The Gut Microbiome and Symptom Burden After Kidney Transplantation: An Overview and Research Opportunities.

Many kidney transplant recipients continue to experience high symptom burden despite restoration of kidney function. High symptom burden is a significant driver of quality of life. In the post-transplant setting, high symptom burden has been linked to negative outcomes including medication non-adherence, allograft rejection, graft loss, and even mortality. Symbiotic bacteria (microbiota) in the human gastrointestinal tract critically interact with the immune, endocrine, and neurological systems to maintain homeostasis of the host. The gut microbiome has been proposed as an underlying mechanism mediating symptoms in several chronic medical conditions including irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, and psychoneurological disorders via the gut-brain-microbiota axis, a bidirectional signaling pathway between the enteric and central nervous system. Post-transplant exposure to antibiotics, antivirals, and immunosuppressant medications results in significant alterations in gut microbiota community composition and function, which in turn alter these commensal microorganisms' protective effects. This overview will discuss the current state of the science on the effects of the gut microbiome on symptom burden in kidney transplantation and future directions to guide this field of study.

Pain Interference in End Stage Kidney Disease is Associated with Changes in Gut Microbiome Features Before and After Kidney Transplantation.

BACKGROUND: Pain, a common debilitating symptom among kidney transplant recipients (KTRs), is among the most common and undertreated symptoms after kidney transplantation. AIMS: Characterize associations between gut microbiome features and pain interference before and after kidney transplantation. DESIGN: Longitudinal, repeated measures study, collecting fecal specimens and pain interference data pretransplant and 3 months posttransplant. SETTING: Participants were recruited at the kidney transplant clinic at the University of Illinois Hospital & Health Sciences System. PARTICIPANTS/SUBJECTS: 19 living donor kidney transplant recipients. METHODS: We assessed fecal microbial community structure with shotgun metagenomic sequencing; we used pain interference scores derived from the Patient-Reported Outcomes Measurement Information System-57. RESULTS: We measured a reduction in the Shannon diversity index in both groups after transplantation but observed no significant differences between groups at either time point. We did observe significant differences in fecal microbial Bray-Curtis similarity index among those reporting pain interference pre- transplant versus no pain interference at 3-months posttransplant (R = .306, p = .022), and between pain interference groups at posttransplant (R = .249, p = .041). Pairwise models showed significant differences between groups posttransplant in relative abundances of several taxa, including a 5-fold reduction.ßin Akkermansia among those with pain interference and a higher relative abundance of taxa associated with chronic inflammation in those with pain interference posttransplant. Functional gene analysis identified two features that were significantly enriched in those with pain interference, including a peptide transport system gene. CONCLUSIONS: Gut microbiota community structure differs between groups with and without pain interference at 3 months after kidney transplantation. Several taxa involved in intestinal barrier integrity and chronic inflammation were associated with posttransplant pain.

A pilot study of a school lunchroom intervention in a predominantly Latinx sample.

OBJECTIVE: The purpose of the study was to assess the feasibility of an environmental school lunchroom intervention ('Smarter Lunchrooms') and test initial efficacy within a predominantly Latinx population. DESIGN: We collected baseline and intervention lunchroom food consumption and waste data in a pre-post, single group design. Meal consumption data was analyzed using Nutrition Data System for Research software to obtain estimates of nutritional content. MAIN OUTCOME MEASURES: Feasibility. SECONDARY MEASURES: Plate Waste, Nutrient Intake. RESULTS: Participants were 88 1st-4th graders (51% female; 77% Latinx). Our recruitment rate was 45%, we were able to implement 8 Smarter Lunchroom strategies, and we were able to collect 82 baseline plate photos (93%) and 80 intervention photos (90%) of school lunches. On average, students threw away more than half of their meals on both days. Fruit consumption and fiber per 1000 kcal were significantly poorer at intervention compared to baseline. CONCLUSIONS: Our findings highlight challenges in collecting consumption data in a real-world setting. We describe directions for future research taking into consideration our "lessons learned" from this formative work.

