A Rationale for the Development of a Nutrition Education Program to Increase Fiber Intake Among Rural Minnesota Women
Heart Disease is the Number One Killer of Women
According to the Centers for Disease Control and Prevention (CDC) (2023), the leading cause of death among women in the United States is heart disease, and over 60 million American women are already living with the disease. That is equal to roughly the population of Italy (U.S. Census Bureau, n.d.). Also concerning is the total annual cost of heart disease-related health care, including medications and premature death, which is about $219 billion (CDC, 2023; CDC & Office of the Associate Director for Policy and Strategy, 2021). Sadly, heart disease is also the number one cause of disability-adjusted life-years lost in American women (Woodward, 2019).
Women are likely at a disadvantage in both primary and secondary prevention efforts because heart disease is often thought of as a “man’s” disease (Woodward, 2019). Many women are also shockingly unaware of their risk as only about half know is it the number one cause of death for women (CDC, 2023).
To make matters worse, most adult American women do not reach the recommended fiber intakes which puts them at a higher risk for heart disease due to the protective benefits of fiber (U.S. Department for Health and Human Services (HHS), 2021). Menopause can also accelerate risk factors for heart disease during midlife (American Heart Association, 2023). This is due to metabolic changes that occur during this time (Min et al., 2022).
Research indicates individuals in rural portions of America are at a higher risk for heart disease as well (Seguin, 2018). Women in Minnesota are greatly affected with 3,890 heart disease deaths in 2021, which is over 96 women per 100,000 (Minnesota Department of Health, 2023). From 2018 to 2020, Yellow Medicine County, Minn., itself had an age-adjusted death rate between 129.5 and 171.8 women per 100,000. Additionally, the per capita cost of Medicare beneficiaries with heart disease ranged from $21,000 to $26,000 in Yellow Medicine County, Minn. (CDC, n.d.). That is enough money for each person in the county to buy a brand new, 2023 Honda Civic (Brandt, 2023).
National and regional data indicate there is a dire need to raise awareness about heart disease in women in rural Southwest Minnesota, especially those between ages 40 and 64, and to educate them about the benefits of adequate fiber intake in relation to heart disease.
A Simple Solution
Increasing fiber intake is a simple, accessible way to reduce the risk of many chronic diseases. Eating the recommended amount of fiber lowers cholesterol, regulates blood sugar and helps control weight (Cleveland Clinic, 2019). It also significantly reduces the risk of incidence of heart disease (McRae, 2017). Diets high in fiber improve gut health which reduces the risk of heart disease by reducing inflammation (Trøseid et al., 2020). These benefits also protect against other chronic concerns like type 2 diabetes and inflammatory diseases (HHS, 2021).
Fiber & Fabulous educates and empowers women in all stages of menopause living in rural, Southwest Minnesota to increase their fiber intake, improve gut health and reduce their risk for heart disease. The goals of the program are for women ages 40 to 64 living in rural Southwest Minnesota to:
Increase awareness of the prevalence and risk of heart disease in women.
For women in Southwest Minnesota to identify the risks of low fiber intake.
Increase the fiber intake of women in Southwest Minnesota to reach the recommendations set forth by the Dietary Guidelines for Americans.
Improve gut health of women in rural Southwest Minnesota.
Reduce the incidence of cardiovascular disease in women living in rural Southwest Minnesota.
The program aims to do this through 12, bi-monthly, in-person classes including discussions, demonstrations and printed resources. The proposed curriculum is follows:
Heart Disease in Women
Why Fiber Matters
Inflammation and Heart Disease
Heart Health Risk Factors and Screening for Women
Improving Gut health
High Fiber Foods Meal Planning and Prep
Low Carb Diets
Mediterranean Diet & DASH Diet
Grocery Store Visit to identify high-fiber foods
Farmers Market Visit to identify high-fiber foods
Managing Stress
Overcoming Barriers
The program also offers a website for digital resources, a social media group for support and environmental approaches such as grocery store and farmers market tours. A strategic partnership with The Sanford Canby Wellness Center located in Canby, Minn., will offer greater opportunities for program promotion, participant recruiting and group activities. The wellness center is well established in the community, has a Facebook group with 275 members (as of April 11, 2023), conference rooms with updated technology which are adjacent to a kitchenette and staff that is interested and motivated to improve the health and well-being of their members and surrounding community.
The Potential
Dietary interventions have the potential to reduce the risk of heart disease by up to 10 percent in some cases (Jeong et al., 2023). This program will help improve the health and well-being of local women and reduce the costs related to heart disease in women which subsequently improves the health of local families as many women make the health decisions for the family (Woodward, 2019). Women participating in the program will also be seen as role-models in the community improving the environment (Seguin, 2018).
