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

https://doi.org/10.1016/j.jand.2015.02.027Get rights and content

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.

Section snippets

Study Design and Participant Recruitment

This study was a randomized controlled trial designed to examine the effects of a nine-session (24 hours over 12 weeks), culturally based dietary intervention vs standard written materials on change in F/V and total fat intake among Hispanic breast cancer survivors. Spanish-speaking women with a history of stage 0 to III breast cancer and who were at least 3 months post treatment (surgery, radiation, or chemotherapy; current hormonal therapy allowed) with no evidence of metastatic disease were

Recruitment, Baseline Characteristics, Enrollment, and Retention

Between April 7, 2011 and March 30, 2012, 70 women were randomized into the Intervention (n=34) and Control (n=36) arms. The median number of days between screening and randomization was 43 days. A CONSORT (Consolidated Standards of Reporting Trials) diagram is illustrated in Figure 2. At study enrollment, participants’ scored a mean of 11.6 (standard deviation [SD] 4.2) on the Block Fruit/Vegetable/Fiber Screener, translating to <4 servings of F/V per day (data not shown). At baseline, there

Discussion

The 3-month ¡Cocinar Para Su Salud! culturally based dietary intervention successfully increased the combined intake of F/V among a diverse group of urban Hispanic breast cancer survivors, the majority of whom were of low socioeconomic status, and the dietary changes persisted at 6 months. Future analyses will investigate specific factors related to dietary change. The intervention focused on helping women achieve and maintain the dietary composition guidelines set forth by the AICR and ACS.1, 2

Conclusions

The ¡Cocinar Para Su Salud! study successfully identified an effective method to increase short-term F/V intake among a diverse and under-represented group of Hispanic breast cancer survivors. These dietary changes toward a healthier lifestyle have the potential to improve breast cancer prognosis and cardiovascular and metabolic disease outcomes. The success of this intervention could inform the implementation of community-based nutrition education programs for Hispanic breast cancer survivors

Acknowledgements

The authors thank Lisa Zullig of God's Love We Deliver (New York, NY) for providing nutrition information materials used in the study, Monica Gonzalez, RD, CDN, for her work as the intervention RDN, Ela Guidon for her work as the intervention chef, and all of the study participants for their contributions.

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.

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  • Cited by (0)

    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.

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

    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.

    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.

    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.

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

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

    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.

    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.

    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.

    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.

    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.

    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.

    Clinicaltrials.gov Identifier: NCT01414062.

    Statement of Potential Conflict of Interest: The authors have no potential conflict of interest to disclose.

    Supplementary materials: Table 3 is available at www.andjrnl.org

    STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

    FUNDING/SUPPORT Supported by National Cancer Institute/National Institutes of Health R21CA152903, and in part by Columbia University's Clinical and Translational Science Award grant no. UL1TR000040 from the National Center for Advancing Translational Sciences/National Institutes of Health.

    Clinicaltrials.gov Identifier: NCT01414062.

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