Effects of DASH Groceries on Blood Pressure in Black Residents of Urban Food Deserts Without Treated Hypertension
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 180
- Locations
- 1
- Primary Endpoint
- Seated, office-based, systolic blood pressure (intervention phase)
Study Overview
Brief Summary
GoFresh is a randomized trial, testing the effects of a home-delivered DASH-patterned grocery intervention on blood pressure in Black adults, residing in Boston area urban food deserts.
Detailed Description
Hypertension affects over half of Black adults in the United States - more than any other group - and diet is a principal determinant of disparities in hypertension among Black adults. While the DASH diet is a proven strategy for lowering blood pressure in Black adults, diet disparities are increasing in urban food deserts due to poor access and the high costs of healthy foods. This clinical trial will randomize 150 Black adults residing in Boston area urban food deserts to either:
- 12 weeks of dietitian-assisted, DASH grocery delivery via an online, virtual grocery store at an amount sufficient to replace all Calorie needs of each participant, allowing for some sharing with family members
or 2. Self-directed shopping with a monthly stipend over a 3-month period
After the 12-week intervention phase, participants will undergo a 9-month observation phase. At 3-months after the intervention is complete the investigators will repeat in-person study assessments and perform qualitative interviews in a subset of the population to determine barriers and facilitators to intermediate-term maintenance of the intervention. At 9-months after the intervention, participants will participate in a phone visit designed to assess longer-term maintenance of the intervention.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Double (Investigator, Outcomes Assessor)
Masking Description
Outcomes assessors will not know randomization assignment. Investigators will not know randomization assignment. Participants and the nutritionist/dietitian interventionist will need to know randomization assignment in order to carry out the intervention.
Eligibility Criteria
- Ages
- 18 Years to 100 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Self-reported/self-identified as Black or African American
- •Resting systolic blood pressure of 120 to <150 mm Hg and diastolic blood pressure <100 mm Hg
- •Residence in communities identified as Boston area food deserts: Brighton, Chelsea, Dorchester, East Boston, Everett, Hyde Park, Jamaica Plain, Malden, Mattapan, Revere, Roslindale, Roxbury, or Winthrop
- •Able to receive home-delivered groceries or pick them up at a convenient location and willing to eat only the groceries provided over a 12-week period
- •Have access to refrigeration, cooking appliances, and Wi-Fi/cellular service
- •Have access to mobile device or computer to be able to conduct grocery orders via video conference or by phone
- •Willing and able to complete required measurement procedures
Exclusion Criteria
- •Laboratory Exclusions:
- •Serum potassium ≥5.0 mmol/L or <3.5 mmol/L
- •Estimated glomerular filtration rate (eGFR) <30 mL/min per 1.73 m^2 by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation
- •Hemoglobin A1c ≥6.5%
- •Medication Exclusions:
- •Any use of medications that lower blood pressure or medications intended for hypertension treatment (including antihypertensives taken for non-hypertension purposes) within the last 6 months
- •Unstable doses (i.e. a change in the 2 months prior to screening or randomization) of the following:
- •Sodium-glucose co-transporter 2 (SGLT2) inhibitors
- •Stimulants
- •Inhaled or oral medications for asthma or chronic obstructive pulmonary disease (COPD)
- •Hormone replacement therapy or thyroid hormone
- •Weight-increasing psychotropic agents, including antipsychotic agents, lithium, and mirtazapine
- •Use of any of the following medications:
- •Potassium supplement, except if part of a multivitamin
- •Warfarin (Coumadin)
- •Chronic oral corticosteroid (intermittent use is okay)
- •Weight loss medications (including GLP-1 receptor agonists)
- •Unwillingness to keep same dose of vitamin, mineral, and botanical supplements
- •Any medication not compatible with participation as determined by the investigators
- •Physical Exclusions:
- •Systolic blood pressure ≥150 mm Hg or diastolic blood pressure ≥100 mm Hg
- •Body weight >420 pounds
- •Arm circumference >50cm
- •Weight loss or gain of >5.0% of body weight during prior 2 months
