Effects of a Lifestyle Intervention on Diabetes Risk in Latino Youth

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Description
Background: The prevalence of childhood obesity has disproportionately affected Latino youth. This increase in obesity is seen with an increased incidence of Type 2 Diabetes. Objective/Hypothesis: The objective of this study was to determine the effects of a community based

Background: The prevalence of childhood obesity has disproportionately affected Latino youth. This increase in obesity is seen with an increased incidence of Type 2 Diabetes. Objective/Hypothesis: The objective of this study was to determine the effects of a community based lifestyle intervention, which encompassed nutrition education and physical activity, on diabetes risk in pre-diabetic Latino adolescents. Diabetes risk was assessed using pancreatic beta cell function as measured by proinsulin: insulin ratio. It was hypothesized that reductions in added sugar intake and reductions in saturated fat intake will be associated with improved beta cell function as measured by proinsulin: insulin ratio. Study Design/Participants: In this quasi-experimental study design, n=17 pre-diabetic Latino adolescents between the ages of 14-16 participated in a lifestyle intervention. Methods: Anthropometric measurements (weight, height, waist circumference, BMI) and body composition (body %) were determined for all participants at baseline and post intervention. Fasting proinsulin (PI), fasting insulin (I) and 2hr-OGTT were also determined. Dietary intake was measured using the Block Kids Food Screener for kids ages 2-17y (2007). The intervention consisted of nutrition education classes and physical activity sessions for 12 weeks. Results: We found significant decreases in body fat % following the intervention. There were no significant decreases in fasting insulin. Proinsulin significantly decreased. However we did no see a significant change in PI/I (p= 0.003). Dietary behaviors of added sugar (p=0.03) and saturated fat (p=0.04) showed significant decreases. No significant associations were found between changes in added sugar to improvements in beta cell function, r=0.072, p-value= 0.7. We also did not observe significant associations between reductions in saturated fat intake and improvements in beta cell function, r=0.152, p-value =0.6. Conclusions: We concluded that a 12-week lifestyle intervention resulted in significant changes in dietary behaviors. These changes were not however associated with improvements in beta cell function.
Date Created
2015-05
Agent

Can-Do-Tude: an online intervention using principles of motivational interviewing and tailored diabetes self-management education for adolescents with Type 1 diabetes

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Description
Type 1 diabetes (T1D) is one of the most common chronic diseases in youth and it has been shown that adolescents have the worst glycemic control of any age group. The objective of this study was to develop, test

Type 1 diabetes (T1D) is one of the most common chronic diseases in youth and it has been shown that adolescents have the worst glycemic control of any age group. The objective of this study was to develop, test and evaluate the feasibility of an online intervention (Can-Do-Tude) that uses the principles of motivational interviewing (MI) to deliver tailored diabetes self-management education to adolescents with T1D. Bandura’s efficacy belief system was used to guide the design of this study.



The study used a multi-phase, multi-method approach. The first phase (alpha) of this study was a qualitative descriptive design to examine the intervention’s fidelity. Evaluation of performance was conducted by experts in the fields of MI, T1D, adolescence and/or online education. The second phase (beta) was a quantitative descriptive design conducted in order to evaluate feasibility by examining the acceptability (recruitment, retention and satisfaction) and implementation (diabetes self-management self-efficacy) to determine whether the intervention was appropriate for further testing.

First phase findings showed that the intervention passed all measures with the content experts (n = 6): it was functional, accurate, usable and secure. Improvements to the intervention were made based on reviewer recommendations. For the second phase 5 adolescents between 14 and 17 were enrolled. Three adolescents completed all 4 weeks of the intervention while 2 completed only 3 weeks. Participants (n = 3) rated satisfaction on a 5-point Likert-type scale ranging from “not at all” satisfied (1) to “very much” satisfied (5). There was a positive response to the intervention (M = 4.28, SD = 0.55). Implementation was measured by a pre- and post-test for diabetes self-management self-efficacy. Participants (n = 3) demonstrated overall improvements in diabetes self-management self-efficacy (Z = -2.952, p = .007).

