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，非裔美国人 (AA) 受高血压和慢性肾病 (CKD) 的影响尤为严重。社会经济地位（SES）较低的人的种族差异最为严重，而饮食因素可能是造成这种差异的主要原因。与白人相比，社会经济地位低的 AA 更有可能经历粮食不安全并生活在“食物荒漠”中，并且不太可能遵循预防高血压饮食方法 (DASH) 规定的饮食。尽管有证据表明，与白人相比，坚持 DASH 饮食对 AA 患者的血压益处可能更大，并且有证据表明 DASH 饮食可能会减缓 CKD 进展（包括尿白蛋白排泄减少）。我们建议以我们的试点研究“五加坚果和豆类试验”令人鼓舞的结果为基础，该研究是约翰·霍普金斯大学研究人员、社区超市、巴尔的摩市卫生局的“虚拟超市”计划、社区诊所和高度参与的社区咨询委员会合作进行的。这项随机试验测试了饮食方法对增加 DASH 饮食核心特征（高钾食物）摄入量的影响。从社区诊所招募的总共 123 名高血压得到控制的 AA 患者在 8 周内获得了个性化饮食建议、杂货订购和送货方面的帮助，以及每周价值 30 美元的高钾食品。通过这种方法，我们发现水果、蔬菜、钾、镁和纤维的摄入量在统计上显着增加，而钠的摄入量却减少了。此外，尿白蛋白排泄总体减少了 14%，入组时有明显白蛋白尿的患者减少了 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（受控或不受控）加上轻度/中度 CKD 的人群——受不良饮食不良影响的风险极高的人群。在随机试验中，主要目的是检验以下假设：提供采用 DASH 饮食的营养建议和 30 美元 根据从社区诊所招募的患者的个人选择和附近商店的供应情况，每周摄入富含钾的食物，将降低患有高血压和 CKD 的低 SES AA 患者的血压并减少尿白蛋白排泄。我们提案的优势包括整合一支经验丰富、高度协作的研究团队，他们在临床试验、肾病学、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、巴尔的摩市卫生局和当地超市建立了密切的合作伙伴关系。如果我们的假设正确，那么我们的试验将建立一种可立即转化、廉价且安全的辅助治疗方法，用于治疗低 SES AA 中的高血压和肾损伤（白蛋白尿）。