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） （1R18-DK075981）旨在评估一项为期12个月、以家庭为基础的干预措施的效果，该干预措施旨在改善生活在一个少数民族代表性高的社区的7-12岁儿童的BMI z分数和心血管疾病危险因素，这些儿童的BMI z分数为85百分位。被招募的家庭将被随机分为对照组和实验干预组。控制干预组将收到一本关于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，包括核心饮食和体育活动课程，随后是为期9个月的每月核心后课程，以促进课程的遵守。核心课程中有针对性的饮食策略包括增加高色素水果、蔬菜和鱼类的摄入量；用脱脂和低脂牛奶代替全脂牛奶和奶制品；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内，将向家庭提供社会支持和量身定制的个性化咨询，并辅以电话和家访，以解决坚持治疗的障碍。本辅助研究申请的目的是扩大famwt研究的范围，包括1)儿童母亲/女性监护人对饮食质量生物标志物的测量，2)儿童和母亲/女性监护人对心血管疾病危险因素的测量，以及3)评估儿童母亲/女性监护人对饮食质量生物标志物和心血管疾病危险因素干预前和干预后变化的相关性。选择饮食质量的每一种生物标志物，是因为它是母体研究所针对的饮食中不同成分的指标，可以提供依从性的指示——植物油、肉类和鱼类的红细胞（RBC） 18:3n- 3,20:4 n- 6,20:5 n-3和22:6n-3；血浆类胡萝卜素和叶绿醌用于高色素水果和蔬菜；全脂牛奶和奶制品的RBC为15:0；红细胞反式脂肪酸和血浆二氢叶绿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危险因素（总胆固醇、高密度脂蛋白和低密度脂蛋白胆固醇、甘油三酯、hsCRP、葡萄糖和胰岛素浓度、血压和腰围），将允许评估家庭中的“溢出”效应和儿童-母亲/女性监护人对之间的一致性。无论结果如何，这些结果将提供关键的数据，用于设计在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，这个领域将继续挑战当前在一个高风险亚群体中遏制儿童肥胖浪潮的努力，并威胁到我们的医疗保健系统。响应是时间敏感的，因为FamWtStudy干预始于2009年8月，拥有收集、处理、存档、转移和分析血浆和红细胞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重和对儿童的母亲/女性监护人产生潜在“溢出”效应的基于家庭的方案的有效性提供客观措施。客观措施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，以及儿童与母亲/女性监护人对之间的变化关系。制定和评估防止体重过度增加的策略对于支持当前遏制美国儿童肥胖浪潮的努力至关重要，这是一个威胁到我们医疗保健系统的公共卫生问题。（摘要结束）

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)