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Gross RS, Thaweethai T, Rosenzweig EB, Chan J, Chibnik LB, Cicek MS, Elliott AJ, Flaherman VJ, Foulkes AS, Gage Witvliet M, Gallagher R, Gennaro ML, Jernigan TL, Karlson EW, Katz SD, Kinser PA, Kleinman LC, Lamendola-Essel MF, Milner JD, Mohandas S, Mudumbi PC, Newburger JW, Rhee KE, Salisbury AL, Snowden JN, Stein CR, Stockwell MS, Tantisira KG, Thomason ME, Truong DT, Warburton D, Wood JC, Ahmed S, Akerlundh A, Alshawabkeh AN, Anderson BR, Aschner JL, Atz AM, Aupperle RL, Baker FC, Balaraman V, Banerjee D, Barch DM, Baskin-Sommers A, Bhuiyan S, Bind MAC, Bogie AL, Bradford T, Buchbinder NC, Bueler E, Bükülmez H, Casey BJ, Chang L, Chrisant M, Clark DB, Clifton RG, Clouser KN, Cottrell L, Cowan K, D'Sa V, Dapretto M, Dasgupta S, Dehority W, Dionne A, Dummer KB, Elias MD, Esquenazi-Karonika S, Evans DN, Faustino EVS, Fiks AG, Forsha D, Foxe JJ, Friedman NP, Fry G, Gaur S, Gee DG, Gray KM, Handler S, Harahsheh AS, Hasbani K, Heath AC, Hebson C, Heitzeg MM, Hester CM, Hill S, Hobart-Porter L, Hong TKF, Horowitz CR, Hsia DS, Huentelman M, Hummel KD, Irby K, Jacobus J, Jacoby VL, Jone PN, Kaelber DC, Kasmarcak TJ, Kluko MJ, Kosut JS, Laird AR, Landeo-Gutierrez J, Lang SM, Larson CL, Lim PPC, Lisdahl KM, McCrindle BW, McCulloh RJ, McHugh K, Mendelsohn AL, Metz TD, Miller J, Mitchell EC, Morgan LM, Müller-Oehring EM, Nahin ER, Neale MC, Ness-Cochinwala M, Nolan SM, Oliveira CR, Osakwe O, Oster ME, Payne RM, Portman MA, Raissy H, Randall IG, Rao S, Reeder HT, Rosas JM, Russell MW, Sabati AA, Sanil Y, Sato AI, Schechter MS, Selvarangan R, Sexson Tejtel SK, Shakti D, Sharma K, Squeglia LM, Srivastava S, Stevenson MD, Szmuszkovicz J, Talavera-Barber MM, Teufel RJ, Thacker D, Trachtenberg F, Udosen MM, Warner MR, Watson SE, Werzberger A, Weyer JC, Wood MJ, Yin HS, Zempsky WT, Zimmerman E, Dreyer BP. Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design. PLoS One 2024; 19:e0285635. [PMID: 38713673 DOI: 10.1371/journal.pone.0285635] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/14/2023] [Indexed: 05/09/2024] Open
Abstract
IMPORTANCE The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. OBSERVATIONS We describe the protocol for the Pediatric Observational Cohort Study of the NIH's REsearching COVID to Enhance Recovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of four cohorts that comprise RECOVER-Pediatrics: 1) a de novo RECOVER prospective cohort of children and young adults with and without previous or current infection; and 2) an extant cohort derived from the Adolescent Brain Cognitive Development (ABCD) study (n = 10,000). The de novo cohort incorporates three tiers of data collection: 1) remote baseline assessments (Tier 1, n = 6000); 2) longitudinal follow-up for up to 4 years (Tier 2, n = 6000); and 3) a subset of participants, primarily the most severely affected by PASC, who will undergo deep phenotyping to explore PASC pathophysiology (Tier 3, n = 600). Youth enrolled in the ABCD study participate in Tier 1. The pediatric protocol was developed as a collaborative partnership of investigators, patients, researchers, clinicians, community partners, and federal partners, intentionally promoting inclusivity and diversity. The protocol is adaptive to facilitate responses to emerging science. CONCLUSIONS AND RELEVANCE RECOVER-Pediatrics seeks to characterize the clinical course, underlying mechanisms, and long-term effects of PASC from birth through 25 years old. RECOVER-Pediatrics is designed to elucidate the epidemiology, four-year clinical course, and sociodemographic correlates of pediatric PASC. The data and biosamples will allow examination of mechanistic hypotheses and biomarkers, thus providing insights into potential therapeutic interventions. CLINICAL TRIALS.GOV IDENTIFIER Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT05172011.
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Affiliation(s)
- Rachel S Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Erika B Rosenzweig
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York, United States of America
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Lori B Chibnik
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Mine S Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Rochester, Minnesota, United States of America
| | - Amy J Elliott
- Avera Research Institute, Avera Health, Sioux Falls, South Dakota, United States of America
| | - Valerie J Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, California, United States of America
| | - Andrea S Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Margot Gage Witvliet
- Department of Sociology, Lamar University, Beaumont, Texas, United States of America
| | - Richard Gallagher
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Maria Laura Gennaro
- Public Health Research Institute and Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Terry L Jernigan
- Center for Human Development, Department of Cognitive Science, University of California San Diego, San Diego, California, United States of America
- Departments of Psychiatry and Radiology, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Elizabeth W Karlson
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stuart D Katz
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Patricia A Kinser
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Lawrence C Kleinman
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Michelle F Lamendola-Essel
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Joshua D Milner
- Division of Pediatric Allergy, Department of Pediatrics, Immunology and Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York, United States of America
| | - Sindhu Mohandas
- Department of Infectious Diseases, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Praveen C Mudumbi
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, United States of America
| | - Kyung E Rhee
- Division of Child and Community Health, Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Amy L Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Jessica N Snowden
- Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Cheryl R Stein
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York, United States of America
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Kelan G Tantisira
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Moriah E Thomason
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Dongngan T Truong
- Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, United States of America
| | - David Warburton
- Division of Neonatology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - John C Wood
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, California, United States of America
| | - Shifa Ahmed
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Almary Akerlundh
- Department of Pulmonary Research, Rady Children's Hospital-San Diego, San Diego, California, United States of America
| | - Akram N Alshawabkeh
- College of Engineering, Northeastern University, Boston, Massachusetts, United States of America
| | - Brett R Anderson
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, New York, United States of America
| | - Judy L Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Andrew M Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Robin L Aupperle
- Oxley College of Health Sciences, Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
| | - Fiona C Baker
- Department of Biosciences, SRI International, Menlo Park, California, United States of America
| | - Venkataraman Balaraman
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, United States of America
| | - Dithi Banerjee
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, Missouri, United States of America
| | - Deanna M Barch
- Department of Psychiatry, Washington University in St. Louis, Saint Louis, Missouri, United States of America
| | - Arielle Baskin-Sommers
- Department of Psychology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Sultana Bhuiyan
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Marie-Abele C Bind
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Amanda L Bogie
- Department of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, United States of America
| | - Tamara Bradford
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of New Orleans and LSU Health Sciences Center, New Orleans, United States of America
| | - Natalie C Buchbinder
- Center for Human Development, University of California San Diego, San Diego, California, United States of America
| | - Elliott Bueler
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Hülya Bükülmez
- Division of Rheumatology, Department of Pediatrics, The MetroHealth System, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - B J Casey
- Department of Neuroscience and Behavior, Barnard College-Columbia University, New York, New York, United States of America
| | - Linda Chang
- Departments of Diagnostic Radiology & Nuclear Medicine and Neurology, University of Maryland Baltimore, Baltimore, Maryland, United States of America
| | - Maryanne Chrisant
- Department of Women's and Children's Health, Charles E. Schmidt College of Medicine at Florida Atlantic University, Hollywood, Florida, United States of America
| | - Duncan B Clark
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Rebecca G Clifton
- Biostatistics Center, George Washington University, Washington, DC, United States of America
| | - Katharine N Clouser
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University, Morgantown, West Virginia, United States of America
| | - Kelly Cowan
- Department of Pediatrics, Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, Vermont, United States of America
| | - Viren D'Sa
- Department of Pediatrics, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, United States of America
| | - Soham Dasgupta
- Department of Pediatrics, Norton Children's Hospital, University of Louisville, Louisville, Kentucky, United States of America
| | - Walter Dehority
- Division of Infectious Diseases, Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, United States of America
| | - Kirsten B Dummer
- Department of Pediatrics, University of California San Diego, San Diego, California, United States of America
| | - Matthew D Elias
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Shari Esquenazi-Karonika
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Danielle N Evans
- Arkansas Children's Research Institute, Arkansas Children's Hospital, Little Rock, Arkansas, United States of America
| | - E Vincent S Faustino
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Alexander G Fiks
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Daniel Forsha
- Department of Cardiology, Children's Mercy Kansas City, Ward Family Heart Center, Kansas City, Missouri, United States of America
| | - John J Foxe
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Naomi P Friedman
- Institute for Behavioral Genetics and Department of Psychology and Neuroscience, University of Colorado Boulder, Bolder, Colorado, United States of America
| | - Greta Fry
- Pennington Biomedical Research Center Clinic, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Sunanda Gaur
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Dylan G Gee
- Department of Psychology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Stephanie Handler
- Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Ashraf S Harahsheh
- Division of Cardiology, Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, United States of America
| | - Keren Hasbani
- Division of Pediatric Cardiology, Department of Pediatrics, Dell Children's Medical Center, Dell Medical School, Austin, Texas, United States of America
| | - Andrew C Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, United States of America
| | - Camden Hebson
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Mary M Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Christina M Hester
- Division of Practice-Based Research, Innovation, & Evaluation, American Academy of Family Physicians, Leawood, Kansas, United States of America
| | - Sophia Hill
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Laura Hobart-Porter
- Departments of Pediatrics and Physical Medicine & Rehabilitation, Section of Pediatric Rehabilitation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Travis K F Hong
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, United States of America
| | - Carol R Horowitz
- Center for Health Equity and Community Engaged Research and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Daniel S Hsia
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Matthew Huentelman
- Division of Neurogenomics, Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Kathy D Hummel
- Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas Medical School, Little Rock, Arkansas, United States of America
| | - Katherine Irby
- Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas Medical School, Little Rock, Arkansas, United States of America
| | - Joanna Jacobus
- Department of Psychiatry, University of California San Diego, San Diego, California, United States of America
| | - Vanessa L Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Pei-Ni Jone
- Department of Pediatrics, Pediatric Cardiology, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - David C Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System and the Departments of Pediatrics, Internal Medicine, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
- Departments of Pediatrics, Internal Medicine, and Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Tyler J Kasmarcak
- Department of Pediatric Clinical Research, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Matthew J Kluko
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Jessica S Kosut
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, United States of America
| | - Angela R Laird
- Department of Physics, Florida International University, Miami, Florida, United States of America
| | - Jeremy Landeo-Gutierrez
- Respiratory Medicine Division, Department of Pediatrics, University of California San Diego, San Diego, California, United States of America
| | - Sean M Lang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Christine L Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States of America
| | - Peter Paul C Lim
- Department of Pediatric Infectious Disease, Avera McKennan University Health Center, University of South Dakota, Sioux Falls, South Dakota, United States of America
| | - Krista M Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States of America
| | - Brian W McCrindle
- Department of Pediatrics, University of Toronto, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Russell J McCulloh
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Kimberly McHugh
- Department of Pediatric Clinical Research, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Alan L Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Torri D Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Julie Miller
- Carelon Research, Newton, Massachusetts, United States of America
| | - Elizabeth C Mitchell
- Division of Pediatric Cardiology, Department of Pediatrics, Cohen Children's Medical Center (Northwell Health), New Hyde Park, New York, United States of America
| | - Lerraughn M Morgan
- Department of Pediatrics, Valley Children's Healthcare, Madera, California, United States of America
| | - Eva M Müller-Oehring
- Department of Biosciences, SRI International, Menlo Park, California, United States of America
| | - Erica R Nahin
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Michael C Neale
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Manette Ness-Cochinwala
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States of America
| | - Sheila M Nolan
- Department of Pediatrics, New York Medical College, Valhalla, New York, United States of America
| | - Carlos R Oliveira
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Onyekachukwu Osakwe
- Division of Pediatric Cardiology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Matthew E Oster
- Department of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States of America
| | - R Mark Payne
- Division of Pediatric Cardiology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Michael A Portman
- Division of Cardiology, Department of Pediatrics, Seattle Children's and University of Washington, Seattle, Washington, United States of America
| | - Hengameh Raissy
- Department of Pediatrics, University of New Mexico, Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Isabelle G Randall
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Suchitra Rao
- Division of Infectious Diseases, Department of Pediatrics, Epidemiology and Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Harrison T Reeder
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Johana M Rosas
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Mark W Russell
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, United States of America
| | - Arash A Sabati
- Department of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, Arizona, United States of America
| | - Yamuna Sanil
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, United States of America
| | - Alice I Sato
- Department of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Michael S Schechter
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, Missouri, United States of America
| | - S Kristen Sexson Tejtel
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, United States of America
| | - Divya Shakti
- Division of Pediatric Cardiology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Kavita Sharma
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Shubika Srivastava
- Division of Cardiovascular Medicine, Department of Pediatric Cardiology, Nemours Children's Health, Wilmington, Delaware, United States of America
| | - Michelle D Stevenson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, United States of America
| | - Jacqueline Szmuszkovicz
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California, United States of America
| | - Maria M Talavera-Barber
- Department of Pediatrics, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, United States of America
| | - Ronald J Teufel
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Deepika Thacker
- Division of Cardiovascular Medicine, Department of Pediatric Cardiology, Nemours Children's Health, Wilmington, Delaware, United States of America
| | | | - Mmekom M Udosen
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Megan R Warner
- Department of Pulmonary Research, Rady Children's Hospital-San Diego, San Diego, California, United States of America
| | - Sara E Watson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, United States of America
| | - Alan Werzberger
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States of America
| | - Jordan C Weyer
- Center for Individualized Medicine, Mayo Clinic Hospital, Rochester, Minnesota, United States of America
| | - Marion J Wood
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - H Shonna Yin
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - William T Zempsky
- Department of Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut, United States of America
| | - Emily Zimmerman
- Department of Communication Sciences & Disorders, Northeastern University, Boston, Massachusetts, United States of America
| | - Benard P Dreyer
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, United States of America
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Kirkman MS, Tripputi M, Krause-Steinrauf H, Bebu I, AbouAssi H, Burch H, Duran-Valdez E, Florez H, Garvey WT, Hsia DS, Salam M, Pop-Busui R. Comparative Effects of Randomized Second-line Therapy for Type 2 Diabetes on a Composite Outcome Incorporating Glycemic Control, Body Weight, and Hypoglycemia: An Analysis of the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care 2024; 47:594-602. [PMID: 38194519 PMCID: PMC10973908 DOI: 10.2337/dc23-1332] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/03/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE In Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) (5,047 participants, mean follow-up 5.0 years), differences in glycemic control were demonstrated over time among four randomized therapies added to metformin. Weight gain and hypoglycemia are also important outcomes for people with type 2 diabetes. We compared the effects of the four randomized GRADE medications on a composite outcome incorporating glycemic deterioration, weight gain, and hypoglycemia. RESEARCH DESIGN AND METHODS The composite outcome was time to first occurrence of any of the following: HbA1c >7.5%, confirmed; ≥5% weight gain; or severe or recurrent nonsevere hypoglycemia. Secondary analyses included examination of individual components of the composite outcome, subgroup effects and potential mediators, and treatment satisfaction. Cumulative incidence was estimated with the Kaplan-Meier estimator. Cox proportional hazards models were used to assess pairwise group differences in risk of an outcome. RESULTS Risk of reaching the composite outcome (events per 100 participants per treatment year [PTYs]) was lowest with liraglutide (19 per 100 PTYs) followed by sitagliptin (26 per 100 PTYs), glargine (29 per 100 PTYs), and glimepiride (40 per 100 PTYs); all pairwise comparisons were statistically significant. The order was the same for risk of weight gain and hypoglycemia, but risk of glycemic deterioration was lowest with glargine, followed by liraglutide, glimepiride, and sitagliptin. No significant heterogeneity in risk of composite outcome was detected across prespecified covariates. Participants who reached the composite outcome had modestly but significantly lower treatment satisfaction. CONCLUSIONS Among participants treated with common second-line drug classes for type 2 diabetes, the liraglutide group had the lowest and glimepiride the highest risk of reaching a composite outcome encompassing glycemic deterioration, weight gain, and hypoglycemia. These findings may inform decision-making regarding type 2 diabetes therapy.
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Affiliation(s)
- M. Sue Kirkman
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mark Tripputi
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Ionut Bebu
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | | | - Henry Burch
- National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Rockville, MD
| | | | - Hermes Florez
- Department of Medicine, University of Miami, Miami, FL
- Medical University of South Carolina, Charleston, SC
| | | | | | - Maamoun Salam
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI
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Hernandez N, Lokhnygina Y, Ramaker ME, Ilkayeva O, Muehlbauer MJ, Crawford ML, Grant RP, Hsia DS, Jain N, Bain JR, Armstrong S, Newgard CB, Freemark M, Gumus Balikcioglu P. Sex Differences in Branched-chain Amino Acid and Tryptophan Metabolism and Pathogenesis of Youth-onset Type 2 Diabetes. J Clin Endocrinol Metab 2024; 109:e1345-e1358. [PMID: 38066593 PMCID: PMC10940256 DOI: 10.1210/clinem/dgad708] [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: 04/02/2023] [Indexed: 03/16/2024]
Abstract
OBJECTIVES Insulin resistance is associated with elevations in plasma branched-chain amino acids (BCAAs). BCAAs compete with aromatic amino acids including tryptophan for uptake into β cells. To explore relationships between BCAAs and tryptophan metabolism, adiposity, and glucose tolerance, we compared urine metabolites in overweight/obese youth with type 2 diabetes (T2D) with those in nondiabetic overweight/obese and lean youth. METHODS Metabolites were measured in 24-hour and first-morning urine samples of 56 nondiabetic adolescents with overweight/obesity, 42 adolescents with T2D, and 43 lean controls, aged 12 to 21 years. Group differences were assessed by Kruskal Wallis or ANOVA. RESULTS Groups were comparable for age, pubertal status, and ethnicity. Youth with T2D were predominantly female and had highest percent body fat. BCAAs, branched-chain ketoacids (BCKAs), tryptophan, and kynurenine were higher in urine of subjects with T2D. There were no differences between lean controls and nondiabetic youth with overweight/obesity. T2D was associated with diversion of tryptophan from the serotonin to the kynurenine pathway, with higher urinary kynurenine/serotonin ratio and lower serotonin/tryptophan and 5-HIAA/kynurenine ratios. Urinary BCAAs, BCKAs, tryptophan, and ratios reflecting diversion to the kynurenine pathway correlated positively with metrics of body fat and hemoglobin A1c. Increases in these metabolites in the obese T2D group were more pronounced and statistically significant only in adolescent girls. CONCLUSION Increases in urinary BCAAs and BCKAs in adolescent females with T2D are accompanied by diversion of tryptophan metabolism from the serotonin to the kynurenine pathway. These adaptations associate with higher risks of T2D in obese adolescent females than adolescent males.
