Nutrition and obesity in under-represented population (NOURISH): study protocol to examine the effect of restricted and unrestricted financial benefits on infant food insecurity, growth, and nutrition.

BACKGROUND: Studies have shown that food insecurity (FI) during infancy is associated with higher odds of obesity in early childhood, but the evidence regarding the impact of FI interventions on improving child body mass index (BMI) remains inconclusive. This study explores whether reducing food insecurity during infancy is effective in preventing early life obesity. METHODS: Using a randomized comparative effectiveness design, NOURISH delivers two interventions: an “unrestricted benefit” group that receives a cash benefit in the form of study-specific debit cards, and a “grocery benefit” group that receives healthy groceries with nutritional guidance. Additionally, a “usual care” contemporary comparison matched cohort of infants will be constructed using electronic health record data. The primary endpoint is change in infant BMI z-score over one year. The secondary endpoints are FI status and diet quality. DISCUSSION: Study findings will be instrumental in guiding future policy decisions around food assistance and the development of “food as medicine” interventions, offering evidence-based strategies regarding the types of support that families facing food insecurity need to improve children’s health outcomes.