Unidas por la Vida: A Healthy Lifestyle Intervention for High-risk Latina Dyads

描述（由申请人提供）：大约一半的墨西哥裔美国妇女报告有久坐的生活方式，近78%的人超重或肥胖。与所有其他种族的女性相比，墨西哥裔美国女性患2型糖尿病的风险最高。为这一人群制定文化上适当的生活方式干预措施是当务之急，因此，拟议的研究将调查一种新型的二元干预措施，旨在改善健康行为并促进同一家庭中两个高危成员的体重减轻：患有2型糖尿病的母亲和他们超重/肥胖的成年女儿，她们有患糖尿病的风险。干预措施，Unidas por la维达（团结生活），利用家庭在拉丁美洲文化中的重要性，动员现有的家庭二元结构作为相互支持的来源，这可能会促进更大和更持久的健康行为改变。该研究建立在一项成功的试点研究（R34 DK 083500）的基础上，该研究在墨西哥裔美国人家庭成员的高风险样本中建立了这种二元行为生活方式干预的可行性和可接受性，这些家庭成员具有糖尿病及其并发症的风险。为期16周的干预是仿照糖尿病预防计划（DPP），但适用于母女配对，并以社区为基础，因此，更容易获得低收入的拉丁美洲人。Unidas试点研究的初步数据表明，二元干预促进了体重的显著减轻。拟议的研究将成功的试点研究扩展到：1）目标体重减轻>基线体重的5%，并使用渐减干预促进维持，2）添加比较组，允许评估与伴侣干预独特相关的改善，3）评估理论上推导的干预介质。参与者（N=460名母亲-成年女儿二人组）将被随机分配到以下三种情况之一：1）参加Unidas伴侣干预的二人组（母亲-女儿）（第1组）; 2）参加Unidas个体干预的个体组（单独母亲;单独无血缘关系的女儿）（第2组）; 3）仅接受常规护理的母女二人组（第3组）。主要结果是体重减轻。次要结果包括体力活动、饮食摄入、生理指标（如HbA 1c、LDL）、身体成分、生活质量、成本和过程评估。据推测，无论是partne和个人干预将产生显着更大的体重减轻在6个月，12个月和18个月 在方案启动后，与通常的仅护理条件相比，分配到伴侣干预的妇女体重减轻更多，并且比分配到个人干预的妇女保持体重减轻的时间更长。

DESCRIPTION (provided by applicant): Approximately half of Mexican-American women report having a sedentary lifestyle, and nearly 78 percent are overweight or obese. Compared to women in all other ethnic groups, Mexican-American women have the highest lifetime risk of type 2 diabetes. The development of culturally appropriate lifestyle interventions for this population is an urgent priority, and the proposed study accordingly will investigate a novel dyadic intervention designed to improve health behaviors and promote weight loss in two at-risk members of the same family: mothers with type 2 diabetes and their overweight/obese adult daughters who are at risk for developing diabetes. The intervention, Unidas por la Vida (United for Life), capitalizes on the importance of the family in Latino culture to mobilize an existing family dyad as a source of mutual support that is likely to foster greater and longer-lasting healt behavior change. The study builds on a successful pilot study (R34 DK083500) that established the feasibility and acceptability of this dyadic behavioral lifestyle intervention in a high-risk sample of Mexican-American family members who share a risk for diabetes and its complications. The 16-week intervention was modeled after the Diabetes Prevention Program (DPP), but was adapted for use with mother- daughter pairs and to be community-based and, thus, more easily accessible to low-income Latinas. Preliminary data from the Unidas pilot study indicated that the dyadic intervention promoted significant weight loss. The proposed study extends the successful pilot study to: 1) target weight loss > 5 percent of baseline body weight and to foster maintenance using a tapered intervention, 2) add comparison groups that permit evaluation of the improvement uniquely associated with the partner intervention, and 3) assess theoretically derived mediators of the intervention. Participants (N=460 mother-adult daughter dyads) will be randomized into one of three conditions: 1) dyadic (mother-daughter) participation in a Unidas partner intervention (Arm 1); 2) individual participation (mothers alone; unrelated daughters alone) in a Unidas individual intervention (Arm 2); and 3) mother-daughter dyad in a usual care only condition (Arm 3). The primary outcome is weight loss. Secondary outcomes include physical activity, dietary intake, physiological measures (e.g. HbA1c, LDL), body composition, quality of life, cost, and process evaluation. It is hypothesized that both the partne and individual interventions will produce significantly greater weight loss at 6, 12, and 18 months following program initiation than will the usual care only condition, with women assigned to the partner intervention losing more weight and maintaining the weight loss longer than women assigned to the individual intervention.