Nutritional and Metabolic Diseases

Gland and Hormone Related Diseases

All Conditions

Symptoms and General Pathology

Diabetes Mellitus, Type 2

Diabetes Mellitus

Obesity

Metabolic Diseases

Glucose Metabolism Disorders

Endocrine System Diseases

Nutrition classes for 1 hour \& 30 minutes once a week for 16 weeks + motivational interviewing (4 individual sessions)

Nutrition

Strength Training twice a week for 1 hour a day for 16 weeks + Nutrition once a week for 1 hour \& 30 minutes for 16 weeks + motivational interviewing (4 individual \& 4 group sessions)

Strength Training & Nutrition

Circuit Training twice a week for 1 hour a day for 16 weeks + Nutrition once a week for 1 hour \& 30 minutes for 16 weeks + motivational interviewing (4 individual \& 4 group sessions)

Circuit Training & Nutrition

Michael I Goran, PhD

We are conducting an intervention study to examine the effects of a 16-week exercise and diet interventions on prevention of disease, specifically type 2 diabetes and heart disease, in Latino youth. Eighty overweight Latino boys and girls will be recruited and placed in one of the following intervention groups: 1) Control Group (delayed intervention), 2) Dietary Education Group (nutrition education focused on reducing sugar \& soda, increased fiber \& whole grain intake), 3) Combination of Strength Training (twice/week for 60 min, progressive increases in exercise volume and intensity) + Dietary Education (nutrition education focused on reducing sugar \& soda, increased fiber \& whole grain intake) or 4) Combination of Circuit Training (twice/week for 60 min, aerobic + strength training exercises) + Dietary Education (same as above). We will assess which intervention group has the most effects on health parameters such as weight, body composition, and insulin related measures.

The overall historical goal of this grant has been to examine the determinants of insulin resistance in children, especially the role of total fat and visceral fat during pubertal development in "high risk" minority children. Our previous longitudinal work has provided the platform to propose a new intervention phase of this research. This new emphasis is justified based on the magnitude of the pediatric obesity problem, particularly in susceptible ethnic groups, and the need to design and test novel interventions to reduce not just obesity, but the profound insulin resistance that we have observed in overweight minority children. Insulin resistance is thought to be central (and perhaps causative) to several metabolic abnormalities associated with type 2 diabetes and cardiovascular disease. Thus, interventions aimed at improving insulin resistance in susceptible children could be an effective means in the primary prevention of type 2 diabetes and cardiovascular disease.

The overall objective of this proposal is therefore to conduct a randomized controlled study to examine the effects of 16-week exercise and diet interventions on insulin sensitivity, insulin secretion, beta-cell function, and body fat distribution. Overweight Hispanic boys and girls (n=80) will be recruited and randomized to one of the following interventions:

Ø Control (delayed intervention) Ø Modification of carbohydrate intake (reduced sugar \& soda, increased fiber \& whole grain intake) using an individualized healthy exchange system and motivational interviewing Ø Strength training + modification of carbohydrate intake Ø Circuit Training + modification of carbohydrate intake

This study will provide new information on the effects of these interventions on primary outcomes at the level of body composition (total lean and fat mass, visceral fat, intramyocellular fat and liver fat) and insulin related measures (insulin secretion \& sensitivity and beta-cell function). The hypotheses are:

1. All interventions will have separate and independent effects on improving insulin resistance
2. Strength training will improve insulin resistance by re-distribution of body fat (lower visceral fat, intramyocellular lipid and liver fat)
3. Carbohydrate modification will improve insulin secretion and beta-cell function
4. Circuit training will have similar improvements in insulin resistance and have more improvements on adiposity compared to the strength training group.
5. The aforementioned effects on insulin dynamics will be independent of any effects of either intervention on weight loss or loss in whole body fat.

The overall rationale for these interventions is based on three main factors. First, preliminary data are presented in overweight Hispanic boys showing that 16-weeks of strength training significantly improves insulin sensitivity in the absence of a reduction in total body fat and in the absence of any dietary intervention. Second, preliminary data suggests that overweight Hispanic children consume high levels of simple sugar, and low levels of fiber and complex carbohydrates, and data from the literature suggests that modification of carbohydrate consumption (reduced sugar, increased fiber \& whole grain) can improve glucose control independent of body composition. Third we provide new preliminary data showing that the only dietary variable associated with insulin dynamics in overweight Hispanic children was high sugar intake which was associated with poor beta-cell function.

We have chosen to focus on Hispanic children because they are an understudied, high-risk population, and display significant obesity-related metabolic abnormalities probably emanating from profound insulin resistance (see preliminary data). In support of the feasibility of our proposal, we have developed extensive expertise in recruiting and retaining research volunteers from the large Hispanic population of East Los Angeles, we have an experienced multi-disciplinary group of investigators, and the University of Southern California has the necessary clinical research infrastructure to tackle this project. If our hypotheses are borne out, it will provide evidence for the incorporation of strength training and more specific and individualized dietary recommendations in the prevention and management of obesity, type 2 diabetes, and cardiovascular risk in overweight Hispanic youth.

Strength and Nutrition Outcomes for Latino Adolescents

Intra-Abdominal Fat and Risk of Disease in Adolescents

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

University of Southern California

Professor

Overweight

Overnutrition

Nutrition Disorders

Body Weight

The investigators are conducting an intervention study to examine the effects of a 16-week exercise and diet interventions on prevention of disease, specifically type 2 diabetes and heart disease, in African American youth. Sixty overweight African American boys and girls will be recruited and placed in one of the following intervention groups: 1) Control Group (delayed intervention), 2) Dietary Education Group (nutrition education focused on reducing sugar \& soda, increased fiber \& whole grain intake), or 3) Combination of Strength Training (twice/week for 60 min, progressive increases in exercise volume and intensity) + Dietary Education (nutrition education focused on reducing sugar \& soda, increased fiber \& whole grain intake). The investigators will assess which intervention group has the most effects on health parameters such as weight, body composition, and insulin related measures.

