1
|
Yu F, Pituch KA, Maxfield M, Baena E, Geda YE, Pruzin JJ, Coon DW, Shaibi GQ. The associations between type 2 diabetes and plasma biomarkers of Alzheimer's disease in the Health and Aging Brain Study: Health Disparities (HABS-HD). PLoS One 2024; 19:e0295749. [PMID: 38558059 PMCID: PMC10984470 DOI: 10.1371/journal.pone.0295749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 11/28/2023] [Indexed: 04/04/2024] Open
Abstract
Alzheimer's disease (AD) affects Latinos disproportionately. One of the reasons underlying this disparity may be type 2 diabetes (T2D) that is a risk factor for AD. The purpose of this study was to examine the associations of T2D and AD blood biomarkers and the differences in these associations between Mexican Americans and non-Hispanic Whites. This study was a secondary analysis of baseline data from the observational Health and Aging Brain Study: Health Disparities (HABS-HD) that investigated factors underlying health disparities in AD in Mexican Americans in comparison to non-Hispanic Whites. HABS-HD participants were excluded if they had missing data or were large outliers (z-scores >|4|) on a given AD biomarker. Fasting blood glucose and glycosylated hemoglobin (HbA1c) levels were measured from clinical labs. T2D was diagnosed by licensed clinicians. Plasma amyloid-beta 42 and 40 (Aβ42/42) ratio, total tau (t-tau), and neurofilament light (NfL) were measured via ultra-sensitive Simoa assays. The sample sizes were 1,552 for Aβ42/40 ratio, 1,570 for t-tau, and 1,553 for NfL. Mexican Americans were younger (66.6±8.7 vs. 69.5±8.6) and had more female (64.9% female vs. 55.1%) and fewer years of schooling (9.5±4.6 vs. 15.6±2.5) than non-Hispanic Whites. Mexican Americans differed significantly from non-Hispanic Whites in blood glucose (113.5±36.6 vs. 99.2±17.0) and HbA1c (6.33±1.4 vs. 5.51±0.6) levels, T2D diagnosis (35.3% vs. 11.1%), as well as blood Aβ42/40 ratio (.051±.012 vs. .047±.011), t-tau (2.56±.95 vs. 2.33±.90), and NfL levels (16.3±9.5 vs. 20.3±10.3). Blood glucose, blood HbA1c, and T2D diagnosis were not related to Aβ42/40 ratio and t-tau but explained 3.7% of the variation in NfL (p < .001). Blood glucose and T2D diagnosis were not, while HbA1c was positively (b = 2.31, p < .001, β = 0.26), associated with NfL among Mexican Americans. In contrast, blood glucose, HbA1c, and T2D diagnosis were negatively (b = -0.09, p < .01, β = -0.26), not (b = 0.34, p = .71, β = 0.04), and positively (b = 3.32, p < .01, β = 0.33) associated with NfL, respectively in non-Hispanic Whites. To conclude, blood glucose and HbA1c levels and T2D diagnosis are associated with plasma NfL levels, but not plasma Aβ and t-tau levels. These associations differ in an ethnicity-specific manner and need to be further studied as a potential mechanism underlying AD disparities.
Collapse
Affiliation(s)
- Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, United States of America
| | - Keenan A. Pituch
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, United States of America
| | - Molly Maxfield
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, United States of America
| | - Elsa Baena
- Clinical Neuropsychology Department, Barrow Neurological Institute, Phoenix, Arizona, United States of America
| | - Yonas E. Geda
- Department of Neurology and the Franke Neursciene Education Center, Barrow Neurological Institute, Phoenix, Arizona, United States of America
| | - Jeremy J. Pruzin
- Department of Neurology, Banner Alzheimer’s Institute, Phoenix, Arizona, United States of America
| | - David W. Coon
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, United States of America
| | - Gabriel Q. Shaibi
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, United States of America
| | | |
Collapse
|
2
|
DiStefano JK, Piras IS, Wu X, Sharma R, Garcia-Mansfield K, Willey M, Lovell B, Pirrotte P, Olson ML, Shaibi GQ. Changes in proteomic cargo of circulating extracellular vesicles in response to lifestyle intervention in adolescents with hepatic steatosis. Clin Nutr ESPEN 2024; 60:333-342. [PMID: 38479932 PMCID: PMC10937812 DOI: 10.1016/j.clnesp.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Recent studies suggest that proteomic cargo of extracellular vesicles (EVs) may play a role in metabolic improvements following lifestyle interventions. However, the relationship between changes in liver fat and circulating EV-derived protein cargo following intervention remains unexplored. METHODS The study cohort comprised 18 Latino adolescents with obesity and hepatic steatosis (12 males/6 females; average age 13.3 ± 1.2 y) who underwent a six-month lifestyle intervention. EV size distribution and concentration were determined by light scattering intensity; EV protein composition was characterized by liquid chromatography tandem-mass spectrometry. RESULTS Average hepatic fat fraction (HFF) decreased 23% by the end of the intervention (12.5% [5.5] to 9.6% [4.9]; P = 0.0077). Mean EV size was smaller post-intervention compared to baseline (120.2 ± 16.4 nm to 128.4 ± 16.5 nm; P = 0.031), although the difference in mean EV concentration (1.1E+09 ± 4.1E+08 particles/mL to 1.1E+09 ± 1.8E+08 particles/mL; P = 0.656)) remained unchanged. A total of 462 proteins were identified by proteomic analysis of plasma-derived EVs from participants pre- and post-intervention, with 113 proteins showing differential abundance (56 higher and 57 lower) between the two timepoints (adj-p <0.05). Pathway analysis revealed enrichment in complement cascade, initial triggering of complement, creation of C4 and C2 activators, and regulation of complement cascade. Hepatocyte-specific EV affinity purification identified 40 proteins with suggestive (p < 0.05) differential abundance between pre- and post-intervention samples. CONCLUSIONS Circulating EV-derived proteins, particularly those associated with the complement cascade, may contribute to improvements in liver fat in response to lifestyle intervention.
Collapse
Affiliation(s)
- Johanna K DiStefano
- Diabetes and Metabolic Disease Research Unit, Translational Genomics Research Institute, Phoenix, AZ, USA.
| | - Ignazio S Piras
- Neurogenomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Xiumei Wu
- Diabetes and Metabolic Disease Research Unit, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Ritin Sharma
- Integrated Mass Spectrometry Shared Resource, City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Cancer & Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Krystine Garcia-Mansfield
- Integrated Mass Spectrometry Shared Resource, City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Cancer & Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Maya Willey
- Integrated Mass Spectrometry Shared Resource, City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Cancer & Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Brooke Lovell
- Integrated Mass Spectrometry Shared Resource, City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Cancer & Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Patrick Pirrotte
- Integrated Mass Spectrometry Shared Resource, City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Cancer & Cell Biology Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Micah L Olson
- Division of Endocrinology and Diabetes, Phoenix Children's, Phoenix, AZ, USA; Center for Health Promotion and Disease Prevention, Edson College of Nursing, Arizona State University, Phoenix, AZ, USA
| | - Gabriel Q Shaibi
- Division of Endocrinology and Diabetes, Phoenix Children's, Phoenix, AZ, USA; Center for Health Promotion and Disease Prevention, Edson College of Nursing, Arizona State University, Phoenix, AZ, USA
| |
Collapse
|
3
|
Chakravarthy V, Barger K, Gonsalves R, Shaibi GQ, Vaidya V, Kapadia C, Newbern D. Implementation of IT supported standardization of individualized hydrocortisone management for treatment of patients with adrenal insufficiency. J Pediatr Endocrinol Metab 2023; 36:1175-1180. [PMID: 37915243 DOI: 10.1515/jpem-2023-0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Hydrocortisone stress dosing guidelines for children with adrenal insufficiency (AI) recommend a wide range of acceptable stress doses. This has led to variability in dosing recommendations resulting in confusion among endocrine, non-endocrine providers and patient families. This quality improvement project sought to standardize documentation and hydrocortisone stress dosing within our pediatric endocrine division to optimize communication regarding AI management. METHODS Plan-Do-Study-Act (PDSA) cycle one aimed to address documentation of components important in AI management including body surface area (BSA), home daily dose, home stress dose, in-patient stress dose, procedure dose and crisis dose using a smart phrase within the electronic health record (EHR). To automate the process, PDSA cycle two introduced two smart buttons within the endocrine notes. PDSA cycle three focused on standardizing hydrocortisone stress doses. RESULTS Initial documentation targets were met for all AI management components except for the crisis dose. The second target was only met for the home stress dose. Implementing the smart buttons aided in reaching the second target for home daily and home stress doses. Dose standardization targets were achieved in all categories except for the on-going crisis dose. A follow up survey after an in-service for non-endocrine providers showed increased knowledge of locating hydrocortisone stress dosing recommendations within the EHR. CONCLUSIONS With the assistance of technology, this quality improvement project ultimately enhanced communication through the standardization of documentation and individualized hydrocortisone stress dosing for children with AI. Although not all secondary targets were met, there was meaningful improvement in documentation and stress dose standardization compliance.
Collapse
Affiliation(s)
| | - Katie Barger
- Pediatric Endocrinology and Diabetes, Phoenix Children's, Phoenix, AZ, USA
| | - Rob Gonsalves
- Pediatric Endocrinology and Diabetes, Phoenix Children's, Phoenix, AZ, USA
| | - Gabriel Q Shaibi
- Pediatric Endocrinology and Diabetes, Phoenix Children's, Phoenix, AZ, USA
| | - Vinay Vaidya
- Department of Information Technology, Phoenix Children's, Phoenix, AZ, USA
| | - Chirag Kapadia
- Pediatric Endocrinology and Diabetes, Phoenix Children's, Phoenix, AZ, USA
| | - Dorothee Newbern
- Pediatric Endocrinology and Diabetes, Phoenix Children's, Phoenix, AZ, USA
| |
Collapse
|
4
|
Braxton ME, Nwabichie E, Diaz M, Lish E, Ayers SL, Williams AN, Tornel M, McKim P, Treichel J, Knowler WC, Olson ML, Shaibi GQ. Preventing diabetes in Latino families: A protocol for a randomized control trial. Contemp Clin Trials 2023; 135:107361. [PMID: 37852533 PMCID: PMC10790650 DOI: 10.1016/j.cct.2023.107361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/18/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Latino families are disproportionately affected by type 2 diabetes (T2D) and lifestyle intervention is the first-line approach for preventing T2D. The purpose of this study is to test the efficacy of a culturally-grounded lifestyle intervention that prioritizes health promotion and diabetes prevention for Latino families. The intervention is guided by a novel Family Diabetes Prevention Model, leveraging the family processes of engagement, empowerment, resilience, and cohesion to orient the family system towards health. METHOD Latino families (N = 132) will be recruited and assessed for glucose tolerance as measured by an Oral Glucose Tolerance Test (OGTT) and General and Weight-Specific Quality of Life (QoL) at baseline, four months, and 12 months. All members of the household age 10 and over will be invited to participate. Families will be randomized to the intervention group or a control group (2:1). The 16-week intervention includes weekly nutrition and wellness classes delivered by bilingual, bicultural Registered Dietitians and community health educators at a local YMCA along with two days/week of supervised physical activity classes and a third day of unsupervised physical activity. Control families will meet with a physician and a Registered Dietitian to discuss the results of their metabolic testing and recommend lifestyle changes. We will test the efficacy of a family-focused diabetes prevention intervention for improving glucose tolerance and increasing QoL and test for mediators and moderators of long-term changes. CONCLUSION This study will provide much needed data on the efficacy of a family-focused Diabetes Prevention Program among high-risk Latino families.
Collapse
Affiliation(s)
- Morgan E Braxton
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA
| | - Eucharia Nwabichie
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA
| | - Monica Diaz
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA; Ivy Center for Family Wellness, The Society of St Vincent de Paul, USA
| | - Elvia Lish
- Ivy Center for Family Wellness, The Society of St Vincent de Paul, USA
| | - Stephanie L Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, USA
| | - Allison N Williams
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA
| | - Mayra Tornel
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA
| | | | | | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, USA
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA; Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA; Southwest Interdisciplinary Research Center, Arizona State University, USA; Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, USA.
| |
Collapse
|
5
|
Peña A, Olson ML, Ayers SL, Sears DD, Vega-López S, Colburn AT, Shaibi GQ. Inflammatory Mediators and Type 2 Diabetes Risk Factors before and in Response to Lifestyle Intervention among Latino Adolescents with Obesity. Nutrients 2023; 15:nu15112442. [PMID: 37299403 DOI: 10.3390/nu15112442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Obesity is associated with chronic inflammation that may contribute to T2D among youth. We examined the association between inflammatory biomarkers and insulin sensitivity and β-cell function and response to lifestyle intervention among Latino youth with obesity. Latino youth (n = 64) were randomized to six months of lifestyle intervention (INT, n = 40) or usual care (UC, n = 24). INT included nutrition education and physical activity. UC involved meeting with a pediatric endocrinologist and registered dietitian to discuss healthy lifestyles. At baseline, multiple linear regression assessed fasting serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), high-molecular weight adiponectin (HMW Adpn), IL-10, IL-1 receptor antagonist (IL-1ra) as predictors of insulin sensitivity (whole-body insulin sensitivity index, WBISI) and β-cell function (oral disposition index, oDI). Changes in outcomes between groups were assessed using covariance pattern models. At baseline, MCP-1 (β ± SE, -0.12 ± 0.05, p = 0.027) and IL-1ra (-0.03 ± 0.01, p = 0.005) were negatively associated with WBISI. Treatment effects were not observed for inflammatory markers. WBISI was significantly increased among both INT (from 1.8 ± 0.2 to 2.6 ± 0.4, p = 0.005) and UC (from 1.6 ± 0.2 to 2.8 ± 0.5, p = 0.002) with no significant differences between the groups. Obesity-related inflammatory mediators were associated with T2D risk factors but were unaffected by lifestyle intervention among Latino youth.
