Nutritional management is an important component in the control of diabetes, and appropriate dietary adherence is associated with better glycemic control. However, adherence to a nutrition program is one of the most challenging aspects of diabetes care. From data from our baseline study, the Massachusetts Hispanic Elders Study, we have identified diabetes as highly prevalent among elderly Hispanics of Caribbean origin. Their disease status is characterized by high rates of uncontrolled diabetes and lack of appropriate strategies to self-manage the nutritional component of their disease. We hypothesize that, compared to the standard recommendations for nutrition care of Hispanics with diabetes, an ethnically and culturally specific nutrition program will result in improved fruit and vegetable and fiber intakes. To address this hypothesis, our proposed project has two phases: 1) development of a Caribbean Nutrition Program, including an ethnographic study to obtain the culturally relevant elements that will make this program unique for the target population, and 2) a pilot study to test the feasibility of implementing the Caribbean Nutrition Program with elderly Hispanics of Caribbean origin living in Massachusetts. The goal is to have a culturally specific nutrition self-management program designed to improve dietary intake of fruit and vegetables and dietary fiber, which, once incorporated into the diabetes self-management plan of Hispanic elders with diabetes will result in appropriate food choices, in better quality of life, and in improved glycemic control.
Specific aims are: 1) To design a culturally appropriate nutrition program to increase access and use of fruit and vegetables and other high fiber foods for Caribbean Hispanics with diabetes. 2) To pilot test the Caribbean Nutrition Program in a sample of Hispanic elders with diabetes, and 3) To evaluate adherence to the Program by assessing intakes of specific foods and dietary components as well as levels of total plasma carotenoids. The study population will be recruited among Puerto Rican and Dominican men and women, (50-70 years of age) with diabetes. Volunteers for both phases of the study will be recruited in the Greater Springfield area (Hampden County), Massachusetts. For the intervention pilot study (4 months), volunteers will be randomly divided into two groups and will be given the standard recommendations for individuals with diabetes (control group) or the Caribbean Nutrition Program (intervention group). A semi-quantitative food frequency questionnaire will be administered to obtain detailed data on food intake and patterns. Volunteers will also provide a fasting blood sample and serum carotenoids, HbA1c and blood glucose will be tested. Differences between baseline and 4 months, within and between groups, will be assessed to test our hypotheses as follow: 1) A nutrition program that is consonant with current dietary guidelines and tailored to the ethnic and cultural characteristics of elderly Caribbean Hispanics with diabetes is feasible. It will be accepted and followed by participants, as measured by indicators of adherence and compliance. 2) Among Caribbean Hispanics with diabetes, dietary self-management to increase fruit and vegetables consumption and fiber intake, as evaluated by changes in certain dietary components from food frequency questionnaire and by plasma carotenoids, will be more effective with the Caribbean Nutrition Program than with standard dietary recommendations.
