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

Abstract

BACKGROUND There is a need for culturally-relevant nutrition programs targeted to underserved cancer survivors. OBJECTIVE To examine the effect of a culturally-based approach to dietary change on increasing fruit/vegetable intake and decreasing fat intake among Hispanic breast cancer (BC) survivors. DESIGN Participants were randomized to intervention (IG) and control (CG) 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-III BC who completed adjuvant treatment and lived in New York City were randomized between April 2011 and March 2012. INTERVENTION The IG (n=34) participated in ¡Cocinar Para Su Salud! (¡CPSS!), a culturally-based 9-session (24-hours over 12 weeks) intervention including nutrition education, cooking classes and food shopping field trips. The CG (n=36) received written dietary recommendations for BC survivors. MAIN OUTCOME MEASURES Change at 6 months in daily fruit/vegetable servings and % calories from total fat. 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: mean age 56.6 years (SD 9.7), mean time since diagnosis 3.4 years (SD 2.7), mean BMI 30.9 kg/m2 (SD 6.0), 62.9% with annual household income ≤$15,000, average daily servings of all fruits/vegetables 5.3 (targeted fruits/vegetables 3.7 servings excluding legumes/juices/starchy vegetables/fried foods) and 27.7% of daily calories from fat. Over 60% in the IG attended ≥7/9 classes with overall study retention of 87% retention at 6 months. At month 6, the IG compared to CG reported an increase in mean servings of fruits/vegetables from baseline (all fruits/vegetables: +2.0 vs. −0.1, P=0.005; targeted fruits/vegetables: +2.7 vs. +0.5, P=0.002) and a non-significant decrease in % calories from fat (−7.5% vs. −4.4%, P=0.23) and weight (−2.5kg vs. +3.8kg, P=0.22). CONCLUSIONS ¡CPSS! was effective at increasing short-term fruit/vegetable intake in a diverse population of Hispanic BC survivors.

Head and neck cancer survivors’ preferences for and evaluations of a post-treatment dietary intervention

“…This is an important concept to acknowledge in designing future interventions as group counseling may initially appear to be a way of increasing peer support and thus intervention adherence. However, in two previous studies of breast cancer survivors, results indicated that group dietary counseling sessions did not lead to an increase fruit and vegetable intake [26, 27]. In comparison, in a mixed cancer cohort study patients who received individualized dietary counseling during treatment reported better weight maintenance and higher intakes of adequate protein and calories as compared to those in the control arm who did not receive individualized counseling [28].…”

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

“…From the outset, the research team was aware that the population of Latina breast cancer survivors living in Northern Manhattan is highly diverse in terms of national background, socioeconomic status, and level of acculturation. 15 , 42 , 43 The intervention was designed to be broadly applicable to this population. Written, informed consent was obtained for participants who engaged in the pilot testing (n = 19).…”

“… 11 - 13 Our prior work has shown low fruit/vegetable intake and low physical activity in Latina breast cancer survivors living in Northern Manhattan. 14 , 15 …”

“…(Cook for Your Health), a culturally-tailored curriculum for Hispanic/Latina breast cancer survivors, which we previously tested in a randomized, controlled trial to examine its effect on increasing fruit and vegetable intake and reducing dietary fat over 6 months. 15 , 36 , 37 The intervention was based on Social Cognitive Theory 38 and the Transtheoretical Model. 39 Activities and education material targeted increasing self-efficacy and behavioral capability with observational learning and reinforcement through supportive group education and hands-on skills building lessons.…”

Characteristics of Users of the Cook for Your Life Website, an Online Nutrition Resource for Persons Affected by Cancer: Descriptive Study

“…In 2009, AOG met HG, a cancer epidemiologist and cancer prevention scientist, when she was a faculty member at Columbia University’s Mailman School of Public Health. With funding from the National Cancer Institute (NCI), they developed AOG’s program into a formal curriculum and tested it in the Cocinar Para Su Salud (Cook for Your Health) study (ClinicalTrials.gov NCT01414062) [ 16 , 17 ]. In 2012, AOG founded the Cook for Your Life website [ 15 ], recognizing that sharing tips and recipes online could broaden the reach to patients with cancer and survivors worldwide.…”