1
|
McNeish D, Peña A, Vander Wyst KB, Ayers SL, Olson ML, Shaibi GQ. Facilitating Growth Mixture Model Convergence in Preventive Interventions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:505-516. [PMID: 34235633 PMCID: PMC9004621 DOI: 10.1007/s11121-021-01262-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 01/09/2023]
Abstract
Growth mixture models (GMMs) are applied to intervention studies with repeated measures to explore heterogeneity in the intervention effect. However, traditional GMMs are known to be difficult to estimate, especially at sample sizes common in single-center interventions. Common strategies to coerce GMMs to converge involve post hoc adjustments to the model, particularly constraining covariance parameters to equality across classes. Methodological studies have shown that although convergence is improved with post hoc adjustments, they embed additional tenuous assumptions into the model that can adversely impact key aspects of the model such as number of classes extracted and the estimated growth trajectories in each class. To facilitate convergence without post hoc adjustments, this paper reviews the recent literature on covariance pattern mixture models, which approach GMMs from a marginal modeling tradition rather than the random effect modeling tradition used by traditional GMMs. We discuss how the marginal modeling tradition can avoid complexities in estimation encountered by GMMs that feature random effects, and we use data from a lifestyle intervention for increasing insulin sensitivity (a risk factor for type 2 diabetes) among 90 Latino adolescents with obesity to demonstrate our point. Specifically, GMMs featuring random effects-even with post hoc adjustments-fail to converge due to estimation errors, whereas covariance pattern mixture models following the marginal model tradition encounter no issues with estimation while maintaining the ability to answer all the research questions.
Collapse
Affiliation(s)
| | | | | | | | - Micha L Olson
- Arizona State University, Tempe, AZ, USA
- Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Gabriel Q Shaibi
- Arizona State University, Tempe, AZ, USA
- Phoenix Children's Hospital, Phoenix, AZ, USA
| |
Collapse
|
2
|
Sheehan CM, Gotlieb EE, Ayers SL, Tong D, Oesterle S, Vega-López S, Wolfersteig W, Ruelas DM, Shaibi GQ. Neighborhood Conditions and Type 2 Diabetes Risk among Latino Adolescents with Obesity in Phoenix. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137920. [PMID: 35805578 PMCID: PMC9265310 DOI: 10.3390/ijerph19137920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/20/2022] [Accepted: 06/25/2022] [Indexed: 12/10/2022]
Abstract
Type 2 Diabetes (T2D) has reached epidemic levels among the pediatric population. Furthermore, disparities in T2D among youth are distributed in a manner that reflects the social inequality between population sub-groups. Here, we investigated the neighborhood determinants of T2D risk among a sample of Latino adolescents with obesity residing in Phoenix, Arizona (n = 133). In doing so we linked together four separate contextual data sources: the American Community Survey, the United States Department of Agriculture Food Access Research Atlas, the Arizona Healthy Community Map, and the National Neighborhood Data Archive to systematically analyze how and which neighborhood characteristics were associated with T2D risk factors as measured by fasting and 2-h glucose following a 75 g oral glucose tolerance test. Using linear regression models with and without individual/household covariates, we investigated how twenty-two housing and transportation sociodemographic and built and food environment characteristics were independently and jointly associated with T2D risk. The main finding from these analyses was the strong association between the density of fast food restaurants and 2-h glucose values (b = 2.42, p < 0.01). This association was independent of individual, household, and other neighborhood characteristics. Our results contribute to an increasingly robust literature demonstrating the deleterious influence of the neighborhood food environment, especially fast food, for T2D risk among Latino youth.
Collapse
Affiliation(s)
- Connor M. Sheehan
- School of Social and Family Dynamics, Arizona State University, Tempe, AZ 85281, USA
- Correspondence: ; Tel.: +1-(480)-965-0354
| | - Esther E. Gotlieb
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ 85004, USA; (E.E.G.); (S.L.A.); (S.O.)
| | - Stephanie L. Ayers
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ 85004, USA; (E.E.G.); (S.L.A.); (S.O.)
| | - Daoqin Tong
- School of Geographical Sciences & Urban Planning, Arizona State University, Tempe, AZ 85281, USA;
| | - Sabrina Oesterle
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ 85004, USA; (E.E.G.); (S.L.A.); (S.O.)