Collapse
Affiliation(s)
- Armando Peña
- Department of Health and Wellness Design, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ 85004, USA
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ 85004, USA
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ 85016, USA
| | - Stephanie L Ayers
- Southwestern Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA
| | - Dorothy D Sears
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Sonia Vega-López
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
- Southwestern Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA
| | - Abigail T Colburn
- Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
- John B. Pierce Laboratory, Yale School of Medicine, New Haven, CT 06519, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ 85004, USA
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ 85016, USA
- Southwestern Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA
| |
Collapse
|
6
|
Standage-Beier CS, Garcia LA, De Filippis E, Shaibi GQ, Mandarino LJ, Coletta DK. Association of Vitamin D Receptor Gene Polymorphisms with Cardiometabolic Phenotypes in Hispanics: A Life Course Approach. Nutrients 2023; 15:2118. [PMID: 37432296 PMCID: PMC10180542 DOI: 10.3390/nu15092118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 07/12/2023] Open
Abstract
The vitamin D receptor (VDR) is vital for maintaining calcium and phosphate balance and regulating bone metabolism. Recent research has suggested that VDR also plays an essential role in metabolic diseases. Previous studies on non-Hispanic whites have shown that VDR single nucleotide polymorphisms (SNP) are associated with cardiometabolic phenotypes. However, the association between VDR SNPs and cardiometabolic traits in Hispanics remains unclear. This study investigated the association between VDR SNPs and cardiometabolic phenotypic data in self-reported Hispanics (n = 1610) from the Arizona Insulin Resistance registry and Sangre Por Salud Biobank. The study population was predominantly female (66.4%) with a mean age of 40 ± 14 years (n = 121 <18 years) and an average body mass index (BMI) of 29.8 ± 6.3 kg/m2. We performed a genotyping association analysis of VDR SNPs (Taq1-rs731236, Fok1-rs2228570 and Apa1-rs7975232) with cardiometabolic traits using linear regression models. The results showed that Taq1 and Apa1 were strongly associated with systolic blood pressure (SBP) in children (<18 years), while Fok1 was associated with measures of adiposity, including fat mass, waist circumference, and BMI. In age-stratified adult (≥18 years) models, Taq1 was strongly associated with hemoglobin A1c, while Apa1 was associated with BMI and fasting glucose. Fok1 had no significant associations in the adult models. In conclusion, the VDR SNPs were associated with several cardiometabolic phenotypes in this Hispanic sample, but the type and strength of the associations varied by age group.
Collapse
Affiliation(s)
| | - Luis A. Garcia
- Center for Disparities in Diabetes, Obesity, and Metabolism, University of Arizona, Tucson, AZ 85724, USA; (L.A.G.); (L.J.M.)
| | - Eleanna De Filippis
- Division of Endocrinology, Metabolism and Diabetes, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA;
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ 85004, USA;
| | - Lawrence J. Mandarino
- Center for Disparities in Diabetes, Obesity, and Metabolism, University of Arizona, Tucson, AZ 85724, USA; (L.A.G.); (L.J.M.)
- Department of Medicine, Division of Endocrinology, University of Arizona, Tucson, AZ 85724, USA
| | - Dawn K. Coletta
- Center for Disparities in Diabetes, Obesity, and Metabolism, University of Arizona, Tucson, AZ 85724, USA; (L.A.G.); (L.J.M.)
- Department of Medicine, Division of Endocrinology, University of Arizona, Tucson, AZ 85724, USA
- Department of Physiology, University of Arizona, Tucson, AZ 85724, USA
| |
Collapse
|
7
|
Linder JE, Allworth A, Bland HT, Caraballo PJ, Chisholm RL, Clayton EW, Crosslin DR, Dikilitas O, DiVietro A, Esplin ED, Forman S, Freimuth RR, Gordon AS, Green R, Harden MV, Holm IA, Jarvik GP, Karlson EW, Labrecque S, Lennon NJ, Limdi NA, Mittendorf KF, Murphy SN, Orlando L, Prows CA, Rasmussen LV, Rasmussen-Torvik L, Rowley R, Sawicki KT, Schmidlen T, Terek S, Veenstra D, Velez Edwards DR, Absher D, Abul-Husn NS, Alsip J, Bangash H, Beasley M, Below JE, Berner ES, Booth J, Chung WK, Cimino JJ, Connolly J, Davis P, Devine B, Fullerton SM, Guiducci C, Habrat ML, Hain H, Hakonarson H, Harr M, Haverfield E, Hernandez V, Hoell C, Horike-Pyne M, Hripcsak G, Irvin MR, Kachulis C, Karavite D, Kenny EE, Khan A, Kiryluk K, Korf B, Kottyan L, Kullo IJ, Larkin K, Liu C, Malolepsza E, Manolio TA, May T, McNally EM, Mentch F, Miller A, Mooney SD, Murali P, Mutai B, Muthu N, Namjou B, Perez EF, Puckelwartz MJ, Rakhra-Burris T, Roden DM, Rosenthal EA, Saadatagah S, Sabatello M, Schaid DJ, Schultz B, Seabolt L, Shaibi GQ, Sharp RR, Shirts B, Smith ME, Smoller JW, Sterling R, Suckiel SA, Thayer J, Tiwari HK, Trinidad SB, Walunas T, Wei WQ, Wells QS, Weng C, Wiesner GL, Wiley K, Peterson JF. Returning integrated genomic risk and clinical recommendations: The eMERGE study. Genet Med 2023; 25:100006. [PMID: 36621880 PMCID: PMC10085845 DOI: 10.1016/j.gim.2023.100006] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Assessing the risk of common, complex diseases requires consideration of clinical risk factors as well as monogenic and polygenic risks, which in turn may be reflected in family history. Returning risks to individuals and providers may influence preventive care or use of prophylactic therapies for those individuals at high genetic risk. METHODS To enable integrated genetic risk assessment, the eMERGE (electronic MEdical Records and GEnomics) network is enrolling 25,000 diverse individuals in a prospective cohort study across 10 sites. The network developed methods to return cross-ancestry polygenic risk scores, monogenic risks, family history, and clinical risk assessments via a genome-informed risk assessment (GIRA) report and will assess uptake of care recommendations after return of results. RESULTS GIRAs include summary care recommendations for 11 conditions, education pages, and clinical laboratory reports. The return of high-risk GIRA to individuals and providers includes guidelines for care and lifestyle recommendations. Assembling the GIRA required infrastructure and workflows for ingesting and presenting content from multiple sources. Recruitment began in February 2022. CONCLUSION Return of a novel report for communicating monogenic, polygenic, and family history-based risk factors will inform the benefits of integrated genetic risk assessment for routine health care.
Collapse
Affiliation(s)
- Jodell E Linder
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Aimee Allworth
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Harris T Bland
- Department of Biomedical Informatics and Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Pedro J Caraballo
- Department of Internal Medicine and Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Rex L Chisholm
- Center for Genetic Medicine, Northwestern University, Chicago, IL
| | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN
| | - David R Crosslin
- Division of Biomedical Informatics and Genomics, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Ozan Dikilitas
- Mayo Clinician Investigator Training Program, Department of Internal Medicine and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Alanna DiVietro
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | | | - Sophie Forman
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Robert R Freimuth
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN
| | - Adam S Gordon
- Department of Pharmacology, Feinberg School of Medicine, and Center for Genetic Medicine, Northwestern University, Chicago, IL
| | - Richard Green
- Department of Biomedical Informatics and Medical Education, University of Washington Medical Center, Seattle, WA
| | | | - Ingrid A Holm
- Division of Genetics and Genomics and Manton Center for Orphan Diseases Research, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine and Department of Genome Science, University of Washington Medical Center, Seattle, WA
| | - Elizabeth W Karlson
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sofia Labrecque
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | | | - Nita A Limdi
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Kathleen F Mittendorf
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Shawn N Murphy
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Lori Orlando
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC
| | - Cynthia A Prows
- Divisions of Human Genetics and Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Luke V Rasmussen
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | | | - Robb Rowley
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD
| | - Konrad Teodor Sawicki
- Department of Cardiology and Center for Genetic Medicine, Northwestern University, Chicago, IL
| | | | - Shannon Terek
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - David Veenstra
- School of Pharmacy, University of Washington, Seattle, WA
| | - Digna R Velez Edwards
- Division of Quantitative Science, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Vanderbilt University Medical Center, Nashville, TN
| | | | - Noura S Abul-Husn
- Institute for Genomic Health, Department of Medicine, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Hana Bangash
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mark Beasley
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Jennifer E Below
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Eta S Berner
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL
| | - James Booth
- Department of Emergency Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University Irving Medical Center, Columbia University, New York, NY
| | - James J Cimino
- Division of General Internal Medicine and the Informatics Institute, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - John Connolly
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Patrick Davis
- Department of Biomedical Informatics and Medical Education, University of Washington Medical Center, Seattle, WA
| | - Beth Devine
- School of Pharmacy, University of Washington, Seattle, WA
| | - Stephanie M Fullerton
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA
| | | | - Melissa L Habrat
- Department of Biomedical Informatics and Medical Education, University of Washington Medical Center, Seattle, WA
| | - Heather Hain
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Hakon Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Margaret Harr
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Christin Hoell
- Department of Obstetrics & Gynecology and Center for Genetic Medicine, Northwestern University, Chicago, IL
| | - Martha Horike-Pyne
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, Columbia University, New York, NY
| | - Marguerite R Irvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | | | - Dean Karavite
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Eimear E Kenny
- Institute for Genomic Health, Department of Medicine, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Atlas Khan
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Bruce Korf
- Department of Genetics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Leah Kottyan
- The Center for Autoimmune Genomics and Etiology, Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Katie Larkin
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Cong Liu
- Department of Biomedical Informatics, Columbia University Irving Medical Center, Columbia University, New York, NY
| | | | - Teri A Manolio
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD
| | - Thomas May
- Elson S. Floyd College of Medicine, Washington State University, Vancouver, WA
| | | | - Frank Mentch
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alexandra Miller
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sean D Mooney
- Department of Biomedical Informatics and Medical Education, University of Washington Medical Center, Seattle, WA
| | - Priyanka Murali
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Brenda Mutai
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Naveen Muthu
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bahram Namjou
- The Center for Autoimmune Genomics and Etiology, Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Emma F Perez
- Department of Medicine, Brigham and Women's Hospital, Mass General Brigham Personalized Medicine, Boston, MA
| | - Megan J Puckelwartz
- Department of Pharmacology, Feinberg School of Medicine, and Center for Genetic Medicine, Northwestern University, Chicago, IL
| | | | - Dan M Roden
- Departments of Medicine, Pharmacology, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Elisabeth A Rosenthal
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | | | - Maya Sabatello
- Division of Nephrology, Department of Medicine & Division of Ethics, Department of Medical Humanities and Ethics, Columbia University Irving Medical Center, New York, NY
| | - Dan J Schaid
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Baergen Schultz
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD
| | - Lynn Seabolt
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ
| | - Richard R Sharp
- Biomedical Ethics Program, Department of Quantitative Health Science, Mayo Clinic, Rochester, MN
| | - Brian Shirts
- Department of Laboratory Medicine & Pathology, University of Washington Medical Center, Seattle, WA
| | - Maureen E Smith
- Department of Cardiology and Center for Genetic Medicine, Northwestern University, Chicago, IL
| | - Jordan W Smoller
- Department of Psychiatry and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Rene Sterling
- Division of Genomics and Society, National Human Genome Research Institute, Bethesda, MD
| | - Sabrina A Suckiel
- The Institute for Genomic Health, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeritt Thayer
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Hemant K Tiwari
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Susan B Trinidad
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA
| | - Theresa Walunas
- Department of Medicine and Center for Health Information Partnerships, Northwestern University, Chicago, IL
| | - Wei-Qi Wei
- Department of Biomedical Informatics and Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Quinn S Wells
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University Irving Medical Center, Columbia University, New York, NY
| | - Georgia L Wiesner
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Ken Wiley
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, MD
| | - Josh F Peterson
- Center for Precision Medicine, Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.
| |
Collapse
|
8
|
McNeish D, Peña A, Vander Wyst KB, Ayers SL, Olson ML, Shaibi GQ. Facilitating Growth Mixture Model Convergence in Preventive Interventions. Prev Sci 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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
9
|
Cielonko LA, Sabati AA, Chambers MA, Newbern D, Swing E, Chakravarthy V, Mullen J, Schmidt J, Lutz N, Shaibi GQ, Olson M. Impact of overweight and obesity on epicardial adipose tissue in children with type 1 diabetes. J Pediatr Endocrinol Metab 2023; 36:371-377. [PMID: 36829271 DOI: 10.1515/jpem-2022-0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVES Epicardial adipose tissue (EAT) thickness, a novel marker of cardiovascular disease (CVD), is increased in children with a healthy weight and type 1 diabetes (T1D). The prevalence of obesity has increased in children with T1D and may confer additional CVD risk. The purpose of this study was to examine EAT thickness in youth with and without T1D in the setting of overweight/obesity. METHODS Youth with overweight/obesity and T1D (n=38) or without T1D (n=34) between the ages of 6-18 years were included in this study. Echocardiogram using spectral and color flow Doppler was used to measure EAT and cardiac function. Waist circumference, blood pressure, and HbA1c, were used to calculate estimated glucose disposal rate (eGDR) to estimate insulin resistance in children with T1D. RESULTS EAT thickness was not significantly different in youth with T1D compared to controls (2.10 ± 0.67 mm vs. 1.90 ± 0.59 mm, p=0.19). When groups were combined, EAT significantly correlated with age (r=0.449, p≤0.001), BMI (r=0.538, p≤0.001), waist circumference (r=0.552, p≤0.001), systolic BP (r=0.247, p=0.036), myocardial performance index (r=-0.287, p=0.015), ejection fraction (r=-0.442, p≤0.001), and cardiac output index (r=-0.306, p=0.009). In the group with T1D, diastolic BP (r=0.39, p=0.02) and eGDR (r=-0.48, p=0.002) correlated with EAT. CONCLUSIONS EAT was associated with measures of adiposity and insulin resistance but does not differ by diabetes status among youth with overweight/obesity. These findings suggest that adiposity rather than glycemia is the main driver of EAT thickness among youth with T1D.
