PROJECT SUMMARY/ABSTRACT
This is an application for an R21 award for Dr. Bermúdez-Millán, a Public Health Nutritionist and junior faculty
at the Department of Community Health and Health Care, School of Medicine at the University of Connecticut
Health Center. As compared with non-Latino White women, Latino women are at higher risk of developing type
2 diabetes mellitus. A novel putative risk factor for the development of diabetes that disproportionately affects
Latinas is food insecurity, and more specifically, the monthly cycling of food insecurity. Food insecurity has
been linked to obesity, diabetes, and cardiovascular disease although the mechanisms are not well elucidated.
The proposed research narrows in, specifically, the monthly cycling of food insecurity and its associations
with dietary intake/quality, eating disturbance, mental distress and diabetes risk markers. The research plan
involves conducting a formative pilot study among 100 food insecure Latinas of childbearing age, to investigate
the influence of food insecurity on diabetes risk. Since food insecurity is a long term and episodic experience,
our overall hypothesis is that, compared to weeks of food adequacy (food security), weeks of food inadequacy
(food insecurity) will be characterized by worsened near-term diabetes risk markers, i.e., fasting glucose,
insulin resistance, fructosamine, and glycated albumin and higher long-term metabolic risk markers, i.e.
HbA1c, waist circumference, and body mass index. We are also planning to determine if diet, eating
disturbance, and psychological distress mediate the relationship between food insecurity and diabetes risk. We
hypothesize that, compared to weeks of food adequacy (food security), weeks of food inadequacy (food
insecurity) (1) will be characterized by eating disturbance (emotional eating and binge-eating); poorer diet
quality (Fat/Sugar/Fruit/Vegetable Screener); and increased psychological distress (depression and anxiety
symptoms). Using a repeated measure design, we will collect data at timepoints that will allow us to model
mediation effects. Finally, we will develop and collect household food inventory data using an app for smart
phones, where subjects can enter foods left in their pantry and refrigerator weekly, as well as uploading
photographs. Following completion of the quantitative study, we will conduct 15 in-depth interviews with
women having the worse glycemic control, to identify barriers and facilitators to improve
Fat/Sugar/Fruit/Vegetable intake among food insecure Latinas using the Health Action Process Approach
(HAPA) framework, and inform the design of a larger study for an intervention application. Eventually this line
of research will lead to novel interventions and inform policy to decrease the deleterious effects of food
insecurity on risk for type 2 diabetes. My established relationships with community agencies in the Latino
community make this project highly feasible.
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