The Monthly Cycling of Food Insecurity and Diabetes Risk

项目摘要/摘要 这是对贝穆德斯-米兰博士的R21奖的申请，他是一名公共卫生营养师和初级教员 康涅狄格大学医学院社区健康与保健系 健康中心。与非拉丁裔白人妇女相比，拉丁裔妇女患上类型症的风险更高 2糖尿病。一种新的糖尿病发展的假定危险因素，它不成比例地影响 拉丁语是粮食不安全，更具体地说，是每月粮食不安全的循环。粮食不安全已经 与肥胖、糖尿病和心血管疾病有关，尽管其机制尚未很好地阐明。 拟议的研究缩小了每月粮食不安全的循环及其关联的范围。 与饮食摄入量/质量、进食障碍、精神痛苦和糖尿病风险标记物有关。研究计划 包括在100名食物不安全的育龄拉丁人中进行一项形成性初步研究，以调查 食品不安全对糖尿病风险的影响。由于粮食不安全是一种长期和时断时续的经历， 我们的总体假设是，与数周的粮食充足(粮食安全)相比，数周的粮食不足 (食品不安全)将以近期糖尿病风险标记物恶化为特征，即空腹血糖， 胰岛素抵抗、果糖胺和糖化白蛋白，以及较高的长期代谢风险标记物，即 糖化血红蛋白、腰围和体重指数。我们还计划确定饮食、饮食 粮食不安全和糖尿病风险之间的关系通过干扰、心理困扰等因素起到调节作用。我们 假设与数周的粮食充足(粮食安全)相比，数周的粮食不足(粮食安全) 不安全感)(1)表现为进食障碍(情绪化进食和暴饮暴食)；较差的饮食 质量(脂肪/糖/水果/蔬菜筛选器)；以及增加的心理困扰(抑郁和焦虑 症状)。使用重复测量设计，我们将在允许我们建模的时间点收集数据 调解效果。最后，我们将使用SMART应用程序开发和收集家庭食品库存数据 手机，受试者可以每周输入放在储藏室和冰箱里的食物，以及上传 照片。在量化研究完成后，我们会进行15次深入访问 血糖控制较差的女性，找出障碍和促进者改善 使用健康行动程序方法在食物不安全的拉美裔人中摄入脂肪/糖/水果/蔬菜 (HAPA)框架，并为干预应用程序的更大规模研究的设计提供信息。最终这条线 研究将导致新的干预措施，并为减少食品有害影响的政策提供信息 对2型糖尿病风险的不安全感。我与拉丁裔社区机构建立的关系 社区使这个项目具有很高的可行性。 1

PROJECT SUMMARY/ABSTRACT This is an application for an R21 award for Dr. Bermúdez-Millán, a Public Health Nutritionist and junior faculty at the Department of Community Health and Health Care, School of Medicine at the University of Connecticut Health Center. As compared with non-Latino White women, Latino women are at higher risk of developing type 2 diabetes mellitus. A novel putative risk factor for the development of diabetes that disproportionately affects Latinas is food insecurity, and more specifically, the monthly cycling of food insecurity. Food insecurity has been linked to obesity, diabetes, and cardiovascular disease although the mechanisms are not well elucidated. The proposed research narrows in, specifically, the monthly cycling of food insecurity and its associations with dietary intake/quality, eating disturbance, mental distress and diabetes risk markers. The research plan involves conducting a formative pilot study among 100 food insecure Latinas of childbearing age, to investigate the influence of food insecurity on diabetes risk. Since food insecurity is a long term and episodic experience, our overall hypothesis is that, compared to weeks of food adequacy (food security), weeks of food inadequacy (food insecurity) will be characterized by worsened near-term diabetes risk markers, i.e., fasting glucose, insulin resistance, fructosamine, and glycated albumin and higher long-term metabolic risk markers, i.e. HbA1c, waist circumference, and body mass index. We are also planning to determine if diet, eating disturbance, and psychological distress mediate the relationship between food insecurity and diabetes risk. We hypothesize that, compared to weeks of food adequacy (food security), weeks of food inadequacy (food insecurity) (1) will be characterized by eating disturbance (emotional eating and binge-eating); poorer diet quality (Fat/Sugar/Fruit/Vegetable Screener); and increased psychological distress (depression and anxiety symptoms). Using a repeated measure design, we will collect data at timepoints that will allow us to model mediation effects. Finally, we will develop and collect household food inventory data using an app for smart phones, where subjects can enter foods left in their pantry and refrigerator weekly, as well as uploading photographs. Following completion of the quantitative study, we will conduct 15 in-depth interviews with women having the worse glycemic control, to identify barriers and facilitators to improve Fat/Sugar/Fruit/Vegetable intake among food insecure Latinas using the Health Action Process Approach (HAPA) framework, and inform the design of a larger study for an intervention application. Eventually this line of research will lead to novel interventions and inform policy to decrease the deleterious effects of food insecurity on risk for type 2 diabetes. My established relationships with community agencies in the Latino community make this project highly feasible. 1