Collapse
Affiliation(s)
- Luke A Cielonko
- Division of Endocrinology, Cook Children's Medical Center, Fort Worth, TX, USA
- Division of Pediatric Endocrinology & Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Arash A Sabati
- Division of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Melissa A Chambers
- Division of Pediatric Endocrinology & Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Dorothee Newbern
- Division of Pediatric Endocrinology & Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Edward Swing
- Division of Graduate Medical Education, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Varshini Chakravarthy
- Division of Pediatric Endocrinology & Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - John Mullen
- Division of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Jaclyn Schmidt
- Division of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Natalie Lutz
- Division of Pediatric Endocrinology & Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Gabriel Q Shaibi
- Division of Pediatric Endocrinology & Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Micah Olson
- Division of Pediatric Endocrinology & Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| |
Collapse
|
10
|
Peña A, Olson ML, Hooker E, Ayers SL, Castro FG, Patrick DL, Corral L, Lish E, Knowler WC, Shaibi GQ. Effects of a Diabetes Prevention Program on Type 2 Diabetes Risk Factors and Quality of Life Among Latino Youths With Prediabetes: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2231196. [PMID: 36094502 PMCID: PMC9468887 DOI: 10.1001/jamanetworkopen.2022.31196] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Latino youths are disproportionately impacted by prediabetes and type 2 diabetes (T2D). Lifestyle intervention is the first-line approach for preventing or delaying T2D among adults with prediabetes. OBJECTIVE To assess the efficacy of a diabetes prevention program among Latino youths aged 12 to 16 years with prediabetes. DESIGN, SETTING, AND PARTICIPANTS This 2-group parallel randomized clinical trial with 2:1 randomization assessed a lifestyle intervention against usual care among Latino youths with prediabetes and obesity with 6- and 12-month follow-up. The study was conducted at YMCA facilities in Phoenix, Arizona from May 2016 to March 2020. INTERVENTION Participants were randomized to lifestyle intervention (INT) or usual care control (UCC). The 6-month INT included 1 d/wk of nutrition and health education and 3 d/wk of physical activity. UCC included 2 visits with a pediatric endocrinologist and a bilingual, bicultural registered dietitian to discuss diabetes risks and healthy lifestyle changes. MAIN OUTCOMES AND MEASURES Insulin sensitivity, glucose tolerance, and weight-specific quality of life (YQOL-W) at 6- and 12-month follow-up. RESULTS A total of 117 Latino youths (mean [SD] age, 14 [1] years; 47 [40.1%] girls) were included in the analysis. Overall, 79 were randomized to INT and 38 to UCC. At 6 months, the INT led to significant decreases in mean (SE) 2-hour glucose (baseline: 144 [3] mg/dL; 6 months: 132 [3] mg/dL; P = .002) and increases in mean (SE) insulin sensitivity (baseline: 1.9 [0.2]; 6 months: 2.6 [0.3]; P = .001) and YQOL-W (baseline: 75 [2]; 6 months: 80 [2]; P = .006), but these changes were not significantly different from UCC (2-hour glucose: mean difference, -7.2 mg/dL; 95% CI, -19.7 to 5.3 mg/dL; P for interaction = .26; insulin sensitivity: mean difference, 0.1; 95% CI, -0.7 to 0.9; P for interaction = .79; YQOL-W: mean difference, 6.3; 95% CI, -1.1 to 13.7; P for interaction = .10, respectively). Both INT (mean [SE], -15 mg/dL [4.9]; P = .002) and UCC (mean [SE], -15 mg/dL [5.4]; P = .005) had significant 12-month reductions in 2-hour glucose that did not differ significantly from each other (mean difference, -0.3; 95% CI, -14.5 to 14.1 mg/dL; P for interaction = .97). At 12 months, changes in mean (SE) insulin sensitivity in INT (baseline: 1.9 [0.2]; 12 months: 2.3 [0.2]; P = .06) and UCC (baseline: 1.9 [0.3]; 12 months: 2.0 [0.2]; P = .70) were not significantly different (mean difference, 0.3; 95% CI, -0.4 to 1.0; P for interaction = .37). At 12 months, YQOL-W was significantly increased in INT (basline: 75 [2]; 12 months: 82 [2]; P < .001) vs UCC (mean difference, 8.5; 95% CI, 0.8 to 16.2; P for interaction = .03). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, both INT and UCC led to similar changes in T2D risk factors among Latino youths with diabetes; however, YQOL-W was improved in INT compared with UCC. Diabetes prevention interventions that are effective in adults also appeared to be effective in high risk youths. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02615353.
Collapse
Affiliation(s)
- Armando Peña
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix
| | - Micah L. Olson
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, Arizona
| | - Elva Hooker
- Ivy Center for Family Wellness, The Society of St Vincent de Paul, Phoenix, Arizona
| | - Stephanie L. Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix
| | | | | | | | - Elvia Lish
- Ivy Center for Family Wellness, The Society of St Vincent de Paul, Phoenix, Arizona
| | - William C. Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, Arizona
| |
Collapse
|
11
|
Chambers M, Hoekstra F, Radcliffe IK, Puffenberger S, Holzmeister LA, McClellan DR, Shaibi GQ, Kapadia C. Feasibility, Acceptability, and Preliminary Efficacy of an Intensive Clinic-Based Intervention for Children with Poorly Controlled Type 1 Diabetes. Endocr Pract 2022; 28:1146-1151. [PMID: 35952986 DOI: 10.1016/j.eprac.2022.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/16/2022] [Accepted: 07/22/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the feasibility, acceptability and preliminary efficacy of a team-based intervention for youth with type 1 diabetes (T1D) with suboptimal glycemia as measured by hemoglobin A1c (HbA1c). METHODS 40 participants with T1D >1 year and HbA1c ≥9.5% (80mmol/mol) enrolled in a multidisciplinary intervention that included pediatric endocrinology, pediatric psychology, and a Certified Diabetes Care and Education Specialist (CDCES). The CDCES integrated medical management while reinforcing physical, emotional, and behavioral health, connected with families to set and monitor goals, and reviewed medication adjustments. Feasibility was assessed by enrollment targets, acceptability by retention rates, and preliminary efficacy by changes in HbA1c, quality of life (QoL), diabetes strengths and resilience, and hospital admissions, emergency room visits, and school days missed. RESULTS Of the 43 patients and families approached, 40 agreed to participate, 36 completed the 4-month intervention and 31 completed full 8-month follow-up data collection. The CDCES coach averaged 6.8 contacts per participant during the 8-month study period. HbA1c was reduced significantly from baseline to 4-months (12.1±1.6% to 11.0±1.9%, p=0.001) and sustained at 8-months (10.7±1.9%, p<0.001). Participants reported significant increases in diabetes-specific QoL (p<0.05) and diabetes strength and resilience (p=0.003). School days missed was reduced from 7.23±7.5 days to 1.55±1.9 days (p <0.001) and diabetes-related hospitalizations decreased from 0.4±0.6 to 0.1±0.3 (p=0.009). CONCLUSIONS Preliminary data suggest that a multidisciplinary intervention leveraging a team approach with a physician, psychologist and CDCES can support improvements in glycemic control and psychosocial outcomes among youth with type 1 diabetes with HbA1c above target.
Collapse
Affiliation(s)
- Melissa Chambers
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ.
| | - Fran Hoekstra
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ
| | - Ivy K Radcliffe
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ
| | - Synthia Puffenberger
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ
| | - Lea Ann Holzmeister
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ
| | - Donald R McClellan
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ
| | - Gabriel Q Shaibi
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ; Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Chirag Kapadia
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ
| |
Collapse
|
12
|
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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
13
|
Lee RE, Szeszulski J, Lorenzo E, Arriola A, Bruening M, Estabrooks PA, Hill JL, O’Connor TM, Shaibi GQ, Soltero EG, Todd M. Sustainability via Active Garden Education: The Sustainability Action Plan Model and Process. Int J Environ Res Public Health 2022; 19:5511. [PMID: 35564909 PMCID: PMC9102810 DOI: 10.3390/ijerph19095511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/16/2022] [Accepted: 04/27/2022] [Indexed: 02/06/2023]
Abstract
Sustainability of intervention programming is challenging to achieve under real world conditions, since few models exist and many studies do not plan far beyond the funding period. Programming content in early care and education centers (ECECs) is often driven by guidelines. However, implementation is very sensitive to contextual factors, such as the setting and implementer (teacher) characteristics. This paper presents the model, definitions, and methodology used for the sustainability action plan capitalizing on a community-based participatory research (CBPR) approach, developed for a multi-site, multi-level garden-based childhood obesity prevention study, Sustainability via Active Garden Education (SAGE). The Ecologic Model of Obesity is applied to develop a sustainability action plan (SAP) and accompanying measures to link early care and education (ECE) environment, the community, policies, and classroom practices to an early childhood obesity prevention program. The SAGE SAP provides an example of how to iteratively evaluate and refine sustainability processes for an obesity prevention intervention utilizing CBPR approaches and will be applied to assess the sustainability of SAGE in a cluster randomized controlled trial. This SAP model can also help inform intervention delivery and scalability within ECECs.
Collapse
Affiliation(s)
- Rebecca E. Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd St., Phoenix, AZ 85004, USA;
| | - Jacob Szeszulski
- Institute for Advancing Health through Agriculture (IHA), Texas A&M AgriLife Research, 17360 Coit Rd., Dallas, TX 75252, USA;
| | - Elizabeth Lorenzo
- School of Nursing, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
| | - Anel Arriola
- City of Phoenix Office of Arts and Culture, 200 W. Washington St., 10th Floor, Phoenix, AZ 85003, USA;
| | - Meg Bruening
- College of Health Solutions, Arizona State University, 550 N. 3rd St., Phoenix, AZ 85004, USA;
| | - Paul A. Estabrooks
- College of Health, University of Utah, 260 1850 E, Salt Lake City, UT 84112, USA;
| | - Jennie L. Hill
- Population Health Sciences, University of Utah, 295 S Chipeta Way, Salt Lake City, UT 84108, USA;
| | - Teresia M. O’Connor
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; (T.M.O.); (E.G.S.)
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd St., Phoenix, AZ 85004, USA;
| | - Erica G. Soltero
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; (T.M.O.); (E.G.S.)
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd St., Phoenix, AZ 85004, USA;
| |
Collapse
|
14
|
Pimentel JL, Vander Wyst KB, Soltero EG, Peña A, Hu HH, Bailey S, Pokorney A, Ayers S, Valencia AM, Olson ML, Shaibi GQ. Organ fat in Latino youth at risk for type 2 diabetes. Pediatr Diabetes 2022; 23:286-290. [PMID: 35001468 PMCID: PMC8983449 DOI: 10.1111/pedi.13311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/13/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Obesity in youth increases the risk for type 2 diabetes (T2D) and elevated abdominal adipose tissue and organ fat may be particularly deleterious. The purpose of this study was to examine associations among measures of adiposity including total, visceral, and organ fat (hepatic and pancreatic) and whether these measures were independently associated with glycemia in Latino youth at risk for diabetes. METHODS Latino adolescents (47 boys and 32 girls, 13.7 ± 1.4 years) with obesity (BMIz 2.3 ± 0.3) were assessed for total fat by DXA and visceral and organ fat by 3 T magnetic resonance imaging. Glycemic indicators included HbA1c, fasting glucose (FG), and 2-h glucose (2-HrG) following an oral glucose tolerance test. Pearson correlations and stepwise linear regression analyses controlling for age and sex were used to examine independent associations between adiposity and glycemia. RESULTS Total fat was associated with visceral (r = 0.66, p = 0.001) and hepatic fat (r = 0.34, p < 0.01) while visceral fat was associated with hepatic (r = 0.42, p < 0.001) and pancreatic fat (r = 0.36, p < 0.001). In stepwise linear regression analysis, hepatic and pancreatic fat were significant predictors of FG, explaining 4.7% and 5.2% of the variance, respectively (total R2 = 0.14, p = 0.02). Hepatic fat was the only significant predictor of 2-HrG explaining 9.9% of the variance in the model (total R2 = 0.12, p = 0.03). No measure of adiposity was retained as a significant predictor of HbA1c. CONCLUSION Hepatic and pancreatic fat were the only adiposity measures independently associated with glycemia but the small amount of variance explained underscores the need for additional T2D biomarkers in high risk youth.
