NUTRITION/BEHAVIOR IN CHILDREN WITH CHRONIC ILLNESS

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。目的是：1)开发行为干预的有效性，提高患有囊性纤维化、1型糖尿病和肥胖症儿童的饮食依从性，改善结果，提高生活质量；2)为候选人提供保护时间，指导正在进行行为营养临床研究的心理学/儿科学博士后和初级教师。候选人的研究重点是影响饮食依从性的行为因素，并将其转化为可在临床试验中进行测试的干预措施。对于每个人群，目标是通过临床结果研究确定行为治疗的疗效，并将研究结果转化为改进标准治疗。候选人在心理学/儿科学方面有指导研究员和初级教员的记录。该培训计划将进一步提高候选人在临床试验设计和结果分析方面的知识，并使他能够改善指导。该研究计划包括两个正在进行的项目：一项由美国国立卫生研究院资助的R01研究，“囊性纤维化幼儿饮食问题的行为治疗”，以及一项专注于“1型糖尿病幼儿饮食坚持障碍”的新研究。此外，候选人将继续研究低收入儿童的肥胖预防。指导计划将包括：1)指导两名研究员和一名心理学/儿科学的初级教员；2)监督研究人员的研究计划；3)参与研究人员的论文/拨款写作、临床试验设计、临床研究的方法和伦理等教学项目。（NIH/NIDDK资助）囊性纤维化，糖尿病和肥胖研究目标的简要描述如下：行为和营养治疗帮助患有囊性纤维化的学龄前儿童生长尽管有需要，但实现囊性纤维化（CF）幼儿最佳生长的循证营养干预措施并不存在。干预可以积极改变临床肺部疾病的进程，提高这些儿童的生存率。目的：开展一项多中心、随机、对照试验，比较行为加营养干预条件与注意控制干预条件。具体目标：1；确定行为干预对能量摄入和体重增加的影响；2. 在治疗一年后检查行为干预对生长（体重和身高）影响的持久性；和3。探讨体育活动与成长的关系。中心假设：行为干预将导致更好的成长，通过体重和身高的变化来衡量z年龄分数。100名2至6岁患有CF和胰腺功能不全的学龄前儿童将被随机分为两种情况之一。这两组将被分层，因此他们在治疗开始时的体重与年龄z分相似。铜绿假单胞菌感染史和性别将作为统计分析的协变量。将在基线、治疗后（6个月）和12个月随访后（基线后18个月）获得结局数据（通过7天饮食记录测量的能量摄入、体重、身高）。次要测量包括BMI、DXA测量的身体成分和皮肤褶皱、生长速度。长期目标是改变患有CF的幼儿的营养护理标准，因为行为干预可导致最佳生长并最终改善肺部健康。（NIH/NIDDK资助）影响幼儿1型糖尿病最佳血糖控制的因素维持良好的血糖控制是现代糖尿病管理的首要目标。胰岛素泵治疗，也被称为持续皮下胰岛素输注（CSII），是一种新的、安全的1型糖尿病（T1DM）患者胰岛素输送方法。胰岛素泵的工作原理是全天为T1DM患者提供稳定的胰岛素流。泵也允许患者在进食时获得更高剂量的胰岛素。胰岛素泵治疗已经改变了糖尿病的管理。在使用泵之前，T1DM患者必须严格遵循与体内胰岛素水平相匹配的膳食/零食时间表。通过胰岛素泵治疗，患者可以在想吃的时候吃东西，也可以在吃饭时吃任何想吃的东西。胰岛素泵治疗已被证明可以改善青少年和成人T1DM患者的血糖控制。在年幼的T1DM儿童中，胰岛素泵治疗改善了一些患者的血糖控制，但对其他患者没有效果。我们建议研究可能影响T1DM患儿接受CSII治疗家庭血糖控制的父母和儿童因素。研究目的将通过对儿童每日血糖水平、父母使用胰岛素的行为、父母的社会心理功能和儿童的社会心理功能的横断面研究来实现。所有数据将按照分组均值呈现。本研究的结果将用于开发一种干预措施，以改善年幼T1DM儿童的血糖控制，并改善父母的功能。（NIH/NIDDK资助）父母教养行为与低收入非裔美国学龄前儿童肥胖本研究将完善学龄前儿童喂养问卷（一种识别儿童肥胖发展的行为风险因素的工具），以供低收入非裔美国人使用。研究项目将分两个阶段进行。第一阶段的目标是使用定性研究方法，如焦点小组和结构化的个人访谈，以确定两组低收入的非裔美国母亲在养育学龄前儿童方面的差异。第二阶段的目标是开发和测试新版的学龄前儿童喂养问卷。新项目将使用本项目第一阶段的数据生成，并通过认知访谈进行测试。这些项目将被开发用来定义我们假设与学龄前儿童超重发展有关的喂养和养育的构式。订正的调查表将发给300个家庭。问卷调查结果与儿童和父母体重状况之间的关系将被检验。我们研究计划的下一步将调查父母喂养限制（通过父母报告和直接观察来测量）和儿童饮食（通过能量摄入和在没有饥饿的情况下的实验室饮食测量来测量）之间的关系。我们还将探讨父母喂养限制（通过父母报告和直接观察测量）与儿童体重（根据DEXA评估以BMI和总脂肪量测量）之间的关系。本研究的长期目标是制定以提高父母技能为重点的低收入学龄前儿童肥胖预防策略。（NIH资助）T32儿童行为和营养博士后培训基金T32培训计划是为了支持儿童行为和营养方面的博士后培训，特别关注儿科慢性病。这项T32拨款为多学科培训项目提供了基础设施，在合作的基础上，将行为、生物医学和营养科学家聚集在一起，以一种增强和扩展辛辛那提儿童医院医学中心儿童行为和营养科学博士后培训的方式。T32培训补助金现在是资助以来的第三个年头。(NIH /趋势,资金)

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The Aims are 1) to develop the efficacy of behavioral interventions that increase dietary adherence, improve outcomes, and enhance quality of life for children with Cystic Fibrosis, Type 1 Diabetes, and Obesity, 2) to provide the candidate protected time to mentor postdoctoral fellows and junior faculty in psychology/pediatrics that are pursuing clinical investigations in behavioral nutrition. The Candidate's research has focused on behavioral factors that compromise dietary adherence and translating this into interventions that can be tested in clinical trials. For each population, the objective is to establish the efficacy of behavioral treatments through clinical outcome studies and transfer findings to improve standard care. The candidate has a track record of mentorship to fellows and junior faculty in psychology/pediatrics. The Training Plan will further the candidate's knowledge of clinical trial design and analysis of outcomes and allow him improve mentorship. The Research Plan includes two ongoing projects: