This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. This two-year study is one of the first dietary clinical trials to determine the feasibility of adopting and maintaining a low-fat dietary eating plan in a low-income African American (AA) population of breast cancer survivors. Our goal in this pilot study is to design, implement, and evaluate a culturally specific dietary intervention, based on the Women's Intervention Nutrition Study (WINS) Low-fat Eating Plan (WLEP), which reduces consumption of dietary fat to 20% of total calories, while increasing fruits and vegetables. We will accomplish four Specific Aims in two phases: 1- Investigate the individual, cultural, and environmental factors which may serve as barriers and supports for the adoption and maintenance of the WLEP in low-income AA breast cancer survivors; 2- Develop and deliver a culturally specific approach to the WLEP intervention; 3- Assess the eating patterns of study participants in the two intervention arms (WLEP and standard dietary information),and the psychosocial and behavioral factors which may be associated with them, at baseline, 6, and 12 months for correspondence with the WLEP, and the USDA/DHHS 2005 Dietary Guidelines; 4- Assess dietary biomarkers at baseline, 6, and 12 months, including weight, height, waist hip circumference, serum fatty acid concentrations, lipids, insulin and insulin-like growth factors, glucose, and levels of sex hormone-binding globulins. Research studies have found that women who do not gain weight following breast cancer treatment are less likely to have a recurrence. Weight gain after treatment is one of the few risk factors that survivors can modify to increase their years of healthy living. We explored women's thoughts about this in one of our ongoing studies, and found that many African American breast cancer survivors had no clear plan of follow-up care as a way of reducing their risk of breast cancer recurrence. They requested guidance in developing plans of self-care, which target diet and physical activity in the context of their cultural lifestyles. We will address this request in this study by developing a culturally-specific dietary intervention, based on the Women's Intervention Nutrition Study (WINS) Low-Fat Eating Plan. This Eating Plan reduces consumption of dietary fat to 20% of total calories, while increasing fruits and vegetables, and has been shown to reduce breast cancer recurrence by 24% in a group of survivors. Our primary study outcome is to determine the feasibility of adopting and maintaining these dietary approaches in a low to middle income population of women with limited education, experience, and resources for preventing cancer recurrence through diet. This is an important question since most dietary clinical trials for breast cancer survivors have included more educated women than the general population diagnosed with early stage breast cancer. We are enrolling a population of African American breast cancer survivors, whose cancer outcomes are often poorer, and who have higher rates of obesity, recurrence, and mortality, compared to their Caucasian counterparts. To date, we have examined the individual, cultural, and environmental factors which may serve as barriers and supports for the adoption and maintenance of a low-fat eating plan in focus groups. Based on focus group data, we developed a culturally-specific approach to a low-fat diet, and are currently assessing the eating patterns, and related biomarkers, of nine study participants who are receiving dietary counseling designed to promote following the low-fat eating plan. We are also assessing dietary biomarkers at baseline, 6, and 12 months, including weight, height, waist-hip circumference, serum fatty acid concentrations, lipids, insulin and insulin-like growth factors, glucose, and levels of sex hormone-binding globulins. Process evaluation will assess patients'reactions to the interventions, in preparation for testing in a larger scale dietary clinical trial.
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