| | - Sonia Vega-López
- College of Health Solutions and Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA;
| | - Wendy Wolfersteig
- School of Social Work, Arizona State University, Tempe, AZ 85281, USA;
| | - Dulce María Ruelas
- College of Nursing & Healthcare Professions, Grand Canyon University, Phoenix, AZ 85017, USA;
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA;
| |
Collapse
|
3
|
Peña A, Kim JY, Reyes JA, Vander Wyst KB, Ayers SL, Olson ML, Williams AN, Shaibi GQ. Changes in OGTT-derived biomarkers in response to lifestyle intervention among Latino adolescents with obesity. Pediatr Obes 2022; 17:e12867. [PMID: 34734482 PMCID: PMC8923905 DOI: 10.1111/ijpo.12867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Glucose concentrations during an oral glucose tolerance test (OGTT) have been used as biomarkers to differentiate type 2 diabetes risk phenotypes. No studies have examined changes in OGTT-glucose phenotypes following lifestyle intervention among high-risk youth. OBJECTIVE To examine changes in OGTT-glucose phenotypes following lifestyle intervention and to explore differences in insulin sensitivity and β-cell function among post-intervention phenotypes. METHODS Latino adolescents with obesity (n = 48, age 15.4 ± 1.0, BMI% 98.2 ± 1.4, female 56.3%) completed a 12-week lifestyle intervention that included weekly nutrition education and physical activity. At baseline and 12 weeks, youth completed a 2-h OGTT with glucose and insulin concentrations assessed at 0', 30', 60', 90' and 120'. Glucose concentrations during the OGTT were used to identify biomarkers, 1-h glucose, glucose response curve and time to glucose peak. Using these respective biomarkers, high-risk (1-h glucose ≥ 155 mg/dl, Monophasic, Late Peak) and lower-risk phenotypes (1-h glucose < 155 mg/dl, Biphasic, Early Peak) were categorized. Insulin sensitivity was estimated by whole-body insulin sensitivity index (WBISI) and β-cell function by oral disposition index (oDI). RESULTS Following intervention, the prevalence of Monophasic phenotypes decreased from 81% to 67% (p = 0.048) and 1-h glucose ≥ 155 mg/dl from 38% to 10% (p = 0.054). Although Late Peak phenotypes did not significantly change (from 58% to 29%, p = 0.200), Early Peak phenotypes at post-intervention demonstrated significantly higher WBISI compared to Late Peak (2.3 ± 0.1 vs 1.7 ± 0.2, p = 0.023). CONCLUSIONS OGTT-glucose phenotypes improve following lifestyle intervention among high-risk youth. These findings further support their potential utility as clinical biomarkers to identify diabetes risk and risk reduction in youth.
Collapse
Affiliation(s)
- Armando Peña
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona, USA,College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Joon Young Kim
- Department of Exercise Science, Syracuse University, Syracuse, New York, USA
| | - Jessica A. Reyes
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | | | - Stephanie L. Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona, USA
| | - Micah L. Olson
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona, USA,Division of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Allison N. Williams
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona, USA
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona, USA,College of Health Solutions, Arizona State University, Phoenix, Arizona, USA,Division of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| |
Collapse
|
4
|
Tremblay ES, Ruiz J, Dykeman B, Maldonado M, Garvey K. Hispanic Caregivers' experience of pediatric type 1 diabetes: A qualitative study. Pediatr Diabetes 2021; 22:1040-1050. [PMID: 34232537 PMCID: PMC8530860 DOI: 10.1111/pedi.13247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/30/2021] [Accepted: 07/05/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE It is widely recognized that Type 1 Diabetes (T1D) outcomes are worse among Hispanic children; however, little is published about the perspectives of these patients and their caregivers. Our intent was to characterize the lived experience of Hispanic caregivers of children with T1D, focusing on the role of language and culture and their perspectives on current medical care and alternative care models. We studied Hispanic caregivers of patients (age 2-17 years) with T1D of greater than 6 months' duration. RESEARCH DESIGN AND METHODS We completed semi-structured interviews and focus-groups of a purposive sample of 20 members of our population of interest. We developed a codebook and completed multidisciplinary consensus coding, then conducted iterative thematic analysis using qualitative software and discussion to generate themes. RESULTS We gathered data from 20 Hispanic caregivers of T1D patients (11.37 ± 3.00 years old, 4.80 ± 2.84 years since diagnosis). 85% of caregivers were female, 80% preferred Spanish, and 15% were college-educated. Our analysis yielded 4 themes across the participants: (1) Culturally-based nutrition challenges, (2) Social isolation and lack of support for T1D care, (3) Hesitancy to fully embrace diabetes technology, and (4) Deferential views of care experience and providers. Overarching all of these themes was support for Hispanic group-based models of care tailored to address these concerns. CONCLUSIONS The unique concerns among Hispanic caregivers of children with T1D suggest the importance of culturally tailored interventions to improve care. With successful implementation, such interventions could diminish widening disparities in healthcare outcomes.
Collapse
Affiliation(s)
- Elise Schlissel Tremblay
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Jessica Ruiz
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Blair Dykeman
- Boston Children’s Hospital, Institutional Centers for Clinical and Translational Research
| | - Michele Maldonado
- Boston Children’s Hospital, Children’s Hospital Primary Care Center, Social Work
| | - Katharine Garvey
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| |
Collapse
|
5
|
Soltero EG, O'Connor TM, Thompson D, Shaibi GQ. Opportunities to Address Obesity Disparities Among High-Risk Latino Children and Adolescents. Curr Obes Rep 2021; 10:332-341. [PMID: 34263434 PMCID: PMC9116051 DOI: 10.1007/s13679-021-00445-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW This review highlights obesity-related disparities among Latino children and adolescents, discusses the social determinants of health (SDoH) that drive disparities, and presents case studies of strategies for reducing disparities and promoting health equity. RECENT FINDINGS Recommended strategies for reducing obesity-related disparities include the use of culturally grounded programming, multi-sector collaborations, and technology. We present two exemplar studies that demonstrate that integrating cultural values and enhancing the overall cultural fit of prevention programs can increase engagement among high-risk Latino families. We also examine the use of multi-sector collaborations to build community capacity and address key SDoH that impact health behaviors and outcomes. Our last example study demonstrates the utility of technology for engaging youth and extending the reach of prevention strategies in vulnerable communities. To address growing obesity-related disparities, there is an urgent need to develop and test these strategies among high-risk, vulnerable populations like Latino children and adolescents.
