Diet quality, ultra-processed food consumption, and quality of life in a cross-sectional cohort of adults and teens with celiac disease

BACKGROUND

Coeliac disease (CeD), a common autoimmune condition, requires strict adherence to a gluten-free diet (GFD). Adherence to the GFD has been associated with quality of life (QOL). However, there may be other diet-related concerns, such as overall diet patterns, including diet quality or ultra-processed food (UPF) consumption, possibly associated with QOL among people with CeD following a GFD that have not been examined.

METHODS

Diet quality was determined based on 24-h diet recalls of a cross-sectional prospectively recruited sample of 80 participants (50 adults and 30 teens) with biopsy-confirmed CeD ('Study Sample') using the Healthy Eating Index and Alternate Mediterranean Diet score. The amount of UPF consumed was assessed using Nova, a food processing classification system. QOL was measured using Celiac Disease-Specific Quality of Life (CDQOL) and Celiac Disease Pediatric-Specific Quality of Life (CDPQOL). The Study Sample's diet patterns were compared with National Health and Nutrition Examination Survey (NHANES) groups (25 adults reporting prior CeD and GFD; 51 adults with new CeD and no GFD; 15,777 adults and 2296 teens without CeD). The relationship of the Study Sample's diet patterns with CDQOL/CDPQOL was assessed using analysis of covariance.

RESULTS

The Study Sample's diet patterns were suboptimal but generally favourable compared with all NHANES groups. Compared to Study Adults with the highest tertile of UPF, those with the lowest tertile had significantly higher CDQOL (mean: 67.6 vs. 78.3, p < 0.001). Compared to Study Teens with the lowest tertile of AMED, those with the highest tertile had significantly higher CDPQOL (mean: 67.0 vs. 79.9, p < 0.01).

CONCLUSIONS

Maintaining high diet quality and minimising UPF may be important for CeD-specific QOL among individuals with CeD maintaining a GFD.

Position of the Society for Nutrition Education and Behavior: Nutrition Educator Competencies for Promoting Healthy Individuals, Communities, and Food Systems: Rationale and Application

It is the position of the Society for Nutrition Education and Behavior that to improve the health of individuals, communities, and food systems, it is essential that nutrition educators meet each of 6 content competencies (basic food and nutrition knowledge, nutrition across the life cycle, food science, physical activity, food and nutrition policy, and agricultural production and food systems) and 4 process competencies (behavior and education theory; nutrition education program design, implementation and evaluation; written, oral, and social media communication; and nutrition education research methods). These competencies reflect the breadth of the nutrition education field and are grounded in peer-reviewed research. The rationale and evidence base for these competencies are presented. They are designed for educational institutions to plan curricula and programs; public, private, and nonprofit organizations for training; individuals for professional development; and policymakers and advocates to inform strong, comprehensive nutrition education policy.

Developing a Diet and Physical Activity Intervention for Hispanic/Latina Breast Cancer Survivors

Objectives

There is limited guidance on how to effectively educate cancer survivors to adopt and maintain specific diet and physical activity recommendations, especially among underserved and under-resourced populations. Here, the objective is to present the development of a behavioral and theoretically-based multi-modal diet and physical activity intervention program for Hispanic/Latina breast cancer survivors, Mi Vida Saludable (My Healthy Life).

Methods

The development process was based on the 6 steps of the Nutrition Education DESIGN Procedure: (1). Decide behaviors; (2). Explore determinants; (3). Select theory-based model; (4). Indicate objectives; (5). Generate plans; and (6). Nail down evaluation. The theoretical framework for the intervention is Social Cognitive Theory.

Results

The resulting behavioral intervention consists of 2 components. The first component is in-person group education consisting of 4 lessons over 1 month. Each 4-hour group lesson includes a hands-on cooking component, a physical activity component, and facilitator-led nutrition education and discussion, with 2 field trips to a local grocery store and farmers’ market. The second component is an e-Health program that includes weekly text messages, biweekly emailed newsletters, and ongoing website access.

Conclusion

The systematic DESIGN Procedure provided practical guidance for developing a behaviorally-focused, theory-based, and culturally sensitive program that addresses both dietary and physical activity behaviors for delivery both in-person education and through eHealth. The Procedure may be useful for developing other behaviorally focused and theory-based interventions.

Associations Between Acculturation and Weight, Diet Quality, and Physical Activity Among Latina Breast Cancer Survivors: The ¡Mi Vida Saludable! Study

BACKGROUND

Among Latinos, greater acculturation to the United States (US) is associated with risk of obesity and obesity-related comorbidities. Less is known about the associations between acculturation and obesity-related modifiable risk factors, such as diet quality and physical activity (PA) among Latina breast cancer survivors.

OBJECTIVE

The aim of this study was to explore associations between acculturation and weight status, diet quality, and PA among Latina breast cancer survivors.

DESIGN

This is a cross-sectional secondary analysis of baseline data on demographic and clinical characteristics, acculturation, anthropometric measures, diet quality, and PA collected from Latina breast cancer survivors enrolled in the ¡Mi Vida Saludable! (My Healthy Life) behavioral diet and PA intervention trial.

PARTICIPANTS/SETTING

Participants were Latina women (n = 167) residing in New York City, with a medical history of stage 0 to III breast cancer, no evidence of recurrent or metastatic disease, and at least 90 days post cancer treatment who participated in the ¡Mi Vida Saludable! randomized controlled trial between July 2016 and October 2018.

MAIN OUTCOME MEASURES

Acculturation status was measured by the Short Acculturation Scale for Hispanics score, language preference, place of birth, and duration of US residence. Weight, height, and waist and hip circumferences were measured at an in-person clinic visit. Diet information was collected via 3 telephone-based 24-hour dietary recalls and PA information was collected via staff administered 7-day recalls.

STATISTICAL ANALYSES PERFORMED

Linear regression models examined associations between acculturation and weight status, diet quality, and PA.

RESULTS

Based on the Short Acculturation Scale for Hispanics acculturation score, more acculturated compared with less acculturated Latinas were younger in age, more educated, and had higher annual household incomes (all, P < .05). Compared with Spanish-speaking Latinas, English-speaking Latinas had larger waist circumference (103 vs 96.1 cm; P = .01) and poorer-quality diets (Healthy Eating Index 2015 scores, 57.3 vs 71.5; P < .001). Greater levels of acculturation were also associated with higher levels of leisure walking at a moderate-to-vigorous intensity (265.8 vs 179.0 min/wk; P =.04).

CONCLUSIONS

Greater levels of acculturation were associated with higher central obesity and poorer-quality diets. Future lifestyle modification trials tailored to the unique role of acculturation on adopting behavior change recommendations is a promising next step in this line of research.

A secondary analysis of maternal ultra-processed food intake in women with overweight or obesity and associations with gestational weight gain and neonatal body composition outcomes

BACKGROUND

This study is an observational secondary analysis of the Lifestyle Intervention for Two (LIFT) randomised controlled trial data. There is a paucity of data related to mechanisms of health effects and dietary intake of ultra-processed foods (UPF). Earlier studies demonstrate associations between greater UPF intake and weight gain. The purpose of the study was to describe associations among maternal UPF intake with gestational weight gain (GWG) and neonatal body composition.

