Nutrition Intervention Leads to Changes Among Latina Breast Cancer Survivors

--Underserved population made healthful changes with simple tools; Successful strategies have implications for other cancer survivors and larger popu

January 8, 2015

Researchers at Columbia University’s Mailman School of Public Health in partnership with the New York City-based, not-for-profit Cook for Your Life initiative have published the results of an intervention designed to provide a diverse and under-represented group of Latina breast cancer survivors with the knowledge and skills needed to change and sustain dietary behaviors. Founded by a breast and kidney cancer survivor, the Cook For Your Life program helps fellow survivors adhere to recommended guidelines to eat a diet high in fruits and vegetables and maintain these changes going forward. Using a culturally based hands-on educational approach, the Cook for Your Life program or ¡Cocinar Para Su Salud! is geared toward Latina breast cancer survivors who are at higher risk of obesity, low physical activity, and poorer access to quality healthcare.

Overall, New York City Hispanic populations have a low intake of fruits and vegetables. However, after being given certain dietary information and some basic tools the participants increased their number of fruits and vegetables servings to 6.8 per day, well within the American Cancer Society’s recommended 5-9 servings per day to improve clinical outcomes. After six months the women in Cook for Your Life had increased the amount of targeted fruits and vegetables by over 2.5 servings a day. Findings are available online in the Journal of the Academy of Nutrition and Dietetics.

According to the American Cancer Society, only 18 percent of breast cancer survivors meet the recommended number of daily fruits and vegetable servings, and even fewer survivors of lower socio-economic status are likely to adhere to guidelines. Of the current estimated 12 million cancer survivors in the U.S., approximately 5 percent are Hispanic.

Latinas with stage 0 to III breast cancer who completed adjuvant treatment at least three months prior to the study and lived in New York City were randomized between April 2011 and March 2012. Those assigned to the intervention group participated in the Cook for Your Life ¡Cocinar Para Su Salud!  program with nutrition roundtables, food shopping field trips, and cooking classes. The control group received written dietary recommendations for breast cancer survivors. More than half of the women in the study reported participation in the Supplemental Nutrition Assistance Program (SNAP) and had annual household incomes less than $15,000.
“Many of the women who took part are first-generation immigrants from Spanish-speaking Latin American countries who live in disadvantaged communities and do not have a lot of extra income to spend on food,” said Heather Greenlee, ND, PhD, assistant professor of Epidemiology, who led the study at Columbia in collaboration with Ann Ogden Gaffney, president and founder of Cook For Your Life.  Dr. Greenlee studies whether lifestyle behaviors, such as eating a healthier diet, can improve cancer outcomes.
Data from 34 participants was compared to a group of 36 women who were given the brief description of the dietary recommendations for cancer survivors. Dietary change was assessed using three 24-hour dietary recalls, which is the gold standard for assessing dietary change.
“Our findings are both noteworthy and encouraging, given the lack of previous studies evaluating dietary behavior change among Latina breast cancer survivors and the relatively high cancer mortality among this population,” said Dr. Greenlee. “This is a unique population to focus these kinds of trials. Most breast cancer behavioral studies are among well-educated and fairly affluent white women.”
The program also taught the women how to increase fruits and vegetables in some of their favorite traditional recipes from their native countries, use traditional spices to make healthy recipes taste great, and prepare these dishes using less fat. The program familiarized them with local markets and grocery stores in their neighborhoods that sold fresh foods, and helped tailor the shopping trips to the women’s budgets. Additionally, the women became adept at reading nutrition labels.
Although the study was not specifically designed to monitor weight loss, the researchers found that the women in the ¡Cocinar Para Su Salud! program lost 2.5 percent of their body weight, compared to women in the control group who gained 3.8 percent.
Results from the study have larger implications for policy and medical research and practice. Currently, the departments of agriculture in New York and New Jersey have programs to help farmers grow foods for ethnic and immigrant populations in New York City, which could be expanded. There also could be the possibility to expand New York’s “health bucks” program, which gives people additional dollars for shopping at participating farmers’ markets.
Dr. Greenlee noted that the study demonstrates the importance of conducting studies of minorities and lower-income groups. If we can demonstrate that behavior change interventions can work in vulnerable populations, it may be even easier to extrapolate to non-vulnerable populations. “Many people say that it is too hard to get people to change their diets and to maintain the changes over time.  Our study proves the naysayers wrong,” observed Dr. Greenlee. “Dietary change programs that provide individuals with the knowledge and skills needed to achieve and maintain change can and do work.”
Columbia co-investigators on the study included Dawn Hershman, MD, MS, associate professor of Epidemiology; Katherine Crew, MD, MS, assistant professor of Medicine and Epidemiology; Pam Koch, PhD, Center for Food, Education & Policy; and Isobel Contento, PhD, Rose Professor in Nutrition and Education.

The study was funded by the National Cancer Institute (R21CA152903).

About Columbia University's Mailman School of Public Health
Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP (formerly the International Center for AIDS Care and Treatment Programs) and the Center for Infection and Immunity. For more information, please visit