Collapse
Affiliation(s)
- Erica G Soltero
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX, 77030, USA.
| | - Teresia M O'Connor
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX, 77030, USA
| | - Deborah Thompson
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX, 77030, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| |
Collapse
|
6
|
Perceptions of Family-Level Social Factors That Influence Health Behaviors in Latinx Adolescents and Young Adults at High Risk for Type 2 Diabetes. CHILDREN-BASEL 2021; 8:children8050406. [PMID: 34069897 PMCID: PMC8157582 DOI: 10.3390/children8050406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/30/2021] [Accepted: 05/15/2021] [Indexed: 11/29/2022]
Abstract
Given that health behaviors occur within the context of familial social relationships, a deeper understanding of social factors that influence health behaviors in Latinx families is needed to develop more effective diabetes prevention programming. This qualitative study identified perceived family-level social factors that influence health behaviors in Latinx adolescents (12–16 years; N = 16) and young adults (18–24 years; N = 15) with obesity and explored differences in perceptions across sex and age. Participants completed an in-depth interview that was recorded, transcribed, and coded using thematic content analysis. Emergent themes central to health behaviors included: perceived parental roles and responsibilities, perceived family social support for health behaviors, and familial social relationships. Mom’s role as primary caregiver and dad’s role as a hard worker were seen as barriers to engaging in health behaviors among adolescent females and young adults, males and females. Adolescents perceived receiving more support compared to young adults and males perceived receiving more support compared to females. Health behaviors in both age groups were shaped through early familial social interactions around physical activity. These insights suggest that traditional gender roles, social support, and social interaction around health behaviors are critical components for family-based diabetes prevention programs in high-risk Latinx youth and young adults.
Collapse
|
7
|
Soltero EG, Ayers SL, Avalos MA, Peña A, Williams AN, Olson ML, Konopken YP, Castro FG, Arcoleo KJ, Keller CS, Patrick DL, Jager J, Shaibi GQ. Theoretical Mediators of Diabetes Risk and Quality of Life Following a Diabetes Prevention Program for Latino Youth With Obesity. Am J Health Promot 2021; 35:939-947. [PMID: 33949215 DOI: 10.1177/08901171211012951] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE This study tested self-efficacy and social support for activity and dietary changes as mediators of changes in type 2 diabetes related outcomes following a lifestyle intervention among Latino youth. SETTING AND INTERVENTION Latino adolescents (14-16 years) with obesity (BMI% = 98.1 ± 1.4) were randomized to a 3-month intervention (n = 67) that fostered self-efficacy and social support through weekly, family-centered sessions or a comparison condition (n = 69). MEASURES Primary outcomes included insulin sensitivity and weight specific quality of life. Mediators included self-efficacy, friend, and family social support for health behaviors. Data was collected at baseline, 3-months, 6-months, and 12-months. ANALYSIS Sequential path analysis was used to examine mediators as mechanisms by which the intervention influenced primary outcomes. RESULTS The intervention had a direct effect on family (β = 0.33, P < .01) and friend social support (β = 0.22, P < .001) immediately following the intervention (3-months). Increased family social support mediated the intervention's effect on self-efficacy at 6-months (β = 0.09, P < .01). However, social support and self-efficacy did not mediate long-term changes in primary outcomes (P > .05) at 12-months. CONCLUSIONS Family social support may improve self-efficacy for health behaviors in high-risk Latino youth, highlighting the important role of family diabetes prevention. Fostering family social support is a critical intervention target and more research is needed to understand family-level factors that have the potential to lead to long-term metabolic and psychosocial outcome in vulnerable youth.
Collapse
Affiliation(s)
- Erica G Soltero
- Children's Nutrition Research Center, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Stephanie L Ayers
- Southwest Interdisciplinary Research Center, 7864Arizona State University, Phoenix, AZ, USA
| | - Marvyn A Avalos
- Southwest Interdisciplinary Research Center, 7864Arizona State University, Phoenix, AZ, USA
| | - Armando Peña
- Center for Health Promotion and Disease Prevention, 7864Arizona State University, Phoenix, AZ, USA
| | - Allison N Williams
- Center for Health Promotion and Disease Prevention, 7864Arizona State University, Phoenix, AZ, USA
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, 7864Arizona State University, Phoenix, AZ, USA.,Department of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Yolanda P Konopken
- Family Wellness Program, St. Vincent De Paul Medical and Dental Clinic, Phoenix, AZ, USA
| | - Felipe G Castro
- Center for Health Promotion and Disease Prevention, 7864Arizona State University, Phoenix, AZ, USA
| | | | - Colleen S Keller
- Center for Health Promotion and Disease Prevention, 7864Arizona State University, Phoenix, AZ, USA
| | - Donald L Patrick
- Department of Health Services, 49462School of Public Health, University of Washington, Seattle, WA, USA
| | - Justin Jager
- Southwest Interdisciplinary Research Center, 7864Arizona State University, Phoenix, AZ, USA.,T. Denny Sanford School of Social and Family Dynamics, 7864Arizona State University, Tempe, AZ, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, 7864Arizona State University, Phoenix, AZ, USA
| |
Collapse
|
8
|
Arévalo Avalos MR, Ayers SL, Patrick DL, Jager J, Castro FG, Konopken YP, Olson ML, Keller CS, Soltero EG, Williams AN, Shaibi GQ. Familism, Self-Esteem, and Weight-Specific Quality of Life Among Latinx Adolescents With Obesity. J Pediatr Psychol 2021; 45:848-857. [PMID: 32632446 DOI: 10.1093/jpepsy/jsaa047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 04/03/2020] [Accepted: 05/17/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Obesity is a critical public health condition affecting Latinx adolescents and contributes to health disparities across the lifespan. Childhood and adolescent obesity is associated with reduced quality of life (QoL) and decreased self-esteem. The purpose of this study is to examine the role of cultural (e.g., familism) and psychosocial (e.g., self-esteem) factors as predictors of weight-specific QoL among Latinx adolescents with obesity. METHODS Baseline data from 160 Latinx adolescents (ages 14-16 years) with obesity (BMI > 95th percentile for age and sex) who were recruited for a diabetes prevention intervention were used. Structural equation modeling tested the relationships between four latent constructs (familism, positive self-esteem, self-deprecation, and weight-specific QoL). RESULTS The model tested paths from familism to positive self-esteem, self-deprecation, and weight-specific QoL, and paths from positive self-esteem and self-deprecation to weight-specific QoL. Higher familism was positively associated with positive self-esteem but not self-deprecation. In turn, positive self-esteem was positively associated with higher weight-specific QoL, whereas self-deprecation was negatively associated. Furthermore, there was an indirect effect of familism on QoL via positive self-esteem. CONCLUSIONS These data shed light into specific cultural and psychosocial constructs that influence QoL among Latinx adolescents with obesity. This study suggests that familism and positive self-esteem can operate as protective factors associated with higher weight-specific QoL in Latinx adolescents with obesity; whereas self-deprecation may operate as a risk factor for lower weight-specific QoL.
