A Multisite, Randomized, Controlled Trial Of A Supermarket And Web-based Intervention Targeting Nutrition For Cardiovascular Risk Reduction (SuperWIN)

Presented at ACC.22 by Dylan Steen, MD (Cincinnati, OH, USA)

Introduction and methods

Three out of four Americans have a poor dietary quality. Innovation is needed to close the gap between guidelines and what is happening in real life communities.

In the SuperWIN study, 247 primary care network adult patients with at least 1 CV risk factor who shopped regularly at a Kroger supermarket (a large US supermarket chain) were enrolled. They were not an online Kroger shopper and willing to follow the DASH diet.

They received medical nutrition therapy during 1 education visit and were then randomized (in a 1:2:2 ratio) to strategy 1 (6 dietary education visits), strategy 2 (6 dietary education visits with training for online shopping) or the control group (no further dietary education). Study visits were conducted at patients’ preferred supermarket.

The control group was provided data on their own dietary intake by the dietician in the education visit (enhanced control). In the strategy 1 group, participants came back for 6 “in the aisles” education sessions. The session was guided by their own purchasing data. Strategy 2 consisted of the same 6 educational sessions as in strategy 1 with the addition of a stepwise introduction and training on online shopping.

Primary endpoint was the DASH score (a measure of DASH diet adherence). Two tests for DASH score change (from baseline to 3 months) were performed: strategies 1 and 2 versus control, and if P<0.05 then strategy 2 versus strategy 1.

Follow-up was at 3 and 6 months.

Results

• DASH adherence improved in all 3 groups (DASH change was 5.8 [95%CI: 2.5-9.2] in control group, 8.6 [95%CI: 6.4-10.8] with strategy 1, and 12.4 [95%CI: 10.3-14.5] with strategy 2).
• Change in DASH score was greater with combined strategies 1 and 2 when compared to control (4.7, 95%CI:0.9-8.5, P=0.02).
• DASH score change was greater with strategy 2 when compared to strategy 1 (3.8, 95%CI:0.8-6.9, P=0.01).
• At 6 months, changes in DASH in the control group were 4.4 (95%CI:0.6-8.1), 6.6 (95%CI:4.0-9.2) with strategy 1 and 8.4 (95%CI: 5.9 to 11.0) with strategy 2. Between group differences were no longer significant.

Conclusion

SuperWIN provides evidence for interventions in modern supermarkets and retail-based clinics; for online shopping and nutrition applications; and for automatically, electronically collected purchasing data to guide healthcare interventions.

Steen said: “We are faced with many public health challenges, without great solutions to address them. We need to think about how we can extend the reach of modern health care systems into the communities and better deliverance of services where people live”.

“Finally, SuperWIN was made possible by a first-of-its-kind research collaboration and the hope is that with the explosion of retail-based healthcare more scientist will start working with retailers to shape the evidence for the change that is needed in our healthcare system”, concluded Steen.

Discussion

The discussant Prof. Eileen Handberg (Gainesville, FL, USA) was very excited about this, because there is much potential. From the perspective of primary prevention, children go shopping with their parents and with this intervention you have the ability to change behavior at the grocery store.

The challenge according to Handberg is to get to the underserved and under representatives who shop at different grocery stores. “We have to think about partnerships across the whole spectrum of grocery stories. And also, how to change behavior on the long run, as 3 months is not a long time”.

Furthermore, interventions likely need to be more intensive to observe changes in blood pressure and weight to reduce CV risk. But there is an opportunity here, she said, as more people started to order online due to COVID. Meaningful partnerships are needed to find the right strategy for people to get a healthier life.

– Our coverage of ACC.22 is based on the information provided during the congress –

Watch a video on the SuperWIN study