Implications for further Can-Do-Tude research are planned at a metropolitan diabetes center using updated technology including an application platform. Although the sample was small, findings indicate that the intervention can be conducted using a web-based format and there is initial evidence of improvement in self-efficacy for diabetes self-management.
Date Created
2017
Agent

Preventing diabetes in obese Latino youth with prediabetes: a study protocol for a randomized controlled trial

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Description
Background
Obese Latino adolescents are disproportionately impacted by insulin resistance and type 2 diabetes. Prediabetes is an intermediate stage in the pathogenesis of type 2 diabetes and represents a critical opportunity for intervention. However, to date, no diabetes prevention studies have

Background
Obese Latino adolescents are disproportionately impacted by insulin resistance and type 2 diabetes. Prediabetes is an intermediate stage in the pathogenesis of type 2 diabetes and represents a critical opportunity for intervention. However, to date, no diabetes prevention studies have been conducted in obese Latino youth with prediabetes, a highly vulnerable and underserved group. Therefore, we propose a randomized-controlled trial to test the short-term (6-month) and long-term (12-month) efficacy of a culturally-grounded, lifestyle intervention, as compared to usual care, for improving glucose tolerance and reducing diabetes risk in 120 obese Latino adolescents with prediabetes.
Methods
Participants will be randomized to a lifestyle intervention or usual care group. Participants in the intervention group will attend weekly nutrition and wellness sessions and physical activity sessions twice a week for six months, followed by three months of booster sessions. The overall approach of the intervention is framed within a multilevel Ecodevelopmental model that leverages community, family, peer, and individual factors during the critical transition period of adolescence. The intervention is also guided by Social Cognitive Theory and employs key behavioral modification strategies to enhance self-efficacy and foster social support for making and sustaining healthy behavior changes. We will test intervention effects on quality of life, explore the potential mediating effects of changes in body composition, total, regional, and organ fat on improving glucose tolerance and increasing insulin sensitivity, and estimate the initial incremental cost effectiveness of the intervention as compared with usual care for improving glucose tolerance.
Discussion
The proposed trial builds upon extant collaborations of a transdisciplinary team of investigators working in concert with local community agencies to address critical gaps in how diabetes prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution oriented programs to prevent type 2 diabetes in this and other populations of high-risk youth.
Date Created
2017-03-16
Agent

Whole Blood Gene Expression Profiles in Insulin Resistant Latinos With the Metabolic Syndrome

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Description

Although insulin resistance in skeletal muscle is well-characterized, the role of circulating whole blood in the metabolic syndrome phenotype is not well understood. We set out to test the hypothesis that genes involved in inflammation, insulin signaling and mitochondrial function

Although insulin resistance in skeletal muscle is well-characterized, the role of circulating whole blood in the metabolic syndrome phenotype is not well understood. We set out to test the hypothesis that genes involved in inflammation, insulin signaling and mitochondrial function would be altered in expression in the whole blood of individuals with metabolic syndrome. We further wanted to examine whether similar relationships that we have found previously in skeletal muscle exist in peripheral whole blood cells. All subjects (n=184) were Latino descent from the Arizona Insulin Resistance registry. Subjects were classified based on the metabolic syndrome phenotype according to the National Cholesterol Education Program’s Adult Treatment Panel III. Of the 184 Latino subjects in the study, 74 were classified with the metabolic syndrome and 110 were without. Whole blood gene expression profiling was performed using the Agilent 4x44K Whole Human Genome Microarray. Whole blood microarray analysis identified 1,432 probes that were altered in expression ≥1.2 fold and P<0.05 after Benjamini-Hochberg in the metabolic syndrome subjects. KEGG pathway analysis revealed significant enrichment for pathways including ribosome, oxidative phosphorylation and MAPK signaling (all Benjamini-Hochberg P<0.05). Whole blood mRNA expression changes observed in the microarray data were confirmed by quantitative RT-PCR. Transcription factor binding motif enrichment analysis revealed E2F1, ELK1, NF-kappaB, STAT1 and STAT3 significantly enriched after Bonferroni correction (all P<0.05). The results of the present study demonstrate that whole blood is a useful tissue for studying the metabolic syndrome and its underlying insulin resistance although the relationship between blood and skeletal muscle differs.

