|Abstract:||Across the lifespan, Hispanics in the United States (US) suffer from higher prevalence of obesity than the general population. Efforts to prevent the development of obesity among children in this at-risk group have had mixed success. Cultural tailoring, such as inclusion of Hispanic cultural values and traditional foods, has proved to be successful in the modification of obesogenic behaviors among Hispanic youth. Though overall diet quality in Hispanic adults and children, assessed through tools such as the Healthy Eating Index, is high, this group consumes the highest reported intakes of sugar-sweetened beverages (SSB) and saturated fats. Nutrition education interventions are needed to address these two problem areas, which can contribute to weight gain in Hispanic children. In addition to increased obesity burden, Hispanics are at additional risk for related comorbidities, including type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). The proportion of individuals without health insurance is also highest in Hispanics compared to any other ethnic group in the US, indicating that rates of these diseases could be much higher. Health screenings and educational tools are needed to allow these individuals to understand and be aware of their risk for disease, so they can seek medical attention or adopt lifestyle change. The objective of this thesis is to adapt, deliver, and evaluate a family-focused, culturally-sensitive nutrition education program for the prevention of childhood obesity in Hispanic families, and to conduct a minimally-invasive cardiovascular and metabolic health screen in this population.
The Abriendo Caminos (AC2) nutrition education curriculum was adapted to reflect applied behavior theory, community feedback, and advances in evidence-based nutritional guidance. This was done through literature search and review of theory-based educational interventions, structured focus groups and communication with community leaders, and review of position statements and policy documents regarding adoption of healthy dietary patterns and prevention of obesity in adults and children. The AC2 nutrition curriculum included elements of Social Cognitive Theory (SCT) through interactive activities including skill-building, content reinforcement, and immediate assessments. Cultural tailoring and community feedback were reflected in the foods used for examples and content added to lectures. Recent nutrition evidence was added specifically in the adult lessons, where the facilitator could teach concepts in greater depth than in the child lessons.
The evaluation phase of AC2 took place following adaptation and delivery of the curriculum. AC2 is a randomized control trial, in which participants in the intervention group are enrolled in a six-week workshop series on topics related to nutrition, physical activity (PA), and family togetherness. The abbreviated attention control group received three workshops on topics unrelated to health. Survey data and anthropometric measurements were taken at baseline (T0) and after the intervention period (T1). Dietary intake was collected through semi-quantitative food frequency questionnaires, and diet quality was evaluated through adherence to the 2015 Dietary Guidelines for Americans (HEI-A) and to a low-fat diet in mothers. In children, weekly consumption of SSB, fast food, fruits, and vegetables was compared at T0 and T1 between experimental groups. Compared to the control group, mothers in the intervention reported increases in HEI-A scores from a 44.7 ± 13.5 to 66.1 ± 13.5 (P<0.01), and in limiting calories from saturated fat and increasing consumption of low-fat dairy. Children in the intervention group also significantly decreased their SSB consumption from 6.7 to 2.7 times per week (P=0.003). Also, prevalence of obesity and overweight in children enrolled in the AC2 intervention did not increase at T1. In children in the control group, prevalence of both overweight and obesity increased at T1. These changes in weight were not statistically significant.
Adults and children were invited to participate in a health screen in which values for total and high-density lipoprotein cholesterol, triglycerides, glucose, and hemoglycosylated A1C were measured through a finger stick procedure. Blood pressure and body composition were also measured, the latter through bioelectrical impedance analysis. Descriptive statistics were calculated for all measures and compared to the national prevalence of risk factors such as hypercholesterolemia, dyslipidemia, hypertension, T2DM, and obesity. Both adults and children had high values for percent body fat (PBF), with 71% of males and 76% of females having PBF above PBF levels recommended for optimal health. Children were categorized as high- or low-risk by PBF for age and sex. In this sample, 78% of boys and 88% of girls were determined to be in the high-risk category. There was also high prevalence of high blood pressure in children, determined by age, sex and height specific growth charts. Half of boys and 25% of girls in this sample had blood pressure values greater than the 90th percentile, likely secondary to high obesity rates in this population.
Interventions to prevent the development of obesity in Hispanic children are needed, as this group is at increased risk for obesity and related comorbidities. When designing interventions for this group, consideration of sound behavior theory, the individual needs of the community, and cultural values are of utmost important. This intervention was successful in improving dietary behaviors in participants and preventing weight gain in children in the short term. However, because this population also has high prevalence of hypertension and obesity-related comorbidities, there is a need for long-term follow-up and continued attention to improving the health of the Hispanic population.