Sylvie A. Akohoue

Energy expenditure, inflammation, and oxidative stress in steady-state adolescents with sickle cell anemia.

Sickle cell anemia (HbSS) is characterized by hypermetabolism, chronic inflammation, and increased oxidative stress, but the relationship between these factors is undefined. In this study, we examined indicators of inflammatory process and markers of oxidative damage and their impact on resting energy expenditure (REE) in stable HbSS adolescents (n = 35) and healthy controls carrying normal hemoglobin genotype (HbAA) (n = 39). C-reactive protein (CRP), white blood cell (WBC) count, and proinflammatory cytokines were measured as markers of inflammation and 2,3-dinor-5,6-dihydro-15-F2t-isoprostane (F2-IsoPM) as a marker of oxidative stress. REE was measured by indirect calorimetry. WBC counts (11.90 ± 5.3 ×103/μL versus 5.6 ± 1.9 ×103/μL; p < 0.001), serum CRP (9.1 ± 11.0 μg/mL versus 0.4 ± 0.7 μg/mL; p < 0.001) and serum IL-8 (7.5 ± 4.4 pg/mL versus 5.5 ± 4.8 pg/mL; p = 0.011) were higher in HbSS than HbAA, suggesting an anti-inflammatory response in HbSS. Higher urinary F2-IsoPM in HbSS (1.2 ± 0.4 versus 0.7 ± 0.3 ng/mg creatinine; p < 0.001) indicates increased oxidative stress. Fat free mass (FFM), hemoglobin (Hgb), interleukin (IL)-8, and F2-IsoPM were independent predictors of REE in HbSS (overall r2 = 0.778; p < 0.001). Low-grade inflammation and increased oxidative stress are present in adolescents with HbSS in the absence of acute crisis, and their markers are correlated with elevated REE.

Validity of a multisensor armband in estimating 24-h energy expenditure in children.

UNLABELLED Physical activity (PA) and energy expenditure (EE) in children are frequently assessed using portable activity monitors. Algorithms used to predict EE by these monitors are often based on adult populations and may not be accurate for children. PURPOSE To evaluate the accuracy of the SenseWear Pro Armband (SWA) for assessing EE in African American children during treadmill exercise, sedentary activities, rest, sleep, and total 24-h EE, using indirect room calorimetry (IRC) as a reference standard. METHODS Participants were healthy African American children (10 boys, 11 girls; age: 11.6 +/- 0.9 yr; weight: 47.3 +/- 13.0 kg; height: 151.6 +/- 8.8 cm; BMI: 20.4 +/- 4.8 kg.m). EE was measured simultaneously using IRC and SWA during a 24-h stay in the IRC. Recorded activities included sedentary behaviors, treadmill exercise, rest periods, and sleep. Results from both methods were matched minute-by-minute and compared by Bland-Altman plot. Multiple linear regression analysis was used to describe the relationship between EE assessed by both methods and childrens descriptive characteristics. RESULTS SWA overestimated EE compared with IRC during all activities and time periods, ranging from 116% during sleep to 143% during rest after treadmill exercise. The SWA-predicted EE was improved by using linear regression modeling. Simple equations for sedentary activities and treadmill exercise were EE [kcal.min] = 0.462EE (SWA) [kcal.min] + 0.015 x body weight [kg], and EE [kcal.min] = 0.637EE (SWA) [kcal.min] + 0.034 x body weight [kg], respectively. The prediction equation for RMR was RMR [kcal.min] = 0.453EE (SWA) [kcal.min] + 0.011 x body weight [kg]. CONCLUSION EE estimated using SWA was significantly higher than EE measured using IRC in African American children ages 10-14 yr. Bias in individual EE estimated using SWA could be improved by an adjustment for the body weight of a child. The SWA manufacturer should work with researchers on improving existing algorithms for children.

Growth Patterns in Children with Sickle Cell Anemia during Puberty

Previous studies of children with homozygous sickle cell anemia (SCA) show impaired growth and maturation. The correlation of this suboptimal growth with metabolic and hematological factors during puberty is poorly understood.