Diet quality of children in the United States by body mass index and sociodemographic characteristics.

OBJECTIVE: The primary objective was to use the Healthy Eating Index-2015 (HEI-2015) to describe diet quality by categories of body mass index (BMI) and by sociodemographic characteristics within categories of BMI using a nationally representative sample of US children. METHODS: Dietary datasets from three cycles of the National Health and Nutrition Examination Survey (2009-2014) were analysed for children 2 to 18 years of age (N = 8894). Using the population ratio method, mean and 95% confidence intervals for HEI-2015 total and component scores were computed by BMI (underweight, normal weight, overweight, and obese) and by age (2-5, 6-11, and 12-18 y), gender, race/ethnicity (non-Hispanic black, non-Hispanic white, Mexican American, other Hispanic, and other race), and family poverty to income ratio (below and at/above poverty threshold). RESULTS: HEI-2015 mean total scores were 50.4, 55.2, 55.1, and 54.0 out of 100 points for children with underweight, normal weight, overweight, and obesity, respectively, and were not significantly different. Within BMI categories, significant differences in total and mean component scores were present for age and race/ethnicity groups. CONCLUSIONS: Total and most components of diet quality did not significantly differ among child populations classified by BMI status. Within BMI categories, significant diet quality differences were found for age and race/ethnicity groups, although scores were low for all child groups. Researchers may need to address or target specific dietary components with low quality in various child populations to have the greatest effect on improving nutrition nationwide.

A Step toward Understanding Diet Quality in Urban African-American Breast Cancer Survivors: A Cross-sectional Analysis of Baseline Data from the Moving Forward Study.

PURPOSE: Little is known about the dietary behaviors of African-American breast cancer survivors (AABCS). We sought to describe dietary intake and quality in AABCS and examine associations with demographic, social, lifestyle, and body composition factors to potentially inform the development of effective dietary interventions. METHODS: Baseline data from a prospective weight loss trial of 210 AABCS were assessed. A food frequency questionnaire was used to evaluate dietary intake and diet quality via the Healthy Eating Index 2010 (HEI-2010) and Alternative Healthy Eating Index 2010 (AHEI-2010). Linear regression analysis was conducted to determine the most influential variables on diet quality. RESULTS: Mean HEI- and AHEI-2010 total scores were 65.11 and 56.83 indicating that diet quality needs improvement. Women were the least adherent to recommendations for intake of whole grains, dairy, sodium, empty calories, sugary beverages, red/processed meats, and trans-fat. Increased self-efficacy for healthy eating behaviors, more years of education (AHEI only), negative smoking status, smaller waist circumference, and increased physical activity (HEI only) were significantly associated with higher diet quality scores. CONCLUSION: Our findings suggest the diet quality of AABCS needs improvement. Intervention programs may achieve higher diet quality in AABCS by focusing on increasing self-efficacy for healthy eating behaviors.

Diet quality in a nationally representative sample of American children by sociodemographic characteristics.

