Culturally Tailored Nutrition Therapy To Improve Dietary Adherence of Type 2 Diabetes Patients in Benin, Africa

摘要 需要有效的医学营养治疗（MNT）来阻止2型糖尿病（T2 D）的惊人增长 贝宁是一个法属撒哈拉以南非洲国家， 在过去十年中，流行率翻了两番，从3%增至12.4%，在某些地区达到22%。的影响 这种疾病超越了那些患有这种疾病的人，影响到他们的家庭，社会和医疗保健系统， 为减轻其负担作出战略性努力。遵循符合MNT指南的饮食是很好的- 帮助T2 D患者更好地控制血糖，降低心血管风险， 并发症然而，尽管有这些好处，低坚持饮食建议是一贯的， 报道原因包括缺乏营养知识，难以将建议转化为实践， 饮食的文化可接受性以及获得健康食品的机会。因此，文化上适当的饮食 通过指导性咨询，根据当地可获得和可接受的食物提出建议， 提高该国T2 D患者的饮食依从率。本国际的宗旨 研究科学家发展奖（K 01）旨在授权Halimatou Alaofè博士开发研究 该计划整合了营养护理提供的创新方法，以优化低血糖患者的糖尿病控制， 非洲人收入。为了实现这一目标，本奖项的指导和培训建议， 支持：1）菜单规划和食谱开发，社会和行为科学方面的额外培训，以及 研究方法; 2）保护时间进行计划的以患者为导向的研究; 3） 收集和公布初步数据，以促进研究计划的下一步工作。下 John Ehiri博士和Waliou Amoussa Hounkpatin博士的指导，以及来自 美国和贝宁，Alaofè博士计划1）调整现有的MNT干预措施， 基于4A框架（食物的充足性、可接受性、可获得性和可用性）的菜单计划， 个体咨询，以满足贝宁T2 D患者营养治疗指南; 2）开发SmartMenu， 使用协同设计方法为T2 D患者进行文化定制的MNT;以及3）评估可行性，可接受性， 以及SmartMenu对贝宁T2 D患者的初步疗效。本研究的预期结果是 高质量的试验数据，将作为R 01应用程序的基础，以进行更大的实用 随机对照试验，以评估干预措施的成本效益和可持续性。我们假设 一个文化定制的MNT结合个人咨询和菜单计划，解决饮食依从性 通过4A框架的障碍将促进患者接受和遵守MNT指南。如果 如果成功，这一模式可以大大改善资源有限环境中的营养保健。培训和 所描述的研究活动补充了候选人的营养教育和饮食背景 修改，并将她的位置，以大大有助于营养保健提供系统的变化。

ABSTRACT Effective medical nutrition therapy (MNT) is needed to stem the alarming increase in Type 2 diabetes (T2D) related morbidity and mortality in Benin, a French sub-Saharan African (SSA) country, where diabetes prevalence has quadrupled from 3% to 12.4% in the last decade, reaching 22% in some areas. The impact of the disease reaches beyond those living with the condition to their families, society, and the healthcare system, warranting strategic efforts to reduce its burden. Following a diet consistent with MNT guidelines is well- documented to help people with T2D achieve better glycemic control, reduce cardiovascular risks and prevent complications. However, despite these benefits, low adherence to dietary recommendations is consistently reported. The reasons include lack of nutrition knowledge, difficulty translating recommendations to practice, cultural acceptability of the diet, and access to healthy foods. Thus, culturally appropriate dietary recommendations based on locally available and accepted foods through guided counseling are key to improving dietary adherence rates among T2D patients in the country. The purpose of this International Research Scientist Development Award (K01) is to empower Dr. Halimatou Alaofè to develop a research program that integrates innovative approaches to nutrition care delivery to optimize diabetes control in low- income African populations. To achieve this goal, mentorship and training in this award are proposed to support: 1) additional training in menu planning and recipe development, social and behavioral sciences, and research methodologies; 2) protected time to conduct the planned patient-oriented research; and 3) the collection and publication of preliminary data to facilitate the next steps in the research program. Under the mentorship of Drs. John Ehiri and Waliou Amoussa Hounkpatin, as well as co-mentors and collaborators from the US and Benin, Dr. Alaofè plans to 1) adapt an existing MNT intervention that combines a 4-week local food menu plan based on the 4A framework (adequacy, acceptability, accessibility, and availability of foods) with individual counseling to meet the Benin nutrition therapy guidelines for T2D patients; 2) develop SmartMenu, a culturally tailored MNT for T2D patients using codesign methods; and 3) assess the feasibility, acceptability, and preliminary efficacy of SmartMenu for Benin patients with T2D. The anticipated outcome of this study is high-quality pilot data that will serve as the foundation for an R01 application to conduct a larger pragmatic randomized controlled trial to assess the intervention’s cost-effectiveness and sustainability. We hypothesize that a culturally tailored MNT combining individual counseling and menu plans that address dietary adherence barriers through the 4A framework will facilitate patient acceptance and adherence to MNT guidelines. If successful, this model could significantly improve nutrition care in resource-limited settings. The training and research activities delineated complement the candidate’s background in nutrition education and diet modification and will position her to contribute substantially to nutrition care delivery system change.