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Affiliation(s)
- Natalie Hernandez
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27710, USA
| | - Yuliya Lokhnygina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27701, USA
| | - Megan Elizabeth Ramaker
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA
| | - Olga Ilkayeva
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC 27710, USA
| | - Michael J Muehlbauer
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
| | - Matthew L Crawford
- Department of Research and Development, LabCorp, Burlington, NC 27215, USA
| | - Russell P Grant
- Department of Research and Development, LabCorp, Burlington, NC 27215, USA
| | - Daniel S Hsia
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Nina Jain
- Division of Endocrinology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27514, USA
| | - James R Bain
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC 27710, USA
| | - Sarah Armstrong
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27701, USA
- Division of General Pediatrics and Adolescent Health, Duke University Medical Center, Durham, NC 27710, USA
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC 27710, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Christopher B Newgard
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC 27710, USA
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA
| | - Michael Freemark
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27710, USA
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
| | - Pinar Gumus Balikcioglu
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27710, USA
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
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Carmichael OT, Singh M, Bashir A, Russell AM, Bolding M, Redden DT, Storrs J, Willoughby WR, Howard-Claudio C, Hsia DS, Kimberly RP, Gray ME, Ravussin E, Denney TS. Harmonized Multisite MRI-Based Quantification of Human Liver Fat and Stiffness: A Pilot Study. J Magn Reson Imaging 2024; 59:1070-1073. [PMID: 37246446 DOI: 10.1002/jmri.28790] [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: 09/29/2022] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a leading cause of end-stage liver disease. NAFLD diagnosis and follow-up relies on a combination of clinical data, liver imaging, and/or liver biopsy. However, intersite imaging differences impede diagnostic consistency and reduce the repeatability of the multisite clinical trials necessary to develop effective treatments. PURPOSE/HYPOTHESIS The goal of this pilot study was to harmonize commercially available 3 T magnetic resonance imaging (MRI) measurements of liver fat and stiffness in human participants across academic sites and MRI vendors. STUDY TYPE Cohort. SUBJECTS Four community-dwelling adults with obesity. FIELD STRENGTH/SEQUENCE 1.5 and 3 T, multiecho 3D imaging, PRESS, and GRE. ASSESSMENT Harmonized proton density fat fraction (PDFF) and magnetic resonance spectroscopy (MRS) protocols were used to quantify the FF of synthetic phantoms and human participants with obesity using standard acquisition parameters at four sites that had four different 3 T MRI instruments. In addition, a harmonized magnetic resonance elastography (MRE) protocol was used to quantify liver stiffness among participants at two different sites at 1.5 and 3 T field strengths. Data were sent to a single data coordinating site for postprocessing. STATISTICAL TESTS Linear regression in MATLAB, ICC analyses using SAS 9.4, one-sided 95% confidence intervals for the ICC. RESULTS PDFF and MRS FF measurements were highly repeatable among sites in both humans and phantoms. MRE measurements of liver stiffness in three individuals at two sites using one 1.5 T and one 3 T instrument showed repeatability that was high although lower than that of MRS and PDFF. CONCLUSIONS We demonstrated harmonization of PDFF, MRS, and MRE-based quantification of liver fat and stiffness through synthetic phantoms, traveling participants, and standardization of postprocessing analysis. Multisite MRI harmonization could contribute to multisite clinical trials assessing the efficacy of interventions and therapy for NAFLD. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Owen T Carmichael
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, 70808, USA
| | - Maninder Singh
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, 70808, USA
| | - Adil Bashir
- Auburn University, Samuel Ginn College of Engineering, Auburn, Alabama, 36849, USA
| | - Anne M Russell
- The University of Alabama, Birmingham, Alabama, 35294, USA
| | - Mark Bolding
- The University of Alabama, Birmingham, Alabama, 35294, USA
- The University of Alabama Medical Center, Birmingham, Alabama, 35233, USA
| | - David T Redden
- The University of Alabama, Birmingham, Alabama, 35294, USA
- School of Public Health, The University of Alabama, Birmingham, Alabama, 35233, USA
| | - Judd Storrs
- The University of Mississippi Medical Center, Jackson, Mississippi, 39216, USA
| | - William R Willoughby
- The University of Alabama, Birmingham, Alabama, 35294, USA
- The University of Alabama Medical Center, Birmingham, Alabama, 35233, USA
| | | | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, 70808, USA
| | - Robert P Kimberly
- The University of Alabama, Birmingham, Alabama, 35294, USA
- School of Medicine, The University of Alabama, Birmingham, Alabama, 35233, USA
| | - Meagan E Gray
- The University of Alabama, Birmingham, Alabama, 35294, USA
- School of Medicine, The University of Alabama, Birmingham, Alabama, 35233, USA
- The University of Alabama Hospital, Birmingham, Alabama, 35205, USA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, 70808, USA
- The University of Alabama, Birmingham, Alabama, 35294, USA
| | - Thomas S Denney
- Auburn University, Samuel Ginn College of Engineering, Auburn, Alabama, 36849, USA
- The University of Alabama, Birmingham, Alabama, 35294, USA
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Bays HE, Hsia DS, Nguyen LT, Peterson CA, Varghese ST. Effects of phentermine / topiramate extended-release, phentermine, and placebo on ambulatory blood pressure monitoring in adults with overweight or obesity: A randomized, multicenter, double-blind study. Obes Pillars 2024; 9:100099. [PMID: 38304225 PMCID: PMC10831272 DOI: 10.1016/j.obpill.2024.100099] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/06/2024] [Accepted: 01/06/2024] [Indexed: 02/03/2024]
Abstract
Background A fixed-dose combination of phentermine and extended-release topiramate (PHEN/TPM - approved for weight management) has demonstrated in-clinic reduction of blood pressure (BP). Ambulatory BP monitoring (ABPM) may be a better predictor of cardiovascular disease risk than in-clinic BP. Methods This randomized, multicenter, double-blind study enrolled 565 adults with overweight/obesity. Inclusion criteria included participants willing to wear ABPM device for 24 h. Exclusion criteria included screening blood pressure >140/90 mmHg and antihypertensive medications not stable for 3 months prior to randomization. Participants received placebo (n = 184), phentermine 30 mg; (n = 191), or PHEN 15 mg/TPM 92 mg; (n = 190). 24-hour ABPM was performed at baseline and at week 8. The primary endpoint was mean 24-h systolic BP (SBP) as measured by ABPM, in the per protocol population. Results Participants were mostly female (73.5 %) and White (81.6 %), with a mean age of 53.4 years; 32.4 % had no hypertension diagnosis or treatment, 62.5 % had hypertension using 0 to 2 antihypertensive medications, and 5.1 % had hypertension using ≥ 3 antihypertensive medications. Baseline mean SBP/diastolic BP (DBP) was 123.9/77.6 mmHg. At week 8, mean SBP change was -0.1 mmHg (placebo), +1.4 mmHg (phentermine 30 mg), and -3.3 mmHg (PHEN/TPM). Between-group difference for PHEN/TPM versus placebo was -3.2 mmHg (95 % CI: -5.48, -0.93 mmHg; p = 0.0059). The between-group difference for PHEN/TPM versus phentermine 30 mg was -4.7 mmHg (95 % CI: -6.96, -2.45 mmHg; p < 0.0001). Common (>2 % in any treatment group) adverse events (i.e., dry mouth, constipation, nausea, dizziness, paresthesia, dysgeusia, headache, COVID-19, urinary tract infection, insomnia, and anxiety) were mostly mild or moderate. Conclusions In this randomized, multicenter, double-blind ABPM study, PHEN/ TPM reduced SBP compared to either placebo or phentermine 30 mg (Funding: Vivus LLC; ClinicalTrials.gov: NCT05215418).
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Affiliation(s)
- Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
| | - Daniel S. Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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6
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Hsia DS, Younes N, Krause-Steinrauf H, Kassem LS. The incidence of retinopathy in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness study (GRADE). J Diabetes Complications 2024; 38:108692. [PMID: 38354481 PMCID: PMC10923170 DOI: 10.1016/j.jdiacomp.2024.108692] [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: 09/28/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
Based on self-report in the GRADE diabetes study, cumulative incidence of retinopathy was low over 5 years (3.7 %; 184 of 4098 participants) and did not differ among the 4 treatment groups (glargine 4.0 %, glimepiride 3.2 %, liraglutide 3.7 %, sitagliptin 3.8 %). There were no differences in retinopathy with specific therapies in GRADE. Clinicaltrials.gov identifier: NCT01794143.
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Affiliation(s)
- Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA, United States of America.
| | - Naji Younes
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, United States of America
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, United States of America
| | - Laure Sayyed Kassem
- Endocrine Section, Department of Medicine, Louis Stokes VA Medical Center, Cleveland, OH, United States of America; Division of Clinical and Molecular Endocrinology, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States of America
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Dorling JL, Apolzan JW, Johannsen NM, Thomas DM, Höchsmann C, Hsia DS, Martin CK. Exercise-induced Changes in Central Adiposity During an RCT: Effect of Exercise Dose and Associations With Compensation. J Clin Endocrinol Metab 2024; 109:e997-e1005. [PMID: 38019946 PMCID: PMC10876389 DOI: 10.1210/clinem/dgad696] [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: 08/24/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023]
Abstract
CONTEXT Exercise can decrease central adiposity, but the effect of exercise dose and the relationship between central adiposity and exercise-induced compensation is unclear. OBJECTIVE Test the effect of exercise dose on central adiposity change and the association between central adiposity and exercise-induced weight compensation. METHODS In this ancillary analysis of a 6-month randomized controlled trial, 170 participants with overweight or obesity (mean ± SD body mass index: 31.5 ± 4.7 kg/m2) were randomized to a control group or exercise groups that reflected exercise recommendations for health (8 kcal/kg/week [KKW]) or weight loss and weight maintenance (20 KKW). Waist circumference was measured, and dual-energy X-ray absorptiometry assessed central adiposity. Predicted weight change was estimated and weight compensation (weight change - predicted weight change) was calculated. RESULTS Between-group change in waist circumference (control: .0 cm [95% CI, -1.0 to 1.0], 8 KKW: -.7 cm [95% CI, -1.7 to .4], 20 KKW: -1.3 cm [95% CI, -2.4 to -.2]) and visceral adipose tissue (VAT; control: -.02 kg [95% CI, -.07 to .04], 8 KKW: -.01 kg [95% CI, -.07 to .04], 20 KKW: -.04 kg [95% CI, -.10 to .02]) was similar (P ≥ .23). Most exercisers (82.6%) compensated (weight loss less than expected). Exercisers who compensated exhibited a 2.5-cm (95% CI, .8 to 4.2) and .23-kg (95% CI, .14 to .31) increase in waist circumference and VAT, respectively, vs those who did not (P < .01). Desire to eat predicted VAT change during exercise (β = .21; P = .03). CONCLUSION In the presence of significant weight compensation, exercise at doses recommended for health and weight loss and weight maintenance leads to negligible changes in central adiposity.
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Affiliation(s)
- James L Dorling
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life of Sciences, University of Glasgow, Glasgow G31 2ER, UK
| | - John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Neil M Johannsen
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
- School of Kinesiology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Diana M Thomas
- Department of Mathematical Sciences, United States Military Academy, West Point, NY 10996, USA
| | - Christoph Höchsmann
- TUM School of Medicine and Health, Technical University of Munich, Munich 80809, Germany
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
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LeBlanc ES, Pittas AG, Nelson J, Chatterjee R, Rasouli N, Rhee MK, Pratley RE, Desouza CV, Neff LM, Peters AM, Dagogo-Jack S, Hsia DS. Racial differences in measures of glycemia in the Vitamin D and Type 2 Diabetes (D2d) Study: a secondary analysis of a randomized trial. BMJ Open Diabetes Res Care 2024; 12:e003613. [PMID: 38350671 PMCID: PMC10862329 DOI: 10.1136/bmjdrc-2023-003613] [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: 07/14/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Understanding how race may influence the association between A1c and glycemia can improve diabetes screening. We sought to determine whether, for a given A1c level, glucose levels during an oral glucose tolerance test (OGTT) differed by race. RESEARCH DESIGN AND METHODS From data collected at 22 US clinical sites, we conducted a cross-sectional study of concurrently measured A1c and OGTT and observational longitudinal follow-up of the subset with high-risk pre-diabetes. Numerical integration methods were used to calculate area under the glycemic curve (AUCglu) during OGTT and least squares regression model to estimate A1c for a given AUCglu by race, controlling for potential confounders. RESULTS 1016 black, 2658 white, and 193 Asian persons at risk of diabetes were included in cross-sectional analysis. Of these, 2154 with high-risk pre-diabetes were followed for 2.5 years. For a given A1c level, AUCglu was lower in black versus white participants. After adjustment for potential confounders, A1c levels for a given AUCglu quintile were 0.15-0.20 and 0.02-0.19 percentage points higher in black and Asian compared with white participants, respectively (p<0.05). In longitudinal analyses, black participants were more likely to be diagnosed with diabetes by A1c than white participants (28% vs 10%, respectively; p<0.01). Black and Asian participants were less likely to be diagnosed by fasting glucose than white participants (16% vs 15% vs 37%, respectively; p<0.05). Black participants with A1c levels in the lower-level quintiles had greater increase in A1c over time compared with white participants. CONCLUSIONS Use of additional testing beyond A1c to screen for diabetes may better stratify diabetes risk in the diverse US population.
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Affiliation(s)
- Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Anastassios G Pittas
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jason Nelson
- Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Neda Rasouli
- Endocrinology, Metabolism and Diabetes, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
- Endocrinology, VA Eastern Colorado Health Care System, Denver, Colorado, USA
| | - Mary K Rhee
- Medicine/Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Richard E Pratley
- Translational Research Institute, AdventHealth Research Institute, Orlando, Florida, USA
| | | | - Lisa M Neff
- Northwestern Medicine, Chicago, Illinois, USA
| | - Anne M Peters
- Endocrinology, USC, Manhattan Beach, California, USA
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes & Metabolism General Clinical Research Center, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Myers CA, Beyl RA, Hsia DS, Harris MN, Reed IJ, Eliser DD, Bagneris L, Apolzan JW. Effects of Episodic Food Insecurity on Psychological and Physiological Responses in African American Women With Obesity (RESPONSES): Protocol for a Longitudinal Observational Cohort Study. JMIR Res Protoc 2023; 12:e52193. [PMID: 38117554 PMCID: PMC10765303 DOI: 10.2196/52193] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Food insecurity is a risk factor for multiple chronic diseases, including obesity. Importantly, both food insecurity and obesity are more prevalent in African American women than in other groups. Furthermore, food insecurity is considered a cyclic phenomenon, with episodes of food adequacy (ie, enough food to eat) and food shortage (ie, not enough food to eat). More research is needed to better understand why food insecurity is linked to obesity, including acknowledging the episodic nature of food insecurity as a stressor and identifying underlying mechanisms. OBJECTIVE The objective of this study is to investigate the episodic nature of food insecurity as a stressor via responses in body weight and psychological and physiological parameters longitudinally and do so in a health-disparate population-African American women. METHODS We enrolled 60 African American women (food-insecure cohort: n=30, 50%; food-secure cohort: n=30, 50%) aged 18-65 years with obesity (BMI 30-50 kg/m2) to measure (1) daily body weight remotely over 22 weeks and (2) psychological and physiological parameters via clinic assessments at the beginning and end of the 22-week study. Furthermore, we are assessing episodes of food insecurity, stress, hedonic eating, and appetite on a weekly basis. We hypothesize that food-insecure African American women with obesity will demonstrate increased body weight and changes in psychological and physiological end points, whereas food-secure African American women with obesity will not. We are also examining associations between changes in psychological and physiological parameters and changes in body weight and performing a mediation analysis on the psychological parameters assessed at the study midpoint. Psychological questionnaires are used to assess stress; executive function, decision-making, and motivation; and affect and nonhomeostatic eating. Physiological measurements are used to evaluate the levels of cortisol, dehydroepiandrosterone-sulfate (DHEA-S), C-reactive protein, thyroid hormones, blood glucose, glycated hemoglobin, and insulin, as well as allostatic load. RESULTS This study has completed participant recruitment (n=60). At the time of study enrollment, the mean age of the participants was almost 47 (SD 10.8) years, and they had a mean BMI of 39.6 (SD 5.31) kg/m2. All data are anticipated to be collected by the end of 2023. CONCLUSIONS We believe that this is the first study to examine changes in body weight and psychological and physiological factors in food-insecure African American women with obesity. This study has significant public health implications because it addresses the cyclic nature of food insecurity to identify underlying mechanisms that can be targeted to mitigate the adverse relationship between food insecurity and obesity and reduce health disparities in minority populations. TRIAL REGISTRATION ClinicalTrials.gov NCT05076487; https://clinicaltrials.gov/study/NCT05076487. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52193.