A.1 Aims

The overall goal of this project is to examine role of strength training as a therapeutic intervention to improve the cancer and obesity-related metabolic risk profile in African-American adolescents. The project is prompted by the urgent public health need to prevent and treat cancer and obesity-related problems, including diabetes and cardiovascular disease, in African-American adolescents, a population that is understudied and medically under-served in the Los Angeles area. A recent report from the Institute of Medicine underscored this major public health concern in the childhood obesity field:

"Children's health has made tremendous strides over the past century. In general, life expectancy has increased by more than thirty years since 1900 and much of this improvement is due to the reduction of infant and early childhood mortality. Given this trajectory toward a healthier childhood, the investigators begin the 21st century with a shocking development - an epidemic of obesity in children and youth. The increased number of obese children throughout the US during the past 25 years has led policymakers to rank it as one of the most critical public health threats of the 21st century. (92)" Obesity and metabolic syndrome problems disproportionately affect African-American adolescents (51). This project will explore why African-Americans have greater cancer risk than Hispanics (91), despite a reduced prevalence of the metabolic syndrome (7, 62).

Preliminary work from this laboratory has shown that both African-American and Hispanic children are more insulin resistant than Caucasian children, and this difference is apparently not explained by differences in body fatness. Moreover, the metabolic compensation to a similar degree of insulin resistance markedly differs between African-American and Hispanic children (62). African-Americans display greater hyperinsulinemia in response to a glucose challenge, whereas Hispanics have a more subdued increase in insulin levels due to an increase in second phase insulin secretion. The investigators will have the opportunity to build upon this preliminary work to examine the effects of resistance training on three factors predictive of cancer and metabolic disease risk: 1) body fat distribution; 2) insulin resistance and 3) measures of oxidative stress in African America adolescents. The investigators previously studying Hispanic adolescents in a parallel protocol.

The overall hypotheses of this project are that: (1) hyperinsulinemia in overweight African-American youth is associated with increased long-term cancer risk; and (2) insulin resistance, obesity and oxidative stress in overweight African-American youth will be improved with chronic resistance training and a modified carbohydrate dietary approach. The investigators will specifically examine the following metabolic outcomes, because they have been hypothesized to contribute to the obesity-related increase in cancer and metabolic disease risk:

* Insulin concentrations and insulin sensitivity;
* Total body fat, abdominal visceral fat, muscle fat and liver fat;
* Circulating adipocytokines;
* Intima-media thickness of the carotid artery
* Markers of oxidative stress, including: F2-isoprostanes, malondialdehyde (MDA), myeloperoxidase (MPO), oxygen radical absorbance capacity and ROS detection by flow cytometry.

A.2 Aims

The specific aims and hypotheses of project 1 are as follows:

Study 1: Cross-Sectional Measures Specific Aim 1 (Body Fat Compartments): To determine the association of visceral fat, muscle and liver fat and plasma adipocytokines to variation in insulin resistance in African-American youth.

* Hypothesis 1: Visceral fat, muscle and liver fat, and adipokines will independently contribute to greater insulin resistance.

  • Specific Aim 2 (Insulin Resistance): To examine metabolic compensation to insulin resistance in African-American youth.
* Hypothesis 2: Insulin resistant African-American youth will exhibit a higher acute insulin response to glucose.

  • Specific Aim 3 (Oxidative Stress): To examine the influence of body fat and insulin resistance on markers of oxidative stress and markers of metabolic disease risk.
* Hypothesis 3: Increased total body fat and insulin resistance will be associated with greater oxidative stress. The increased oxidative stress will be correlated with the higher acute insulin response.

Study 2 (Randomized Trial of Modification of Carbohydrate Intake and Strength Training) • Specific Aim 4 (Linkage of factors in Aims 1-3): To determine the effects of a randomized modification of carbohydrate intake, and/or strength training intervention in overweight African-American adolescents on potential factors linking obesity, insulin resistance, and oxidative stress.

- Hypothesis 4: Strength training will improve metabolic factors for cancer risk. That is, resistance training will reduce visceral fat; increase insulin sensitivity, reduce hyperinsulinemia, and reduce oxidative stress. The decreases in total body fat and visceral adipose tissue will be associated with improved insulin sensitivity and oxidative stress.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Strength and Nutrition Outcomes for Latino Adolescents	NCT00697580	Obesity Type 2 Diabetes Cardiovascular ... Cancer	Nutrition Strength Traini... Circuit Trainin...	14 Years - 18 Years	University of Southern California
Strength Training and Nutrition Development for African American Youth	NCT01441323	Obesity Type 2 Diabetes Cardiovascular ... Cancer	Nutrition Strength Traini...	14 Years - 18 Years	University of Southern California
Strength and Nutrition Outcomes for Latino Adolescents	NCT00697580	Obesity Type 2 Diabetes Cardiovascular ... Cancer	Nutrition Strength Traini... Circuit Trainin...	14 Years - 18 Years	University of Southern California
Strength and Nutrition Outcomes for Latino Adolescents	NCT00697580	Obesity Type 2 Diabetes Cardiovascular ... Cancer	Nutrition Strength Traini... Circuit Trainin...	14 Years - 18 Years	University of Southern California

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