MATERIAL AND METHODS

Women with overweight or obesity (n=156) and offspring (n=126) with complete energy intake, anthropometrics and body composition measures were selected. Maternal weights and diet recalls (Automated Self-Administered 24) were measured at weeks 14 and 35 gestational age (GA). Body composition was assessed by infant quantitative magnetic resonance (infant-QMR) and air displacement plethysmography (ADP) at birth. Dependent variables were GWG and neonatal fat mass, fat-free mass, and lean mass at birth; covariates were dietary, socioeconomic and biological. Stepwise linear regressions were used to test associations.

RESULTS

Highest quartile of percentage of energy intake from UPF (PEI-UPF) was not significantly correlated with maternal GWG (p=0.215), infant QMR fat (p=0.816) and lean mass (p=0.423) or ADP fat (p=0.482) or fat-free mass (p=0.835).

CONCLUSIONS

While no significant associations with UPF were observed in this smaller size cohort, further investigations would be justified in larger cohorts on the relationships of maternal UPF intake and GWG and offspring outcomes. Clinical Trial NCT01616147.

Abstract PO-076: Social support, diet, and physical activity among Latina breast cancer survivors

Background: The American Institute for Cancer Research and the American Cancer Society recommendations for diet and physical activity are less likely to be followed by minority cancer populations, such as Latina breast cancer survivors, compared to non-Hispanic White women. Moreover, Latinas are also more likely to suffer from other comorbidities, such as diabetes, which could be alleviated by improved diet and physical activity (PA). Social support is one potential mechanism that can encourage a healthy lifestyle. Studies to date have been inconsistent in showing that higher levels of social support among cancer survivors is associated with higher levels of PA and healthy eating and most of these studies were conducted in majority White populations. Purpose: This study examines the associations between social support from different social support sources with PA and diet behaviors in Latina breast cancer survivors. We hypothesized that higher levels of social support would be associated with higher levels of PA and healthier eating. Method: Latina breast cancer survivors (n=85; M age = 55.47, SD =9.63) of mostly Dominican heritage with a history of breast cancer (stages 0-III) completed the Multidimensional Scale of Perceived Social Support scale, which measures social support from friends, family, and a significant other. Physical activity was assessed via a 7-day physical activity recall and dietary intake was measured via three 24-hour dietary recalls. In this cross-sectional analysis, associations between social support, dietary intake (calories, fruit/vegetable intake, fat, and energy density), and PA (moderate, hard, very hard, and moderate-to-vigorous PA activity levels) were examined using bivariate correlations. Linear Regression Models tested whether statistically significant correlations (p&lt;.05) held with covariates of age, income, education, and acculturation. Results: There were no significant associations between social support and PA. More social support from all three types of networks were each associated with a low energy density diet controlling for covariates: (family β =-.02, p=.003), friends (β =-.01, p=.01), significant other (β =-.014, p=.012). Further, a low-energy density diet was associated with a higher Healthy Eating Index score in post-hoc analyses (r=-.27, p=.01). Higher caloric intake was only associated with more social support from a significant other (r=.36, p&lt;.001) and remained controlling for covariates (β=21.53, p=.03). Total fruit and vegetable (F/V) and fat intake were not associated with any of the social support variables controlling for covariates. Conclusions: Findings suggest that having social support from family, friends, or a significant person may contribute to a low-energy density diet, which was associated with a higher quality diet.

Citation Format: Amanda M. Marin-Chollom, Pam Koch, Ann Ogden Gaffney, Isobel Contento, Hanjie Shen, Dawn Hershman, Heather Greenlee. Social support, diet, and physical activity among Latina breast cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-076.

¡Mi Vida Saludable! A randomized, controlled, 2 × 2 factorial trial of a diet and physical activity intervention among Latina breast cancer survivors: Study design and methods

BACKGROUND

Most Latina breast cancer survivors do not meet diet and physical activity (PA) guidelines for cancer survivors and effective lifestyle interventions to adopt and maintain these recommendations are limited, especially among underserved populations. Here we describe the design, methods and enrollment of a 2 × 2 factorial-designed trial testing the separate effects of the ¡Mi Vida Saludable! (My Healthy Life!) intervention program on changes in diet and PA behaviors among Latina breast cancer survivors.

METHODS

Latinas with a history of stage 0-III breast cancer, no evidence of recurrent/metastatic disease, and > 90 days post-treatment were primarily identified via cancer registries and physician referral. Participants were randomized to four arms: 1) 4 weeks of in-person group sessions plus 11 months of eHealth communication, 2) in-person group sessions alone, 3) eHealth alone, or 4) control. All participants received a Fitbit to self-monitor PA. Assessments at baseline, 6 and 12 months include diet, PA, anthropometrics, predictors and mediators of behavior change, psychosocial and quality of life outcomes, and blood draw.

RESULTS

Of 884 women screened between January 2016 and September 2018, 27% were eligible. Primary reasons for ineligibility included not being willing/able to participate due to work/life responsibilities, health reasons, or transportation. Of 241 eligible women, 167 completed baseline assessment and enrolled.

CONCLUSIONS

We successfully enrolled a diverse group of breast cancer survivors representing more than 15 Latin American nationalities to a diet and physical activity trial. If effective, the ¡Mi Vida Saludable! program can be implemented by community groups and medical centers.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02780271, registered May 2016.

Diet Quality of Mothers of Children in NYC Head Start Is Not Associated With Child Adiposity

Objectives

To assess whether maternal diet quality, measured when child was between ages 3 and 5, is associated with child overweight/obesity at ages 3 to 5.

Methods

Baseline data from the Endotoxin Obesity and Asthma longitudinal study were used for these analyses. 380 African American and Hispanic mothers of children attending NYC Head Start answered a food frequency questionnaire (FFQ) about their own intake and a demographic questionnaire about themselves and child. FFQ data were converted to Healthy Eating Index (HEI)-2015 total scores (higher scores suggest better diet quality). Anthropometric measurements (weight, height, skinfolds, and waist circumference) were obtained from children. BMI, triceps and subscapular z-scores, and weight-to-height ratio (WHtR) were calculated.

Results

Mean HEI total score at baseline was 64.3 ± 8.7 of 100 (considered a “D” grade or poor diet quality), but 69.8 ± 8.6 for Dominican and 60.2 ± 6.5 for Mexican mothers. Children were 50% female, 25% Mexican, 18% Dominican, 19% African American, 15% Puerto Rican and 23% Other. Mean age was 49 months. 52% of children fell below the 85th percentile for BMI, 20% between 85th and 95th, and 28% above the 95th percentile. Mother's HEI-2015 total score was not associated with child's BMI z-score (p = 0.830), child's triceps z-score (p = 0.77), child's subscapular z-score (p = 0.29), or child's WHtR (p = 0.83). More weight loss attempts by the mother (p = 0.03) and child's birthplace in (vs. outside) the United States (p = 0.01) were associated with higher BMI z-scores. Mexican ethnicity was associated with greater triceps z-scores (p = 0.03). Child's age was positively associated with subscapular z-score (p = 0.02). Child's age (p &lt; 0.001) and Mexican ethnicity (p &lt; 0.001) were associated with greater WHtR.

