Sharon E. FlemingProfessor Professor and Food Scientist in the Agricultural Research Station Ph.D. (Food Science and Nutrition), University of Saskatchewan, Saskatoon, 1975 (510) 642-4797 |
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The objective of our research program is to develop, implement and evaluate community-based interventions that can reduce the risk of type 2 diabetes mellitus in overweight, inner-city African American and Mexican American children. The intervention components targeted in our programs include improvements in dietary intakes, increased physical activity, and building of strong self-esteem. The research team includes collaborators with established expertise in nutrition, exercise physiology, public health, psychology, medicine, education, and African American and Mexican American cultural sensitivity. This diversity is needed to develop and test the multi-component intervention proposed. Our projects are multi-institutional, a hallmark of efforts undertaken by the Center for Weight and Health. Actively involved are academics from the University of California at Berkeley, San Francisco and Riverside, Pennington Biomedical Research Center, Brock University in Toronto, and UC Cooperative Extension. An Advisory Board that includes key individuals who have successfully developed extra-curricular, nutrition and physical education activities for children provide advice and guidance.
There is a critical need for programs, targeting children, which prevent T2DM and obesity, oftentimes referred to as ‘diabesity’ because of the inextricable link between the two conditions. Associated with a 3-4 fold increase in obesity since the 1970’s, the incidence of T2DM in children has risen at an unprecedented 9-10 fold rate in the last decade. Formerly a rare occurrence, now nearly 55% of diabetes cases in AA youth and over a third of cases in Hispanic youth are T2DM. Additionally, for nearly every individual with frank diabetes, there is another with pre-diabetes; nearly 1 in 6 overweight youth has pre-diabetes. In a study of overweight and obese inner-city AA youth, 35% had metabolic syndrome; this proportion increased to 55% in youth with BMI Z-scores >2.5. In a nationally representative study of adolescents, the prevalence of metabolic syndrome was highest among Mexican-Americans. It is projected that nearly 50% of AA and MA children born in the US in 2000 will develop T2DM in their lifetimes. Low socioeconomic status can increase risk of obesity and T2DM. If the current situation continues unabated, in merely two decades,10% of the U.S. population is expected to be afflicted with diabetes or pre-diabetes. As in excess of $170B/yr is spent on diabetes and its co-morbidities, prevention in youth is especially critical since early age of onset increases T2DM-related morbidity.
Primary prevention programs that improve diet and physical activity are the most efficacious means of delaying or preventing T2DM and obesity. Even modest weight loss induced by changes in diet and physical activity reduces diabetes risk in adults and improves glucoregulation in obese children. Unfortunately, maintaining weight loss has proven challenging in most populations, including AAs and MAs. Reinforcement of behavioral change is likely needed to maintain weight loss and associated improvements in glucoregulation. A recent position paper by the American Dietetic Association and a meta-analysis of the effectiveness of weight loss programs in children support taking a comprehensive approach when developing strategies to reduce body fatness and improve health in youth. The authors concluded - “A combination of variables, dietary, physical activity, behavioral change and parental involvement can be effective in assisting children to effectively lose weight”.
Community-based organizations that are an integral part of a family’s and child’s life offer a convenient and sustainable means of offering programs that can improve diet and physical activity of the neighborhood populations. The after-school setting represents a widely accessible, but largely untapped venue for T2DM prevention. Compared to studies taking place during the school day, little research has been conducted in out-of-school settings. With more parents in the workforce, after-school programs have become increasingly popular.
In the near future, we hope to implement and evaluate an after-school intervention to address the unprecedented increase in obesity-associated type 2 diabetes in African American and Mexican American children. Few prevention interventions have been designed for children and those tested have had mixed results. Findings from our previous Taking Action Together study of low-income, African American children indicate that targeting improvements in diet, physical activity and self-esteem result in significant reductions in insulin resistance in boys after 1-year of once weekly programming. Among girls, only those whose weight stabilized (even though weight was not targeted) improved insulin resistance. We plan to continue this work by undertaking a new project would involve the adaptation and testing of After-School Taking Action Together in partnership with community partners such as the YMCA and Boys & Girls Club. The target population would include 8-10 year old overweight African American and Mexican American children. Using the same cluster randomized, controlled design, the goal would be to evaluate effectiveness under conditions that: 1) broaden reach using existing after-school settings and including two ethnic groups; 2) intensify impact by offering programming 4 times weekly for 1 school year; 3) expand parent outreach by engaging a community liaison group and increasing targeted parent activities; and 4) address weight concerns in a second intervention arm with a participant-centered focus on realistic weight goals. Treatment effectiveness on body weight stabilization would be evaluated using BMI-Z scores as the primary outcome variable; and treatment effectiveness on insulin sensitivity would be evaluated using HOMA-IR, a variable calculated from fasting glucose and insulin concentrations. Consistent with social cognitive theory, we hypothesize that development of self-efficacy with respect to targeted behaviors will improve children’s dietary intake, physical activity, and self-esteem which, in turn, will stabilize body weight and reduce insulin resistance. Further we hypothesize that addressing weight management will further reduce obesity and diabetes risk in girls and boys, both African American and Mexican American. Identifying interventions for delivery in readily accessible after-school settings that reduce obesity, improve nutrition, and prevent disease in vulnerable youth will effectively address the NIH goal of reducing health disparities among minority and underserved children.
Most Recent Publications
Jorgensen, J.R., Fitch, M.D., Mortensen, P.B. and Fleming, S.E. 2001. In vivo absorption of medium-chain fatty acids by the rat colon exceeds that of short-chain fatty acids. Gastroent. 120:1152-1161, 2001.
Cremin, J.D. Jr., Fitch, M.D. and Fleming. S.E. Glucose alleviates ammonia-induced ihibition of short-chain fatty acid metabolism in colonic epithelial cells. Am. J. Physiol. 285:G105-G114, 2003
Ritchie, L., Ganapathy, S., Woodward-Lopez, G., Gerstein, D. and Fleming, S.E. Prevention of type 2 diabetes in yough: pathogenesis to public policy. Ped. Diabetes. 4:174-209, 2003.
Zambell, K.L., Fitch, M.D. and Fleming, S.E. Acetate and butyrate are the major substrates for de novo lipogenesis in rat colonic epithelial cells. J. Nutr., 133:3509-3515, 2003.
Kobayashi, H., Tan, E.M. and Fleming, S.E. Acetylation of histones associated with the p21WAF1/CIP1 gene by butyrate is not sufficient for p21 gene transcription in human colorectal adenocarcinoma cells. Internat. J. Cancer, 109:207-213, 2004.
Woodward-Lopez, G., Ritchie, L., Gerstein, D. and Fleming, S.E. Carbohydrates and obesity. In "Functional Carbohydrates. Ed. C. Biliaderis and M. Izydorczyk, CRC Press, Roca Baton, FL, pp. 321-370, 2007.
Raman A, Fitch M, Hudes ML, Lustig R H, Murray C, Ikeda JP & Fleming SE. Baseline correlates of insulin resistance in inner city BMI African American children. Obesity. In Press. Obesity advance online publication, 26 June 2008 (doi:10.1038/oby.2008.329). 2008.
Hay J, Raman A, Fitch MD & Fleming SE. Examining predictors of physical activity among inner-city African American children. North American Society for Pediatric Exercise Medicine meeting, abstract, with publication in Ped Exercise Med. Sept, 2008.