Collapse
Affiliation(s)
- Janiel L. Pimentel
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ,Division of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, AZ
| | - Kiley B. Vander Wyst
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ,Master of Public Health Program, College of Graduate Studies, Midwestern University, Glendale, AZ
| | - Erica G. Soltero
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ,Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Armando Peña
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Houchun H. Hu
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ,Hyperfine, Inc., Guilford, CT
| | - Smita Bailey
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ,Department of Radiology, Phoenix Children’s Hospital, Phoenix, AZ
| | - Amber Pokorney
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ,Department of Radiology, Phoenix Children’s Hospital, Phoenix, AZ
| | - Stephanie Ayers
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Ana Martinez Valencia
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Micah L. Olson
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ,Division of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, AZ
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ,Division of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, AZ
| |
Collapse
|
15
|
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: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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
|
16
|
Szeszulski J, Lorenzo E, Todd M, O’Connor TM, Hill J, Shaibi GQ, Vega-López S, Buman MP, Hooker SP, Lee RE. Early Care and Education Center Environmental Factors Associated with Product- and Process-Based Locomotor Outcomes in Preschool-Age Children. Int J Environ Res Public Health 2022; 19:ijerph19042208. [PMID: 35206392 PMCID: PMC8871663 DOI: 10.3390/ijerph19042208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 11/27/2022]
Abstract
Environmental characteristics of early care and education centers (ECECs) are an important context for preschool-aged children’s development, but few studies have examined their relationship with children’s locomotor skills. We examined the association between characteristics of the ECEC environment with quantitatively (i.e., product-based) and qualitatively (i.e., process-based) measured locomotor skills, using the Progressive Aerobic Cardiovascular Endurance Run (PACER) and the locomotor portion of the Children’s Activity and Movement in Preschool Study (CHAMPS) motor skills protocol (CMSP), respectively. ECEC characteristics included outdoor and indoor play environment quality, outdoor and indoor play equipment, screen-time environment quality, and policy environment quality. Mean (SD) scores for the PACER (n = 142) and CSMP (n = 91) were 3.7 ± 2.3 laps and 19.0 ± 5.5 criteria, respectively, which were moderately correlated with each other (Pearson r = 0.5; p < 0.001). Linear regression models revelated that a better policy environment score was associated with fewer PACER laps. Better outdoor play and screen-time environment quality scores and more outdoor play equipment were positively associated with higher CMSP scores. ECEC environments that reflect best practice guidelines may be opportunities for locomotor skills development in preschool-aged children. ClinicalTrials.gov Identifier: NCT03261492 (8/25/17).
Collapse
Affiliation(s)
- Jacob Szeszulski
- Institute for Advancing Health through Agriculture, Texas A&M AgriLife Research, 17360 Coit Rd., Dallas, TX 75252, USA
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 North 3rd St., Phoenix, AZ 85004, USA; (E.L.); (G.Q.S.)
- College of Health Solutions, Arizona State University, 550 North 5th St., Phoenix, AZ 85004, USA; (S.V.-L.); (M.P.B.); (R.E.L.)
- Correspondence:
| | - Elizabeth Lorenzo
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 North 3rd St., Phoenix, AZ 85004, USA; (E.L.); (G.Q.S.)
- School of Nursing, University of Texas Medical Branch, 1114 Mechanic St., Galveston, TX 77555, USA
| | - Michael Todd
- College of Nursing and Health Innovation, Arizona State University, 550 North 3rd St., Phoenix, AZ 85004, USA;
| | - Teresia M. O’Connor
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Ave., Houston, TX 77030, USA;
| | - Jennie Hill
- Department of Population Health Sciences, University of Utah, 201 Presidents’ Cir, Salt Lake City, UT 84112, USA;
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 North 3rd St., Phoenix, AZ 85004, USA; (E.L.); (G.Q.S.)
| | - Sonia Vega-López
- College of Health Solutions, Arizona State University, 550 North 5th St., Phoenix, AZ 85004, USA; (S.V.-L.); (M.P.B.); (R.E.L.)
- Southwestern Interdisciplinary Research Center, Arizona State University, 400 E. Van Buren St., Suite 800 Phoenix, Phoenix, AZ 85004, USA
| | - Matthew P. Buman
- College of Health Solutions, Arizona State University, 550 North 5th St., Phoenix, AZ 85004, USA; (S.V.-L.); (M.P.B.); (R.E.L.)
| | - Steven P. Hooker
- College of Health and Human Services, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA;
| | - Rebecca E. Lee
- College of Health Solutions, Arizona State University, 550 North 5th St., Phoenix, AZ 85004, USA; (S.V.-L.); (M.P.B.); (R.E.L.)
| |
Collapse
|
17
|
McGraw MB, Kohler LN, Shaibi GQ, Mandarino LJ, Coletta DK. A performance review of novel adiposity indices for assessing insulin resistance in a pediatric Latino population. Front Pediatr 2022; 10:1020901. [PMID: 36275055 PMCID: PMC9582658 DOI: 10.3389/fped.2022.1020901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/21/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Body mass index (BMI) percentile or BMI adjusted for age and sex is the most common anthropometric index to monitor and assess obesity in children. However, the ability of BMI to accurately predict insulin resistance (IR) in youth is debated. Determining the best method to noninvasively measure IR in the pediatric population is especially important due to the growing prevalence of type 2 diabetes mellitus (T2DM), which is more likely to develop in people with IR. Therefore, this study analyzed the performance of BMI against newer anthropometric indices in assessing IR in a pediatric Latino identifying sample. METHODS We studied 127 pediatric Latino participants from the Arizona Insulin Resistance (AIR) registry and performed linear regression analyses between various measures of IR and adiposity indices, including body mass index (BMI), triponderal mass index (TMI), body adiposity index (BAI), pediatric body adiposity index (pBAI), a body shape index (ABSI), abdominal volume index (AVI), waist to height ratio (WtHR) and waist to hip ratio (WHR). Log transformations of each index adjusted for age and sex and IR were used for the linear regressions. Additionally, we generated receiver operating characteristics (ROC) from logistic regressions between HOMA-IR and HOMA2IR against the same indices. RESULTS Using the homeostatic assessment of insulin resistance (HOMA-IR), HOMA2IR, the quantitative insulin-sensitivity check index (QUICKI), fasting serum insulin, and FPG/FSI to measure IR, we showed that BMI adjusted for age and sex performs similarly to many of the newer indices in our sample. The correlation coefficients for pBAI [R2: 0.27, 95% confidence interval: 0.88-1.81, p < 0.001] and BMI [R2: 0.27, 95% confidence interval: 0.92-1.92, p < 0.001] were the highest for HOMA-IR. Similarly, pBAI [R2: 0.29, 95% confidence interval: 0.88-1.72, p < 0.001] and BMI [R2: 0.29, 95% confidence interval: 0.93-1.83, p < 0.001] were the highest for HOMA2IR. A similar trend was observed with QUICKI, FSI, and FPG/FSI. ABSI had the lowest R 2 value for all measures of IR. Area under the curve (AUC) values for the receiver operating characteristics (ROC) for HOMA-IR and HOMA2IR support these conclusions. CONCLUSIONS BMI adjusted for age and sex, despite its usage and simplicity, still stacks up well against newer indices in our Latino sample. Testing these indices across larger samples is necessary to generalize these findings and translate performance to adults.
Collapse
Affiliation(s)
- Mac B McGraw
- Department of Physiology, The University of Arizona College of Medicine, Tucson, AZ, United States
| | - Lindsay N Kohler
- Center for Disparities in Diabetes, Obesity and Metabolism, The University of Arizona, Tucson, AZ, United States.,Exos, Phoenix, AZ, United States
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ, United States
| | - Lawrence J Mandarino
- Center for Disparities in Diabetes, Obesity and Metabolism, The University of Arizona, Tucson, AZ, United States.,Department of Medicine, Division of Endocrinology, The University of Arizona College of Medicine, Tucson, AZ, United States
| | - Dawn K Coletta
- Department of Physiology, The University of Arizona College of Medicine, Tucson, AZ, United States.,Center for Disparities in Diabetes, Obesity and Metabolism, The University of Arizona, Tucson, AZ, United States.,Department of Medicine, Division of Endocrinology, The University of Arizona College of Medicine, Tucson, AZ, United States
| |
Collapse
|
18
|
Vander Wyst KB, Olson ML, Bailey SS, Valencia AM, Peña A, Miller J, Shub M, Seabrooke L, Pimentel J, Olsen K, Rosenberg RB, Shaibi GQ. Communicating incidental and reportable findings from research MRIs: considering factors beyond the findings in an underrepresented pediatric population. BMC Med Res Methodol 2021; 21:275. [PMID: 34865631 PMCID: PMC8647358 DOI: 10.1186/s12874-021-01459-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/27/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The application of advanced imaging in pediatric research trials introduces the challenge of how to effectively handle and communicate incidental and reportable findings. This challenge is amplified in underserved populations that experience disparities in access to healthcare as recommendations for follow-up care may be difficult to coordinate. Therefore, the purpose of the present report is to describe the process for identifying and communicating findings from a research MRI to low-income Latino children and families. METHODS Latino adolescents (n = 86) aged 12-16 years old with obesity and prediabetes underwent a research MRI (3 Tesla Philips Ingenia®) as part of a randomized controlled diabetes prevention trial. The research MRIs were performed at baseline and 6 months to assess changes in whole-abdominal fat distribution and organ fat in response to the intervention. An institutional pathway was developed for identifying and reporting findings to participants and families. The pathway was developed through a collaborative process with hospital administration, research compliance, radiology, and the research team. All research images were reviewed by a board-certified pediatric radiologist who conveyed findings to the study pediatrician for determination of clinical actionability and reportability to children and families. Pediatric sub-specialists were consulted as necessary and a primary care practitioner (PCP) from a free community health clinic agreed to receive referrals for uninsured participants. RESULTS A total of 139 images (86 pre- and 53 post-intervention) were reviewed with 31 findings identified and 23 deemed clinically actionable and reportable. The only reportable finding was severely elevated liver fat (> 10%, n = 14) with the most common and concerning incidental findings being horseshoe kidney (n = 1) and lung lesion (n = 1). The remainder (n = 7) were less serious. Of youth with a reportable or incidental finding, 18 had a PCP but only 7 scheduled a follow-up appointment. Seven participants without a PCP were referred to a safety-net clinic for follow-up. CONCLUSIONS With the increased utilization of high-resolution imaging in pediatric research, additional standardization is needed on what, when, and how to return incidental and reportable findings to participants, particularly among historically underrepresented populations that may be underserved in the community. TRIAL REGISTRATION Preventing Diabetes in Latino Youth, NCT02615353.
Collapse
Affiliation(s)
- Kiley B Vander Wyst
- College of Graduate Studies, Midwestern University, Glendale, AZ, USA
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Smita S Bailey
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Ana Martinez Valencia
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA
| | - Armando Peña
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA
| | - Jeffrey Miller
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Mitchell Shub
- Division of Gastroenterology, Phoenix Children's Hospital, Phoenix, AZ, USA
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Lee Seabrooke
- Office of Research, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Janiel Pimentel
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Kiri Olsen
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
- Office of Research, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Robert B Rosenberg
- Office of Research, Phoenix Children's Hospital, Phoenix, AZ, USA
- Division of Pediatric Critical Care Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA.
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA.
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA.
| |
Collapse
|
19
|
Wyst KBV, Hu HH, Peña A, Olson ML, Bailey SS, Shaibi GQ. Bone marrow adipose tissue content in Latino adolescents with prediabetes and obesity. Obesity (Silver Spring) 2021; 29:2100-2107. [PMID: 34582099 PMCID: PMC8612952 DOI: 10.1002/oby.23279] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aimed to examine whether total, regional, and organ fat predicts bone marrow adipose tissue (BMAT) fat content and to explore whether BMAT fat content differs by sex among Latino youth. METHODS Latino youth (n = 86; age 13.6 [1.4] years, 62% male) with obesity (BMI percentile = 98.5% [1.2%]) underwent a dual-energy x-ray absorptiometry scan to assess body composition and a magnetic resonance imaging scan to determine abdominal adiposity, liver fat, and vertebral BMAT fat content in the thoracic (average of T8-T12) and lumbar (average of L1-L5) spine. RESULTS Male youth exhibited significantly greater thoracic (male youth = 30.8% [1.4%] vs. female youth = 24.5% [2.1%], p = 0.027) and lumbar (male youth = 36.3% [1.5%] vs. female youth = 30.2% [2.2%], p = 0.038) BMAT fat content compared with female youth. Visceral adipose tissue was a significant predictor of thoracic (β = 0.434, t[86] = 3.016, p = 0.003) and lumbar (β = 0.389, t[86] = 2.677, p = 0.009) BMAT fat content, explaining 8.9% and 6.9% of the variance, respectively. Liver fat was a significant predictor of both thoracic (β = 0.487, t[86] = 4.334, p < 0.001) and lumbar (β = 0.436, t[86] = 3.793, p < 0.001) BMAT fat content, explaining 17.6% and 13.8% of the variance, respectively. CONCLUSIONS Male youth had significantly greater thoracic and lumbar BMAT fat content than female youth. Greater BMAT fat content is associated with greater liver fat and visceral adipose tissue among youth with obesity. Further investigation of the mechanistic underpinnings of BMAT may help to differentiate its metabolic and bone-related functions.