Conclusions

Maternal diet quality was not associated with child adiposity; however, mother's weight loss attempts, child's age and being born in the US, and a child being identified as Mexican were related did. A novel maternal characteristic, number of weight loss attempts, and several child characteristics suggest targets for intervention.

Funding Sources

National Heart, Lung, and Blood Institute; National Institute of Diabetes and Digestive and Kidney Diseases.

Abstract A034: Baseline characteristics of participants enrolled in a randomized controlled trial of a diet and physical activity intervention among Hispanic/Latina breast cancer survivors (in progress)

Background: Cancer survivors are recommended to consume a diet high in fruits and vegetables (F/V), low in energy dense foods, and engage in 150 minutes of moderate-to-vigorous physical activity (MVPA). Hispanic/Latina breast cancer (BC) survivors have higher rates of obesity and lower rates of physical activity compared to non-Hispanic white women. The Mi Vida Saludable (My Healthy Life) trial is testing the effectiveness of a culturally based behavioral intervention on improving and maintaining diet and physical activity changes among Hispanic/Latina BC survivors (R01CA186080, PI: H Greenlee). The primary outcomes are changes, from baseline to 12 months, in daily servings of F/V, total energy density, and physical activity.

Methods: Mi Vida Saludable is a 2 × 2 factorial randomized controlled trial conducted in Hispanic/Latina BC survivors living in New York City. The eligibility criteria include: self-identified as Hispanic/Latina female; aged 21 years; diagnosed with stage 0-III BC with no detectable disease; &gt;3 months post-treatment (current use of hormonal therapy allowed); have access to text messaging and the Internet; and available for Saturday intervention classes. Additional eligibility criteria include intake of &lt;5 servings of F/V per day (assessed using NIH's Quick Food Scan Questionnaire) and/or &lt;150 minutes of MVPA per week (assessed via a modified International Physical Activity Questionnaire Short Form). Baseline data collection includes self-reported demographic, medical history, anthropometric measures, technology use, diet, and physical activity. Participants (target enrollment n=200) are randomized to four arms: A) in-person education plus e-communication, B) e-communication alone, C) in-person education alone, or D) control. Randomization is stratified on preferred language (English vs. Spanish) and current use of hormonal therapy. All participants receive a Fitbit, 30-minute health coaching session, and printed materials. Here, we report the screening and baseline characteristics of participants enrolled to date.

Results: As of July 2018, a total of 128 participants have been enrolled and randomized into the study. Baseline characteristics include: mean age of 56 years (SD 9), 56% with annual household income $15,000, 54% with some college education or higher, 44% overweight (BMI 25-&lt;30 kg/m2), 41% obese (BMI 30 kg/m2), mean time since diagnosis 5 years (SD 4), average 2 servings/day of F/V (SD 1), and mean 51 minutes/week of MVPA (SD 92), 59% comfortable using email, and 80% comfortable using text messaging.

Conclusion: To date, the majority of participants enrolled are overweight/obese and on average do not meet the recommendations for cancer survivors on daily F/V intake and MVPA. Over half of participants enrolled have some college education or more, and more women are comfortable using text messaging compared to email. Trial enrollment will be completed in fall 2019 with a target goal of 200 participants.

Citation Format: Kathleene T. Ulanday, Margarita Santiago-Torres, Zaixing Shi, Rachel Paul, Amanda Marin-Chollom, Marisol Castellano, Yanette Fuentes, Isobel Contento, Pam Koch, Heewon L. Gray, Ann O. Gaffney, Dawn Hershman, Heather Greenlee. Baseline characteristics of participants enrolled in a randomized controlled trial of a diet and physical activity intervention among Hispanic/Latina breast cancer survivors (in progress) [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A034.

Feasibility, Acceptability, and Short-term Behavioral Impact of the MySmileBuddy Intervention for Early Childhood Caries

OBJECTIVES

To evaluate acceptability, feasibility, and short-term behavioral impact of an early childhood caries (ECC) intervention.

METHODS

Predominantly low-income Hispanic parent/child (2-6 years) dyads attending a busy pediatric dental clinic in New York City completed a single administration of the iPad-based technology-assisted education, goal-setting, and behavior change MySmileBuddy program. Self-reported behavior change was assessed via telephone survey one month post-intervention.

RESULTS

Of 113 parent/child dyads approached, 108 (95.6%) participated and all completed MySmileBuddy in its entirety. Over 96% (n = 76) of 79 parents reached for follow-up recalled MySmileBuddy; 63.3% (n = 50) recalled their diet-and/or oral hygiene-related behavioral goal; and 79.7% (n = 79) reported taking action to initiate behavior change.

CONCLUSIONS

Findings suggest that MySmileBuddy was feasibly implemented in a busy clinic, acceptable to this high-risk population, and effectively promoted preliminary ECC-related behavior changes. Larger, long-term studies are warranted to further investigate the impact of the MySmileBuddy program.

Challenges and Facilitators to Promoting a Healthy Food Environment and Communicating Effectively with Parents to Improve Food Behaviors of School Children

Background Childhood obesity is a major public health concern and families play an important role. Improving strategies to reach parents and directing tailored nutrition education to them is needed. Purpose To investigate the challenges and facilitators to promoting a healthy environment at home and to identify communication preferences to inform intervention strategies for effectively reaching low-income urban minority families. Procedure Semi-structured focus group interviews were conducted with four groups involving 16 low-income urban parents (94% female; 88% Hispanic/Latino, 12% African American) of elementary school children. Interviews were transcribed and analyzed applying Social Cognitive Theory and using in-vivo coding. Main Findings The most common barriers to parents providing healthy foods to their children were accommodating child preferences and familial opposition. Parents showed intentionality to engage in healthy behaviors, and often shared procedural knowledge for reaching health goals. The analyses of desired communication channels yielded major preferences: tailored information, information provided through multiple mediums, appropriate duration/frequency of messages, and presented from a voice of authority. Conclusion and Implication While parents expressed desires to be healthy, the home food environment presented substantial challenges. Multi-media supports such as workshops, flyers, and text messaging may be useful to facilitate the sharing of information to minimize the tensions between intentionality and reaching desired goals to be healthy. Some parents thought that information received through text messaging could be easily shared and would act as a voice of authority to support child behavior change.

