Location: Office of The Area Director2013 Annual Report
1a. Objectives (from AD-416):
This SCA involves three separate research projects with specific objectives as detailed below: “Obesity Prevention in the Mississipi Delta Region of Mississippi” (1) Evaluate a church-based intervention program “Delta Body and Soul” to increase adherence to Dietary Guidelines for Americans (DGA) diet and physical activity recommendations; and (2) serve as a nutritional consultant in the development, implementation, and evaluation of a project designed to improve maternal and neonatal/infant metabolic health and weight outcomes via education of the mothers. “Dietary Intake Patterns Associated with Excess Adiposity in U.S. Children” Using three dietary pattern identification methods, Healthy Eating Index (HEI) 2005, principal component analysis, and reduced rank regression, determine associations among the dietary pattern scores, excess adiposity, physical activity, and sedentary behavior in 2-18 year old U.S. children using the most recent National Health and Nutrition Examination Survey (NHANES) data. “Maternal Overweight, Delta Health Alliance (DHA) Supplementation, and Iron Status: An Ancillary Study” (1) Evaluate pre-pregnancy Body Mass Index (BMI), pre-pregnancy iron status, perinatal weight gain (current weight - pre-pregnancy weight), inflammation, iron status, serum hepcidin concentrations, and dietary intake in overweight pregnant women at baseline (weeks 17-20 gestation); and assess relationships among these parameters; (2) evaluate perinatal weight gain, inflammation, iron status, and serum hepcidin concentrations in overweight pregnant women at 30 and 36 weeks gestation and at delivery; and assess for differences in parameter changes (from baseline) by supplementation group and relationships among these parameters; (3) evaluate neonatal inflammation, iron status, and serum hepcidin concentration (via cord blood), infant birth weight, and infant Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score at delivery; and assess for differences in these parameters by supplementation group and for relationships among the parameters; and (4) assess for relationships between maternal and neonatal inflammation, iron status, and serum hepcidin concentrations, and maternal perinatal weight gain at delivery.
1b. Approach (from AD-416):
“Obesity Prevention in the Mississipi Delta Region of Mississippi” Statistical methods will be used to compare changes in diet and physical activity outcomes between the Delta Body and Soul control and intervention participants while accounting for group (church) randomization as well as sociodemographic covariates. An existing education program, Parents as Teachers, will be enhanced to specifically address nutritional prenatal and postnatal topics (e.g. breast-feeding) for mothers and their infants. Statistical methods will also be used to compare health outcomes between mothers and their infants in the standard vs. the enhanced education programs. “Dietary Intake Patterns Associated with Excess Adiposity in U.S. Children” Individual foods consumed by children in the National Health and Nutrition Examination Survey (NHANES) datasets will be assigned to defined food groups based on previous research and investigators’ interest in specific foods. Statistical methods will be used to identify dietary patterns in the NHANES datasets using three different approaches -- Healthy Eating Index (HEI)-2005, principal component analysis, and reduced rank regression. Statistical methods will be used to determine associations among the dietary pattern scores, excess adiposity, physical activity, and sedentary behavior. “Maternal Overweight, Delta Health Alliance (DHA) Supplementation, and Iron Status: An Ancillary Study” Statistical methods will be used to summarize and assess relationships among the parameters listed previously in the Objectives section. Assessments will be performed for baseline (maternal), 30 weeks gestation (maternal), 36 weeks gestation (maternal), and delivery (maternal and infant) parameters. Assessments will also be performed for within supplement group and between supplement group changes.
3. Progress Report:
The University of Illinois at Chicago (UIC), in cooperation with ARS, aims to address the obesity epidemic in the Mississippi Delta region through community-based prevention and intervention programs. Toward this effort, Delta Body and Soul, a 6-month, church based, diet and physical activity intervention for African American adults residing in the Mississippi Delta was conducted. Delta Body and Soul was designed to improve diet quality and increase physical activity in adults. The data collection and implementation phases of this study have been completed for all three cohorts of participants (2009-2010, 2010-2011, and 2011-2012). One manuscript reporting results from the first cohort of participants (45 control and 81 intervention) is being revised for submission to a peer-reviewed journal. One manuscript reporting results from the second cohort of participants (208 control and 194 intervention) has been published in a peer-reviewed journal while a second manuscript has been accepted for publication in the peer-reviewed journal. Data from the third cohort of participants (122 control and 287 intervention) has been cleaned and is being analyzed. Further, UIC, in cooperation with ARS, categorized over 3,700 individual foods and beverages into food groups to facilitate the use of principal component analysis to derive dietary patterns from the relevant National Health and Nutrition Examination Survey (NHANES) child datasets. Exploratory principal component analysis has been initiated to identify dietary patterns based on these food groupings. Additionally, UIC, in cooperation with ARS, designed an 18-month, randomized, controlled comparative trial testing the efficacy of two Maternal, Infant, and Early Childhood Home Visiting programs on weight status, dietary intake, and health behaviors of African American mothers and their infants residing in the rural Mississippi Delta region. The control arm of the intervention, Parents as Teachers, is an evidence-based approach to increase parental knowledge of child development and improve parenting practices. The experimental arm of the intervention, Parents as Teachers Enhanced, builds on the Parents as Teachers curriculum by including nutrition and physical activity components specifically designed for the gestational and postnatal periods. Both arms of the intervention are delivered in the participant’s home by trained Parent Educators. Training in recruiting techniques and strategies, Parents as Teachers curriculum, Parents as Teachers Enhanced curriculum, anthropometric measurement, 24-hour dietary recall methodology, and computer-assisted personal interviewing for the Project Manager and three Parent Educators was conducted from August 2012, to present and is on-going. Institutional Review Board (IRB) approval was received for this study in December 2012. Participant recruitment began in late January 2013. As of July 2013, 56 individuals were referred to the study, 53 were screened, 35 were determined ineligible, and 18 were enrolled into the study. Data collection is on-going. In June 2013, a protocol manuscript was submitted to a peer-reviewed journal for publication. Finally, UIC, in cooperation with ARS and the Louisiana State University, aims to address maternal overweight in Louisiana. Toward this effort, an ancillary study was added to the Louisiana Moms and Babies Study (LAMBS). LAMBS is a randomized clinical trial of docosahexaenoic acid (DHA) supplementation in overweight pregnant women residing in Louisiana. Institutional Review Board (IRB) approvals were received for the parent study, LAMBS, on March 12, 2013, from Woman’s Hospital in Baton Rouge, Louisiana, and on May 14, 2013, from Pennington Biomedical Research Center, Baton Rouge, Louisiana. IRB approval for the ancillary study is currently underway. An agreement for supply of the DHA capsules has been made with an industry partner. This company will produce, package, and randomize the capsules (DHA and placebo) for distribution in the study. The first shipment of capsules is scheduled for June 2013.