1. KIDPOWER Investigators and Co-investigators: Research by:
Ginger Hester, RD, LDN; Janalynn Beste, MD; Catherine Sullivan, MPH, RD, LDN, Kathryn Kolasa, PhD, RD, LDN; John Olsson, MD; Tate Holbrook MD; Doyle Cummings, Pharm D; Susan Morrissey, MA; Virginia Spencer, BSN, MBA; Ronald Perkin, MD; Jen-Jar Lin, MD
Research by:
Departments of Pediatrics and Family Medicine
Brody School of Medicine at East Carolina University
Dr. Olsson—primary investigator
Funded by the Children’s Miracle Network and the Departments of Family Medicine and Pediatrics at The Brody School of Medicine
Partners: Pitt Memorial Hospital Foundation and The Brody School of Medicine
Our project was designed to determine the feasibility of conducting research and providing lifestyle intervention on obese children in eastern NC

2. KIDPOWER STUDY: Goals Identify children at BMI > 85% for age
Define the prevalence of hyperinsulinemia (HI) and associated CVD risk factors
Investigate the feasibility of a dietary intervention for HI children

3. KIDPOWER STUDY: Methods
Children age 4-18 years with BMI > 85th%ile
Fasting labs
Serum insulin
Serum glucose
C-peptide
Lipid panel
Children were recruited from pediatric and family practice clinics in the area by primary care providers
Entry requirements: BMI > 85th%ile for age, willingness to participate, provision of transportation, exclusion of complicated diagnosis and frequent hospitalizations, must not be on medications that would alter fasting lab results
Consent signed

4. Study Population N (%) Age Mean age = 11.1 years 4-10 years old
86 (50.6)
84 (49.4)
Race
African American
Caucasian
Other
86 (56.6)
59 (38.8)
7 (4.6)
Gender
Male
Female
54 (32.3)
113 (67.7)
Total number
171
Statistics as of 8/02

5. Prevalence of Hyperinsulinemia (Insulin:glu ≥ 33% or serum insulin > 25 mcU/ml)
29.8% have HI (n=51)
HI were older than non-HI children (mean age 12.1 vs. 10.7, p<.05)
There were no significant differences by race or gender
Statistics as of 8/02

6. Fun for Kids/Body Works
KIDPOWER Flow Chart
Referral
Labs
+ I/G
- I/G
Diet Intervention
Fun for Kids/Body Works
Hyperinsulinemic children were sent through diet intervention consisting of 3 or 4 sessions and then routed to the Vi Quest center
All non-hyperinsulinemic children were offered one free dietary session and were sent immediately to the Vi Quest
At the Vi Quest Center, children were given a sleep apnea questionnaire and children at-risk were routed to the Sleep Apnea arm
Also, BP was measured at various points throughout the study arms and children with elevated blood pressures were sent to the HTN arm for further evaluation.
HTN Study
Sleep Apnea Study

7. Comparison of Hyperinsulinemic and Non-Hyperinsulinemic Children
Note the difference in serum insulin, BMI, lipids b/t hyperinsulinemic vs. non-hyperinsulinemic children.
*p<.05, **p<.001
Statistics as of 8/02

8. KIDPOWER STUDY: Results
BMI was the most important independent predictor of CV risk score
Dr. Skip Cummings—linear regression analysis of the KIDPOWER data

9. KIDPOWER STUDY: Diet Arm
Diet intervention for HI children
40% carbohydrate, 30% protein and 30% fat
Standard kcal level for age with consideration for ht and activity level
Counseled 3 times during 12 weeks
Repeat fasting labs after 12 weeks

10. Modified Food Guide Pyramid
Fats, oil, and sweets
2 – 3 servings
Milk, Yogurt, and Cheese Group
2 – 3 servings
Meat, Poultry, Fish, Dry
Beans, and Eggs
3 + servings
Fruit Group
2 – 4 servings
Vegetable Group
3 – 5 servings
Bread, Pasta, Cereal
And Rice Group
5 – 8 servings
© Department of Family Medicine, The Brody School of Medicine at ECU
For use in Hyperinsulinemia Research Study Only

11. KIDPOWER STUDY: Diet Arm Results
8 out of 31 enrolled have completed the dietary intervention
7 showed improvement in labs with 4 showing normalization of insulin-to-glucose ratio
Last summarization of our diet data showed that

12. KIDPOWER STUDY : Limitations
No established criteria to diagnose HI
Attrition
Transportation
Communication
Family Support/Dynamic
Fear of blood draw
Noncompliance with diet

13. KIDPOWER STUDY: Conclusions
Children with HI have higher BMI, Total Cholesterol, LDL, TG, C-peptide, Serum Glu and Insulin:Glu vs. children without HI
HI children were older than non-HI children
BMI is an independent risk factor for HI

14. KIDPOWER STUDY: Conclusions
Obesity (BMI) was the strongest independent predictor of increased CV risk and should continue to be used by primary care physicians in risk assessment
HI was present in a large percentage (30%) of children with BMI>85%
Dietary intervention may be beneficial but compliance is a barrier to success

15. Referrals For participation at Vi Quest:
Contact Virginia Spencer or Rose Ann Simmons
Nutrition appointments—Peds or FPC