an NIH funded R01 study, "Behavioral Treatment of Eating Problems in Toddlers with Cystic Fibrosis," and a novel study focusing on "Barriers to Dietary Adherence in Young Children with Type 1 Diabetes." Additionally, the candidate will continue research, on obesity prevention in low-income children. The Mentoring Plan for beginning investigators will consist of 1) mentoring of 2 fellows and a junior faculty member in psychology/pediatrics, 2) supervision of fellows in development of their research proposals, and 3) participation of fellows in didactic programs on manuscript/grant writing, design of clinical trials, and methodology and ethics in clinical research. (NIH/NIDDK funding) Brief descriptions of the objectives of the Cystic Fibrosis, Diabetes, and Obesity studies are below: Behavioral and Nutrition Treatment to Help Preschoolers with Cystic Fibrosis Grow Evidence-based nutritional interventions that achieve optimal growth in young children with cystic fibrosis (CF) do not exist, despite a need. Intervention could positively change the course of clinical lung disease and enhance survival for these children. Objective: To conduct a multi-center, randomized, controlled trial comparing a behavioral plus nutrition intervention condition to an attention control intervention condition. Specific Aims: 1. determine the impact of the behavioral intervention on energy intake and weight gain; 2. examine the durability of the behavioral intervention's impact on growth (weight and height) one year following treatment; and 3. explore the relation between physical activity and growth. Central hypothesis: Behavioral intervention will lead to better growth as measured by change in weight and height for age z scores. 100 preschoolers with CF and pancreatic insufficiency age 2 to 6 years will be randomized to one of the two conditions. The two groups will be stratified so they are similar at the initiation of treatment on weight for age z score. History of Pseudomonas aeruginosa infection and gender will be used as covariates in the statistical analysis. Outcome data (energy intake measured by 7-day diet record, weight, height) will be obtained at baseline, post-treatment (6 months), and after a 12-month follow-up (18 months post baseline). Secondary measures include BMI, body composition measured by DXA and skinfolds, and growth velocity. The long-range goal is to change the standard of nutritional care for young children with CF because behavioral intervention leads to optimal growth and ultimately improves lung health. (NIH/NIDDK funding) Factors Affecting Optimal Glycemic Control in Young Children with Type 1 Diabetes Maintaining good blood sugar control is a primary goal of modern diabetes management. Insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII), is a new and safe method of delivering insulin to people with type 1 diabetes (T1DM). Insulin pumps work by giving patients with T1DM a steady stream of insulin throughout the day. Pumps also allow for patients to get higher doses of insulin when they eat. Insulin pump therapy has transformed diabetes management. Before pumps, patients with T1DM had to follow a strict schedule of meals/snacks that matched the insulin levels in their bodies. With insulin pump therapy, patients are