The African-American population of the US continues to experience high rates of mortality from cardiovascular (CV) disease, including coronary heart disease, stroke and renal failure. The major syndromes which determine CV risk, including obesity, hypercholesterolemia, glucose intolerance, and hypertension, all occur more frequently among African Americans. Nutritional factors underlie many forms of CV disease and are an important focus of current prevention efforts. Very little is currently known, however, about specific nutritional patterns among African Americans that might lead to CV risk, or the applicability of structured interventions. The applicants are currently engaged in a series of epidemiologic studies in a stable, working class community adjacent to Chicago, IL. In this setting a randomized controlled trial is proposed to evaluate the effectiveness of an intervention to reduce dietary fat. Given the growing recognition of the importance of total fat, from the point of view of both disease risk and eating patterns, the primary focus of the intervention will be reduced to the percentage of calories in the diet from fat. Four hundred households will be recruited and randomly assigned to either an active intervention or observation group for a period of 18 months. Dietary change consistent with specific recommendations being made to the American public for reducing cardiovascular (CV) risk will be encouraged, namely, reduction in total fat, saturated fat (SFA), and cholesterol (Chol). A practical, community-based program will be developed which can be taken into households. Nutrition education and enhancement of skills helpful in making behavioral change will form the basis of the intervention. Lay educators, recruited from the target neighborhoods, will work under the close supervision of a community nutritionist. Changes in reported dietary intake, serum lipids/lipoproteins and body weights will be measured. In addition to the formal evaluation of the trial outcome, an important secondary goal will be to obtain detailed information about eating patterns in this community and characterize behavior associated with the achievement and maintenance of target nutrient goals. This project should lead to nutrition intervention model that can be broadly implemented in the African-American community.
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