The PILI 'Āina Project

总结 夏威夷土著人的心脏代谢疾病患病率是夏威夷所有人口中最高的。饮食是 强烈暗示是这些差异的原因。夏威夷原住民历来食用富含鱼类的食物， 新鲜水果和蔬菜，但西方化导致了食品系统的深刻变化。夏威夷之家 委员会法案为夏威夷土著人建立了土地基础，使他们能够从事生计生活，并在其土地上进行活动。 文化然而，今天只有20%的夏威夷原住民宅地居民至少食用一份蔬菜。 相比之下，其他夏威夷原住民每天的死亡率为73%。自耕农的饮食习惯也是普通人的两倍 相关疾病（肥胖，糖尿病，高血压，血脂异常）比其他夏威夷土著。我们有 开发了一种多层次的干预措施，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，称为“皮利'Escinina”。在个人一级，皮利'Ekraina提供3个月的时间， 基于糖尿病预防计划的生活方式干预的文化定制教育。教育 目的是改善自我管理的流行心脏代谢疾病（2型糖尿病，高血压， 血脂异常），并减少发生新的饮食相关疾病的风险因素。皮利'Ekraina还包括一个6- 一个月的家庭层面的组成部分，提供家庭花园的材料和培训，作为一种连接 传统的NH文化，价值观和生活方式在家庭环境中。一项关于皮利'Escherina的初步研究很好- 受试者收到的，在9个月内保持100%，并对心脏代谢结局产生了有希望的结果。 我们现在将在7个O 'orbes家园进行一项皮利' acetina的分组随机对照试验。一是 采访过去的皮利'家庭健康计划试点参与者，以完善干预措施，更好地支持全年家庭 园艺和传统的夏威夷原住民饮食第二，我们将进行分组随机对照试验 在180名成年自耕农中，与对照组相比， 超重/肥胖者，至少有1种其他心脏代谢疾病。数据收集将在基线时进行， 3、9、12个月。主要结果是饮食质量、肥胖、血红蛋白A1 c、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）， 对主要结果的中介影响。第三，社区一级的计划将以传统烹饪为特色， 在所有7个家园品尝活动。我们的具体目标是：1）完善皮利的药物干预， 它对夏威夷原住民改善饮食和管理饮食相关心脏代谢疾病的有效性 2）与对照组相比，测试皮利'peptidina在改善饮食、生物标志物和营养方面的功效。 患有饮食相关心脏代谢疾病的自耕农的行为和心理社会风险因素; 3)评估全社区食品示范推广传统饮食和改善社会 夏威夷原住民家园的凝聚力结果将回应美国心脏协会的呼吁， 以证据为基础的计划，以改善家庭一级的饮食，预防心血管疾病。

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.