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Published byEaster Rose Modified over 6 years ago
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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
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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
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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
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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
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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
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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
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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
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KIDPOWER STUDY: Results
BMI was the most important independent predictor of CV risk score Dr. Skip Cummings—linear regression analysis of the KIDPOWER data
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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
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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
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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
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KIDPOWER STUDY : Limitations
No established criteria to diagnose HI Attrition Transportation Communication Family Support/Dynamic Fear of blood draw Noncompliance with diet
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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
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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
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Referrals For participation at Vi Quest:
Contact Virginia Spencer or Rose Ann Simmons Nutrition appointments—Peds or FPC
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