Defects in Postabsorptive Plasma Homeostasis of Fatty Acids in Sickle Cell Disease

BACKGROUND The chronic hemolytic anemia experienced by sickle cell disease (SCD) patients leads to adverse effects on oxygen transport by the blood and to a decrease in oxygen availability for peripheral tissues. Limited tissue oxygen availability has the potential to modify events of intracellular metabolism and, thus, alter lipid homeostasis. METHODS The impact of SCD on plasma fatty acid homeostasis was determined in 8 African American SCD patients and in 6 healthy African American control subjects under postabsorptive conditions and during a 3-hour IV infusion of a nutrient solution containing lipid, glucose, and amino acids. RESULTS SCD patients had higher fasting levels of plasma nonesterified fatty acids (NEFA), triglycerides, and phospholipids than healthy controls. Similarly, SCD patients had higher fasting levels of fatty acids in plasma triglycerides and phospholipids than healthy controls. Infusion of nutrients resulted in equivalent plasma NEFA profiles, total NEFA, and triglycerides in SCD patients and controls. However, the plasma phospholipid concentrations and fatty acid composition of plasma triglycerides and phospholipids were significantly higher in SCD patients; in particular, plasma pools of oleic acid were consistently increased in SCD. Plasma free oleic acid levels were elevated basally, leading to increased oleic acid content in triglycerides and phospholipids both post absorptively and during nutrient infusion. CONCLUSIONS There is an underlying defect in lipid metabolism associated with SCD best manifested during the fasting state. This abnormality in lipid homeostasis has the potential to alter red blood cell (RBC) membrane fluidity and function in SCD patients.

Healthy Families Study: Design of a Childhood Obesity Prevention Trial for Hispanic Families

BACKGROUND The childhood obesity epidemic disproportionately affects Hispanics. This paper reports on the design of the ongoing Healthy Families Study, a randomized controlled trial testing the efficacy of a community-based, behavioral family intervention to prevent excessive weight gain in Hispanic children using a community-based participatory research approach. METHODS The study will enroll 272 Hispanic families with children ages 5-7 residing in greater Nashville, Tennessee, United States. Families are randomized to the active weight gain prevention intervention or an alternative intervention focused on oral health. Lay community health promoters implement the interventions primarily in Spanish in a community center. The active intervention was adapted from the We Can! parent program to be culturally-targeted for Hispanic families and for younger children. This 12-month intervention promotes healthy eating behaviors, increased physical activity, and decreased sedentary behavior, with an emphasis on parental modeling and experiential learning for children. Families attend eight bi-monthly group sessions during four months then receive information and/or support by phone or mail each month for eight months. The primary outcome is change in childrens body mass index. Secondary outcomes are changes in childrens waist circumference, dietary behaviors, preferences for fruits and vegetables, physical activity, and screen time. RESULTS Enrollment and data collection are in progress. CONCLUSION This study will contribute valuable evidence on efficacy of a childhood obesity prevention intervention targeting Hispanic families with implications for reducing disparities.

Identification of patient-centered outcomes among African American women with type 2 diabetes

AIMS African American women carry a disproportionate diabetes burden, yet there is limited information on strategies to identify outcomes women perceive as important intervention outcomes (patient-centered outcomes). This study presents a brief strategy to solicit these outcomes and to describe outcomes identified using the highlighted strategy. METHODS Thirty-four African-American women with type 2 diabetes were enrolled in group-based, diabetes/weight management interventions. A diabetes educator asked participants to write down their intervention expectations followed by verbal sharing of responses. Expectation-related themes were identified using an iterative, qualitative, team analytic approach based on audio-recorded responses. RESULTS The majority of the expectation-related themes (6 of 10) were reflective of self-care education/management and weight loss-related patient-centered outcomes. The remaining themes were associated with desires to help others prevent or manage diabetes, reduce negative diabetes-related emotions, get rid of diabetes, and stop taking diabetes medications. CONCLUSION This study adds to a limited body of knowledge regarding patient-centered outcomes among a group that experiences a disproportionate diabetes burden. Future work could include integrating outcomes that are less commonly addressed in diabetes-related lifestyle interventions (e.g., diabetes-related negative emotions), along with more commonly addressed outcomes (e.g., weight loss), to increase the patient-centeredness of the interventions.

Two-year follow-up study of a group-based diabetes medical nutrition therapy and motivational interviewing intervention among African American women