Behavior change is not one size fits all: psychosocial phenotypes of childhood obesity prevention intervention participants

Variability in individuals' responses to interventions may contribute to small average treatment effects of childhood obesity prevention interventions. But, neither the causes of this individual variability nor the mechanism by which it influences behavior are clear. We used qualitative methods to characterize variability in students' responses to participating in a childhood obesity prevention intervention and psychosocial characteristics related to the behavior change process. We interviewed 18 students participating in a school-based curriculum and policy behavior change intervention. Descriptive coding, summary, and case-ordered descriptive meta-matrices were used to group participants by their psychosocial responses to the intervention and associated behavior changes. Four psychosocial phenotypes of responses emerged: (a) Activated-successful behavior-changers with strong internal supports; (b) Inspired-motivated, but not fully successful behavior-changers with some internal supports, whose taste preferences and food environment overwhelmed their motivation; (c) Reinforced-already practiced target behaviors, were motivated, and had strong family support; and (d) Indifferent-uninterested in behavior change and only did target behaviors if family insisted. Our findings contribute to the field of behavioral medicine by suggesting the presence of specific subgroups of participants who respond differently to behavior change interventions and salient psychosocial characteristics that differentiate among these phenotypes. Future research should examine the utility of prospectively identifying psychosocial phenotypes for improving the tailoring of nutrition behavior change interventions.

Does the Mexican sugar-sweetened beverage tax have a signaling effect? ENSANUT 2016

OBJECTIVE

To evaluate the potential signaling effect of the Mexican tax on sugar-sweetened beverages (SSBs) by analyzing the association between awareness of and opinions about its effectiveness with current consumption of taxed SSBs and with a self-reported change in consumption of SSBs since the implementation of the tax. We also examined the association between psychosocial and environmental determinants of SSB consumption with current consumption of taxed SSBs and with a reported change in consumption of SSBs.

METHODS

Cross-sectional analyses of survey and food-frequency questionnaire data from the Mexican National Health and Nutrition Survey 2016. Participants were Mexican adults (20-59 years, N = 6,650). Logistic regression was used to evaluate the probability of a person reporting a decrease in SSB consumption, given their awareness of the tax, opinion about its effectiveness, psychosocial (SSB health-related beliefs, self-efficacy, and liking of SSBs) and environmental (availability of potable water) determinants. Multiple linear regression analysis was utilized to examine the association between the aforementioned factors and current consumption of taxed SSBs.

RESULTS

Compared with adults not aware, adults who were aware of the SSB tax were more likely (OR = 1.30) to report a decrease in SSB consumption (p = .012). In urban areas, adults aware of the tax drank a significantly lower amount of taxed SSBs (-15.7%; p = .023) than those not aware. Self-efficacy and liking of SSBs were significantly associated with a reported decrease in consumption and with current consumption (p < .001), while health beliefs and availability of potable water were not significantly associated with either reported change in SSB consumption or current consumption of taxed SSBs.

CONCLUSIONS

Implementation of an SSB tax accompanied by highly visible campaigns may further influence the impact of taxes on SSBs consumption. Future public health and nutrition education campaigns designed to increase knowledge and enhance motivation should be complemented by programs to assist individuals develop self-efficacy and self-regulation skills.

Psychosocial mediators of dietary change among Hispanic/Latina breast cancer survivors in a culturally tailored dietary intervention

OBJECTIVE

To examine psychosocial mediators of the effect of a culturally tailored dietary intervention on dietary change among Hispanic/Latina breast cancer survivors.

METHODS

Hispanic/Latina breast cancer survivors (n = 70) were randomized to receive either a 12-week theory-based and culturally tailored dietary change program (intervention group, n = 34), or standard-of-care printed recommendations (control group, n = 36) (ClinicalTrials.gov NCT01414062). Fruit/vegetable intake (F/V), % calories from fat, and hypothesized psychosocial mediators were assessed at baseline, 6 and 12 months. Analysis of covariance assessed intervention effects on psychosocial mediators at 6 and 12 months. Mediation analysis using the bootstrap method evaluated the indirect intervention effects on dietary intake at 6 and 12 months through changes in psychosocial mediators at 6 and 12 months.

RESULTS

Compared with controls, at 6 and 12 months, the intervention group reported greater improvements in stages of change (P < .001, P < .001, respectively), self-efficacy (P = .009, P = .002, respectively), snack preference for F/snack preference for F/V (P = .045, P = .002, respectively); at 12 months, the intervention group reported a decrease in chance-oriented external locus of control (P = .02). At 6 months, mediation analysis showed that the intervention effect was associated with an increase of 1.0 (95% CI, -0.1-2.4) serving/day of F/V, compared with the control group, although no indirect effect through the hypothesized psychosocial mediators was observed. At 12 months, the intervention was associated with an increase in 0.5 serving/day F/V through improved taste/snack preference for F/V at 6 and 12 months (95% CIs, 0.1-1.3, 0.0-1.4, respectively).

CONCLUSIONS

Future programs can target improving taste/snack preference for F/V to promote dietary change in Hispanic/Latina breast cancer survivors.

A Mixed-Methods Comparison of Classroom Context During Food, Health & Choices, a Childhood Obesity Prevention Intervention

BACKGROUND

Schools are frequent settings for childhood obesity prevention; however, intervention results are mixed. Classroom context may hold important clues to improving these interventions.

METHODS

We used mixed methods to examine classroom context during a curriculum intervention taught by trained instructors in fifth grade classrooms. We identified classrooms with high and low buy-in using cluster analysis and compared intervention delivery and reception, student energy balance-related behavior, and student perceptions about supports and barriers to energy balance.

RESULTS

Delivery and reception did not differ between the groups. Between-group differences in unhealthy behaviors were smaller at posttest, due to improvement in low buy-in classes. Although student perceptions of supports and barriers to energy balance were similar across groups, students in high buy-in classes indicated food preferences as a support while students in low buy-in classes indicated food preferences as a barrier. Neighborhood environment emerged as a universal barrier.

CONCLUSIONS

Trained instructors may improve intervention delivery and reception regardless of classroom context. Social norms could explain high levels of unhealthy behavior in low buy-in classes at baseline; improvement at posttest suggests that the curriculum may have motivated change. All children need more strategies and supportive policies to overcome a challenging food environment.

Development of the GREEN (Garden Resources, Education, and Environment Nexus) Tool: An Evidence-Based Model for School Garden Integration

BACKGROUND

Researchers have established the benefits of school gardens on students' academic achievement, dietary outcomes, physical activity, and psychosocial skills, yet limited research has been conducted about how school gardens become institutionalized and sustained.

OBJECTIVE

Our aim was to develop a tool that captures how gardens are effectively established, integrated, and sustained in schools.

DESIGN

We conducted a sequential, exploratory, mixed-methods study. Participants were identified with the help of Grow To Learn, the organization coordinating the New York City school garden initiative, and recruited via e-mail.

PARTICIPANTS/SETTING

A stratified, purposeful sample of 21 New York City elementary and middle schools participated in this study throughout the 2013/2014 school year. The sample was stratified in their garden budgets and purposeful in that each of the schools' gardens were determined to be well integrated and sustained.

MAIN OUTCOME MEASURES

The processes and strategies used by school gardeners to establish well-integrated school gardens were assessed via data collected from surveys, interviews, observations, and concept mapping.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics as well as multidimensional scaling and hierarchical cluster analysis were used to examine the survey and concept mapping data. Qualitative data analysis consisted of thematic coding, pattern matching, explanation building and cross-case synthesis.

