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¡Cocinar Para Su Salud!: Randomized Controlled Trial of a Culturally Based Dietary Intervention among Hispanic Breast Cancer Survivors

Published:January 07, 2015DOI:https://doi.org/10.1016/j.jand.2014.11.002

      Abstract

      Background

      There is a need for culturally relevant nutrition programs targeted to underserved cancer survivors.

      Objective

      Our aim was to examine the effect of a culturally based approach to dietary change on increasing fruit/vegetable (F/V) intake and decreasing fat intake among Hispanic breast cancer survivors.

      Design

      Participants were randomized to Intervention and Control groups. Diet recalls, detailed interviews, fasting blood, and anthropometric measures were collected at baseline, 3, 6, and 12 months.

      Participants/setting

      Hispanic women (n=70) with stage 0 to III breast cancer who completed adjuvant treatment and lived in New York City were randomized between April 2011 and March 2012.

      Intervention

      The Intervention group (n=34) participated in ¡Cocinar Para Su Salud!, a culturally based nine-session (24 hours over 12 weeks) intervention including nutrition education, cooking classes, and food-shopping field trips. The Control group (n=36) received written dietary recommendations for breast cancer survivors.

      Main outcome measures

      Change at 6 months in daily F/V servings and percent calories from total fat were the main outcome measures.

      Statistical analyses

      Linear regression models adjusted for stratification factors and estimated marginal means were used to compare changes in diet from baseline to 3 and 6 months.

      Results

      Baseline characteristics were the following: mean age 56.6 years (standard deviation 9.7 years), mean time since diagnosis 3.4 years (standard deviation 2.7 years), mean body mass index (calculated as kg/m2) 30.9 (standard deviation 6.0), 62.9% with annual household income ≤$15,000, mean daily servings of all F/V was 5.3 (targeted F/V 3.7 servings excluding legumes/juices/starchy vegetables/fried foods), and 27.7% of daily calories from fat. More than 60% in the Intervention group attended seven or more of nine classes, with overall study retention of 87% retention at 6 months. At month 6, the Intervention group compared with Control group reported an increase in mean servings of F/V from baseline (all F/V: +2.0 vs −0.1; P=0.005; targeted F/V: +2.7 vs +0.5; P=0.002) and a nonsignificant decrease in percent calories from fat (−7.5% vs −4.4%; P=0.23) and weight (−2.5 kg vs +3.8 kg; P=0.22).

      Conclusions

      ¡Cocinar Para Su Salud! was effective at increasing short-term F/V intake in a diverse population of Hispanic breast cancer survivors.

