Field Notes

Childhood Obesity Historically High in Low-Income Communities

Childhood obesity rates are at historically high levels, especially among racial/ethnic minorities and low-income families. In the journal Obesity, three papers present outcomes from the Massachusetts Childhood Obesity Research Demonstration Project (MA-CORD), a comprehensive, systematic intervention to prevent and reduce childhood obesity among low-income children aged 2 to 12 in two selected cities in Massachusetts.

“Childhood Obesity Prevention in the Women, Infants, and Children Program: Outcomes of the MA-CORD Study” lead author Jennifer Woo Baidal, MD, MPH, and colleagues examined the extent to which a WIC intervention improved BMI z-scores and obesity-related behaviors among children aged 2 to 4. “This study is one of the first to incorporate WIC into a whole-of-community intervention, which resulted in reduced prevalence of childhood obesity risk factors,” says Woo Baidal, an assistant professor of pediatrics and director of pediatric weight management at Columbia University Medical Center and NewYork-Presbyterian Morgan Stanley Children’s Hospital.

The second MA-CORD study was conducted by Elsie M. Taveras, MD, MPH, and colleagues and examined the impact of the MA-CORD multicomponent clinical intervention on BMI z-scores compared with routine practice over two years using electronic health records. The clinical intervention package included specialized training for health care providers and other clinic staff on best practices for treating childhood obesity and encouraging healthful changes; electronic support tools, including computerized alerts when physicians opened electronic health records of children with overweight or obesity during well-child visits; Healthy Weight Clinics, to which children with overweight or obesity and their parents could be referred; environmental changes at the health centers designed to encourage healthful behaviors; and a community health worker dedicated full time to the program. The study sought to examine the extent to which the clinical intervention resulted in reduced BMI z-scores among children aged 2 to 12 compared with routine practice. “The results of this research directly relate to children, families, and the medical and community organizations that serve them. Our study reflects a best practice in the design of an effective multilevel intervention addressing childhood obesity in low-income communities,” says The Obesity Society Spokesperson and lead author Taveras, a professor of pediatrics at Harvard Medical School and incoming executive director of the Kraft Center for Community Health at Mass General Hospital.

The third MA-CORD study, led by Rebecca Franckle, ScD, MPH, and colleagues reported on the school-based component of MA-CORD, examining changes in prevalence of obesity and target health behaviors (food and beverage consumption, physical activity, screen time, sleep duration) for first, fourth, and seventh graders. Among seventh graders, a significant decrease in prevalence of obesity was reported in one intervention community. “Schools remain a critical environment for health promotion and obesity prevention establishing behaviors for life,” according to Franckle, a postdoctoral fellow in the department of nutrition at Harvard T.H. Chan School of Public Health.

In accompanying editorials published in Obesity pertaining to the MA-CORD, Jackson P. Sekhobo, PhD, MPA, examined the WIC study in depth, while Christina Economos, PhD, and Ross A. Hammond, PhD, explored all three studies and corresponding results. Overall, the conclusion from these three studies collectively demonstrates the potential power of multisector multilevel approaches to childhood obesity prevention in low-income communities.

— Source: Obesity Society


Preliminary Research Suggests Insulin May Protect Against Heart Disease in Type 1 Diabetes

One additional injection of insulin three hours after eating has been shown to protect people with type 1 diabetes from cardiovascular disease (CVD)—the leading cause of death among people with the condition.

A small preliminary clinical trial published in Diabetes and Vascular Disease Research has found the easy step allows people with type 1 diabetes to better regulate their blood sugar levels. Crucially, it also reduces fat and inflammatory markers in the blood that can damage blood vessels and increase risk of heart disease. People with type 1 diabetes are up to 10 times more likely to suffer from CVD than the general population, and the condition accounts for more than one-half of all deaths in this patient group.

The team is now looking to continue with a larger trial over a longer period to look at blood vessel health and diabetes control.

Coauthor of the study Matthew Campbell, PhD, from Leeds Beckett University in Leeds, England, United Kingdom (UK), explains, “Many people with type 1 diabetes struggle to regulate their blood sugar levels around mealtimes, because the fat content in their food is metabolized after their standard insulin injection has lost its potency or has left their blood. Most meals in a typical UK diet have a high-fat content, and slower metabolism of this fat can lead to raised blood sugar levels—with risk of hyperglycemia—and also higher levels of fat and inflammatory markers in the blood, which increase the risk of cardiovascular disease.”

The small trial held at the UK National Institute for Health Research Newcastle Clinical Research Facility involved 10 men with type 1 diabetes who were given three meals with identical carbohydrate and protein content. One of the meals had a low fat content, and two had a high fat content. With the low-fat meal, the volunteers administered their insulin dose as normal, calculated by the carbohydrate levels in the food. The volunteers did the same after one high-fat meal, but with the other, they also administered an additional insulin injection of one-third of the original dose three hours after eating. Blood samples were taken for analysis every 30 minutes, until six hours after eating.

The team found that after the high-fat meal and the standard insulin injection, sugar, fat, and inflammatory markers in the blood were significantly elevated six hours after eating. However, when the extra insulin shot was taken, the blood analysis showed normal levels of sugar, fat, and inflammatory markers, similar to after the low-fat meal.

Coauthor Daniel West, PhD, of Newcastle University, says, “Improving the sugar and fat levels in the blood after eating is important for the long-term health of the heart and blood vessels. But calculating insulin injection dose based on carbohydrates alone is clearly too simplistic, as most people eat meals that include fat and protein too.”

Campbell adds, “Our findings show that, after a high-fat meal, an extra dose of insulin provides a very simple way of both regulating blood sugar levels for short-term health and protecting against the long-term risks of cardiovascular disease. We feel strongly that the advice given to people with type 1 diabetes needs to be updated to take this new information into account.”

The UK team urges people to seek medical advice before altering their insulin injection. They’re now intending to begin a larger-scale trial.

— Source: Leeds Beckett University