Abstract
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 <$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<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.