Objectives To assess the 2-year efficacy of a combined medical nutrition therapy and motivational interviewing (MI) pilot study intervention and factors that influenced long-term dietary self-care. Research design and methods Pilot study participants, African American women with type 2 diabetes, completed a 2-year follow-up study visit, including clinical assessments and completion of a dietary self-care questionnaire and a semi-structured interview. Wilcoxon signed-rank tests were used to evaluate differences between baseline and 2-year follow-up clinical and dietary self-care outcomes. Hierarchical coding was used to analyze semi-structured interviews and categorize facilitator and barrier themes into subthemes. Subthemes were quantified based on the number of subtheme-related comments. Results Among the 12 participants (mean age 57.1±5.7 years), improvements were observed for HbA1c (baseline: 10.25%; interquartile range [IQR]: 8.10, 11.72 and follow-up: 8.8%; IQR: 7.48,10.22), systolic blood pressure (baseline: 142 mm Hg; IQR: 134.25, 157.25 and follow-up: 127 mm Hg; IQR: 113.5, 143.25), frequency of eating high-fat foods (baseline: 3.5 days; IQR: 2.75, 4.25 and follow-up: 3 days; IQR: 2.5, 4.5), and of spacing carbohydrates throughout the day (baseline: 3 days; IQR: 3.0, 4.0 and follow-up: 4 days; IQR: 1.5, 4.5). There was a statistically significant decrease (p=0.04) in the frequency of fruit and vegetable intake (baseline: 4 days; IQR: 3.75, 7.0 and follow-up: 3.5 days; IQR: 2.75, 4.0). Dietary self-care barriers and facilitators included internal (eg, motivation) and external factors (eg, social support). Motivation (70 comments) and lack of motivation (67 comments) were the most pervasive facilitator and barrier subthemes, respectively. Conclusion Overall, diabetes-related clinical and dietary self-care outcomes were improved following a combined medical nutritional therapy/MI intervention, and motivation played an important role in dietary self-care engagement. Future research is needed to assess the added benefit of MI in improving clinical and dietary self-care outcomes and to identify best strategies to support post-intervention dietary self-care engagement.

Psychometric evaluation of the short version of the Personal Diabetes Questionnaire to assess dietary behaviors and exercise in patients with type 2 diabetes

BACKGROUND Patients with diabetes and of lower socioeconomic status have difficulty adhering to dietary recommendations. Practical and effective tools assessing self-management behaviors are needed to help evaluate interventions tailored to the needs of individual patients or population groups. This study examined the psychometric properties of a short 11-item version of the Personal Diabetes Questionnaire scale (PDQ-11) using data from the Public-Private Partnership to Improve Diabetes Education trial. METHODS Patients (n=411) with type 2 diabetes from ten safety net primary care clinics in the Mid-Cumberland Region of Tennessee completed the PDQ-11, the Summary of Diabetes Self-Care Activities (SDSCA), the Perceived Diabetes Self-Management Scale (PDSMS), and the Adherence to Refills and Medications Scale (ARMS). Statistical analyses were conducted to explore the subscale structure of the PDQ-11, and the internal consistency and validity of its subscales. RESULTS Exploratory factor analysis of the PDQ-11 revealed four components (Cronbachs α=0.50 to 0.81): Eating Behavior Problems; Use of Information for Dietary Decision Making; Calorie Restriction; and Activity and Exercise. Eating Behavior Problems and Use of Information for Dietary Decision Making had the strongest associations with the diet subscales of the SDSCA and were also correlated with the PDSMS and the ARMS scores (all ps<0.001). Different PDQ-11 subscales were correlated with BMI (Calorie Restriction Activity and Exercise) and blood pressure (Eating Behavior Problems). CONCLUSIONS The PDQ-11 is a useful measure of dietary behaviors in patients with type 2 diabetes; its use may help providers tailor individual nutrition intervention strategies to patients.

Diabetes Education, Specialty Care, and Self-Care Advice among Obese African American Women with Type 2 Diabetes

OBJECTIVE Healthy People 2020 (HP2020) includes benchmarks for diabetes management. The objective of our study was to describe diabetes management among African American women, a patient group that carries a disproportionate diabetes burden. PARTICIPANTS African American women with type 2 diabetes enrolled in dietary and weight management interventions. MAIN OUTCOME MEASURES Self-report assessments of diabetes education, specialty care, self-care behaviors and advice. Associations between diabetes self-care behaviors and diabetes advice using Chi-square tests. RESULTS Among 96 participants (age = 53 ± 9.4; BMI = 37.9 ± 7.3 kg/m(2)), reported diabetes education and foot exams were lower than HP2020 benchmarks, 48.9% vs 62.5% and 35.1% vs 74.8%, respectively and higher for dilated eye exams (70.1% vs 58.7%). The most frequently reported dietary advice was to increase fruit/vegetable intake (58%) and approximately 50% reported physical activity advice. Receiving no exercise advice was associated with greater odds of little or no physical activity (OR = 3.38) and planned exercises (OR = 2.65). CONCLUSIONS Receipt of diabetes education and some specialty care were below national benchmarks while health care provider advice influenced patient self-care behaviors. Increasing diabetes education and specialty care should be included within existing efforts to address the excess diabetes burden experienced by African American women. Longitudinal studies exploring the relationship between health care provider advice and self-care behaviors are needed.