Culturally-Adapted Diet for Puerto Rican Adults

This pilot intervention will culturally-tailor a diet to the Puerto Rican adult population based on staple foods as well as culturally-appropriate strategies to reduce cardiometabolic risk factors of type 2 diabetes and obesity. Based on preliminary results from studies in the island, investigators will conduct a 4-month, 2-arm intervention among 200 adults (100 per arm) ages 25-65 living in Puerto Rico with at least 2 of 5 cardiometabolic risk factors. The two arms are: (1) intervention group consisting of culturally-appropriate advice in an initial individual session with daily text messages for 2 months (delivery phase); (2) control arm of standard general nutritional advice at the initial individual session, and text messages for 2 months. A reinforcement phase of 2-months will follow to repeat the education and text messages. Investigators will measure changes in cardiometabolic risk factors and in eating-behaviors and psychological measures.

Inclusion criteria

• Age 25-65 y old at the time of enrollment
• Non-institutionalized
• Living in PR at the time of recruitment and for at least the previous year and not planning to move from the island within the next 6 months
• Able to answer questions without assistance
• Having a cellphone with the capacity to receive text messages
• Having at least two of the following:

• elevated BMI
• elevated waist circumference
• self-reported physician-diagnosed hypertension or use of hypertension medication or measured high blood pressure
• self-reported physician-diagnosed pre-diabetes or measured pre-diabetes
• self-reported physician-diagnosed dyslipidemia or use of lipid-lowering agents or laboratory values confirming dyslipidemia

Exclusion criteria

• Under 25 or over 65 years of age
• Currently do not live in Puerto Rico or have not lived in PR for at least 1 year or plan to move within 6 months
• Institutionalized
• Not able to answer questions without assistance
• Not having at least 2 of the five listed metabolic criteria
• Self-reported physician-diagnosed type 1 or type 2 diabetes or use of diabetes medication (including insulin), or diabetes-diagnosis values confirmed by laboratory.
• Self-reported pregnancy
• Gastrointestinal or chronic conditions
• Food intolerance or allergies