Collapse
Affiliation(s)
- Kiley B. Vander Wyst
- College of Graduate Studies, Midwestern University, Glendale, AZ
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Houchun H. Hu
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
- Clinical Science, Hyperfine, Inc., Guilford, CT
| | - Armando Peña
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Micah L. Olson
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, AZ
| | - Smita S. Bailey
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
- Department of Radiology, Phoenix Children’s Hospital, Phoenix, AZ
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, AZ
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ
| |
Collapse
|
20
|
Soltero EG, Navabi N, Vander Wyst KB, Hernandez E, Castro FG, Ayers SL, Mendez J, Shaibi GQ. Examining 24-Hour Activity and Sleep Behaviors and Related Determinants in Latino Adolescents and Young Adults With Obesity. Health Educ Behav 2021; 49:291-303. [PMID: 34791905 DOI: 10.1177/10901981211054789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Few studies have examined 24-hour activity and sleep behaviors and their contribution to type 2 diabetes (T2D) in Latino adolescents and young adults with obesity. Aim. This study included quantitative data on T2D risk and 24-hour activity and sleep behaviors and qualitative data on individual, social, and environmental behavioral determinants. Method. A 7 day, 24-hour, wrist-worn accelerometer protocol assessed moderate-to-vigorous physical activity (PA), sedentary behaviors (SB), sleep, and sleep regularity, in adolescents (N = 38; 12-16 years) and young adults (N = 22; 18-22 years). T2D-related outcomes included adiposity (BMI, BF%, waist circumference), fasting, and 2-hour glucose. A subsample of participants (N = 16 adolescents, N = 15 young adults) completed interviews to identify behavioral determinants. Results. High levels of PA were observed among adolescents (M = 103.8 ± 67.5 minutes/day) and young adults (M = 96.8 ± 78.8 minutes/day) as well as high levels of SB across both age groups (≥10 hours/day). Sleep regularity was negatively associated with adiposity (all ps < .05) in both age groups as well as fasting and 2-hour glucose in young adults (all ps < .05). Social support was associated with PA in both age groups as well as SB in younger youth. Auditory noises, lights, and safety inhibited sleep in both age groups. Conclusion. PA is critical for disease reduction, yet reducing SB and improving sleep are also important targets for reducing T2D risk in Hispanic adolescents and young adults. Future health promotion and disease prevention strategies should leverage qualitative findings regarding behavioral determinants.
Collapse
Affiliation(s)
- Erica G Soltero
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Neeku Navabi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ, USA
| | | | - Edith Hernandez
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Felipe G Castro
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ, USA
| | - Stephanie L Ayers
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ, USA
| | | | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ, USA
| |
Collapse
|
21
|
Coletta DK, Hlusko LJ, Scott GR, Garcia LA, Vachon CM, Norman AD, Funk JL, Shaibi GQ, Hernandez V, De Filippis E, Mandarino LJ. Association of EDARV370A with breast density and metabolic syndrome in Latinos. PLoS One 2021; 16:e0258212. [PMID: 34618839 PMCID: PMC8496850 DOI: 10.1371/journal.pone.0258212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/21/2021] [Indexed: 12/02/2022] Open
Abstract
The ectodysplasin receptor (EDAR) is a tumor necrosis factor receptor (TNF) superfamily member. A substitution in an exon of EDAR at position 370 (EDARV370A) creates a gain of function mutant present at high frequencies in Asian and Indigenous American populations but absent in others. Its frequency is intermediate in populations of Mexican ancestry. EDAR regulates the development of ectodermal tissues, including mammary ducts. Obesity and type 2 diabetes mellitus are prevalent in people with Indigenous and Latino ancestry. Latino patients also have altered prevalence and presentation of breast cancer. It is unknown whether EDARV370A might connect these phenomena. The goals of this study were to determine 1) whether EDARV370A is associated with metabolic phenotypes and 2) if there is altered breast anatomy in women carrying EDARV370A. Participants were from two Latino cohorts, the Arizona Insulin Resistance (AIR) registry and Sangre por Salud (SPS) biobank. The frequency of EDARV370A was 47% in the Latino cohorts. In the AIR registry, carriers of EDARV370A (GG homozygous) had significantly (p < 0.05) higher plasma triglycerides, VLDL, ALT, 2-hour post-challenge glucose, and a higher prevalence of prediabetes/diabetes. In a subset of the AIR registry, serum levels of ectodysplasin A2 (EDA-A2) also were associated with HbA1c and prediabetes (p < 0.05). For the SPS biobank, participants that were carriers of EDARV370A had lower breast density and higher HbA1c (both p < 0.05). The significant associations with measures of glycemia remained when the cohorts were combined. We conclude that EDARV370A is associated with characteristics of the metabolic syndrome and breast density in Latinos.
Collapse
Affiliation(s)
- Dawn K. Coletta
- Department of Medicine, Division of Endocrinology, University of Arizona, Tucson, Arizona, United States of America
- Department of Physiology, University of Arizona, Tucson, Arizona, United States of America
- Center for Disparities in Diabetes Obesity, and Metabolism, University of Arizona, Tucson, Arizona, United States of America
- * E-mail:
| | - Leslea J. Hlusko
- Department of Integrative Biology, University of California, Berkeley, California, United States of America
- Centro Nacional de Investigación sobre la Evolución Humana, Burgos, Spain
| | - G. Richard Scott
- Department of Anthropology, University of Nevada, Reno, Nevada, United States of America
| | - Luis A. Garcia
- Department of Medicine, Division of Endocrinology, University of Arizona, Tucson, Arizona, United States of America
- Center for Disparities in Diabetes Obesity, and Metabolism, University of Arizona, Tucson, Arizona, United States of America
| | - Celine M. Vachon
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Aaron D. Norman
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Janet L. Funk
- Department of Medicine, Division of Endocrinology, University of Arizona, Tucson, Arizona, United States of America
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, United States of America
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona, United States of America
| | | | - Eleanna De Filippis
- Department of Endocrinology, Metabolism and Diabetes, Mayo Clinic Arizona, Scottsdale, Arizona, United States of America
| | - Lawrence J. Mandarino
- Department of Medicine, Division of Endocrinology, University of Arizona, Tucson, Arizona, United States of America
- Center for Disparities in Diabetes Obesity, and Metabolism, University of Arizona, Tucson, Arizona, United States of America
| |
Collapse
|
22
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
23
|
Langer SL, Castro FG, Chen ACC, Davis KC, Joseph RP, Kim WS, Larkey L, Lee RE, Petrov ME, Reifsnider E, Youngstedt SD, Shaibi GQ. Recruitment and retention of underrepresented and vulnerable populations to research. Public Health Nurs 2021; 38:1102-1115. [PMID: 34240459 DOI: 10.1111/phn.12943] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.
Collapse
Affiliation(s)
- Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Felipe González Castro
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Angela Chia-Chen Chen
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Kelly Cue Davis
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Rodney P Joseph
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Wonsun Sunny Kim
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Linda Larkey
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Megan E Petrov
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Elizabeth Reifsnider
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Shawn D Youngstedt
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| |
Collapse
|
24
|
DiStefano JK, Shaibi GQ. The relationship between excessive dietary fructose consumption and paediatric fatty liver disease. Pediatr Obes 2021; 16:e12759. [PMID: 33305889 PMCID: PMC8195317 DOI: 10.1111/ijpo.12759] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/16/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022]
Abstract
The global prevalence of non-alcoholic fatty liver disease (NAFLD) in children and adolescents is escalating and currently represents the most common chronic liver disease in the paediatric population. NAFLD is associated with high daily caloric intake and sedentary behaviour, with excessive consumption of added sugar emerging as an important contributor to NAFLD risk in children. This is a particularly important factor for adolescents with obesity, who are the heaviest consumers of added sugar. Table sugar, or sucrose, is a disaccharide comprised of fructose and glucose, yet only fructose has been strongly linked to NAFLD pathogenesis largely due to the unique characteristics of its metabolism and detrimental effects on key metabolic pathways. To date, the relationship between excessive fructose intake and risk of NAFLD in children and adolescents remains incompletely understood, and it is not yet known whether fructose actually causes NAFLD or instead exacerbates hepatic fat accumulation and possible hepatocellular injury only within the context of cardiometabolic factors. The purpose of this review is to summarize recent studies linking fructose consumption with NAFLD in the paediatric population and integrate results from interventional studies of fructose restriction in children and adolescents on NAFLD and related metabolic markers. Given the overall positive impact of lifestyle modifications in the management of paediatric NAFLD, reduction of added sugar consumption may represent an important, early opportunity to mitigate or prevent NAFLD in high-risk children and adolescents.
Collapse
Affiliation(s)
- Johanna K. DiStefano
- Diabetes and Fibrotic Disease Research Unit, Translational Genomics Research Institute,corresponding author: 445 N 5 Street, Phoenix, AZ 85004,
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing, Arizona State University
| |
Collapse
|
25
|
Pena A, Vander Wyst KB, Soltero E, Olson M, Pimentel J, Ayers S, Knowler W, Konopken Y, Patrick D, Hu H, Castro F, Keller C, Williams AN, Fernandez AD, Shaibi GQ. Abstract MP13: Lipid Peroxidation And Inflammatory Response Differentiate With Changes In Liver Fat Among Obese Latino Youth Following Lifestyle Intervention. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.mp13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Lipid peroxidation and inflammation are pivotal pathological processes involved in the progression of NAFLD, a prelude to cardiovascular disease. Lifestyle intervention is the cornerstone approach for preventing cardiometabolic disease among high-risk populations, yet studies have not examined the mechanisms by which lifestyle intervention may mediate changes in liver fat in youth.
Hypothesis:
Lifestyle intervention will decrease hepatic fat fraction (HFF), tumor necrosis alpha (TNF)-α, and malondialdehyde (MDA)-protein adducts.
Methods:
Latino youth with obesity (n=26, age 13.9±1.3, BMI% 98.1±1.1) and prediabetes completed a 6-month lifestyle intervention that included nutrition education (1 d/wk) and physical activity (3 d/wk). HFF was measured by MRI before and after intervention. Fasting serum samples were collected for measurement of lipid peroxidation, measured by MDA-protein adducts, and inflammation, measured by TNF-α. Repeated measures ANOVA models were used to examine the effect of lifestyle intervention on HFF, MDA-protein adducts, and TNF-α. Data are presented as Mean±SE.
Results:
The intervention led to significant decreases in HFF (from 7.0±1.1% to 5.4±0.7%, p=0.027) and TNF-α (from 1.7±1.0 to 1.5±0.1 pg/mL, p=0.050), but not MDA-protein adducts (from 266.4±28.4 to 253.8±29.3 pmol/mL, p=0.105). However, there was significant heterogeneity in changes in HFF whereby those with the greatest response (n=14) decreased HFF by -44.0% while non-responders (n=12) increased HFF by 67.5%. HFF responders exhibited significantly greater reductions in MDA-protein adducts (from 256.2±39.4 to 228.1±40.0 pmol/mL, Δ-10.1%) compared to HFF non-responders (from 278.4±42.5 to 283.7±43.2 pmol/mL, Δ2.0%; p=0.023). TNF-α was reduced in HFF responders (from 1.8±0.2 to 1.5±0.1 pg/mL, Δ-17.8%) compared to HFF non-responders (from 1.5±0.2 to 1.5±0.1 pg/mL, Δ-4.4%) but was not significant (p=0.231).
Conclusions:
Reductions in HFF through lifestyle changes were associated with greater reductions in markers of lipid peroxidation, but not inflammation. The effect of lifestyle intervention on HFF may be mediated by markers that extend beyond traditional clinical risk factors among high-risk youth.
Collapse
|
26
|
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: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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
|
27
|
Srinivasan T, Sutton EJ, Beck AT, Cuellar I, Hernandez V, Pacyna JE, Shaibi GQ, Kullo IJ, Lindor NM, Singh D, Sharp RR. Integrating Genomic Screening into Primary Care: Provider Experiences Caring for Latino Patients at a Community-Based Health Center. J Prim Care Community Health 2021; 12:21501327211000242. [PMID: 33729042 PMCID: PMC7975483 DOI: 10.1177/21501327211000242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: Minority communities have had limited access to advances in genomic medicine.
