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

摘要 需要有效的医学营养疗法(MNT)来遏制2型糖尿病(T2D)的惊人增长 贝宁的相关发病率和死亡率，这是一个法国撒哈拉以南非洲国家，在那里糖尿病 在过去的十年中，患病率从3%增加到12.4%，在一些地区达到了22%。网络的影响 这种疾病不仅波及那些患有这种疾病的人，还波及到他们的家庭、社会和医疗系统， 有必要做出战略性努力，减轻其负担。遵循符合MNT指南的饮食是很好的- 记录帮助T2D患者实现更好的血糖控制，降低心血管风险和预防 并发症。然而，尽管有这些好处，低依从性饮食建议是始终如一的 据报道。原因包括缺乏营养知识，难以将建议转化为实践， 饮食的文化可接受性，以及获得健康食品的机会。因此，在文化上适宜的饮食 通过指导咨询基于当地可获得和接受的食物的推荐是关键 提高该国T2D患者的饮食依从率。本国际会议的宗旨是 研究科学家发展奖(K01)是为了授权Halimatou Alaofè博士开展一项研究 该计划整合了提供营养护理的创新方法，以优化低血糖患者的糖尿病控制 非洲人口的收入。为了实现这一目标，建议在该奖项中进行指导和培训 支持：1)菜单规划和食谱开发、社会和行为科学方面的额外培训，以及 研究方法；2)有保障的时间进行计划中的以患者为中心的研究；3) 收集和发布初步数据，以促进研究计划的下一步工作。在.之下 John Ehiri博士和Waliou Amoussa Hounkpatin博士的指导，以及 在美国和贝宁，Alaofè博士计划1)调整现有的MNT干预措施，将为期4周的当地食物 基于4A框架(食物的充分性、可接受性、可获得性和可用性)的菜单计划 个人咨询，以满足贝宁对T2D患者的营养治疗指南；2)开发SmartMenu，a 使用CoDesign方法为T2D患者文化定制MNT；以及3)评估可行性、可接受性、 SmartMenu对贝宁T2D患者的初步疗效。这项研究的预期结果是 高质量的试点数据，将作为R01应用的基础，进行更大的务实 评估干预措施的成本效益和可持续性的随机对照试验。我们假设 这是一种文化定制的MNT，结合了个人咨询和解决饮食坚持问题的菜单计划 通过4A框架的障碍将促进患者接受和遵守MNT指南。如果 如果成功，这种模式可以在资源有限的情况下显著改善营养护理。培训和 所描述的研究活动补充了候选人在营养教育和饮食方面的背景 并将使她能够为营养护理提供系统的改变做出重大贡献。

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.