Intended and Unintended Consequences of a Community-Based Fresh Fruit and Vegetable Dietary Intervention on the Flathead Reservation of the Confederated Salish and Kootenai Tribes.

Tribal communities in the United States face disparities to accessing healthy foods including high-quality produce. A six-week fresh fruit and vegetable (FV) dietary intervention, Eat Fresh, was co-designed with a Community Advisory Board of local food and nutrition stakeholders on the Flathead Reservation of the Confederated Salish and Kootenai Tribes in Montana. Eat Fresh was implemented as a pilot study with low-income participants (n = 19) enrolled in the Food Distribution Program on Indian Reservations toward improving dietary quality and perceptions of well-being. We evaluated Eat Fresh at pre- and post-intervention on the basis on food procurement practices, dietary quality using the Healthy Eating Index (HEI), Body Mass Index (BMI), blood pressure, and participant perceptions of health. Participants reported consuming a greater number of types of FVs daily during the intervention (p < 0.005 for fruits and p > 0.19 for vegetables). Overall, participants found Eat Fresh moderately challenging to adhere to with the main barriers being access to ingredients in recipes (39.51% of responses), time constraints to cook (35.80%), and lack of financial resources (33.33%). Dietary quality improved during the intervention from a mean HEI score of 48.82 (± 11.88) out of 100-56.92 (± 11.88; (p > 0.12). HEI scores for fruit consumption significantly increased (p < 0.05) from 1.69 (out of 5 points) during the pre-intervention to 2.96 during the post-intervention. BMI and blood pressure increased for several participants, highlighting an unintended consequence. Most participants responded that FV consumption made them feel either very good (51.16%) or good about their health (43.02%) with the majority (83%) perceiving an improvement in energy. Findings of this pilot study highlight both intended and unintended consequences of a dietary intervention that provide lessons in co-designing community-based programs.

Dietary Quality Varies Among Adults on the Flathead Nation of the Confederated Salish and Kootenai Tribes in Montana.

Diet-related chronic disease is among the most pressing public health issues and represents a health disparity among Native American communities. A community-based participatory approach was taken to evaluate dietary quality of adult residents of the Flathead Reservation of the Confederated Salish & Kootenai Tribes in Montana (the Flathead Nation). A survey was administered to collect basic demographic information and food security status (N = 80). Dietary quality was assessed using the 24-h dietary recall method with subsequent calculation of Healthy Eating Index 2010 (HEI-2010) scores, modified HEI without a dairy category, and the Dietary Diversity Scores (DDS). Participants included 80 adults from different households across eight communities (n = 10 per community) at the Flathead Nation. Approximately 50% of participants reported low or very low food security status while the remainder scored high or marginal food security. The mean total HEI-2010 score of study participants was 45.5 out of 100 points with a range between 20.0 and 78.1. The mean DDS of study participants was 4.6 (± 1.365) out of a total of 9 points. Participants with higher DDS had significantly higher intake of dietary fiber (p < 0.0003), potassium (0.0024), and cholesterol (p < 0.0048) compared to the lower DDS group. No significant correlations were found between HEI-2010 scores with DDS, demographic information, or food security status while significant differences were found between food security status and income (p < 0.01) and enrollment in nutrition assistance programs (p < 0.03). This study highlights the need to evaluate multiple parameters of dietary quality coupled with a community-based participatory approach in order for findings to be culturally relevant and support food and nutrition interventions.