Collapse
Affiliation(s)
| | - Stephanie L Ayers
- Southwest Interdisciplinary Research Center, Arizona State University
| | | | - Justin Jager
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University
| | | | | | - Micah L Olson
- Center for Health Promotion and Disease Prevention, Arizona State University.,Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital
| | - Colleen S Keller
- Center for Health Promotion and Disease Prevention, Arizona State University
| | - Erica G Soltero
- Center for Health Promotion and Disease Prevention, Arizona State University
| | - Allison N Williams
- Center for Health Promotion and Disease Prevention, Arizona State University
| | - Gabriel Q Shaibi
- Southwest Interdisciplinary Research Center, Arizona State University.,Center for Health Promotion and Disease Prevention, Arizona State University.,Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital
| |
Collapse
|
9
|
Peña A, McNeish D, Ayers SL, Olson ML, Vander Wyst KB, Williams AN, Shaibi GQ. Response heterogeneity to lifestyle intervention among Latino adolescents. Pediatr Diabetes 2020; 21:1430-1436. [PMID: 32939893 PMCID: PMC8274397 DOI: 10.1111/pedi.13120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To characterize the heterogeneity in response to lifestyle intervention among Latino adolescents with obesity. METHODS We conducted secondary data analysis of 90 Latino adolescents (age 15.4 ± 0.9 y, female 56.7%) with obesity (BMI% 98.1 ± 1.5%) that were enrolled in a 3 month lifestyle intervention and were followed for a year. Covariance pattern mixture models identified response phenotypes defined by changes in insulin sensitivity as measured using a 2 hour oral glucose tolerance test. Baseline characteristics were compared across response phenotypes using one-way ANOVA and chi-square test. RESULTS Three distinct response phenotypes (PH1, PH2, PH3) were identified. PH1 exhibited the most robust response defined by the greatest increase in insulin sensitivity over time (β ± SE, linear 0.52 ± 0.17, P < .001; quadratic -0.03 ± 0.01, P = .001). PH2 showed non-significant changes, while PH3 demonstrated modest short-term increases in insulin sensitivity which were not sustained over time (linear 0.08 ± 0.03, P = .002; quadratic -0.01 ± 0.002, P = .003). At baseline, PH3 (1.1 ± 0.4) was the most insulin resistant phenotype and exhibited the highest BMI% (98.5 ± 1.1%), 2 hours glucose concentrations (144.0 ± 27.5 mg/dL), and lowest beta-cell function as estimated by the oral disposition index (4.5 ± 2.8). CONCLUSION Response to lifestyle intervention varies among Latino youth with obesity and suggests that precision approaches are warranted to meet the prevention needs of high risk youth.
Collapse
Affiliation(s)
- Armando Peña
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ,College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Daniel McNeish
- Department of Psychology, Arizona State University, Tempe, AZ
| | - Stephanie L. Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ
| | - Micah L. Olson
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ,College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Kiley B. Vander Wyst
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ
| | - Allison N. Williams
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ,College of Health Solutions, Arizona State University, Phoenix, AZ,Department of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, AZ
| |
Collapse
|
10
|
Vander Wyst KB, Olson ML, Keller CS, Soltero EG, Williams AN, Peña A, Ayers SL, Jager J, Shaibi GQ. Sex as a moderator of body composition following a randomized controlled lifestyle intervention among Latino youth with obesity. Pediatr Obes 2020; 15:e12620. [PMID: 32072749 PMCID: PMC9275591 DOI: 10.1111/ijpo.12620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/05/2020] [Accepted: 01/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Body composition differences between males and females emerge during adolescence and continue throughout adulthood; however, whether sex moderates body composition changes in adolescents with obesity after an intervention is unknown. OBJECTIVE To examine sex as a moderator of changes in adiposity following lifestyle intervention. METHODS A total of 136 Latino youth with obesity (BMI% 98.2 ± 1.3) aged 14 to 16 years old were randomized to either a 12-week lifestyle intervention (27 males/40 females) or control (35 males/34 females) group. The intervention included nutrition education (1 h/wk) and moderate-to-vigorous physical activity (3 h/wk). Anthropometric data (body mass index [BMI], BMI%, waist circumference, total body fat, and fat-free mass) were obtained pre- and post-intervention. Sex differences were examined by general linear models with significance determined at P < .05 for the F-statistic. RESULTS Sex did not moderate changes in BMI (F1,115 = 0.01, P = .9), BMI% (F1,115 = 0.14, P = .7), or waist circumference (F1,117 = 1.1, P = .3). Sex significantly moderated changes in body fat percent (F1,117 = 5.3, P = .02), fat mass (F1,116 = 4.5, P = .04), and fat-free mass (F1,116 = 4.3, P = .04). Intervention males compared with females had greater relative reductions in fat percent (-4.1 ± 0.8% vs -1.2 ± 0.7%, P = .02) and fat mass (-5.0 ± 1.1 kg vs -1.5 ± 0.9 kg, P = .02) and gained more fat free mass (3.6 ± 0.9 kg vs 0.5 ± 0.8 kg, P = .02) when compared with same sex controls. CONCLUSION Males and females exhibited a differential response to lifestyle intervention for percent fat, fat mass, and fat-free mass indicating that sex-specific improvements in body composition favours males over females.
