
    1. Di Noia J., Monica D., Gray H.L., Cullen K.W. The Special Supplemental Nutrition Program for Women, Infants, and Children Fresh Start Randomized Controlled Trial: Baseline Participant Characteristics and Reliability of Measures. J. Acad. Nutr. Diet. 2016;116:1899–1913. doi: 10.1016/j.jand.2016.07.020.
    1. Yaroch A.L., Tooze J., Thompson F.E., Blanck H.M., Thompson O.M., Colon-Ramos U., Shaikh A.R., McNutt S., Nebeling L.C. Evaluation of three short dietary instruments to assess fruit and vegetable intake: The National Cancer Institute’s food attitudes and behaviors survey. J. Acad. Nutr. Diet. 2012;112:1570–1577. doi: 10.1016/j.jand.2012.06.002.
    1. U.S. Census Bureau 2008–2012 American Community Survey. [(accessed on 25 November 2017)]; Available online:
    1. Haynes-Maslow L., Parsons S.E., Wheeler S.B., Leone L.A. A qualitative study of perceived barriers to fruit and vegetable consumption among low-income populations, North Carolina, 2011. Prev. Chronic Dis. 2013;10:E34. doi: 10.5888/pcd10.120206.
    1. Eicher-Miller H.A., Mason A.C., Abbott A.R., McCabe G.P., Boushey C.J. The effect of Food Stamp Nutrition Education on the food insecurity of low-income women participants. J. Nutr. Educ. Behav. 2009;41:161–168. doi: 10.1016/j.jneb.2008.06.004.
    1. Rivera R.L., Maulding M.K., Abbott A.R., Craig B.A., Eicher-Miller H.A. SNAP-Ed (Supplemental Nutrition Assistance Program-Education) Increases Long-Term Food Security among Indiana Households with Children in a Randomized Controlled Study. J. Nutr. 2016;146:2375–2382. doi: 10.3945/jn.116.231373.
    1. Hanson K.L., Connor L.M. Food insecurity and dietary quality in US adults and children: A systematic review. Am. J. Clin. Nutr. 2014;100:684–692. doi: 10.3945/ajcn.114.084525.
    1. Eicher-Miller H.A., Mason A.C., Weaver C.M., McCabe G.P., Boushey C.J. Food insecurity is associated with diet and bone mass disparities in early adolescent males but not females in the United States. J. Nutr. 2011;141:1738–1745. doi: 10.3945/jn.111.142059.
    1. Park C.Y., Eicher-Miller H.A. Iron deficiency is associated with food insecurity in pregnant females in the United States: National Health and Nutrition Examination Survey 1999–2010. J. Acad. Nutr. Diet. 2014;114:1967–1973. doi: 10.1016/j.jand.2014.04.025.
    1. Leung C.W., Epel E.S., Willett W.C., Rimm E.B., Laraia B.A. Household food insecurity is positively associated with depression among low-income supplemental nutrition assistance program participants and income-eligible nonparticipants. J. Nutr. 2015;145:622–627. doi: 10.3945/jn.114.199414.
    1. Laraia B.A. Food Insecurity and Chronic Disease. Adv. Nutr. 2013;4:203–212. doi: 10.3945/an.112.003277.
    1. Molitor F., Sugerman S.B., Sciortino S. Fruit and Vegetable, Fat, and Sugar-Sweetened Beverage Intake Among Low-Income Mothers Living in Neighborhoods With Supplemental Nutrition Assistance Program-Education. J. Nutr. Educ. Behav. 2016;48:683–690. doi: 10.1016/j.jneb.2016.07.002.
    1. Molitor F., Sugerman S., Yu H., Biehl M., Aydin M., Levy M., Ponce N.A. Reach of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) interventions and nutrition and physical activity-related outcomes, California, 2011–2012. Prev. Chronic Dis. 2015;12:E33. doi: 10.5888/pcd12.140449.
    1. Guenther P.M., Luick B.R. Improved Overall Quality of Diets Reported by Expanded Food and Nutrition Education Program Participants in the Mountain Region. J. Nutr. Educ. Behav. 2015;47:421–426. doi: 10.1016/j.jneb.2015.05.001.
    1. Gans K.M., Risica P.M., Strolla L.O., Fournier L., Kirtania U., Upegui D., Zhao J., George T., Acharyya S. Effectiveness of different methods for delivering tailored nutrition education to low income, ethnically diverse adults. Int. J. Behav. Nutr. Phys. Act. 2009;6:24. doi: 10.1186/1479-5868-6-24.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다