Background: To date, Healthy Eating Index 2015 (HEI-2015) scores have not been published in the peer-reviewed literature for nationally representative samples of American children. Objective: The aim of this study was to use the HEI-2015 to describe the diet quality of American children overall and within various sociodemographic populations. Design: We used 3 cycles of NHANES dietary data sets (2009-2010, 2011-2012, and 2013-2014) to calculate HEI-2015 total and component scores by use of the population ratio method for children aged 2-18 y (n = 9000). Diet-quality scores were computed overall and by age (2-5, 6-11, and 12-18 y), gender, race or ethnicity (non-Hispanic black, non-Hispanic white, Mexican American, other Hispanic, and other race), and family poverty-to-income ratio (below or at or above the poverty threshold). HEI-2015 mean total and component scores were computed along with 95% CIs. Results: The HEI-2015 total mean score for children overall was 54.9 (range: 0-100). As the age group increased, the total scores decreased; the total mean score was significantly higher for children in the youngest age group compared with the 2 older age groups (60.1 compared with 53.9 compared with 52.0, respectively). The total mean score was significantly lower for non-Hispanic black children compared with Mexican American children, other Hispanic children, and children of other races (52.6 compared with 57.0, 56.8, and 57.1, respectively). The total mean score was significantly lower for non-Hispanic white children compared with Mexican-American children (54.2 compared with 57.0). No differences in total mean scores were apparent between boys and girls or between poverty threshold classes. The total mean scores for cross-classified sociodemographic characteristics generally followed the same patterns observed for single characteristics, with notable differences occurring within age and race or ethnicity classes. Conclusions: The diet quality of American children remains low overall, with continued disparities across some sociodemographic populations, notably age and race or ethnicity. The results of these analyses can help guide the efforts of child nutrition researchers, practitioners, and other stakeholders.

Infant activity and sleep behaviors in a maternal and infant home visiting project among rural, southern, African American women.

BACKGROUND: Physical inactivity and inadequate amounts of sleep are two potential causes for excessive weight gain in infancy. Thus, parents and caregivers of infants need to be educated about decreasing infant sedentary behavior, increasing infant unrestrained floor time, as well as age specific recommended amounts of sleep for infants. The aims of this study were to determine if maternal knowledge about infant activity and sleep changed over time and to evaluate maternal compliance rates with expert recommendations for infant sleep in a two-arm, randomized, controlled, comparative impact trial. METHODS: Pregnant women at least 18 years of age, less than 19 weeks pregnant, and residing in a lower Mississippi Delta county were recruited between March 2013 and December 2014. Postnatal data was collected from 54 participants between September 2013 and May 2016. McNemar's test of symmetry was used to determine if maternal knowledge changed over time, while generalized linear mixed models and Kaplan-Meier survival curves were used to assess compliance with expert recommendations for infant sleep. RESULTS: The postnatal retention rate was 85%. Maternal knowledge significantly increased for correct infant sleep position (back) and beginning tummy time by one month of age. Odds of meeting sleep duration recommendations increased by 30% for every one month increase in infant age. Only 20% of the participants were compliant with the back to sleep recommendation for the first 12 months of their infant's life; median time to noncompliance was 7.8 months. CONCLUSIONS: Although baseline knowledge concerning infant activity and sleep was high in this cohort of rural, Southern, African American mothers, compliance with recommendations was not optimal. TRIAL REGISTRATION: The study was registered at clinicaltrials.gov (NCT01746394) on December 5, 2012.

No Improvements in Postnatal Dietary Outcomes Were Observed in a Two-Arm, Randomized, Controlled, Comparative Impact Trial among Rural, Southern, African-American Women.

BACKGROUND: Suboptimal diet quality, prevalent among postpartum women, is troubling for mothers and their children because positive relationships between maternal and child diet quality exist. OBJECTIVE: The primary objective was to determine whether postnatal diet quality scores of participants in the two treatment arms differed or changed over time. DESIGN: Delta Healthy Sprouts was a two-arm, randomized, controlled, comparative impact trial. PARTICIPANTS AND SETTING: Pregnant women at least 18 years of age, less than 19 weeks pregnant, and residing in three Mississippi counties were recruited between March 2013 and December 2014. Postnatal data was collected from 54 participants between September 2013 and May 2016. The postnatal attrition rates were 17% and 13% for the control and experimental arms. INTERVENTION: The control arm received the Parents as Teachers curriculum, and the experimental arm received a nutrition- and physical activity-enhanced Parents as Teachers curriculum. MAIN OUTCOME MEASURES: Multiple-pass 24-hour dietary recalls were collected from participants at the postnatal month 1, 4, 6, 8, and 12 visits. Healthy Eating Index-2010 was used to calculate diet quality. STATISTICAL ANALYSIS PERFORMED: Linear mixed models were used to test for treatment, time, and treatment by time (interaction) effects on postnatal dietary outcomes. RESULTS: Control arm mean (95% confidence limits) total Healthy Eating Index-2010 scores were 36.8 (range=32.5 to 41.1), 36.5 (range=31.9 to 41.1), 40.2 (range=35.7 to 44.8), 39.3 (range=34.7 to 43.9), and 36.4 (range=31.8 to 41.0) at postnatal months 1, 4, 6, 8, and 12, respectively. Corresponding experimental arm scores were 42.3 (range=37.5 to 47.0), 41.6 (range=36.3 to 46.9), 40.2 (range=34.8 to 45.7), 45.8 (range=40.5 to 51.1), and 37.6 (range=32.6 to 42.7), respectively. Experimental scores were significantly higher than control scores across time. No other effects were significant. CONCLUSIONS: Neither the standard Parents as Teachers curriculum nor the enhanced Parents as Teachers curriculum was effective at improving the poor diet quality of this cohort of rural, Southern, African-American women during the 12 months following the birth of their infant.

