(PTFS09-05-23) Impact of an Online Grocery Shopping Intervention in Children With Obesity Assessed Through a Novel Dietary DNA Biomarker Method

Objectives: We conducted a pilot, randomized clinical trial to assess the impact of a nutritionist-guided online grocery shopping dietary intervention for improving dietary quality in children with obesity and verify intervention impact through a novel and objective dietary DNA biomarker approach.

Methods: Participants (n= 33, age= 6-11 yrs) were recruited from the Healthy Lifestyles Clinic (HLC) at Duke University Hospital and randomized to either a standard dietary intervention at HLC (HI) or delivery-based dietary intervention (DI) for a 4-week period. HI consisted of dietary and behavioral counseling weekly at the HLC while DI involved weekly deliveries of groceries purchased online by participants’ parents in collaboration with a nutritionist. The primary endpoint was a change in child dietary quality, as measured by the NHANES Dietary Screener Questionnaire (DSQ), between the HI and DI groups. A novel DNA biomarker method was used for objective tracking of dietary plant composition on a weekly basis. Dietary patterns revealed by DNA biomarker were further compared to another pediatric-adolescent obesity cohort (PA-Ob, n= 318, age = 10-18 yrs) to assess clinical impact.

Results: The DI group showed a statistically significant increase in the DSQ wholegrain score (B= 0.20, 95% CI [0.05, 0.34], p = 0.013), decrease in the DSQ dairy score (B= -1.31, 95% CI [-2.02, -0.60], p = 0.001), and non-significant increase in the DSQ fruits and vegetables but no French fries score (B= 0.38, 95% CI [0.00, 0.76], p = 0.062). DNA biomarker dietary tracking replicated these findings with the DI group demonstrating a significant increase in fruits and vegetables species and decrease in plant species likely to be processed (F= 1.51, R2= 0.018, p= 0.017). The HI group did not show any significant dietary pattern shift. Comparing DNA biomarker dietary patterns to the PA-Ob cohort showed a statistically significant separation for DI but not for HI.

Conclusions: Our results demonstrated the impact of a delivery-based dietary intervention over standard of care for improving dietary quality in children with obesity. Our results were further demonstrated to be robust to potential limitations of the dietary-survey assessment or a positive response bias using a novel dietary DNA biomarker approach.

Funding Sources: Duke Microbiome Center, NIH, Burroughs Wellcome Fund, Chan-Zuckerburg Initiative