Nutrition Fellow Update

Robyn D. Foreman, MHSRobyn D. Foreman, MHS

Advisor: Laura Caulfield, PhDAdvisor: Laura Caulfield, PhD

2 October 2009

Disclosures• None

Completed/Ongoing Activities

• Participation on manuscript 89 NHLBI TAAG writing group• Teaching Assistant for Nutrition in

Disease Treatment & Prevention (4th term 2008 & 2009)• Data Collector for TOPS project

(06/2008-01/2009) @ UMD; PI: Dr. Black• Guest lecture for Assessment of

Nutritional Status with Dr. Kristen Hurley

• Proposal development (2008-2009)• Certificate of Training in Child & Adolescent

Weight Management program• Data Collection Manager for Challenge! (12/2008

– 05/2009) (also UMD; PI: Dr. Black)• Reverse Research Day• Youth Fitness Circle (Spring 2009)• Attended seminar on How to Write a National

Research Service Award• Attended USDA conference on obesity @ UMD

Completed/Ongoing Activities

• Attended PAS• Reviewing nutrition papers with Dr. Kristen Hurley• Attending seminars @ UMD SOM Dept of

Pediatrics• Attending graduate student meetings @ UMD• Attending writing group meetings for Challenge!• Data analysis with Dr. Kristen Hurley• Studying for RD exam – signed up for a date!• Prepare for Orals• Project Coordinator for Challenge! (05/2009 –

present) (also UMD; PI: Dr. Black)

Completed/Ongoing Activities

• Proposal Development I,II,III,IV

• Research Ethics & Integrity• Epidemiologic & Preventive

Aspects of CVD• Adolescent Health &

Development• Current Issues in Public

Health• Intro to SAS• Nutrition in Disease

Treatment & Prevention

Coursework during LEAH• Epidemiology of Diabetes

and Obesity• Seminar in Child Health• Social Ecology of

Adolescent Health• Advanced Nutrient

Metabolism• Epidemiologic Methods I,II,III• Assessment of Clinical CVD• Current: Advanced Topics in

CVD Epi

Accomplishments• Completed Collaborative Institutional

Training Initiative (CITI)• Completed AMPM training (NHANES 24-

hr recall)• Completed HIPAA for UMD & JHU• Earned Certificate of Training in Child

and Adolescent Weight Management

Accomplishments• Led a lecture on cardiovascular disease for

Nutrition in Disease Treatment and Prevention class• Submitted research proposal to American

Diabetes Association, American Heart Association, & Baltimore Diabetes Research and Training Center• Received American Dietetic Association

Foundation Scholarship

Plans• RD Exam (date is scheduled)• Oral Exams• Apply for American Heart Association Predoctoral

Fellowship next January• Renew CITI & HIPAA training• Continued involvement with LEAH & Youth

Fitness Circle

Challenge!• NIH funded study• Multilevel intervention • Cluster-randomized design• 3 academic years of intervention• Target sample size = 800 • Evaluations at baseline, 6 mo, end of year, ~12mo• Anthropometrics (ht, wt, WC)• %BF• BP• CRF

• FFQ• PA: accelerometry & self report• Psychological measures

Challenge Study Details

•Old Challenge – individually-based, founded upon SCT, Transtheoretical Model, Developmental-Ecological Theory•Demonstrated success related to the following outcomes: proportion adolescents progressing to 85th BMI %ile, diet, fat free mass•New Challenge – reformatted for small groups & added environmental component•Health Behavior Goal Setting, Trips to YMCA, Traffic Light Diet•Control group = bullying prevention intervention

Challenge Study Design

Challenge! in Middle Schools has a 2x2 factorial design involving cluster- as well as

individual-level randomization

Background / Rationale•Why do we care about overweight?