Collapse
Affiliation(s)
- Kiley B. Vander Wyst
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| | - Micah L. Olson
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, Arizona
| | - Colleen S. Keller
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| | - Erica G. Soltero
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| | - Allison N. Williams
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| | - Armando Peña
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| | - Stephanie L. Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona
| | - Justin Jager
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Phoenix, Arizona
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, Arizona
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona
| |
Collapse
|
11
|
Peña A, Olson ML, Soltero EG, Lee C, Toledo MJ, Ayers SL, Shaibi GQ. Evaluating a pragmatic estimate of insulin sensitivity in Latino youth with obesity. Clin Obes 2020; 10:e12353. [PMID: 31962378 PMCID: PMC9275660 DOI: 10.1111/cob.12353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/03/2020] [Indexed: 11/26/2022]
Abstract
The whole-body insulin sensitivity index (WBISI) is a widely used surrogate of insulin sensitivity estimated from glucose and insulin concentrations during an oral glucose tolerance test (OGTT). The original WBISI uses five timepoints but reduced sampling models have been proposed. These reduced models have not been applied to the paediatric population. The purpose of this study is to compare cross-sectional agreement and changes in response to lifestyle intervention between the original WBISI and the WBISI120 using fasting and 2-hour glucose and insulin concentrations from OGTT among Latino adolescents with obesity. We also examined the cost-differential between the two measures. Secondary analyses were conducted with data from Latino adolescents (14-16 years) with obesity (BMI ≥ 95th percentile) who were recruited for a randomized controlled lifestyle intervention trial. Baseline data in youth (n = 148) who underwent a 2-hour OGTT was used to analyse agreement between WBISI and WBISI120 . Data from 65 participants who completed a 12-week lifestyle intervention were used to assess changes and the rate of change between WBISI and WBISI120 . Research costs to determine both measures were compared. WBISI120 showed good cross-sectional agreement (ICCagreement = 0.88) with the full WBISI. Following intervention, WBISI120 increased 62.5% (M ± SD, 1.6 ± 1.2 to 2.6 ± 1.7, P < .001) while WBISI increased by 25.0% (1.6 ± 1.0 to 2.0 ± 1.0, P < .001) but the rate of change for WBISI and WBISI120 was not significantly different (P = .11). WBISI120 costs ~70% less than WBISI. WBISI120 may offer a cost-effective surrogate estimate of insulin sensitivity in Latino youth with obesity.
Collapse
Affiliation(s)
- Armando Peña
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Micah L. Olson
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
- Department of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, Arizona
| | - Erica G. Soltero
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona
| | - Chong Lee
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Meynard J. Toledo
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Stephanie L. Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
- College of Health Solutions, Arizona State University, Phoenix, Arizona
- Department of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, Arizona
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona
| |
Collapse
|
12
|
Soltero EG, Ramos C, Williams AN, Hooker E, Mendez J, Wildy H, Davis K, Hernandez V, Contreras OA, Silva M, Lish E, Shaibi GQ. ¡Viva Maryvale!: A Multilevel, Multisector Model to Community-Based Diabetes Prevention. Am J Prev Med 2019; 56:58-65. [PMID: 30573148 PMCID: PMC6815673 DOI: 10.1016/j.amepre.2018.07.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/05/2018] [Accepted: 07/24/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Latino communities are disproportionately affected by type 2 diabetes and experience disparities in access to diabetes prevention programs. The purpose of this study was to test the preliminary efficacy of a culturally grounded, diabetes prevention program for high-risk Latino families delivered through an integrated research-practice partnership. STUDY DESIGN The integrated research-practice partnership was established in a predominantly Latino community and consisted of a Federally Qualified Health Center, a YMCA, an accredited diabetes education program, and an academic research center. Data were collected and analyzed from 2015 to 2018. SETTING/PARTICIPANTS Latino families consisting of a parent with an obese child between age 8 and 12 years. INTERVENTION The 12-week lifestyle intervention included nutrition education and behavioral skills training (60 minutes, once/week) and physical activity classes (60 minutes, three times/week) delivered at a YMCA. MAIN OUTCOME MEASURES Outcomes included measures of adiposity (BMI, waist circumference, and body fat); HbA1c; and weight-specific quality of life. RESULTS Over the course of the 2-year project period, 58 families (parents n=59, children n=68) were enrolled with 36% of parents and 29% of children meeting the criteria for prediabetes at baseline. Feasibility and acceptability were high, with 83% of enrolled families completing the program, 91% of the intervention sessions attended, and 100% of families stating they would recommend the program. The intervention led to significant decreases in percentage body fat among parents (46.4% [SD=10.8] to 43.5% [SD=10.5], p=0.001) as well as children (43.1% [SD=8.0] to 41.8% [SD=7.2], p=0.03). Additionally, HbA1c was significantly reduced in parents (5.6% [SD=0.4] to 5.5% [SD=0.3], p=0.03), and remained stable in children (5.5% [SD=0.3] vs 5.5% [SD=0.3], p>0.05). Significant improvements in quality of life were reported in parents (64.6 [SD=15.8] to 71.0 [SD=13.7], p=0.001) and children (69.7 [SD=15.8] to 72.6 [SD=13.7], p=0.05). CONCLUSIONS These findings support the preliminary efficacy of an integrated research-practice partnership to meet the diabetes prevention needs of high-risk Latino families within a vulnerable community.
