NIH Nutrition Health Disparities Framework: A Model to Advance Health Equity

Abstract Objectives Disparities in nutrition such as poor diet quality and inadequate nutrient intake arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and diet-related cancers. The objective is to develop a nutrition-centric socioecological (SE) framework that delineates determinants and levels of influence that perpetuate diet-related disparities among disadvantaged populations. Methods Adapted from the National Institute of Minority Health and Health Disparities Research Framework, the Nutrition Health Disparities Framework (NHDF) examines the synergistic interactions across biological, behavioral, and environmental domains at every SE level that contribute to nutrition health disparities. Based on the scientific literature, NIH nutrition experts developed a consensus in selecting nutrition-related determinants of health within each domain and SE level when creating the NHDF. Results The NHDF identifies how neighborhood food availability, access, and affordability (individual/built environment) can intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors and risk for diet-related disease. Similarly, the NHDF shows how genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may promote the consumption of unhealthy foods and increase chronic disease risk. Additionally, family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition can interact with resource-poor environments such as lack of preventative health care (societal/health care system) and inadequate use of Federal nutrition programs (societal/behavioral), which may increase the risk for childhood malnutrition and food insecurity. Conclusions The NHDF expands our understanding of the synergistic interrelationships among factors at different levels of the SE model that influence nutrition-related outcomes and exacerbate health disparities. This framework is an important resource for nutrition professionals and researchers and may inform the development of multilevel nutrition interventions to improve health outcomes and increase health equity in diverse populations. Funding Sources N/A.