Date Created
2013-12-17
Agent

Physical Activity and FTO Genotype by Physical Activity Interactive Influences on Obesity

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Description

Background: Although the effect of the fat mass and obesity-associated (FTO) gene on adiposity is well established, there is a lack of evidence whether physical activity (PA) modifies the effect of FTO variants on obesity in Latino populations. Therefore, the purpose

Background: Although the effect of the fat mass and obesity-associated (FTO) gene on adiposity is well established, there is a lack of evidence whether physical activity (PA) modifies the effect of FTO variants on obesity in Latino populations. Therefore, the purpose of this study was to examine PA influences and interactive effects between FTO variants and PA on measures of adiposity in Latinos.

Results: After controlling for age and sex, participants who did not engage in regular PA exhibited higher BMI, fat mass, HC, and WC with statistical significance (P < 0.001). Although significant associations between the three FTO genotypes and adiposity measures were found, none of the FTO genotype by PA interaction assessments revealed nominally significant associations. However, several of such interactive influences exhibited considerable trend towards association.

Conclusions: These data suggest that adiposity measures are associated with PA and FTO variants in Latinos, but the impact of their interactive influences on these obesity measures appear to be minimal. Future studies with large sample sizes may help to determine whether individuals with specific FTO variants exhibit differential responses to PA interventions.

Date Created
2016-02-24
Agent

Next-Generation Sequencing Methylation Profiling of Subjects With Obesity Identifies Novel Gene Changes

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Description

Background: Obesity is a metabolic disease caused by environmental and genetic factors. However, the epigenetic mechanisms of obesity are incompletely understood. The aim of our study was to investigate the role of skeletal muscle DNA methylation in combination with transcriptomic changes

Background: Obesity is a metabolic disease caused by environmental and genetic factors. However, the epigenetic mechanisms of obesity are incompletely understood. The aim of our study was to investigate the role of skeletal muscle DNA methylation in combination with transcriptomic changes in obesity.

Results: Muscle biopsies were obtained basally from lean (n = 12; BMI = 23.4 ± 0.7 kg/m[superscript 2]) and obese (n = 10; BMI = 32.9 ± 0.7 kg/m[superscript 2]) participants in combination with euglycemic-hyperinsulinemic clamps to assess insulin sensitivity. We performed reduced representation bisulfite sequencing (RRBS) next-generation methylation and microarray analyses on DNA and RNA isolated from vastus lateralis muscle biopsies. There were 13,130 differentially methylated cytosines (DMC; uncorrected P < 0.05) that were altered in the promoter and untranslated (5' and 3'UTR) regions in the obese versus lean analysis. Microarray analysis revealed 99 probes that were significantly (corrected P < 0.05) altered. Of these, 12 genes (encompassing 22 methylation sites) demonstrated a negative relationship between gene expression and DNA methylation. Specifically, sorbin and SH3 domain containing 3 (SORBS3) which codes for the adapter protein vinexin was significantly decreased in gene expression (fold change −1.9) and had nine DMCs that were significantly increased in methylation in obesity (methylation differences ranged from 5.0 to 24.4 %). Moreover, differentially methylated region (DMR) analysis identified a region in the 5'UTR (Chr.8:22,423,530–22,423,569) of SORBS3 that was increased in methylation by 11.2 % in the obese group. The negative relationship observed between DNA methylation and gene expression for SORBS3 was validated by a site-specific sequencing approach, pyrosequencing, and qRT-PCR. Additionally, we performed transcription factor binding analysis and identified a number of transcription factors whose binding to the differentially methylated sites or region may contribute to obesity.

Conclusions: These results demonstrate that obesity alters the epigenome through DNA methylation and highlights novel transcriptomic changes in SORBS3 in skeletal muscle.

Date Created
2016-07-18
Agent

Ethnicity and Elevated Liver Transaminases Among Newly Diagnosed Children With Type 2 Diabetes

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Description

Background: To examine the influence of ethnicity on liver transaminases among adolescents with type 2 diabetes mellitus (T2DM).

Methods: A retrospective medical chart review of 57 (30 males and 27 females) newly diagnosed patients with T2DM. Ethnicity was determined by self-report and height,

Background: To examine the influence of ethnicity on liver transaminases among adolescents with type 2 diabetes mellitus (T2DM).