Enhanced Curriculum Intervention Did Not Result in Increased Postnatal Physical Activity in Rural, Southern, Primarily African American Women.

PURPOSE: To test the impact of an enhanced home visiting curriculum on postnatal physical activity in rural, southern, primarily African American mothers. DESIGN: Randomized controlled trial. SETTING: Three rural counties in Mississippi. PARTICIPANTS: Between September 2013 and May 2016, 54 postpartum women randomized to standard home visiting curriculum (n = 30 control) or lifestyle enhanced home visiting curriculum (n = 24 experimental) were followed for 12 months. INTERVENTION: The experimental arm of the intervention built upon the Parents as Teachers curriculum (control arm) by adding culturally tailored, maternal weight management and early childhood obesity prevention components. MEASURES: Physical activity behavior and related psychosocial constructs including attitudes, expectations, self-efficacy, social support, and barriers. ANALYSIS: Generalized linear mixed models were applied to test for treatment and time effects on physical activity and related psychosocial constructs. RESULTS: Postnatal retention rates were 83% and 88% for control and experimental arms, respectively. Mean weekly minutes of moderate-to-vigorous physical activity were 28 and 50 minutes at postnatal months 1 and 12 in the control arm and 40 minutes for both time points in the experimental arm. Although a significant time effect was found, pairwise comparisons failed to reach statistical significance. CONCLUSION: The enhanced treatment was not effective at increasing postnatal physical activity nor improving related psychosocial construct measures in this cohort of rural, southern women.

Maternal weight in the postpartum: results from the Delta healthy sprouts trial.

BACKGROUND: Excessive postnatal weight retention may pose a threat to a woman's health and future pregnancies. Women in the Lower Mississippi Delta (LMD) region of Mississippi suffer from among the highest rates of obesity in the U.S. and are more likely to gain an excessive amount of weight during pregnancy. The aim of this study was to determine if LMD women who received a lifestyle enhanced maternal, infant, and early childhood home visiting (MIECHV) curriculum had more favorable weight outcomes through 12-months postpartum compared to women who received a standard MIECHV curriculum. METHODS: Delta Healthy Sprouts was a two-arm, randomized, controlled, comparative impact trial. Pregnant women at least 18 years of age, less than 19 weeks pregnant with a singleton pregnancy, and residing in the LMD region were recruited. On a monthly basis in the participant's home, the control arm (PAT) received the Parents as Teachers curriculum while the experimental arm (PATE) received a lifestyle enhanced Parents as Teachers curriculum. Pre-pregnancy body weight via self-report and maternal body weight at baseline (gestational month 4) and at every subsequent monthly visit through 12 months postpartum was measured. Linear mixed models were used to test for significant treatment, time, and treatment by time effects on postnatal weight outcomes. RESULTS: Mean postnatal weight losses were 0.8 and 1.1 kg at postnatal month (PM) 6 and PM 12, respectively, for PAT participants. Mean postnatal weight losses for PATE participants were 1.5 and 1.2 kg at PM 6 and PM 12, respectively. Mean weight retention, based on pre-pregnancy weight, were 5.2, 4.0, and 3.6 kg at PM 1, PM 6, and PM 12, respectively, for PAT participants. Mean weight retention for PATE participants were 6.3, 4.5, and 4.0 kg at PM 1, PM 6, and PM 12, respectively. Significant effects were not found for treatment, time, or treatment by time. CONCLUSIONS: An enhanced MIECHV curriculum was not associated with more favorable postpartum weight outcomes when compared to a standard MIECHV curriculum in a cohort of LMD women during the 12 months following the birth of their infant. Trial registration: clinicaltrials.gov, NCT01746394. Registered 5 December 2012.

