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女性报告有久坐不动的生活方式，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型糖尿病的终身风险最高。为这一群体开发符合文化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的二元干预措施，旨在改善同一家庭中两个高危成员的健康行为并促进体重减轻：患有2型糖尿病的母亲及其超重/肥胖的成年女儿有患糖尿病的风险。这项名为Unidas por la Vida(Unidas Por La Vida)的干预措施利用了家庭在拉丁裔文化中的重要性，动员现有的家庭二元组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。这项研究建立在一项成功的试点研究(R34 DK083500)的基础上，该研究在墨西哥裔美国家庭成员的高危样本中确立了这种二元行为生活方式干预的可行性和可接受性，这些家庭成员都有糖尿病及其并发症的风险。这项为期16周的干预是仿照糖尿病预防计划(DPP)进行的，但经过调整，适合母女配对使用，并以社区为基础，因此更容易为低收入拉丁裔提供服务。Unidas试点研究的初步数据表明，二元干预促进了显著的体重减轻。拟议的研究将成功的初步研究扩展到：1)目标体重下降&基线体重的5%，并使用渐进式干预促进维持；2)增加允许评估与伴侣干预唯一相关的改善的对照小组；以及3)评估干预的理论派生的中介。参与者(N=460名母亲-成年女儿二人组)将被随机分成以下三种情况之一：1)双亲(母亲-女儿)参与工发组织伙伴干预(第1组)；2)个人参与(只有母亲；只有无关的女儿)参加工发组织个人干预(第2组)；以及3)母女二人组在通常情况下只接受照顾(第3组)。主要结果是体重减轻。次要结果包括体力活动、饮食摄入量、生理指标(如糖化血红蛋白、低密度脂蛋白)、身体成分、生活质量、成本和过程评估。据推测，部分干预和单独干预在6个月、12个月和18个月时都会产生显著更大的减肥效果 在计划启动后，将比通常的仅护理情况下，分配到伙伴干预的妇女比分配到单独干预的妇女减重更多，并保持减肥的时间更长。

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.