      Keywords

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      References

        • Kushi L.H.
        • Doyle C.
        • McCullough M.
        • et al.
        American Cancer Society guidelines on nutrition and physical activity for cancer prevention.
        CA Cancer J Clin. 2012; 62: 30-67
        • World Cancer Research Fund/American Institute for Cancer Research
        Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective.
        AICR, Washington, DC2007
        • Blanchard C.M.
        • Courneya K.S.
        • Stein K.
        Cancer survivors' adherence to lifestyle behavior recommendations and associations with health-related quality of life: Results from the American Cancer Society's SCS-II.
        J Clin Oncol. 2008; 26: 2198-2204
        • Centers for Disease Control and Prevention
        Prevalence of fruit and vegetable consumption and physical activity by race/ethnicity in the United States, 2005.
        MMWR Weekly. 2007; 56 (391-304)
        • Harper S.
        • Lynch J.
        Methods for Measuring Cancer Disparities: Using Data Relevant to Healthy People 2010 Cancer-Related Objectives.
        National Cancer Institute, Bethesda, MD2005
        • Kanarek N.F.
        • Tsai H.L.
        • Metzger-Gaud S.
        • et al.
        Geographic proximity and racial disparities in cancer clinical trial participation.
        J Natl Compr Canc Netw. 2010; 8: 1343-1351
        • US Census Bureau
        2011 Population Estimates: National Characteristics.
        US Census Bureau, Washington, DC2012
        • Howlander N.
        • Noone A.M.
        • Krapcho M.
        • et al.
        SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations).
        National Cancer Institute, Bethesda, MD2012
        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • Flegal K.M.
        PRevalence of childhood and adult obesity in the United States, 2011-2012.
        JAMA. 2014; 311: 806-814
        • Schoenborn C.A.
        • Heyman K.M.
        Health characteristics of adults aged 55 years and over: United States, 2004-2007.
        Natl Health Stat Report. 2009; : 1-31
        • Adams P.F.
        • Barnes P.M.
        • Vickerie J.L.
        Summary health statistics for the US population: National Health Interview Survey, 2007.
        Vital Health Stat. 2008; : 1-104
        • Ooi S.L.
        • Martinez M.E.
        • Li C.I.
        Disparities in breast cancer characteristics and outcomes by race/ethnicity.
        Breast Cancer Res Treat. 2011; 127: 729-738
        • Block G.
        • Gillespie C.
        • Rosenbaum E.H.
        • Jenson C.
        A rapid food screener to assess fat and fruit and vegetable intake.
        Am J Prev Med. 2000; 18: 284-288
        • Marín G.
        • Sabogal F.
        • VanOss Marín B.
        • Otero-Sabogal F.
        • Pérez-Stable E.J.
        Development of a short acculturation scale for Hispanics.
        Hisp J Behav Sci. 1987; 9: 183-205
      1. The Short Acculturation Scale For Hispanics (SASH). Updated September 1995. http://dgim.ucsf.edu/diversity/SASH_manual.pdf. Accessed September 23, 2014.

        • Weiss B.D.
        • Mays M.Z.
        • Martz W.
        • et al.
        Quick assessment of literacy in primary care: The newest vital sign.
        Ann Fam Med. 2005; 3: 514-522
        • Dwyer J.
        • Picciano M.F.
        • Raiten D.J.
        Collection of food and dietary supplement intake data: What we eat in America-NHANES.
        J Nutr. 2003; 133: 590S-600S
      2. NutritionQuest. Assessment & Analysis Services: Questionnaires and Screeners. 2011; http://nutritionquest.com/assessment/list-of-questionnaires-and-screeners/. Accessed November 1, 2011.