able to eat when they want and can eat whatever they want at meals. Insulin pump therapy has been shown to improve blood sugar control in adolescents and adults with T1DM. In young children with T1DM, insulin pump therapy has improved blood sugar control in some patients, but not in other patients. We propose to study parent and child factors that may affect blood sugar control in families of young children with T1DM who are prescribed CSII therapy. Study aims will be accomplished through a cross-sectional study of children's daily blood sugar levels, parents' behaviors for insulin administration, parents' psychosocial functioning, and children's psychosocial functioning. All data will be presented according to group means. The results of this study will be used to develop an intervention to improve blood sugar control in young children with T1DM and to improve parent functioning. (NIH/NIDDK Funding) Parenting Practices and Obesity in Low-Income African American Preschoolers This study will refine the Preschooler Feeding Questionnaire ¿ an instrument for identifying behavioral risk factors for the development of childhood obesity ¿ for use in low-income African Americans. A two-phase research project will be conducted. The goal of the first phase is to use qualitative research methods such as focus groups and structured individual interviews to identify differences in parenting practices between two groups of low-income African American mothers with preschoolers. The goal of the second phase is to develop and test a new version of the Preschooler Feeding Questionnaire. New items will be generated using data from phase 1 of this project and tested by cognitive interviewing. The items will be developed to define constructs about feeding and parenting that we hypothesize are related to the development of overweight in preschool children. The revised questionnaire will be administered to 300 families. Relations between questionnaire findings and child and parent weight status will be examined. The next step in our research program will investigate the relation between parental feeding restriction (measured by parent report and direct observation) and child eating (measured by energy intake and a laboratory measure of eating in the absence of hunger). We will also investigate the relation between parental feeding restriction (measured by parent report and direct observation) and child weight (measured as BMI and total fat mass based upon DEXA assessment) The long-range goal of this study is to develop obesity prevention strategies for low-income preschool aged children that focus on improving parenting skills. (NIH Funding) T32 Postdoctoral Training Grant in Child Behavior and Nutrition The T32 training program is to support postdoctoral training in child behavior and nutrition, with a specific focus on pediatric chronic illnesses. This T32 grant provides the infrastructure for a multidisciplinary training program, bringing together on a cooperative basis, behavioral, biomedical, and nutrition scientists in a manner that will enhance and extend postdoctoral training in child behavioral and nutrition sciences at Cincinnati Children's Hospital Medical Center. T32 training grant is now in its third year since funding. (NIH/NIDDK funding)