Field Notes

Lifestyle May Not Prevent Childhood Obesity in Low‑Income Communities

Young children and their families in low-income communities were able to make some achievable and sustainable behavioral changes during the longest and largest obesity prevention intervention, but, in the end, the results were insufficient to prevent early childhood obesity.

The results of the Growing Right Onto Wellness (GROW) trial, published in JAMA, showed a short-term reduction in obesity that diminished over the three-year study period even in the face of improved, sustained nutrition and use of neighborhood recreation centers.

Principal Investigator Shari Barkin, MD, director of pediatric obesity research at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, says the amount of behavioral change likely needs to increase to be successful, but it remains unclear what would be enough to prevent childhood obesity in underserved, low-income populations—those most at risk of obesity and its long-term health consequences.

“The interventions, even for prevention, likely need to be intense and active for longer periods of time,” Barkin says. “We tested a tiered intervention consistent with adult obesity treatment trials, but childhood obesity prevention for underserved families might require sustained highly active interventions.”

A total of 610 parent-preschool child pairs, 90% of whom were Hispanic, received high-dose behavioral intervention during the three-year study period. The children were at risk of obesity but not yet obese.

“This was a pragmatic study, based in families and the communities in which they lived,” says Barkin, also the William K. Warren Foundation Endowed Professor and chief of the division of academic general pediatrics at Children’s Hospital.

Forty-two percent of families reported food insecurity with hunger, and 80% of participating parents were either overweight or obese.

“The intervention seemed to work best for children who reported food insecurity with hunger at baseline,” Barkin says. “We think this could be due to the fact that the intervention connected families to existing resources in their community and to other families in their neighborhoods, but this finding needs to be tested further.”

The behavioral intervention included three phases: a 12-week skills-building intensive phase, a nine-month phone call coaching maintenance phase, and a 24-month cue-to-action sustainability phase.

“In the face of the childhood obesity epidemic, this study underscores the ongoing need to find effective prevention interventions, particularly among low-income minority populations who have a high prevalence of obesity,” says Charlotte Pratt, PhD, RD, National Heart, Lung, and Blood Institute program director for the GROW trial and a coauthor of the study.

— Source: Vanderbilt University Medical Center

 

Study Questions Treatment for Patients With Kidney Disease and Diabetes at High Risk of CVD

New research suggests that attempts to normalize blood pressure and cholesterol may have negative long-term effects on kidney health in adults with type 2 diabetes who are at high risk of CVD. The results appear in the Clinical Journal of the American Society of Nephrology and were presented at the American Society of Nephrology’s Kidney Week 2018, which took place in October in San Diego.

Type 2 diabetes greatly increases the risk of both CVD and chronic kidney disease. Therefore, it’s especially important to protect the heart and kidney health of patients with type 2 diabetes. In these patients, aggressive control of blood sugar, blood pressure, and cholesterol has resulted in conflicting short-term effects on kidney health. To determine the long-term kidney effects of these interventions, Amy K. Mottl, MD, of the University of North Carolina Kidney Center; Timothy E. Craven, MSPH, of Wake Forest School of Medicine; and their colleagues examined information on more than 10,000 participants in ACCORDION, which is an extension phase of the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Trial, a multifactorial intervention study in people with type 2 diabetes at high risk of CVD.

The team found that intensive blood sugar control aiming for normal average blood sugar (hemoglobin A1c target <6%) reduced the risk of macroalbuminuria (a high amount of protein excreted in the urine) over an average follow-up of 7.7 years, but it had no impact on more significant kidney outcomes such as serum creatinine doubling (a marker of worsening kidney function) or the need for dialysis or transplantation. Intensive control of blood pressure or the use of fenofibrate to lower cholesterol increased the risk of doubling of serum creatinine but didn’t increase the need for dialysis or transplantation.

“These results, along with those from the primary study, which showed no benefit of the interventions on heart attacks and strokes, provide evidence against aggressive targets for glucose, blood pressure, and use of fenofibrate in adults with type 2 diabetes at high risk of cardiovascular events,” Mottl says.

An accompanying editorial takes issue with some of the conclusions. “In our view, the findings observed for doubling of serum creatinine do not suggest harm to the kidneys, but rather are more likely to reflect the limitations of the small number of creatinine measurements available,” the authors wrote. “We believe that the data actually suggest possible benefit for ESKD [end-stage kidney disease] with intensive glucose control, and remain inconclusive for intensive blood pressure control and fibrate use given the wide confidence intervals for the more reliable ESKD outcomes.”

— Source: American Society of Nephrology