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Affiliation(s)
- Candice A Myers
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Robbie A Beyl
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Melissa N Harris
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Isabella J Reed
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Danielle D Eliser
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Lauren Bagneris
- Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
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Schneider N, Hartweg M, O’Regan J, Beauchemin J, Redman L, Hsia DS, Steiner P, Carmichael O, D’Sa V, Deoni S. Impact of a Nutrient Formulation on Longitudinal Myelination, Cognition, and Behavior from Birth to 2 Years: A Randomized Clinical Trial. Nutrients 2023; 15:4439. [PMID: 37892514 PMCID: PMC10610069 DOI: 10.3390/nu15204439] [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] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Observation studies suggest differences in myelination in relation to differences in early life nutrition. This two-center randomized controlled trial investigates the effect of a 12-month nutritional intervention on longitudinal changes in myelination, cognition, and behavior. Eighty-one full-term, neurotypical infants were randomized into an investigational (N = 42) or a control group (N = 39), receiving higher versus lower levels of a blend of nutrients. Non-randomized breastfed infants (N = 108) served as a reference group. Main outcomes were myelination (MRI), neurodevelopment (Bayley-III), social-emotional development (ASQ:SE-2), infant and toddler behavior (IBQ-R and TBAQ), and infant sleep (BISQ) during the first 2 years of life. The full analysis set comprised N = 67 infants from the randomized groups, with 81 myelin-sensitive MRI sequences. Significantly higher myelination was observed in the investigational compared to the control group at 6, 12, 18, and 24 months of life, as well as significantly higher gray matter volume at 24 months, a reduced number of night awakenings at 6 months, increased day sleep at 12 months, and reduced social fearfulness at 24 months. The results suggest that brain development may be modifiable with brain- and age-relevant nutritional approaches in healthy infants and young children, which may be foundational for later learning outcomes.
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Affiliation(s)
- Nora Schneider
- Brain Health, Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., 1010 Lausanne, Switzerland
| | - Mickaël Hartweg
- Biostatistics and Data Management, Clinical Research Unit, Nestlé Research, Société des Produits Nestlé S.A., Vers-chez-les-Blanc, 1000 Lausanne, Switzerland
| | - Jonathan O’Regan
- Nestlé Development Centre Nutrition, Askeaton, Co., RH6 0PA Limerick, Ireland
| | - Jennifer Beauchemin
- Advanced Baby Imaging Lab, Hasbro Children’s Hospital, Providence, RI 02903, USA
| | - Leanne Redman
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA (O.C.)
| | - Daniel S. Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA (O.C.)
| | - Pascal Steiner
- Brain Health, Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., 1010 Lausanne, Switzerland
| | - Owen Carmichael
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA (O.C.)
| | - Viren D’Sa
- Advanced Baby Imaging Lab, Hasbro Children’s Hospital, Providence, RI 02903, USA
- Department of Pediatrics, Brown University, Providence, RI 02903, USA
| | - Sean Deoni
- Department of Pediatrics, Brown University, Providence, RI 02903, USA
- Spinn Neuroscience, Mukilteo, WA 98275, USA
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Kim SH, Arora I, Hsia DS, Knowler WC, LeBlanc E, Mylonakis E, Pratley R, Pittas AG. New-Onset Diabetes After COVID-19. J Clin Endocrinol Metab 2023; 108:e1164-e1174. [PMID: 37207448 PMCID: PMC11009784 DOI: 10.1210/clinem/dgad284] [Citation(s) in RCA: 2] [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: 03/17/2023] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023]
Abstract
There is evidence suggesting that infection with SARS-CoV-2 can lead to several long-term sequelae including diabetes. This mini-review examines the rapidly evolving and conflicting literature on new-onset diabetes after COVID-19, which we term NODAC. We searched PubMed, MEDLINE, and medRxiv from inception until December 1, 2022, using Medical Subject Headings (MeSH) terms and free text words including "COVID-19," "SARS-CoV-2," "diabetes," "hyperglycemia," "insulin resistance," and "pancreatic β-cell." We also supplemented searches by examining reference lists from retrieved articles. Current evidence suggests that COVID-19 increases the risk of developing diabetes, but the attributable risk is uncertain because of limitations of study designs and the evolving nature of the pandemic, including new variants, widespread population exposure to the virus, diagnostic options for COVID-19, and vaccination status. The etiology of diabetes after COVID-19 is likely multifactorial and includes factors associated with host characteristics (eg, age), social determinants of health (eg, deprivation index), and pandemic-related effects both at the personal (eg, psychosocial stress) and the societal-community level (eg, containment measures). COVID-19 may have direct and indirect effects on pancreatic β-cell function and insulin sensitivity related to the acute infection and its treatment (eg, glucocorticoids); autoimmunity; persistent viral residency in multiple organs including adipose tissue; endothelial dysfunction; and hyperinflammatory state. While our understanding of NODAC continues to evolve, consideration should be given for diabetes to be classified as a post-COVID syndrome, in addition to traditional classifications of diabetes (eg, type 1 or type 2), so that the pathophysiology, natural history, and optimal management can be studied.
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Affiliation(s)
- Sun H Kim
- Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Ipsa Arora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Tufts Medical Center, Boston, MA 02111, USA
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA 70808, USA
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ 85016, USA
| | - Erin LeBlanc
- Center for Health Research, Kaiser Permanente, Portland, OR 97227, USA
| | | | - Richard Pratley
- AdventHealth Translational Research Institute, Orlando, FL 32804, USA
| | - Anastassios G Pittas
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Tufts Medical Center, Boston, MA 02111, USA
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Hempe JM, Yang S, Hsia DS. Effect of biological variation in HbA1c and blood glucose on the diagnosis of prediabetes. Endocrinol Diabetes Metab 2023; 6:e442. [PMID: 37496158 PMCID: PMC10495557 DOI: 10.1002/edm2.442] [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: 04/02/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION People with a low or high haemoglobin glycation index (HGI) have lower or higher HbA1c than other people with the same FPG. This study compared the prevalence of prediabetes based on FPG, 2hOGTT and HbA1c in people with low, moderate or high HGI. METHODS Prediabetes was diagnosed based on ADA cutpoints in 10,488 NHANES participants without self-reported diabetes. HGI was calculated as the difference between a participant's observed HbA1c and a predicted HbA1c where predicted HbA1c = 0.024 FPG + 3.1. Participants were divided into low (HGI < -0.15%), moderate (HGI -0.15% to +0.15%) and high (HGI > +0.15%) HGI subgroups. RESULTS The prevalence of prediabetes was 42.4% based on FPG, 27.2% based on HbA1c and 17.2% based on 2hOGTT. FPG and HbA1c thus overdiagnosed prediabetes by 25.2% and 10.0%, respectively, compared to the OGTT gold standard. Prevalence was (1) similar in low, moderate and high HGI participants based on 2hOGTT, (2) highest in low HGI participants based on FPG, and (3) highest in high HGI participants based on HbA1c. Among participants with mismatched FPG and HbA1c, OGTT was normal in (1) 79.5% of participants with normal FPG but prediabetic HbA1c (mean HGI = +0.53%), and (2) 75.2% of participants with normal HbA1c but prediabetic FPG (mean HGI = -0.30%). CONCLUSIONS FPG overdiagnosed prediabetes in people with low HGI. HbA1c overdiagnosed prediabetes in people with high HGI. Clinical use of HGI could improve prediabetes diagnosis and help health care providers avoid inappropriate or delayed treatment of people with extremes of HGI.
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Affiliation(s)
- James M. Hempe
- Department of PediatricsLouisiana State University Health Sciences CenterNew OrleansLouisianaUSA
| | - Shengping Yang
- Pennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - Daniel S. Hsia
- Pennington Biomedical Research CenterBaton RougeLouisianaUSA
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Hsia DS, Nelson J, Vickery EM, Rasouli N, LeBlanc ES, Kim S, Brodsky I, Pratley R, Dawson-Hughes B, Pittas AG. Effect of vitamin D on regression to normal glucose regulation and individual glycemic measures: A secondary analysis among participants adherent to the trial protocol in the randomized clinical trial vitamin D and type 2 diabetes (D2d) study. Diabetes Res Clin Pract 2023; 202:110792. [PMID: 37343726 PMCID: PMC10491428 DOI: 10.1016/j.diabres.2023.110792] [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: 12/22/2022] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Abstract
AIMS To examine the effect of vitamin D on regression to normal glucose regulation (NGR) and individual glycemic measures in the D2d study. METHODS In per-protocol analyses, we examined time to new-onset diabetes; time to new-onset NGR defined as first occurrence of: 2-or-3 glycemic criteria in the normal range (NGR-1) or fasting plasma glucose (FPG) and 2-hour post-load-glucose (2hPG) in the normal range (NGR-2); proportion meeting NGR at the last study visit; and change in FPG, 2hPG, and HbA1c. RESULTS Among 2423 participants, hazard ratio [HR] for diabetes was 0.84 [95%CI, 0.71, 0.99]). HR (95%CI) was 1.16 (0.99, 1.36) for new-onset NGR-1 and 1.06 (0.87, 1.30) for NGR-2. At the last visit, NGR-1 occurred in 12.4% vs. 9.5% participants in the vitamin D vs. placebo group (rate ratio for vitamin D 1.31 [1.02, 1.70]); whereas, NGR-2 occurred in 8.7% vs. 6.0% (rate ratio for vitamin D 1.45 [1.05, 2.00]). During follow-up, FPG, HbA1c, and 2hPG increased in both groups. Mean difference in FPG favored vitamin D (-0.80 mg/dL; 95%CI, -1.26, -0.33). CONCLUSIONS In secondary analyses among participants adherent to the trial protocol, vitamin D lowered risk of developing diabetes and increased likelihood of NGR at the end of the study.
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Affiliation(s)
- Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | - Jason Nelson
- Tufts CTSI, BERD Center, Tufts Medical Center, Boston, MA, USA
| | - Ellen M Vickery
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, MA, USA
| | - Neda Rasouli
- University of Colorado, School of Medicine and VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Erin S LeBlanc
- Center for Health Research, Kaiser Permanente NW, Portland, OR, USA
| | - Sun Kim
- Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Irwin Brodsky
- Endocrinology and Diabetes Center, Maine Medical Center and Maine Medical Center Research Institute, Scarborough, ME, USA
| | - Richard Pratley
- AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL, USA
| | - Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Anastassios G Pittas
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, MA, USA
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14
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Gross R, Thaweethai T, Rosenzweig EB, Chan J, Chibnik LB, Cicek MS, Elliott AJ, Flaherman VJ, Foulkes AS, Witvliet MG, Gallagher R, Gennaro ML, Jernigan TL, Karlson EW, Katz SD, Kinser PA, Kleinman LC, Lamendola-Essel MF, Milner JD, Mohandas S, Mudumbi PC, Newburger JW, Rhee KE, Salisbury AL, Snowden JN, Stein CR, Stockwell MS, Tantisira KG, Thomason ME, Truong DT, Warburton D, Wood JC, Ahmed S, Akerlundh A, Alshawabkeh AN, Anderson BR, Aschner JL, Atz AM, Aupperle RL, Baker FC, Balaraman V, Banerjee D, Barch DM, Baskin-Sommers A, Bhuiyan S, Bind MAC, Bogie AL, Buchbinder NC, Bueler E, Bükülmez H, Casey B, Chang L, Clark DB, Clifton RG, Clouser KN, Cottrell L, Cowan K, D’Sa V, Dapretto M, Dasgupta S, Dehority W, Dummer KB, Elias MD, Esquenazi-Karonika S, Evans DN, Faustino EVS, Fiks AG, Forsha D, Foxe JJ, Friedman NP, Fry G, Gaur S, Gee DG, Gray KM, Harahsheh AS, Heath AC, Heitzeg MM, Hester CM, Hill S, Hobart-Porter L, Hong TK, Horowitz CR, Hsia DS, Huentelman M, Hummel KD, Iacono WG, Irby K, Jacobus J, Jacoby VL, Jone PN, Kaelber DC, Kasmarcak TJ, Kluko MJ, Kosut JS, Laird AR, Landeo-Gutierrez J, Lang SM, Larson CL, Lim PPC, Lisdahl KM, McCrindle BW, McCulloh RJ, Mendelsohn AL, Metz TD, Morgan LM, Müller-Oehring EM, Nahin ER, Neale MC, Ness-Cochinwala M, Nolan SM, Oliveira CR, Oster ME, Payne RM, Raissy H, Randall IG, Rao S, Reeder HT, Rosas JM, Russell MW, Sabati AA, Sanil Y, Sato AI, Schechter MS, Selvarangan R, Shakti D, Sharma K, Squeglia LM, Stevenson MD, Szmuszkovicz J, Talavera-Barber MM, Teufel RJ, Thacker D, Udosen MM, Warner MR, Watson SE, Werzberger A, Weyer JC, Wood MJ, Yin HS, Zempsky WT, Zimmerman E, Dreyer BP. Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design. medRxiv 2023:2023.04.27.23289228. [PMID: 37214806 PMCID: PMC10197716 DOI: 10.1101/2023.04.27.23289228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Importance The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. Observations We describe the protocol for the Pediatric Observational Cohort Study of the NIH's RE searching COV ID to E nhance R ecovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of five cohorts that comprise RECOVER-Pediatrics: 1) a de novo RECOVER prospective cohort of children and young adults with and without previous or current infection; and 2) an extant cohort derived from the Adolescent Brain Cognitive Development (ABCD) study ( n =10,000). The de novo cohort incorporates three tiers of data collection: 1) remote baseline assessments (Tier 1, n=6000); 2) longitudinal follow-up for up to 4 years (Tier 2, n=6000); and 3) a subset of participants, primarily the most severely affected by PASC, who will undergo deep phenotyping to explore PASC pathophysiology (Tier 3, n=600). Youth enrolled in the ABCD study participate in Tier 1. The pediatric protocol was developed as a collaborative partnership of investigators, patients, researchers, clinicians, community partners, and federal partners, intentionally promoting inclusivity and diversity. The protocol is adaptive to facilitate responses to emerging science. Conclusions and Relevance RECOVER-Pediatrics seeks to characterize the clinical course, underlying mechanisms, and long-term effects of PASC from birth through 25 years old. RECOVER-Pediatrics is designed to elucidate the epidemiology, four-year clinical course, and sociodemographic correlates of pediatric PASC. The data and biosamples will allow examination of mechanistic hypotheses and biomarkers, thus providing insights into potential therapeutic interventions. Clinical Trialsgov Identifier Clinical Trial Registration: http://www.clinicaltrials.gov . Unique identifier: NCT05172011.