Physical Activity Changes during Pregnancy in a Comparative Impact Trial.

OBJECTIVES: Delta Healthy Sprouts was designed to test the comparative impact of 2 home visiting curricula on weight status, dietary intake, physical activity, and other health behaviors of rural, southern African-American women and their infants. Results pertaining to physical activity outcomes in the gestational period are reported. METHODS: Eighty-two women, early in their second trimester of pregnancy, were enrolled and randomly assigned to one of 2 treatment arms. Self-reported physical activity was measured 3 times in the gestational period (gestational months 4, 6 and 8). Generalized linear mixed models were used to test for significant treatment, time, and treatment by time effects on weekly minutes of moderate-to-vigorous physical activity (MVPA). RESULTS: Significantly less MVPA was performed at gestational month 8 when compared with gestational month 4 (enrollment) for both treatment arms. Statistically significant effects were not found for treatment or treatment by time interaction. CONCLUSIONS: Neither the Parents as Teachers (control) curriculum nor the Parents as Teachers Enhanced intervention proved effective at increasing or maintaining MVPA in this cohort of pregnant women. Lack of adequate physical activity in pregnancy remains an important public health concern, especially given its known health benefits.

Gestational Weight Gain: Results from the Delta Healthy Sprouts Comparative Impact Trial.

Introduction. Delta Healthy Sprouts trial was designed to test the comparative impact of two home visiting programs on weight status, dietary intake, and health behaviors of Southern African American women and their infants. Results pertaining to the primary outcome, gestational weight gain, are reported. Methods. Participants (n = 82), enrolled early in their second trimester of pregnancy, were randomly assigned to one of two treatment arms. Gestational weight gain, measured at six monthly home visits, was calculated by subtracting measured weight at each visit from self-reported prepregnancy weight. Weight gain was classified as under, within, or exceeding the Institute of Medicine recommendations based on prepregnancy body mass index. Chi-square tests and generalized linear mixed models were used to test for significant differences in percentages of participants within recommended weight gain ranges. Results. Differences in percentages of participants within the gestational weight gain guidelines were not significant between treatment arms across all visits. Conclusions. Enhancing the gestational nutrition and physical activity components of an existing home visiting program is feasible in a high risk population of primarily low income African American women. The impact of these enhancements on appropriate gestational weight gain is questionable given the more basic living needs of such women. This trial is registered with ClinicalTrials.gov NCT01746394, registered 4 December 2012.

Maternal diet quality and nutrient intake in the gestational period: results from the delta healthy sprouts comparative impact trial.

