ABSTRACTEffective medical nutrition therapy (MNT) is needed to stem the alarming increase in Type 2 diabetes (T2D)related morbidity and mortality in Benin a French sub-Saharan African (SSA) country where diabetesprevalence has quadrupled from 3% to 12.4% in the last decade reaching 22% in some areas. The impact ofthe disease reaches beyond those living with the condition to their families society and the healthcare systemwarranting strategic efforts to reduce its burden. Following a diet consistent with MNT guidelines is well-documented to help people with T2D achieve better glycemic control reduce cardiovascular risks and preventcomplications. However despite these benefits low adherence to dietary recommendations is consistentlyreported. The reasons include lack of nutrition knowledge difficulty translating recommendations to practicecultural acceptability of the diet and access to healthy foods. Thus culturally appropriate dietaryrecommendations based on locally available and accepted foods through guided counseling are key toimproving dietary adherence rates among T2D patients in the country. The purpose of this InternationalResearch Scientist Development Award (K01) is to empower Dr. Halimatou Alaof to develop a researchprogram that integrates innovative approaches to nutrition care delivery to optimize diabetes control in low-income African populations. To achieve this goal mentorship and training in this award are proposed tosupport: 1) additional training in menu planning and recipe development social and behavioral sciences andresearch methodologies; 2) protected time to conduct the planned patient-oriented research; and 3) thecollection and publication of preliminary data to facilitate the next steps in the research program. Under thementorship of Drs. John Ehiri and Waliou Amoussa Hounkpatin as well as co-mentors and collaborators fromthe US and Benin Dr. Alaof plans to 1) adapt an existing MNT intervention that combines a 4-week local foodmenu plan based on the 4A framework (adequacy acceptability accessibility and availability of foods) withindividual counseling to meet the Benin nutrition therapy guidelines for T2D patients; 2) develop SmartMenu aculturally tailored MNT for T2D patients using codesign methods; and 3) assess the feasibility acceptabilityand preliminary efficacy of SmartMenu for Benin patients with T2D. The anticipated outcome of this study ishigh-quality pilot data that will serve as the foundation for an R01 application to conduct a larger pragmaticrandomized controlled trial to assess the interventions cost-effectiveness and sustainability. We hypothesizethat a culturally tailored MNT combining individual counseling and menu plans that address dietary adherencebarriers through the 4A framework will facilitate patient acceptance and adherence to MNT guidelines. Ifsuccessful this model could significantly improve nutrition care in resource-limited settings. The training andresearch activities delineated complement the candidates background in nutrition education and dietmodification and will position her to contribute substantially to nutrition care delivery system change.