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Affiliation(s)
- Rachel Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Erika B. Rosenzweig
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Lori B. Chibnik
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Mine S. Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Rochester, MN, USA
| | - Amy J. Elliott
- Avera Research Institute, Avera Health, Sioux Falls, SD, USA
| | - Valerie J. Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Andrea S. Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | | | - Richard Gallagher
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Maria Laura Gennaro
- Public Health Research Institute and Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Terry L. Jernigan
- Center for Human Development, Cognitive Science, Psychiatry, Radiology, University of California San Diego, La Jolla, CA, USA
| | | | - Stuart D. Katz
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Patricia A. Kinser
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Lawrence C. Kleinman
- Department of Pediatrics, Division of Population Health, Quality, and Implementation Sciences (POPQuIS), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Joshua D. Milner
- Department of Pediatrics, Columbia University Medical Center: Columbia University Irving Medical Center, New York, NY, USA
| | - Sindhu Mohandas
- Department of Infectious Diseases, Children’s Hospital Los Angeles and the Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Praveen C. Mudumbi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - Kyung E. Rhee
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Amy L. Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Jessica N. Snowden
- Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Cheryl R. Stein
- Department of Child and Adolescent Psychiatry, Hassenfeld Children’s Hospital at NYU Langone, New York, NY, USA
| | - Melissa S. Stockwell
- Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY, USA
| | - Kelan G. Tantisira
- Division of Pediatric Respiratory Medicine, University of California San Diego, San Diego, CA, USA
| | - Moriah E. Thomason
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Dongngan T. Truong
- Division of Pediatric Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA
| | - David Warburton
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Shifa Ahmed
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Almary Akerlundh
- Department of Pulmonary Research, Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | | | - Brett R. Anderson
- Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Andrew M. Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Robin L. Aupperle
- Oxley College of Health Sciences, Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Venkataraman Balaraman
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Dithi Banerjee
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Deanna M. Barch
- Department of Psychological & Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, Saint Louis, MO, USA
| | | | - Sultana Bhuiyan
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Marie-Abele C. Bind
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Amanda L. Bogie
- Department of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Natalie C. Buchbinder
- Center for Human Development, University of California San Diego, San Diego, CA, USA
| | - Elliott Bueler
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Hülya Bükülmez
- Department of Pediatrics, Division of Rheumatology, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
| | - B.J. Casey
- Department of Neuroscience and Behavior, Barnard College - Columbia University, New York, NY, USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Duncan B. Clark
- Departments of Psychiatry and Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Katharine N. Clouser
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University, Morgantown, WV, USA
| | - Kelly Cowan
- Department of Pediatrics, Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Viren D’Sa
- Department of Pediatrics, Rhode Island Hospital, Providence, RI, USA
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Soham Dasgupta
- Department of Pediatrics, Norton Children’s Hospital, University of Louisville, Louisville, KY, USA
| | - Walter Dehority
- Department of Pediatrics, Division of Infectious Diseases, University of New Mexico, Albuquerque, NM, USA
| | - Kirsten B. Dummer
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Matthew D. Elias
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shari Esquenazi-Karonika
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Danielle N. Evans
- Arkansas Children’s Research Institute, Arkansas Children’s Hospital, Little Rock, AR, USA
| | | | - Alexander G. Fiks
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel Forsha
- Department of Cardiology, Children’s Mercy Kansas City, Ward Family Heart Center, Kansas City, MO, USA, Kansas City, MO, USA
| | - John J. Foxe
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Naomi P. Friedman
- Institute for Behavioral Genetics and Department of Psychology and Neuroscience, University of Colorado Boulder, Bolder, CO, USA
| | - Greta Fry
- Pennington Biomedical Research Center Clinic, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Sunanda Gaur
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dylan G. Gee
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ashraf S. Harahsheh
- Department of Pediatrics, Division of Cardiology, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Andrew C. Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Mary M. Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Christina M. Hester
- Division of Practice-Based Research, Innovation, & Evaluation, American Academy of Family Physicians, Leawood, KS, USA
| | - Sophia Hill
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Laura Hobart-Porter
- Departments of Pediatrics and Physical Medicine & Rehabilitation, Section of Pediatric Rehabilitation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Travis K.F. Hong
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Carol R. Horowitz
- Center for Health Equity and Community Engaged Research and Department of Population Health Science and Policy, New York, NY, USA
| | - Daniel S. Hsia
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Matthew Huentelman
- Division of Neurogenomics, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Kathy D. Hummel
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - William G. Iacono
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Katherine Irby
- Department of Pediatrics, Arkansas Children’s Hospital, University of Arkansas Medical School, Little Rock, AR, USA
| | - Joanna Jacobus
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Vanessa L. Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Pei-Ni Jone
- Department of Pediatrics, Pediatric Cardiology, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David C. Kaelber
- Departments of Pediatrics, Internal Medicine, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Tyler J. Kasmarcak
- Department of Pediatric Clinical Research, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J. Kluko
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Jessica S. Kosut
- Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | - Angela R. Laird
- Department of Physics, Florida International University, Miami, FL, USA
| | - Jeremy Landeo-Gutierrez
- Department of Pediatrics, Respiratory Medicine Division, University of California San Diego, San Diego, CA, USA
| | - Sean M. Lang
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Christine L. Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Peter Paul C. Lim
- Department of Pediatric Infectious Disease, Avera McKennan University Health Center, University of South Dakota, Sioux Falls, SD, USA
| | - Krista M. Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Brian W. McCrindle
- Department of Pediatrics, University of Toronto, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, ON, Canada
| | - Russell J. McCulloh
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alan L. Mendelsohn
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Torri D. Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - Lerraughn M. Morgan
- Department of Pediatrics, Valley Children’s Healthcare, Department of Pediatrics, Madera, CA, Madera, CA, USA
| | | | - Erica R. Nahin
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Michael C. Neale
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Manette Ness-Cochinwala
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sheila M. Nolan
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Carlos R. Oliveira
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew E. Oster
- Department of Pediatric Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - R. Mark Payne
- Department of Pediatrics, Division of Pediatric Cardiology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hengameh Raissy
- Department of Pediatrics, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA
| | - Isabelle G. Randall
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Suchitra Rao
- Department of Pediatrics, Division of Infectious Diseases, Epidemiology and Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Harrison T. Reeder
- Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA
| | - Johana M. Rosas
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Mark W. Russell
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA
| | - Arash A. Sabati
- Department of Pediatric Cardiology, Phoenix Children’s Hospital, Phoenix, AZ, USA
| | - Yamuna Sanil
- Division of Pediatric Cardiology, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Alice I. Sato
- Department of Pediatric Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael S. Schechter
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Divya Shakti
- Department of Pediatrics, Pediatric Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kavita Sharma
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Michelle D. Stevenson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Maria M. Talavera-Barber
- Department of Pediatrics, Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USA
| | - Ronald J. Teufel
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Deepika Thacker
- Nemours Cardiac Center, Nemours Childrens Health, Delaware, Wilmington, DE, USA
| | - Mmekom M. Udosen
- RECOVER Neurocognitive and Wellbeing/Mental Health Team, NYU Grossman School of Medicine, New York, NY, USA
| | - Megan R. Warner
- Department of Pulmonary Research, Rady Children’s Hospital-San Diego, San Diego, CA, USA
| | - Sara E. Watson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | - Alan Werzberger
- Department of Pediatrics, Columbia University Medical Center: Columbia University Irving Medical Center, New York, NY, USA
| | - Jordan C. Weyer
- Center for Individualized Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Marion J. Wood
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - H. Shonna Yin
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - William T. Zempsky
- Department of Pediatrics, Connecticut Children’s Medical Center, Hartford, CT, USA
| | - Emily Zimmerman
- Department of Communication Sciences & Disorders, Northeastern University, Boston, MA, USA
| | - Benard P. Dreyer
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
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15
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Kracht CL, Katzmarzyk PT, Champagne CM, Broyles ST, Hsia DS, Newton RL, Staiano AE. Association between Sleep, Sedentary Time, Physical Activity, and Adiposity in Adolescents: A Prospective Observational Study. Med Sci Sports Exerc 2023; 55:110-118. [PMID: 35977103 PMCID: PMC9771953 DOI: 10.1249/mss.0000000000003018] [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] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to examine the effects of substituting sedentary time with sleep or physical activity on adiposity in a longitudinal sample of adolescents. METHODS Adolescents (10-16 yr) were recruited for a prospective observational cohort. Parents and adolescents reported demographic characteristics and pubertal development. Accelerometry was used to measure sleep, physical activity, and sedentary time. Adiposity was quantified with imaging techniques. Isotemporal substitution modeling was conducted to examine the effect of substituting 10 min of sedentary time with sleep or differing intensities of physical activity. Results were stratified by sex and race and adjusted for covariates. RESULTS A total of 217 adolescents provided complete measures at both baseline and 2 yr later (58.1% White, 51.8% girls; 12.9 ± 1.9 yr at baseline). Sleep was negatively related to adiposity 2 yr later when considering other movement behaviors, but substituting baseline sedentary time with sleep was not related to future adiposity ( P > 0.05). In boys and non-White adolescents, substituting sedentary time with vigorous-intensity physical activity was related to lower adiposity 2 yr later ( P < 0.05). Substituting sedentary time for moderate- to vigorous-intensity physical activity was not associated with future adiposity. CONCLUSIONS Substituting sedentary time with vigorous-intensity physical activity was related to lower adiposity in later adolescence in certain groups. Opportunities to promote an adequate balance of sleep, sedentary time, and physical activity in all adolescents are encouraged for optimal development.
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16
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Giessner S, Ramaker ME, Blew K, Crawford ML, Grant RP, Bain JR, Muehlbauer M, Jain N, Hsia DS, Armstrong S, Freemark M, Gumus Balikcioglu P. Disrupted Circadian Rhythm of Epinephrine in Males With Youth-Onset Type 2 Diabetes. J Endocr Soc 2022; 7:bvac190. [PMID: 36632209 PMCID: PMC9825134 DOI: 10.1210/jendso/bvac190] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
Context Blood pressure and plasma catecholamines normally decline during sleep and rapidly increase in early morning. This is blunted in adults with type 2 diabetes (T2D). Objective We hypothesize that increased sympatho-adrenal activity during sleep differentiates youth with T2D from nondiabetic obese youth and lean youth. Methods Fasting spot morning and 24-hour urines were collected in obese adolescents with and without T2D, and normal-weight controls. Fractionated free urine catecholamines (epinephrine, norepinephrine, and dopamine) were measured, and the ratio of fasting spot morning to 24-hour catecholamines was calculated. Results Urinary 24-hour catecholamine levels were comparable across the 3 groups. Fasting morning epinephrine and the ratio of fasting morning/24-hour epinephrine were higher in youth with T2D (P = 0.004 and P = 0.035, respectively). In males, the ratio of fasting morning/24-hour epinephrine was also higher in youth with T2D (P = 0.005). In females, fasting morning norepinephrine and the ratio of fasting morning/24-hour dopamine were lower in obese youth with and without T2D (P = 0.013 and P = 0.005, respectively) compared with lean youth. Systolic blood pressure was higher in diabetic participants than other groups; males trended higher than females. Conclusion Circadian rhythm in catecholamines is disrupted in youth-onset T2D, with a blunted overnight fall in urinary epinephrine in males. Conversely, fasting morning norepinephrine and dopamine levels were lower in obese females with or without T2D. Higher nocturnal catecholamines in males with T2D might associate with, or predispose to, hypertension and cardiovascular complications. Lower catecholamine excretion in females with obesity might serve an adaptive, protective role.
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Affiliation(s)
- Stephanie Giessner
- Correspondence: Stephanie Giessner, MD, General Pediatrics, Duke University Medical Center (DUMC), 2301 Erwin Road, Box 3127 DUMC, Durham, NC 27710, USA.
| | | | - Kathryn Blew
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27710, USA
| | - Matthew L Crawford
- Department of Research and Development, LabCorp, Burlington, NC 27215, USA
| | - Russell P Grant
- Department of Research and Development, LabCorp, Burlington, NC 27215, USA
| | - James R Bain
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA,Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA,Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC 27710, USA
| | - Michael Muehlbauer
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA,Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
| | - Nina Jain
- Division of Endocrinology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Daniel S Hsia
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Sarah Armstrong
- Division of General Pediatrics and Adolescent Health, Duke University Medical Center, Durham, NC 27710, USA,Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC 27710, USA,Department of Population Health Sciences, Duke University Medical Center, Durham, NC 27701, USA,Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27701, USA
| | - Michael Freemark
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA,Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27710, USA
| | - Pinar Gumus Balikcioglu
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA,Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27710, USA,Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
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17
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Magge SN, Wolf RM, Pyle L, Brown EA, Benavides VC, Bianco ME, Chao LC, Cymbaluk A, Balikcioglu PG, Halpin K, Hsia DS, Huerta-Saenz L, Kim JJ, Kumar S, Levitt Katz LE, Marks BE, Neyman A, O'Sullivan KL, Pillai SS, Shah AS, Shoemaker AH, Siddiqui JAW, Srinivasan S, Thomas IH, Tryggestad JB, Yousif MF, Kelsey MM. The Coronavirus Disease 2019 Pandemic is Associated with a Substantial Rise in Frequency and Severity of Presentation of Youth-Onset Type 2 Diabetes. J Pediatr 2022; 251:51-59.e2. [PMID: 35985535 PMCID: PMC9383958 DOI: 10.1016/j.jpeds.2022.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/31/2022] [Accepted: 08/10/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate the frequency and severity of new cases of youth-onset type 2 diabetes in the US during the first year of the pandemic compared with the mean of the previous 2 years. STUDY DESIGN Multicenter (n = 24 centers), hospital-based, retrospective chart review. Youth aged ≤21 years with newly diagnosed type 2 diabetes between March 2018 and February 2021, body mass index ≥85th percentile, and negative pancreatic autoantibodies were included. Demographic and clinical data, including case numbers and frequency of metabolic decompensation, were compared between groups. RESULTS A total of 3113 youth (mean [SD] 14.4 [2.4] years, 50.5% female, 40.4% Hispanic, 32.7% Black, 14.5% non-Hispanic White) were assessed. New cases of type 2 diabetes increased by 77.2% in the year during the pandemic (n = 1463) compared with the mean of the previous 2 years, 2019 (n = 886) and 2018 (n = 765). The likelihood of presenting with metabolic decompensation and severe diabetic ketoacidosis also increased significantly during the pandemic. CONCLUSIONS The burden of newly diagnosed youth-onset type 2 diabetes increased significantly during the coronavirus disease 2019 pandemic, resulting in enormous strain on pediatric diabetes health care providers, patients, and families. Whether the increase was caused by coronavirus disease 2019 infection, or just associated with environmental changes and stressors during the pandemic is unclear. Further studies are needed to determine whether this rise is limited to the US and whether it will persist over time.
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Affiliation(s)
- Sheela N Magge
- Division of Pediatric Endocrinology and Diabetes, Johns Hopkins Hospital/Johns Hopkins University School of Medicine, Baltimore, MD
| | - Risa M Wolf
- Division of Pediatric Endocrinology and Diabetes, Johns Hopkins Hospital/Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, Aurora, CO
| | - Elizabeth A Brown
- Division of Pediatric Endocrinology and Diabetes, Johns Hopkins Hospital/Johns Hopkins University School of Medicine, Baltimore, MD
| | - Valeria C Benavides
- Department of Pediatrics, Division of Endocrinology, University of Illinois, College of Medicine of Peoria/Children's Hospital of Illinois, Peoria, IL
| | - Monica E Bianco
- Department of Pediatrics, Division of Pediatric Endocrinology, Northwestern University/Ann and Robert H Lurie Children's Hospital, Chicago, IL
| | - Lily C Chao
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA
| | - Anna Cymbaluk
- Department of Pediatric Diabetes and Endocrinology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Pinar Gumus Balikcioglu
- Division of Pediatric Endocrinology and Diabetes and Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC
| | - Kelsee Halpin
- Division of Endocrinology and Diabetes, University of Missouri-Kansas City School of Medicine, Children's Mercy Kansas City, Kansas City, MO
| | - Daniel S Hsia
- Our Lady of the Lake Children's Hospital/Pennington Biomedical Research Center, Baton Rouge, LA
| | - Lina Huerta-Saenz
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Penn State Health Children's Hospital/Penn State College of Medicine, Hershey, PA
| | - Jane J Kim
- Department of Pediatrics, Division of Pediatric Endocrinology, University of California San Diego/Rady Children's Hospital San Diego, San Diego, CA
| | - Seema Kumar
- Department of Pediatrics, Division of Pediatric Endocrinology, Mayo Clinic, Rochester, MN
| | - Lorraine E Levitt Katz
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Brynn E Marks
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington DC
| | - Anna Neyman
- Department of Pediatrics, Indiana University School of Medicine/Riley Hospital for Children, Indianapolis, IN
| | - Katie L O'Sullivan
- Section of Adult & Pediatric Endocrinology, Diabetes & Metabolism, University of Chicago Medical Center, Chicago, IL
| | - Sabitha Sasidharan Pillai
- Division of Pediatric Endocrinology, Warren Alpert Medical School of Brown University/Hasbro Children's Hospital, Providence, RI
| | - Amy S Shah
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center & The University of Cincinnati, Cincinnati, OH
| | - Ashley H Shoemaker
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN
| | | | - Shylaja Srinivasan
- Department of Pediatrics, Division of Endocrinology, University of California, San Francisco, San Francisco, CA
| | - Inas H Thomas
- Department of Pediatrics, Pediatric Endocrinology, University of Michigan, Ann Arbor, MI
| | - Jeanie B Tryggestad
- Department of Pediatrics, Section of Diabetes/Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Maha F Yousif
- Department of Pediatrics, Pediatric Endocrinology, University of Texas Southwestern, Dallas, TX
| | - Megan M Kelsey
- Department of Pediatrics, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, Aurora, CO.
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Armstrong S, Bain JR, Crawford M, Freemark M, Grant RP, Gumus Balikcioglu P, Hsia DS, Ilkayeva O, Jain N, Muehlbauer M, Newgard C, Ramaker M, Delgado N. OR14-5 Branched-chain Amino Acid and Tryptophan Metabolism and the Pathogenesis of Youth-Onset Type 2 Diabetes Mellitus (T2D). J Endocr Soc 2022. [PMCID: PMC9625596 DOI: 10.1210/jendso/bvac150.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objectives We have previously demonstrated that insulin resistance (IR) in youth is associated with elevated levels of branched-chain amino acids (BCAAs). BCAAs compete with aromatic amino acids (AAA) including tryptophan, the precursor of serotonin, for uptake into β-cells and other tissues via the large neutral amino acid transporter. Serotonin has been reported to increase β-cell mass and glucose-dependent insulin secretion. In this study we have explored how BCAA, tryptophan (one of the AAA), and a subset of their metabolites are modulated in youth-onset T2D. Based on our prior studies in neuronal BCAA metabolism, we hypothesized that elevated BCAA could induce diversion of tryptophan metabolism towards production of kynurenine rather than serotonin in youth with T2D. To test this, we analyzed 24-hour urine samples and compared levels of byproducts of BCAAs and tryptophan metabolism in obese youth with T2D with those in non-diabetic obese and lean youth of comparable age, pubertal status and ethnicity. Methods 56 non-diabetic adolescents with overweight/obesity ("obese"), 42 adolescents with T2D ("T2D"), and 43 normal weight controls ("lean"), ages 12-21 years-old were studied. Weight, height, BMI, BMI% were extracted from medical charts. Body fat percent (BF%) was measured by TANITA. We also measured metabolites derived from BCAA catabolism, including the branched-chain ketoacids (BCKAs), and tryptophan metabolism, including intermediates of the serotonergic and kynurenine pathways, in spot and 24-hour urine samples by liquid chromatography/tandem-mass spectrometry (LC/MS-MS). Levels were normalized to urine creatinine. Group differences were assessed by Kruskal Wallis or ANOVA. Results Groups were comparable for age (obese 14.8 +/- 1.9; T2D 15.7 +/- 2.1 and lean 14.9 +/- 1.9-yr), pubertal status, and ethnicity. Youth with T2D were predominantly female (T2D, 28 F, 14 M; obese 33 F, 23 M and lean, 17 F, 26 M), and had highest BF% (obese 37.3 +/- 9.5; T2D 42.9 +/- 9.9; lean 20.1 +/- 6.3%; p=2.58e-22). In 24-hour urine samples, BCKAs, tryptophan, and kynurenine levels were higher in T2D (p=0.0002, p= 0.0045 and p= 0.00009 respectively) than in either lean controls or nondiabetic youth with obesity; in contrast, there were no differences between lean controls and non-diabetic youth with obesity. The levels of 5-HIAA, the principal metabolite of serotonin, were comparable across groups; however, the ratio of kynurenine/tryptophan was higher (p= 0.0112) in youth with T2D and the ratios of 5-HIAA/ tryptophan (p=0.027) and 5-HIAA/Kynurenine (p=0.0067) were lower compared to the other two groups. Those ratios were comparable between lean controls and non-diabetic youth with obesity. Conclusions Increased BCKAs are accompanied by diversion of tryptophan metabolism from the serotonin pathway to the kynurenine pathway, suggesting perturbations in both BCAA and AAA metabolism in youth-onset T2D. These alterations could contribute to development of beta-cell dysfunction and progression to T2D in youth. Presentation: Sunday, June 12, 2022 12:00 p.m. - 12:15 p.m.
