Diet and Health Behavior Change to Improve Bone Health

 描述（由申请人提供）：Sabrina诺埃尔，博士，RD目前是马萨诸塞州洛厄尔大学的研究助理教授。她在营养和流行病学方面受过高级培训，并在临床和社区环境中工作。诺埃尔博士在饮食和代谢健康研究方面的经验，以及在骨骼健康差异方面的工作经验，鼓励她从事以人口为基础的骨骼研究。她的目标是评估饮食质量对骨骼健康的影响，并针对加勒比海西班牙裔成年人的饮食和身体活动行为制定一种文化和识字量身定制的行为改变干预措施。与先前的观点相反，西班牙裔最近被证明与非西班牙裔白人相比骨质疏松症的患病率更高;然而，大多数研究都集中在墨西哥裔美国人身上，因为他们在美国西班牙裔人口中占多数。加勒比海裔西班牙人是美国人口中增长最快的群体之一，在骨骼相关研究中的代表性不足。在马萨诸塞州波士顿对波多黎各成年人进行的一项大型研究的初步数据表明，加勒比海西班牙裔人患骨质疏松症的风险比以前认为的要高。确定可改变的健康行为，如饮食和体育活动，以防止骨质流失是一个重要的公共卫生优先事项，因为对骨骼药物的依从性通常很差。越来越多的证据表明，整体饮食质量对骨骼健康至关重要;然而，使用预定义的饮食模式作为整体饮食质量衡量标准的研究报告与骨骼结果的相关性不一致。这可能是由于已知对骨骼重要的营养素和食物在这些现有指数中代表性不足。因此，我们建议制定一个骨骼特定的饮食质量指数，以全国为基础的数据，然后调整它，包括种族（加勒比拉丁美洲人）特定的食物选择与骨骼健康。很少有以理论为基础的干预措施针对饮食和体育活动行为来促进骨骼健康，我们所知道的没有一个关注整体饮食质量或加勒比裔西班牙裔成年人。该K 01奖将为诺埃尔博士提供骨健康和骨质疏松症预防、健康行为理论、行为干预设计、实施和评估以及先进生物统计学方面的培训和研究经验。这项培训将帮助诺埃尔博士实现她的长期职业目标，成为营养和骨骼健康领域领先的独立研究者，拥有设计和实施文化定制行为干预措施以改善不同人群骨骼健康的专业知识。诺埃尔博士的导师高度致力于她的职业发展和未来的成功，并将帮助她建立额外的知识和技能，在骨骼健康和干预研究。诺埃尔博士提出的研究目标是：1）开发一个骨骼特定的饮食质量指数，强调已知对骨骼重要的特定食物和营养素;并使用全国调查数据评估由此产生的饮食质量评分对骨骼健康的影响; 2）调整该指数， 包括加勒比海裔西班牙人的种族特定的食物选择，使用现有的波多黎各成年人的研究数据，以指导生活方式行为改变干预的饮食组成部分; 3）适应和试点测试的可行性和初步影响的理论为基础的文化和识字量身定制的干预措施，以改善饮食和身体活动的行为在60个加勒比海裔西班牙成年人。这种以骨骼为重点的干预将仿照另一种独特的行为干预，这种干预成功地改善了低收入加勒比拉丁美洲人的饮食质量和其他健康行为。创新的策略，包括叙事形式的沟通，将被用来帮助个人采取健康的行为。这项工作将为一项更大规模的随机对照试验提供信息，以评估行为干预对加勒比海西班牙裔人骨结局的有效性。这有可能对改善高风险、服务不足的少数民族人群的骨骼健康和预防骨质疏松症产生重大的公共卫生影响。

 DESCRIPTION (provided by applicant): Sabrina Noel, PhD, RD is currently a Research Assistant Professor at the University of Massachusetts Lowell. She has advanced training in nutrition and epidemiology and experience working in both clinical and community settings. Dr. Noel's experience with diet and metabolic health research, and exposure to work with disparities in bone health, has encouraged her to pursue a career in population-based bone research. Her goal is to evaluate the effects of dietary quality on bone health and to develop a culturally and literacy-tailored behavior change intervention targeting dietary and physical activity behaviors among Caribbean Hispanic adults. In contrast to what has been earlier believed, Hispanics have recently been shown to have higher prevalence of osteoporosis, compared with non-Hispanic whites; however, most of this research has focused on Mexican Americans because of their majority status in the U.S. Hispanic population. Caribbean origin Hispanics are one of the fastest growing segments of the U.S. population and are underrepresented in bone- related research. Preliminary data from a large study of Puerto Rican adults in Boston, MA, indicates that Caribbean Hispanics are at higher risk for osteoporosis than previously thought. Identifying modifiable health behaviors, such as diet and physical activity, to prevent bone loss is an important public health priority, as adherence to bone medications is generally poor. Increasing evidence suggests that overall dietary quality is critical for bone health; however, studies that use predefined dietary patterns as a measure of overall dietary quality have reported inconsistent associations with bone outcomes. This is likely due to the fact that nutrients and foods known to be important for bone are underrepresented in these existing indices. We, therefore, propose to develop a bone-specific dietary quality index with nationally based data, and to then adapt it to include ethnic (Caribbean Latino) specific food choices related to bone health. Few theory-based interventions have targeted both dietary and physical activity behaviors to promote bone health and none that we know of have focused on overall dietary quality or on Caribbean origin Hispanic adults. This K01 award will provide Dr. Noel with training and research experience in bone health and osteoporosis prevention, health behavior theory, behavioral intervention design, implementation and evaluation, and advanced biostatistics. This training will help Dr. Noel achieve her long-term career goals of becoming a leading independent investigator in nutrition and bone health with expertise in designing and conducting culturally tailored behavioral interventions to improve bone health in diverse populations. Dr. Noel's mentors are highly committed to her career development and future success and will help her build additional knowledge and skills in bone health and intervention research. Dr. Noel's proposed research aims are to: 1) develop a bone-specific dietary quality index that emphasizes specific foods and nutrients known to be important for bone; and to evaluate the effects of a resulting dietary quality score on bone health using national survey data; 2) to adapt the index to include ethnic-specific food choices of Caribbean origin Hispanics, using data from an existing study of Puerto Rican adults, to guide the dietary component of a lifestyle behavior change intervention and; 3) to adapt and pilot test the feasibility and preliminary impact of a theory-based cultural and literacy-tailored intervention to improve dietary and physical activity behaviors among 60 Caribbean origin Hispanic adults. This bone-focused intervention will be modeled after another unique behavioral intervention, which successfully improved dietary quality and other health behaviors in low-income Caribbean Latinos. Innovative strategies, including narrative forms of communication, will be employed to help individuals adopt healthy behaviors. This work will inform a larger scale randomized controlled trial to evaluate the effectiveness of the behavioral intervention on bone outcomes in Caribbean Hispanics. This has the potential to have significant public health implications for improving bone health and preventing osteoporosis in high-risk, underserved ethnic minority populations.