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

Abstract

Background Among Hispanic breast cancer (BC) 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 BC recurrence risk. Methods Spanish-speaking women (n=70) with a history of stage 0-III BC 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 BC 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 to the control group reported higher increases in mean daily F/V servings (total: +2.0 vs. −0.4; P=0.006), and non-significant decreases in percent calories from fat (−2.2% vs. −1.1%; P=0.69) and weight (−2.6 kg vs. −1.5 kg; P=0.56). Compared to controls, participants in the intervention group had higher increases in plasma lutein (+20.4% vs. −11.5%; P=0.002), 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 BC survivors and changed biomarkers associated with BC 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.

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

“…The primary outcomes of the intervention at 6 and 12 months have been previously reported . Briefly, the intervention group compared with control group reported an increase in mean servings of all F/V (6 months: F/V: +2.0 vs −0.1, P < .01; 12 months: +2.0 vs −0.4, P < .01), and targeted F/V (+2.3 vs −0.1; P < .01) from baseline.…”

“…Figure illustrates participant enrollment, randomization, and follow‐up in a CONSORT diagram. Participant characteristics have been previously reported . Briefly, the mean age of participants was 56.6 years (SD = 9.7 years), mean time since diagnosis was 3.4 years (SD = 2.7 years), mean body mass index was 30.9 kg/m 2 (SD = 6.0 kg/m 2 ), and 62.9% of women had an annual household income ≤$15 000.…”

“…Cultural values related to family and community were acknowledged and addressed throughout the sessions as potential facilitators and barriers to dietary change. Study results showed that the 9 sessions/12‐week intervention was effective at improving fruit and vegetable intake by over 2 servings per day at 12 months . The methods used and rationale for the intervention design have been previously published .…”

“…was a randomized controlled trial designed to test a theory-based, culturally tailored dietary change program for a diverse population of Hispanic/Latina, lowincome breast cancer survivors living in New York City. 7,14 The intervention focused on foods common to Hispanics/Latinos living in northern Manhattan. Recipes were developed based on traditional Latin American cuisines.…”

“…Study results showed that the 9 sessions/12-week intervention was effective at improving fruit and vegetable intake by over 2 servings per day at 12 months. 7,14 The methods used and rationale for the intervention design have been previously published. 15 Briefly, the intervention framework used 2 psychosocial theories, social cognitive theory (SCT) and the Transtheoretical Model (TTM), to provide a unified conceptual framework to identify both determinants and mechanisms of behavioral change.…”