Limitations
diet-related disease
The major limitations of our study include the small sample size, which may have been underpowered to detect a between group effect or a between-within interaction. Systematic reviews that assess nutrition interventions in food pantries suggest it may take up to three-months to see differences in diet quality and up to six-months to see differences in clinical outcomes (e.g., HbA1c) [Effects observed on food security and perceived diet quality may be caused by the provision of additional food outside of our study rather than the nutritional quality of the study foods. We could not find a study that explored whether providing extra food in addition to typical pantry offerings led to greater increases in food security, perceived dietary quality, or related outcomes (e.g., objective dietary quality, clinical outcomes), but is an option to consider as an active comparator group in the future.Finally, we describe costs associated with implementing these interventions for this study but did not examine the comparative cost-effectiveness of the interventions. Given that there are different economies of scale in preparation of no-prep meals and meal kits, as well as different ways in which these processes can be integrated into food pantry operation at scale, these analyses were outside the scope of the pilot RCT. In this study, we purchased no-prep meals from a nutrition-focused meal distributor and purchased food for meal kits from a local grocery store. A more cost-effective way to implement in the future could be to use the pantries commercial kitchen to repurpose food donations into no-prep meals and meal kits, which could also have sustainability benefits if food nearing expiration could be used to create no-prep heat-and-eat meals. Having the pantry purchase ingredients that may not be consistently available through donations but needed to make the meal kits (e.g., spices, oils, eggs), directly at wholesale cost instead of buying in-store at retail cost could also save money and time. As the evidence base for no-prep meals and meal kits is more firmly established, cost-effectiveness and innovations in the integration of these programs into pantry operations will become an increasingly impactful area of inquiry.Our study provides preliminary evidence that meal kits and no-prep meals were feasible to implement in a food pantry, well-liked by clients, and may increase food security and perceived diet quality among clients in the short-term. Future studies should continue to test both interventions as strategies to improve food security and dietary quality and include larger samples that allow for determining potential confounders or moderators. Studies should also include longer follow-up and objective measures of dietary quality and diet-related disease outcomes (e.g., HbA1c, blood pressure). While we included some preliminary implementation outcomes in the present study (e.g., acceptability, feasibility, fidelity), it is imperative to measure and compare intervention cost effectiveness and sustainability to ensure funds and efforts are being used effectively and able to be implemented on a wider scale [