Mayo Clinic and Mountain Park Health Center, a Federally Qualified Health
Center in Phoenix, Arizona, partnered to assess the feasibility of offering
genomic screening to Latino patients receiving care at a community-based
health center. We examined primary care provider (PCP) experiences reporting
genomic screening results and integrating those results into patient
care. Methods: We conducted open-ended, semi-structured interviews with PCPs and other
members of the health care team charged with supporting patients who
received positive genomic screening results. Interviews were recorded,
transcribed, and analyzed thematically. Results: Of the 500 patients who pursued genomic screening, 10 received results
indicating a genetic variant that warranted clinical management. PCPs felt
genomic screening was valuable to patients and their families, and that
genomic research should strive to include underrepresented minorities.
Providers identified multiple challenges integrating genomic sequencing into
patient care, including difficulties maintaining patient contact over time;
arranging follow-up medical care; and managing results in an environment
with limited genetics expertise. Providers also reflected on the ethics of
offering genomic sequencing to patients who may not be able to pursue
diagnostic testing or follow-up care due to financial constraints. Conclusions: Our results highlight the potential benefits and challenges of bringing
advances in precision medicine to community-based health centers serving
under-resourced populations. By proactively considering patient support
needs, and identifying financial assistance programs and patient-referral
mechanisms to support patients who may need specialized medical care, PCPs
and other health care providers can help to ensure that precision medicine
lives up to its full potential as a tool for improving patient care.
Collapse
|
28
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
29
|
Cheema AW, Sutton EJ, Beck AT, Cuellar I, Moreno Garzon GG, Hernandez V, Lindor NM, Shaibi GQ, Kullo IJ, Sharp RR. Experiences of Latino Participants Receiving Neutral Genomic Screening Results: A Qualitative Study. Public Health Genomics 2021; 24:44-53. [PMID: 33592611 PMCID: PMC10291848 DOI: 10.1159/000513219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of the study was to characterize experiences of Latino participants receiving genomic screening results. METHODS Participants were recruited at a federally qualified health center in the USA. In-person, semi-structured interviews were conducted in either Spanish or English by a bilingual, bicultural interviewer. Questions focused on motivations for pursuing genomic sequencing, concerns about receiving genomic screening results, and perceived benefits of receiving genomic information. Interviews were audio-recorded, transcribed, and translated. RESULTS Fifty individuals completed an interview; 39 were conducted in Spanish. Participants described mixed motivations for pursuing genomic screening. Participants viewed the benefits of genomic screening in relation to not only their personal health but to the health of their families and their communities. Participants tended to have few concerns about genomic screening. Those concerns related to potential loss of privacy, misuses of genomic information, and the possibility of receiving distressing results. Some participants had misunderstandings about the scope of the test and the potential implications of their results. Most felt it was better to know about a genetic predisposition to disease than to remain uninformed. Participants felt that genomic screening was worthwhile. DISCUSSION This is one of the first studies to examine the experiences of Latino individuals receiving genomic screening results. Our results suggest that many Latino patients in the US see value in genomic screening and have limited concerns about its potential to cause harm. These results inform ongoing efforts to increase the availability of genomic medicine to underrepresented populations and add to our understanding of sociocultural drivers in the adoption of precision medicine.
Collapse
Affiliation(s)
- Amal W Cheema
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Erica J Sutton
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Annika T Beck
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Idali Cuellar
- Biospecimens Accessioning and Processing, Mayo Clinic, Scottsdale, Arizona, USA
| | | | | | - Noralane M Lindor
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA,
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA,
| |
Collapse
|
30
|
Pacyna JE, Shaibi GQ, Lee A, Byrne JO, Cuellar I, Sutton EJ, Hernandez V, Lindor NM, Singh D, Kullo IJ, Sharp RR. Increasing access to individualized medicine: a matched-cohort study examining Latino participant experiences of genomic screening. Genet Med 2021; 23:934-941. [PMID: 33500569 PMCID: PMC8495890 DOI: 10.1038/s41436-020-01079-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 01/30/2023] Open
Abstract
Purpose: Multiple efforts are underway to increase the inclusion of racial minority participants in genomic research and new forms of individualized medicine. These efforts should include studies that characterize how individuals from minority communities experience genomic medicine in diverse healthcare settings and how they integrate genetic knowledge into their understandings of healthcare needs. Methods: As part of a large, multisite genomic sequencing study, we surveyed individuals to assess their decision to pursue genomic risk evaluation. Participants included Latino patients recruited at Mountain Park Health Center, a Federally Qualified Health Center in Phoenix, AZ, and non-Latino patients recruited at a large academic medical center (Mayo Clinic in Rochester, MN). Both groups agreed to receive individualized genomic risk assessments. Results: Comparisons between cohorts showed that Latino respondents had lower levels of decisional conflict about pursuing genomic screening but generally scored lower on genetic knowledge. Latino respondents were also more likely to have concerns about the misuse of genomic information, despite both groups having similar views about the value of genomic risk evaluation. Conclusion: Our results highlight the importance of evaluating sociocultural factors that influence minority patient engagement with genomic medicine in diverse healthcare settings.
Collapse
Affiliation(s)
- Joel E Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ, USA
| | - Alex Lee
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jamie O Byrne
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Idali Cuellar
- Center for Individualized Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Erica J Sutton
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA. .,Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
31
|
Hingle M, Blew R, James K, Mockbee J, Palmer KN, Roe DJ, Saboda K, Shaibi GQ, Whitlatch S, Marrero D. Feasibility and Acceptability of a Type 2 Diabetes Prevention Intervention for Mothers and Children at a Federally Qualified Healthcare Center. J Prim Care Community Health 2021; 12:21501327211057643. [PMID: 34866483 PMCID: PMC8652912 DOI: 10.1177/21501327211057643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Maternal obesity and gestational diabetes mellitus (GDM) contribute to increased risk for type 2 diabetes mellitus (T2DM) among both mothers and their offspring. Randomized trials demonstrated T2DM risk reduction in adults following lifestyle behavior change and modest weight loss; the evidence base for at-risk children remains limited. PURPOSE Evaluate the feasibility, acceptability, and preliminary efficacy of a T2DM prevention intervention for mother-child dyads delivered by Federally Qualified Health Center staff. METHODS A group randomized design tested the effects of a behavioral lifestyle intervention on T2DM risk factors in women with a history of GDM and their 8- to 12-year-old children. Mother-child dyads were recruited and randomized to intervention or wait-listed control conditions. Intervention participants completed the 13-week intervention; control participants received standard of care. Baseline and 13-week measures assessed program acceptability and feasibility, and explored effects on body weight, waist circumference, hemoglobin A1c, and lifestyle behaviors. RESULTS Forty-two dyads were randomized and 35 (83%) completed pre-/post-measurements. Participants and program leaders positively rated content and engagement. Nearly all strongly agreed that activities were enjoyable (97%), applicable (96%), useful (97%), and motivational (96%). Attendance averaged 65% across 2 cohorts; delivery costs were approximately $225/dyad. There were no significant differences in body weight, BMI (or BMI z-score), waist circumference, hemoglobin A1c, diet quality, physical activity, sleep, or home environment changes between intervention and control groups. CONCLUSIONS A family T2DM prevention program was feasibly delivered by FQHC staff, and acceptable to mothers and children. Program efficacy will be evaluated in an adequately powered clinical trial.
Collapse
Affiliation(s)
| | | | - Kyla James
- El Rio Community Health Center, Tucson,
AZ, USA
| | - Joy Mockbee
- El Rio Community Health Center, Tucson,
AZ, USA
| | | | | | | | | | | | | |
Collapse
|
32
|
Soltero EG, Solovey AN, Hebbel RP, Palzer EF, Ryder JR, Shaibi GQ, Olson M, Fox CK, Rudser KD, Dengel DR, Evanoff NG, Kelly AS. Relationship of Circulating Endothelial Cells With Obesity and Cardiometabolic Risk Factors in Children and Adolescents. J Am Heart Assoc 2020; 10:e018092. [PMID: 33372524 PMCID: PMC7955458 DOI: 10.1161/jaha.120.018092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Circulating endothelial cells (CECs) reflect early changes in endothelial health; however, the degree to which CEC number and activation is related to adiposity and cardiovascular risk factors in youth is not well described. Methods and Results Youth in this study (N=271; aged 8-20 years) were classified into normal weight (body mass index [BMI] percentage <85th; n=114), obesity (BMI percentage ≥95th to <120% of the 95th; n=63), and severe obesity (BMI percentage ≥120% of the 95th; n=94) catagories. CEC enumeration was determined using immunohistochemical examination of buffy coat smears and activated CEC (percentage of vascular cell adhesion molecule-1 expression) was assessed using immunofluorescent staining. Cardiovascular risk factors included measures of body composition, blood pressure, glucose, insulin, lipid profile, C-reactive protein, leptin, adiponectin, oxidized low-density lipoprotein cholesterol, carotid artery intima-media thickness, and pulse wave velocity. Linear regression models examined associations between CEC number and activation with BMI and cardiovascular risk factors. CEC number did not differ among BMI classes (P>0.05). Youth with severe obesity had a higher degree of CEC activation compared with normal weight youth (8.3%; 95% CI, 1.1-15.6 [P=0.024]). Higher CEC number was associated with greater body fat percentage (0.02 per percentage; 95% CI, 0.00-0.03 [P=0.020]) and systolic blood pressure percentile (0.01 per percentage; 95% CI, 0.00-0.01 [P=0.035]). Higher degree of CEC activation was associated with greater visceral adipose tissue (5.7% per kg; 95% CI, 0.4-10.9 [P=0.034]) and non-high-density lipoprotein cholesterol (0.11% per mg/dL; 95% CI, 0.01-0.21 [P=0.039]). Conclusions Methods of CEC quantification are associated with adiposity and cardiometabolic risk factors and may potentially reflect accelerated atherosclerosis as early as childhood.
Collapse
Affiliation(s)
- Erica G Soltero
- Department of Pediatrics Children's Nutrition Research CenterBaylor College of Medicine Houston TX
| | - Anna N Solovey
- Vascular Biology Center Division of Hematology Oncology & Transplantation University of Minnesota Medical School Minneapolis MN
| | - Robert P Hebbel
- Vascular Biology Center Division of Hematology Oncology & Transplantation University of Minnesota Medical School Minneapolis MN.,Department of Medicine University of Minnesota Medical School Minneapolis MN
| | - Elise F Palzer
- Division of Biostatistics School of Public Health University of Minnesota Minneapolis MN
| | - Justin R Ryder
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN.,Department of Pediatrics University of Minnesota Medical School Minneapolis MN
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention Arizona State University Phoenix AZ.,Department of Pediatric Endocrinology and Diabetes Phoenix Children's Hospital Phoenix AZ
| | - Micah Olson
- Center for Health Promotion and Disease Prevention Arizona State University Phoenix AZ.,Department of Pediatric Endocrinology and Diabetes Phoenix Children's Hospital Phoenix AZ
| | - Claudia K Fox
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN.,Department of Pediatrics University of Minnesota Medical School Minneapolis MN
| | - Kyle D Rudser
- Division of Biostatistics School of Public Health University of Minnesota Minneapolis MN.,Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN
| | - Donald R Dengel
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN.,Department of Pediatrics University of Minnesota Medical School Minneapolis MN.,School of Kinesiology University of Minnesota Minneapolis MN
| | - Nicholas G Evanoff
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN.,School of Kinesiology University of Minnesota Minneapolis MN
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN.,Department of Pediatrics University of Minnesota Medical School Minneapolis MN
| |
Collapse
|
33
|
Szeszulski J, Lorenzo E, O'Connor T, Hill JL, Shaibi GQ, Buman MP, Vega-López S, Hooker SP, Lee RE. Exploring Correlates of Preschool-Aged Children's Locomotor Skills: Individual and Parent Demographics and Home Environment. Percept Mot Skills 2020; 128:649-671. [PMID: 33342342 DOI: 10.1177/0031512520980938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined individual and parental demographics and home environment factors associated with locomotor skills in predominantly Hispanic preschool-aged children. We used questionnaires to survey parents, included inquiries regarding parenting practices, parents' physical activity levels, and home-based physical activity resources; and we administered the Progressive Aerobic Cardiovascular Endurance Run (PACER) and the CHAMPS Motor Skills Protocol (CMSP) to children to measure the quantity and quality of their locomotor skills. Participants were 144 parents and their children (78.9% Hispanic, 49.3% girls) recruited from urban, community-based childcare and education centers. We examined the relationship between survey measures and PACER and CMSP scores with forward-selection stepwise linear regression models. Overall, 142 children completed the PACER, and 91 completed the CMSP. At the individual level, a child's age was positively associated with both PACER and CMSP scores, and girls had lower PACER scores than boys. In the home environment, parental promotion of more screen time was associated with a higher children's PACER score. In addition, higher parent concern for children's safety was associated with a lower PACER score. We identified several physical activity promoting parent practices as new home environment factors related to the preschool-aged children's locomotor development. Additional studies are needed to test new hypotheses generated from these data. ClinicalTrials.gov Identifier: NCT03261492 (date of registration 8/25/17).
