Diet Quality and CVD Risk Factors in a Family Based Weight Management Study

描述（由申请人提供）：家庭体重管理研究（FamWtStudy）（1 R18-DK 075981）旨在评价为期12个月的以家庭为基础的干预措施的效果，该干预措施旨在改善居住在少数民族代表性较高的社区的7-12岁儿童的BMI z评分和CVD风险因素，这些儿童的BMI z评分>第85百分位数。 招募的家庭将被随机分配到对照组或实验干预组。控制干预组将收到一本有健康饮食行为目标的小册子，一份关于如何增加体力活动的讲义，以及每季度一次的访问，其中包括对生活方式建议的简要回顾。实验干预组将接受为期3个月的每周课程，其中包括核心饮食和体育活动课程，然后是为期9个月的每月核心后课程，以促进对课程的遵守。核心课程中有针对性的饮食策略包括增加高色素水果和蔬菜以及鱼类的摄入量;以脱脂和低脂替代全脂牛奶和乳制品;减少肉类、油炸食品和美味小吃的摄入量。在为期一年的干预期间，将向家庭提供社会支持和量身定制的个性化咨询，并通过电话和家访来解决依从性障碍。本辅助研究应用的目的是扩大FamWtStudy的范围，以包括1）儿童-母亲/女性监护人对的饮食质量生物标志物测量，2）儿童和母亲/女性监护人的CVD风险因素测量，以及3）儿童-母亲/女性监护人对内饮食质量生物标志物和CVD风险因素干预前和干预后变化的关联评估。选择用于饮食质量的每种生物标志物是因为其是母研究所针对的饮食的不同组分的指标，并且可以提供粘附的指示-红细胞（RBC）18：3 n-3、20：4 n-6、20：5 n-3和22：6 n-3用于植物油、肉和鱼;血浆类胡萝卜素和叶绿醌用于高度着色的水果和蔬菜; RBC 15：0用于全脂牛奶和乳制品;和红细胞反式脂肪酸和血浆二乙酰基醌用于油炸食品和美味小吃。测量儿童和母亲/女性监护人的心血管疾病风险因素（总胆固醇、高密度脂蛋白和低密度脂蛋白胆固醇、甘油三酯、高敏C反应蛋白、葡萄糖和胰岛素浓度、血压和腰围），将允许评估家庭内的“溢出”效应和儿童-母亲/女性监护人对内的一致性。无论结果如何，这些结果将提供关键数据，用于设计少数民族社区的后续干预措施，以增加以家庭为基础的肥胖预防计划的影响和公共卫生的重要性，因为这些数据将提供一个领域的信息，该领域将继续挑战目前的努力，以阻止儿童肥胖症在高风险亚组中的趋势，并威胁到我们的医疗保健系统。由于FamWtStudy干预措施于2009年8月开始，因此响应具有时间敏感性，因此拥有收集、处理、存档、转移和分析血浆和RBC样本的资源至关重要。 公共卫生相关性：拟议工作的结果将对公共卫生具有重要意义，因为它们将为旨在防止高危儿童体重过度增加和儿童母亲/女性监护人潜在“溢出”效应的家庭方案的有效性提供客观衡量标准。客观衡量标准将包括儿童及其母亲/女性监护人的饮食质量和心血管疾病风险因素指标，以及儿童和母亲/女性监护人之间变化的关系。制定和评估防止体重过度增加的策略对于支持目前在美国遏制儿童肥胖浪潮的努力至关重要，一个威胁到我们医疗系统的公共卫生问题。(End摘要）

DESCRIPTION (provided by applicant): The Family Weight Management Study (FamWtStudy) (1R18-DK075981) is designed to evaluate the effects of a 12-month, family-based intervention designed to improve BMI z-scores and CVD risk factors in children ages 7-12 years living in a community with a high minority representation, who have a BMI z-score >85th percentile. The families recruited will be randomized to either the Control or Experimental Intervention group. The Control Intervention group will receive a booklet with targets for healthy eating behaviors, a handout on how to increase physical activity, and quarterly visits that will include a brief review of lifestyle recommendations. The Experimental Intervention group will receive weekly sessions for 3 months that include a core diet and physical activity curriculum followed by monthly post-core sessions for 9 months promoting adherence to the curriculum. Targeted diet strategies in the core curriculum include increasing highly pigmented fruit and vegetable, and fish intake; substituting non-fat and low-fat for full-fat milk and dairy products; and reducing meat, fried food and savory snack intakes. During the one-year intervention period social support and tailored individualized counseling will be provided to the families, augmented with telephone calls and home visits addressing barriers to adherence. The goal of this ancillary study application is to expand the scope of the FamWtStudy to include 1) measures of diet quality biomarkers in child-mother/female guardian pairs, 2) measures of CVD risk factors in children and mothers/female guardians, and 3) assessment of associations within child-mother/female guardian pairs for diet quality biomarkers and CVD risk factors pre-intervention and post-intervention change. Each biomarker for diet quality was chosen because it is an indicator of a different component of the diet targeted by the parent study and can provide an indication of adherence - red blood cell (RBC) 18:3n-3, 20:4n-6, 20:5n-3 and 22:6n-3 for vegetable oil, meat and fish; plasma carotenoids and phylloquinone for highly pigmented fruits and vegetables; RBC 15:0 for full-fat milk and dairy products; and RBC trans fatty acids and plasma dihydrophylloquinone for fried food and savory snacks. Measuring the CVD risk factors (total, HDL and LDL cholesterol, triglyceride, hsCRP, glucose and insulin concentrations, blood pressure and waist circumference) in the children and mothers/female guardians, will allow for an assessment of 'spill-over' effect within families and concordance within child-mother/female guardian pairs. Regardless of the outcomes, the results will provide critical data with which to design subsequent interventions in minority communities to increase the impact of family-based obesity prevention programs and public health importance because the data will provide information in an area that continues to challenge current efforts to stem the tide of childhood obesity in a high-risk subgroup and an area that threatens to overwhelm our healthcare system. The response is time-sensitive because the FamWtStudy intervention started in August, 2009 and it is critical to have resources to collect, process, archive, transfer and analyze plasma and RBC samples. Public Health Relevance: The results of the proposed work will be of public health importance because they will provide objective measures for the effectiveness of a family-based program designed to prevent excess weight gain in high-risk children and potential 'spill-over' effects in the mothers/female guardians of the children. The objective measures will include indicators of diet quality and cardiovascular disease risk factors in the children and their mothers/female guardians, as well as the relationship of change within children and mothers/female guardian pairs. Developing and evaluating strategies to prevent excess weight gain is critical to support current efforts to stem the tide of childhood obesity in the U.S., a public health problem that threatens to overwhelm our healthcare system. (End of Abstract)