Methods: A retrospective medical chart review of 57 (30 males and 27 females) newly diagnosed patients with T2DM. Ethnicity was determined by self-report and height, weight, body mass index (BMI) and glycosylated hemoglobin (HbA1c) were obtained using standard clinical procedures. Fasting levels of alanine aminotransaminase (ALT) and aspartate aminotransferase (AST) were collected prior to the initiation of any therapy.

Results: Age, gender, height, weight, BMI, and HbA1c did not differ between ethnic groups. Compared to African-Americans, Hispanics had significantly higher ALT (23.9 ± 3.4 vs. 107.8 ± 20.3, p=0.002) and AST (17.7 ± 2.5 vs. 71.1 ± 15.7, p<0.001) and were significantly more likely to have ALT values above the upper limit of normal (20% vs. 71%, p=0.005) and twice the upper limit of normal (0% vs. 39%, p=0.05) as well as AST values above the upper limit of normal (0% vs. 53%, p=0.002). No differences in ALT or AST were found between Hispanics and non-Hispanic whites or between African-Americans and non-Hispanic whites.

Conclusions: These preliminary findings suggest that Hispanic children with T2DM may be at higher risk for developing non-alcoholic fatty liver disease and indicate that a comprehensive hepatic evaluation is warranted in this population. Future studies that incorporate more precise and proximal measures of liver health are warranted in this population.

Date Created
2012-11-07
Agent

Abdominal Adiposity, Insulin Resistance, and Oxidized Low-Density Lipoproteins in Latino Adolescents

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Description

Abdominal obesity and insulin resistance (IR) place youth at higher risk for premature cardiovascular disease (CVD), but the underlying mechanisms are not clear. In adults, abdominal obesity and IR contribute to the oxidation of low-density lipoprotein (LDL). Whether similar mechanisms

Abdominal obesity and insulin resistance (IR) place youth at higher risk for premature cardiovascular disease (CVD), but the underlying mechanisms are not clear. In adults, abdominal obesity and IR contribute to the oxidation of low-density lipoprotein (LDL). Whether similar mechanisms are operational in Latino adolescents is unknown. Therefore, we determined whether IR and abdominal adiposity are associated with higher oxLDL concentrations in Latino adolescents. Data from 123 Latino adolescents (16.3 ± 2.5 years; female = 74) were used for the present analysis. Participants were assessed for waist circumference, fasting serum oxLDL, and insulin sensitivity by the whole body insulin sensitivity index. In separate linear regression models adjusting for age and sex, both waist circumference and insulin sensitivity were significant predictors of oxLDL (β = 1.9; p = 0.002; R[superscript 2] = 0.13, β = −1.7; p = 0.006; R[superscript 2] = 0.11, respectively). When insulin sensitivity and waist circumference were included in the same model, both remained independent predictors of oxLDL (β = 1.7; p = 0.016 and, β = −1.5; p = 0.055, respectively; R[superscript 2] = 0.16). These results suggest that insulin resistance and abdominal adiposity are associated with higher levels of LDL oxidation which may be a mechanism contributing to increased CVD risk in Latino adolescents.

Date Created
2013-11-16

Effects of a fat-sugar supplemented diet, with and without exercise training, on body fat mass and selected cardiometabolic risk markers in overweight and obese, sedentary males

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Description
The winter holiday period has been highlighted as a major risk period for weight gain due to excess caloric intake in the form of fat and sugar. Furthermore, diets high in fat and sugar have been implicated in the pathogenesis

