Impact of an Integrative Intervention with Creative Art Therapies and Nutrition Education (I2CAN) on physiological health outcomes in postmenopausal women: (a focus on nutrition-centered outcomes)

Emad Aldeen Ali K Alsayed

doi:10.17918/00011563

Background. The menopausal transition is accompanied by declining estrogen, central fat redistribution, loss of lean mass, accelerated bone loss, and increased cardiometabolic risk. Diet quality is a key modifiable determinant of these outcomes, yet conventional nutrition education (NE) addresses knowledge alone and leaves largely unaddressed the psychosocial barriers such as stress, emotional eating, body image, and self-efficacy that undermine sustained dietary change in postmenopausal women (PW). Creative arts therapies (CATs) target these determinants but have rarely been integrated with NE among PW. Objective. This dissertation evaluated the Integrative Intervention with Creative Arts Therapies and Nutrition Education (I2CAN), a 16-week pilot randomized controlled trial, to determine whether combining CATs with NE produces more favorable outcomes than NE alone across three aims: (1) dietary quality (Healthy Eating Index-2015 total and 13 component scores from multiple 24-hour recalls); (2) anthropometric and blood pressure outcomes (BMI, waist circumference (WC), systolic and diastolic blood pressure (SBP, DBP); and (3) DXA-derived bone mineral density (BMD), fat mass, body-fat percentage, lean mass, lean-mass percentage, and visceral adipose tissue (VAT). Methods. PWs reporting [greater than or equal to] 12 months of amenorrhea were recruited and randomized. The I2CAN group received eight NE and eight CAT sessions in alternating format; the control group received 16 NE sessions. All sessions were delivered via Zoom in group sessions. Of 37 women screened, 24 were randomized, 20 comprised the primary analytic sample (10 per group), and 19 had complete DXA data. Baseline-adjusted Week-16 ANCOVA was the pre-specified primary model, supported by assumption testing, Holm and Benjamini-Hochberg multiplicity adjustment, Reliable Change Index (RCI) analyses, and a sensitivity suite (change-score, Welch, permutation, robust HC3, and GEE models). Results. Findings were directional rather than confirmatory. Total HEI-2015 improved in both groups, with a larger increase in I2CAN (+4.01) than control (+2.13); the adjusted difference (1.74, 2.17 points) was not significant. Whole grains and total dairy showed the strongest component-level signals but did not survive multiplicity correction. WC, SBP, and DBP declined more in I2CAN, whereas BMI declined more in the control group; within-group, WC (-1.46 in) and DBP (-6.10 mmHg) declined significantly in I2CAN and BMI (-1.16 kg/m²) in the control. Lean mass numerically favored I2CAN, whereas fat mass, body-fat percentage, VAT, and BMD favored control. No difference between-group survived the Holm correction. RCI analyses showed reliable individual change was rare and not concentrated in either group. Design-based power analysis indicated sensitivity only to very large effects (minimum detectable d ~ 1.32). Conclusions. I2CAN was feasible, acceptable, and completed by PW, yielding directionally favorable but statistically inconclusive signals for diet quality, central adiposity, blood pressure, and lean-mass preservation. Null findings reflect imprecision inherent to a pilot sample, a 16-week window shorter than the physiological timescale of bone and body-composition change, and an active comparator. These preliminary estimates provide the effect sizes, measurement refinements, and comparison-condition design (3-group) required for a fully powered trial.

Impact of an Integrative Intervention with Creative Art Therapies and Nutrition Education (I2CAN) on physiological health outcomes in postmenopausal women: (a focus on nutrition-centered outcomes)

Files and links (1)

Abstract

Metrics

Details

Impact of an Integrative Intervention with Creative Art Therapies and Nutrition Education (I2CAN) on physiological health outcomes in postmenopausal women: (a focus on nutrition-centered outcomes)

Files and links (1)

Abstract

Metrics

Details

Drexel University Social media