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19
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Barrientos‐Pérez M, Hsia DS, Sloan L, Nell H, Mungur O, Hovsepian L, Schmider W, Spranger R, Yang N, Niemoeller E. A study on pharmacokinetics, pharmacodynamics and safety of lixisenatide in children and adolescents with type 2 diabetes. Pediatr Diabetes 2022; 23:641-648. [PMID: 35411611 PMCID: PMC9790255 DOI: 10.1111/pedi.13343] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/28/2022] [Accepted: 03/30/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the pharmacokinetic, pharmacodynamic and safety profile of the glucagon-like peptide-1 receptor agonist, lixisenatide, for the treatment of type 2 diabetes (T2D) in pediatric individuals. MATERIALS AND METHODS In this Phase 1, multicenter, randomized, double-blind, placebo-controlled, parallel-group, ascending repeated dose study (NCT02803918), participants aged ≥10 and < 18 years were randomized 3:1 to receive once-daily lixisenatide in 2-week increments of 5, 10, and 20 μg (n = 18) or placebo (n = 5) for 6 weeks. RESULTS Mean lixisenatide concentrations generally increased with increasing doses irrespective of anti-drug antibody (ADA) status; however, mean lixisenatide concentrations and inter-subject variability were higher for participants with positive ADA status. Improvements in fasting plasma glucose, post-prandial glucose, AUC0-4.5 , HbA1c , and body weight were observed with lixisenatide. Overall, the safety profile was consistent with the known profile in adults, with no unexpected side effects and no treatment-emergent adverse events resulting in death or discontinuation. The most common events in the lixisenatide group were vomiting (11.1%) and nausea (11.1%). No symptomatic hypoglycemia was reported in either group. No clinically significant hematologic, biochemical or vital sign abnormalities were observed. CONCLUSIONS Mean lixisenatide concentrations generally increased with increasing dose, irrespective of ADA status. Lixisenatide was associated with improved glycemic control and a trend in body weight reduction compared with placebo. The safety and tolerability profile of repeated lixisenatide doses of up to 20 μg per day in children and adolescents with T2D was reflective of the established safety profile of lixisenatide in adults.
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Affiliation(s)
| | - Daniel S. Hsia
- Pennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - Lance Sloan
- Texas Institute for Kidney and Endocrine DisordersLufkinTexasUSA,Department of Internal MedicineUniversity of Texas Medical BranchGalvestonTexasUSA
| | - Haylene Nell
- Tiervlei Trial CentreKarl Bremer HospitalCape TownSouth Africa
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20
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Abstract
A high hemoglobin glycation index (HGI) has been repeatedly associated with greater risk for hypoglycemia in people with diabetes and greater risk for chronic vascular disease in people with or without diabetes. This review explores how different sources of analytical and biological variation in HbA1c and blood glucose individually and collectively affect the clinical information value of HGI. We conclude that HGI is a complex quantitative trait that is a clinically practical biomarker of risk for both hypoglycemia and chronic vascular disease.
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Affiliation(s)
- James M Hempe
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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21
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Kelly AS, Bensignor MO, Hsia DS, Shoemaker AH, Shih W, Peterson C, Varghese ST. Phentermine/Topiramate for the Treatment of Adolescent Obesity. NEJM Evidence 2022; 1. [PMID: 36968652 PMCID: PMC10035585 DOI: 10.1056/evidoa2200014] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Antiobesity medication may be useful for the treatment of pediatric obesity, yet few safe and effective options exist. We evaluated phentermine/topiramate (PHEN/TPM) for weight management in adolescents with obesity. METHODS This 56-week, randomized, double-blind trial enrolled adolescents 12 to less than 17 years of age with obesity. Participants were randomly assigned 1:1:2 to receive either placebo (n=56), mid-dose PHEN/TPM (7.5 mg/46 mg; n=54), or top-dose PHEN/TPM (15 mg/92 mg; n=113), respectively. All participants received lifestyle therapy. The primary end point was mean percent change in body-mass index (BMI) from randomization to week 56. RESULTS Participants had a mean (±SD) age of 14.0±1.4 years and a mean (±SD) BMI of 37.8±7.1 kg/m2; 54.3% were female. The primary end point of percent change in BMI at week 56 showed differences from placebo of -10.44 percentage points (95% CI, -13.89 to -6.99; P<0.001) and -8.11 percentage points (95% CI, -11.92 to -4.31; P<0.001) for the top and mid doses of PHEN/TPM, respectively. Differences from placebo in percent change in triglycerides nominally favored PHEN/TPM (mid dose, -21%; 95% CI, -40 to -2; and top dose, -21%; 95% CI, -38 to -4), as did differences in percent change in high-density lipoprotein cholesterol (HDL-C) (mid dose, 10%; 95% CI, 3 to 18; and top dose, 9%; 95% CI, 2 to 15). The incidence of participants reporting at least one adverse event was 51.8%, 37.0%, and 52.2% in the placebo, mid-dose, and top-dose groups, respectively. Serious adverse events were reported for two participants in the top-dose group. CONCLUSIONS PHEN/TPM at both the mid and top doses offered a statistically significant reduction in BMI and favorably impacted triglyceride and HDL-C levels in adolescents with obesity. (Funded by VIVUS LLC, with project support provided by Covance LLC; ClinicalTrials.gov number, NCT03922945.).
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Affiliation(s)
- Aaron S. Kelly
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis
| | - Megan O. Bensignor
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis
| | | | - Ashley H. Shoemaker
- Division of Pediatric Endocrinology, Vanderbilt University Medical Center, Nashville
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22
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Hsia DS, Williams KM, Beyl RA. Participant Perspectives Concerning Resuming Clinical Research in the Era of COVID-19. J Clin Med Res 2022; 14:165-169. [PMID: 35573934 PMCID: PMC9076135 DOI: 10.14740/jocmr4670] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/24/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Daniel S. Hsia
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Corresponding Author: Daniel S. Hsia, Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.
| | - Karlie M. Williams
- Department of Biology, Xavier University of Louisiana, New Orleans, LA, USA
| | - Robbie A. Beyl
- Department of Biostatistics, Pennington Biomedical Research Center, Baton Rouge, LA, USA
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23
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Floyd ZE, Ribnicky DM, Raskin I, Hsia DS, Rood JC, Gurley BJ. Designing a Clinical Study With Dietary Supplements: It's All in the Details. Front Nutr 2022; 8:779486. [PMID: 35118104 PMCID: PMC8804374 DOI: 10.3389/fnut.2021.779486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
A successful randomized clinical trial of the effect of dietary supplements on a chosen endpoint begins with developing supporting data in preclinical studies while paying attention to easily overlooked details when planning the related clinical trial. In this perspective, we draw on our experience studying the effect of an ethanolic extract from Artemisia dracunculus L. (termed PMI-5011) on glucose homeostasis as a potential therapeutic option in providing resilience to metabolic syndrome (MetS). Decisions on experimental design related to issues ranging from choice of mouse model to dosing levels and route of administration in the preclinical studies will be discussed in terms of translation to the eventual human studies. The more complex considerations in planning the clinical studies present different challenges as these studies progress from testing the safety of the dietary supplement to assessing the effect of the dietary supplement on a predetermined clinical outcome. From the vantage point of hindsight, we will outline potential pitfalls when translating preclinical studies to clinical studies and point out details to address when designing clinical studies of dietary supplements.
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Affiliation(s)
- Z. Elizabeth Floyd
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States
- *Correspondence: Z. Elizabeth Floyd
| | - David M. Ribnicky
- Department of Plant Biology, Rutgers University, New Brunswick, NJ, United States
| | - Ilya Raskin
- Department of Plant Biology, Rutgers University, New Brunswick, NJ, United States
| | - Daniel S. Hsia
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States
| | - Jennifer C. Rood
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States
| | - Bill J. Gurley
- National Center for Natural Products Research, University of Mississippi, University, MS, United States
- Bill J. Gurley
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24
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Fearnbach N, Staiano AE, Johannsen NM, Hsia DS, Beyl RA, Carmichael OT, Martin CK. Predictors of Post-Exercise Energy Intake in Adolescents Ranging in Weight Status from Overweight to Severe Obesity. Nutrients 2022; 14:223. [PMID: 35011098 PMCID: PMC8747392 DOI: 10.3390/nu14010223] [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: 11/21/2021] [Revised: 01/01/2022] [Accepted: 01/02/2022] [Indexed: 11/17/2022] Open
Abstract
Exercise may sensitize individuals with overweight and obesity to appetitive signals (e.g., hunger and fullness cues), overriding trait eating behaviors that contribute to overeating and obesity, such as uncontrolled eating. The objective of the current study was to measure predictors of objective ad libitum energy intake at a laboratory-based, post-exercise test-meal in adolescents ranging in weight status from overweight to severe obesity. We hypothesized that appetitive states, rather than appetitive traits, would be the strongest predictors of energy intake at a post-exercise test-meal, after controlling for body size. At Baseline, 30 adolescents (ages 10-16 years, 50% female (F), 43% non-Hispanic white (NHW), 83% with obesity (OB)) completed state and trait appetite measures and an ad libitum dinner meal following intensive exercise. Nineteen of those participants (47% F, 32% NHW, 79% OB) completed identical assessments two years later (Year 2). Energy intake (kcal) at each time point was adjusted for fat-free mass index (i.e., body size). Adjusted energy intake was reliable from Baseline to Year 2 (ICC = 0.84). Multiple pre-meal appetite ratings were associated with test-meal energy intake. In stepwise linear regression models, pre-meal prospective food consumption was the strongest and only significant predictor of test-meal energy intake at both Baseline (R2 = 0.25, p = 0.005) and Year 2 (R2 = 0.41, p = 0.003). Baseline post-exercise energy intake was associated with weight change over two years (R2 = 0.24, p = 0.04), but not with change in fat mass (p = 0.11). Appetitive traits were not associated with weight or body composition change (p > 0.22). State appetite cues were the strongest predictors of post-exercise energy intake, independent of body size. Future studies should examine whether long-term exercise programs enhance responsiveness to homeostatic appetite signals in youth with overweight and obesity, with a goal to reduce excess energy intake and risk for weight gain over time.
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Affiliation(s)
- Nicole Fearnbach
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA; (A.E.S.); (N.M.J.); (D.S.H.); (R.A.B.); (O.T.C.); (C.K.M.)
| | - Amanda E. Staiano
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA; (A.E.S.); (N.M.J.); (D.S.H.); (R.A.B.); (O.T.C.); (C.K.M.)
| | - Neil M. Johannsen
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA; (A.E.S.); (N.M.J.); (D.S.H.); (R.A.B.); (O.T.C.); (C.K.M.)
- School of Kinesiology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Daniel S. Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA; (A.E.S.); (N.M.J.); (D.S.H.); (R.A.B.); (O.T.C.); (C.K.M.)
| | - Robbie A. Beyl
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA; (A.E.S.); (N.M.J.); (D.S.H.); (R.A.B.); (O.T.C.); (C.K.M.)
| | - Owen T. Carmichael
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA; (A.E.S.); (N.M.J.); (D.S.H.); (R.A.B.); (O.T.C.); (C.K.M.)
| | - Corby K. Martin
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA; (A.E.S.); (N.M.J.); (D.S.H.); (R.A.B.); (O.T.C.); (C.K.M.)
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Bekelman TA, Johnson SL, Steinberg RI, Martin CK, Sauder KA, Luckett-Cole S, Glueck DH, Hsia DS, Dabelea D. A Qualitative Analysis of the Remote Food Photography Method and the Automated Self-Administered 24-hour Dietary Assessment Tool for Assessing Children's Food Intake Reported by Parent Proxy. J Acad Nutr Diet 2021; 122:961-973. [PMID: 34767972 PMCID: PMC9038614 DOI: 10.1016/j.jand.2021.11.001] [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] [Received: 04/26/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Accuracy and participant burden are two key considerations in the selection of a dietary assessment tool for assessing children's full-day dietary intake. OBJECTIVE The aim of this study was to identify barriers experienced by parents and burden when using two technology-based measures of dietary intake to report their child's intake: the Remote Food Photography Method (RFPM) and the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24). DESIGN Qualitative, semistructured, focus groups were conducted with parents who served as proxy reporters of their child's dietary intake using the two different dietary assessment methods (ie, RFPM and ASA24) 1 week apart. PARTICIPANTS/SETTING This study was conducted in 2019 and included 32 parents of children aged 7 to 8 years in Colorado and Louisiana. MAIN OUTCOME MEASURES Barriers adhering to the protocol and burden with the RFPM and ASA24. QUALITATIVE ANALYSES Qualitative content analysis and Atlas.ti software were used to analyze and interpret focus group data. RESULTS For the RFPM, parents described missing photos due to unobserved intake, forgetting to capture images, disruption of mealtimes, and child embarrassment when meals were photographed at school. For the ASA24, parents described the time commitment as the main source of burden and the need to expand the food database to include additional ethnic foods and restaurant items. The main strengths were ease of use for the RFPM and the consolidated workload for the ASA24. CONCLUSIONS The barriers experienced by parents and burden differed by method, highlighting the importance of considering the unique characteristics of each assessment tool when designing a pediatric dietary assessment study and interpreting findings.
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Affiliation(s)
- Traci A Bekelman
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, Aurora, Colorado; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.
| | - Susan L Johnson
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz
| | - Rachel I Steinberg
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, Aurora, Colorado
| | - Corby K Martin
- Ingestive Behavior, Weight Management & Health Promotion Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana; Human Phenotyping Core, Nutrition Obesity Research Center, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, Aurora, Colorado; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz
| | - Sophie Luckett-Cole
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, Aurora, Colorado; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Deborah H Glueck
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, Aurora, Colorado; Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz
| | - Daniel S Hsia
- Ingestive Behavior, Weight Management & Health Promotion Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, Aurora, Colorado; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz
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Hempe JM, Yang S, Liu S, Hsia DS. Standardizing the haemoglobin glycation index. Endocrinol Diabetes Metab 2021; 4:e00299. [PMID: 34558807 PMCID: PMC8502217 DOI: 10.1002/edm2.299] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/11/2021] [Accepted: 09/08/2021] [Indexed: 02/02/2023]
Abstract
Aims A high haemoglobin glycation index (HGI) is associated with greater risk for hypoglycaemia and chronic vascular disease. Standardizing how the HGI is calculated would normalize results between research studies and hospital laboratories and facilitate the clinical use of HGI for assessing risk. Methods The HGI is the difference between an observed HbA1c and a predicted HbA1c obtained by inserting fasting plasma glucose (FPG) into a regression equation describing the linear relationship between FPG and HbA1c in a reference population. We used data from the 2005–2016 U.S. National Health and Nutrition Examination Survey (NHANES) to identify a reference population of 18,675 diabetes treatment–naïve adults without self‐reported diabetes. The reference population regression equation (predicted HbA1c = 0.024 FPG + 3.1) was then used to calculate the HGI and divide participants into low (<−0.150), moderate (−0.150 to <0.150) and high (≥0.150) HGI subgroups. Diabetes status was classified by OGTTs. Results As previously reported in multiple studies, a high HGI was associated with black race independent of diabetes status, and with older age, higher BMI and higher CRP in normal and prediabetic but not diabetic participants. The mean HGI was 0.6% higher in self‐reported diabetic adults. The HGI was not associated with plasma insulin, HOMA‐IR or 2 h OGTT in participants classified as normal, prediabetic or diabetic. Conclusions The regression equation derived from this demographically diverse diabetes treatment–naïve adult NHANES reference population is suitable for standardizing how the HGI is calculated for both clinical use and in research to mechanistically explain population variation in the HGI and why a high HGI is associated with greater risk for chronic vascular disease.
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Affiliation(s)
- James M Hempe
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Shengping Yang
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Shuqian Liu
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Dorling JL, Höchsmann C, Fearnbach SN, Apolzan JW, Hsia DS, Johannsen N, Church TS, Martin CK. Initial Weight Change and Long-Term Changes in Weight and Compensation during Supervised Exercise Training. Med Sci Sports Exerc 2021; 53:1675-1684. [PMID: 33731664 PMCID: PMC8282755 DOI: 10.1249/mss.0000000000002633] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Our primary aim was to investigate the association between initial weight change and longer-term changes in weight and compensation (predicted weight loss-observed weight loss) during exercise. As secondary aims, we investigated if initial weight change was related to change in cardiometabolic risk markers and energy balance modulators. METHODS Two 6-month randomized controlled exercise trials conducted in individuals with overweight or obesity were analyzed (study 1, n = 312; study 2, n = 102). In both studies, participants in an exercise condition (4 kcal·kg-1·wk-1 [KKW], 8 KKW, 12 KKW, or 20 KKW) were split into tertiles based on percent weight change from baseline to week 4. Tertiles 1 and 3 exhibited the least and most initial weight loss, respectively. Changes in end points were compared between tertiles. RESULTS At month 6, weight loss was lower in tertile 1 than tertile 3 (study 1: -3.6%, 95% confidence interval [CI] = -4.6 to -2.6; study 2: -1.8%, 95% CI = -3.1 to -0.4; P ≤ 0.034). Tertile 1 also showed greater compensation than tertile 3 in study 1 (3.0 kg, 95% CI = 2.2 to 3.9) and study 2 (1.5 kg, 95% CI = 0.3 to 2.6; P ≤ 0.048). Changes in triglycerides and, in study 1, HDL cholesterol were less favorable in tertile 1 versus tertile 3 (P ≤ 0.043); however, changes in other cardiometabolic markers were similar (P ≥ 0.209). In study 2, tertile 1 increased energy intake and exhibited maladaptive changes in eating behaviors relative to tertile 3 (P < 0.050). No between-tertile differences in cumulative exercise energy expenditure and physical activity were evident (P ≥ 0.321). CONCLUSIONS Less initial weight loss was associated with longer-term attenuated weight loss and greater compensation during aerobic exercise training. Individuals who display less initial weight loss during exercise may require early interventions to decrease compensation and facilitate weight loss.
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Affiliation(s)
| | | | | | | | | | - Neil Johannsen
- Pennington Biomedical Research Center, Baton Rouge, LA
- Louisiana State University, Baton Rouge, LA, USA
| | - Tim S. Church
- Pennington Biomedical Research Center, Baton Rouge, LA
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Rifas-Shiman SL, Bailey LC, Lunsford D, Daley MF, Eneli I, Finkelstein J, Heerman W, Horgan CE, Hsia DS, Jay M, Rao G, Reynolds JS, Sturtevant JL, Toh S, Trasande L, Young J, Lin PID, Forrest CB, Block JP. Early Life Antibiotic Prescriptions and Weight Outcomes in Children 10 Years of Age. Acad Pediatr 2021; 21:297-303. [PMID: 33130067 DOI: 10.1016/j.acap.2020.10.016] [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: 11/11/2019] [Revised: 05/11/2020] [Accepted: 10/25/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We previously found that antibiotic use at <24 months of age was associated with slightly higher body weight at 5 years of age. In this study, we examine associations of early life antibiotic prescriptions with weight outcomes at 108 to 132 months of age ("10 years"). METHODS We used electronic health record data from 2009 through 2016 from 10 health systems in PCORnet, a national distributed clinical research network. We examined associations of any (vs no) antibiotics at <24 months of age with body mass index z-score (BMI-z) at 10 years adjusted for confounders selected a priori. We further examined dose response (number of antibiotic episodes) and antibiotic spectrum (narrow and broad). RESULTS Among 56,727 included children, 57% received any antibiotics at <24 months; at 10 years, mean (standard deviation) BMI-z was 0.54 (1.14), and 36% had overweight or obesity. Any versus no antibiotic use at <24 months was associated with a slightly higher BMI-z at 10 years among children without a complex chronic condition (β 0.03; 95% confidence interval [CI] 0.01, 0.05) or with a complex chronic condition (β 0.09; 95% CI 0.03, 0.15). Any versus no antibiotic use was not associated with odds of overweight or obesity at 10 years among children without (odds ratio 1.02; 95% CI 0.97, 1.07) or with a complex chronic condition (odds ratio 1.07; 95% CI 0.96, 1.19). CONCLUSIONS The small and likely clinically insignificant associations in this study are consistent with our previous 5-year follow-up results, suggesting that, if this relationship is indeed causal, early increases in weight are small but maintained over time.
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Affiliation(s)
- Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (SL Rifas-Shiman, J Young, P-ID Lin, and JP Block), Boston, Mass.
| | - L Charles Bailey
- Applied Clinical Research Center, Department of Pediatrics, Children's Hospital of Philadelphia (LC Bailey and CB Forrest), Philadelphia, Pa
| | - Doug Lunsford
- North Fork School District (D Lunsford), Utica, Ohio
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado (MF Daley), Denver, Colo
| | - Ihuoma Eneli
- Nationwide Children's Hospital (I Eneli), Columbus, Ohio
| | | | - William Heerman
- Department of Pediatrics, Vanderbilt University Medical Center (W Heerman), Nashville, Tenn
| | - Casie E Horgan
- Therapeutics Research and Infectious Disease Epidemiology Group, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (CE Horgan, JS Reynolds, JL Sturtevant, and S Toh), Boston, Mass
| | - Daniel S Hsia
- Pennington Biomedical Research Center (DS Hsia), Baton Rouge, La
| | - Melanie Jay
- Department of Population Health, New York University School of Medicine (M Jay), New York, NY
| | - Goutham Rao
- Case Western Reserve University and University Hospitals of Cleveland (G Rao), Cleveland, Ohio
| | - Juliane S Reynolds
- Therapeutics Research and Infectious Disease Epidemiology Group, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (CE Horgan, JS Reynolds, JL Sturtevant, and S Toh), Boston, Mass
| | - Jessica L Sturtevant
- Therapeutics Research and Infectious Disease Epidemiology Group, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (CE Horgan, JS Reynolds, JL Sturtevant, and S Toh), Boston, Mass
| | - Sengwee Toh
- Therapeutics Research and Infectious Disease Epidemiology Group, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (CE Horgan, JS Reynolds, JL Sturtevant, and S Toh), Boston, Mass
| | - Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine (L Trasande), New York, NY
| | - Jessica Young
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (SL Rifas-Shiman, J Young, P-ID Lin, and JP Block), Boston, Mass
| | - Pi-I Debby Lin
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (SL Rifas-Shiman, J Young, P-ID Lin, and JP Block), Boston, Mass
| | - Christopher B Forrest
- Applied Clinical Research Center, Department of Pediatrics, Children's Hospital of Philadelphia (LC Bailey and CB Forrest), Philadelphia, Pa
| | - Jason P Block
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (SL Rifas-Shiman, J Young, P-ID Lin, and JP Block), Boston, Mass
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Annett RD, Chervinskiy S, Chun TH, Cowan K, Foster K, Goodrich N, Hirschfeld M, Hsia DS, Jarvis JD, Kulbeth K, Madden C, Nesmith C, Raissy H, Ross J, Saul JP, Shiramizu B, Smith P, Sullivan JE, Tucker L, Atz AM. IDeA States Pediatric Clinical Trials Network for Underserved and Rural Communities. Pediatrics 2020; 146:peds.2020-0290. [PMID: 32943534 PMCID: PMC7786822 DOI: 10.1542/peds.2020-0290] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2020] [Indexed: 01/19/2023] Open
Abstract
The National Institutes of Health's Environmental Influences on Child Health Outcomes (ECHO) program aims to study high-priority and high-impact pediatric conditions. This broad-based health initiative is unique in the National Institutes of Health research portfolio and involves 2 research components: (1) a large group of established centers with pediatric cohorts combining data to support longitudinal studies (ECHO cohorts) and (2) pediatric trials program for institutions within Institutional Development Awards states, known as the ECHO Institutional Development Awards States Pediatric Clinical Trials Network (ISPCTN). In the current presentation, we provide a broad overview of the ISPCTN and, particularly, its importance in enhancing clinical trials capabilities of pediatrician scientists through the support of research infrastructure, while at the same time implementing clinical trials that inform future health care for children. The ISPCTN research mission is aligned with the health priority conditions emphasized in the ECHO program, with a commitment to bringing state-of-the-science trials to children residing in underserved and rural communities. ISPCTN site infrastructure is critical to successful trial implementation and includes research training for pediatric faculty and coordinators. Network sites exist in settings that have historically had limited National Institutes of Health funding success and lacked pediatric research infrastructure, with the initial funding directed to considerable efforts in professional development, implementation of regulatory procedures, and engagement of communities and families. The Network has made considerable headway with these objectives, opening two large research studies during its initial 18 months as well as producing findings that serve as markers of success that will optimize sustainability.
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Affiliation(s)
- Robert D. Annett
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sheva Chervinskiy
- Data Coordinating and Operations Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Thomas H. Chun
- Departments of Emergency Medicine and Pediatrics, Brown University, Providence, Rhode Island
| | - Kelly Cowan
- University of Vermont Medical Center, Burlington, Vermont
| | | | | | | | - Daniel S. Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | | | - Kurtis Kulbeth
- Data Coordinating and Operations Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Christi Madden
- The Children’s Hospital at University of Oklahoma Medical Center, Oklahoma City, Oklahoma
| | | | - Hengameh Raissy
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Judith Ross
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - J. Philip Saul
- Department of Pediatrics, West Virginia University, Morgantown, West Virginia
| | - Bruce Shiramizu
- Departments of Tropical Medicine, Pediatrics, and Medicine, University of Hawai’i, Honolulu, Hawaii
| | - Paul Smith
- Department of Pediatrics, University of Montana, Missoula, Montana
| | - Janice E. Sullivan
- Department of Pediatrics, University of Louisville, Louisville, Kentucky; and
| | - Lauren Tucker
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Andrew M. Atz
- Medical University of South Carolina, Charleston, South Carolina
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Eysenbach G, Altazan AD, Comardelle NR, Gilmore LA, Apolzan JW, St Romain J, Hardee JC, Puyau RS, Mayet CL, Beyl RA, Barlow SA, Bounds SS, Olson KN, Kennedy BM, Hsia DS, Redman LM. The Design of a Randomized Clinical Trial to Evaluate a Pragmatic and Scalable eHealth Intervention for the Management of Gestational Weight Gain in Low-Income Women: Protocol for the SmartMoms in WIC Trial. JMIR Res Protoc 2020; 9:e18211. [PMID: 32909954 PMCID: PMC7516677 DOI: 10.2196/18211] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/09/2020] [Accepted: 06/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Less than one-third of women gain an appropriate amount of weight during pregnancy, which can influence the long-term health of both the mother and the child. Economically disadvantaged women are the most vulnerable to maternal obesity, excessive weight gain during pregnancy, and poor birth outcomes. Effective and scalable health care strategies to promote healthy weight gain during pregnancy specifically tailored for these women are lacking. OBJECTIVE This paper presents the design and protocol of a biphasic, community-based eHealth trial, SmartMoms in WIC, to increase the adherence to healthy gestational weight gain (GWG) recommendations in low-income mothers receiving women, infant, and children (WIC) benefits. METHODS Phase 1 of the trial included using feedback from WIC mothers and staff and participants from 2 community peer advisory groups to adapt an existing eHealth gestational weight management intervention to meet the needs of women receiving WIC benefits. The health curriculum, the format of delivery, and incentive strategies were adapted to be culturally relevant and at an appropriate level of health literacy. Phase 2 included a pragmatic randomized controlled trial across the 9 health care regions in Louisiana with the goal of enrolling 432 women. The SmartMoms in WIC intervention is an intensive 24-week behavioral intervention, which includes nutrition education and exercise strategies, and provides the technology to assist with weight management, delivered through a professionally produced website application. RESULTS Phase 1 of this trial was completed in July 2019, and recruitment for phase 2 began immediately thereafter. All data are anticipated to be collected by Spring 2023. CONCLUSIONS The SmartMoms in WIC curriculum was methodically developed using feedback from community-based peer advisory groups to create a culturally relevant, mobile behavioral intervention for mothers receiving WIC benefits. The randomized clinical trial is underway to test the effectiveness of a sustainable eHealth program on the incidence rates of appropriate GWG. SmartMoms in WIC may be able to offer an innovative, cost-effective, and scalable solution for GWG management in women served by WIC. TRIAL REGISTRATION ClinicalTrials.gov NCT04028843; https://clinicaltrials.gov/ct2/show/NCT04028843. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18211.
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Affiliation(s)
| | - Abby D Altazan
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | | | - L Anne Gilmore
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Jessica St Romain
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Julie C Hardee
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Renee S Puyau
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Christy L Mayet
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Robbie A Beyl
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - S Ariel Barlow
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | | | - Kelsey N Olson
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Betty M Kennedy
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
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Fearnbach SN, Martin CK, Heymsfield SB, Staiano AE, Newton RL, Garn AC, Johannsen NM, Hsia DS, Carmichael OT, Ramakrishnapillai S, Murray KB, Blundell JE, Finlayson G. Validation of the Activity Preference Assessment: a tool for quantifying children's implicit preferences for sedentary and physical activities. Int J Behav Nutr Phys Act 2020; 17:108. [PMID: 32831103 PMCID: PMC7444062 DOI: 10.1186/s12966-020-01014-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/13/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND High levels of sedentary behavior and low physical activity are associated with poor health, and the cognitive determinants of these behaviors in children and adolescents are not well understood. To address this gap, we developed a novel, non-verbal, computer-based assessment to quantify the degree to which youth prefer to be sedentary relative to physically active in their leisure time. METHODS The Activity Preference Assessment (APA) uses a forced-choice paradigm to understand implicit decision-making processes when presented with common sedentary and physical activities. The APA bias score ranges from - 100 to + 100, with positive scores indicating a relative preference for sedentary activities, and negative scores representing a preference for physical activities. In 60 children ages 8-17 years, we assessed the validity of this behavioral task against a free-choice play observation, accelerometry-measured activity, anthropometrics and body composition, and cardiorespiratory fitness. We explored neighborhood, family, and individual-level factors that may influence implicit activity preferences. Test-retest reliability was assessed over one week. RESULTS The majority of children (67%) preferred sedentary relative to physical activities. APA bias scores were positively associated with sedentary time during free-choice play. In girls, bias scores were negatively associated with average daily MVPA. APA bias scores were positively associated with body fat and negatively associated with cardiorespiratory fitness. These findings were independent of age, sex, and race/ethnicity. Neighborhood access to physical activity spaces, the number of people in the home, perceived physical self-competence (e.g., coordination, strength), and self-reported depressive symptoms were associated with activity preferences. The intra-class correlation for test-retest reliability was r = 0.59. CONCLUSIONS The APA shows promise as a novel tool for quantifying children's relative preference for sedentary versus physical activities. Implicit bias scores from the APA are clinically meaningful, as shown by significant associations with adiposity and cardiorespiratory fitness. Future longitudinal studies should examine the directionality of the association between preferences and health markers, and the degree to which implicit activity preferences are modifiable. Importantly, the task only takes an average of 10 min to complete, highlighting a potential role as an efficient screening tool for the propensity to be sedentary versus physically active. TRIAL REGISTRATION ClinicalTrials.gov NCT03624582 .
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Affiliation(s)
- S Nicole Fearnbach
- Clinical Sciences Division, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.
| | - Corby K Martin
- Clinical Sciences Division, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Steven B Heymsfield
- Clinical Sciences Division, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Amanda E Staiano
- Population and Public Health Sciences Division, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Robert L Newton
- Population and Public Health Sciences Division, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Alex C Garn
- Louisiana State University, Baton Rouge, Louisiana, USA
| | - Neil M Johannsen
- Clinical Sciences Division, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
- Louisiana State University, Baton Rouge, Louisiana, USA
| | - Daniel S Hsia
- Clinical Sciences Division, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Owen T Carmichael
- Clinical Sciences Division, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - Kori B Murray
- Clinical Sciences Division, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Kracht CL, Champagne CM, Hsia DS, Martin CK, Newton RL, Katzmarzyk PT, Staiano AE. Association Between Meeting Physical Activity, Sleep, and Dietary Guidelines and Cardiometabolic Risk Factors and Adiposity in Adolescents. J Adolesc Health 2020; 66:733-739. [PMID: 31987725 PMCID: PMC7263948 DOI: 10.1016/j.jadohealth.2019.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 09/03/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE The aim of the study was to assess the associations of meeting physical activity (PA), sleep, and dietary guidelines with cardiometabolic risk factors and adiposity in adolescents. METHODS The sample included adolescents aged 10-16 years. Accelerometry was used to measure PA and sleep over 7 days, 24 h/d. The PA guideline was defined as ≥60 min/d of moderate-to-vigorous PA. The sleep guideline was 9-11 hours (10-13 years) or 8-10 hours (14-16 years) per night. The dietary guideline was based on the Healthy Eating Index calculated from dietary recalls. Cardiometabolic risk factors and adiposity were assessed in an in-patient setting. Linear regression was used to examine the association between meeting each guideline and cardiometabolic risk factors/adiposity, adjusted for confounders and meeting other guidelines. RESULTS Of the 342 participants, 251 (73%) provided complete measurements. Adolescents were 12.5 ± 1.9 years (African American [37%] and white [57%], girls [54%], and overweight or obesity [48%]). Half met the sleep guideline (52%), few met the PA guideline (11%), and the top quintile was preselected as meeting the diet guideline (20%). Most met one (47%) or no guidelines (35%), and few met multiple guidelines (18%). Meeting the PA guideline was associated with lower cardiometabolic risk factors and adiposity (p < .05 for all). Compared with meeting no guidelines, those who met multiple guidelines had lower cardiometabolic risk factors and adiposity (p < .05 for all). CONCLUSIONS Few met the PA or multiple guidelines, and those not meeting guidelines were associated with adverse cardiometabolic factors and adiposity. Multidisciplinary strategies for improving multiple behaviors are needed to improve adolescent health.
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Affiliation(s)
- Chelsea L. Kracht
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808
| | | | - Daniel S. Hsia
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808
| | - Corby K. Martin
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808
| | - Robert L. Newton
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808
| | - Peter T. Katzmarzyk
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808
| | - Amanda E. Staiano
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808
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Höchsmann C, Dorling JL, Apolzan JW, Johannsen NM, Hsia DS, Martin CK. Baseline Habitual Physical Activity Predicts Weight Loss, Weight Compensation, and Energy Intake During Aerobic Exercise. Obesity (Silver Spring) 2020; 28:882-892. [PMID: 32144895 PMCID: PMC7180105 DOI: 10.1002/oby.22766] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/15/2019] [Accepted: 01/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to determine whether different measures of habitual physical activity (PA) at baseline predict weight change, weight compensation, and changes in energy intake (EI) during a 24-week supervised aerobic exercise intervention. METHODS Data from 108 participants (78 women; 48.7 [SD: 11.6] years; BMI 31.4 [SD: 4.6] kg/m2 ), randomly assigned to either the moderate-dose exercise group (8 kcal/kg of body weight per week) or the high-dose exercise group (20 kcal/kg of body weight per week) of the Examination of Mechanisms of Exercise-induced Weight Compensation (E-MECHANIC) trial, were analyzed. Moderate-to-vigorous PA (MVPA), steps per day, and PA energy expenditure (PAEE) were measured with SenseWear armbands (BodyMedia, Pittsburgh, Pennsylvania), and total activity energy expenditure and EI were estimated with doubly labeled water, all over 2 weeks, before and toward the end of the intervention. Multiple linear regression models, adjusted for sex, exercise group, and baseline value of the outcome, were used. RESULTS Baseline habitual MVPA levels predicted weight change (β = -0.275; P = 0.020), weight compensation (β = -0.238; P = 0.043), and change in EI (β = -0.318; P = 0.001). Associations between baseline PAEE and outcomes were comparable, whereas steps per day and, importantly, total activity energy expenditure (via doubly labeled water) did not significantly predict change in weight-related outcomes. CONCLUSIONS While acknowledging substantial variability in the data, on average, lower baseline habitual MVPA and PAEE levels were associated with less weight loss from exercise, higher compensation, and increased EI.
