According to a September 2019 study published in the The Journal of Nutrition, Adherence to the Healthy Eating Index–2015 and Other Dietary Patterns May Reduce Risk of Cardiovascular Disease, Cardiovascular Mortality, and All-Cause Mortality, “a higher diet quality, characterized by the Healthy Eating Index-2015 and 3 other dietary indices, was associated with reduced risks of incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality in a prospective cohort of 12,413 Black and White adults.”  Emily A. Hu et al. further noted, “our results were consistent with previous studies that reported inverse associations between healthy dietary patterns and cardiovascular disease, cardiovascular disease mortality, and all-cause mortality.”

Despite a growing body of strong evidence pointing to the health benefits of adopting and adhering to a healthy diet, most people don’t: “In 2019, 12.3% and 10.0% of surveyed adults met fruit and vegetable intake recommendations, respectively,” according to the CDC’s report “Adults Meeting Fruit and Vegetable Intake Recommendations—United States, 2019.”

In response, ASN Journals have been investigating which types of interventions are likely to lead to lasting healthy dietary choices.  Below are a few examples of recently published ASN Journal original research studies and reviews that help point the way:

Randomized Trial of a Novel Lifestyle Intervention Compared with the Diabetes Prevention Program for Weight Loss in Adult Dependents of Military Service Members, The American Journal of Clinical Nutrition, August 2021

The Diabetes Prevention Program is based on a health behavior change model that emphasizes goal setting and the development of self-regulation skills; participant weight loss has been low.  In contrast, Healthy Weight for Living, a new lifestyle intervention approach, focuses on the biological drivers of food intake, specifically managing hunger and reducing food cravings in tandem with increasing preferences for healthy food.  In this parallel-group randomized trial, ASN member Sai Krupa Das et al. assigned 238 participants to either the Healthy Weight for Living or a modified Diabetes Prevention Program, which included additional components such as planning, stimulus control, relapse recovery, and flexible eating restraint.  Both interventions were delivered by group video conference with additional midweek emails over a 12-month period.  Almost all the participants were women with overweight or obesity, ranging in age from 19 to 70.  At the end of the study, the hypothesis that Healthy Weight for Living enrollees would achieve greater weight loss compared to the Diabetes Prevention Program enrollees was not proven.  On the other hand, the authors noted that “results of both interventions exceeded those achieved with most pharmacotherapy at 12 months.”

The Effect of Dietary-based Lifestyle Modification Approaches on Anthropometric Indices and Dietary Intake Parameters in Women with Breast Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials, Advances in Nutrition, May 2022

Recent surveys have found that women with breast cancer often gain weight during and after cancer therapy.  Increased body weight, coupled with unhealthy dietary intake and physical inactivity, can increase both the duration of treatment and the risk of breast cancer recurrence.  In response, Mahsa Raji Lahiji et al. investigated the effect of dietary-based lifestyle modification interventions on anthropometric measures and dietary intake among women with breast cancer.  The authors assessed 51 randomized controlled trials, with a total of 7,743 participants, that studied the effects of dietary intervention alone or in combination with physical activity and/or behavioral therapy.  The findings suggest that “a comprehensive dietary-based intervention, which included a combination of diet and exercise, or diet, exercise and behavioral therapy, would have the most positive effects on anthropometric and dietary intake parameters in women with breast cancer, especially when started as soon as the cancer was diagnosed.”  The authors did acknowledge that the majority of the studies they reviewed were conducted among American and European populations.  More research on Asian and African populations is needed for a fuller understanding.

Effectiveness of an Integrated Agriculture, Nutrition-specific and Nutrition-sensitive Program on Child Growth in Western Kenya: A Cluster-randomized Controlled Trial, Current Developments in Nutrition, April 2022

In Kenya, 26% of children less than five years of age are stunted.  In response, Rita Wegmüller et al. conducted a study in rural Western Kenya to assess the effectiveness of a bundle of basic agriculture, nutrition-specific, and nutrition-sensitive interventions on child growth compared to a control group which received basic agriculture interventions only.  The 1,927 children aged 6-35 months upon enrollment and their families who participated in the study were randomly divided into the intervention group and the control group.  Over a period of two years, families participating in the intervention group received regular supplies of micronutrient powders, poultry, greens and onion seeds, soap, and chlorine solution.  Moreover, families participated in monthly behavior change trainings.  The results of the study indicated that the bundle of interventions “resulted in a modest improvement in linear growth compared to the agriculture intervention alone.”  Moreover, the authors noted that “our observation that younger children 6-23 months of age at recruitment may benefit more from the interventions suggests a more targeted provision of interventions to children younger than 2 years.”

Evaluating an Intervention to Increase Cereal Fiber Intake in Children: A Randomized Controlled Feasibility Trial, The Journal of Nutrition, December 2020

Observational studies have shown that higher cereal fiber intake is associated with reduced type 2 diabetes risk.  By conducting a two-arm parallel group randomized controlled trial among 272 children aged 9-10, Angela S. Donin et al. evaluated the feasibility of an intervention to increase cereal fiber intake among children.  The children, who were recruited from 23 London primary schools, were randomly divided into two groups: one group received free supplies of high-fiber breakfast cereals (>3.5 g/portion); the other received free supplies of low-fiber breakfast cereals (<1.0 g/portion) to eat daily for a period of one month.  To improve their adherence and engagement, as well as to chart their progress, children were given a breakfast diary, wall chart, stickers, pens, pencils, refrigerator magnets, and badges.  In addition, a trial coordinator visited the children at their schools one week into the trial to administer a quiz about breakfast and general nutrition, with the goal of keeping participants engaged with the study. According to the study results, the intervention “successfully increased cereal fiber intakes in the intervention group over a one-month period,” verified by biomarkers of whole-grain and rye intake.  The authors noted that “some previous interventions that aimed to increase fiber intakes were unsuccessful, even when substitute foods were provided, results emphasizing the importance of the behavioral support to encourage consumption of the breakfast cereal.”

If you are conducting research that explores how to instill healthy dietary choices, please consider submitting your original research study or review to an ASN Journal.  In particular, we are interested in studies that target diverse, under-studied populations.  If your article is selected for publication, we will ensure that it is published quickly and disseminated broadly around the world.