Community-Based Dietary Approach for Hypertensive African Americans with Chronic Kidney Disease

针对患有慢性肾病的高血压非裔美国人的社区饮食方法

• 批准号: 9128134
• 负责人: DEIDRA CANDICE CREWS
• 金额: $ 47.97万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-27 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9128134
• 关键词: Address; Adherence; Adjuvant Therapy; Adopted; Adverse effects; Affect; African American; Age; Albumins; Albuminuria; Antihypertensive Agents; Baltimore; Blood Pressure; Body Weight Changes; Cellular Phone; Chronic Kidney Failure; Cities; Clinic; Clinical Trials; Communities; Community Physician; Consumption; Cost Analysis; DASH diet; Diabetes Mellitus; Diet; Dietary Factors; Dietary Fiber; Dietary Intervention; Dietary Practices; Direct Costs; Disease Progression; End stage renal failure; Enrollment; Ensure; Excretory function; Fiber; Food; Food Selections; Gender; Health; Health Food; Hypertension; Income; Intake; Intervention; Investigation; Kidney; Kidney Diseases; Lead; Life; Low income; Magnesium; Mediating; Milk; Neighborhoods; Nephrology; Nutritional; Nuts; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Pilot Projects; Population; Potassium; Primary Health Care; Randomized Clinical Trials; Recruitment Activity; Research Infrastructure; Research Personnel; Risk; Sodium; Subgroup; Supermarket; Testing; United States; Urine; base; bean; blood pressure reduction; community based participatory research; dietary approach; early onset; experience; follow-up; fruits and vegetables; health disparity; high risk; hypertension control; hypertension treatment; intervention effect; low socioeconomic status; mobile computing; pilot trial; programs; racial difference; racial disparity; randomized trial; socioeconomic disadvantage; urinary; virtual

 DESCRIPTION (provided by applicant): African Americans (AAs) are disproportionately affected by hypertension and chronic kidney disease (CKD) when compared to whites. Racial disparities are most profound among persons of low socioeconomic status (SES) and dietary factors likely underlie much of this disparity. Low SES AAs are more likely to experience food insecurity and live in "food deserts" and are less likely to follow a Dietary Approaches to Stop Hypertension (DASH) accordant diet than are whites. This is despite evidence that adherence to the DASH diet may have greater blood pressure benefit for AAs than whites, and evidence that the DASH diet may slow CKD progression (including reductions in urine albumin excretion). We propose to build upon encouraging results of our pilot study, "The Five-Plus Nuts and Beans Trial", which was conducted as a partnership between Johns Hopkins investigators, a community supermarket, the Baltimore City Health Department's "Virtual Supermarket" program, a community-based clinic and a highly engaged Community Advisory Board. This randomized trial tested the effects of a dietary approach to increase consumption of a central feature of the DASH diet--high potassium foods. A total of 123 AA patients with controlled hypertension, and recruited from a community-based clinic, were provided personalized dietary advice, assistance with grocery ordering and delivery, and $30 per week worth of high potassium foods for an 8-week period. With this approach, we demonstrated statistically significant increases in consumption of fruits, vegetables, potassium, magnesium and fiber, and decreases in sodium intake. Also, there was a 14% reduction in urinary albumin excretion overall, and a 30% reduction among patients with significant albuminuria at enrollment. In this application, we propose a larger (n=150) and longer (1 year) trial of a dietary intervention in AAs with hypertension (controlled or uncontrolled) plus mild/moderate CKD-a population at very high risk of the adverse effects of poor diets. The primary aim, in the setting of a randomized trial, is to test the hypothesis that delivery of nutritional advice to adopt the DASH diet and $30 per week worth of potassium-rich foods, tailored to personal choices and availability in neighborhood stores of patients recruited from community-based clinics, will reduce blood pressure and reduce urinary albumin excretion in low SES AAs with hypertension and CKD. Strengths of our proposal include the integration of an experienced, highly collaborative team of investigators with expertise in clinical trials, nephrology, health disparities, community-based participatory research, integration of trials into primary care practices, and statistical analyses The investigation team includes a highly involved Community Advisory Board, and has an established close partnership with Johns Hopkins Community Physicians, the Baltimore City Health Department and local supermarkets. If our hypothesis is correct, then our trial will establish an immediately translatable, inexpensive, and safe approach for adjuvant therapy in the treatment of hypertension and kidney damage (albuminuria) among low SES AAs.

 描述（由申请人提供）：与白人相比，非洲裔美国人（AA）受高血压和慢性肾脏疾病（CKD）的影响不成比例。种族差异在社会经济地位低的人中最为严重，饮食因素可能是这种差异的主要原因。低SES的AA更有可能经历食物不安全，生活在“食物沙漠”中，并且不太可能遵循与白人一致的饮食方法来阻止高血压（DASH）。尽管有证据表明，坚持DASH饮食可能比白人对AA有更大的血压益处，并且有证据表明DASH饮食可能减缓CKD进展（包括尿白蛋白排泄减少）。我们建议建立在我们的试点研究，“五加坚果和豆类试验”，这是作为约翰霍普金斯调查员，社区超市，巴尔的摩市卫生局的“虚拟超市”计划，一个社区为基础的诊所和高度参与社区咨询委员会之间的伙伴关系进行的令人鼓舞的结果。这项随机试验测试了饮食方法对增加DASH饮食的核心特征-高钾食物消费的影响。共有123名高血压控制的AA患者从社区诊所招募，提供个性化的饮食建议，协助杂货店订购和送货，以及每周价值30美元的高钾食物，为期8周。通过这种方法，我们证明了水果，蔬菜，钾，镁和纤维的消费量在统计学上显着增加，钠的摄入量减少。此外，尿白蛋白排泄总体减少14%，入组时有显著白蛋白尿的患者减少30%。在本申请中，我们提出了一项更大（n=150）和更长（1年）的AA饮食干预试验 患有高血压（控制或不控制）和轻度/中度CKD的人群-不良饮食不良反应的风险非常高。在随机试验的背景下，主要目的是检验以下假设：提供营养建议以采用DASH饮食和30美元 根据社区诊所招募的患者的个人选择和社区商店的可用性，每周提供价值的富钾食物，将降低患有高血压和CKD的低SES AA的血压并减少尿白蛋白排泄。我们建议的优势包括整合一个经验丰富，高度合作的研究人员团队，他们在临床试验，肾脏病学，健康差异，基于社区的参与性研究，将试验纳入初级保健实践和统计分析方面具有专业知识。调查团队包括一个高度参与的社区咨询委员会，并与约翰霍普金斯社区医生建立了密切的伙伴关系，巴尔的摩市卫生局和当地超市。如果我们的假设是正确的，那么我们的试验将在低SES AA中建立一种可立即转化的、廉价的和安全的辅助治疗方法，用于治疗高血压和肾损伤（蛋白尿）。