An intervention designed to provide a diverse and under-represented group of Latina breast cancer survivors with the knowledge and skills needed to change and sustain dietary behaviors led to increased consumption of fruits and vegetables per day.
The study, published in the Journal of the Academy of Nutrition and Dietetics (2015; doi:10.1016/j.jand.2014.11.002), was done by researchers at Columbia University Mailman School of Public Health in partnership with the New York City-based, not-for-profit Cook for Your Life initiative.
Founded by a breast and kidney cancer survivor, the Cook For Your Life program helps fellow survivors adhere to recommended guidelines to eat a diet high in fruits and vegetables and maintain these changes going forward.
Using a culturally based hands-on educational approach, the Cook for Your Life program, or ¡Cocinar Para Su Salud! is geared toward Latina breast cancer survivors who are at higher risk of obesity, low physical activity, and poorer access to quality health care.
Overall, New York City Hispanic populations have a low intake of fruits and vegetables. However, after given certain dietary information and some basic tools the participants in this study increased their number of fruits and vegetables servings to 6.8 per day, well within the American Cancer Society’s recommended 5 to 9 servings per day to improve clinical outcomes. After 6 months the women participating in Cook for Your Life had increased the amount of targeted fruits and vegetables by more than 2.5 servings a day.
According to the American Cancer Society, only 18% of breast cancer survivors meet the recommended number of daily fruits and vegetable servings, and even fewer survivors of lower socio-economic status are likely to adhere to guidelines. Of the current estimated 12 million cancer survivors in the United States, approximately 5% are Hispanic.
Latinas with stage 0 to III breast cancer who completed adjuvant treatment at least 3 months prior to the study and lived in New York City were randomly selected to the intervention group or a control group between April 2011 and March 2012.
Those assigned to the intervention group participated in the Cook for Your Life ¡Cocinar Para Su Salud! program with nutrition roundtables, food shopping field trips, and cooking classes. The control group received written dietary recommendations for breast cancer survivors. More than half of the women in the study reported participation in the Supplemental Nutrition Assistance Program (SNAP) and had annual household incomes less than $15,000.
“Many of the women who took part in the study are first-generation immigrants from Spanish-speaking Latin American countries who live in disadvantaged communities and do not have a lot of extra income to spend on food,” said Heather Greenlee, ND, PhD, assistant professor of Epidemiology, who led the study at Columbia in collaboration with Ann Ogden Gaffney, president and founder of Cook For Your Life.
Data from 34 participants in the intervention was compared with data from a group of 36 women who were given a brief description of the dietary recommendations for cancer survivors. Dietary change was assessed using three 24-hour dietary recalls, which is the gold standard for assessing dietary change.
“Our findings are both noteworthy and encouraging, given the lack of previous studies evaluating dietary behavior change among Latina breast cancer survivors and the relatively high cancer mortality among this population,” said Greenlee. “This is a unique population to focus these kinds of trials. Most breast cancer behavioral studies are among well-educated and fairly affluent white women.”