Collapse
Affiliation(s)
- Jacob Szeszulski
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, United States.,Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, Austin Campus, United States.,Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States
| | - Elizabeth Lorenzo
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States
| | - Teresia O'Connor
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
| | - Jennie L Hill
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, United States
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Phoenix, United States
| | - Sonia Vega-López
- College of Health Solutions, Arizona State University, Phoenix, United States.,Southwestern Interdisciplinary Research Center, Arizona State University, Phoenix, United States
| | - Steven P Hooker
- College of Health and Human Services, San Diego State University, San Diego, California, United States
| | - Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States
| |
Collapse
|
34
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
35
|
Vander Wyst KB, Olson ML, Hooker E, Soltero EG, Konopken YP, Keller CS, Castro FG, Williams AN, Fernández ADR, Patrick DL, Ayers SL, Hu HH, Peña A, Pimentel J, Knowler WC, Shaibi GQ. Yields and costs of recruitment methods with participant phenotypic characteristics for a diabetes prevention research study in an underrepresented pediatric population. Trials 2020; 21:716. [PMID: 32799920 PMCID: PMC7429699 DOI: 10.1186/s13063-020-04658-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/05/2020] [Indexed: 12/18/2022] Open
Abstract
Background/aims Prediabetes and diabetes disproportionately impact Latino youth, yet few diabetes prevention programs have prioritized inclusion of this underrepresented population. This report describes the recruitment process, yields, associated costs, and phenotypic characteristics of Latino youth with obesity and prediabetes enrolled in a randomized controlled diabetes prevention study in the USA. Methods Recruitment efforts included referrals from clinics, community outlets, local media, and word of mouth with the goal of enrolling 120 Latino adolescents aged 12–16 with obesity (BMI > 95th percentile) and prediabetes. Prediabetes eligibility was determined by any of the following: HbA1c between 5.7 and 6.5%, fasting glucose between 100 and 125 mg/dL, or a 2-h glucose between 120 and 199 mg/dL following a 75-g oral glucose tolerance test (OGTT), but not meeting any of the diagnostic criteria for diabetes. Eligible participants were randomized 2:1 to either a 6-month community-based lifestyle intervention that included group nutrition and health education classes (1 day/week) and group exercise classes (2 days/week) or usual care control arm. Recruitment yields were determined by review of referral source in the study screening database. Recruitment costs were determined by an after-the-fact financial review of actual and in-kind costs. Participant phenotypic characteristics (i.e., demographics, anthropometrics, and biochemical data) were compared by recruitment strategy using a one-way ANOVA. Results Recruitment efforts covered 160 mile2 (414 km2) across 26 ZIP codes (postcode) in the Phoenix Metropolitan Area and yielded 655 referrals from clinics (n = 344), community (n = 143), media (n = 137), and word-of-mouth (n = 31). From this pool, 26% (n = 167) did not meet general, pre-screening eligibility criteria; 29% (n = 187) declined participation; and 10% (n = 64) were unable to be contacted. A total of 237 youth were invited to the clinical research unit to determine final eligibility. Following the OGTT, 52% (n = 122) met prediabetes criteria and 117 were subsequently randomized. Clinical recruitment yielded the highest number of referrals (53%; n = 344) while word-of-mouth yielded the highest proportion (35%; n = 11) of randomized participants per referred youth. There were no significant differences in anthropometric or biochemical measures among youth by recruitment strategy. Based upon final enrollment numbers, community recruitment was the costliest approach ($486/randomized participant) followed by clinical ($248/randomized participant) and media ($236/randomized participant). Conclusions The ability to meet enrollment goals for a clinical trial of an underrepresented population required multiple recruitment strategies. Although strategies vary in yields and costs, it appears they produce similar phenotypical risk profiles of eligible youth. Trial registration ClinicalTrials.gov NCT02615353. Registered on 26 November 2015
Collapse
Affiliation(s)
- Kiley B Vander Wyst
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.,Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Elva Hooker
- Ivy Center for Family Wellness, The Society of St. Vincent de Paul of Arizona, Phoenix, AZ, USA
| | - Erica G Soltero
- USDA/ARS Children's Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Yolando P Konopken
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Colleen S Keller
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Felipe G Castro
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Allison N Williams
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Arlene D R Fernández
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Donald L Patrick
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Stephanie L Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
| | | | - Armando Peña
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Janiel Pimentel
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA. .,Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA. .,Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA.
| |
Collapse
|
36
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
37
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
38
|
Vander Wyst KB, Buman MP, Shaibi GQ, Petrov ME, Reifsnider E, Whisner CM. Resting Energy Expenditure Relationship with Macronutrients and Gestational Weight Gain: A Pilot Study. Nutrients 2020; 12:nu12020450. [PMID: 32053977 PMCID: PMC7071224 DOI: 10.3390/nu12020450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 02/04/2023] Open
Abstract
Resting energy expenditure (REE) comprises 60% of total energy expenditure and variations may be associated with gestational weight gain (GWG) or maternal diet. The objective of this study was to examine the impact of metabolic tracking on GWG and the association with maternal macronutrients. Pregnant women aged 29.8 ± 4.9 years (78.6% non-Hispanic, White) with gestational age (GA) < 17 week were randomized to Breezing™ (n = 16) or control (n = 12) groups for 13 weeks. REE by Breezing™ indirect calorimetry, anthropometrics and dietary intake were collected every two weeks. Early (14–21 weeks), late (21–28 weeks), and overall (14–28 weeks) changes in macronutrients and GWG were calculated. The Breezing™ group had a significantly greater rate of GWG [F (1,23) = 6.8, p = 0.02] in the latter half of the second trimester. Late (−155.3 ± 309.2 vs. 207.1 ± 416.5 kcal, p = 0.01) and overall (−143.8 ± 339.2 vs. 191.8 ± 422.2 kcal, p = 0.03) changes in energy consumption were significantly different between Breezing™ and control groups, respectively. Early changes in REE were positively correlated with overall changes in carbohydrates (r = 0.58, p = 0.02). Regular metabolism tracking alone did not have an impact on GWG. Early shifts in REE might impact GWG later in pregnancy. Investigation in a larger population from preconception through postpartum is needed.
Collapse
Affiliation(s)
- Kiley B. Vander Wyst
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (K.B.V.W.); (M.P.B.)
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA; (G.Q.S.); (M.E.P.); (E.R.)
| | - Matthew P. Buman
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (K.B.V.W.); (M.P.B.)
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA; (G.Q.S.); (M.E.P.); (E.R.)
| | - Megan E. Petrov
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA; (G.Q.S.); (M.E.P.); (E.R.)
| | - Elizabeth Reifsnider
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA; (G.Q.S.); (M.E.P.); (E.R.)
| | - Corrie M. Whisner
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (K.B.V.W.); (M.P.B.)
- Correspondence: ; Tel.: +1-(602)-496-3348
| |
Collapse
|
39
|
Vega-López S, Marsiglia FF, Ayers S, Williams LR, Bruening M, Gonzalvez A, Vega-Luna B, Perilla A, Harthun M, Shaibi GQ, Delgado F, Rosario C, Hartmann L. Methods and rationale to assess the efficacy of a parenting intervention targeting diet improvement and substance use prevention among Latinx adolescents. Contemp Clin Trials 2020; 89:105914. [PMID: 31843638 PMCID: PMC7242150 DOI: 10.1016/j.cct.2019.105914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/27/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
Latinx adolescents are at higher risk for chronic diseases relative to adolescents of other ethnic groups, in part because of their lack of adherence to diet recommendations and their higher rates of substance use. Given the proximal influence of family factors during the developmental stage of adolescence, parenting interventions may be an effective way to promote healthy nutrition and substance use prevention simultaneously. This article describes the design and theoretical rationale of a study assessing the effects of Families Preparing the New Generation Plus (FPNG Plus), a 10-week culturally-tailored nutrition and substance use prevention parenting program, on diet and substance use outcomes among Latinx middle school students (6th-8th grade). The 3-arm cluster randomized controlled trial compares FPNG Plus (substance use prevention and healthy nutrition), FPNG (substance use prevention only), and a comparison condition (focusing on academic success) in 1494 parent-child dyads from 18 schools, randomized at the school level. Adolescents and parents will complete surveys pre- and post-intervention, and 16-weeks after program participation, regarding diet behaviors, substance use, and parenting practices. A random subsample of 126 dyads (42 from each program), will participate in additional data collection to assess the home food environment, detailed dietary intake (via two 24-h recalls), and provide biomarkers of cardiometabolic risk (blood pressure, total cholesterol and HbA1c). If successful, this study will provide evidence contributing to helping Latinx parents assist their adolescent children develop and maintain long-lasting positive lifestyle behaviors in order to prevent concurrent substance use and diet-related chronic diseases.
Collapse
Affiliation(s)
- Sonia Vega-López
- College of Health Solutions, Arizona State University, 550 North 3rd Street, Phoenix, AZ 85004, United States of America; Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America.
| | - Flavio F Marsiglia
- Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America
| | - Stephanie Ayers
- Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America
| | - Lela Rankin Williams
- Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America
| | - Meg Bruening
- College of Health Solutions, Arizona State University, 550 North 3rd Street, Phoenix, AZ 85004, United States of America
| | - Anaid Gonzalvez
- Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America
| | - Beatriz Vega-Luna
- Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America
| | - Alex Perilla
- American Dream Academy, Arizona State University, 542 E. Monroe Street, Suite D-100, Phoenix, AZ 85004, United States of America
| | - Mary Harthun
- Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America
| | - Gabriel Q Shaibi
- Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America; College of Nursing and Health Innovation, Arizona State University, 500 North 3rd Street, Phoenix, AZ 85004, United States of America
| | - Freddy Delgado
- American Dream Academy, Arizona State University, 542 E. Monroe Street, Suite D-100, Phoenix, AZ 85004, United States of America
| | - Christian Rosario
- American Dream Academy, Arizona State University, 542 E. Monroe Street, Suite D-100, Phoenix, AZ 85004, United States of America
| | - Leopoldo Hartmann
- College of Nursing and Health Innovation, Arizona State University, 500 North 3rd Street, Phoenix, AZ 85004, United States of America
| |
Collapse
|
40
|
Chambers MA, Shaibi GQ, Kapadia CR, Vander Wyst KB, Campos A, Pimentel J, Gonsalves RF, Sandweiss BM, Olson ML. Epicardial adipose thickness in youth with type 1 diabetes. Pediatr Diabetes 2019; 20:941-945. [PMID: 31294894 DOI: 10.1111/pedi.12893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Epicardial adipose thickness (EAT) is increased in adults with type 1 diabetes (T1D) and is thought to contribute to cardiovascular disease (CVD) in this population. Given that CVD risk factors emerge early in life, the purpose of this study was to identify whether EAT is increased in pediatric patients with T1D compared with non-diabetic controls. METHODS Anthropometric data, blood pressure (BP), and EAT were evaluated in 20 youth with T1D and 20 age, sex, and body mass index (BMI) matched healthy controls between the ages of 5 and 18 years. RESULTS EAT was 18.5% higher among youth with T1D compared to healthy controls (1.65 ± 0.44 mm vs 1.37 ± 0.27 mm, P = .02). In the entire cohort, EAT was correlated with age (r = 0.71, P < .001), BMI (r = .69, P < .001), waist circumference (r = 0.60, P < .001), systolic BP (r = .34, P = .03), and diastolic BP (r = 0.41, P = .009). Among youth with T1D, there were no significant correlations between EAT and HbA1c (r = -0.16, P = .50), insulin dose (r = .09, P = .71), or duration of disease (r = 0.06, P = .82). CONCLUSIONS Youth with T1D exhibited significantly higher EAT compared to controls. Increased EAT was associated with adiposity and BP, but not duration of disease, insulin dose, or glycemic control. Increased EAT may represent a pathophysiologic mechanism leading to premature CVD in pediatric patients with T1D.
Collapse
Affiliation(s)
- Melissa A Chambers
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona
| | - Gabriel Q Shaibi
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona.,Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| | - Chirag R Kapadia
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona
| | | | - Amanda Campos
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona.,Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| | - Janiel Pimentel
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona.,Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| | - Robert F Gonsalves
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona
| | - Bryan M Sandweiss
- Children's Heart Center for Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Micah L Olson
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona.,Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| |
Collapse
|
41
|
Vander Wyst KB, Whisner CM, Reifsnider E, Buman M, Shaibi GQ, Petrov ME. 0247 Relationships between Changes in Sleep and Gestational Weight Gain Among Pregnant Women. Sleep 2019. [DOI: 10.1093/sleep/zsz067.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
42
|
Ryder JR, Kaizer AM, Jenkins TM, Kelly AS, Inge TH, Shaibi GQ. Heterogeneity in Response to Treatment of Adolescents with Severe Obesity: The Need for Precision Obesity Medicine. Obesity (Silver Spring) 2019; 27:288-294. [PMID: 30677258 PMCID: PMC6352902 DOI: 10.1002/oby.22369] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/29/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Treating pediatric severe obesity is challenging because of the complex biological, behavioral, and environmental factors that underpin the disease. The multifactorial etiology of obesity combined with the physiologic complexity of the energy regulatory system contributes to treatment variability. The goal of this secondary analysis of pooled data was to describe the degree of individual variation in response to various interventions among adolescents with severe obesity. METHODS Data from three centers across the United States conducting either lifestyle (n = 53), pharmacotherapy (n = 40), or metabolic and bariatric surgery (n = 78) interventions were pooled. Inclusion criteria were severe obesity at baseline and at least one follow-up visit > 30 days after treatment start. RESULTS Change in BMI following intervention ranged from -50.2% to +12.9%, with each intervention (lifestyle [range: -25.4% to 5.0%], pharmacotherapy [range: -10.8% to 12.9%], and metabolic and bariatric surgery [range: -50.2% to -13.3%]) exhibiting wide individual variation in response. Changes in cardiometabolic risk factors demonstrated similarly high variability. CONCLUSIONS Adolescents with severe obesity demonstrated a high degree of heterogeneity in terms of BMI reduction and cardiometabolic risk factor response across treatment modalities. Reporting individual response data in trials and identifying factors driving variability in response will be vital for advancing precision medicine approaches to address obesity.