•The prevalence of overweight is rising

•Overweight is associated with increased chronic disease risk

•Many studies attempt to reduce overweight

•Few of these studies measure metabolic risk factors

•The success of an intervention should be measured by reduction in risk which may not be equivalent to change in BMI

Background / Rationale•Challenge! in Middle Schools targets environmental and behavioral change (diet and physical activity)

•Changes in body composition are associated with improved metabolic risk

•Changes in diet and physical activity are associated with improvements in metabolic risk independent of change in body composition

Goal

The goal of Living Up to Our Challenge (LUTOC) is to measure

indicators of chronic disease risk in adolescent girls and determine the

effect of changes in health behavior on these measures.

Where LUTOC Fits in to Challenge!

•Current funding supports the intervention & measurement of diet, PA, anthropometric measurements, BIA, & psychological parameters

•Living Up To Our Challenge will tack on additional measurements at two CHALLENGE evaluation time points to strengthen the ability to detect a meaningful difference in chronic disease risk profile

Aim 1: To examine the effect of the Challenge! in Middle Schools interventions on

metabolic risk factors.

Aim 1

Aim 2: To examine the degree to which changes in dietary patterns, physical activity and fitness, BMI, and body

composition are associated with changes in metabolic risk factors.

Aim 2

Aim 3: To examine the degree to which the effect of the intervention on metabolic risk factors varies by baseline measures of dietary patterns, physical activity and

fitness, BMI, and body composition.

Aim 3

Sample Size/Power•CHALLENGE: recruit 800, 20% attrition, n=640•20% refusal for blood draws, LUTOC n=512•Similar study observed effect size on TC was 0.27

•AIM 1 – INTERVENTION EFFECT: SMALL GROUP•n=512 •85% power

ENVIRONMENTAL•Requires consideration of increased variance due to clustered randomization (reduces power)•Ability to detect trends

Sample Size/Power•AIM 2– EFFECT OF CHANGES IN PREDICTORS:

•n=512•Power = 85%

•AIM 3 – EFFECT MODIFICATION•n=512•85% power

Data AnalysesOutcomes of interest:

FPG

Insulin

HbA1c

HOMA

TC

LDL

HDL

TG

BP

Continuous Metabolic Syndrome Score (WC, TG, HDL, BP, HOMA)

Proposal: Funding Search• Submitted proposal to:• American Diabetes Association• American Heart Association• Baltimore Diabetes Research and Training

Center Pilot andFeasibility Award Program• Resubmitted to American Diabetes

Association

Current Status

•My Role with Challenge!•Lessons learned from working with the schools•Strategy for moving forward

My Role with Challenge!

• As Project Coordinator for Challenge! I have the following responsibilities:• Project Management• Personnel Management• Financial Management• IRB Management• Data Collection/ Management• Facilitator for other aspects of project

Lessons from Schools• BCPSS – very dynamic – always changing• Absolutely no blood draws in the school – would

have to be off site• Contact with children (i.e. acticals)• After school programs must work around

academic activities after school• Necessary to have school liaison for constant

communication

Strategy: New Ideas• Need to come up with new idea for proposal• Plan to apply for AHA Predoctoral

Fellowship – would like to focus on cardiovascular disease risk• Focus on blood pressure• Covariates I would be interested in

include diet, physical activity, cardiorespiratory fitness, family history, stages of change, disparities (income)

Strategy: New Aims• To examine the degree to which changes in dietary

patterns, physical activity, cardiorespiratory fitness, and body composition affect changes in blood pressure over a 6-month period.

• To determine whether changes in lifestyle factors (i.e. dietary patterns and physical activity) have an impact on blood pressure independent of changes in body composition over a 6-month period.

• To examine whether family history of hypertension has a moderating effect on the relationship between changes in diet, physical activity, cardiorespiratory fitness, and body composition and blood pressure.

Suggestions?

Please provide me with any suggestions you may have regarding:•Ways I can reach my goals•Activities that will help develop my expertise and leadership capabilities•Skills I should focus on developing•Ideas for my new focus