Fiber & Fabulous will address the concerns and needs of the priority population by offering opportunities for community assessment and engagement. The program’s success will be a result of a multilevel approach which includes experiential learning, community alignment, the support of the Sanford Canby Wellness Center, actionable steps and social support.
A similar, successful program called Strong Hearts, Healthy Communities, was created for women over the age of 40 living in rural communities. This six-month program aimed to target key behaviors related to heart disease risk through a multilevel approach. Experiential learning, including grocery store audits and label reading exercises, was a key strategy leading to the program’s positive outcomes as was partnership with the local health system (Seguin, 2018). Fiber and Fabulous will apply similar multilevel strategies in its design and implementation.
References:
American Heart Association. (2023). The facts about women and heart disease. Go Red for Women. https://www.goredforwomen.org/en/about-heart-disease-in-women/facts
Brandt, E. (2023, March 7). 2023 Honda civic review. Kelley Blue Book. https://www.kbb.com/honda/civic/
Centers for Disease Control and Prevention (CDC) (2023, February 21). Heart disease: Women and heart disease. CDC. https://www.cdc.gov/heartdisease/women.htm
Centers for Disease Control and Prevention (CDC) (n.d.). Interactive atlas of heart disease and stroke. CDC. https://nccd.cdc.gov/DHDSPAtlas/Default.aspx?state=MN
Centers for Disease Control and Prevention, Office of the Associate Director for Policy and Strategy. (2021, August 17). Health topics: Heart disease and heart attack. CDC. https://www.cdc.gov/policy/polaris/healthtopics/heartdisease/index.html
Cleveland Clinic. (2019, April 15). Improving your health with fiber. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/14400-improving-your-health-with-fiber
McRae, M. P. (2017). Dietary fiber is beneficial for the prevention of cardiovascular disease: An umbrella review of meta-analyses. Journal of Chiropractic Medicine, 16(4), 289–299. https://doi.org/10.1016/j.jcm.2017.05.005
Min, S. H., Docherty, S. L., Im, E.-O., & Yang, Q. (2022). Identification of symptom clusters among midlife menopausal women with metabolic syndrome. Western Journal of Nursing Research, 44(9), 838–853. https://doi.org/10.1177/01939459211018824
Minnesota Department of Health. (2023, February 13). Measure: Heart disease death rate. Minnesota Department of Health. https://www.health.state.mn.us/diseases/cardiovascular/cardio-dashboard/heartdeathr.html
Seguin, R. A., Paul, L., Folta, S. C., Nelson, M. E., Strogatz, D., Graham, M. L., Diffenderfer, A., Eldridge, G., & Parry, S. A. (2018). Strong hearts, healthy communities: A community‐based randomized trial for rural women. Obesity, 26(5), 845–853. https://doi.org/10.1002/oby.22158
Trøseid, M., Andersen, G. Ø., Broch, K., & Hov, J. R. (2020). The gut microbiome in coronary artery disease and heart failure: Current knowledge and future directions. EBioMedicine, 52, 102649–102649. https://doi.org/10.1016/j.ebiom.2020.102649
United States Census Bureau. (n. d). Italy. United States Census Bureau. https://www.census.gov/popclock/world/it
U.S. Department of Agriculture, Agricultural Research Service. (2020). Nutrient Intakes from Food and Beverages: Mean Amounts Consumed per Individual, by Gender and Age, What We Eat in America, NHANES 2017-2018. https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/1718/Table_1_NIN_GEN_17.pdf
U.S. Department for Health and Human Services. (2021, February 17). Healthy eating and women. OASH: Office on Women’s Health. https://www.womenshealth.gov/healthy- eating/healthy-eating-and-women
U.S. Department of Health and Human Services (HHS) & Office of Disease Prevention and Health Promotion (OSHA). (n.d.). Improve cardiovascular health in adults – HDS – 01: Data methodology and measurements. Healthy People 2030. Retrieved April 11, 2023, from https://health.gov/healthypeople/objectives-and-data/browse-objectives/heart-disease-and-stroke/improve-cardiovascular-health-adults-hds-01/data-methodology
Woodward, M. (2019). Cardiovascular disease and the female disadvantage. International Journal of Environmental Research and Public Health, 16(7), 1165. https://doi.org/10.3390/ijerph16071165
Zhang, F., Fan, D., Huang, J., & Zuo, T. (2022). The gut microbiome: Linking dietary fiber to inflammatory diseases. Medicine in Microecology, 14, 100070–. https://doi.org/10.1016/j.medmic.2022.100070