        • God's Love We Deliver
        Every Bite Counts: Nutrition Tips for Breast Cancer Survivors.
        Nutrition Services Department, God's Love We Deliver, New York, NY2009
        • Contento I.R.
        Nutrition education: Linking research, theory, and practice.
        Asia Pac J Clin Nutr. 2008; 17: 176-179
        • Bandura A.
        Human agency in social cognitive theory.
        Am Psychol. 1989; 44: 1175-1184
        • Prochaska J.O.
        • Velicer W.F.
        The Transtheoretical Model of Health Behavior Change.
        Am J Health Promot. 1997; 12: 38-48
        • Kahan B.C.
        • Morris T.P.
        Improper analysis of trials randomised using stratified blocks or minimisation.
        Stat Med. 2012; 31: 328-340
        • Greenlee H.A.
        • Crew K.D.
        • Mata J.M.
        • et al.
        A pilot randomized controlled trial of a commercial diet and exercise weight loss program in minority breast cancer survivors.
        Obesity (Silver Spring). 2013; 21: 65-76
        • Griffith K.A.
        • Royak-Schaler R.
        • Nesbitt K.
        • et al.
        A culturally specific dietary plan to manage weight gain among African American breast cancer survivors: A feasibility study.
        Nutr Health. 2012; 21: 97-105
        • Paxton R.J.
        • Jones L.A.
        • Chang S.
        • et al.
        Was race a factor in the outcomes of the Women's Healthy Eating and Living Study?.
        Cancer. 2011; 117: 3805-3813
        • Pierce J.P.
        • Bardwell W.A.
        • Carlson R.W.
        • et al.
        Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: The Women's Healthy Eating and Living (WHEL) randomized trial.
        JAMA. 2007; 298: 289-298
        • Chlebowski R.T.
        • Blackburn G.L.
        • Thomson C.A.
        • et al.
        Dietary fat reduction and breast cancer outcome: Interim efficacy results from the Women's Intervention Nutrition Study.
        J Natl Cancer Inst. 2006; 98: 1767-1776
        • Flegal K.M.
        • Carroll M.D.
        • Ogden C.L.
        • Curtin L.R.
        PRevalence and trends in obesity among us adults, 1999-2008.
        JAMA. 2010; 303: 235-241
        • Mertens I.L.
        • Van Gaal L.F.
        Overweight, obesity, and blood pressure: The effects of modest weight reduction.
        Obes Res. 2000; 8: 270-278
        • Van Gaal L.F.
        • Wauters M.A.
        • De Leeuw I.H.
        The beneficial effects of modest weight loss on cardiovascular risk factors.
        Int J Obes Relat Metab Disord. 1997; 21: S5-S9
        • Goldstein D.J.
        Beneficial health effects of modest weight loss.
        Int J Obes Relat Metab Disord. 1992; 16: 397-415
        • Wing R.R.
        • Lang W.
        • Wadden T.A.
        • et al.
        Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes.
        Diabetes Care. 2011; 34: 1481-1486
        • US Department of Health and Human Services
        Minority Health: Recent Finding.
        Agency for Healthcare Research and Quality, Rockville, MD2009
        • Rhee H.
        • Belyea M.
        • Brasch J.
        Family support and asthma outcomes on adolescents: Barriers to adherence as a mediator.
        J Adolesc Health. 2010; 47: 472-478
        • Traylor A.
        • Schimittdiel J.
        • Uratsu C.
        Adherence to cardiovascular disease medications: Does patient-provider race/ethnicity and language concordance matter?.
        J Gen Intern Med. 2010; 25: 1172-1177
        • Neuhouser M.L.
        • Tinker L.
        • Shaw P.A.
        • et al.
        Use of recovery biomarkers to calibrate nutrient consumption self-reports in the Women's Health Initiative.
        Am J Epidemiol. 2008; 167: 1247-1259
        • Siega-Riz A.M.
        • Sotres-Alvarez D.
        • Ayala G.X.
        • et al.
        Food-group and nutrient-density intakes by Hispanic and Latino backgrounds in the Hispanic Community Health Study/Study of Latinos.
        Am J Clin Nutr. 2014; 99: 1487-1498

      Biography

      H. Greenlee is an assistant professor, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, and a member of the Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY.

      Biography

      A. O. Gaffney is founder and president, Cook for Your Life, New York, NY.

      Biography

      A. C. Aycinena is a clinical research coordinator, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, and a doctoral student, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY.

      Biography

      P. Koch is a research associate professor, Department of Health and Behavior Studies, and executive director, Laurie M. Tisch Center for Food, Education, and Policy in Teachers College, Columbia University, New York, NY.

      Biography

      I. Contento is the Mary Swartz Rose Professor of Nutrition and Education, Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY.

      Biography

      W. Karmally is an associate research scientist and director of nutrition, Irving Institute for Clinical and Translational Research, Columbia University, New York, NY.

      Biography

      J. M. Richardson is a data analyst, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.

      Biography

      E. Lim is an assistant professor, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, and a member of the Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY.

      Biography

      W.-Y. Tsai is a professor, Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, and a member of the Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY.

      Biography

      K. Crew is an assistant professor, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY; an assistant professor, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; and a member of the Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY.

      Biography

      M. Maurer is an assistant professor, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, and a member of the Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY.

      Biography

      K. Kalinsky is an assistant professor, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, and a member of the Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY.

      Biography

      D. L. Hershman is an associate professor, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY; an associate professor, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; and a member of the Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY.