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Hu L, Shi Y, Wylie-Rosett J, Sevick MA, Xu X, Lieu R, Wang C, Li H, Bao H, Jiang Y, Zhu Z, Yeh MC, Islam N. Feasibility of a family-oriented mHealth intervention for Chinese Americans with type 2 diabetes: A pilot randomized control trial. PLoS One 2024; 19:e0299799. [PMID: 38466714 PMCID: PMC10927140 DOI: 10.1371/journal.pone.0299799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/30/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES To test the feasibility, acceptability, and potential efficacy of a mHealth intervention tailored for Chinese immigrant families with type 2 diabetes (T2D). METHODS We conducted a pilot randomized controlled trial (RCT) with baseline, 3-, and 6-month measurements. Participating dyads, T2D patients and families/friends from NYC, were randomized into the intervention group (n = 11) or the wait-list control group (n = 12). Intervention includes 24 videos covering T2D self-management, behavioral techniques, and family-oriented sessions. Feasibility and acceptability were measured respectively by the retention rate and video watch rate, and a satisfaction survey. Patients' HbA1c, weight, and self-management were also assessed to test potential efficacy. RESULTS Most T2D patients (n = 23; mean age 56.2±9.4 years; 52.2% male) and families/friends (n = 23, mean age 54.6±11.2 years; 52.2% female) had high school education or less (69.6% and 69.6%), annual household income < $25,000 (65.2% and 52.2%), and limited English proficiency (95.7% and 95.7%). The retention rates were not significantly different between the intervention and the control groups for both the patients (90.91% vs 83.3%, p = 0.589); and their families/friends (3-month: 90.9% vs 75%, p = 0.313; 6-month: 90.9% vs 83.3%, p = 0.589). The mean video watch rate was 76.8% (7%). T2D patients and families/friends rated satisfaction as 9.4 and 10 out of 10, respectively. Despite no between-group differences, the intervention group had significantly lower HbA1c (p = 0.014) and better self-management (p = 0.009), and lost 12 lbs. on average at 6 months (p = 0.079), compared to their baseline levels. CONCLUSIONS A culturally-tailored, family-based mHealth intervention is feasible and acceptable among low-income, limited English-proficient Chinese families with T2D in NYC. Significant changes in HbA1c and self-management within the intervention group indicate this intervention may have potential efficacy. Given the small sample size of this study, a future RCT with adequate power is needed to test efficacy.
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Affiliation(s)
- Lu Hu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Yun Shi
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Judith Wylie-Rosett
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, NY, United States of America
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States of America
| | - Mary Ann Sevick
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
- Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Xinyi Xu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Ricki Lieu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Chan Wang
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Huilin Li
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Han Bao
- Jacobi Medical Center, New York, NY, United States of America
| | - Yulin Jiang
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Ziqiang Zhu
- Wellsure Medical Practice, New York, NY, United States of America
| | - Ming-Chin Yeh
- School of Urban Public Health, Hunter College, City University of New York, New York, NY, United States of America
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
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Popp CJ, Wang C, Hoover A, Gomez LA, Curran M, St-Jules DE, Barua S, Sevick MA, Kleinberg S. Objective Determination of Eating Occasion Timing: Combining Self-Report, Wrist Motion, and Continuous Glucose Monitoring to Detect Eating Occasions in Adults With Prediabetes and Obesity. J Diabetes Sci Technol 2024; 18:266-272. [PMID: 37747075 PMCID: PMC10973869 DOI: 10.1177/19322968231197205] [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] [Indexed: 09/26/2023]
Abstract
BACKGROUND Accurately identifying eating patterns, specifically the timing, frequency, and distribution of eating occasions (EOs), is important for assessing eating behaviors, especially for preventing and managing obesity and type 2 diabetes (T2D). However, existing methods to study EOs rely on self-report, which may be prone to misreporting and bias and has a high user burden. Therefore, objective methods are needed. METHODS We aim to compare EO timing using objective and subjective methods. Participants self-reported EO with a smartphone app (self-report [SR]), wore the ActiGraph GT9X on their dominant wrist, and wore a continuous glucose monitor (CGM, Abbott Libre Pro) for 10 days. EOs were detected from wrist motion (WM) using a motion-based classifier and from CGM using a simulation-based system. We described EO timing and explored how timing identified with WM and CGM compares with SR. RESULTS Participants (n = 39) were 59 ± 11 years old, mostly female (62%) and White (51%) with a body mass index (BMI) of 34.2 ± 4.7 kg/m2. All had prediabetes or moderately controlled T2D. The median time-of-day first EO (and interquartile range) for SR, WM, and CGM were 08:24 (07:00-09:59), 9:42 (07:46-12:26), and 06:55 (04:23-10:03), respectively. The median last EO for SR, WM, and CGM were 20:20 (16:50-21:42), 20:12 (18:30-21:41), and 21:43 (20:35-22:16), respectively. The overlap between SR and CGM was 55% to 80% of EO detected with tolerance periods of ±30, 60, and 120 minutes. The overlap between SR and WM was 52% to 65% EO detected with tolerance periods of ±30, 60, and 120 minutes. CONCLUSION The continuous glucose monitor and WM detected overlapping but not identical meals and may provide complementary information to self-reported EO.
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Affiliation(s)
- Collin J. Popp
- Department of Population Health,
Institute for Excellence in Health Equity, NYU Langone Health, New York, NY,
USA
| | - Chan Wang
- Division of Biostatistics, Department
of Population Health, NYU Langone Health, New York, NY, USA
| | - Adam Hoover
- Holcombe Department of Electrical and
Computer Engineering, Clemson University, Clemson, SC, USA
| | - Louis A. Gomez
- Department of Computer Science, Stevens
Institute of Technology, Hoboken, NJ, USA
| | - Margaret Curran
- Department of Population Health,
Institute for Excellence in Health Equity, NYU Langone Health, New York, NY,
USA
| | | | - Souptik Barua
- Department of Medicine, NYU Langone
Health, New York, NY, USA
| | - Mary Ann Sevick
- Division of Precision Medicine,
Department of Medicine, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Langone
Health, New York, NY, USA
| | - Samantha Kleinberg
- Department of Computer Science, Stevens
Institute of Technology, Hoboken, NJ, USA
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Arivazhagan L, Popp CJ, Ruiz HH, Wilson RA, Manigrasso MB, Shekhtman A, Ramasamy R, Sevick MA, Schmidt AM. The RAGE/DIAPH1 axis: mediator of obesity and proposed biomarker of human cardiometabolic disease. Cardiovasc Res 2024; 119:2813-2824. [PMID: 36448548 DOI: 10.1093/cvr/cvac175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 12/07/2023] Open
Abstract
Overweight and obesity are leading causes of cardiometabolic dysfunction. Despite extensive investigation, the mechanisms mediating the increase in these conditions are yet to be fully understood. Beyond the endogenous formation of advanced glycation endproducts (AGEs) in overweight and obesity, exogenous sources of AGEs accrue through the heating, production, and consumption of highly processed foods. Evidence from cellular and mouse model systems indicates that the interaction of AGEs with their central cell surface receptor for AGE (RAGE) in adipocytes suppresses energy expenditure and that AGE/RAGE contributes to increased adipose inflammation and processes linked to insulin resistance. In human subjects, the circulating soluble forms of RAGE, which are mutable, may serve as biomarkers of obesity and weight loss. Antagonists of RAGE signalling, through blockade of the interaction of the RAGE cytoplasmic domain with the formin, Diaphanous-1 (DIAPH1), target aberrant RAGE activities in metabolic tissues. This review focuses on the potential roles for AGEs and other RAGE ligands and RAGE/DIAPH1 in the pathogenesis of overweight and obesity and their metabolic consequences.
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Affiliation(s)
- Lakshmi Arivazhagan
- Diabetes Research Program, Department of Medicine, New York University Grossman School of Medicine, Science Building, 435 E. 30th Street, New York, NY 10016, USA
| | - Collin J Popp
- Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Henry H Ruiz
- Diabetes Research Program, Department of Medicine, New York University Grossman School of Medicine, Science Building, 435 E. 30th Street, New York, NY 10016, USA
| | - Robin A Wilson
- Diabetes Research Program, Department of Medicine, New York University Grossman School of Medicine, Science Building, 435 E. 30th Street, New York, NY 10016, USA
| | - Michaele B Manigrasso
- Diabetes Research Program, Department of Medicine, New York University Grossman School of Medicine, Science Building, 435 E. 30th Street, New York, NY 10016, USA
| | - Alexander Shekhtman
- Department of Chemistry, The State University of New York at Albany, Albany, NY 12222, USA
| | - Ravichandran Ramasamy
- Diabetes Research Program, Department of Medicine, New York University Grossman School of Medicine, Science Building, 435 E. 30th Street, New York, NY 10016, USA
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Ann Marie Schmidt
- Diabetes Research Program, Department of Medicine, New York University Grossman School of Medicine, Science Building, 435 E. 30th Street, New York, NY 10016, USA
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Beasley JM, Johnston EA, Costea D, Sevick MA, Rogers ES, Jay M, Zhong J, Chodosh J. Adapting the Diabetes Prevention Program for Older Adults: Descriptive Study. JMIR Form Res 2023; 7:e45004. [PMID: 37642989 PMCID: PMC10498315 DOI: 10.2196/45004] [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: 12/12/2022] [Revised: 06/22/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Prediabetes affects 26.4 million people aged 65 years or older (48.8%) in the United States. Although older adults respond well to the evidence-based Diabetes Prevention Program, they are a heterogeneous group with differing physiological, biomedical, and psychosocial needs who can benefit from additional support to accommodate age-related changes in sensory and motor function. OBJECTIVE The purpose of this paper is to describe adaptations of the Centers for Disease Control and Prevention's Diabetes Prevention Program aimed at preventing diabetes among older adults (ages ≥65 years) and findings from a pilot of 2 virtual sessions of the adapted program that evaluated the acceptability of the content. METHODS The research team adapted the program by incorporating additional resources necessary for older adults. A certified lifestyle coach delivered 2 sessions of the adapted content via videoconference to 189 older adults. RESULTS The first session had a 34.9% (38/109) response rate to the survey, and the second had a 34% (30/88) response rate. Over three-quarters (50/59, 85%) of respondents agreed that they liked the virtual program, with 82% (45/55) agreeing that they would recommend it to a family member or a friend. CONCLUSIONS This data will be used to inform intervention delivery in a randomized controlled trial comparing in-person versus virtual delivery of the adapted program.
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Affiliation(s)
- Jeannette M Beasley
- Department of Nutrition and Food Studies, New York University Steinhardt School of School of Culture, Education, and Human Development, New York, NY, United States
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Emily A Johnston
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Denisa Costea
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Mary Ann Sevick
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Erin S Rogers
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Melanie Jay
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
- VA New York Harbor Healthcare System, New York, NY, United States
| | - Judy Zhong
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Joshua Chodosh
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
- VA New York Harbor Healthcare System, New York, NY, United States
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5
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Kharmats AY, Popp C, Hu L, Berube L, Curran M, Wang C, Pompeii ML, Li H, Bergman M, St-Jules DE, Segal E, Schoenthaler A, Williams N, Schmidt AM, Barua S, Sevick MA. A randomized clinical trial comparing low-fat with precision nutrition-based diets for weight loss: impact on glycemic variability and HbA1c. Am J Clin Nutr 2023; 118:443-451. [PMID: 37236549 PMCID: PMC10447469 DOI: 10.1016/j.ajcnut.2023.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 06/09/2022] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Recent studies have demonstrated considerable interindividual variability in postprandial glucose response (PPGR) to the same foods, suggesting the need for more precise methods for predicting and controlling PPGR. In the Personal Nutrition Project, the investigators tested a precision nutrition algorithm for predicting an individual's PPGR. OBJECTIVE This study aimed to compare changes in glycemic variability (GV) and HbA1c in 2 calorie-restricted weight loss diets in adults with prediabetes or moderately controlled type 2 diabetes (T2D), which were tertiary outcomes of the Personal Diet Study. METHODS The Personal Diet Study was a randomized clinical trial to compare a 1-size-fits-all low-fat diet (hereafter, standardized) with a personalized diet (hereafter, personalized). Both groups received behavioral weight loss counseling and were instructed to self-monitor diets using a smartphone application. The personalized arm received personalized feedback through the application to reduce their PPGR. Continuous glucose monitoring (CGM) data were collected at baseline, 3 mo and 6 mo. Changes in mean amplitude of glycemic excursions (MAGEs) and HbA1c at 6 mo were assessed. We performed an intention-to-treat analysis using linear mixed regressions. RESULTS We included 156 participants [66.5% women, 55.7% White, 24.1% Black, mean age 59.1 y (standard deviation (SD) = 10.7 y)] in these analyses (standardized = 75, personalized = 81). MAGE decreased by 0.83 mg/dL per month for standardized (95% CI: 0.21, 1.46 mg/dL; P = 0.009) and 0.79 mg/dL per month for personalized (95% CI: 0.19, 1.39 mg/dL; P = 0.010) diet, with no between-group differences (P = 0.92). Trends were similar for HbA1c values. CONCLUSIONS Personalized diet did not result in an increased reduction in GV or HbA1c in patients with prediabetes and moderately controlled T2D, compared with a standardized diet. Additional subgroup analyses may help to identify patients who are more likely to benefit from this personalized intervention. This trial was registered at clinicaltrials.gov as NCT03336411.
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Affiliation(s)
- Anna Y Kharmats
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Collin Popp
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Lu Hu
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Lauren Berube
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States.
| | - Margaret Curran
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Chan Wang
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Mary Lou Pompeii
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Huilin Li
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Michael Bergman
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States; Division of Endocrinology, Diabetes and Metabolism, New York University Grossman School of Medicine, New York, NY, United States
| | - David E St-Jules
- Department of Nutrition, University of Nevada, Reno, Reno, NV, United States
| | - Eran Segal
- Department of Computer Science and Applied Math, Weizmann Institute of Science, Rehovot, Israel
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Natasha Williams
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Ann Marie Schmidt
- Diabetes Research Program, Department of Medicine, New York University Langone Health, New York, NY, United States
| | - Souptik Barua
- Division of Precision Medicine, Department of Medicine, New York University Langone Health, New York, NY, United States
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States; Division of Endocrinology, Diabetes and Metabolism, New York University Grossman School of Medicine, New York, NY, United States
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Beasley JM, Johnston EA, Sevick MA, Jay M, Rogers ES, Zhong H, Zabar S, Goldberg E, Chodosh J. Study protocol: BRInging the Diabetes prevention program to GEriatric Populations. Front Med (Lausanne) 2023; 10:1144156. [PMID: 37275370 PMCID: PMC10232977 DOI: 10.3389/fmed.2023.1144156] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023] Open
Abstract
In the Diabetes Prevention Program (DPP) randomized, controlled clinical trial, participants who were ≥ 60 years of age in the intensive lifestyle (diet and physical activity) intervention had a 71% reduction in incident diabetes over the 3-year trial. However, few of the 26.4 million American adults age ≥65 years with prediabetes are participating in the National DPP. The BRInging the Diabetes prevention program to GEriatric Populations (BRIDGE) randomized trial compares an in-person DPP program Tailored for Older AdulTs (DPP-TOAT) to a DPP-TOAT delivered via group virtual sessions (V-DPP-TOAT) in a randomized, controlled trial design (N = 230). Eligible patients are recruited through electronic health records (EHRs) and randomized to the DPP-TOAT or V-DPP-TOAT arm. The primary effectiveness outcome is 6-month weight loss and the primary implementation outcome is intervention session attendance with a non-inferiority design. Findings will inform best practices in the delivery of an evidence-based intervention.
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Affiliation(s)
- Jeannette M Beasley
- Department of Nutrition and Food Studies, New York University, New York, NY, United States
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Emily A Johnston
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Mary Ann Sevick
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
- Department of Population Health, Institute for Excellence in Health Equity, New York University, New York, NY, United States
| | - Melanie Jay
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
- Department of Population Health, Institute for Excellence in Health Equity, New York University, New York, NY, United States
- VA New York Harbor Healthcare System, Medicine Service, New York, NY, United States
| | - Erin S Rogers
- Department of Population Health, Institute for Excellence in Health Equity, New York University, New York, NY, United States
| | - Hua Zhong
- Department of Population Health, Institute for Excellence in Health Equity, New York University, New York, NY, United States
| | - Sondra Zabar
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Eric Goldberg
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Joshua Chodosh
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
- Department of Population Health, Institute for Excellence in Health Equity, New York University, New York, NY, United States
- VA New York Harbor Healthcare System, Medicine Service, New York, NY, United States
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7
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Clark JM, Garvey WT, Niswender KD, Schmidt AM, Ahima RS, Aleman JO, Battarbee AN, Beckman J, Bennett WL, Brown NJ, Chandler‐Laney P, Cox N, Goldberg IJ, Habegger KM, Harper LM, Hasty AH, Hidalgo BA, Kim SF, Locher JL, Luther JM, Maruthur NM, Miller ER, Sevick MA, Wells Q. Obesity and Overweight: Probing Causes, Consequences, and Novel Therapeutic Approaches Through the American Heart Association's Strategically Focused Research Network. J Am Heart Assoc 2023; 12:e027693. [PMID: 36752232 PMCID: PMC10111504 DOI: 10.1161/jaha.122.027693] [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: 08/08/2022] [Accepted: 01/03/2023] [Indexed: 02/09/2023]
Abstract
As the worldwide prevalence of overweight and obesity continues to rise, so too does the urgency to fully understand mediating mechanisms, to discover new targets for safe and effective therapeutic intervention, and to identify biomarkers to track obesity and the success of weight loss interventions. In 2016, the American Heart Association sought applications for a Strategically Focused Research Network (SFRN) on Obesity. In 2017, 4 centers were named, including Johns Hopkins University School of Medicine, New York University Grossman School of Medicine, University of Alabama at Birmingham, and Vanderbilt University Medical Center. These 4 centers were convened to study mechanisms and therapeutic targets in obesity, to train a talented cadre of American Heart Association SFRN-designated fellows, and to initiate and sustain effective and enduring collaborations within the individual centers and throughout the SFRN networks. This review summarizes the central themes, major findings, successful training of highly motivated and productive fellows, and the innovative collaborations and studies forged through this SFRN on Obesity. Leveraging expertise in in vitro and cellular model assays, animal models, and humans, the work of these 4 centers has made a significant impact in the field of obesity, opening doors to important discoveries, and the identification of a future generation of obesity-focused investigators and next-step clinical trials. The creation of the SFRN on Obesity for these 4 centers is but the beginning of innovative science and, importantly, the birth of new collaborations and research partnerships to propel the field forward.
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Affiliation(s)
- Jeanne M. Clark
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins University School of MedicineBaltimoreMD
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
- Welch Center for Prevention, Epidemiology and Clinical ResearchThe Johns Hopkins UniversityBaltimoreMD
| | - W. Timothy Garvey
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAL
| | - Kevin D. Niswender
- Tennessee Valley Healthcare SystemVanderbilt University Medical CenterNashvilleTN
- Division of Diabetes, Department of Medicine, Endocrinology and MetabolismVanderbilt University Medical CenterNashvilleTN
| | - Ann Marie Schmidt
- Department of Medicine, Diabetes Research Program, Division of Endocrinology, Diabetes and MetabolismNew York University Grossman School of MedicineNew YorkNY
| | - Rexford S. Ahima
- Department of Medicine, Division of Endocrinology, Diabetes and MetabolismThe Johns Hopkins University School of MedicineBaltimoreMD
| | - Jose O. Aleman
- Division of Endocrinology, Department of Medicine, Diabetes and MetabolismNew York University Grossman School of MedicineNew YorkNY
| | - Ashley N. Battarbee
- Division of Maternal Fetal Medicine, Department of Obstetrics and GynecologyUniversity of Alabama at BirminghamBirminghamAL
| | - Joshua Beckman
- Division of Cardiovascular Medicine, Department of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Wendy L. Bennett
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins University School of MedicineBaltimoreMD
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
- Welch Center for Prevention, Epidemiology and Clinical ResearchThe Johns Hopkins UniversityBaltimoreMD
- Department of Population, Family and Reproductive HealthThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | | | - Nancy Cox
- Vanderbilt Genetics Institute and Division of Genetic Medicine, Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
| | - Ira J. Goldberg
- Division of Endocrinology, Department of Medicine, Diabetes and MetabolismNew York University Grossman School of MedicineNew YorkNY
| | - Kirk M. Habegger
- Division of Endocrinology, Department of Medicine, Diabetes, and MetabolismUniversity of Alabama at BirminghamBirminghamAL
| | - Lorie M. Harper
- Division of Maternal Fetal Medicine, Department of Obstetrics and GynecologyUniversity of Alabama at BirminghamBirminghamAL
- Division of Maternal‐Fetal Medicine, Department of Women’s Health, Dell Medical SchoolUniversity of Texas at AustinAustinTXUSA
| | - Alyssa H. Hasty
- Department of Molecular Physiology and BiophysicsVanderbilt University School of MedicineNashvilleTN
- VA Tennessee Valley Healthcare SystemNashvilleTN
| | - Bertha A. Hidalgo
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAL
| | - Sangwon F. Kim
- Department of Medicine, Division of Endocrinology, Diabetes and MetabolismThe Johns Hopkins University School of MedicineBaltimoreMD
- Department of NeuroscienceThe Johns Hopkins University School of MedicineBaltimoreMD
| | - Julie L. Locher
- Division of Gerontology, Department of Medicine, Geriatrics, and Palliative CareUniversity of Alabama at BirminghamBirminghamAL
| | - James M. Luther
- Division of Clinical Pharmacology, Department of MedicineVanderbilt University Medical Center TennesseeNashvilleTN
| | - Nisa M. Maruthur
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins University School of MedicineBaltimoreMD
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
- Welch Center for Prevention, Epidemiology and Clinical ResearchThe Johns Hopkins UniversityBaltimoreMD
| | - Edgar R. Miller
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins University School of MedicineBaltimoreMD
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
- Welch Center for Prevention, Epidemiology and Clinical ResearchThe Johns Hopkins UniversityBaltimoreMD
| | - Mary Ann Sevick
- Division of Endocrinology, Department of Medicine, Diabetes and MetabolismNew York University Grossman School of MedicineNew YorkNY
- Department of Population Health, Center for Healthful Behavior ChangeNew York University Langone HealthNew YorkNY
| | - Quinn Wells
- Department of PharmacologyVanderbilt UniversityNashvilleTN
- Department of MedicineVanderbilt University Medical CenterNashvilleTN
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8
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St-Jules DE, Hu L, Woolf K, Wang C, Goldfarb DS, Katz SD, Popp C, Williams SK, Li H, Jagannathan R, Ogedegbe O, Kharmats AY, Sevick MA. An Evaluation of Alternative Technology-Supported Counseling Approaches to Promote Multiple Lifestyle Behavior Changes in Patients With Type 2 Diabetes and Chronic Kidney Disease. J Ren Nutr 2023; 33:35-44. [PMID: 35752400 PMCID: PMC9772360 DOI: 10.1053/j.jrn.2022.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/10/2022] [Accepted: 05/27/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Although technology-supported interventions are effective for reducing chronic disease risk, little is known about the relative and combined efficacy of mobile health strategies aimed at multiple lifestyle factors. The purpose of this clinical trial is to evaluate the efficacy of technology-supported behavioral intervention strategies for managing multiple lifestyle-related health outcomes in overweight adults with type 2 diabetes (T2D) and chronic kidney disease (CKD). DESIGN AND METHODS Using a 2 × 2 factorial design, adults with excess body weight (body mass index ≥27 kg/m2, age ≥40 years), T2D, and CKD stages 2-4 were randomized to an advice control group, or remotely delivered programs consisting of synchronous group-based education (all groups), plus (1) Social Cognitive Theory-based behavioral counseling and/or (2) mobile self-monitoring of diet and physical activity. All programs targeted weight loss, greater physical activity, and lower intakes of sodium and phosphorus-containing food additives. RESULTS Of 256 randomized participants, 186 (73%) completed 6-month assessments. Compared to the ADVICE group, mHealth interventions did not result in significant changes in weight loss, or urinary sodium and phosphorus excretion. In aggregate analyses, groups receiving mobile self-monitoring had greater weight loss at 3 months (P = .02), but between 3 and 6 months, weight losses plateaued, and by 6 months, the differences were no longer statistically significant. CONCLUSIONS When engaging patients with T2D and CKD in multiple behavior changes, self-monitoring diet and physical activity demonstrated significantly larger short-term weight losses. Theory-based behavioral counseling alone was no better than baseline advice and demonstrated no interaction effect with self-monitoring.
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Affiliation(s)
- David E St-Jules
- Department of Nutrition, University of Nevada, Reno, Reno, Nevada
| | - Lu Hu
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York
| | - Kathleen Woolf
- Department of Nutrition and Food Studies, New York University Steinhardt, New York, New York
| | - Chan Wang
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York
| | - David S Goldfarb
- Department of Medicine, Grossman School of Medicine, New York University, New York, New York
| | - Stuart D Katz
- Department of Medicine, Grossman School of Medicine, New York University, New York, New York
| | - Collin Popp
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York
| | - Stephen K Williams
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York; Department of Medicine, Grossman School of Medicine, New York University, New York, New York
| | - Huilin Li
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York
| | - Ram Jagannathan
- Division of Hospital Medicine, Emory University, Atlanta, Georgia
| | - Olugbenga Ogedegbe
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York; Institute for Excellence in Health Equity, Grossman School of Medicine, New York University, New York, New York
| | - Anna Y Kharmats
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York
| | - Mary Ann Sevick
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York; Department of Medicine, Grossman School of Medicine, New York University, New York, New York.
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9
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Lee BY, Ordovás JM, Parks EJ, Anderson CAM, Barabási AL, Clinton SK, de la Haye K, Duffy VB, Franks PW, Ginexi EM, Hammond KJ, Hanlon EC, Hittle M, Ho E, Horn AL, Isaacson RS, Mabry PL, Malone S, Martin CK, Mattei J, Meydani SN, Nelson LM, Neuhouser ML, Parent B, Pronk NP, Roche HM, Saria S, Scheer FAJL, Segal E, Sevick MA, Spector TD, Van Horn L, Varady KA, Voruganti VS, Martinez MF. Research gaps and opportunities in precision nutrition: an NIH workshop report. Am J Clin Nutr 2022; 116:1877-1900. [PMID: 36055772 PMCID: PMC9761773 DOI: 10.1093/ajcn/nqac237] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/06/2022] [Accepted: 08/30/2022] [Indexed: 02/01/2023] Open
Abstract
Precision nutrition is an emerging concept that aims to develop nutrition recommendations tailored to different people's circumstances and biological characteristics. Responses to dietary change and the resulting health outcomes from consuming different diets may vary significantly between people based on interactions between their genetic backgrounds, physiology, microbiome, underlying health status, behaviors, social influences, and environmental exposures. On 11-12 January 2021, the National Institutes of Health convened a workshop entitled "Precision Nutrition: Research Gaps and Opportunities" to bring together experts to discuss the issues involved in better understanding and addressing precision nutrition. The workshop proceeded in 3 parts: part I covered many aspects of genetics and physiology that mediate the links between nutrient intake and health conditions such as cardiovascular disease, Alzheimer disease, and cancer; part II reviewed potential contributors to interindividual variability in dietary exposures and responses such as baseline nutritional status, circadian rhythm/sleep, environmental exposures, sensory properties of food, stress, inflammation, and the social determinants of health; part III presented the need for systems approaches, with new methods and technologies that can facilitate the study and implementation of precision nutrition, and workforce development needed to create a new generation of researchers. The workshop concluded that much research will be needed before more precise nutrition recommendations can be achieved. This includes better understanding and accounting for variables such as age, sex, ethnicity, medical history, genetics, and social and environmental factors. The advent of new methods and technologies and the availability of considerably more data bring tremendous opportunity. However, the field must proceed with appropriate levels of caution and make sure the factors listed above are all considered, and systems approaches and methods are incorporated. It will be important to develop and train an expanded workforce with the goal of reducing health disparities and improving precision nutritional advice for all Americans.
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Affiliation(s)
- Bruce Y Lee
- Health Policy and Management, City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - José M Ordovás
- USDA-Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Elizabeth J Parks
- Nutrition and Exercise Physiology, University of Missouri School of Medicine, MO, USA
| | | | - Albert-László Barabási
- Network Science Institute and Department of Physics, Northeastern University, Boston, MA, USA
| | | | - Kayla de la Haye
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Valerie B Duffy
- Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Paul W Franks
- Novo Nordisk Foundation, Hellerup, Denmark, Copenhagen, Denmark, and Lund University Diabetes Center, Sweden
- The Lund University Diabetes Center, Malmo, SwedenInsert Affiliation Text Here
| | - Elizabeth M Ginexi
- National Institutes of Health, Office of Behavioral and Social Sciences Research, Bethesda, MD, USA
| | - Kristian J Hammond
- Computer Science, Northwestern University McCormick School of Engineering, IL, USA
| | - Erin C Hanlon
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Michael Hittle
- Epidemiology and Clinical Research, Stanford University, Stanford, CA, USA
| | - Emily Ho
- Public Health and Human Sciences, Linus Pauling Institute, Oregon State University, Corvallis, OR, USA
| | - Abigail L Horn
- Information Sciences Institute, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | | | | | - Susan Malone
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Corby K Martin
- Ingestive Behavior Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Josiemer Mattei
- Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Simin Nikbin Meydani
- USDA-Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Lorene M Nelson
- Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | | | - Brendan Parent
- Grossman School of Medicine, New York University, New York, NY, USA
| | | | - Helen M Roche
- UCD Conway Institute, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Suchi Saria
- Johns Hopkins University, Baltimore, MD, USA
| | - Frank A J L Scheer
- Brigham and Women's Hospital, Boston, MA, USA
- Medicine and Neurology, Harvard Medical School, Boston, MA, USA
| | - Eran Segal
- Computer Science and Applied Math, Weizmann Institute of Science, Rehovot, Israel
| | - Mary Ann Sevick
- Grossman School of Medicine, New York University, New York, NY, USA
| | - Tim D Spector
- Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Linda Van Horn
- Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Krista A Varady
- Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Venkata Saroja Voruganti
- Nutrition and Nutrition Research Institute, Gillings School of Public Health, The University of North Carolina, Chapel Hill, NC, USA
| | - Marie F Martinez
- Health Policy and Management, City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
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10
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Hu L, Islam N, Zhang Y, Shi Y, Li H, Wang C, Sevick MA. Leveraging Social Media to Increase Access to an Evidence-Based Diabetes Intervention in Low-income Chinese Immigrants: Protocol for a Pilot Randomized Controlled Trial (Preprint). JMIR Res Protoc 2022; 11:e42554. [DOI: 10.2196/42554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
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11
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Popp CJ, Hu L, Kharmats AY, Curran M, Berube L, Wang C, Pompeii ML, Illiano P, St-Jules DE, Mottern M, Li H, Williams N, Schoenthaler A, Segal E, Godneva A, Thomas D, Bergman M, Schmidt AM, Sevick MA. Effect of a Personalized Diet to Reduce Postprandial Glycemic Response vs a Low-fat Diet on Weight Loss in Adults With Abnormal Glucose Metabolism and Obesity: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2233760. [PMID: 36169954 PMCID: PMC9520362 DOI: 10.1001/jamanetworkopen.2022.33760] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Interindividual variability in postprandial glycemic response (PPGR) to the same foods may explain why low glycemic index or load and low-carbohydrate diet interventions have mixed weight loss outcomes. A precision nutrition approach that estimates personalized PPGR to specific foods may be more efficacious for weight loss. OBJECTIVE To compare a standardized low-fat vs a personalized diet regarding percentage of weight loss in adults with abnormal glucose metabolism and obesity. DESIGN, SETTING, AND PARTICIPANTS The Personal Diet Study was a single-center, population-based, 6-month randomized clinical trial with measurements at baseline (0 months) and 3 and 6 months conducted from February 12, 2018, to October 28, 2021. A total of 269 adults aged 18 to 80 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) ranging from 27 to 50 and a hemoglobin A1c level ranging from 5.7% to 8.0% were recruited. Individuals were excluded if receiving medications other than metformin or with evidence of kidney disease, assessed as an estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration equation, to avoid recruiting patients with advanced type 2 diabetes. INTERVENTIONS Participants were randomized to either a low-fat diet (<25% of energy intake; standardized group) or a personalized diet that estimates PPGR to foods using a machine learning algorithm (personalized group). Participants in both groups received a total of 14 behavioral counseling sessions and self-monitored dietary intake. In addition, the participants in the personalized group received color-coded meal scores on estimated PPGR delivered via a mobile app. MAIN OUTCOMES AND MEASURES The primary outcome was the percentage of weight loss from baseline to 6 months. Secondary outcomes included changes in body composition (fat mass, fat-free mass, and percentage of body weight), resting energy expenditure, and adaptive thermogenesis. Data were collected at baseline and 3 and 6 months. Analysis was based on intention to treat using linear mixed modeling. RESULTS Of a total of 204 adults randomized, 199 (102 in the personalized group vs 97 in the standardized group) contributed data (mean [SD] age, 58 [11] years; 133 women [66.8%]; mean [SD] body mass index, 33.9 [4.8]). Weight change at 6 months was -4.31% (95% CI, -5.37% to -3.24%) for the standardized group and -3.26% (95% CI, -4.25% to -2.26%) for the personalized group, which was not significantly different (difference between groups, 1.05% [95% CI, -0.40% to 2.50%]; P = .16). There were no between-group differences in body composition and adaptive thermogenesis; however, the change in resting energy expenditure was significantly greater in the standardized group from 0 to 6 months (difference between groups, 92.3 [95% CI, 0.9-183.8] kcal/d; P = .05). CONCLUSIONS AND RELEVANCE A personalized diet targeting a reduction in PPGR did not result in greater weight loss compared with a low-fat diet at 6 months. Future studies should assess methods of increasing dietary self-monitoring adherence and intervention exposure. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03336411.
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Affiliation(s)
- Collin J. Popp
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Lu Hu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Anna Y. Kharmats
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Margaret Curran
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Lauren Berube
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Chan Wang
- Division of Biostatistics, Department of Population Health, NYU Langone Health, New York, New York
| | - Mary Lou Pompeii
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Paige Illiano
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | | | - Meredith Mottern
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Huilin Li
- Division of Biostatistics, Department of Population Health, NYU Langone Health, New York, New York
| | - Natasha Williams
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Antoinette Schoenthaler
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Anastasia Godneva
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Diana Thomas
- Department of Mathematical Sciences, United States Military Academy, West Point, New York
| | - Michael Bergman
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, NYU Langone Health, New York, New York
| | - Ann Marie Schmidt
- Diabetes Research Program, Department of Medicine, NYU Langone Health, New York, New York
| | - Mary Ann Sevick
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, NYU Langone Health, New York, New York
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12
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Dorcely B, Sifonte E, Popp C, Divakaran A, Katz K, Musleh S, Jagannathan R, Curran M, Sevick MA, Aleman JO, Goldberg IJ, Bergman M. Continuous glucose monitoring and 1-h plasma glucose identifies glycemic variability and dysglycemia in high-risk individuals with HbA1c < 5.7%: a pilot study. Endocrine 2022; 77:403-407. [PMID: 35729471 PMCID: PMC9212201 DOI: 10.1007/s12020-022-03109-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/05/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Brenda Dorcely
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA.
| | - Eliud Sifonte
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Collin Popp
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Anjana Divakaran
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Karin Katz
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Sarah Musleh
- Department of Endocrinology, Diabetes & Metabolism and Internal Medicine, Hawaii Permanente Medical Group, Honolulu, HI, 96814, USA
| | - Ram Jagannathan
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Margaret Curran
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Mary Ann Sevick
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - José O Aleman
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Ira J Goldberg
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Michael Bergman
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Grossman School of Medicine, New York, NY, 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10016, USA
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13
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Mottern M, Kharmats A, Curran M, Berube L, Popp C, Hu L, Vanegas S, Bergman M, Pompeii ML, St-Jules D, Sevick MA. Impact of the COVID-19 Pandemic on Dietary Counseling Session Attendance and Self-Monitoring Adherence Dur034 a Behavioral Weight Loss Intervention. Curr Dev Nutr 2022. [PMCID: PMC9193975 DOI: 10.1093/cdn/nzac048.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To assess the impact of the COVID-19 pandemic on participants’ intervention counseling session attendance and dietary self-monitoring adherence during the Personal Diet Study, a remote behavioral weight loss intervention for individuals with overweight and obesity with pre-diabetes and moderately controlled type 2 diabetes.
Methods
Participants (n = 200) were instructed to complete four in-person measurement visits, enter their meals daily in a smartphone application, and attend 14 virtual group nutrition counseling sessions over a 6-month intervention period. Due to COVID-19, the assessments were modified to be conducted remotely. We stratified participants into 3 categories: a) all study measures and intervention occurred before the start of the COVID-19 pandemic (BEFORE, n = 106) b) a portion of the intervention or follow-up measures occurred after the start of the pandemic (MIXED, n = 54), and 3) all study measures and intervention took place after the start of the pandemic (AFTER, n = 40). Attendance was defined as percentage of counseling intervention sessions attended. Dietary self-monitoring adherence was measured as percentage of days participants entered at least 50% of their daily caloric goal in a smart phone application. Between-group differences were assessed using linear regression models.
Results
Mean [SD] counseling session attendance for the MIXED (72.6%, [28.9%]) and AFTER (73.8% [28.1%]) groups did not differ from the BEFORE group (64.5% [31.8%]), p = 0.26 and 0.22 respectively. Adherence to dietary self-monitoring was lower for the MIXED group (25.5% [30.55]) compared to BEFORE group (36.0% [34.8%], p = 0.03), but did not differ between the AFTER (44.5% [35.8%]) and BEFORE groups (p = 0.288).
Conclusions
Intervention counseling attendance did not change substantially due to the COVID-19 pandemic. The MIXED group had lower self-monitoring adherence rates than the BEFORE grouip, which may be due to disruptions in daily life and habits that occurred in the early months of the COVID-19 pandemic. Virtual weight loss counseling methods are a practical way of circumventing program disruptions without compromising protocol adherence.
Funding Sources
This research was supported by the American Heart Association.
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14
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Mavragani A, Islam N, Trinh-Shevrin C, Wu B, Feldman N, Tamura K, Jiang N, Lim S, Wang C, Bubu OM, Schoenthaler A, Ogedegbe G, Sevick MA. A Social Media-Based Diabetes Intervention for Low-Income Mandarin-Speaking Chinese Immigrants in the United States: Feasibility Study. JMIR Form Res 2022; 6:e37737. [PMID: 35544298 PMCID: PMC9492091 DOI: 10.2196/37737] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Chinese immigrants bear a high diabetes burden and face significant barriers to accessing diabetes self-management education (DSME) and counseling programs. OBJECTIVE The goal of this study was to examine the feasibility and acceptability and to pilot test the potential efficacy of a social media-based DSME intervention among low-income Chinese immigrants with type 2 diabetes (T2D) in New York City. METHODS This was a single group pretest and posttest study in 30 Chinese immigrants with T2D. The intervention included 24 culturally and linguistically tailored DSME videos, focusing on diabetes education and behavioral counseling techniques. Over 12 weeks, participants received 2 brief videos each week via WeChat, a free social media app popular among Chinese immigrants. Primary outcomes included the feasibility and acceptability of the intervention. Feasibility was evaluated by recruitment processes, retention rates, and the video watch rate. Acceptability was assessed via a satisfaction survey at 3 months. Secondary outcomes, that is, hemoglobin A1c (HbA1c), self-efficacy, dietary intake, and physical activity, were measured at baseline, 3 months, and 6 months. Descriptive statistics and paired 2-sided t tests were used to summarize the baseline characteristics and changes before and after the intervention. RESULTS The sample population (N=30) consisted of mostly females (21/30, 70%) who were married (19/30, 63%), with limited English proficiency (30/30, 100%), and the mean age was 61 (SD 7) years. Most reported an annual household income of <US $25,000 (24/30, 80%) and a high school education or less (19/30, 63%). Thirty participants were recruited within 2 months (January and February 2020), and 97% (29/30) of the participants were retained at 6 months. A video watch rate of 92% (28/30) was achieved. The mean baseline HbA1c level was 7.3% (SD 1.3%), and this level declined by 0.5% (95% CI -0.8% to -0.2%; P=.003) at 6 months. The mean satisfaction score was 9.9 (SD 0.6) out of 10, indicating a high level of satisfaction with the program. All strongly agreed or agreed that they preferred this video-based DSME over face-to-face visits. Compared to baseline, there were significant improvements in self-efficacy, dietary, and physical activity behaviors at 6 months. CONCLUSIONS This pilot study demonstrated that a social media-based DSME intervention is feasible, acceptable, and potentially efficacious in a low-income Chinese immigrant population with T2D. Future studies need to examine the efficacy in an adequately powered clinical trial.
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Affiliation(s)
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chau Trinh-Shevrin
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Naumi Feldman
- Charles B Wang Community Health Center, New York, NY, United States
| | - Kosuke Tamura
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, United States
| | - Nan Jiang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chan Wang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Omonigho M Bubu
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, United States
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
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Hu L, Trinh-Shevrin C, Islam N, Wu B, Cao S, Freeman J, Sevick MA. Mobile Device Ownership, Current Use, and Interest in Mobile Health Interventions Among Low-Income Older Chinese Immigrants With Type 2 Diabetes: Cross-sectional Survey Study. JMIR Aging 2022; 5:e27355. [PMID: 35107426 PMCID: PMC9135111 DOI: 10.2196/27355] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/28/2021] [Accepted: 12/23/2021] [Indexed: 01/29/2023] Open
Abstract
Background Chinese immigrants suffer a disproportionately high type 2 diabetes (T2D) burden and tend to have poorly controlled disease. Mobile health (mHealth) interventions have been shown to increase access to care and improve chronic disease management in minority populations. However, such interventions have not been developed for or tested in Chinese immigrants with T2D. Objective This study aims to examine mobile device ownership, current use, and interest in mHealth interventions among Chinese immigrants with T2D. Methods In a cross-sectional survey, Chinese immigrants with T2D were recruited from Chinese community centers in New York City. Sociodemographic characteristics, mobile device ownership, current use of social media software applications, current use of technology for health-related purposes, and interest in using mHealth for T2D management were assessed. Surveys were administered face-to-face by bilingual study staff in the participant’s preferred language. Descriptive statistics were used to characterize the study sample and summarize technology use. Results The sample (N=91) was predominantly female (n=57, 63%), married (n=68, 75%), and had a high school education or less (n=58, 64%); most participants had an annual household income of less than US $25,000 (n=63, 69%) and had limited English proficiency (n=78, 86%). The sample had a mean age of 70 (SD 11) years. Almost all (90/91, 99%) participants had a mobile device (eg, basic cell phones, smart devices), and the majority (n=83, 91%) reported owning a smart device (eg, smartphone or tablet). WeChat was the most commonly used social media platform (65/91, 71%). When asked about their top source for diabetes-related information, 63 of the 91 participants (69%) reported health care providers, followed by 13 who reported the internet (14%), and 10 who reported family, friends, and coworkers (11%). Less than one-quarter (21/91, 23%) of the sample reported using the internet to search for diabetes-related information in the past 12 months. About one-third of the sample (34/91, 37%) reported that they had watched a health-related video on their cell phone or computer in the past 12 months. The majority (69/91, 76%) of participants reported interest in receiving an mHealth intervention in the future to help with T2D management. Conclusions Despite high mobile device ownership, the current use of technology for health-related issues remained low in older Chinese immigrants with T2D. Given the strong interest in future mHealth interventions and high levels of social media use (eg, WeChat), future studies should consider how to leverage these existing low-cost platforms and deliver tailored mHealth interventions to this fast-growing minority group.
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Affiliation(s)
- Lu Hu
- Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Nadia Islam
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Shimin Cao
- Charles B Wang Community Health Center, New York, NY, United States
| | - Jincong Freeman
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
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Popp CJ, Curran M, Wang C, Prasad M, Fine K, Gee A, Nair N, Perdomo K, Chen S, Hu L, St-Jules DE, Manoogian ENC, Panda S, Sevick MA, Laferrère B. Temporal Eating Patterns and Eating Windows among Adults with Overweight or Obesity. Nutrients 2021; 13:nu13124485. [PMID: 34960035 PMCID: PMC8705992 DOI: 10.3390/nu13124485] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022] Open
Abstract
We aim to describe temporal eating patterns in a population of adults with overweight or obesity. In this cross-sectional analysis, data were combined from two separate pilot studies during which participants entered the timing of all eating occasions (>0 kcals) for 10-14 days. Data were aggregated to determine total eating occasions, local time of the first and last eating occasions, eating window, eating midpoint, and within-person variability of eating patterns. Eating patterns were compared between sexes, as well as between weekday and weekends. Participants (n = 85) had a median age of 56 ± 19 years, were mostly female (>70%), white (56.5%), and had a BMI of 31.8 ± 8.0 kg/m2. The median eating window was 14 h 04 min [12 h 57 min-15 h 21 min], which was significantly shorter on the weekend compared to weekdays (p < 0.0001). Only 13.1% of participants had an eating window <12 h/d. Additionally, there was greater irregularity with the first eating occasion during the week when compared to the weekend (p = 0.0002). In conclusion, adults with overweight or obesity have prolonged eating windows (>14 h/d). Future trials should examine the contribution of a prolonged eating window on adiposity independent of energy intake.
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Affiliation(s)
- Collin J. Popp
- Department of Population Health, Center for Healthful Behavior Change, New York University Langone Health, 180 Madison Ave, New York, NY 10016, USA; (M.C.); (K.P.); (S.C.); (L.H.); (M.A.S.)
- Correspondence: ; Tel.: +1-(646)-501-3446
| | - Margaret Curran
- Department of Population Health, Center for Healthful Behavior Change, New York University Langone Health, 180 Madison Ave, New York, NY 10016, USA; (M.C.); (K.P.); (S.C.); (L.H.); (M.A.S.)
| | - Chan Wang
- Department of Population Health, Division of Biostatistics, New York University Langone Health, 180 Madison Ave, New York, NY 10016, USA;
| | - Malini Prasad
- Department of Medicine, Division of Endocrinology, New York Obesity Research Center, Columbia University Irving Medical Center, 1150 Saint Nicholas Avenue, R-121-G, New York, NY 10032, USA; (M.P.); (K.F.); (A.G.); (N.N.); (B.L.)
| | - Keenan Fine
- Department of Medicine, Division of Endocrinology, New York Obesity Research Center, Columbia University Irving Medical Center, 1150 Saint Nicholas Avenue, R-121-G, New York, NY 10032, USA; (M.P.); (K.F.); (A.G.); (N.N.); (B.L.)
| | - Allen Gee
- Department of Medicine, Division of Endocrinology, New York Obesity Research Center, Columbia University Irving Medical Center, 1150 Saint Nicholas Avenue, R-121-G, New York, NY 10032, USA; (M.P.); (K.F.); (A.G.); (N.N.); (B.L.)
| | - Nandini Nair
- Department of Medicine, Division of Endocrinology, New York Obesity Research Center, Columbia University Irving Medical Center, 1150 Saint Nicholas Avenue, R-121-G, New York, NY 10032, USA; (M.P.); (K.F.); (A.G.); (N.N.); (B.L.)
| | - Katherine Perdomo
- Department of Population Health, Center for Healthful Behavior Change, New York University Langone Health, 180 Madison Ave, New York, NY 10016, USA; (M.C.); (K.P.); (S.C.); (L.H.); (M.A.S.)
| | - Shirley Chen
- Department of Population Health, Center for Healthful Behavior Change, New York University Langone Health, 180 Madison Ave, New York, NY 10016, USA; (M.C.); (K.P.); (S.C.); (L.H.); (M.A.S.)
| | - Lu Hu
- Department of Population Health, Center for Healthful Behavior Change, New York University Langone Health, 180 Madison Ave, New York, NY 10016, USA; (M.C.); (K.P.); (S.C.); (L.H.); (M.A.S.)
| | - David E. St-Jules
- Department of Nutrition, University of Nevada, Reno, 1664 N. Virginia Street, Reno, NV 89557, USA;
| | - Emily N. C. Manoogian
- Regulatory Biology Department, Salk Institute for Biological Studies, 10010 N Torrey Pines Rd., La Jolla, CA 92037, USA; (E.N.C.M.); (S.P.)
| | - Satchidananda Panda
- Regulatory Biology Department, Salk Institute for Biological Studies, 10010 N Torrey Pines Rd., La Jolla, CA 92037, USA; (E.N.C.M.); (S.P.)
| | - Mary Ann Sevick
- Department of Population Health, Center for Healthful Behavior Change, New York University Langone Health, 180 Madison Ave, New York, NY 10016, USA; (M.C.); (K.P.); (S.C.); (L.H.); (M.A.S.)
- Department of Medicine, New York University Langone Health, 550 First Avenue, New York, NY 10016, USA
| | - Blandine Laferrère
- Department of Medicine, Division of Endocrinology, New York Obesity Research Center, Columbia University Irving Medical Center, 1150 Saint Nicholas Avenue, R-121-G, New York, NY 10032, USA; (M.P.); (K.F.); (A.G.); (N.N.); (B.L.)
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St-Jules DE, Woolf K, Goldfarb DS, Pompeii ML, Li H, Wang C, Mattoo A, Marcum ZA, Sevick MA. Feasibility and Acceptability of mHealth Interventions for Managing Hyperphosphatemia in Patients Undergoing Hemodialysis. J Ren Nutr 2021; 31:403-410. [DOI: 10.1053/j.jrn.2020.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 06/25/2020] [Accepted: 07/26/2020] [Indexed: 11/11/2022] Open
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18
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Herbert S, Fu Z, Woolf K, St-Jules D, Popp C, Hu L, Li H, Williams S, Goldfarb D, Katz S, Sevick MA. Dietary Inflammatory Index and Cardiovascular Disease Risk Factors in Patients With Chronic Kidney Disease and Type 2 Diabetes. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab038_024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Inflammation is associated with several chronic diseases, including chronic kidney disease (CKD) and type 2 diabetes (T2D). Because dietary choices may impact chronic inflammation, the Dietary Inflammatory Index (DII) was developed to assess the inflammatory potential of the diet. Using the DII, this study examined the association of cardiovascular disease (CVD) risk factors and diet in patients with CKD and T2D.
Methods
Baseline three-day food records were obtained from 241 participants in a lifestyle intervention study, and analyzed using Nutrition Data System for Research (2014). DII scores were calculated, with higher scores suggesting a more pro-inflammatory diet. Participants were dichotomized into an anti-inflammatory diet (AID; DII < 0; n = 118) or pro-inflammatory diet (PID; DII ≥ 0; n = 123) group, based on DII score. CVD risk factors included estimated glomerular filtration rate (eGFR), C-reactive protein (CRP), systolic blood pressure (BP), diastolic BP, pulse wave velocity, fasting lipids (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides), and hemoglobin A1C (HbA1C). Independent two sample t-tests assessed differences in CVD risk factors between groups.
Results
Participants were 50% male, 88% non-Hispanic, 66% white, and 65 ± 9SD years of age with a mean body mass index of 33.7 ± 5.1SD kg/m2. Approximately 51% of the participants followed a diet that would be considered pro-inflammatory. Participants in the AID group had a higher eGFR (AID: 75 ± 21SD mL/min/1.73m2, PID: 68 ± 20SD mL/min/1.73m2; p = 0.017) compared to the PID group. No significant differences were found between groups for the other CVD risk factors (CRP, systolic BP, diastolic BP, pulse wave velocity, fasting lipids [total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides], and HbA1C).
Conclusions
Participants reporting an AID had a higher eGFR than those reporting a PID. Contrary to expectations, other CVD risk factors did not differ between groups. Additional research should examine the role of an AID, emphasizing whole grains, fruits, vegetables, fatty fish, nuts, and legumes, for disease management in patients with CKD and T2D.
Funding Sources
Supported by NIH RO1 DK100492.
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Affiliation(s)
- Anna Y Kharmats
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Scott J Pilla
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland
| | - Mary Ann Sevick
- Department of Population Health, New York University Grossman School of Medicine, New York
- Department of Medicine, New York University Grossman School of Medicine, New York
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20
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Kwon S, Riggs J, Crowley G, Lam R, Young IR, Nayar C, Sunseri M, Mikhail M, Ostrofsky D, Veerappan A, Zeig-Owens R, Schwartz T, Colbeth H, Liu M, Pompeii ML, St-Jules D, Prezant DJ, Sevick MA, Nolan A. Food Intake REstriction for Health OUtcome Support and Education (FIREHOUSE) Protocol: A Randomized Clinical Trial. Int J Environ Res Public Health 2020; 17:E6569. [PMID: 32916985 PMCID: PMC7559064 DOI: 10.3390/ijerph17186569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023]
Abstract
Fire Department of New York (FDNY) rescue and recovery workers exposed to World Trade Center (WTC) particulates suffered loss of forced expiratory volume in 1 s (FEV1). Metabolic Syndrome increased the risk of developing WTC-lung injury (WTC-LI). We aim to attenuate the deleterious effects of WTC exposure through a dietary intervention targeting these clinically relevant disease modifiers. We hypothesize that a calorie-restricted Mediterranean dietary intervention will improve metabolic risk, subclinical indicators of cardiopulmonary disease, quality of life, and lung function in firefighters with WTC-LI. To assess our hypothesis, we developed the Food Intake REstriction for Health OUtcome Support and Education (FIREHOUSE), a randomized controlled clinical trial (RCT). Male firefighters with WTC-LI and a BMI > 27 kg/m2 will be included. We will randomize subjects (1:1) to either: (1) Low Calorie Mediterranean (LoCalMed)-an integrative multifactorial, technology-supported approach focused on behavioral modification, nutritional education that will include a self-monitored diet with feedback, physical activity recommendations, and social cognitive theory-based group counseling sessions; or (2) Usual Care. Outcomes include reduction in body mass index (BMI) (primary), improvement in FEV1, fractional exhaled nitric oxide, pulse wave velocity, lipid profiles, targeted metabolic/clinical biomarkers, and quality of life measures (secondary). By implementing a technology-supported LoCalMed diet our FIREHOUSE RCT may help further the treatment of WTC associated pulmonary disease.
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Affiliation(s)
- Sophia Kwon
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Jessica Riggs
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - George Crowley
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Rachel Lam
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Isabel R. Young
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Christine Nayar
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Maria Sunseri
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Mena Mikhail
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Dean Ostrofsky
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Arul Veerappan
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
| | - Rachel Zeig-Owens
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, NY 11201, USA; (R.Z.-O.); (T.S.); (H.C.); (D.J.P.)
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Theresa Schwartz
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, NY 11201, USA; (R.Z.-O.); (T.S.); (H.C.); (D.J.P.)
| | - Hilary Colbeth
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, NY 11201, USA; (R.Z.-O.); (T.S.); (H.C.); (D.J.P.)
| | - Mengling Liu
- Department of Population Health, Division of Biostatistics, New York University School of Medicine, New York, NY 10016, USA;
- Department of Environmental Medicine, School of Medicine, New York University, New York, NY 10016, USA
| | - Mary Lou Pompeii
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, School of Medicine, New York University, New York, NY 10016, USA; (M.L.P.); (D.S.-J.); (M.A.S.)
| | - David St-Jules
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, School of Medicine, New York University, New York, NY 10016, USA; (M.L.P.); (D.S.-J.); (M.A.S.)
| | - David J. Prezant
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, NY 11201, USA; (R.Z.-O.); (T.S.); (H.C.); (D.J.P.)
- Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Mary Ann Sevick
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, School of Medicine, New York University, New York, NY 10016, USA; (M.L.P.); (D.S.-J.); (M.A.S.)
- Departments of Medicine, Division of Endocrinology, School of Medicine, New York University, New York, NY 10016, USA
| | - Anna Nolan
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University, New York, NY 10016, USA; (S.K.); (J.R.); (G.C.); (R.L.); (I.R.Y.); (C.N.); (M.S.); (M.M.); (D.O.); (A.V.)
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, NY 11201, USA; (R.Z.-O.); (T.S.); (H.C.); (D.J.P.)
- Department of Environmental Medicine, School of Medicine, New York University, New York, NY 10016, USA
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El Shatanofy M, Chodosh J, Sevick MA, Wylie-Rosett J, DeLuca L, Beasley JM. Characterizing Intervention Opportunities among Home-Delivered Meals Program Participants: Results from the 2017 National Survey of Older Americans Act Participants and a New York City Survey. J Frailty Aging 2020; 9:172-178. [PMID: 32588033 DOI: 10.14283/jfa.2020.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Home Delivered Meals Program (HDMP) serves a vulnerable population of adults aged 60 and older who may benefit from technological services to improve health and social connectedness. OBJECTIVE The objectives of this study are (a) to better understand the needs of HDMP participants, and (b) to characterize the technology-readiness and the utility of delivering information via the computer. DESIGN We analyzed data from the 2017 NSOAAP to assess the health and functional status and demographic characteristics of HDMP participants. We also conducted a telephone survey to assess technology use and educational interests among NYC HDMP participants. MEASUREMENTS Functional measures of the national sample included comorbidities, recent hospitalizations, and ADL/IADL limitations. Participants from our local NYC sample completed a modified version of the validated Computer Proficiency Questionnaire. Technology readiness was assessed by levels of technology use, desired methods for receiving health information, and interest in learning more about virtual senior centers. RESULTS About one-third (32.4%) of national survey HDMP participants (n=902) reported insufficient resources to buy food and 17.1% chose between food or medications. Within the NYC HDMP participant survey sample (n=33), over half reported having access to the internet (54.5%), 48.5% used a desktop or laptop, and 30.3% used a tablet, iPad, or smartphone. CONCLUSION The HDMP provides an opportunity to reach vulnerable older adults and offer additional resources that can enhance social support and improve nutrition and health outcomes. Research is warranted to compare technological readiness of HDMP participants across urban and rural areas in the United States.
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Affiliation(s)
- M El Shatanofy
- Jeannette M. Beasley, PhD MPH RD, Assistant Professor, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 462 First Avenue, 6th Floor CD673, New York, NY 10016, T: 646-501-4681,
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22
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Hu L, Wang C, Li H, Curran M, Popp CJ, St-Jules DE, Schoenthaler A, Williams N, Sevick MA. Does Personalized Nutrition Increase Weight Loss Self-Efficacy? Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa059_027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
We examined whether a diet personalized to reduce postprandial glycemic response (PPGR) to foods increases weight loss self-efficacy.
Methods
The Personal Diet Study is an ongoing clinical trial that aims to compare two weight loss diets: a one-size-fits-all, calorie-restricted, low-fat diet (Standardized) versus a diet having the same calorie restriction but utilizing a machine learning algorithm to predict and reduce PPGR (Personalized). Both groups receive the same behavioral counseling to enhance weight loss self-efficacy. Both groups self-monitor dietary intake using a mobile app, with Standardized receiving real-time feedback on calories and macronutrient distribution, and Personalized receiving real time feedback on calories, macronutrient distribution, and predicted PPGR. We examined changes in self-efficacy between baseline and 3 mos, using the 20-item Weight Efficacy Lifestyle questionnaire (WEL). Linear mixed models were used to analyze differences, adjusting for age, gender, and race.
Results
The analyses included the first 75 participants to complete 3-mos assessments (41 Personalized and 34 Standardized). The majority of the participants were white (69.3%), female (61.3%), with a mean age of 61.7 years (SD = 9.9) and BMI of 33.4 kg/m2 (SD = 4.8). At baseline, WEL scores were similar between the 2 groups [Standardized WEL: 118.8 (SD = 27.6); Personalized WEL: 124.9 (SD = 29.5), P = 0.47]. At 3 mos, the WEL score was significantly improved in both groups [16.0 (SD = 4.1) in the Standardized group (P < 0.001) and 7.4 (SD = 3.7) in the Personalized group (P = 0.048)], but the between group difference was not significant (P = 0.12).
Conclusions
Personalized feedback on predicted PPGRs does not appear to enhance weight loss self-efficacy at 3 mos. The lack of significance may be related to the short follow-up period in these preliminary analyses, the small sample accrued to date, or the fact that WEL is designed to assess confidence in various situations (e.g., depressed, anxious) that may not be impacted by personalization. These analyses will be replicated with a larger sample using data obtained through the 6-mos follow-up. New self-efficacy measures may be required to assess the impact of personalized dietary counseling.
Funding Sources
This research was supported by the American Heart Association.
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Curran M, Popp CJ, St-Jules DE, Sevick MA. Self-Reported Weight Cycling Is Associated with Adaptive Thermogenesis in Individuals with Overweight and Obesity. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa063_022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
We aimed to examine the association between self-reported weight cycling (WC) history and the presence of adaptive thermogenesis (AT) in overweight and obese individuals.
Methods
Data for this analysis were collected during baseline visits of participants enrolled in an ongoing weight loss study, the Personal Diet study. The sample was limited to participants who had reported attempting weight loss prior to enrollment. Body composition (fat mass (FM), fat-free mass (FFM)) and resting energy expenditure (REE) were measured via bioelectrical impedance analysis and indirect calorimetry, respectively. Weight and dieting history was obtained via investigator-generated questionnaire, and WC was defined as the reported number of successful weight loss attempts of ≥5 lbs since age 18. Predicted REE (REEp) was determined using a multiple regression model including FM (kg), FFM (kg), and age. AT (kcal/day) was defined as the difference between predicted and measured REE (REEm-REEp). Pearson's correlations and multivariable models were run using SAS 9.4.
Results
Complete datasets for both WC and REE were collected from 121 participants. Participants (n = 5) with AT ± 2 SD were considered outliers and excluded from this analysis. The sample was mostly female (70%), with a mean age of 59 ± 12 years and a BMI of 34.1 ± 4.8 kg/m2. AT ≥100 kcal/day was found in 41 participants (35%). Mean number of weight cycles was 8.6 ± 5.7, with 49 participants (42.2%) reporting ≥10 cycles. WC was positively associated with AT after adjusting for sex (P = 0.018).
Conclusions
As predicted, WC is common in individuals with overweight and obesity and was significantly associated with AT. However, the clinical relevance of AT is unknown. Therefore, future directions should include an assessment of the effect of WC and AT on weight loss success.
Funding Sources
The Personal Diet study is supported by the American Heart Association.
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Affiliation(s)
- Lu Hu
- Department of Population Health, Center for Healthful Behavior Change, New York University Grossman School of Medicine, New York
| | - Collin Popp
- Department of Population Health, Center for Healthful Behavior Change, New York University Grossman School of Medicine, New York
| | - Mary Ann Sevick
- Department of Population Health, Center for Healthful Behavior Change, New York University Grossman School of Medicine, New York
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Minen MT, Jalloh A, Ortega E, Powers SW, Sevick MA, Lipton RB. User Design and Experience Preferences in a Novel Smartphone Application for Migraine Management: A Think Aloud Study of the RELAXaHEAD Application. Pain Med 2020; 20:369-377. [PMID: 29868895 DOI: 10.1093/pm/pny080] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Scalable nonpharmacologic treatment options are needed for chronic pain conditions. Migraine is an ideal condition to test smartphone-based mind-body interventions (MBIs) because it is a very prevalent, costly, disabling condition. Progressive muscle relaxation (PMR) is a standardized, evidence-based MBI previously adapted for smartphone applications for other conditions. We sought to examine the usability of the RELAXaHEAD application (app), which has a headache diary and PMR capability. METHODS Using the "Think Aloud" approach, we iteratively beta-tested RELAXaHEAD in people with migraine. Individual interviews were conducted, audio-recorded, and transcribed. Using Grounded Theory, we conducted thematic analysis. Participants also were asked Likert scale questions about satisfaction with the app and the PMR. RESULTS Twelve subjects participated in the study. The mean duration of the interviews (SD, range) was 36 (11, 19-53) minutes. From the interviews, four main themes emerged. People were most interested in app utility/practicality, user interface, app functionality, and the potential utility of the PMR. Participants reported that the daily diary was easy to use (75%), was relevant for tracking headaches (75%), maintained their interest and attention (75%), and was easy to understand (83%). Ninety-two percent of the participants would be happy to use the app again. Participants reported that PMR maintained their interest and attention (75%) and improved their stress and low mood (75%). CONCLUSIONS The RELAXaHEAD app may be acceptable and useful to migraine participants. Future studies will examine the use of the RELAXaHEAD app to deliver PMR to people with migraine in a low-cost, scalable manner.
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Affiliation(s)
- Mia T Minen
- Departments of Neurology and Population Health, NYU Langone Medical Center, New York, New York
| | | | - Emma Ortega
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Scott W Powers
- Department of Population Health, NYU Langone Medical Center, New York, New York
| | - Mary Ann Sevick
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
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Sevick MA, Levine DW, Burkart JM, Rocco MV, Keith J, Cohen SJ. Measurement of Continuous Ambulatory Peritoneal Dialysis Prescription Adherence Using a Novel Approach. Perit Dial Int 2020. [DOI: 10.1177/089686089901900105] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective The purpose of the study was to test a novel approach to monitoring the adherence of continuous ambulatory peritoneal dialysis (CAPD) patients to their dialysis prescription. Design A descriptive observational study was done in which exchange behaviors were monitored over a 2-week period of time. Setting Patients were recruited from an outpatient dialysis center. Participants A convenience sample of patients undergoing CAPD at Piedmont Dialysis Center in Winston–Salem, North Carolina was recruited for the study. Of 31 CAPD patients, 20 (64.5%) agreed to participate. Measures Adherence of CAPD patients to their dialysis prescription was monitored using daily logs and an electronic monitoring device (the Medication Event Monitoring System, or MEMS; APREX, Menlo Park, California, U.S.A.). Patients recorded in their logs their exchange activities during the 2-week observation period. Concurrently, patients were instructed to deposit the pull tab from their dialysate bag into a MEMS bottle immediately after performing each exchange. The MEMS bottle was closed with a cap containing a computer chip that recorded the date and time each time the bottle was opened. Results One individual's MEMS device malfunctioned and thus the data presented in this report are based upon the remaining 19 patients. A significant discrepancy was found between log data and MEMS data, with MEMS data indicating a greater number and percentage of missed exchanges. MEMS data indicated that some patients concentrated their exchange activities during the day, with shortened dwell times between exchanges. Three indices were developed for this study: a measure of the average time spent in noncompliance, and indices of consistency in the timing of exchanges within and between days. Patients who were defined as consistent had lower scores on the noncompliance index compared to patients defined as inconsistent ( p = 0.015). Conclusions This study describes a methodology that may be useful in assessing adherence to the peritoneal dialysis regimen. Of particular significance is the ability to assess the timing of exchanges over the course of a day. Clinical implications are limited due to issues of data reliability and validity, the short-term nature of the study, the small sample, and the fact that clinical outcomes were not considered in this methodology study. Additional research is needed to further develop this data-collection approach.
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Affiliation(s)
- Mary Ann Sevick
- Departments of Public Health Sciences and Internal Medicine/Nephrology, Wake Forest University School of Medicine, Winston–Salem, North Carolina, U.S.A
| | - Douglas W. Levine
- Departments of Public Health Sciences and Internal Medicine/Nephrology, Wake Forest University School of Medicine, Winston–Salem, North Carolina, U.S.A
| | - John M. Burkart
- Departments of Public Health Sciences and Internal Medicine/Nephrology, Wake Forest University School of Medicine, Winston–Salem, North Carolina, U.S.A
| | - Michael V. Rocco
- Departments of Public Health Sciences and Internal Medicine/Nephrology, Wake Forest University School of Medicine, Winston–Salem, North Carolina, U.S.A
| | - Jennifer Keith
- Departments of Public Health Sciences and Internal Medicine/Nephrology, Wake Forest University School of Medicine, Winston–Salem, North Carolina, U.S.A
| | - Stuart J. Cohen
- Departments of Public Health Sciences and Internal Medicine/Nephrology, Wake Forest University School of Medicine, Winston–Salem, North Carolina, U.S.A
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Beasley JM, Kirshner L, Wylie-Rosett J, Sevick MA, DeLuca L, Chodosh J. BRInging the Diabetes prevention program to GEriatric populations (BRIDGE): a feasibility study. Pilot Feasibility Stud 2019; 5:129. [PMID: 31741744 PMCID: PMC6849183 DOI: 10.1186/s40814-019-0513-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this 6-week intervention was to test the feasibility and acceptability of implementing a telehealth-adapted Diabetes Prevention Program (DPP) at a senior center. Methods Older adults (n = 16) attended weekly interactive webinars. At each measurement time point, participants completed questionnaires covering lifestyle, physical activity, quality of life, and food records and wore physical activity trackers. Qualitative data were gathered from 2 focus groups inviting all 16 participants with 13 and 10 participants attending, respectively. Results Over 2000 senior center members were contacted, approximately 2% (n = 39) responded to the recruitment email, and 16 were recruited into the study. Retention was 75%, and attendance rates averaged 80% across the six intervention sessions. The focus group participants provided positive opinions for most program components, especially the webinar group interaction and using physical activity trackers. Suggestions for improvement included a greater focus on specific needs of older adults (i.e., adapting activities) and placing a greater emphasis on dietary strategies to prevent diabetes. Mean weight loss was 2.9% (2.7 kg [95% CI 1.6, 3.7]; p value = 0.001). Conclusion The feasibility of providing DPP via webinar appears to be high based on the retention and attendance rates. Similar to other behavioral interventions engaging older adults, recruitment rates were low. Acceptability was evidenced by high attendance at the intervention sessions and feedback from participants during focus group sessions. The intervention efficacy should be evaluated based on CDC criteria for program recognition in a larger scale randomized trial. Trial registration NCT03524404. Registered 14 May 2018—retrospectively registered. Trial protocol will be provided by the corresponding author upon request.
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Affiliation(s)
- Jeannette M Beasley
- 1Department of Medicine, NYU Langone Health, 462 First Avenue, 6th Floor, New York, NY 10016 USA
| | - Lindsey Kirshner
- 1Department of Medicine, NYU Langone Health, 462 First Avenue, 6th Floor, New York, NY 10016 USA
| | - Judith Wylie-Rosett
- 2Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park 438 Avenue, 1307 Belfer Building, Bronx, NY 10461 USA
| | - Mary Ann Sevick
- 1Department of Medicine, NYU Langone Health, 462 First Avenue, 6th Floor, New York, NY 10016 USA.,3Department of Population Health, NYU Langone Health, 227 East 30th Street, 6th Floor, New York, NY 10016 USA
| | - Laura DeLuca
- 4Ferkauf Graduate School of Psychology at Yeshiva University, 1165 Morris Park Ave, Bronx, NY 10461 USA
| | - Joshua Chodosh
- 1Department of Medicine, NYU Langone Health, 462 First Avenue, 6th Floor, New York, NY 10016 USA.,3Department of Population Health, NYU Langone Health, 227 East 30th Street, 6th Floor, New York, NY 10016 USA.,5VA New York Harbor Healthcare System, New York, NY 10016 USA
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Beasley J, Wylie-Rosett J, Sevick MA, DeLuca L, Chodosh J. PARTNERING WITH NUTRITION SERVICES PROGRAM PROVIDERS TO DISSEMINATE EVIDENCE-BASED PROGRAMS USING TELE-HEALTH. Innov Aging 2019. [PMCID: PMC6846432 DOI: 10.1093/geroni/igz038.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Among adults ≥ age 65, 48% have prediabetes and are eligible to participate in the Medicare-covered Diabetes Prevention Program (DPP). We conducted a six-week pilot study to evaluate the feasibility and acceptability of a telehealth-adapted DPP for Nutrition Services Program (NSP) older adult meal program recipients. We enrolled NSP recipients (n=16) from a New York City senior center. These DPP participants attended weekly interactive DPP webinars and completed questionnaires covering lifestyle, physical activity, quality of life, and food records, and wore physical activity trackers. Retention was 75%; attendance averaged 80%; and weight loss was 2.9% (p=0.001). Our six-week pilot data suggest that a tele-adapted DPP intervention can achieve the Medicare reimbursement goals for attendance and 5% weight loss. We are surveying NSP recipients, who receive home-delivered meals, to evaluate the acceptability and feasibility of conducting a larger scale tele-adapted DPP intervention trial among NSP participants.
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Affiliation(s)
- Jeannette Beasley
- New York University Langone Health, New York, New York, United States
| | | | - Mary Ann Sevick
- New York University Langone Health, New York, New York, United States
| | - Laura DeLuca
- Yeshiva University, Bronx, New York, United States
| | - Joshua Chodosh
- New York University Langone Health, New York, New York, United States
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Popp CJ, Butler M, Curran M, Illiano P, Sevick MA, St-Jules DE. Evaluating steady-state resting energy expenditure using indirect calorimetry in adults with overweight and obesity. Clin Nutr 2019; 39:2220-2226. [PMID: 31669004 DOI: 10.1016/j.clnu.2019.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/08/2019] [Accepted: 10/02/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Determining a period of steady state (SS) is recommended when estimating resting energy expenditure (REE) using a metabolic cart. However, this practice may be unnecessarily burdensome and time-consuming in the research setting. AIM The aim of the study was to evaluate the use of SS criteria, and compare it to alternative approaches in adults with overweight and obesity. METHODS In this cross-sectional, ancillary analysis, participants enrolled in a bariatric (study 1; n = 13) and lifestyle (study 2; n = 51) weight loss intervention were included. Indirect calorimetry was performed during baseline measurements using a metabolic cart for 25 min, including a 5-min stabilization period at the start. SS was defined as the first 5-min period with a coefficient of variation (CV) ≤10% for both VO2 and VCO2 (hereafter REE5-SS). Body composition was measured using bioelectrical impedance analysis in study 2 participants only. REE5-SS was compared against the lowest CV (REECV-lowest), 5-min time intervals (REE6-10, REE11-15, REE16-20, REE21-25), 4-min and 3-min SS intervals (REE4-SS and REE3-SS), and time intervals of 6-15, 6-20 and 6-25 min (REE6-15, REE6-20, and REE6-25) using repeated measures ANOVA and Bland-Altman analysis to test for bias, limits of agreement and accuracy (±6% measured REE). RESULTS Participants were 54 ± 13 years old, mostly women (75%) and had a BMI of 35 ± 5 kg/m2. Overall, 54/63 (84%) of participants reached REE5-SS, often (47/54, 87%) within the first 10-min (6-15 min). Alternative approaches to estimating REE had a relatively low bias (-16 to 13 kcals), narrow limits of agreement and high accuracy (83-98%) when compared to REE5-SS, in particular, outperforming standard prediction equations (e.g., Mifflin St. Joer). CONCLUSION Indirect calorimetry measurements that utilize the 5-min SS approach to estimate REE are considered the gold-standard. Under circumstances of non-SS, it appears 4-min and 3-min SS periods, or fixed time intervals of atleast 5 min are accurate and practical alternatives for estimating REE in adults with overweight and obesity. However, future trials should validate alternative methods in similar populations to confirm these findings.
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Affiliation(s)
- C J Popp
- Department of Population Health, New York University, USA.
| | - M Butler
- Department of Population Health, New York University, USA
| | - M Curran
- Department of Population Health, New York University, USA
| | - P Illiano
- Department of Population Health, New York University, USA
| | - M A Sevick
- Department of Population Health, New York University, USA; Department of Medicine, New York University, USA
| | - D E St-Jules
- Department of Population Health, New York University, USA
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Rogers E, Aidasani SR, Friedes R, Hu L, Langford AT, Moloney DN, Orzeck-Byrnes N, Sevick MA, Levy N. Barriers and Facilitators to the Implementation of a Mobile Insulin Titration Intervention for Patients With Uncontrolled Diabetes: A Qualitative Analysis. JMIR Mhealth Uhealth 2019; 7:e13906. [PMID: 31368439 PMCID: PMC6693299 DOI: 10.2196/13906] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/23/2019] [Accepted: 06/12/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND In 2016, a short message service text messaging intervention to titrate insulin in patients with uncontrolled type 2 diabetes was implemented at two health care facilities in New York City. OBJECTIVE This study aimed to conduct a qualitative evaluation assessing barriers to and the facilitators of the implementation of the Mobile Insulin Titration Intervention (MITI) program into usual care. METHODS We conducted in-depth interviews with 36 patients enrolled in the MITI program and the staff involved in MITI (n=19) in the two health care systems. Interviews were transcribed and iteratively coded by two study investigators, both inductively and deductively using a codebook guided by the Consolidated Framework for Implementation Research. RESULTS Multiple facilitator themes emerged: (1) MITI had strong relative advantages to in-person titration, including its convenience and time-saving design, (2) the free cost of MITI was important to the patients, (3) MITI was easy to use and the patients were confident in their ability to use it, (4) MITI was compatible with the patients' home routines and clinic workflow, (5) the patients and staff perceived MITI to have value beyond insulin titration by reminding and motivating the patients to engage in healthy behaviors and providing a source of patient support, and (6) implementation in clinics was made easy by having a strong implementation climate, communication networks to spread information about MITI, and a strong program champion. The barriers identified included the following: (1) language limitations, (2) initial nurse concerns about the scope of practice changes required to deliver MITI, (3) initial provider knowledge gaps about the program, and (4) provider perceptions that MITI might not be appropriate for some patients (eg, older or not tech-savvy). There was also a theme that emerged during the patient and staff interviews of an unmet need for long-term additional diabetes management support among this population, specifically diet, nutrition, and exercise support. CONCLUSIONS The patients and staff were overwhelmingly supportive of MITI and believed that it had many benefits and that it was compatible with the clinic workflow and patients' lives. Initial implementation efforts should address staff training and nurse concerns. Future research should explore options for integrating additional diabetes support for patients.
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Affiliation(s)
- Erin Rogers
- Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Sneha R Aidasani
- Department of Medicine, New York University School of Medicine, New York, NY, United States
| | - Rebecca Friedes
- Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Lu Hu
- Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Aisha T Langford
- Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Dana N Moloney
- Department of Medicine, New York University School of Medicine, New York, NY, United States
| | - Natasha Orzeck-Byrnes
- Department of Medicine, New York University School of Medicine, New York, NY, United States
| | - Mary Ann Sevick
- Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Natalie Levy
- Department of Medicine, New York University School of Medicine, New York, NY, United States
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Popp C, Butler M, St-Jules D, Hu L, Illiano P, Curran M, Schoenthaler A, Sevick MA. Adherence to Self-monitoring of Dietary Intake During a Weight Loss Intervention: Does a Personalized Approach Maintain Adherence? (FS11-04-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz037.fs11-04-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
We compared self-monitoring adherence in participants randomized to two weight loss programs: a STANDARDIZED, one-size-fits-all, low-fat diet, or a diet PERSONALIZED to minimize the postprandial glycemic response.
Methods
Participants were adults with pre-diabetes or type 2 diabetes, and a BMI >27 k/m2. Both groups were instructed to restrict total calories, monitor dietary intake with the Personal Nutrition Program (PNP) smartphone app, and attend videoconference behavioral counseling sessions on the same intervention schedule. STANDARDIZED (n = 12) received app feedback about intake of total calories and dietary fat. PERSONALIZED (n = 20) received app feedback about intake of total calories plus a meal-specific predicted glycemic score. Total meal entries were measured at 1, 2 and 3 months. Self-monitoring adherence was defined as logging >50% of expected meals each month into the PNP app, assuming 3 meals/day. Session attendance was also measured. Repeated measures binomial logistic regression analysis was used to assess change in adherence due to treatment group, time (i.e., months), and the interaction between treatment and time, adjusting for age, gender and BMI.
Results
Proportion adherent was 75.0%, 41.7% and 8.3% in the STANDARDIZED group and 85.0%, 80.0% and 75.0% in the PERSONALIZED group during months 1, 2 and 3, respectively. The repeated measures model demonstrated a significant effect of month (P < 0.001) and a treatment*month interaction (P = 0.011). After adjusting for covariates, these effects remained significant, showing a significant reduction in odds of adherence by month (OR [95%CI]: 0.13 [0.05, 0.37]; P < 0.001). Moreover, compared to the STANDARDIZED, PERSONALIZED participants had greater odds of adherence over time (OR [95%CI]: 5.12 [1.49, 17.6]; P = 0.009). Higher BMI was significantly associated with lower adherence (OR [95%CI]: 0.92 [0.87, 0.98]; P = 0.006). The proportion of attendance at videoconference sessions was similar between groups (STANDARDIZED: 77.1%; PERSONALIZED: 77.5%).
Conclusions
Two weight loss programs having similar calorie targets, behavioral approach, and contact schedule resulted in similar session attendance. However, adherence to self-monitoring was better when feedback was personalized.
Funding Sources
American Heart Association.
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Popp C, Illiano P, Curran M, Sevick MA, St-Jules D. Methods for Estimating Resting Energy Expenditure Using Indirect Calorimetry in Adults with Overweight and Obesity (P13-030-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz036.p13-030-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Standard procedures to estimate resting energy expenditure (REE) using indirect calorimetry are time-consuming, and may be unnecessary. Indeed, the guidelines recommend a pre-test resting period of 30-minutes, followed by a 5-minute stabilization period, and then waiting until the first steady state period (SS), defined as a 5-minute period with a coefficient of variance (CV) of <10% for VO2 and VCO2, to estimate REE. The aim of the study was to evaluate alternative procedures for estimating REE in adults with overweight and obesity.
Methods
Indirect calorimetry was performed in 37 adults enrolled in a weight loss trial using a metabolic cart (Quark RMR, COSMED). The volume of oxygen (VO2) and volume of carbon dioxide (VCO2) were collected every 10 sec for ≥20-minutes following pre-test resting (10-mins) and stabilization (5-mins) periods. The measurement period was segmented into five-minute (REE6–10, REE11–15, REE16–20, and REE21–25) and rolling (REE6–15, REE6–20, and REE6–25) periods, and VO2, VCO2, and CV were calculated for each period. REE was calculated using standard criteria (REESS). Alternative SS periods of 3- and 4-minutes (REE3 and REE4) were applied to those who did not achieve REESS. REESS estimates were compared to the other estimates of REE using paired t-tests.
Results
Participants were 51 ± 14SD yo, primarily women (78%), and had a BMI of 35.4 ± 5.5SD kg/m2. REESS was achieved by 81% (n = 30) of all participants, and 54% (n = 20) achieved REESS during the first 5-minute period (REE6–10) following stabilization. Applying REE3 and REE4 criteria, those who did not reach REESS increased to 92% (n = 34). There were no significant differences between REESS, and REE3 (P = 0.21), REE4 (P = 0.40), REE6–10 (P = 0.38), REE6–15 (P = 0.15) or REE6–20 (P = 0.05).
Conclusions
The majority of adults with overweight and obesity met the standard criteria for SS following a reduced pre-test resting period. However, the non-significant difference between REESS and rolling averages suggest the standard criteria may be unnecessary in a group setting.
Funding Sources
American Heart Association.
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Moore A, Woolf K, St-Jules D, Popp C, Pompeii ML, Li H, Williams S, Goldfarb D, Katz S, Sevick MA. Plant Protein Intake Is Not Associated with Cardiovascular Disease Risk Factors in Diabetic Patients with Chronic Kidney Disease (P08-055-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz044.p08-055-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
A higher percentage of protein consumed from plants may have cardiovascular benefits and be associated with lower mortality in chronic kidney disease (CKD) patients. The purpose of this study was to examine the association of self-reported dietary protein intake with cardiovascular disease (CVD) risk factors in patients with type 2 diabetes (T2D) and CKD.
Methods
Baseline 3-day food records were obtained from 202 participants of an ongoing lifestyle intervention study, and analyzed using Nutrition Data System for Research (2014). Participants were categorized into tertiles based on total protein intake (<66.9 g, 66.9–92.4 g, > 92.4 g) and percent of total protein coming from plant sources (<27.9%, 27.9–37.8%, >37.8%). CVD risk factors included estimated glomerular filtration rate (eGFR), pulse wave velocity (PWV), fasting lipids (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides [TG]), and hemoglobin A1c [HbA1c]). Analyses of covariance examined mean differences in CVD risk factors among the tertiles, controlling for age and total energy intake.
Results
The participants were 57% male, 89% non-Hispanic, 69% white, and 66 ± 9 years of age with a mean body mass index of 33.6 ± 5 kg/m2. Prior myocardial infarction was reported by 25(12.6%) of participants. Average daily protein intake was 83.3 ± 29.3 g (0.9 ± 0.3 g/kg body weight), with the average % of protein consumed from plant sources 34 ± 13%. There were no statistically significant differences between the total protein intake tertiles for the CVD risk factors (eGFR [P = .36], PWV [P = .86], total cholesterol [P = .09], LDL-cholesterol [P = .26], HDL-cholesterol [P = .88], TG [P = .88], HbA1c [P = .82]. Additionally, there were no statistically significant differences between the % of total protein intake from plant sources tertiles for the CVD risk factors (eGFR [P = .32], PWV [P = .92], total cholesterol [P = .29], LDL-cholesterol [P = .10], HDL-cholesterol [P = .57], TG [P = .13], HbA1c [P = .93].
Conclusions
Contrary to expectations, CVD risk factors did not differ among tertiles for total protein intake or % of total protein from plant sources. These findings suggest that, at baseline, dietary protein was not associated with CVD risk factors in patients with T2D and CKD.
Funding Sources
National Institutes of Health (NIDDK, NINR).
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Illiano P, Curran M, St-Jules D, Popp C, Wang C, Li H, Sevick MA. Glycemic Variability and Hemoglobin A1c and Their Associations with Blood Pressure Among Overweight Adults with Prediabetes or Type 2 Diabetes (P12-008-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz035.p12-008-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Hemoglobin A1c (HbA1c) is associated with hypertension in prediabetes (PD) and type 2 diabetes (T2D), both of which are associated with increased cardiovascular disease (CVD) risk. Traditionally, HbA1c is the standard approach to assessing glycemic status, however, glycemic variability (GV)—the daily fluctuations in blood glucose concentrations—may be more predictive of CVD. Little is known regarding the relationship between GV and blood pressure (BP). Therefore, we examined GV and HbA1c and their associations with BP in overweight adults with PD and early stage T2D enrolled in a weight loss study.
Methods
Participants had a history of PD or T2D treated with lifestyle alone or lifestyle and metformin. Data for this report were obtained at baseline and included sociodemographics, height, weight, BP, and HbA1c. Up to two weeks of continuous glucose monitoring data were collected using the Abbott Freestyle Libre Pro, and mean amplitude of glycemic excursions (MAGE) was computed using EasyGV. Linear mixed models were used to test the associations of MAGE and HbA1c with BP, with adjustment for sociodemographic characteristics, as well as to compare MAGE on weekdays versus weekends. Repeated measures ANOVA was used to investigate the within-subject and between-subject variation of MAGE. All analyses were performed using R software.
Results
Study participants (n = 35) were mostly female (66%) and non-Hispanic white (69%), with a mean (SD) age of 57 (11) years, BMI of 33.0 (4.0) kg/m2, HbA1c of 5.6 (0.5) %, and systolic and diastolic BP (SBP, DBP) of 124 (14) and 71 (8) mmHg, respectively. MAGE differed significantly between participants (P < 0.001), however within person was fairly stable (P = 0.14). There were no significant differences in MAGE on weekdays versus weekends (P = 0.27). MAGE, but not HbA1c, was positively associated with SBP (P = 0.02 vs P = 0.44), while adjusting for age, gender, race and BMI. When HbA1c was added to the model, the association of MAGE with SBP remained significant (P = 0.03).
Conclusions
Among overweight adults with PD and early-stage T2D, MAGE was found to be associated with SBP. This suggests that a measure of daily GV may be a good alternative measure of metabolic health outcomes in this population.
Funding Sources
This work was funded by the American Heart Association.
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Woolf K, Seixas A, Moore A, Popp C, Coleman W, Li H, Williams S, Goldfarb D, Katz S, Sevick MA. The Impact of Daytime Sleepiness on Dietary Intake in Overweight/Obese Individuals with Diabetes and Chronic Kidney Disease (P08-019-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz044.p08-019-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Sleep disturbances have been recognized as risk factors in the etiology of chronic disease and obesity. Although multifactorial, the link may be due to dietary intake, mediated by appetite hormones, hedonic feeding, altered intake times, and extended intake hours. The purpose of this study was to examine daytime sleepiness and dietary intake in overweight/obese individuals with diabetes and chronic kidney disease.
Methods
Three-day food records were completed at baseline from 133 participants in an ongoing lifestyle intervention study, and analyzed using the Nutrition Data System for Research (2014). Daily dietary intakes were summarized for energy (kcal), carbohydrate (g), fat (g), alcohol (g), added sugars (g), and refined grains (ounce equivalents). Self-reported measures of daytime sleepiness were measured using the Epworth Sleepiness Scale (ESS). Participants rated their level of sleepiness (scale 0–3) in eight different situations, which were summed to provide a total score. The ESS scores were dichotomized with 0–10 indicating “normal daytime sleepiness” (NDS) and 11–24 indicating “excessive daytime sleepiness” (EDS). IBM SPSS Statistics (version 25.0) was utilized to complete the descriptive and inferential analyses. Independent sample t-tests examined differences between the two sleepiness groups. Results were considered significant at p ≤ 0.05.
Results
The participants were 53.4% male, 89.5% non-Hispanic, 65.4% white, and 65.0 ± 9.4SD years of age with a mean body mass index of 34.0 ± 5.1SD kg/m2. Although there were no differences between sleepiness groups for fat and alcohol intakes, the EDS group reported a higher mean intake of carbohydrate (EDS: 247 ± 148SD g, NDS: 183 ± 76SD g; P = 0.048) and refined grains (EDS: 7.0 ± 6.5SD ounce, NDS: 4.2 ± 3.0SD ounce; P = 0.048). Although not statistically significant, the EDS group exhibited a trend toward having a higher energy intake (EDS: 2130 ± 1083SD kcal, NDS: 1776 ± 618SD kcal; P = 0.133) and added sugar intake (EDS: 44 ± 53SD g, NDS: 28 ± 26SD g, P = 0.179).
Conclusions
Similar to other reports, sleep disturbances, as noted by EDS, were associated with a higher intake of carbohydrate and refined grains. The results of this study support the role of sleep, alongside diet and physical activity, as important modifiable risk factors for chronic disease and obesity.
Funding Sources
National Institutes of Health (NIDDK, NINR)
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Popp CJ, St-Jules DE, Hu L, Ganguzza L, Illiano P, Curran M, Li H, Schoenthaler A, Bergman M, Schmidt AM, Segal E, Godneva A, Sevick MA. The rationale and design of the personal diet study, a randomized clinical trial evaluating a personalized approach to weight loss in individuals with pre-diabetes and early-stage type 2 diabetes. Contemp Clin Trials 2019; 79:80-88. [PMID: 30844471 DOI: 10.1016/j.cct.2019.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/20/2019] [Accepted: 03/01/2019] [Indexed: 12/31/2022]
Abstract
Weight loss reduces the risk of type 2 diabetes mellitus (T2D) in overweight and obese individuals. Although the physiological response to food varies among individuals, standard dietary interventions use a "one-size-fits-all" approach. The Personal Diet Study aims to evaluate two dietary interventions targeting weight loss in people with prediabetes and T2D: (1) a low-fat diet, and (2) a personalized diet using a machine-learning algorithm that predicts glycemic response to meals. Changes in body weight, body composition, and resting energy expenditure will be compared over a 6-month intervention period and a subsequent 6-month observation period intended to assess maintenance effects. The behavioral intervention is delivered via mobile health technology using the Social Cognitive Theory. Here, we describe the design, interventions, and methods used.
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Affiliation(s)
- Collin J Popp
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - David E St-Jules
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - Lu Hu
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - Lisa Ganguzza
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - Paige Illiano
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - Margaret Curran
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - Huilin Li
- Department of Population Health, Division of Biostatistics, New York University School of Medicine, New York, NY, USA
| | - Antoinette Schoenthaler
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - Michael Bergman
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA; Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, New York University School of Medicine, New York, NY, USA
| | - Ann Marie Schmidt
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, New York University School of Medicine, New York, NY, USA
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Anastasia Godneva
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Mary Ann Sevick
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA; Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, New York University School of Medicine, New York, NY, USA.
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Langford AT, Wang B, Orzeck-Byrnes NA, Aidasani SR, Hu L, Applegate M, Moloney DN, Sevick MA, Rogers ES, Levy NK. Sociodemographic and clinical correlates of key outcomes from a Mobile Insulin Titration Intervention (MITI) for medically underserved patients. Patient Educ Couns 2019; 102:520-527. [PMID: 30293934 DOI: 10.1016/j.pec.2018.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/14/2018] [Accepted: 09/15/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Insulin titration is typically done face-to-face with a clinician; however, this can be a burden for patients due to logistical issues associated with in-person clinical care. The Mobile Insulin Titration Intervention (MITI) used basic cell phone technology including text messages and phone calls to help patients with diabetes find their optimal basal insulin dose (OID). OBJECTIVE To evaluate sociodemographic and clinical correlates of reaching OID, text message response rate, and days needed to reach OID. METHODS Primary care providers referred patients to MITI and nurses delivered the program. Three multivariable regression models quantified relationships between various correlates and primary outcomes. RESULTS The sample included 113 patients from 2 ambulatory clinics, with a mean age of 50 years (SD = 10), 45% female, 79% Hispanic, 43% unemployed, and 46% uninsured. In regression models, baseline fasting blood glucose (FBG) was negatively associated with odds of reaching OID and 100% text responses, and positively associated with days to reach OID, p < .05). CONCLUSIONS Patients with higher baseline FBG levels were less successful across outcomes and may need additional supports in future mHealth diabetes programs. PRACTICAL IMPLICATIONS Basic cell phone technology can be used to adjust patients' insulin remotely, thereby reducing logistical barriers to care.
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Affiliation(s)
| | - Binhuan Wang
- NYU School of Medicine, Department of Population Health, USA
| | | | | | - Lu Hu
- NYU School of Medicine, Department of Population Health, USA
| | | | | | - Mary Ann Sevick
- NYU School of Medicine, Department of Population Health, USA
| | - Erin S Rogers
- NYU School of Medicine, Department of Population Health, USA
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Hu L, St-Jules DE, Popp CJ, Sevick MA. Determinants and the Role of Self-Efficacy in a Sodium-Reduction Trial in Hemodialysis Patients. J Ren Nutr 2018; 29:328-332. [PMID: 30579673 DOI: 10.1053/j.jrn.2018.10.006] [Citation(s) in RCA: 8] [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] [Received: 06/03/2018] [Revised: 08/21/2018] [Accepted: 10/12/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study was to assess the impact of baseline dietary self-efficacy on the effect of a dietary intervention to reduce sodium intake in patients undergoing hemodialysis (HD) and to identify determinants of low dietary self-efficacy. METHODS This is a post hoc analysis of the BalanceWise study, a randomized controlled trial that aimed to reduce dietary sodium intake in HD patients recruited from 17 dialysis centers in Pennsylvania. The main outcome measures include dietary self-efficacy and reported dietary sodium density. Analysis of variance with post hoc group-wise comparison was used to examine the effect of baseline dietary self-efficacy on changes in reported sodium density in the intervention and control groups at 8 and 16 weeks. Chi-square test, independent t tests, or Wilcoxon rank-sum tests were used to identify determinants of low dietary self-efficacy. RESULTS The interaction between dietary self-efficacy and the impact of the intervention on changes in reported dietary sodium density approached significance at 8 and 16 weeks (P interaction = 0.051 and 0.06, respectively). Younger age and perceived income inadequacy were significantly associated with low self-efficacy in patients undergoing HD. CONCLUSION The benefits of dietary interventions designed to improve self-efficacy may differ by the baseline self-efficacy status. This may be particularly important for HD patients who are younger and report inadequate income as they had lower dietary self-efficacy.
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Affiliation(s)
- Lu Hu
- New York University School of Medicine, Center for Healthful Behavior Change, New York, New York.
| | - David E St-Jules
- New York University School of Medicine, Center for Healthful Behavior Change, New York, New York
| | - Collin J Popp
- New York University School of Medicine, Center for Healthful Behavior Change, New York, New York
| | - Mary Ann Sevick
- New York University School of Medicine, Center for Healthful Behavior Change, New York, New York
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Beasley JM, Sevick MA, Kirshner L, Mangold M, Chodosh J. Congregate Meals: Opportunities to Help Vulnerable Older Adults Achieve Diet and Physical Activity Recommendations. J Frailty Aging 2018; 7:182-186. [PMID: 30095149 DOI: 10.14283/jfa.2018.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Through diet and exercise interventions, community centers offer an opportunity to address health-related issues for some of the oldest, most vulnerable members of our society. OBJECTIVES The purpose of this investigation is to draw upon nationwide data to better characterize the population served by the congregate meals program and to gather more detailed information on a local level to identify opportunities for service enhancement to improve the health and well-being of older adults. DESIGN We examined community center data from two sources: 2015 National Survey of Older Americans Act and surveys from two New York City community centers. To assess nationwide service delivery, we analyzed participant demographics, functional status defined by activities of daily living, and perceptions of services received. MEASUREMENTS Participants from the two New York City community centers completed a four-day food record. Functional measures included the short physical performance battery, self-reported physical function, grip strength, and the Montreal Cognitive Assessment. RESULTS Nationwide (n=901), most participants rated the meal quality as good to excellent (91.7%), and would recommend the congregate meals program to a friend (96.0%). Local level data (n=22) were collected for an in-depth understanding of diet, physical activity patterns, body weight, and objective functional status measures. Diets of this small, local convenience sample were higher in fat, cholesterol, and sodium, and lower in calcium, magnesium, and fiber than recommended by current United States Dietary Guidelines. Average time engaged in moderate physical activity was 254 minutes per week (SD=227), exceeding the recommended 150 minutes per week, but just 41% (n=9) and 50% (n=11) of participants engaged in strength or balance exercises, respectively. CONCLUSION Research is warranted to test whether improvements in the nutritional quality of food served and access/supports for engaging in strength training within community centers could help older adults achieve diet and physical activity recommendations.
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Affiliation(s)
- J M Beasley
- Jeannette M. Beasley, PhD MPH RD, Assistant Professor, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 462 First Avenue, 6th Floor CD673, New York, NY 10016, T: 646-501-4681,
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Clark-Cutaia MN, Sevick MA, Thurheimer-Cacciotti J, Hoffman LA, Snetselaar L, Burke LE, Zickmund SL. Perceived Barriers to Adherence to Hemodialysis Dietary Recommendations. Clin Nurs Res 2018; 28:1009-1029. [DOI: 10.1177/1054773818773364] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Barriers to following dietary recommendations have been described; however, they remain poorly understood. The purpose of this qualitative study was to explore perceived barriers to adherence to dietary recommendations in a diverse hemodialysis patient population. Participants were eligible to participate in a semi-structured qualitative telephone interview prior to randomization for an ongoing clinical trial to evaluate the efficacy of an intervention designed to reduce dietary sodium intake. Interviews were digitally recorded, transcribed verbatim and coded using an iterative qualitative process. In total, 30 (37% females, 53% Caucasians) participants, 63.2 ± 13.3 years, were interviewed. Time, convenience, and financial constraints hindered dietary adherence. Dietary counseling efforts were rated positively but require individualization. Ability to follow recommended guidelines was challenging. Suggestions for addressing barriers include technology-based interventions that allow patients to improve food choices and real-time decision-making, and permit tailoring to individual barriers and preferences.
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Lee DC, Gallagher MP, Gopalan A, Osorio M, Vinson AJ, Wall SP, Ravenell JE, Sevick MA, Elbel B. Identifying Geographic Disparities in Diabetes Prevalence Among Adults and Children Using Emergency Claims Data. J Endocr Soc 2018; 2:460-470. [PMID: 29719877 PMCID: PMC5920312 DOI: 10.1210/js.2018-00001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/02/2018] [Accepted: 03/29/2018] [Indexed: 02/02/2023] Open
Abstract
Geographic surveillance can identify hotspots of disease and reveal associations between health and the environment. Our study used emergency department surveillance to investigate geographic disparities in type 1 and type 2 diabetes prevalence among adults and children. Using all-payer emergency claims data from 2009 to 2013, we identified unique New York City residents with diabetes and geocoded their location using home addresses. Geospatial analysis was performed to estimate diabetes prevalence by New York City Census tract. We also used multivariable regression to identify neighborhood-level factors associated with higher diabetes prevalence. We estimated type 1 and type 2 diabetes prevalence at 0.23% and 10.5%, respectively, among adults and 0.20% and 0.11%, respectively, among children in New York City. Pediatric type 1 diabetes was associated with higher income (P = 0.001), whereas adult type 2 diabetes was associated with lower income (P < 0.001). Areas with a higher proportion of nearby restaurants categorized as fast food had a higher prevalence of all types of diabetes (P < 0.001) except for pediatric type 2 diabetes. Type 2 diabetes among children was only higher in neighborhoods with higher proportions of African American residents (P < 0.001). Our findings identify geographic disparities in diabetes prevalence that may require special attention to address the specific needs of adults and children living in these areas. Our results suggest that the food environment may be associated with higher type 1 diabetes prevalence. However, our analysis did not find a robust association with the food environment and pediatric type 2 diabetes, which was predominantly focused in African American neighborhoods.
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Affiliation(s)
- David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York.,Department of Population Health, New York University School of Medicine, New York, New York
| | - Mary Pat Gallagher
- Division of Endocrinology, Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Anjali Gopalan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Marcela Osorio
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
| | - Andrew J Vinson
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
| | - Stephen P Wall
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
| | - Joseph E Ravenell
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Mary Ann Sevick
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Brian Elbel
- Department of Population Health, New York University School of Medicine, New York, New York.,Wagner Graduate School of Public Service, New York University, New York, New York
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Levy NK, Orzeck-Byrnes NA, Aidasani SR, Moloney DN, Nguyen LH, Park A, Hu L, Langford AT, Wang B, Sevick MA, Rogers ES. Transition of a Text-Based Insulin Titration Program From a Randomized Controlled Trial Into Real-World Settings: Implementation Study. J Med Internet Res 2018; 20:e93. [PMID: 29555621 PMCID: PMC5881039 DOI: 10.2196/jmir.9515] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/25/2018] [Accepted: 02/12/2018] [Indexed: 12/25/2022] Open
Abstract
Background The Mobile Insulin Titration Intervention (MITI) program helps patients with type 2 diabetes find their correct basal insulin dose without in-person care. Requiring only basic cell phone technology (text messages and phone calls), MITI is highly accessible to patients receiving care in safety-net settings. MITI was shown in a randomized controlled trial (RCT) to be efficacious at a New York City (NYC) safety-net clinic where patients often have challenges coming for in-person care. In 2016, MITI was implemented as usual care at Bellevue Hospital (the site of the original RCT) and at Gouverneur Health (a second NYC safety-net clinic) under 2 different staffing models. Objective This implementation study examined MITI’s transition into real-world settings. To understand MITI’s flexibility, generalizability, and acceptability among patients and providers, we evaluated whether MITI continued to produce positive outcomes in expanded underserved populations, outside of an RCT setting. Methods Patients enrolled in MITI received weekday text messages asking for their fasting blood glucose (FBG) values and a weekly titration call. The goal was for patients to reach their optimal insulin dose (OID), defined either as the dose of once-daily basal insulin required to achieve either an FBG of 80-130 mg/dL (4.4-7.2 mmol/L) or as the reaching of the maximum dose of 50 units. After 12 weeks, if OID was not reached, the patients were asked to return to the clinic for in-person care and titration. MITI program outcomes, clinical outcomes, process outcomes, and patient satisfaction were assessed. Results MITI was successful at both sites, each with a different staffing model. Providers referred 170 patients to the program—129 of whom (75.9%, 129/170) were eligible. Of these, 113 (87.6%, 113/129) enrolled. Moreover, 84.1% (95/113) of patients reached their OID, and they did so in an average of 24 days. Clinical outcomes show that mean FBG levels fell from 209 mg/dL (11.6 mmol/L) to 141 mg/dL (7.8 mmol/L), P<.001. HbA1c levels fell from 11.4% (101 mmol/mol) to 10.0% (86 mmol/mol), P<.001. Process outcomes show that 90.1% of MITI’s text message prompts received a response, nurses connected with patients 81.9% of weeks to provide titration instructions, and 85% of attending physicians made at least one referral to the MITI program. Satisfaction surveys showed that most patients felt comfortable sharing information over text and felt the texts reminded them to take their insulin, check their sugar, and make healthy food choices. Conclusions This implementation study showed MITI to have continued success after transitioning from an RCT program into real-world settings. MITI showed itself to be flexible and generalizable as it easily fits into a second site staffed by general medical clinic–registered nurses and remained acceptable to patients and staff who had high levels of engagement with the program.
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Affiliation(s)
- Natalie Koch Levy
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, NY, United States
| | - Natasha A Orzeck-Byrnes
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, NY, United States
| | - Sneha R Aidasani
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, NY, United States
| | - Dana N Moloney
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, NY, United States
| | - Lisa H Nguyen
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, NY, United States
| | - Agnes Park
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, NY, United States
| | - Lu Hu
- Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Aisha T Langford
- Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Binhuan Wang
- Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Mary Ann Sevick
- Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Erin S Rogers
- Department of Population Health, New York University School of Medicine, New York, NY, United States
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Woolf K, Ganguzza L, Pompeii ML, Li J, St-Jules D, Jagannathan R, Hu L, Skursky N, Sierra A, Goldfarb DS, Katz S, Mattoo A, Li H, Sevick MA. Physical Activity and Self-Efficacy in Overweight/obese Adults with Type 2 Diabetes and Concurrent Kidney Disease. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000519814.92673.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
IN BRIEF Dietary guidelines for patients with diabetes extend beyond glycemic management to include recommendations for mitigating chronic disease risk. This review summarizes the literature suggesting that excess dietary phosphorus intake may increase the risk of skeletal and cardiovascular disease in patients who are in the early stages of chronic kidney disease (CKD) despite having normal serum phosphorus concentrations. It explores strategies for limiting dietary phosphorus, emphasizing that food additives, as a major source of highly bioavailable dietary phosphorus, may be a suitable target. Although the evidence for restricting phosphorus-based food additives in early CKD is limited, diabetes clinicians should monitor ongoing research aimed at assessing its efficacy.
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Affiliation(s)
- David E. St-Jules
- New York University School of Medicine, Center for Healthful Behavior Change, New York, NY
| | - David S. Goldfarb
- New York University Medical Center, Division of Nephrology, New York, NY
| | - Mary Lou Pompeii
- New York University School of Medicine, Center for Healthful Behavior Change, New York, NY
| | - Mary Ann Sevick
- New York University School of Medicine, Center for Healthful Behavior Change, New York, NY
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Lee DC, Yi SS, Fong HF, Athens JK, Ravenell JE, Sevick MA, Wall SP, Elbel B. Identifying Local Hot Spots of Pediatric Chronic Diseases Using Emergency Department Surveillance. Acad Pediatr 2017; 17:267-274. [PMID: 28385326 PMCID: PMC5385887 DOI: 10.1016/j.acap.2016.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/24/2016] [Revised: 10/25/2016] [Accepted: 10/28/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To use novel geographic methods and large-scale claims data to identify the local distribution of pediatric chronic diseases in New York City. METHODS Using a 2009 all-payer emergency claims database, we identified the proportion of unique children aged 0 to 17 with diagnosis codes for specific medical and psychiatric conditions. As a proof of concept, we compared these prevalence estimates to traditional health surveys and registry data using the most geographically granular data available. In addition, we used home addresses to map local variation in pediatric disease burden. RESULTS We identified 549,547 New York City children who visited an emergency department at least once in 2009. Though our sample included more publicly insured and uninsured children, we found moderate to strong correlations of prevalence estimates when compared to health surveys and registry data at prespecified geographic levels. Strongest correlations were found for asthma and mental health conditions by county among younger children (0.88, P = .05 and 0.99, P < .01, respectively). Moderate correlations by neighborhood were identified for obesity and cancer (0.53 and 0.54, P < .01). Among adolescents, correlations by health districts were strong for obesity (0.95, P = .05), and depression estimates had a nonsignificant, but strong negative correlation with suicide attempts (-0.88, P = .12). Using SaTScan, we also identified local hot spots of pediatric chronic disease. CONCLUSIONS For conditions easily identified in claims data, emergency department surveillance may help estimate pediatric chronic disease prevalence with higher geographic resolution. More studies are needed to investigate limitations of these methods and assess reliability of local disease estimates.
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Affiliation(s)
- David C. Lee
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, 462 First Avenue, Room A345, New York, NY 10016,Department of Population Health, NYU School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Stella S. Yi
- Department of Population Health, NYU School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Hiu-Fai Fong
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street; Boston, MA 02115
| | - Jessica K. Athens
- Department of Population Health, NYU School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Joseph E. Ravenell
- Department of Population Health, NYU School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Mary Ann Sevick
- Department of Population Health, NYU School of Medicine, 227 East 30th Street, New York, NY 10016
| | - Stephen P. Wall
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, 462 First Avenue, Room A345, New York, NY 10016
| | - Brian Elbel
- Department of Population Health, NYU School of Medicine, 227 East 30th Street, New York, NY 10016,Wagner Graduate School of Public Service, New York University, 295 Lafayette Street, New York, NY 10012
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Bergman M, Jagannathan R, Buysschaert M, Medina JL, Sevick MA, Katz K, Dorcely B, Roth J, Chetrit A, Dankner R. Reducing the prevalence of dysglycemia: is the time ripe to test the effectiveness of intervention in high-risk individuals with elevated 1 h post-load glucose levels? Endocrine 2017; 55:697-701. [PMID: 28124259 DOI: 10.1007/s12020-017-1236-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 01/17/2017] [Indexed: 02/07/2023]
Abstract
Identifying the earliest time point on the prediabetic continuum is critical to avoid progressive deterioration in β-cell function. Progressively rising glucose levels even within the "normal range" occur considerably late in the evolution to diabetes thus presenting an important opportunity for earlier diagnosis, treatment, and possible reversal. An elevated 1 h postprandial glucose level, not detected by current diagnostic standards, may provide an opportunity for the early identification of those at risk. When the 1 h post-load glucose level is elevated, lifestyle intervention may have the greatest benefit for preserving β-cell function and prevent further progression to prediabetes and diabetes. In view of the considerable consistent epidemiologic data in large disparate populations supporting the predictive capacity of the1 h post-load value for predicting progression to diabetes and mortality, the time is therefore ripe to evaluate this hypothesis in a large, prospective multicenter randomized trial with lifestyle intervention.
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Affiliation(s)
- Michael Bergman
- NYU School of Medicine, Department of Medicine, Division of Endocrinology and Metabolism, NYU Langone Diabetes Prevention Program, New York, NY, 10016, USA.
| | - Ram Jagannathan
- NYU School of Medicine, Department of Population Health, Division of Health Behavior Change, New York, NY, 10016, USA
| | - Martin Buysschaert
- Department of Endocrinology and Diabetology, Université Catholique de Louvain, University Clinic Saint-Luc, Brussels, Belgium
| | | | - Mary Ann Sevick
- NYU School of Medicine, Department of Population Health, Division of Health Behavior Change, New York, NY, 10016, USA
| | - Karin Katz
- NYU School of Medicine, Department of Medicine, Division of Endocrinology and Metabolism, NYU Langone Diabetes Prevention Program, New York, NY, 10016, USA
| | - Brenda Dorcely
- NYU School of Medicine, Department of Medicine, Division of Endocrinology and Metabolism, NYU Langone Diabetes Prevention Program, New York, NY, 10016, USA
| | - Jesse Roth
- The Feinstein Institute for Medical Research, Manhasset, North Shore, New York, 11030, USA
| | - Angela Chetrit
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621, Israel
| | - Rachel Dankner
- The Feinstein Institute for Medical Research, Manhasset, North Shore, New York, 11030, USA
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 52621, Israel
- Sackler Faculty of Medicine, School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, 69978, Israel
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St-Jules DE, Jagannathan R, Gutekunst L, Kalantar-Zadeh K, Sevick MA. Examining the Proportion of Dietary Phosphorus From Plants, Animals, and Food Additives Excreted in Urine. J Ren Nutr 2016; 27:78-83. [PMID: 27810171 DOI: 10.1053/j.jrn.2016.09.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 08/26/2016] [Accepted: 09/01/2016] [Indexed: 01/16/2023] Open
Abstract
Phosphorus bioavailability is an emerging topic of interest in the field of renal nutrition that has important research and clinical implications. Estimates of phosphorus bioavailability, based on digestibility, indicate that bioavailability of phosphorus increases from plants to animals to food additives. In this commentary, we examined the proportion of dietary phosphorus from plants, animals, and food additives excreted in urine from four controlled-feeding studies conducted in healthy adults and patients with chronic kidney disease. As expected, a smaller proportion of phosphorus from plant foods was excreted in urine compared to animal foods. However, contrary to expectations, phosphorus from food additives appeared to be incompletely absorbed. The apparent discrepancy between digestibility of phosphorus additives and the proportion excreted in urine suggests a need for human balance studies to determine the bioavailability of different sources of phosphorus.
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Affiliation(s)
- David E St-Jules
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, New York.
| | - Ram Jagannathan
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, New York
| | - Lisa Gutekunst
- Department of Suburban Dialysis, Davita, Inc., Denver, Colorado
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology & Hypertension, University of California Irvine Medical Center, Orange, California
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, New York
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Chamukuttan S, Ram J, Nanditha A, Shetty AS, Sevick MA, Bergman M, Johnston DG, Ramachandran A. Baseline level of 30-min plasma glucose is an independent predictor of incident diabetes among Asian Indians: analysis of two diabetes prevention programmes. Diabetes Metab Res Rev 2016; 32:762-767. [PMID: 26991329 DOI: 10.1002/dmrr.2799] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 10/01/2015] [Revised: 03/02/2016] [Accepted: 03/06/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The objective was to study the ability of the 30-min plasma glucose (30-min PG) during an oral glucose tolerance test to predict the future risk of type 2 diabetes among Asian Indians with impaired glucose tolerance. METHODS For the present analyses, we utilized data from 753 participants from two diabetes primary prevention studies, having complete data at the end of the study periods, including 236 from Indian Diabetes Prevention Programme-1 and 517 from the 2013 study. Baseline 30-min PG values were divided into tertiles: T1 < 9.1 mmol/L (<163.0 mg/dL); T2 9.2-10.4 mmol/L (164.0-187.0 mg/dL) and T3 ≥ 10.4 mmol/L (≥188 mg/dL). The predictive values of tertiles of 30-min PG for incident diabetes were assessed using Cox regression analyses RESULTS: At the end of the studies, 230 (30.5%) participants developed diabetes. Participants with higher levels of 30-min PG were more likely to have increased fasting, 2-h PG and HbA1c levels, increased prevalence of impaired fasting glucose and decreased beta cell function. The progression rate of diabetes increased with increasing tertiles of 30-min PG. Cox's regression analysis showed that 30-min PG was an independent predictor of incident diabetes after adjustment for an array of covariates [Hazard Ratio (HR):1.44 (1.01-2.06)] CONCLUSIONS: This prospective analysis demonstrates, for the first time, an independent association between an elevated 30-min PG level and incident diabetes among Asian Indians with impaired glucose tolerance. Predictive utility of glycemic thresholds at various time points other than the traditional fasting and 2-h PG values should therefore merit further consideration. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Snehalatha Chamukuttan
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, 600008, India
| | - Jagannathan Ram
- Department of Population Health, Center for Healthful Behavior Change, NYU School of Medicine, NYU Langone Medical Centre, New York, USA
| | - Arun Nanditha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, 600008, India
| | - Ananth Samith Shetty
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, 600008, India
| | - Mary Ann Sevick
- Department of Population Health, Center for Healthful Behavior Change, NYU School of Medicine, NYU Langone Medical Centre, New York, USA
| | - Michael Bergman
- Department of Medicine, Division of Endocrinology and Metabolism, NYU Diabetes Prevention Program, NYU Langone Medical Centre, New York, USA
| | | | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, 600008, India.
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Lee DC, Long JA, Sevick MA, Yi SS, Athens JK, Elbel B, Wall SP. The local geographic distribution of diabetic complications in New York City: Associated population characteristics and differences by type of complication. Diabetes Res Clin Pract 2016; 119:88-96. [PMID: 27497144 DOI: 10.1016/j.diabres.2016.07.008] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/26/2016] [Accepted: 07/15/2016] [Indexed: 01/13/2023]
Abstract
AIMS To identify population characteristics associated with local variation in the prevalence of diabetic complications and compare the geographic distribution of different types of complications in New York City. METHODS Using an all-payer database of emergency visits, we identified the proportion of unique adults with diabetes who also had cardiac, neurologic, renal and lower extremity complications. We performed multivariable regression to identify associations of demographic and socioeconomic factors, and diabetes-specific emergency department use with the prevalence of diabetic complications by Census tract. We also used geospatial analysis to compare local hotspots of diabetic complications. RESULTS We identified 4.6million unique New York City adults, of which 10.5% had diabetes. Adjusting for demographic and socioeconomic factors, diabetes-specific emergency department use was associated with severe microvascular renal and lower extremity complications (p-values<0.001), but not with severe macrovascular cardiac or neurologic complications (p-values of 0.39 and 0.29). Our hotspot analysis demonstrated significant geographic heterogeneity in the prevalence of diabetic complications depending on the type of complication. Notably, the geographic distribution of hotspots of myocardial infarction were inversely correlated with hotspots of end-stage renal disease and lower extremity amputations (coefficients: -0.28 and -0.28). CONCLUSIONS We found differences in the local geographic distribution of diabetic complications, which highlight the contrasting risk factors for developing macrovascular versus microvascular diabetic complications. Based on our analysis, we also found that high diabetes-specific emergency department use was correlated with poor diabetic outcomes. Emergency department utilization data can help identify the location of specific populations with poor glycemic control.
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Affiliation(s)
- David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 560 First Avenue, New York, NY 10016, United States; Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, United States.
| | - Judith A Long
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States; Center for Health Equity Research, Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, United States
| | - Mary Ann Sevick
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, United States
| | - Stella S Yi
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, United States
| | - Jessica K Athens
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, United States
| | - Brian Elbel
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, United States; Wagner Graduate School of Public Service, New York University, 295 Lafayette Street, New York, NY 10012, United States
| | - Stephen P Wall
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 560 First Avenue, New York, NY 10016, United States
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50
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St-Jules DE, Goldfarb DS, Sevick MA. Nutrient Non-equivalence: Does Restricting High-Potassium Plant Foods Help to Prevent Hyperkalemia in Hemodialysis Patients? J Ren Nutr 2016; 26:282-7. [PMID: 26975777 PMCID: PMC5986180 DOI: 10.1053/j.jrn.2016.02.005] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/15/2016] [Accepted: 02/08/2016] [Indexed: 12/21/2022] Open
Abstract
Hemodialysis patients are often advised to limit their intake of high-potassium foods to help manage hyperkalemia. However, the benefits of this practice are entirely theoretical and not supported by rigorous randomized controlled trials. The hypothesis that potassium restriction is useful is based on the assumption that different sources of dietary potassium are therapeutically equivalent. In fact, animal and plant sources of potassium may differ in their potential to contribute to hyperkalemia. In this commentary, we summarize the historical research basis for limiting high-potassium foods. Ultimately, we conclude that this approach is not evidence-based and may actually present harm to patients. However, given the uncertainty arising from the paucity of conclusive data, we agree that until the appropriate intervention studies are conducted, practitioners should continue to advise restriction of high-potassium foods.
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Affiliation(s)
- David E St-Jules
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, New York.
| | - David S Goldfarb
- Division of Nephrology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, New York
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