RESULTS

Nineteen components within four domains of school garden integration were found through the mixed-methods concept mapping analysis. When the analyses of other data were combined, relationships between domains and components emerged. These data resulted in the development of the GREEN (Garden Resources, Education, and Environment Nexus) Tool.

CONCLUSIONS

When schools with integrated and sustained gardens were studied, patterns emerged about how gardeners achieve institutionalization through different combinations of critical components. These patterns are best described by the GREEN Tool, the first framework to identify how to operationalize school gardening components and describe an evidence-based strategy of successful school garden integration.

Testing an Integrated Model of Program Implementation: the Food, Health & Choices School-Based Childhood Obesity Prevention Intervention Process Evaluation

Childhood obesity is a complex, worldwide problem. Significant resources are invested in its prevention, and high-quality evaluations of these efforts are important. Conducting trials in school settings is complicated, making process evaluations useful for explaining results. Intervention fidelity has been demonstrated to influence outcomes, but others have suggested that other aspects of implementation, including participant responsiveness, should be examined more systematically. During Food, Health & Choices (FHC), a school-based childhood obesity prevention trial designed to test a curriculum and wellness policy taught by trained FHC instructors to fifth grade students in 20 schools during 2012-2013, we assessed relationships among facilitator behaviors (i.e., fidelity and teacher interest); participant behaviors (i.e., student satisfaction and recall); and program outcomes (i.e., energy balance-related behaviors) using hierarchical linear models, controlling for student, class, and school characteristics. We found positive relationships between student satisfaction and recall and program outcomes, but not fidelity and program outcomes. We also found relationships between teacher interest and fidelity when teachers participated in implementation. Finally, we found a significant interaction between fidelity and satisfaction on behavioral outcomes. These findings suggest that individual students in the same class responded differently to the same intervention. They also suggest the importance of teacher buy-in for successful intervention implementation. Future studies should examine how facilitator and participant behaviors together are related to both outcomes and implementation. Assessing multiple aspects of implementation using models that account for contextual influences on behavioral outcomes is an important step forward for prevention intervention process evaluations.

Long-term Diet and Biomarker Changes after a Short-term Intervention among Hispanic Breast Cancer Survivors: The ¡Cocinar Para Su Salud! Randomized Controlled Trial

BACKGROUND

Among Hispanic breast cancer survivors, we examined the long-term effects of a short-term culturally based dietary intervention on increasing fruits/vegetables (F/V), decreasing fat, and changing biomarkers associated with breast cancer recurrence risk.

METHODS

Spanish-speaking women (n = 70) with a history of stage 0-III breast cancer who completed treatment were randomized to ¡Cocinar Para Su Salud! (n = 34), a culturally based 9-session program (24 hours over 12 weeks, including nutrition education, cooking classes, and food-shopping field trips), or a control group (n = 36, written dietary recommendations for breast cancer survivors). Diet recalls, fasting blood, and anthropometric measures were collected at baseline, 6, and 12 months. We report changes between groups at 12 months in dietary intake and biomarkers using 2-sample Wilcoxon t tests and generalized estimating equation (GEE) models.

RESULTS

At 12 months, the intervention group compared with the control group reported higher increases in mean daily F/V servings (total: +2.0 vs. -0.4; P < 0.01), and nonsignificant decreases in the percentage of calories from fat (-2.2% vs. -1.1%; P = 0.69) and weight (-2.6 kg vs. -1.5 kg; P = 0.56). Compared with controls, participants in the intervention group had higher increases in plasma lutein (+20.4% vs. -11.5%; P < 0.01), and borderline significant increases in global DNA methylation (+0.8% vs. -0.5%; P = 0.06).

CONCLUSIONS

The short-term ¡Cocinar Para Su Salud! program was effective at increasing long-term F/V intake in Hispanic breast cancer survivors and changed biomarkers associated with breast cancer recurrence risk.

IMPACT

It is possible for short-term behavioral interventions to have long-term effects on behaviors and biomarkers in minority cancer patient populations. Results can inform future study designs. Cancer Epidemiol Biomarkers Prev; 25(11); 1491-502. ©2016 AACR.

Coeliac disease: the association between quality of life and social support network participation

BACKGROUND

There is little information available on the use of social support systems for patients with coeliac disease (CD). We performed a cross-sectional study aiming to examine the association between participation in different types of social support networks and quality of life (QOL) in adults with CD.

METHODS

A survey including a validated CD specific QOL instrument was administered online and in-person to adults with CD who were following a gluten-free diet. Participation in social support networks (type, frequency and duration) were assessed.

RESULTS

Among the 2138 participants, overall QOL scores were high, averaging 68.9 out of 100. Significant differences in QOL scores were found for age, length of time since diagnosis and level of education. Most (58%) reported using no social support networks. Of the 42% reporting use of social support networks (online 17.9%, face-to-face 10.8% or both 12.8%), QOL scores were higher for those individuals who used only face-to-face social support compared to only online support (72.6 versus 66.7; P < 0.0001). A longer duration of face-to-face social support use was associated with higher QOL scores (P < 0.0005). By contrast, a longer duration and increased frequency of online social support use was associated with lower QOL scores (P < 0.03).

CONCLUSIONS

Participation in face-to-face social support networks is associated with greater QOL scores compared to online social support networks. These findings have potential implications for the management of individuals with CD. Emphasis on face-to-face support may improve long-term QOL and patient outcomes.

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

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/m(2)) 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.

Food environments are relevant to recruitment and adherence in dietary modification trials

Few studies have examined the built environment's role in recruitment to and adherence in dietary intervention trials. Using data from a randomized dietary modification trial of urban Latina breast cancer survivors, we tested the hypotheses that neighborhood produce access could act as a potential barrier and/or facilitator to recruitment, and that a participant's produce availability would be associated with increased fruit/vegetable intake, one of the intervention's targets. Eligible women who lived within a higher produce environment had a non-significant trend towards being more likely to enroll in the trial. Among enrollees, women who had better neighborhood access to produce had a non-significant trend toward increasing fruit/vegetable consumption. As these were not a priori hypotheses to test, we consider these analyses to be hypothesis generating and not confirmatory. Results suggest that participants' food environment should be considered when recruiting to and assessing the adherence of dietary intervention studies.

Short-term patient-centered nutrition counseling impacts weight and nutrient intake in patients with systemic lupus erythematosus

BACKGROUND

Patients with systemic lupus erythematosus (SLE) are at a high risk for cardiovascular disease (CVD) due to increased prevalence of traditional and nontraditional CVD risks factors.

OBJECTIVE

To evaluate the effect of patient-centered nutrition counseling methods on changes in select nutrient, anthropometric, and clinical outcomes in SLE patients enrolled in a CVD prevention counseling program (CVD PCP).

METHODS

From March 2009 to June 2011 a subgroup of SLE patients enrolled in our CVD PCP were referred to a registered dietitian for individualized nutrition counseling. Outcomes of interest were assessed at baseline and six months. A primary analysis evaluated the six-month changes in nutrient intake, weight, body mass index (BMI), waist circumference, and lipid levels. A secondary analysis compared the same measurements between the nutrition counseling patients and the group that was referred but did not attend.

