Nutrition Intervention for Older Adults and Research Training

Certain populations are disproportionately affected by nutrition-related chronic diseases. In Baltimore, disparities in healthy food access contribute to poor dietary intake. One-third of Black residents and nearly 25% of older adults live in Healthy Food Priority Areas (HFPA), urban areas where the availability of unhealthy foods exceeds that of healthy foods. Common self-care tasks like food shopping, meal preparation, and cooking can also be barriers to a healthy diet. Poor dietary intake contributes to chronic disease risk and loss of muscle mass and strength, resulting in frailty and impaired functional mobility. Impaired functional mobility impacts >11 million community-dwelling older adults,5 with related complications resulting in an important public health concern. Improving diet by increasing healthy food access and teaching older adults to address barriers limiting diet-related self-care tasks is important to maintain functional independence.

Ensuring that the next generation of researchers reflects the population is essential to address all aspects of disparities, but there is a need to engage students at early education levels. UMB RAMP is a summer research training program that exposes high school (HS) students to translational research concepts and teaches basic lab techniques and clinical skills. Pilot data demonstrate a positive impact on HS students' research career interest, but year-round paid experiences to engage and mentor these students in research labs are lacking for this age group. Additional research is needed to assess the longer-term impact of applied research experiences on the HS students' overall perceptions of research as a professional occupation and matriculation to biomedical science/STEM fields.

Our preliminary data demonstrate feasibility and older adult participant satisfaction of implementing in-person and virtual group nutrition classes with optional participation in a free farmer's market as a strategy to improve dietary quality. In this proposed randomized controlled trial, we will build upon that data to determine if a 3-month virtual group nutrition education and virtual teaching kitchen cooking demonstrations paired with free produce (NUT) tailored for older adults (>65 yrs) living in HFPA will improve diet and health-related outcomes compared to contact control (CON). Our overarching hypothesis is that this intervention, inclusive of attention to this older adult population's barriers to consuming a healthy diet, will improve dietary quality and functional mobility while providing an applied clinical and aging-focused research experience for HS students. As paid research assistants, UMB RAMP students will be integral to this project's delivery.

Objectives are presented at the RCT intervention participant level and the student trainee/staff level.

RCT intervention participant objectives:

One part of the study seeks to determine the impact of the randomized controlled trial intervention on health-related outcomes of older adult participants.

Aim 1: To determine differences in diet quality between the NUT and CON group at 3- month post-randomization. We hypothesize higher diet quality scores (Healthy Eating Index via three 24-hr diet recalls) after 3 months in NUT compared to CON (N= 90/group).

Aim 2: To determine differences in key metabolic health outcomes (blood pressure; lipids; hemoglobin A1C) and functional mobility (via functional assessments; questionnaires) at 3-month post-randomization. We hypothesize greater improvements in metabolic and functional outcomes after 3 months in NUT versus CON.

Aim 3. To determine the sustained effects on primary and secondary outcomes at 6 months post-randomization. If no treatment effects are observed 6 months post-randomization, we will conduct focus groups to explore barriers and facilitators of the intervention.

Student trainee/staff level objectives:

One part of our study seeks to assess the impact of participating in a paid research internship on the high school students' trajectory in STEM fields, and is not a clinical trial.

Aim 1: To determine the impact of participation in a year-long applied research opportunity on HS students using a mixed-methods approach. 1a. Quantitatively, we will track student matriculation to undergraduate STEM majors and future participation in structured research programs. We hypothesize that students in this program will matriculate to undergraduate STEM majors and engage in research opportunities within the first two years of college. 1b. Qualitative interviews will explore students' sense of belonging, confidence, and motivation for pursuing undergraduate/career research experiences, and perceptions about both the aging field and the community impact of their research experience. We hypothesize that introducing them to shifting demographics, mobility issues, and increasing awareness of the impact of chronic conditions and barriers to healthy nutrition could also broaden their perspective about research areas and disparities in aging fields.

One part seeks to assess the staff and older adult participants' perceptions of working with younger students. This is also not a clinical trial.

Exploratory Aim: To explore the impact of tri-generational research engagement, from the perceptions of research staff and older research participants working with HS students through the intervention. We will explore perceived impact from the older adult research participants related to working with young student researchers and how it may change their perceptions of research through qualitative interviews. Staff will complete a pre/post survey related to their perceived mentorship self-efficacy to help us refine HS student roles in this setting