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Nutritional Epidemiology

The Positive Deviance Approach Can Be Used to Create Culturally Appropriate Eating Guides Compatible with Reduced Cancer Risk^1–3,

⁴ Center for Studies of Sensory Impairment, Aging and Metabolism, Guatemala City, 01011, Guatemala and ⁵ Centre for Public Health Nutrition Research, University of Dundee, Dundee DD1 9SY, UK

The 1997 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Report provides 14 individual guidelines to reduce global cancer risk. The positive deviance approach could be appropriate for creating class-appropriate, healthy eating menu guides for consuming a diet to minimize cancer risk in Guatemala. Guatemalan adult participants (n = 873) were enrolled in the Concordance Project from 3 socioeconomic strata: rural area (n = 301), lower urban (n = 298), and higher urban (n = 274). Participants with intakes below recommended nutrient intakes and current smokers were excluded from the analysis. Concordance with 14 selected WCRF/AICR individual guideline components was evaluated. We selected participants for making a set of 14 rotating menus for a cancer prevention healthy eating guide. A priority sorting through the 873 participants of the survey identified a total of 23 and 21 model participants, respectively, from the rural and urban poor groups (concordant with 12 of 14 recommendation components) and 15 from the urban middle class (concordant with 11 of 14 recommendation components), with the highest degree of concordance with the WCRF/AICR guidelines. The most commonly violated recommendation was sugar consumption, followed by maintaining weight stability. The FFQ for 14 individuals from each class were transformed into a day menu to create a rotating diet guide derived from members of each social group. A potentially useful personal guide for eating compatibly with adequate nutrient intake and reduced cancer risk, appropriate to the culture and economic means of distinct social classes in Guatemala, is approaching the stage for application.

^* To whom correspondence should be addressed. E-mail: mvossenaar{at}hotmail.com.

Manuscript received 8 October 2008. Initial review completed 7 November 2008. Revision accepted 29 January 2009.

Published online 18 February 2009.