Collapse
Affiliation(s)
- Erica G Soltero
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| | - Crystal Ramos
- Integrated Behavioral Health, Mountain Park Health Center, Phoenix, Arizona
| | - Allison N Williams
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| | - Elva Hooker
- Family Wellness Program, St. Vincent De Paul Medical and Dental Clinic, Phoenix, Arizona
| | | | | | | | | | - Omar A Contreras
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Maria Silva
- Family Wellness Program, St. Vincent De Paul Medical and Dental Clinic, Phoenix, Arizona
| | - Elvia Lish
- Family Wellness Program, St. Vincent De Paul Medical and Dental Clinic, Phoenix, Arizona
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona.
| |
Collapse
|
13
|
Effects of a lifestyle intervention on markers of cardiometabolic risk and oxidized lipoproteins among obese adolescents with prediabetes. Public Health Nutr 2018; 22:706-713. [PMID: 30588900 DOI: 10.1017/s1368980018003476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Obesity and hyperglycaemia contribute to the atherosclerotic process in part through oxidative modifications to lipoprotein particles. The present study aimed to evaluate the effects of a lifestyle intervention on markers of oxidized lipoproteins in obese Latino adolescents with prediabetes. DESIGN Pre-post design. SETTING Participants were enrolled into a 12-week lifestyle intervention. Measurements pre- and post-intervention included anthropometrics and body composition, lipid panel, oxidized LDL (oxLDL), oxidized HDL (oxHDL), intake of fresh fruits and vegetables, and cardiorespiratory fitness. PARTICIPANTS Thirty-five obese Latino adolescents (seventeen females, eighteen males; mean age 15·5 (sd 1·0) years; mean BMI percentile 98·5 (sd 1·2)) with prediabetes. RESULTS Intervention participation resulted in significant reductions in weight (-1·2 %, P = 0·042), BMI and BMI percentile (-2·0 and -0·4 %, respectively, P < 0·001), body fat (-7·0 %, P = 0·025), TAG (-11·8 %, P = 0·032), total cholesterol (-5·0 %, P = 0·002), VLDL-cholesterol (-12·5 %, P = 0·029), and non-HDL-cholesterol (-6·7 %, P = 0·007). Additionally, fitness (6·4 %, P < 0·001) and intake of fruits and vegetables (42·4 %, P = 0·025) increased significantly. OxLDL decreased significantly after the intervention (51·0 (sd 14·0) v. 48·7 (sd 12·8) U/l, P = 0·022), while oxHDL trended towards a significant increase (395·2 (sd 94·6) v. 416·1 (sd 98·4) ng/ml, P = 0·056). CONCLUSIONS These data support the utility of lifestyle intervention to improve the atherogenic phenotype of Latino adolescents who are at high risk for developing premature CVD and type 2 diabetes.
Collapse
|
14
|
Soltero EG, Olson ML, Williams AN, Konopken YP, Castro FG, Arcoleo KJ, Keller CS, Patrick DL, Ayers SL, Barraza E, Shaibi GQ. Effects of a Community-Based Diabetes Prevention Program for Latino Youth with Obesity: A Randomized Controlled Trial. Obesity (Silver Spring) 2018; 26:1856-1865. [PMID: 30426694 PMCID: PMC6249045 DOI: 10.1002/oby.22300] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/26/2018] [Accepted: 07/18/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study examined the short- and long-term effects of a community-based lifestyle intervention among Latino youth with obesity. METHODS Latino adolescents (14-16 years old) were randomized to a 3-month lifestyle intervention (n = 67) or comparison control (n = 69) and followed for 12 months. The intervention included weekly nutrition and health classes delivered to groups of families and exercise sessions (3 days/week) delivered to groups of adolescents. Comparison youth received laboratory results and general health information. Primary outcomes included insulin sensitivity and weight-specific quality of life (QoL) with secondary outcomes of BMI percentile (BMI%), waist circumference, and percent body fat. RESULTS At 3 months, youth in the intervention group exhibited significant increases in insulin sensitivity (P < 0.05) and weight-specific QoL (P < 0.001), as well as reductions in BMI%, waist circumference, and percent body fat compared with controls. Increases in weight-specific QoL and reductions in BMI% and percent body fat remained significant at 12 months (P < 0.001), while changes in insulin sensitivity did not. In a subsample of youth with prediabetes at baseline, insulin sensitivity (P = 0.01), weight-specific QoL (P < 0.001), and BMI% (P < 0.001) significantly improved at 3 months. CONCLUSIONS Lifestyle intervention can improve cardiometabolic and psychosocial health in a vulnerable population of Latino adolescents at high risk for developing type 2 diabetes.
