COMMUNITY BASED NIDDM PREVENTION TARGETING ZUNI YOUTH

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In spite of advances in the understanding of the mechanisms underlying NIDDM, and some advances in treatment, prevalence among American Indians continues to rise. Cancer prevention research is moving forward by developing clinical trials which target biomarkers of elevated risk, in populations already at high risk. Hyperinsulinemia may provide such a marker for studies targeted to prevention of NIDDM. Certainly American Indian communities provide populations at sufficient risk for adequate trial design. In the past, the only etiologic factor which could be identified with certainty was obesity, a condition which is notoriously difficult to treat. Recent research suggests that lack of exercise and high sucrose consumption may also independently contribute to risk, and these provide more specific behaviors to target in prevention studies. The proposed research, to our knowledge, represents the first fully evaluated primary prevention intervention study for NIDDM. Although this project can only study impact on biomarkers of risk (obesity, insulin levels), the team, including the Pueblo of Zuni, is committed to continuing research in this population to track the long-term impact of these interventions on incidence of GDM and NIDDM. This project is a community-based intervention study directed toward the primary prevention of NIDDM. The target group is high school youth. The intervention will target two components: increases in physical activity (of a type which can be sustained throughout adulthood), and decreases in consumption of simple carbohydrates as sodas, candy, and baked goods. The interventions will be supported by curriculum inputs, development of a teen wellness center (a high school based branch of the Zuni Wellness Center), and a teen wellness task force. The intervention will be assessed using a pre-post design. Assessments will be made of the implementation of the intervention itself by longitudinal assessment of targeted behaviors, attitudes, and knowledge, using self-report, biologic monitoring (heart rate monitoring) and unobtrusive measures. Assessment of the biological impact of the intervention will be made using fitness measures (e.g. step test), body composition and obesity assessment. All juniors and seniors in years 01, 02, and 04 will also be examined using a modified OGTT, examining glucose and insulin levels before and 30 minutes after a 75 gm carbohydrate load.