Acceptability and Objective Understanding of Front-of-Pack Nutritional Labels Among Thai Consumers: A Pilot Randomized Controlled Trial

Objectives: Food insecurity can include episodes of food adequacy (i.e., enough food to eat) and food shortage (i.e., not enough food to eat), which can increase stress.Stress is a central component in the pathway from food insecurity to chronic disease.This study examined allostatic load (AL), as a physiological biomarker of stress, differences between a food secure (FS) cohort and food insecure (FI) cohort of African American women with obesity.Methods: African American women (age 18-65 y) with obesity (BMI 30-50 kg/m 2 ) were enrolled into a ~22 week observational, cohort study.Food security status at baseline was assessed using a modified version of the 6-Item Food Security Scale and 30 FI and 30 FS participants were enrolled.AL was measured via an AL total score, which included cardiovascular (systolic and diastolic blood pressure, high-density lipoprotein, pulse, and total cholesterol), metabolic (albumin, waist to hip ratio, HbA1c), and immune (c-reactive protein) biomarkers.AL was assessed at the beginning (Week 1) and end (~Week 22) of the study.Linear mixed-effects models were used to evaluate differences between cohorts, accounting for repeated measurements.Models included FI vs. FS, week, an interaction term between FI vs. FS and week, and age.Results: Among participants, mean AL total score was 3.32 (SE0.14)at Week 1 and 3.25 (SE0.16)at ~Week 22 (p0.442).AL was 3.52 (SE0.18)and 3.12 (SE0.17) in the FI and FS cohorts, respectively, at Week 1 (p0.092).Following 22 weeks, the FI cohort demonstrated a mean AL of 3.52 (SE0.22)with no significant change (0AE0.13;p1) from Week 1, while the FS cohort demonstrated a slight decrease in AL, 2.98 (SE0.21),but no significant change (-0.15AE0.13;p0.278) from Week 1.At the end of the study the mean difference in AL between the cohorts, -0.54 (SE0.28;p0.061), was not significantly different.Conclusions: African American women with obesity and food insecurity demonstrated greater physiological stress at the beginning and end of a 22-week observational study compared to African American women with obesity and food security.However, these differences were not significant.