Collapse
Affiliation(s)
- Erica G Soltero
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Allison N Williams
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona, USA
| | - Yolanda P Konopken
- Family Wellness Program, St. Vincent de Paul Medical and Dental Clinic, Phoenix, Arizona, USA
| | - Felipe G Castro
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | | | - Colleen S Keller
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Donald L Patrick
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Stephanie L Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona, USA
| | - Estela Barraza
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona, USA
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, Arizona, USA
| |
Collapse
|
15
|
Olson ML, Rentería-Mexía A, Connelly MA, Vega-López S, Soltero EG, Konopken YP, Williams AN, Castro FG, Keller CS, Yang HP, Todd MW, Shaibi GQ. Decreased GlycA after lifestyle intervention among obese, prediabetic adolescent Latinos. J Clin Lipidol 2018; 13:186-193. [PMID: 30342918 DOI: 10.1016/j.jacl.2018.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Obese youth with prediabetes are at increased risk for premature morbidity and mortality through multiple mechanisms, including increased systemic inflammation. GlycA is a novel measure of systemic inflammation that predicts type II diabetes, cardiovascular events, and all-cause mortality in adults. OBJECTIVE The purpose of the present study was to examine changes in GlycA after lifestyle intervention among obese, prediabetic Latino youth. METHODS Obese, prediabetic Latino youth (n = 27; 15.5 ± 1.1 years, 13 males/14 females) completed a 12-week lifestyle intervention that included weekly nutrition education and 3 d/wk of moderate to vigorous physical activity. Prediabetes was characterized by an expanded definition of impaired glucose tolerance, using 2-hour glucose ≥120 mg/dL after an oral glucose tolerance test. GlycA was assessed at baseline and 12 weeks using nuclear magnetic resonance spectroscopy. RESULTS After the lifestyle intervention, GlycA was significantly reduced (445.3 ± 51.3 μmol/L to 419.0 ± 50.0 μmol/L, P = .01) (mean ± standard deviation). Additional improvements were observed in multiple cardiovascular risk factors, including body mass index (BMI; 34.8 ± 5.0 kg/m2 to 34.0 ± 5.1 kg/m2, P < .001), total cholesterol (154.1 ± 30.3 mg/dL to 143.3 ± 29.1 mg/dL, P = .003), and 2-hour glucose (141.0 ± 13.2 mg/dL to 115.9 ± 31.4 mg/dL, P < .001). Decreases in GlycA were associated with decreases in 2-hour glucose (r = 0.49, P = .008) and BMI (r = 0.41, P = .03). CONCLUSION These data are consistent with the hypothesis that lifestyle intervention might improve GlycA levels in obese, prediabetic adolescent Latinos, but randomized trial evidence is needed. Healthy lifestyle modifications among high-risk youth may decrease future risk of cardiometabolic disease through reducing systemic inflammation, in addition to improving traditional cardiovascular risk factors.
Collapse
Affiliation(s)
- Micah L Olson
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA; Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.
| | - Ana Rentería-Mexía
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Departamento de Biotecnología y Ciencias Alimentarias, Instituto Tecnológico de Sonora, Ciudad Obregón, Sonora, México
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (LabCorp), Burlington, NC, USA
| | - Sonia Vega-López
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA; School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | - Erica G Soltero
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Yolanda P Konopken
- Family Wellness Program, Virginia G. Piper, St. Vincent de Paul Medical and Dental Clinic, Phoenix, AZ, USA
| | - Allison N Williams
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
| | - Felipe G Castro
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Colleen S Keller
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Hongwei P Yang
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Michael W Todd
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Gabriel Q Shaibi
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA; Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
| |
Collapse
|
16
|
Soltero EG, Konopken YP, Olson ML, Keller CS, Castro FG, Williams AN, Patrick DL, Ayers S, Hu HH, Sandoval M, Pimentel J, Knowler WC, Frick KD, Shaibi GQ. Preventing diabetes in obese Latino youth with prediabetes: a study protocol for a randomized controlled trial. BMC Public Health 2017; 17:261. [PMID: 28302101 PMCID: PMC5353870 DOI: 10.1186/s12889-017-4174-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/04/2017] [Indexed: 12/12/2022] Open
Abstract
Background Obese Latino adolescents are disproportionately impacted by insulin resistance and type 2 diabetes. Prediabetes is an intermediate stage in the pathogenesis of type 2 diabetes and represents a critical opportunity for intervention. However, to date, no diabetes prevention studies have been conducted in obese Latino youth with prediabetes, a highly vulnerable and underserved group. Therefore, we propose a randomized-controlled trial to test the short-term (6-month) and long-term (12-month) efficacy of a culturally-grounded, lifestyle intervention, as compared to usual care, for improving glucose tolerance and reducing diabetes risk in 120 obese Latino adolescents with prediabetes. Methods Participants will be randomized to a lifestyle intervention or usual care group. Participants in the intervention group will attend weekly nutrition and wellness sessions and physical activity sessions twice a week for six months, followed by three months of booster sessions. The overall approach of the intervention is framed within a multilevel Ecodevelopmental model that leverages community, family, peer, and individual factors during the critical transition period of adolescence. The intervention is also guided by Social Cognitive Theory and employs key behavioral modification strategies to enhance self-efficacy and foster social support for making and sustaining healthy behavior changes. We will test intervention effects on quality of life, explore the potential mediating effects of changes in body composition, total, regional, and organ fat on improving glucose tolerance and increasing insulin sensitivity, and estimate the initial incremental cost effectiveness of the intervention as compared with usual care for improving glucose tolerance. Discussion The proposed trial builds upon extant collaborations of a transdisciplinary team of investigators working in concert with local community agencies to address critical gaps in how diabetes prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution oriented programs to prevent type 2 diabetes in this and other populations of high-risk youth. Trial Registration NCT02615353, registered on June 8, 2016.
