A Tailored Nutrition Education Intervention to Promote Sorghum Consumption and Explore Its Potential in Diabetes Prevention

Diabetes is a chronic disease known as hyperglycemia, a condition characterized by high blood glucose and long-term abnormalities in either the action or secretion of insulin or both. Consequently, diabetes affects how the body metabolizes glucose, leading to changes in carbohydrate, protein and lipid metabolism. Given the importance of insulin and glucose homeostasis, diabetes is associated with other chronic diseases such as dyslipidemia, hypertension, and non-alcoholic fatty liver. In addition to its detrimental health effects, diabetes imposes a significant financial burden. Diabetes can develop with the combination of several modifiable risk factors such as body weight (having overweight or obesity), unhealthy diet, smoking, drinking, and low physical activity. Among these, the main risk factors are being physically inactive and having unhealthy diets; and college students are especially vulnerable, as they transition from a more structured high school program and family lifestyles into independence and an unstructured college lifestyle. College students are likely to eat non-nutrient dense foods high in fat, sugar, and sodium leading to consuming unbalanced meals and failing to meet the dietary recommendations. Moreover, the limited nutrition knowledge put them at a high risk of developing chronic diseases such as obesity, diabetes, and metabolic syndrome. Nutrition education programs designed for college students have the potential to empower and motivate them to make healthier eating choices and a diet that includes whole grains. Despite the dietary recommendations, whole grains remain insufficient, especially among college students. Sorghum is an underutilized gluten-free whole grain and is the fifth leading crop around the world. However, in the United States (U.S.), it is primarily used for animal feed and biofuel, despite its health benefits and nutritional profile for humans. Sorghum has the potential to inhibit α-amylase and α-glucosidase, two enzymes involved in the breakdown of starch resistant- rich carbohydrates. These characteristics confer sorghum anti-diabetic properties capable of reducing glucose levels. Therefore, the purpose of this study was to investigate the effect of a theory-based sorghum nutrition education intervention to promote sorghum consumption and explore its potential in diabetes prevention among college students with overweight and obesity at Texas Tech University, aged 18-44 years old. To achieve the goal, we have designed and conducted three sub-studies: 1) Needs assessment, 2) tailored and theory-based sorghum curriculum development and feasibility test, and 3) implementation of sorghum nutrition intervention as an exploratory study. First, a needs assessment was conducted to determine university students’ knowledge about whole grain, sorghum and prediabetes risk. The survey included 45 items to gain insight into the students’ whole grains perception, practices, primary nutrition information source, and physical activity level. Sixty-three percent of the students were at risk of prediabetes. Compared to their female counterparts, males were at a significantly higher risk of prediabetes. Males had a mean score of 1.70 ± 0.93 compared to females 0.64 ± 0.92 t(246) = -9.07, p<0.001. Participants scored low on whole grain knowledge (2.82±1.03) and sorghum knowledge (1.39± 1.65). Building on this foundation, the second phase of the project focused on the development, execution, and feasibility of the program’s curriculum, with a specific emphasis on diabetes prevention and sorghum. The 6-week nutrition education content, embedded in the Health Belief Model targeted the six constructs of the model. A weekly 120-minute session, divided in a 40-minute lecture and 80-minute hands-on interactive activities such as cooking lessons was delivered. Weekly attendance was 85.16% and retention was 66.66% with a 100% content coverage. Expanding and complementing on the groundwork laid in earlier phases, the third phase focused on exploring the effect of a sorghum-based nutrition intervention on knowledge and metabolic markers utilizing the nutrition education curriculum that was developed and tested in the previous phase. In this 6-week pre- and post-intervention exploratory study, weekly education and cooking sessions were provided. Participants consumed 120g of cooked sorghum with no dietary restrictions. After the six weeks of nutrition education intervention, significant changes were observed in diabetes knowledge (17.42±3.10, p=0.004), whole grain knowledge (3.00±0.81, p=0.008), sorghum knowledge (7.85±0.37, p=0.047), and self-efficacy (22.42±1.81, p=0.005). However, no significant changes were found for metabolic markers (fasting plasma glucose, insulin, total cholesterol, triglycerides, and low-density lipoprotein). Findings from this research highlight the importance and need of tailored and theory-based nutrition education, confirming that interactive learning not only facilitates knowledge acquisition but also plays a critical role in fostering participant engagement and program acceptability. This research also revealed college students’ risk of prediabetes and diabetes at a younger age due to the high prevalence of overweight or obesity that we observed in our population. As an added value, our exploratory study served as a platform to implement the education curriculum while exploring the effect of sorghum consumption on metabolic markers. Although minimal changes were observed in metabolic outcomes following sorghum consumption, in part due to the short duration and exploratory nature of this part of the study, it is worthwhile expanding this approach through a more rigorous clinical trial to assess potential benefits of the food as medicine approach to reduce diet-related diseases.