Non-insulin dependent diabetes mellitus (NIDDM) affects people of Latino origin more often and at an earlier age than whites. The Latino culture influences dietary behaviors which affect diabetes. Although nutrition intervention studies have demonstrated reductions in weight and glucose, culturally sensitive programs for a specific population of Latinos with diabetes have not been developed or validated. Boston, MA is home to a large population of Caribbean Latinos who originate predominantly from Puerto Rico and the Dominican Republic. An NIH planning grant has been used by the investigators to create a multidisciplinary team of practitioners and researchers and to identify and characterize a population of urban Caribbean Latinos with diabetes mellitus. Preliminary data show that these Latinos consume traditional Latino foods (especially rice and beans) primarily at lunch and dinner, use oil and other high fat foods extensively and rarely eat outside of the home. There is a strong need for programs that are culturally sensitive and target specific behaviors. We propose to design, implement, and evaluate a culturally-sensitive program that reduces dietary lipid intake. Using the information gained during the planning grant year, we will develop a program that is oriented towards Caribbean Latino culture, utilizes principles of behavior modification, and consists of proper nutritional guidelines. The intervention will focus on recipe modification, meal planning, informed shopping and group nutrition counseling. After pilot testing and modifying the program, diabetic Caribbean Latinos will be recruited from Boston City Hospital and the South End Community Health Center and randomized to either an intervention nutrition (IN) group or a usual care (UC) group. A separate UC group of Caribbean Latinos from Whittier St. Neighborhood Health Center will be followed to determine whether crossover occurs. The IN group will meet for twelve consecutive weeks, and then at weeks 14,16 18, 20 and 24. The UC group will be followed at 6, 12 and 24 weeks. Follow-up for both groups will be done at 9 and 12 months. Parameters to be measured in both groups include dietary intake, weight, lipid profile, HgbA1C, WHR, and blood pressure. Metabolic studies will include body fat distribution using dual energy x-ray absorptiometry (DEXA) and indices of insulin sensitivity and resistance as measured by IV glucose tolerance test. By designing culturally sensitive programs that target specific behaviors, we believe that dietary fat intake can be reduced in urban Caribbean Latinos with NIDDM.
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