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

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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.