Collapse
Affiliation(s)
- Erica G Soltero
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85013, USA
| | - Yolanda P Konopken
- Family Wellness Program, Virginia G. Piper, St. Vincent de Paul Medical and Dental Clinic, 1730 E. Monroe Street, Phoenix, AZ, 85034, USA
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85013, USA.,Division of Endocrinology and Diabetes, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ, 85016, USA
| | - Colleen S Keller
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85013, USA
| | - Felipe G Castro
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85013, USA
| | - Allison N Williams
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85013, USA.,Southwest Interdisciplinary Research Center, Arizona State University, 411 N. Central Avenue, Suite 720, Phoenix, AZ, 85004-0693, USA
| | - Donald L Patrick
- Seattle Quality of Life Group, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, USA
| | - Stephanie Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, 411 N. Central Avenue, Suite 720, Phoenix, AZ, 85004-0693, USA
| | - Houchun H Hu
- Department of Radiology, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ, 85016, USA
| | - Matthew Sandoval
- Valley of the Sun YMCA, 350 N. 1st Avenue, Phoenix, AZ, 85003, USA
| | - Janiel Pimentel
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ, 85016, USA
| | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 4212 North 16th Street, Phoenix, AZ, 85016, USA
| | - Kevin D Frick
- Johns Hopkins Carey Business School, 100 International Drive, Baltimore, MD, 21202, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85013, USA. .,Division of Endocrinology and Diabetes, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ, 85016, USA. .,Southwest Interdisciplinary Research Center, Arizona State University, 411 N. Central Avenue, Suite 720, Phoenix, AZ, 85004-0693, USA.
| |
Collapse
|
17
|
Soltero EG, Konopken YP, Olson ML, Keller CS, Castro FG, Williams AN, Patrick DL, Ayers S, Hu HH, Sandoval M, Pimentel J, Knowler WC, Frick KD, Shaibi GQ. Preventing diabetes in obese Latino youth with prediabetes: a study protocol for a randomized controlled trial. BMC Public Health 2017. [PMID: 28302101 DOI: 10.1186/s12889‐017‐4174‐2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Obese Latino adolescents are disproportionately impacted by insulin resistance and type 2 diabetes. Prediabetes is an intermediate stage in the pathogenesis of type 2 diabetes and represents a critical opportunity for intervention. However, to date, no diabetes prevention studies have been conducted in obese Latino youth with prediabetes, a highly vulnerable and underserved group. Therefore, we propose a randomized-controlled trial to test the short-term (6-month) and long-term (12-month) efficacy of a culturally-grounded, lifestyle intervention, as compared to usual care, for improving glucose tolerance and reducing diabetes risk in 120 obese Latino adolescents with prediabetes. METHODS Participants will be randomized to a lifestyle intervention or usual care group. Participants in the intervention group will attend weekly nutrition and wellness sessions and physical activity sessions twice a week for six months, followed by three months of booster sessions. The overall approach of the intervention is framed within a multilevel Ecodevelopmental model that leverages community, family, peer, and individual factors during the critical transition period of adolescence. The intervention is also guided by Social Cognitive Theory and employs key behavioral modification strategies to enhance self-efficacy and foster social support for making and sustaining healthy behavior changes. We will test intervention effects on quality of life, explore the potential mediating effects of changes in body composition, total, regional, and organ fat on improving glucose tolerance and increasing insulin sensitivity, and estimate the initial incremental cost effectiveness of the intervention as compared with usual care for improving glucose tolerance. DISCUSSION The proposed trial builds upon extant collaborations of a transdisciplinary team of investigators working in concert with local community agencies to address critical gaps in how diabetes prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution oriented programs to prevent type 2 diabetes in this and other populations of high-risk youth. TRIAL REGISTRATION NCT02615353, registered on June 8, 2016.
Collapse
Affiliation(s)
- Erica G Soltero
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85013, USA
| | - Yolanda P Konopken
- Family Wellness Program, Virginia G. Piper, St. Vincent de Paul Medical and Dental Clinic, 1730 E. Monroe Street, Phoenix, AZ, 85034, USA
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85013, USA.,Division of Endocrinology and Diabetes, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ, 85016, USA
| | - Colleen S Keller
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85013, USA
| | - Felipe G Castro
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85013, USA
| | - Allison N Williams
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85013, USA.,Southwest Interdisciplinary Research Center, Arizona State University, 411 N. Central Avenue, Suite 720, Phoenix, AZ, 85004-0693, USA
| | - Donald L Patrick
- Seattle Quality of Life Group, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, USA
| | - Stephanie Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, 411 N. Central Avenue, Suite 720, Phoenix, AZ, 85004-0693, USA
| | - Houchun H Hu
- Department of Radiology, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ, 85016, USA
| | - Matthew Sandoval
- Valley of the Sun YMCA, 350 N. 1st Avenue, Phoenix, AZ, 85003, USA
| | - Janiel Pimentel
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ, 85016, USA
| | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 4212 North 16th Street, Phoenix, AZ, 85016, USA
| | - Kevin D Frick
- Johns Hopkins Carey Business School, 100 International Drive, Baltimore, MD, 21202, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85013, USA. .,Division of Endocrinology and Diabetes, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ, 85016, USA. .,Southwest Interdisciplinary Research Center, Arizona State University, 411 N. Central Avenue, Suite 720, Phoenix, AZ, 85004-0693, USA.
| |
Collapse
|