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Affiliation(s)
| | | | | | - Neil M. Johannsen
- Pennington Biomedical Research Center, Baton Rouge,
LA
- Louisiana State University, Baton Rouge, LA
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Hsia DS, Gosselin NH, Williams J, Farhat N, Marier JF, Shih W, Peterson C, Siegel R. A randomized, double-blind, placebo-controlled, pharmacokinetic and pharmacodynamic study of a fixed-dose combination of phentermine/topiramate in adolescents with obesity. Diabetes Obes Metab 2020; 22:480-491. [PMID: 31696603 DOI: 10.1111/dom.13910] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/19/2019] [Accepted: 10/31/2019] [Indexed: 01/16/2023]
Abstract
AIMS To assess the pharmacokinetic (PK) and pharmacodynamic characteristics of VI-0521, a fixed-dose combination of immediate-release phentermine (PHEN) and extended-release topiramate (TPM) in adolescents aged 12 to 17 years with obesity, and to report weight loss and adverse events using this drug combination. MATERIALS AND METHODS This was a multicentre, randomized, double-blind, parallel-design, placebo-controlled study in adolescents with obesity. A total of 42 adolescents were randomly assigned in a 1:1:1 ratio to placebo, or to a mid-dose (PHEN/TPM 7.5 mg/46 mg), or a top-dose (PHEN/TPM 15 mg/92 mg) of VI-0521. A total of 26 adolescents were included in the PK analysis (14 from the mid-dose group and 12 from the top-dose group). RESULTS On day 56, arithmetic means of terminal elimination half-life, apparent clearance (CL/F) and apparent central volume of distribution (Vc/F) were consistent across dose levels for both PHEN and TPM. Arithmetic means of CL/F and Vc/F for PHEN and TPM administered as a combination in adolescents with obesity were within 10% to 30% of those previously assessed in adults with obesity enrolled in phase II and III studies. A higher proportion of adolescents in both the mid- and top-dose groups (13.3% and 50.0%, respectively) compared with placebo (0.0%) reached ≥5% weight loss at day 56. The least squares (LS) mean change in systolic blood pressure from baseline to day 56 was -5.2 mmHg for the placebo group, -2.5 mmHg for the mid-dose group, and - 5.5 mmHg for the top-dose group. The LS mean change in diastolic blood pressure from baseline to day 56 was -2.4 mmHg for the placebo group, +3.8 mmHg for the mid-dose group, and + 2.0 mmHg for the top-dose group. Participants in the top-dose group had increases in heart rate from baseline of 4.1 bpm, while participants in the mid-dose group experienced a mean decrease in heart rate of 4.5 bpm at day 56. Both PHEN/TPM dose combinations were safe and well tolerated. CONCLUSIONS Treatment of adolescents with obesity using a fixed-dose combination of PHEN/TPM for 8 weeks resulted in exposure to PHEN and TPM that was comparable to that observed in adults, statistically significant weight loss, and a tolerable safety profile. These data indicate that both mid- and top-dose levels are appropriate for longer-term safety and efficacy studies in adolescents.
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Affiliation(s)
- Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States
| | | | - Jenna Williams
- Cincinnati Children's Hospital/University of Cincinnati, Cincinnati, Ohio, United States
| | | | | | | | | | - Robert Siegel
- Cincinnati Children's Hospital/University of Cincinnati, Cincinnati, Ohio, United States
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Hsia DS, Rasouli N, Pittas AG, Lary CW, Peters A, Lewis MR, Kashyap SR, Johnson KC, LeBlanc ES, Phillips LS, Hempe JM, Desouza CV. Implications of the Hemoglobin Glycation Index on the Diagnosis of Prediabetes and Diabetes. J Clin Endocrinol Metab 2020; 105:5713508. [PMID: 31965161 PMCID: PMC7015453 DOI: 10.1210/clinem/dgaa029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 11/11/2019] [Accepted: 01/16/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG) from a 75-g oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) can lead to different results when diagnosing prediabetes and diabetes. The Hemoglobin Glycation Index (HGI) quantifies the interindividual variation in glycation resulting in discrepancies between FPG and HbA1c. We used data from the Vitamin D and Type 2 Diabetes (D2d) study to calculate HGI, to identify HGI-associated variables, and to determine how HGI affects prediabetes and diabetes diagnosis. MEASUREMENTS A linear regression equation [HbA1c (%) = 0.0164 × FPG (mg/dL) + 4.2] was derived using the screening cohort (n = 6829) and applied to calculate predicted HbA1c. This was subtracted from the observed HbA1c to determine HGI in the baseline cohort with 2hPG data (n = 3945). Baseline variables plus prediabetes and diabetes diagnosis by FPG, HbA1c, and 2hPG were compared among low, moderate, and high HGI subgroups. RESULTS The proportion of women and Black/African American individuals increased from low to high HGI subgroups. Mean FPG decreased and mean HbA1c increased from low to high HGI subgroups, consistent with the HGI calculation; however, mean 2hPG was not significantly different among HGI subgroups. CONCLUSIONS High HGI was associated with Black race and female sex as reported previously. The observation that 2hPG was not different across HGI subgroups suggests that variation in postprandial glucose is not a significant source of population variation in HGI. Exclusive use of HbA1c for diagnosis will classify more Black individuals and women as having prediabetes compared with using FPG or 2hPG.
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Affiliation(s)
- Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Neda Rasouli
- University of Colorado, School of Medicine and VA Eastern Colorado Health Care System, Aurora, Colorado
| | - Anastassios G Pittas
- Tufts Medical Center, Boston, Massachusetts
- Correspondence and Reprint Requests: Anastassios Pittas, MD, Tufts Medical Center, 800 Washington Street, Box #268, Boston, Massachusetts 02111.
| | - Christine W Lary
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine
| | - Anne Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Michael R Lewis
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont
| | | | - Karen C Johnson
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research NW, Portland, Oregon
| | - Lawrence S Phillips
- Atlanta VA Medical Center, Decatur, Georgia and Emory University School of Medicine, Atlanta, Georgia
| | - James M Hempe
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Cyrus V Desouza
- Omaha VA Medical Center, University of Nebraska Medical Center, Omaha, Nebraska
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Ellison BR, Burton JH, Hsia DS. Comparison of proinsulin to C-peptide ratio in children with and without type 1 diabetes and its relation to age. Ann Pediatr Endocrinol Metab 2020; 25:38-41. [PMID: 32252215 PMCID: PMC7136504 DOI: 10.6065/apem.2020.25.1.38] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 10/01/2019] [Indexed: 01/01/2023] Open
Abstract
PURPOSE This study aimed to compare the proinsulin to C-peptide (PI:C) ratio in those with recent-onset type 1 diabetes versus those with no diabetes and to explore the effect of age on PI:C ratio. METHODS Nineteen participants (n=9 with type 1 diabetes and n=10 with no diabetes) between 10 and 19 years of age were enrolled in a single-visit cross-sectional study and underwent blood collection after 10 hours fasting to measure proinsulin and C-peptide levels as well as other glycemic parameters. RESULTS The median PI:C ratio was significantly different between type 1 diabetes and nondiabetes groups (6.24% vs. 1.46%, P<0.01). A significant negative correlation was seen between PI:C ratio and patient age after adjustment for duration of diabetes (r2=0.61, P=0.02) in the type 1 diabetes group. CONCLUSION Even in this narrow age window, a higher degree of β-cell dysfunction indicated by a higher PI:C ratio was seen in younger children.
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Affiliation(s)
| | | | - Daniel S. Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA, USA,Address for correspondence: Daniel S. Hsia, MD Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA 70808, USA Tel: +1-225-763-2831 Fax: +1-225-763-3022 E-mail:
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Abstract
OBJECTIVE The aim of this study is to characterize changes in body composition during pregnancy in women with obesity. METHODS Fifty-four healthy women with obesity (class 1, 30-34.9 kg/m2 : n = 25; class 2, 35-39.9 kg/m2 : n = 21; class 3, ≥ 40.0 kg/m2 : n = 8) expecting a singleton pregnancy were studied. Body composition was measured in early pregnancy (13-16 weeks), midpregnancy (24-27 weeks), and late pregnancy (35-37 weeks) using air displacement plethysmography, stable isotopes, and skinfold thickness measurements. Fasting glucose, insulin, and leptin were measured. RESULTS The gain in fat-free mass was lower in the second trimester compared with the third (2.7 ± 0.2 to 5.3 ± 0.2 kg; P < 0.001), whereas fat mass accumulation declined over time (0.6 ± 0.3 to -0.7 ± 0.4 kg; P = 0.005). Women with class 1 and 2 obesity gained 1.1 ± 0.7 kg of fat mass during pregnancy, while women with class 3 obesity lost 4.1 ± 0.6 kg (both P < 0.001). The difference in fat accumulation between obesity classes was observed only in the second trimester (P = 0.02). Gestational weight gain was associated positively with changes in plasma concentrations of insulin, leptin, and insulin resistance (all P < 0.01). CONCLUSIONS Gestational weight gain in pregnancy differs by obesity class and trimester. Women with class 3 obesity gain less body weight and fat mass. Fat mass gain is most likely preventable in the second trimester.
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Affiliation(s)
- Jasper Most
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Abby D Altazan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Robbie A Beyl
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Newton RL, Johnson WD, Larrivee S, Hendrick C, Harris M, Johannsen NM, Swift DL, Hsia DS, Church TS. A Randomized Community-based Exercise Training Trial in African American Men: Aerobic Plus Resistance Training and Insulin Sensitivity in African American Men. Med Sci Sports Exerc 2020; 52:408-416. [PMID: 31939911 DOI: 10.1249/mss.0000000000002149] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To examine the impact of a community-based exercise training intervention on cardiometabolic outcomes in African American men who have a family history of type 2 diabetes. METHODS The Aerobic Plus Resistance Training and Insulin Sensitivity in African American Men (ARTIIS) study randomized participants into either an exercise training intervention or an information only control group for 5 months. The exercise training intervention consisted of 150 min of moderate intensity aerobic activity and 2 d of resistance training per week, consistent with the current federal physical activity guidelines. Participants in the control group received monthly newsletters featuring topics focused heavily on type 2 diabetes education and prevention. Outcome data were analyzed using repeated-measures ANCOVA models and incorporating both intention-to-treat and per-protocol principles. RESULTS Adherence to the aerobic and resistance training prescriptions were between 77% and 79%. Despite significant within group improvements in glucose and insulin levels (fasting, 2 h, 2 h minus baseline) and Homeostatic Model 2-Insulin Resistance, there were not significant between group differences. There was a marginally significant between group difference for Homeostatic Model 2-Beta (P < 0.06), and significant between group differences in peak cardiorespiratory fitness (P < 0.001) and waist circumference (P = 0.03). CONCLUSIONS These findings suggest that exercise training in accordance with the current national recommendations is effective in improving some health parameters in middle-age African American men who have a family history of type 2 diabetes, but did not have a significant impact on glycemic status.
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Affiliation(s)
| | | | | | | | | | | | - Damon L Swift
- College of Health and Human Performance, East Carolina University, Greenville, NC
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA
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Abstract
While there are eight medications/combinations approved for the treatment of obesity in adults, the options for the treatment of obesity in adolescents remain limited. Evidence for obesity medication use in adolescents is limited due to the relatively small number of clinical trials that have been completed and the few adolescents that have been included in many of the trials. The goal of this review will be to present the current evidence for the medications approved for adolescents, medications not approved for adolescents but have adolescent data, and medications approved for adults with the prospect for use in adolescents. We will also discuss current limitations and next steps in the exploration of future treatment options.
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Affiliation(s)
- Kaylee Woodard
- Pennington Biomedical Research Center, Clinical Trials Unit, Baton Rouge, LA, USA
| | - Logan Louque
- Pennington Biomedical Research Center, Clinical Trials Unit, Baton Rouge, LA, USA
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LeBlanc ES, Pratley RE, Dawson-Hughes B, Staten MA, Sheehan PR, Lewis MR, Peters A, Kim SH, Chatterjee R, Aroda VR, Chadha C, Neff LM, Brodsky IG, Rosen C, Desouza CV, Foreyt JP, Hsia DS, Johnson KC, Raskin P, Kashyap SR, O'Neil P, Phillips LS, Rasouli N, Liao EP, Robbins DC, Pittas AG. Erratum. Baseline Characteristics of the Vitamin D and Type 2 Diabetes (D2d) Study: A Contemporary Prediabetes Cohort That Will Inform Diabetes Prevention Efforts. Diabetes Care 2018;41:1590-1599. Diabetes Care 2019; 42:2347. [PMID: 31548246 PMCID: PMC6868461 DOI: 10.2337/dc19-er12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Carmichael O, Stuchlik P, Pillai S, Biessels GJ, Dhullipudi R, Madden-Rusnak A, Martin S, Hsia DS, Fonseca V, Bazzano L. High-Normal Adolescent Fasting Plasma Glucose Is Associated With Poorer Midlife Brain Health: Bogalusa Heart Study. J Clin Endocrinol Metab 2019; 104:4492-4500. [PMID: 31058974 PMCID: PMC6736207 DOI: 10.1210/jc.2018-02750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/19/2018] [Accepted: 04/30/2019] [Indexed: 12/24/2022]
Abstract
CONTEXT It is unclear how adolescent glycemic status relates to brain health in adulthood. OBJECTIVE To assess the association between adolescent fasting plasma glucose (FPG) and MRI-based brain measures in midlife. DESIGN Between 1973 and 1992, the Bogalusa Heart Study (BHS) collected FPG from children, 3 to 18 years old, and followed up between 1992 and 2018. Cognitive tests and brain MRI were collected in 2013 to 2016 and 2018. SETTING Observational longitudinal cohort study. PARTICIPANTS Of 1298 contacted BHS participants, 74 completed screening, and 50 completed MRI. MAIN OUTCOME MEASURES Mean FPG per participant at ages <20, 20 to 40, and over 40 years old; brain white matter hyperintensity (WMH) volume, gray matter volume, and functional MRI (fMRI) activation to a Stroop task; tests of logical and working memory, executive function, and semantic fluency. RESULTS At MRI, participants were middle aged (51.3 ± 4.4 years) and predominantly female (74%) and white (74%). Mean FPG was impaired for zero, two, and nine participants in pre-20, 20 to 40, and over-40 periods. The pre-20 mean FPG above the pre-20 median value (i.e., above 83.5 mg/dL) was associated with greater WMH volume [mean difference: 0.029% of total cranial volume, CI: (0.0059, 0.052), P = 0.015] and less fMRI activation [-1.41 units (-2.78, -0.05), P = 0.043] on midlife MRI compared with below-median mean FPG. In controlling for over-40 mean FPG status did not substantially modify the associations. Cognitive scores did not differ by pre-20 mean FPG. CONCLUSIONS High-normal adolescent FPG may be associated with preclinical brain changes in midlife.
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Affiliation(s)
- Owen Carmichael
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
- Correspondence and Reprint Requests: Owen Carmichael, PhD, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, Louisiana 70808. E-mail:
| | | | | | - Geert-Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Ram Dhullipudi
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | | | - Shane Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Vivian Fonseca
- Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Lydia Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
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Martin CK, Johnson WD, Myers CA, Apolzan JW, Earnest CP, Thomas DM, Rood JC, Johannsen NM, Tudor-Locke C, Harris M, Hsia DS, Church TS. Effect of different doses of supervised exercise on food intake, metabolism, and non-exercise physical activity: The E-MECHANIC randomized controlled trial. Am J Clin Nutr 2019; 110:583-592. [PMID: 31172175 PMCID: PMC6735935 DOI: 10.1093/ajcn/nqz054] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 11/08/2018] [Accepted: 03/15/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Exercise is recommended for weight management, yet exercise produces less weight loss than expected, which is called weight compensation. The mechanisms for weight compensation are unclear. OBJECTIVE The aim of this study was to identify the mechanisms responsible for compensation. METHODS In a randomized controlled trial conducted at an academic research center, adults (n = 198) with overweight or obesity were randomized for 24 wk to a no-exercise control group or 1 of 2 supervised exercise groups: 8 kcal/kg of body weight/wk (KKW) or 20 KKW. Outcome assessment occurred at weeks 0 and 24. Energy intake, activity, and resting metabolic rate (RMR) were measured with doubly labeled water (DLW; with and without adjustments for change in RMR), armband accelerometers, and indirect calorimetry, respectively. Appetite and compensatory health beliefs were measured by self-report. RESULTS A per-protocol analysis included 171 participants (72.5% women; mean ± SD baseline body mass index: 31.5 ± 4.7 kg/m2). Significant (P < 0.01) compensation occurred in the 8 KKW (mean: 1.5 kg; 95% CI: 0.9, 2.2 kg) and 20 KKW (mean: 2.7 kg; 95% CI: 2.0, 3.5 kg) groups, and compensation differed significantly between the exercise groups (P = 0.01). Energy intake by adjusted DLW increased significantly (P < 0.05) in the 8 KKW (mean: 90.7 kcal/d; 95% CI: 35.1, 146.4 kcal/d) and 20 KKW (mean: 123.6 kcal/d; 95% CI: 64.5, 182.7 kcal/d) groups compared with control (mean: -2.3 kcal/d; 95% CI: -58.0, 53.5 kcal/d). Results were similar without DLW adjustment. RMR and physical activity (excluding structured exercise) did not differentially change among the 3 groups. Participants with higher compared with lower compensation reported increased appetite ratings and beliefs that healthy behaviors can compensate for unhealthy behaviors. Furthermore, they increased craving for sweet foods, increased sleep disturbance, and had worsening bodily pain. CONCLUSIONS Compensation resulted from increased energy intake and concomitant increases in appetite, which can be treated with dietary or pharmacological interventions. Compensation was not due to activity or metabolic changes. This trial was registered at clinicaltrials.gov as NCT01264406.
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Affiliation(s)
- Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA,Address correspondence to CKM (e-mail: )
| | | | | | | | | | | | | | - Neil M Johannsen
- Pennington Biomedical Research Center, Baton Rouge, LA,Louisiana State University, Baton Rouge, LA
| | - Catrine Tudor-Locke
- Pennington Biomedical Research Center, Baton Rouge, LA,University of Massachusetts Amherst, Amherst, MA
| | | | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA
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Dorling JL, Church TS, Myers CA, Höchsmann C, White UA, Hsia DS, Martin CK, Apolzan JW. Racial Variations in Appetite-Related Hormones, Appetite, and Laboratory-Based Energy Intake from the E-MECHANIC Randomized Clinical Trial. Nutrients 2019; 11:nu11092018. [PMID: 31466276 PMCID: PMC6770918 DOI: 10.3390/nu11092018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/20/2019] [Revised: 08/20/2019] [Accepted: 08/24/2019] [Indexed: 01/02/2023] Open
Abstract
African Americans (AAs) have a higher obesity risk than Whites; however, it is unclear if appetite-related hormones and food intake are implicated. We examined differences in appetite-related hormones, appetite, and food intake between AAs (n = 53) and Whites (n = 111) with overweight or obesity. Participants were randomized into a control group or into supervised, controlled exercise groups at 8 kcal/kg of body weight/week (KKW) or 20 KKW. Participants consumed lunch and dinner at baseline and follow-up, with appetite and hormones measured before and after meals (except leptin). At baseline, AAs had lower peptide YY (PYY; p < 0.01) and a blunted elevation in PYY after lunch (p = 0.01), as well as lower ghrelin (p = 0.02) and higher leptin (p < 0.01) compared to Whites. Despite desire to eat being lower and satisfaction being higher in AAs relative to Whites (p ≤ 0.03), no racial differences in food intake were observed. Compared to Whites, leptin increased in the 8 KKW group in AAs (p = 0.01), yet no other race-by-group interactions were evident. Differences in appetite-related hormones between AAs and Whites exist; however, their influence on racial disparities in appetite, food intake, and obesity within this trial was limited.