RESULTS

Of 71 referrals, 41 (58%) attended nutrition counseling (female: 89%, African American/Hispanic: 72%, mean age of 39.7 ± 12.82 years, and a mean disease duration of 11.49 ± 8.02 years). Over a six-month period, patients attending nutritional counseling: (a) reduced their intake of sodium (p = 0.006), total calories (p = 0.07), and percent calories from fat (p = 0.011) and saturated fat (p = 0.068); (b) had decreased weight (-1.64 kg, p = 0.025); and (c) were more likely to report increases in eating a diet rich in fruits and vegetables (p < 0.001), a high fiber diet (p = 0.011), ≥two servings of fish/week (p = 0.002), and a low cholesterol diet (p = 0.034). There were no significant changes observed over the six months in BMI and clinical outcomes among nutrition counseling patients. When comparing nutrition counseling patients to those who were referred but did not attend, we found at six months a higher percentage of nutrition counseling patients reportedly followed a high-fiber diet (p = 0.03), consumed two or more servings of fish per week (p = 0.01), followed a low-cholesterol diet (p = 0.03), and achieved a greater weight loss (p = 0.04) compared to the group that did not attend.

CONCLUSION

At six months we found that nutrition counseling using patient-centered methods appears to be an effective method for promoting changes in nutrient intake, diet habits, and, possibly, anthropometric measures in SLE patients. However, the counseling did not show a significant improvement in lipid levels, possibly due to short follow-up and/or SLE related factors.

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

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.

Barriers and facilitators to recruitment to a culturally-based dietary intervention among urban Hispanic breast cancer survivors

PURPOSE

The purpose of this study was to understand factors related to recruitment to behavioral intervention trials among Spanish-speaking urban Hispanic breast cancer (BC) survivors.

METHODS

Potentially eligible Hispanic BC survivors were recruited from the Columbia University Breast Oncology Clinic, signed informed consent, and completed a screening interview on demographics, medical history, acculturation (Short Acculturation Scale for Hispanics), quality of life (QOL), and perceived benefits/risks of research participation. Trial eligibility criteria included stage 0-III BC, completion of adjuvant treatment, Hispanic, fluency in Spanish, willing to be randomized to active arm (9-session in-person culturally-based ¡Cocinar para su salud! dietary modification program) or control arm (written materials). We compared characteristics between eligible women who did and did not enroll in the trial.

RESULTS

102 women completed the screening interview and were eligible to participate. Overall mean age was 57.3 ± 9.5 years, mean time since diagnosis was 3.4 ± 2.1 years, 71% reported annual household income <$15,000 and mean acculturation index score was 1.6 ± 0.6 (scale 1-5, low-high). Of the 102 women, 70 enrolled and 32 declined participation. Reasons stated for non-participation included lack of interest in dietary change, illness, and work constraints. Compared to women who enrolled, women who did not enroll were less likely to be employed (P=0.03) and more likely to only read/speak Spanish (P=0.02). Compared to women who enrolled, non-enrollers were more likely to state that research is costly to participants (P=0.03).

CONCLUSION

Lower participation was associated with unemployment, monolingualism, and the perception that research is costly to participants. Future behavioral intervention trials among minority BC survivors need to account for these and other factors that may be related to trial participation.

Abstract B04: Development and comparison of 12-week and 4-week dietary interventions among Hispanic breast cancer survivors

Background: Evidence suggests that in-person nutrition education is more effective than written materials in improving diet. The ideal dosage of nutrition education (i.e., number of contacts, intervention duration, type of communication channel) to achieve and maintain dietary change among different populations, including minority populations, is unknown. Few studies have compared the effects of intervention dosage on behavioral outcomes among minority populations.

Methods: We compare results from two dietary interventions: ¡Cocinar Para Su Salud! (CPSS) and ¡Cocinar Para Su Salud Junto A Su Familia! (CPSSJASF). CPSS was a randomized controlled trial of a culturally-based dietary intervention among Hispanic breast cancer survivors (n=70; 35/arm) involving 9 group sessions over 12 weeks (4x2-hour nutrition classes, 3x4-hour cooking classes and 2x2-hour food shopping trips; 24-hours total) vs. standard-of-care written dietary recommendations for breast cancer survivors. The CPSS dietary program was developed using a six-step procedural model for designing nutrition education (DESIGN) as the conceptual model. Social Cognitive Theory and the transtheoretical model were used as theoretical frameworks to identify determinants of behavior and objectives for each lesson. All class materials and assessments were developed in Spanish. Focus groups and informal interviews with community residents were conducted to evaluate both class materials and assessment instruments for cultural relevance and format. CPSSJASF was a single-arm pilot study testing a condensed version of CPSS (2x4-hour nutrition + cooking class, 2x4-hour food shopping field trips + cooking class; 16-hours total) among pairs of Hispanic breast cancer survivors and female first-degree relatives (n=6 pairs). Primary outcomes were change in daily fruit/vegetable (F/V) servings and energy from fat at 6 months. We compared results from 34 breast cancer survivors randomized to CPSS intervention (intensive) vs. 6 breast cancer survivors in CPSSJASF (less intensive). Small sample size precluded statistical testing.

Results: Baseline characteristics of the two groups were similar. Baseline characteristics for the intensive group (n=34): mean age 55.1 years (SD 9.1); mean BMI 30.4 kg/m2 (SD 5.6); average daily F/V intake 4.8 servings (2.9 targeted F/V excluding legumes/juices/starchy vegetables/fried foods); average daily energy from fat, 28.5%. Baseline characteristics for the less intensive group (n=6): mean age 53.2 years (SD 8.6); mean BMI 28.6 kg/m2 (SD 4.2); average daily F/V intake: 5.1 servings (2.1 targeted F/V); average daily energy from fat, 29.8%. At 6 months, changes in the intensive compared to less intensive groups for daily servings of F/V were +2.0 vs. +1.4; daily servings of targeted F/V +2.6 vs. +1.9 and daily kcal from fat -7.3% vs. -2.2%.

Conclusions: Both interventions were effective at improving dietary behavior among Hispanic breast cancer survivors. The more intensive CPSS intervention had a larger impact on behavioral change at 6 months. Further research is needed to determine optimum dosage of dietary interventions that result in sustained behavioral change.

Note: This abstract was withdrawn after the Proceedings was printed and was not presented at the conference.

Citation Format: Ana Corina Aycinena, Ann O. Gaffney, Pam Koch, Isobel Contento, John Richardson, Katherine Crew, Mary Beth Terry, Dawn L. Hershman, Heather Greenlee, Parisa Tehranifar. Development and comparison of 12-week and 4-week dietary interventions among Hispanic breast cancer survivors. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B04. doi:10.1158/1538-7755.DISP13-B04

Abstract B02: ¡Cocinar Para Su Salud!: Long-term effects of a short-term culturally based dietary intervention among Hispanic breast cancer survivors

Background: Guidelines for cancer survivors from the American Cancer Society and the American Institute for Cancer Research recommend a diet high in fruits and vegetables and low in energy dense foods, with the goal of improving cancer outcomes. However, few effective and culturally relevant resources exist to assist minority cancer survivors, including Hispanics, in meeting and maintaining these dietary recommendations. We tested the effects of ¡Cocinar Para Su Salud! (Cook For Your Health!), a short-term (9-week) culturally-based dietary intervention, on increasing fruit/vegetable (F/V) intake and decreasing dietary fat intake over 12 months among Hispanic breast cancer survivors.

