Low glycemic diets in Latino children at risk for type 2 diabetes

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DESCRIPTION (provided by Applicant): The applicant is a pediatrician with a doctorate in public health, who holds primary appointments at the Children's National Medical Center and the George Washington University. Dr. Mirza has extensive clinical experience in pediatrics and public health nutrition in underserved populations. This award will enable her to obtain the training and mentoring to become an independent clinical investigator in the area of childhood obesity. The educational plan includes didactic courses to enhance Dr. Mirza's analytical capabilities, as well as a deeper understanding of the molecular and biological aspects of childhood obesity and its complications. The research project will enable Dr. Mirza to develop skills in intervention methodology and project management, and also provide her with hands-on experience in family-based nutrition interventions. Overweight is highly prevalent among Hispanic children in the U.S., and is commonly accompanied by insulin resistance and hyperinsulinemia in children with a family history of type 2 diabetes mellitus (T2DM). Low-glycemic load (GL) diets have been proposed to reduce hyperinsulinemia and body weight in children. However, it is unknown if reducing GL in Hispanic American children will improve insulin sensitivity or reduce overweight. The objectives of the research project are to compare the short- and long-term effects of a low-GL versus a low-fat diet on insulin sensitivity, body composition, and markers of metabolic risk in overweight Hispanic-American children at risk for T2DM. The hypothesis is that consumption of a low-GL diet will result in greater improvement in insulin sensitivity, greater decrease in BMI z-score and body fat, and a higher reduction in metabolic risk factors and inflammatory response compared to a low-fat diet. 84 children age 7-14y with BMI>95th percentile and at-risk for T2DM will be randomly assigned either to a low-GL or a low-fat dietary plan for 2y. Subjects will also participate in a culturally competent, family-based intervention program which includes behavior modification and enhanced physical activity. Changes in insulin sensitivity, BMI z-score, body fat, and aspects of the metabolic syndrome in the two dietary groups will be compared. Successful interventions to prevent the onset of T2DM are urgently needed for at-risk minority youth. Through this career development award, Dr. Mirza expects to become established as an independent investigator and a leader in pediatric obesity and clinical nutrition.