Havas Stephen, Anliker Jean, Greenberg Deborah, Block Gladys, Block Torin, Blik Cheryl, Langenberg Patricia, DiClemente Carlo
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 660 W. Redwood Street, Baltimore, MD 21201, USA.
Prev Med. 2003 Nov;37(5):406-16. doi: 10.1016/s0091-7435(03)00160-9.
The few randomized community trials in middle-income populations that tried to modify multiple dietary risk factors for cancer only demonstrated small changes. This trial sought to decrease the percent of calories derived from fat and to increase fruit, vegetable, and fiber intake among low-income women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Maryland.
We conducted six-month intervention programs for 1055 women at ten WIC sites; 1011 women served as controls. Intervention participants were invited to five interactive nutrition sessions and were sent written materials. Controls received usual care. Women were surveyed at baseline, two months post intervention, and one year later. All analyses conducted used an intention-to-treat paradigm.
Mean differences (intervention-control) in change from baseline were for percent calories from fat -1.62 +/- 0.33% (P < 0.0001), for consumption of fruits and vegetables 0.40 +/- 0.11 servings (P = 0.0003), and for fiber intake 1.01 +/- 0.31 grams (P = 0.001). These differences in change were related in a dose-response relationship to the number of sessions women attended and remained significant one year post-intervention for the first two outcomes.
Multiple dietary improvements can be achieved in a low-income population with an effective, multi-faceted intervention program. The changes in this trial exceeded those in previous community trials conducted in higher SES populations.
在中等收入人群中进行的少数旨在改变多种癌症饮食风险因素的随机社区试验仅显示出微小变化。本试验旨在降低低收入女性从脂肪中获取的热量百分比，并增加水果、蔬菜和纤维的摄入量，这些女性来自马里兰州妇女、婴儿和儿童特别补充营养计划（WIC）。
我们在10个WIC站点为1055名女性开展了为期6个月的干预项目；1011名女性作为对照。干预参与者被邀请参加5次互动营养课程，并收到书面材料。对照组接受常规护理。在基线、干预后两个月和一年后对女性进行调查。所有分析均采用意向性分析范式。
与基线相比，干预组与对照组在以下方面的平均差异为：来自脂肪的热量百分比-1.62±0.33%（P<0.0001），水果和蔬菜摄入量0.40±0.11份（P=．0003），纤维摄入量1.01±0.31克（P=0.001）。这些变化差异与女性参加课程的次数呈剂量反应关系，并且在前两个结果中，干预后一年仍具有显著性。
通过有效的多方面干预项目，可以在低收入人群中实现多种饮食改善。本试验中的变化超过了先前在较高社会经济地位人群中进行的社区试验中的变化。
