HOME COOKING: Health Empowerment Strategy in People With Type II Diabetes Mellitus
Condition: Type 2 Diabetes Mellitus
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      Currently, one of the health challenges in the field of public health is to improve the
      quality of life of people with metabolic diseases, using new strategies that allow to promote
      healthy eating habits.

      Within the new strategies that may encourage population improving eating habits,
      "HOMECOOKING" is proposed as a transforming tool for health, involving culinary skills and
      knowledge in nutrition. It is suggested as a new paradigm in nutritional education.

      This project will cover the "HOMECOOKING: cooking and eating at home", as an innovative
      strategy, aiming to improve the quality of the diet of people with type II diabetes mellitus
      through an intervention based on cooking workshops. At these sessions, participants will
      learn easy cooking techniques and tools, in order to acquire culinary competences and to be
      empowered to prepare healthy dishes.

      The effect of this intervention programme on the health of the participants will be evaluated
      through the measurement of biochemical parameters related to the disease (glycosylated
      haemoglobin, insulin, glucose, among others). In addition, specific compounds known as
      advanced glycation end products (AGEs) will be measured. The formation of these compounds is
      associated with the type of food consumed and the culinary techniques that are applied.
    

Detailed description: 
      One of the main factors influencing health is nutrition. Therefore, lifestyle and more
      specifically healthy eating habits, are key elements for the promotion of healthy lifestyle
      in society. Eating habits are defined as the more or less conscious, collective and
      repetitive behaviour that leads people to select, consume and use a certain foods or diet, in
      response to social and/or cultural influences. The acquisition of eating habits occurs since
      childhood. For this reason, an education in food and gastronomy is necessary to promote
      healthy eating habits in society. Education programmes so far have focused on nutrition
      education, i.e. on transferring theoretical knowledge about nutrition. However, currently, it
      is known that traditional knowledge about nutrition is not sufficient and it is necessary to
      go deeper into the factors that determine what people eat, and how people eat.

      The studies related to the sensory perception of food and the relationship that this
      perception has with the choice of food, seek to decipher the keys that make different
      individuals to have certain eating habits based on: personal tastes, the influence of
      culture, the emotions that make them feel, learning, and so on. Nutritional recommendations
      will always be simpler to follow when, implicit in them, the tastes and food choices of each
      individual are found.

      From a holistic perspective, individuals should be considered as a human being within a
      social, cultural and technological environment. In this sense, gastronomy is defined as "the
      reasoned knowledge of what people eat and how people eat. It is an interdisciplinary area of
      knowledge that studies and generates physical-chemical, cultural and socioeconomic processes
      where human beings cultivate, process, distribute and consume good foods and beverages that
      affect their physical, mental and social well-being". Gastronomy is a vehicle capable of
      creating social trends and the convergence of this discipline together with nutritional
      education can be a more effective tool to disseminate messages about what is considered a
      healthy diet, how to eat a healthy diet, as well as to transfer cooking skills that allow the
      population to acquire and sustain these eating habits at home.

      Briefly, gastronomy plays a fundamental role in covering the nutritional needs of the general
      population, and at the same time, it satisfies their expectations of flavour. Therefore,
      gastronomy is considered a decisive channel to favour education of taste, a better nutrition
      and, in general, for health promotion.

      The effect of nutrition on health is not homogeneous in the population. On the one hand,
      factors such as the type of food and the culinary techniques used have an influence. On the
      other hand, individual characteristics such as lifestyle, genetic background and wellbeing
      must be taken into account. In this context, Personalized and Precision Gastronomy based on
      individuals' eating habits, genetic profile, intestinal microbiota profile, metabolome,
      epigenome, tastes and preferences, and so on, in order to develop strategies that favour a
      healthy and tailor-made diets for each individual.

      Type 2 diabetes mellitus (T2DM) is one of the most prevalent metabolic diseases worldwide. In
      the Basque Country, it is estimated that the disease affects 10% of the population. People
      with diabetes have a high risk of suffering complications related to this illness. In
      addition, people with T2DM are more prone to develop other diseases such as cardiovascular
      diseases as well as premature mortality. For this reason, it is necessary to prevent the
      disease and to try to reduce the risk of developing complications in people who have already
      been diagnosed with T2DM.

      The current increase in DMT2 is associated with an increase in obesity. This multifactorial
      disease, in turn, has been related to unhealthy lifestyles. Moreover, apart from physical
      activity, following a healthy diet is a determining factor. Although there is increasing
      information on nutrition, the desired effect on the prevention of this disease is not being
      achieved. This may in part be due to a lack of skills to continue a healthy diet.

      Attention should also being paid to individual factors that may influence in specific
      nutritional needs of T2DM. In this sense, personalised gastronomy can facilitate the
      empowerment of people with diabetes providing them with culinary techniques and skills that
      allow patients to follow a healthy diet adapted to the conditions of this disease and to
      personal needs and preferences.

      In this context, the HOME COOKING project seeks to carry out a one-month culinary
      intervention programme with people diagnosed with T2DM, in order to analyse the health
      effects that the programme can produce, comparing it with the results obtained with a
      traditional intervention solely based on the training of theoretical recommendations about
      nutrition.

      In conclusion, the main hypothesis of this project lies in the fact that one of the barriers
      for the population to acquire and maintain healthy eating habits is related, in part, to the
      fact that they do not have enough culinary skills (food preparation) and do not have
      sufficient knowledge about nutrition (knowledge about the product). Thus, bearing in mind
      that several studies have demonstrated the relationship between the trust (empowerment) that
      provides to have food preparation skills (culinary skills), and knowledge about the quality
      of the diet in terms of health, the present project suggests that beneficial effects on
      health can be obtained when nutritionists and public health professionals promote culinary
      intervention programmes aimed at providing theoretical and practical knowledge.

      Therefore, this project is novel since it proposes a paradigm shift promoting the
      incorporation of culinary training as a complement to nutritional education. Likewise, the
      project is based on the Mediterranean diet, a diet pattern whose health benefits have been
      scientifically endorsed. The study is a reference project in this field and its results will
      be of great relevance to public health.
    

Intervention name(s): Mediterranean diet-based culinary intervention; Mediterranean diet-based nutritional education intervention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The culinary intervention was developed integrating four culinary workshops that were given every week, once per week, during one-month intervention. The duration of each culinary workshop was 3,5 h, thus, the program provided a total of 14h of practice in cooking activities. The courses took place in a well-equipped kitchen from the Basque Culinary Center. Each culinary workshop was divided in two differentiated parts in order to work on the specific objectives established for each day. All cooking classes began with a theoretical introductory part that aimed to explain the main take-home messages from the workshop. Subsequently, every class was characterized by a hands-on part that included the demonstration and practical preparation of different elaborations based on the use specific cooking techniques and healthy ingredients. At the end of the session, participants were encouraged to taste the prepared meals, to share their preferences and their view about the cooking experience.; The patients in the nutritional intervention group will receive dietary advice on how to follow a Mediterranean diet. The dietary recommendations will be given at the beginning of the study by nutritionists using comprehensive written material.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This study uses a randomized controlled trial design with one-month intervention program and three months of follow-up in order to test the effects of a culinary intervention program to improve cooking and healthy eating behaviour in type 2 diabetic patients.
The culinary intervention program will be given over a one-month period, one day a week for four weeks. Participants in the control group (CG) will receive dietary training based on Mediterranean diet at the baseline visit and a leaflet explaining this dietary pattern. The participants assigned to the culinary intervention program will receive the same nutritional recommendations and four online cooking classes.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Mediterranean diet; Culinary intervention; Cooking classes; Home cooking