- •Medical History Exclusions:
- •Type 1 or Type 2 Diabetes defined as a hemoglobin A1c ≥6.5% or diabetes treatment
- •Active cardiovascular disease or any event in the prior 6 months, including coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), myocardial infarction (MI), cerebrovascular accident (CVA), or congestive heart failure (CHF) exacerbation requiring hospital admission
- •Cancer diagnosis or treatment in the last 2 years (non-melanoma skin cancer or localized breast or prostate or bladder cancer not requiring systemic therapy is acceptable)
- •Active inflammatory bowel disease, bowel resection, malabsorptive syndrome, pancreatitis (episode within past year), or history of bariatric surgery
- •Pregnancy or lactation or planned pregnancy
- •Any emergency department (ED) visit for asthma or chronic obstructive pulmonary disease (COPD) in the last 6 months
- •Any other serious illness or condition not compatible with participation as determined by the investigators
- •Lifestyle and Other Exclusions:
- •Significant food allergies, preferences, intolerances, or dietary requirements that would interfere with diet adherence
- •Consumption of more than 14 alcoholic drinks per week or consumption of more than 6 drinks on one or more occasion per week
- •Active substance use disorder that would interfere with participation
- •Extreme food insecurity
- •Participation in or planning to start weight loss program
- •Current participation in another clinical trial that could interfere with the study protocol
- •Anticipated change in residence prior to the end of the study
- •Families with more than 6 adults at dinner time (children are considered to be half an adult)
- •Investigator discretion
Arms & Interventions
Dietitian-Assisted DASH groceries
Participants will order groceries sufficient to meet their caloric needs each week for 12 weeks with the assistance of a dietitian/nutrition interventionist. Groceries will be delivered to participants' homes or picked up at a convenient location. The dietitian/nutrition interventionist will provide brief educational content at the time of food delivery. Orders will be placed via phone or through virtual counseling sessions. During the remainder of the study (months 4-12), participants will be asked to apply what they learned without the provision of groceries.
Intervention: Dietitian-Assisted DASH groceries (Behavioral)
Self-directed shopping (referent assignment)
Participants will receive a monthly stipend over a 3 month period and some basic information about healthy eating. The stipend is not restricted to foods. During the remainder of the study (months 4-12), participants will be asked to continue their typical shopping without the provision of the monthly stipend.
Intervention: Self-directed shopping (Behavioral)
Outcomes
Primary Outcomes
Seated, office-based, systolic blood pressure (intervention phase)
Time Frame: Measured 3 months after randomization
In-person, measured with an automated oscillometric device that will perform 3 measurements.
Secondary Outcomes
- Seated, office-based, systolic blood pressure (observation phase)(Measured 6 months after randomization)
- Hemoglobin A1c (intervention & observation phases)(Measured 3 and 6 months after randomization)
- Ambulatory blood pressure monitoring: wake-time systolic and diastolic blood pressure (intervention & observation phases)(Measured 3 and 6 months after randomization)
- 24-hour urine sodium (intervention & observation phases)(Measured 3 and 6 months after randomization)
- Lipids (intervention & observation phases)(Measured 3 and 6 months after randomization)
- Serum potassium (intervention & observation phases)(Measured 3 and 6 months after randomization)
- Serum creatinine (intervention & observation phases)(Measured 3 and 6 months after randomization)
- 24-hour dietary recall (intervention & observation phases)(Measured 3 and 6 months after randomization)
- Seated, office-based, diastolic blood pressure (intervention & observation phases)(Measured 3 and 6 months after randomization)
- 24-hour urine potassium (intervention & observation phases)(Measured 3 and 6 months after randomization)
- Body Mass Index (BMI) (intervention & observation phases)(Measured 3 and 6 months after randomization)
- Daily intake of fat, fruits, and vegetables (intervention & observation phases)(Measured 3, 6, and 12 months after randomization)
Investigators
Stephen Juraschek
Associate Professor of Medicine
Beth Israel Deaconess Medical Center