Collapse
Affiliation(s)
- Justin R. Ryder
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, MN
| | - Alexander M. Kaizer
- University of Colorado, Denver, and Children’s Hospital Colorado, Aurora, CO
| | - Todd M. Jenkins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Aaron S. Kelly
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, MN
| | - Thomas H. Inge
- University of Colorado, Denver, and Children’s Hospital Colorado, Aurora, CO
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ
| |
Collapse
|
43
|
Lee RE, Lorenzo E, Szeszulski J, Arriola A, Bruening M, Estabrooks PA, Hill J, Marsiglia FF, O'Connor T, Pollins KS, Shaibi GQ, Soltero E, Todd M. Design and methodology of a cluster-randomized trial in early care and education centers to meet physical activity guidelines: Sustainability via Active Garden Education (SAGE). Contemp Clin Trials 2019; 77:8-18. [PMID: 30550775 PMCID: PMC6464371 DOI: 10.1016/j.cct.2018.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
Strategies are needed to help early care and education centers (ECEC) comply with policies to meet daily physical activity and fruit and vegetable guidelines for young children. This manuscript describes the design and methodology of Sustainability via Active Garden Education (SAGE), a 12-session cluster-randomized controlled crossover design trial using community-based participatory research (CBPR) to test a garden-based ECEC physical activity and fruit and vegetables promotion intervention for young children aged 3-5 years in 20 sites. The SAGE curriculum uses the plant lifecycle as a metaphor for human development. Children learn how to plant, water, weed, harvest, and do simple food preparation involving washing, cleaning, and sampling fruit and vegetables along with active learning songs, games, science experiments, mindful eating exercises, and interactive discussions to reinforce various healthy lifestyle topics. Parents will receive newsletters and text messages linked to the curriculum, describing local resources and events, and to remind them about activities and assessments. Children will be measured on physical activity, height, and weight and observed during meal and snack times to document dietary habits. Parents will complete measures about dietary habits outside of the ECEC, parenting practices, home physical activity resources, and home fruit and vegetable availability. SAGE fills an important void in the policy literature by employing a participatory strategy to produce a carefully crafted and engaging curriculum with the goal of meeting health policy guidelines and educational accreditation standards. If successful, SAGE may inform and inspire widespread dissemination and implementation to reduce health disparities and improve health equity.
Collapse
Affiliation(s)
- Rebecca E Lee
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States.
| | - Elizabeth Lorenzo
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Jacob Szeszulski
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Anel Arriola
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Meg Bruening
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Paul A Estabrooks
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jennie Hill
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Flavio F Marsiglia
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, United States
| | - Teresia O'Connor
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Kim Sellers Pollins
- Booker T. Washington Early Childhood Learning Center, Phoenix, AZ, United States
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Erica Soltero
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Michael Todd
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| |
Collapse
|
44
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
45
|
Shaibi GQ, Kullo IJ, Singh DP, Sharp RR, De Filippis E, Cuellar I, Hernandez V, Levey S, Radecki Breitkopf C, Olson JE, Cerhan JR, Mandarino LJ, Thibodeau SN, Lindor NM. Developing a Process for Returning Medically Actionable Genomic Variants to Latino Patients in a Federally Qualified Health Center. Public Health Genomics 2018; 21:77-84. [PMID: 30522109 DOI: 10.1159/000494488] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/14/2018] [Indexed: 12/14/2022] Open
Abstract
AIM To develop a process for returning medically actionable genomic variants to Latino patients receiving care in a Federally Qualified Health Center. METHODS Prior to recruitment, researchers met with primary care providers to (1) orient clinicians to the project, (2) establish a process for returning actionable and nonactionable results to participants and providers through the electronic health record, and (3) develop a process for offering clinical decision support for follow-up education and care. A Community Advisory Board was engaged to provide input on recruitment strategies and materials for conveying results to participants. Participants in the Sangre Por Salud (Blood for Health) Biobank with hyperlipidemia or colon polyps represented the pool of potentially eligible participants. RESULTS A total of 1,621 individuals were invited to participate and 710 agreed to an in- person consenting visit (194 no-showed and 16 declined). Over 12-months, 500 participants were enrolled. Participants were primarily Spanish-speaking (81.6%), female (74.2%), and enrolled because of hyperlipidemia (95.4%). All but 2 participants opted to receive primary (i.e., related to enrollment phenotypes) as well as secondary actionable results. CONCLUSION Efforts to bring precision medicine to community-based health centers serving minority patients may require multilevel engagement activities to include individuals, providers, health systems, and the community.
Collapse
Affiliation(s)
- Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA,
| | - Iftikhar J Kullo
- Department of Cardiovascular Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Richard R Sharp
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Idali Cuellar
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Sharon Levey
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Lawrence J Mandarino
- Division of Endocrinology, Department of Medicine, and Center for Disparities in Diabetes, Obesity, and Metabolism, University of Arizona, Tucson, Arizona, USA
| | - Stephen N Thibodeau
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Noralane M Lindor
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
46
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
47
|
Fonseca-Portilla R, Krell-Roesch J, Shaibi GQ, Caselli RJ, Mandarino LJ, Zhang N, Hentz JG, Coletta DK, de Filippis EA, Dawit S, Geda YE. Brain-Derived Neurotrophic Factor and Its Associations with Metabolism and Physical Activity in a Latino Sample. Metab Syndr Relat Disord 2018; 17:75-80. [PMID: 30418087 PMCID: PMC6484340 DOI: 10.1089/met.2018.0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Brain-derived neurotrophic factor (BDNF) is associated with body weight and other health conditions but remains understudied in the Latino population. The aim of this study was to examine the associations of BDNF serum levels with body mass index (BMI), physical activity, and the rs6265 nonconservative polymorphism among 349 Latinos aged ≥18 years enrolled in the Arizona Insulin Resistance Registry. Materials and Methods: Data on physical activity were acquired using a self-reported questionnaire. BDNF serum levels were measured utilizing a modified ELISA method, and the rs6265 polymorphism was genotyped by the Assay-by-Design service. Two sample t-tests or chi-squared tests were employed to compare demographics and outcomes between physically active and nonactive groups as well as between rs6265 CC and CT+TT groups. Results: BDNF levels and rs6265 polymorphism did not differ significantly between the physically active (N = 195) and nonactive group (N = 154). Participants with the rs6265 polymorphism did not show any significant difference in BDNF levels or BMI when compared with those with the normal functional variant. Higher BDNF levels were significantly associated with higher age (r = 0.11, P = 0.04) and higher 2-hr glucose level (r = 0.11, P = 0.04). Conclusions: In this cross-sectional study, the rs6265 polymorphism was not associated with a higher risk of obesity, or lower circulating levels of BDNF. Thus, the rs6265 polymorphism may have a different impact in Latinos as compared with other previously studied populations.
Collapse
Affiliation(s)
| | - Janina Krell-Roesch
- 2 Mayo Clinic Translational Neuroscience and Aging Program, Mayo Clinic, Scottsdale, Arizona
| | - Gabriel Q Shaibi
- 3 Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona
| | | | - Lawrence J Mandarino
- 5 Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Nan Zhang
- 6 Department of Biostatistics, Mayo Clinic, Scottsdale, Arizona
| | - Joseph G Hentz
- 6 Department of Biostatistics, Mayo Clinic, Scottsdale, Arizona
| | - Dawn K Coletta
- 5 Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | | | - Sara Dawit
- 4 Department of Neurology, Mayo Clinic, Scottsdale, Arizona
| | - Yonas E Geda
- 2 Mayo Clinic Translational Neuroscience and Aging Program, Mayo Clinic, Scottsdale, Arizona.,4 Department of Neurology, Mayo Clinic, Scottsdale, Arizona.,8 Department of Psychiatry and Psychology, Mayo Clinic, Scottsdale, Arizona
| |
Collapse
|
48
|
Kullo IJ, Olson J, Fan X, Jose M, Safarova M, Radecki Breitkopf C, Winkler E, Kochan DC, Snipes S, Pacyna JE, Carney M, Chute CG, Gupta J, Jose S, Venner E, Murugan M, Jiang Y, Zordok M, Farwati M, Philogene M, Smith E, Shaibi GQ, Caraballo P, Freimuth R, Lindor NM, Sharp R, Thibodeau SN. The Return of Actionable Variants Empirical (RAVE) Study, a Mayo Clinic Genomic Medicine Implementation Study: Design and Initial Results. Mayo Clin Proc 2018; 93:1600-1610. [PMID: 30392543 PMCID: PMC6652203 DOI: 10.1016/j.mayocp.2018.06.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/04/2018] [Accepted: 06/08/2018] [Indexed: 12/02/2022]
Abstract
OBJECTIVES To identify clinically actionable genetic variants from targeted sequencing of 68 disease-related genes, estimate their penetrance, and assess the impact of disclosing results to participants and providers. PATIENTS AND METHODS The Return of Actionable Variants Empirical (RAVE) Study investigates outcomes following the return of pathogenic/likely pathogenic (P/LP) variants in 68 disease-related genes. The study was initiated in December 2016 and is ongoing. Targeted sequencing was performed in 2533 individuals with hyperlipidemia or colon polyps. The electronic health records (EHRs) of participants carrying P/LP variants in 36 cardiovascular disease (CVD) genes were manually reviewed to ascertain the presence of relevant traits. Clinical outcomes, health care utilization, family communication, and ethical and psychosocial implications of disclosure of genomic results are being assessed by surveys, telephone interviews, and EHR review. RESULTS Of 29,208 variants in the 68 genes, 1915 were rare (frequency <1%) and putatively functional, and 102 of these (60 in 36 CVD genes) were labeled P/LP based on the American College of Medical Genetics and Genomics framework. Manual review of the EHRs of participants (n=73 with P/LP variants in CVD genes) revealed that 33 had the expected trait(s); however, only 6 of 45 participants with non-familial hypercholesterolemia (FH) P/LP variants had the expected traits. CONCLUSION Expected traits were present in 13% of participants with P/LP variants in non-FH CVD genes, suggesting low penetrance; this estimate may change with additional testing performed as part of the clinical evaluation. Ongoing analyses of the RAVE Study will inform best practices for genomic medicine.
Collapse
Affiliation(s)
- Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Janet Olson
- Department of Health Sciences Research, Biomedical Ethics Program, Mayo Clinic, Rochester, MN
| | - Xiao Fan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Merin Jose
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Maya Safarova
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Erin Winkler
- Center for Individualized Medicine-Genomics, Mayo Clinic, Rochester, MN
| | - David C Kochan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sara Snipes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Joel E Pacyna
- Department of Health Sciences Research, Biomedical Ethics Program, Mayo Clinic, Rochester, MN
| | - Meaghan Carney
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Christopher G Chute
- Johns Hopkins University, Schools of Medicine, Public Health and Nursing, Baltimore, MD
| | - Jyoti Gupta
- National Human Genome Research Institute, Bethesda, MD
| | - Sheethal Jose
- National Human Genome Research Institute, Bethesda, MD
| | - Eric Venner
- Baylor College of Medicine Human Genome Sequencing Center, Houston, TX
| | - Mullai Murugan
- Baylor College of Medicine Human Genome Sequencing Center, Houston, TX
| | - Yunyun Jiang
- Baylor College of Medicine Human Genome Sequencing Center, Houston, TX
| | - Magdi Zordok
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Medhat Farwati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Erica Smith
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ
| | | | - Robert Freimuth
- Department of Health Sciences Research, Biomedical Ethics Program, Mayo Clinic, Rochester, MN
| | | | - Richard Sharp
- Department of Health Sciences Research, Biomedical Ethics Program, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
49
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
50
|
Williams AN, Konopken YP, Keller CS, Castro FG, Arcoleo KJ, Barraza E, Patrick DL, Olson ML, Shaibi GQ. Corrigendum to 'Culturally-grounded diabetes prevention program for obese Latino youth: Rationale, design, and methods☆'' [Contemp. Clin. Trials 54 (2017) 68-76]. Contemp Clin Trials 2018; 71:205. [PMID: 30064689 DOI: 10.1016/j.cct.2018.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Allison N Williams
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States; Southwest Interdisciplinary Research Center, Arizona State University, United States
| | - Yolanda P Konopken
- Family Wellness Program, Virginia G. Piper, St. Vincent de Paul Medical and Dental Clinic, United States
| | - Colleen S Keller
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States
| | - Felipe Gonzalez Castro
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States
| | | | - Estela Barraza
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States
| | - Donald L Patrick
- Seattle Quality of Life Group, Department of Health Services, School of Public Health and Community Medicine, University of Washington, United States
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States; Division of Endocrinology and Diabetes, Phoenix Children's Hospital, United States
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States; Southwest Interdisciplinary Research Center, Arizona State University, United States; Division of Endocrinology and Diabetes, Phoenix Children's Hospital, United States.
| |
Collapse
|