Methods: Eligible women included those with a prior diagnosis of stage 0-III breast cancer, completion of adjuvant treatment (hormonal therapy allowed), Hispanic and able to speak Spanish. At baseline, women completed three 24-hour diet recalls, detailed interviews, provided fasting blood and anthropometric measures. Subjects were randomized to: A) the control arm (dietary recommendation booklet for breast cancer survivors), or B) the ¡Cocinar Para Su Salud! program, a 9-week culturally-based dietary intervention using group nutrition education, cooking classes and food shopping field trips to promote behavior change. The intervention was developed via a collaboration between academic and NYC-based community partners. All study activities were conducted in Spanish. Participants were followed for 12 months via monthly phone interviews and clinic visits (3, 6 and 12 months). The primary outcome was change at 6 months in daily F/V servings and % calories from fat. Month 12 outcomes are reported here. Change in dietary intake was analyzed using 2-sample t-tests.

Results: From April 2011 to March 2012, 70 women were randomized (n=36 control, n=34 intervention). Baseline characteristics: mean age 56.6 yrs (SD 9.7), mean time since diagnosis 3.4 yrs (SD 2.7), mean body mass index (BMI) 30.6 kg/m2 (SD 5.4), and 63% had an annual household income &lt;$15,000. At baseline, women reported average daily intake of 5.3 servings of all F/V (3.1 servings of F/V targeted by the intervention, which excluded legumes/juices/starchy vegetables/fried foods) and 27.7% of daily calories from fat. 64% of women in the intervention arm attended ≥7/9 classes. Retention rates were 87% at month 6 and 83% at month 12. At month 6, the intervention group compared to controls reported a significant increase in mean servings of F/V from baseline (all F/V: +2.0 vs. -0.1, P=0.005; targeted F/V: +2.6 vs. +0.1, P&lt;0.001), but a non-significant decrease in % calories from fat (-7.3% vs. -4.5%, P=0.26) and weight (-2.5 kg vs. +2.6 kg, P=0.2). Changes in F/V intake were maintained at month 12: the intervention group compared to controls reported a significant increase in mean servings of F/V from baseline (all F/V: +2.0 vs. -0.4, P=0.006; targeted F/V: +1.9 vs. -0.3, P=0.001). Although the non-significant trend in weight loss in the intervention arm compared to controls was maintained at month 12 (-2.1 kg vs. +2.5 kg, P=0.3), the decrease in % calories from fat was not maintained (-2.2% vs. -1.1%, P=0.69).

Conclusions: ¡Cocinar Para Su Salud! is an effective program to increase fruit/vegetable intake among a diverse group of urban Hispanic breast cancer survivors. The benefit of the 9-week intervention was sustained at 12 months.

Citation Format: Heather Greenlee, Ann Ogden Gaffney, Ana Corina Aycinena, Pam Koch, Isobel Contento, Wahida Karmally, John Richardson, Emerson Lim, Wei Yann Tsai, Katherine Crew, Matthew Maurer, Kevin Kalinsky, Dawn L. Hershman. ¡Cocinar Para Su Salud!: Long-term effects of a short-term culturally based dietary intervention among Hispanic breast cancer survivors. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B02.

Food label use and its relation to dietary intake among US adults

Rates of diet-related chronic disease combined with the lack of current data on patterns of food label use by the US population warrant re-examination of the use and potential influence of this public health tool. The purpose of this study was to describe the prevalence of food label use and the association between food label use and nutrient intake in a nationally representative sample of US adults who participated in the 2005-2006 National Health and Nutrition Examination Survey. Data on food label use were collected during the interview portion of the survey, and nutrient intake was estimated using the average of two 24-hour dietary recalls. In this sample, 61.6% of participants reported using the Nutrition Facts panel, 51.6% looked at the list of ingredients, 47.2% looked at serving size, and 43.8% reviewed health claims at least sometimes when deciding to purchase a food product. There were significant differences (P<0.05) in food label use across all demographic characteristics examined. Significant differences (P<0.05) in mean nutrient intake of total energy, total fat, saturated fat, cholesterol, sodium, dietary fiber, and sugars were observed between food label users and non-users with label users reporting healthier nutrient consumption. The greatest differences observed were for total energy and fat and for use of specific nutrient information on the food label. Despite food label use being associated with improved dietary factors, label use alone is not expected to be sufficient in modifying behavior ultimately leading to improved health outcomes.

Effect of Variable Carbohydrate Intake on Exercise Performance in Female Endurance Cyclists

This study measured the effect of variable carbohydrate intake on time to exhaustion, variations in heart rate (HR), respiratory exchange ratio (RER), and rating of perceived exertion (RPE) in female endurance cyclists during an exercise trial. Subjects were 11 eumenorrheic women with maximal oxygen consumption (VO2max) 60.1 ± 5.1 ml/kg who habitually cycled at least 100 miles per week. In a crossover design, each woman was randomly assigned to a eucaloric diet providing 8, 5, or 3 g of CHO/kg of body weight. Subjects cycled at least 100 miles while adhering to the diet for 6 days. The exercise trial was performed on the 7th day, consisting of a 60 min cycle at 70% VO2max, followed by an increase in intensity to 90% VO2max until that intensity could no longer be maintained. Results indicated no difference in mean time to exhaustion, heart rate, or RPE. RER increased over time-elapsed (F = 40.4, p < .001) and across diets (F = 6.1, p = .015). Conclusions: Female endurance cyclists did not experience a difference in time to exhaustion, HR, or RPE with different levels of CHO intake during an endurance trial. RER varied with diet at submaximal intensities. Further research is needed to determine the optimal level of CHO intake for this population.

Post-diagnosis family adaptation influences glycemic control in women with type 2 diabetes mellitus

Family adaptation to type 2 diabetes management after nutrition education was studied as part of a 2.5-year ethnography. Data analysis included descriptive data (observations, transcribed audio recordings, written field notes) and quantitative data (self-monitored morning fasting blood glucose, food records) from the families of 5 New York suburban women. The following inferences emerged from data analysis. Among the women with improved glycemic control, the home and family routines had changed. Diabetes management was observed as certain tasks: food tasks, patient care tasks, management tasks, and medical advice tasks. The social context of the women's daily lives influenced their glycemic control; specifically, family members other than the women with diabetes took on new "hospital roles and routines." Nutrition education should be directed toward assessing existing family social support and helping women organize and supplement this support to ensure the successful completion of the tasks of diabetes self-management.

Relationships of dietary fat consumption to serum total and low-density lipoprotein cholesterol in hispanic preschool children

BACKGROUND

Studies of the relationship between dietary fat intake and serum lipids in young children have yielded inconclusive results. We studied this relationship in 108 Hispanic children ages 4-5 years.

