Native Youth Participating in the Together on Diabetes 12-Month Home-Visiting Program Reported Improvements in Alternative Healthy Eating Index-2010 Diet Quality Domains Likely to Be Associated With Blood Pressure and Glycemic Control

Background: The Together on Diabetes (TOD) intervention was a home-visiting diabetes prevention and management program for Native youth. Objectives: (1) Examine the impact of the TOD program on diet quality using the Alternative Healthy Eating Index (AHEI-2010); (2) determine association between diet quality and cardiometabolic health. Design: The TOD program was conducted from October 2012 to June 2014 and was evaluated using a pretest-posttest study design from baseline to 12 months. Dietary intake was assessed using a food frequency questionnaire. Participants/setting: There were 240 participants between 10 and 19 years of age from 4 reservation-based, rural tribal communities in the southwestern United States that had been diagnosed with T2DM or prediabetes or were identified as at risk based on body mass index and a qualifying laboratory test. Intervention: Youth were taught a 12-lesson curriculum on goal setting, nutrition, and life skills education. Main outcome measures: Behavioral and physiologic outcomes related to diabetes. Statistical analysis: Changes in AHEI-2010 score and associations with cardiometabolic measures were tested, over time, using adjusted longitudinal linear mixed-effects models. Results: The study sample reported an average energy intake of 2016 kcal/d (±1260) and AHEI-2010 score of 47.4 (±7.4) (range: 0-110, higher = better diet quality), indicating low diet quality at baseline. At 12 months’ follow-up, there was a reduction in kilocalories (mean = −346 kcal/d; P <.001), sugar-sweetened beverages (mean = −2 fluid oz/d; P =.032), red/processed meat (mean = −1.5 oz/d; P =.008), and sodium (mean = −650 mg/d; P <.001) but no change in AHEI-2010 score (P =.600). The change in systolic blood pressure from baseline to 12 months for participants within the highest AHEI-2010 quartile group was significantly larger than the change in participants within the lowest quartile group (mean = −5.90 mm Hg; P =.036). Conclusions: Despite stable AHEI-2010 scores during follow-up, there were improvements in diet quality domains likely to be associated with cardiometabolic health. Home-visiting programs like TOD are promising interventions for decreasing dietary intake of poor-quality foods.