The winter holiday period has been highlighted as a major risk period for weight gain due to excess caloric intake in the form of fat and sugar. Furthermore, diets high in fat and sugar have been implicated in the pathogenesis of diabetes and cardiovascular disease. Exercise aids in the prevention of weight/fat gain, and prevents deleterious changes in cardiometabolic function. The objective of this study was to examine the effects of a fat-sugar supplemented diet, with and without two different exercise training protocols, on body composition, glycemic control and other markers of cardiovascular disease in an at-risk population of overweight and obese males. Twenty-seven, healthy overweight/obese (BMI >25 kg/m2) males were fed 2 donuts per day, 6 days/week, for four weeks, while maintaining their current diet. In addition, all subjects were randomized to one of the following conditions: sedentary control, 1,000 kcal/week moderate-intensity continuous training (MICT) (50% of peak oxygen consumption), or 1,000 kcal/week high-intensity interval training (HIIT) (90-95% of peak heart rate). Supervised exercise training was performed 4 days/week on a cycle ergometer. Changes in body weight and composition, endothelial function, arterial stiffness, glycemic control, blood lipids and cardiorespiratory fitness (CRF) were assessed before and after the intervention. Body weight, lean mass and visceral fat increased significantly in HIIT (p<0.05) and were unchanged in MICT. There was a trend for a significant increase in body weight (p=0.07) and lean mass (p=0.11) in control. Glycemic control during the 2-h OGTT improved significantly in MICT and control, with no change in HIIT. Hepatic insulin resistance index (IRI) and 30-min insulin during the OGTT improved significantly after MICT and worsened following control (p=0.03), while HIIT was unchanged. CRF increased significantly in both HIIT and MICT, with no change in control (p<0.001). There were no significant changes in other markers of cardiovascular disease. The addition of a fat-sugar supplement (~14,500 kcal) over a 4-week period was not sufficient to induce deleterious changes in body composition and cardiometabolic health in overweight/obese young males. Exercise training did not afford overweight/obese males additional health benefits, with the exception of improvements in fitness and hepatic IRI.
Date Created
2016
Agent

Parent outcomes for a family-based behavioral nutrition and physical activity program: the Athletes for Life study

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Description
Background: Latinos have disproportionately high rates of obesity and type 2 diabetes. Family-based interventions may reduce chronic disease risk among Latinos across generations.

Purpose: To assess the efficacy of Athletes for Life (AFL), a 12-week community-and-family-based behavioral intervention, for improving

Background: Latinos have disproportionately high rates of obesity and type 2 diabetes. Family-based interventions may reduce chronic disease risk among Latinos across generations.

Purpose: To assess the efficacy of Athletes for Life (AFL), a 12-week community-and-family-based behavioral intervention, for improving diet, physical activity (PA), anthropometrics, fitness, and biochemical outcomes among mostly Latino parents.

Methods: Parents with at least one child 6-11 years of age were randomized to active AFL participation (n=14) or a wait-list control (n=14) group. AFL consisted of twice weekly 90 minute sessions (45 minutes of nutrition-focused lessons and 45 minutes of PA participation) designed to promote fruit and vegetable consumption, reduction of sugar intake, and increasing habitual PA. Data were collected prior to and immediately after the 12 week intervention.

Results: Participants (37.9±7.2y) were mostly Latino (93%), Spanish speaking (68%), and women (93%). Relative to participants in the control group, AFL participants had a significant reduction in body fat (-1.1±1.2% vs. 0.2±1.2%; p=0.014), resting (-7.6±10.2 bpm vs. +2.1±6.8 bpm; p<0.01), exercise (-8.4±8.7 bpm vs. +0.4±7.3 bpm; p<0.01), and recovery heart rate (-11.9±12.8 bpm vs. -0.3±11.4 bpm; p=0.01), and one mile run time (-1.5±1.0 min vs. -0.1±0.9 min; p<0.01), and a significant increase in estimated VO2 peak (+1.9±1.9 ml/kg/min vs. 0.0±1.8 ml/kg/min; p=0.01). AFL participants also reported an increase in the number of days/week accumulating 30 minutes of MVPA (+0.8±3.2 vs. -1.5±2.3; p=0.004) and daily servings of fruits (+1.3±1.4 vs. +0.3±1.4; p<0.05) and vegetables (+1.8±1.7 vs. +0.1±1.2; p<0.05), relative to control participants. There were no significant differences between groups in changes in diet assessed by 3-day food record, accelerometer-measured PA, weight, blood pressure, visceral fat, biomarkers for cardiovascular disease or nutritional biomarkers.

Conclusions: Despite the lack of effects on diet and PA behaviors, AFL shows promising preliminary efficacy for reducing body fat and improving fitness among adult participants. Future research aimed at improving fitness among Latino parents with family-based intervention is warranted.
Date Created
2015
Agent