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Affiliation(s)
- James L Dorling
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Timothy S Church
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Candice A Myers
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Christoph Höchsmann
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Ursula A White
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
| | - John W Apolzan
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
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Pittas AG, Dawson-Hughes B, Sheehan P, Ware JH, Knowler WC, Aroda VR, Brodsky I, Ceglia L, Chadha C, Chatterjee R, Desouza C, Dolor R, Foreyt J, Fuss P, Ghazi A, Hsia DS, Johnson KC, Kashyap SR, Kim S, LeBlanc ES, Lewis MR, Liao E, Neff LM, Nelson J, O'Neil P, Park J, Peters A, Phillips LS, Pratley R, Raskin P, Rasouli N, Robbins D, Rosen C, Vickery EM, Staten M. Vitamin D Supplementation and Prevention of Type 2 Diabetes. N Engl J Med 2019; 381:520-530. [PMID: 31173679 PMCID: PMC6993875 DOI: 10.1056/nejmoa1900906] [Citation(s) in RCA: 341] [Impact Index Per Article: 68.2] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Observational studies support an association between a low blood 25-hydroxyvitamin D level and the risk of type 2 diabetes. However, whether vitamin D supplementation lowers the risk of diabetes is unknown. METHODS We randomly assigned adults who met at least two of three glycemic criteria for prediabetes (fasting plasma glucose level, 100 to 125 mg per deciliter; plasma glucose level 2 hours after a 75-g oral glucose load, 140 to 199 mg per deciliter; and glycated hemoglobin level, 5.7 to 6.4%) and no diagnostic criteria for diabetes to receive 4000 IU per day of vitamin D3 or placebo, regardless of the baseline serum 25-hydroxyvitamin D level. The primary outcome in this time-to-event analysis was new-onset diabetes, and the trial design was event-driven, with a target number of diabetes events of 508. RESULTS A total of 2423 participants underwent randomization (1211 to the vitamin D group and 1212 to the placebo group). By month 24, the mean serum 25-hydroxyvitamin D level in the vitamin D group was 54.3 ng per milliliter (from 27.7 ng per milliliter at baseline), as compared with 28.8 ng per milliliter in the placebo group (from 28.2 ng per milliliter at baseline). After a median follow-up of 2.5 years, the primary outcome of diabetes occurred in 293 participants in the vitamin D group and 323 in the placebo group (9.39 and 10.66 events per 100 person-years, respectively). The hazard ratio for vitamin D as compared with placebo was 0.88 (95% confidence interval, 0.75 to 1.04; P = 0.12). The incidence of adverse events did not differ significantly between the two groups. CONCLUSIONS Among persons at high risk for type 2 diabetes not selected for vitamin D insufficiency, vitamin D3 supplementation at a dose of 4000 IU per day did not result in a significantly lower risk of diabetes than placebo. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; D2d ClinicalTrials.gov number, NCT01942694.).
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Affiliation(s)
- Anastassios G Pittas
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Bess Dawson-Hughes
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Patricia Sheehan
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - James H Ware
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - William C Knowler
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Vanita R Aroda
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Irwin Brodsky
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Lisa Ceglia
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Chhavi Chadha
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Ranee Chatterjee
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Cyrus Desouza
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Rowena Dolor
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - John Foreyt
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Paul Fuss
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Adline Ghazi
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Daniel S Hsia
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Karen C Johnson
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Sangeeta R Kashyap
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Sun Kim
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Erin S LeBlanc
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Michael R Lewis
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Emilia Liao
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Lisa M Neff
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Jason Nelson
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Patrick O'Neil
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Jean Park
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Anne Peters
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Lawrence S Phillips
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Richard Pratley
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Philip Raskin
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Neda Rasouli
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - David Robbins
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Clifford Rosen
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Ellen M Vickery
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
| | - Myrlene Staten
- From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women's Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) - all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) - both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) - both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) - all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) - both in California; Kaiser Permanente Center for Health Research-Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur - both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.)
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Ravussin E, Beyl RA, Poggiogalle E, Hsia DS, Peterson CM. Early Time-Restricted Feeding Reduces Appetite and Increases Fat Oxidation But Does Not Affect Energy Expenditure in Humans. Obesity (Silver Spring) 2019; 27:1244-1254. [PMID: 31339000 PMCID: PMC6658129 DOI: 10.1002/oby.22518] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [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: 01/01/2019] [Accepted: 04/10/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Eating earlier in the daytime to align with circadian rhythms in metabolism enhances weight loss. However, it is unknown whether these benefits are mediated through increased energy expenditure or decreased food intake. Therefore, this study performed the first randomized trial to determine how meal timing affects 24-hour energy metabolism when food intake and meal frequency are matched. METHODS Eleven adults with overweight practiced both early time-restricted feeding (eTRF) (eating from 8 am to 2 pm) and a control schedule (eating from 8 am to 8 pm) for 4 days each. On the fourth day, 24-hour energy expenditure and substrate oxidation were measured by whole-room indirect calorimetry, in conjunction with appetite and metabolic hormones. RESULTS eTRF did not affect 24-hour energy expenditure (Δ = 10 ± 16 kcal/d; P = 0.55). Despite the longer daily fast (intermittent fasting), eTRF decreased mean ghrelin levels by 32 ± 10 pg/mL (P = 0.006), made hunger more even-keeled (P = 0.006), and tended to increase fullness (P = 0.06-0.10) and decrease the desire to eat (P = 0.08). eTRF also increased metabolic flexibility (P = 0.0006) and decreased the 24-hour nonprotein respiratory quotient (Δ = -0.021 ± 0.010; P = 0.05). CONCLUSIONS Meal-timing interventions facilitate weight loss primarily by decreasing appetite rather than by increasing energy expenditure. eTRF may also increase fat loss by increasing fat oxidation.
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Affiliation(s)
- Eric Ravussin
- Human Translational Physiology, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Robbie A. Beyl
- Human Translational Physiology, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Eleonora Poggiogalle
- Human Translational Physiology, Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Department of Experimental Medicine, Medical Pathophysiology, Food Science and Endocrinology Section, Sapienza University, Rome, Italy
| | - Daniel S. Hsia
- Human Translational Physiology, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Courtney M. Peterson
- Human Translational Physiology, Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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Most J, Amant MS, Hsia DS, Altazan AD, Thomas DM, Gilmore LA, Vallo PM, Beyl RA, Ravussin E, Redman LM. Evidence-based recommendations for energy intake in pregnant women with obesity. J Clin Invest 2019; 129:4682-4690. [PMID: 31369400 PMCID: PMC6819141 DOI: 10.1172/jci130341] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/23/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In women with obesity, excess gestational weight gain (≥270 g/week) occurs in two out of three pregnancies and contributes to metabolic impairments in both mother and baby. To improve obstetrical care, objectively assessed information on energy balance is urgently needed. The objective of this study was to characterize determinants of gestational weight gain in women with obesity. METHODS This was a prospective, observational study of pregnant women with obesity. The primary outcome was energy intake calculated by the energy intake-balance method. Energy expenditure was measured by doubly-labeled water and whole-room indirect calorimetry and body composition as 3-compartment model by air displacement plethysmography and isotope dilution in early (13-16 weeks) and late pregnancy (35-37 weeks). RESULTS In pregnant women with obesity (n=54), recommended weight gain (n=8, 15%) during the second and third trimesters was achieved when energy intake was 125±52 kcal/d less than energy expenditure. In contrast, women with excess weight gain (67%) consumed 186±29 kcal/d more than they expended (P<0.001). Energy balance affected maternal adiposity (recommended: -2.5±0.8 kg fat mass, excess: +2.2±0.5, inadequate: -4.5±0.5, P<0.001), but not fetal growth. Weight gain was not related to demographics, activity, metabolic biomarkers, or diet quality. We estimated that energy intake requirements for recommended weight gain during the second and third trimesters were not increased as compared to energy requirements early in pregnancy (34±53 kcal/d, P=0.83). CONCLUSIONS We here provide the first evidence-based recommendations for energy intake in pregnant women with obesity. Contrary to current recommendations, energy intake should not exceed energy expenditure. FUNDING This study was funded by the National Institutes of Health (R01DK099175; Redman, U54GM104940 and P30DK072476; Core support). TRIAL REGISTRATION clinicaltrials.gov: NCT01954342.
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Affiliation(s)
- Jasper Most
- Reproductive Endocrinology and Women’s Health, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Marshall St Amant
- Maternal and Fetal Medicine, Woman’s Hospital, Baton Rouge, Louisiana, USA
| | - Daniel S. Hsia
- Reproductive Endocrinology and Women’s Health, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Abby D. Altazan
- Reproductive Endocrinology and Women’s Health, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - L. Anne Gilmore
- Reproductive Endocrinology and Women’s Health, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Porsha M. Vallo
- Reproductive Endocrinology and Women’s Health, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Robbie A. Beyl
- Reproductive Endocrinology and Women’s Health, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Eric Ravussin
- Reproductive Endocrinology and Women’s Health, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Leanne M. Redman
- Reproductive Endocrinology and Women’s Health, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Most J, Broskey NT, Altazan AD, Beyl RA, St Amant M, Hsia DS, Ravussin E, Redman LM. Is Energy Balance in Pregnancy Involved in the Etiology of Gestational Diabetes in Women with Obesity? Cell Metab 2019; 29:231-233. [PMID: 30595480 PMCID: PMC6687297 DOI: 10.1016/j.cmet.2018.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/09/2018] [Accepted: 12/01/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Jasper Most
- Clinical Sciences Division, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Nicholas T Broskey
- Clinical Sciences Division, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Abby D Altazan
- Clinical Sciences Division, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Robbie A Beyl
- Biostatistics, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Marshall St Amant
- LSU Health Sciences Center, 433 Bolivar St, New Orleans, LA 70112, USA; Woman's Hospital, 100 Woman's Way, Baton Rouge, LA 70817, USA
| | - Daniel S Hsia
- Clinical Sciences Division, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Eric Ravussin
- Clinical Sciences Division, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Leanne M Redman
- Clinical Sciences Division, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
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Proença M, Schuna JM, Barreira TV, Hsia DS, Pitta F, Tudor-Locke C, Cowley AD, Martin CK. Worker acceptability of the Pennington Pedal Desk™ occupational workstation alternative. Work 2019; 60:499-506. [PMID: 30040784 DOI: 10.3233/wor-182753] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/15/2022] Open
Abstract
BACKGROUND Active workstation alternatives (e.g., treadmill desks and pedal desks) have the potential to elevate workplace energy expenditure by replacing occupational sedentary behavior with opportunities to generate low-intensity non-exercise physical activity, but only to the extent that workers find them acceptable and congruent with their primary working tasks and therefore can frequently use them for extended periods of time. OBJECTIVE To assess workers' acceptability of the Pennington Pedal Desk™. METHODS Full-time sedentary workers (N = 42; 76% female; mean+SD age 39.6±11.3 years; BMI 25.7±5.4 kg/m2) used the pedal desk for 15 minutes while they: 1) searched the internet, 2) composed an email, and 3) completed acceptability ratings using an online Likert scale anchored from 1/strongly disagree to 5/strongly agree. Garmin Vector power meter pedals and EDGE 510 GPS bike computer (Garmin ®, USA) continuously captured revolutions per minute (RPM) and power. RESULTS Participants indicated that they would use the pedal desk for 4 (median) hours per work day and 97.6% of participants were somewhat or completely confident that they could type proficiently while using the pedal desk. Participants pedaled at 54.8±11.2 RPM and 23.1±8.6 watts (mean+SD). CONCLUSIONS Participants rated the Pennington Pedal Desk™ workstation positively and indicated potential for extended daily use.
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Affiliation(s)
- Mahara Proença
- CAPES Foundation, Ministry of Education of Brazil, Brasília - DF, Brazil.,CAPES Foundation, Ministry of Education of Brazil, Brasília - DF, Brazil.,CAPES Foundation, Ministry of Education of Brazil, Brasília - DF, Brazil
| | - John M Schuna
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.,School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, USA
| | - Tiago V Barreira
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.,Department of Exercise Science, Syracuse University, Syracuse, NY, USA
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Fabio Pitta
- Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil
| | - Catrine Tudor-Locke
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.,Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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49
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Block JP, Bailey LC, Gillman MW, Lunsford D, Daley MF, Eneli I, Finkelstein J, Heerman W, Horgan CE, Hsia DS, Jay M, Rao G, Reynolds JS, Rifas-Shiman SL, Sturtevant JL, Toh S, Trasande L, Young J, Forrest CB. Early Antibiotic Exposure and Weight Outcomes in Young Children. Pediatrics 2018; 142:peds.2018-0290. [PMID: 30381474 PMCID: PMC6317759 DOI: 10.1542/peds.2018-0290] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [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] [Accepted: 09/10/2018] [Indexed: 12/27/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5839981580001PEDS-VA_2018-0290Video Abstract OBJECTIVES: To determine the association of antibiotic use with weight outcomes in a large cohort of children. METHODS Health care data were available from 2009 to 2016 for 35 institutions participating in the National Patient-Centered Clinical Research Network. Participant inclusion required same-day height and weight measurements at 0 to <12, 12 to <30, and 48 to <72 months of age. We assessed the association between any antibiotic use at <24 months of age with BMI z score and overweight or obesity prevalence at 48 to <72 months (5 years) of age, with secondary assessments of antibiotic spectrum and age-period exposures. We included children with and without complex chronic conditions. RESULTS Among 1 792 849 children with a same-day height and weight measurement at <12 months of age, 362 550 were eligible for the cohort. One-half of children (52%) were boys, 27% were African American, 18% were Hispanic, and 58% received ≥1 antibiotic prescription at <24 months of age. At 5 years, the mean BMI z score was 0.40 (SD 1.19), and 28% of children had overweight or obesity. In adjusted models for children without a complex chronic condition at 5 years, we estimated a higher mean BMI z score by 0.04 (95% confidence interval [CI] 0.03 to 0.05) and higher odds of overweight or obesity (odds ratio 1.05; 95% CI 1.03 to 1.07) associated with obtaining any (versus no) antibiotics at <24 months. CONCLUSIONS Antibiotic use at <24 months of age was associated with a slightly higher body weight at 5 years of age.
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Affiliation(s)
- Jason P. Block
- Division of Chronic Disease Research Across the
Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care
Institute and
| | - L. Charles Bailey
- Applied Clinical Research Center and Department of
Pediatrics, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | - Matthew W. Gillman
- Division of Chronic Disease Research Across the
Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care
Institute and,Environmental Influences on Child Health Outcomes
Program, National Institutes of Health, Bethesda, Maryland
| | | | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente
Colorado, Denver, Colorado
| | | | - Jonathan Finkelstein
- Department of Pediatrics, Harvard Medical School,
Harvard University, Boston, Massachusetts
| | - William Heerman
- Department of Pediatrics, Vanderbilt University
Medical Center, Nashville, Tennessee
| | - Casie E. Horgan
- Division of Chronic Disease Research Across the
Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care
Institute and
| | - Daniel S. Hsia
- Pennington Biomedical Research Center, Baton Rouge,
Louisiana
| | | | - Goutham Rao
- Department of Family Medicine and Community Health,
Case Western Reserve University and University Hospitals of Cleveland,
Cleveland, Ohio
| | | | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the
Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care
Institute and
| | | | - Sengwee Toh
- Therapeutics Research and Infectious Disease
Epidemiology Group and
| | - Leonardo Trasande
- Pediatrics, School of Medicine, New York University,
New York City, New York; and
| | - Jessica Young
- Division of Chronic Disease Research Across the
Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care
Institute and
| | - Christopher B. Forrest
- Applied Clinical Research Center and Department of
Pediatrics, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
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50
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Staiano AE, Beyl RA, Guan W, Hendrick CA, Hsia DS, Newton RL. Home-based exergaming among children with overweight and obesity: a randomized clinical trial. Pediatr Obes 2018; 13:724-733. [PMID: 30027607 PMCID: PMC6203598 DOI: 10.1111/ijpo.12438] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [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: 02/14/2018] [Revised: 04/30/2018] [Accepted: 05/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Given children's low levels of physical activity and high prevalence of obesity, there is an urgent need to identify innovative physical activity options. OBJECTIVE This study aims to test the effectiveness of exergaming (video gaming that involves physical activity) to reduce children's adiposity and improve cardiometabolic health. METHODS This randomized controlled trial assigned 46 children with overweight/obesity to a 24-week exergaming or control condition. Intervention participants were provided a gaming console with exergames, a gameplay curriculum (1 h per session, three times a week) and video chat sessions with a fitness coach (telehealth coaching). Control participants were provided the exergames following final clinic visit. The primary outcome was body mass index (BMI) z-score. Secondary outcomes were fat mass by dual energy X-ray absorptiometry and cardiometabolic health metrics. RESULTS Half of the participants were girls, and 57% were African-American. Intervention adherence was 94.4%, and children's ratings of acceptability and enjoyment were high. The intervention group significantly reduced BMI z-score excluding one control outlier (intervention [standard error] vs. control [standard error]: -0.06 [0.03] vs. 0.03 [0.03], p = 0.016) with a marginal difference in intent-to-treat analysis (-0.06 [0.03] vs. 0.02 [0.03], p = 0.065). Compared with control, the intervention group improved systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein-cholesterol and moderate-to-vigorous physical activity (all p values <0.05). CONCLUSIONS Exergaming at home elicited high adherence and improved children's BMI z-score, cardiometabolic health and physical activity levels. Exergaming with social support may be promoted as an exercise option for children.
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Affiliation(s)
| | - Robbie A. Beyl
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Win Guan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - Daniel S. Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Robert L. Newton
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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