The PILI 'Āina Project

摘要 夏威夷原住民的心脏代谢性疾病的患病率是夏威夷所有人口中最高的。 与这些差异的原因有很大的牵连。夏威夷原住民历来食用富含鱼类的饮食， 新鲜的水果和蔬菜，但西方化导致了食物系统的深刻变化。夏威夷之家 《委员会法》为夏威夷原住民建立了土地基础，以从事自给自足的生活和实践他们的 文化。然而，今天只有20%的夏威夷原住民至少消费一份蔬菜 相比之下，其他夏威夷原住民的比例为73%。自耕农的饮食普及率也是普通人的两倍。 与相关疾病(肥胖症、糖尿病、高血压、血脂异常)相关的疾病比其他土著夏威夷人多。我们有 开发了多层次的干预措施，以促进健康饮食、减肥和心血管健康 超重/肥胖的夏威夷原住民成年人名为“Pili‘Iina”。在个人层面，Pili‘Tina提供3个月的 以糖尿病预防计划的生活方式干预为基础的文化定制教育。教育 旨在改善对普遍存在的心脏代谢性疾病(2型糖尿病、高血压和 血脂异常)，并减少新的饮食相关疾病的危险因素。皮里尼娜还包括一款6- 月家庭级组成部分，提供家庭园艺材料和培训，作为一种联系手段 在家庭环境中融入传统的NH文化、价值观和生活方式。皮里纳的一项试点研究很好- 参与者接受，100%保留超过9个月，心脏代谢结果有希望的结果。 我们现在将在7个O‘ahu宅基地上进行一项群组随机对照试验。首先，我们将 约谈过往匹利纳试点参与者细化干预更好支持全年居家 园艺和夏威夷传统的土著饮食。第二，我们将进行分组随机对照试验 在180名成年自耕农中测试皮利纳的疗效与对照组的比较 超重/肥胖，至少有一种其他心脏代谢性疾病。数据收集将在基线和 3个月、9个月和12个月。主要结果是饮食质量、肥胖、血红蛋白A1c、血压和血脂。 次要结果是行为和心理社会因素(例如，身体活动、自我效能)，这些因素可能 对初级结果的中介效应。第三，社区层面的节目将以传统烹饪和 所有7个宅基地的品尝活动。我们的具体目标是1)完善毛发的干预措施，以优化 它对夏威夷原住民改善饮食和管理饮食相关心脏代谢性疾病的效果 2)测试皮里纳与对照组在改善饮食、生物标记物和 与饮食有关的心脏代谢性疾病的家庭主妇的行为和心理社会危险因素；以及 3)评估社区食品示范推广传统饮食和改善社会生活的能力 夏威夷原住民家园的凝聚力。结果将满足美国心脏协会对 改善家庭饮食以预防心血管疾病的循证计划。

SUMMARY Native Hawaiians have the highest prevalence of cardiometabolic diseases of any population in Hawai‘i. Diet is strongly implicated as a cause of these disparities. Native Hawaiians historically consumed a diet rich in fish, fresh fruits, and vegetables, but Westernization led to profound shifts in food systems. The Hawaiian Homes Commission Act established a land base for Native Hawaiians to engage in subsistence living and practice their culture. However, today only 20% of Native Hawaiian homesteaders consume at least 1 serving of vegetables per day compared with 73% of other Native Hawaiians. Homesteaders also have twice the prevalence of diet- related diseases (obesity, diabetes, hypertension, dyslipidemia) than other Native Hawaiians. We have developed a multilevel intervention to promote healthy eating, weight loss, and cardiovascular health for overweight/obese Native Hawaiian adults entitled “PILI ‘Āina.” At the individual-level PILI ‘Āina provides 3 months of culturally tailored education based on the Diabetes Prevention Program’s Lifestyle Intervention. The education aims to improve self-management of prevalent cardiometabolic disease (type 2 diabetes, hypertension, and dyslipidemia) and to reduce risk factors for developing new diet-related illness. PILI ‘Āina also includes a 6- month household-level component that provides home garden materials and training as a means of connecting with traditional NH culture, values, and lifestyle in the home environment. A pilot study of PILI ‘Āina was well- received by participants, with 100% retention over 9 months and promising results for cardiometabolic outcomes. We will now conduct a group-randomized controlled trial of PILI ‘Āina on 7 O‘ahu homesteads. First, we will interview the past PILI ‘Āina pilot participants to refine the intervention to better support year-round home gardening and a traditional Native Hawaiian diet. Second, we will conduct a group-randomized controlled trial to test the efficacy of PILI ‘Āina compared to a control group among 180 adult homesteaders with overweight/obesity who have at least 1 other cardiometabolic disease. Data collection will occur at baseline and 3, 9, and 12 months. Primary outcomes are diet quality, adiposity, hemoglobin A1c, blood pressure, and lipids. Secondary outcomes are behavioral and psychosocial factors (e.g., physical activity, self-efficacy) that might mediate effects on primary outcomes. Third, a community-level program will feature traditional cooking and tasting events on all 7 homesteads. Our Specific Aims are to 1) Refine the PILI ‘Āina intervention to optimize its effectiveness for improving diet and managing diet-related cardiometabolic diseases on Native Hawaiian homesteads; 2) Test the efficacy of PILI ‘Āina compared to a control group for improving diet, biomarkers, and behavioral and psychosocial risk factors among homesteaders with diet-related cardiometabolic diseases; and 3) Evaluate the ability of community-wide food demonstrations to promote traditional diets and improve social cohesion on Native Hawaiian homesteads. Results will address the American Heart Association’s call for evidence-based programs to improve diet at the household level for preventing cardiovascular disease.