Easier access to healthy foods contributes to greater improvements in dietary quality among adults with metabolic syndrome following dietary interventions

INTRODUCTION: This study investigates the influence of accessibility to healthy foods on dietary quality improvements among community-living adults with metabolic syndrome after dietary interventions.

METHODS: Participants were recruited from Worcester County, Massachusetts between May 2009 and January 2012, and randomized (N=240) to a high fiber diet (≥30g/day) or the American Heart Association diet. Dietary intakes were measured by 24-hour dietary recalls at baseline, 3-, 6- and 12-months. Participants with geocodable residential addresses were analyzed (N=221). Healthy food availability in participant communities was assessed annually using the Community Nutrition Environment Evaluation Data System. Accessibility was defined as travel distance from residence to the nearest food store with adequate healthy food availability.  Linear regression models were used to evaluate the maximum change in dietary outcomes in relation to accessibility.  

RESULTS: The participants had a mean age of 52 years, body mass index of 34.9 kg/m², and were 72% women and 89% White. The two intervention groups had similar baseline characteristics and healthy food accessibility. In multiple regression models adjusting for baseline characteristics and intervention group, shorter distance to food stores with adequate healthy food availability was associated with greater increases in consumption of dietary fiber (β=-0.94g/day per mile; p<0.01) and total fruit and vegetables (β=-0.19 servings/day per mile; p=0.03) after either intervention.   

DISCUSSION: Participants living in communities with better healthy food accessibility reported greater improvements in dietary quality following dietary interventions. This result highlights the importance of community food environment to healthy eating, which should be considered in future interventions.