METHODS

Four 24-hr recalls approximately 3 months apart and two Willett semiquantitative food frequency questionnaires approximately 6 months apart were obtained by interviewing the children's mothers. Diet measures were averaged for the multiple administrations of each of these instruments.

RESULTS

Based on the 24-hr recalls, children in the highest tertile of total fat consumption (36.2% of total calories) compared with the lowest tertile (30.2% of total calories) had mean total serum cholesterol of 4.32 mmol/liter (167 mg/dl) vs 3.91 mmol/liter (151 mg/d) (test for linear trend across tertiles, P less than 0.05) and mean low-density lipoprotein cholesterol of 2.74 mmol/liter (106 mg/dl) vs 2.29 mmol/liter (89 mg/dl) (test for linear trend, P less than 0.01). Children in the highest tertile of saturated fat consumption (14.6% of total calories) compared with the lowest tertile (11.2% of total calories) had mean total serum cholesterol of 4.39 mmol/liter (170 mg/dl) vs 3.97 mmol/liter (154 mg/dl) (test for linear trend, P less than 0.05) and mean low-density lipoprotein cholesterol of 2.80 mmol/liter (108 mg/dl) vs 2.35 mmol/liter (91 mg/dl) (test for linear trend, P less than 0.01). These relationships remained significant when calorie-adjusted nutrient intakes were examined and after adjustment in multiple linear regression models for age, sex, and body mass index, with the exception of the association of calorie-adjusted total fat with total serum cholesterol level (P = 0.07). Similar results were obtained using the Willett questionnaires.

CONCLUSIONS

These findings indicate that dietary fat, particularly saturated fat consumption, is an important correlate of blood lipid levels in preschool children. These are also the first reported data indicating that the Willett questionnaire, as a method for measuring the atherogenic components of diet, has criterion-related validity in young children.

Resting metabolic rate and energy balance in amenorrheic and eumenorrheic runners

This study investigated metabolic and nutritional factors in association with athletic menstrual dysfunction (AMD). Three groups of women were studied: amenorrheic runners (amenorrheic), eumenorrheic runners (eumenorrheic), and eumenorrheic sedentary controls (sedentary). Amenorrheic and eumenorrheic were similar in age, weight, percent body fat by hydrodensitometry, training pace and mileage, best 10 km race time, years running, and maximal oxygen consumption. When adjusted for body weight or for fat-free mass by analysis of covariance, RMR was significantly lower in amenorrheic than in eumenorrheic and sedentary. The daily caloric intakes of the groups did not differ significantly, but the amenorrheic scored significantly higher than the eumenorrheic and sedentary on a scale of aberrant eating patterns. Amenorrheic high mileage runners seem to have a less adequate diet than eumenorrheic runners but appear to maintain energy balance and stable weight through a reduction in RMR.

Blood pressure, fitness, and fatness in 5- and 6-year-old children

Cross-sectional relations among blood pressure (BP), aerobic fitness, body fatness, and fat patterning were studied in 216 primarily Hispanic inner-city 5- and 6-year-olds. Fitness was measured with a submaximal treadmill test, and fatness was measured with five skin folds. Diastolic BP was inversely related to fitness in the boys and girls, and positively related to fatness for the boys. Systolic BP was positively related to fatness for the boys and girls. Using multiple regression and including parental BPs, fatness explained significant proportions of the variance in systolic BP for both the boys and girls and in diastolic BP for the boys. There were tendencies for central skin folds to explain more of the variation in BP than peripheral skin folds only for the boys. Fitness and fatness were inversely related for the boys and girls. Thus, at 5 and 6 years of age children exhibit some of the same risk factors for cardiovascular disease seen in adults.

Failure of family history to predict high blood cholesterol among hispanic preschool children

Recommendations for screening children for high blood cholesterol remain controversial. The American Academy of Pediatrics, the American Heart Association, and the National Institutes of Health (NIH) Consensus Conference have recommended targeted screening of children with positive family history. We examined data from a sample of 108 Hispanic preschool children and their families to test targeted screening strategies. Thirty-seven children (34.3%) had total cholesterol levels of greater than or equal to 4.40 mmole/liter (170 mg/dl). Using the American Academy of Pediatrics definition of family history, sensitivity (proportion of those with high blood cholesterol with positive family history) was 0.57 (95% confidence interval, 0.40 to 0.73) and accuracy (overall proportion correctly classified) was 0.58 (0.48 to 0.68). Using the American Heart Association and NIH Consensus Conference definition of family history, sensitivity was 0.46 (0.30 to 0.63) and accuracy was 0.62 (0.52 to 0.71). Classification of children based on the mother's total cholesterol level of greater than or equal to 5.17 mmole/liter (200 mg/dl), the mother's low-density lipoprotein cholesterol level of greater than or equal to 4.14 mmole/liter (160 mg/dl), the mother's low-density lipoprotein cholesterol level of greater than or equal to 3.36 mmole/liter (130 mg/dl), or the child's own body mass index greater than or equal to 75th percentile was less sensitive and no more accurate. These findings indicate that current recommendations as well as other potential strategies for targeted cholesterol screening in young children have serious shortcomings and lend support to universal cholesterol screening in childhood.

Screening using National Cholesterol Education Program guidelines in a population of urban Hispanic mothers

We measured serum total cholesterol, high-density lipoprotein cholesterol, and triglycerides and calculated low-density lipoprotein cholesterol in 217 urban Hispanic mothers. On the basis of total cholesterol values, as recommended by the Expert Panel of the National Cholesterol Education Program, 6 subjects (2.8%) had high blood cholesterol (greater than or equal to 240 mg/dl), 27 (12.4%) had borderline-high blood cholesterol (200-239 mg/dl), and 184 (84.8%) had desirable blood cholesterol (less than 200 mg/dl). One of the 27 with borderline-high total cholesterol had two other coronary risk factors. Thus 7 of the 217 (3.2%, 95% confidence interval 1.4 to 6.8%) met Expert Panel criteria for lipoprotein measurement. Six of the seven had high-risk low-density lipoprotein cholesterol (greater than or equal to 160 mg/dl). Four additional subjects with borderline-high total cholesterol, not identified by this sequential screening strategy, also had high-risk low-density lipoprotein cholesterol. Thus a total of 10 of 217 (4.6%, 95% confidence interval 2.4 to 8.6%) met Expert Panel criteria for high-risk low-density lipoprotein cholesterol and initiation of cholesterol-lowering treatment. None of these 10 had been previously identified as having high-risk low-density lipoprotein cholesterol. Two years later subjects with high or borderline-high total cholesterol were rescreened. Seven of 22 subjects completing the second screening were classified differently with regard to having high-risk low-density lipoprotein cholesterol, illustrating the potential for misclassification of individuals on the basis of a single measurement. The prevalence of women with high-risk low-density lipoprotein cholesterol was not significantly different at the two screenings.(ABSTRACT TRUNCATED AT 250 WORDS)