Dylan Steen, MD discusses positive findings from the trial on links between personalized education and DASH diet adherence.
Providing focus on nutrition education in the aisles of a grocery store may actually boost dietary quality, according to new late-breaking findings from The American College of Cardiology (ACC) 2022 Scientific Sessions in Washington, DC.
In an interview with HCPLive, Dylan Steen, MD, Director of Clinical Trials and Population Health Research, University of Cincinnati Heart, Lung and Vascular Institute, discussed positive results from the Supermarket and Web-based Intervention Targeting Nutrition (SuperWIN) Trial on the effects of providing nutrition education and adherence to the Dietary Approaches to Stop Hypertension (DASH) diet.
Check out Steen’s perspectives and insights below. The transcript has been edited for clarity.
What are the key takeaways from your presentation at ACC 2022 on the SuperWIN trial?
For decades, there has been research between academic, independent investigators and industry in the pharma space, the biotech space, medical device space. And that’s really brought us all the therapies that we have today, including a COVID vaccine that came about very quickly. So, there is machinery to produce these innovations.
What is remarkable is the almost complete lack of that same type of research collaboration with other industries. And if you think about the problems of this century, obesity, dietary non-adherence, getting people to take their medicine, get them to their appointments, mental health care, how to keep people independent at home, we need to activate this research engine in these other industries.
The Supermarket and Web-based Intervention Targeting Nutrition (SuperWIN) trial was a study between our diverse academic team and the Kroger Company, the nation’s largest supermarket chain, with over 2200 pharmacies in over 225 retail clinics. This is really the first of its kind to date partnership to do gold standard research to advance care through these other industries and really into the public space into the fabric of communities. That’s the real takeaway of what makes today so special.
Can you walk me through the methodology of the study?
Since we partnered with a supermarket, we focused on diet. And basically, we tested three separate approaches for improving dietary education. The first was our control group, they receive what's called a medical nutrition therapy session, that is standard of care. But we in SuperWIN went way beyond that, we actually gave the dietitians and the participants dietary intake data back to guide the counseling session. That was the first arm to an enhanced kind of standard of care.
The second arm was what we call strategy one. And on top of the medical nutrition therapy session, we then brought people back for six separate educational sessions right in their home grocery store, teaching right within the aisles of the store on how to eat better and how to make better food selections. And a dietitian in each case also had the participants individualized purchasing data to guide it. If you wanted to get someone to eat more fruits and vegetables, you could actually know how many fruits and vegetables this person is buying, which ones over time, caned, fresh, etc. And how much were they spending to help you make more targeted recommendations.
Then the third group of we called strategy 2 did all of that, but then further added on introduction and training regarding online technologies. So shopping on Kroger’s website, getting home delivery, using products like Opt Up or Yummly to select better foods or to meal plan or to build recipes, etc. So three different groups, each one with a sort of a growing intensity or growing comprehensiveness to effect dietary change.
How were the diets determined?
Everyone in SuperWIN was taught the DASH diet. The DASH diet has been studied now and recommended for decades. We focused on DASH because of its proven cardiovascular benefits.
What were the primary endpoints of the study?
The first test that we did from a scientific standpoint was we tested whether doing data guided in-store tours was beneficial over not doing them. And the answer is yes. That is great, because that was statistically significant. We tested our second hypothesis asking if online enhancements alone add value and improved dietary intake compared to not having them. And the answer to that too is yes.
These were unknown phenomena. For something like online shopping, which is exploding around the world globally and has broad applicability. These findings are really encouraging. You may know SNAP or Supplemental Nutrition Program, they are studying whether delivery of gorcering to beneficiaries can have beneficial outcomes on health and so forth. This gives a lot of evidence and a lot of confidence to go full force into this area.
Why is diet and nutrition a continuing important effort to engage with?
I mean the story right now is we do a terrible job on translating dietary guidelines to the public. 75% of Americans, maybe you and I, are classified as having poor dietary quality for cardiovascular matters. Despite all the evidence, all the talk, it is just not landing in communities. That’s the big gap.
The AHA specifically came out in 2019 and said we need immediate action to get sponsored research using retailers and academic groups, we need to study online shopping and other technologies, weather nutrition applications work, all of which we understudied. The hope is you can improve your diet even just a little and if you make it a little bit sticky, these changes will have enormous public health implications.
I believe a study published in Circulation about a year or 2 ago, whether I believe the biggest population attributable risk factor for future cardiovascular events was diet, specifically poor diet. If you can move the needle on one thing, this is the item you want to move the needle on. The problem is, until today, I don’t think we’ve had a path forward to create sustainable evidence based dietary education that is delivered right through supermarkets and other types of retailers.
Check out Part 2 of the Q&A here.