BACKGROUND: A woman's diet while pregnant can play an important role in her reproductive health as well as the health of her unborn child. Diet quality and nutrient intake amongst pregnant women residing in the rural Lower Mississippi Delta (LMD) region of the United States is inadequate. The Delta Healthy Sprouts Project was designed to test the comparative impact of two home visiting programs on weight status, dietary intake, and health behaviors of women and their infants residing in the LMD region. This paper reports results pertaining to maternal diet quality and nutrient intake in the gestational period. METHODS: The experimental arm (PATE) received monthly home visits beginning in the second trimester using the Parents as Teachers curriculum enhanced with a nutrition and lifestyle behavior curriculum. The control arm (PAT) received monthly home visits using the Parents as Teachers curriculum only. Maternal diet was assessed via 24-h dietary recall at gestational months (GM) 4 (baseline), 6, and 8. Diet quality was computed using the Healthy Eating Index-2010 (HEI-2010). RESULTS: Gestational period retention rates for PAT and PATE arms were 77 % (33/43) and 67 % (26/39), respectively. Significant effects were not found for time, treatment, or time by treatment for the HEI-2010 total or component scores, macro- or micronutrient intake or percentage of women meeting recommended nutrient intakes. CONCLUSIONS: Perhaps due to low participant enrollment and higher than expected rates of drop out and noncompliance, we were not able to demonstrate that the enhanced nutrition and lifestyle curriculum (PATE) intervention had a significant effect on diet quality or nutrient intake during pregnancy in this cohort of rural, Southern, primarily African American women. TRIAL REGISTRATION: clinicaltrials.gov, NCT01746394. Registered 5 December 2012.

Baseline Demographic, Anthropometric, Psychosocial, and Behavioral Characteristics of Rural, Southern Women in Early Pregnancy.

Objectives Beginning life in a healthy uterine environment is essential for future well-being, particularly as it relates to chronic disease risk. Baseline (early pregnancy) demographic, anthropometric (height and weight), psychosocial (depression and perceived stress), and behavioral (diet and exercise) characteristics of rural, Southern, pregnant women enrolled in a maternal, infant, and early childhood home visiting program are described. Methods Participants included 82 women early in their second trimester of pregnancy and residing in three Lower Mississippi Delta counties in the United States. Baseline data were collected through direct measurement and surveys. Results Participants were primarily African American (96 %), young (mean age = 23 years), single (93 %), and received Medicaid (92 %). Mean gestational age was 18 weeks, 67 % of participants were overweight or obese before becoming pregnant, and 16 % tested positive for major depression. Participants were sedentary (mean minutes of moderate intensity physical activity/week = 30), had low diet quality (mean Healthy Eating Index-2010 total score = 43 points), with only 38, 4, and 7 % meeting recommendations for saturated fat, fiber, and sodium intakes, respectively. Conclusions for Practice In the Lower Mississippi Delta, there is a need for interventions that are designed to help women achieve optimal GWG by improving their diet quality and increasing the amount of physical activity performed during pregnancy. Researchers also should consider addressing barriers to changing health behaviors during pregnancy that may be unique to this region of the United States.

Psychosocial constructs were not mediators of intervention effects for dietary and physical activity outcomes in a church-based lifestyle intervention: Delta Body and Soul III.

OBJECTIVE: Evaluating an intervention's theoretical basis can inform design modifications to produce more effective interventions. Hence the present study's purpose was to determine if effects from a multicomponent lifestyle intervention were mediated by changes in the psychosocial constructs decisional balance, self-efficacy and social support. DESIGN: Delta Body and Soul III, conducted from August 2011 to May 2012, was a 6-month, church-based, lifestyle intervention designed to improve diet quality and increase physical activity. Primary outcomes, diet quality and aerobic and strength/flexibility physical activity, as well as psychosocial constructs, were assessed via self-report, interviewer-administered surveys at baseline and post intervention. Mediation analyses were conducted using ordinary least squares (continuous outcomes) and maximum likelihood logistic (dichotomous outcomes) regression path analysis. SETTING: Churches (five intervention and three control) were recruited from four counties in the Lower Mississippi Delta region of the USA. SUBJECTS: Rural, Southern, primarily African-American adults (n 321). RESULTS: Based upon results from the multiple mediation models, there was no evidence that treatment (intervention v. control) indirectly influenced changes in diet quality or physical activity through its effects on decisional balance, self-efficacy and social support. However, there was evidence for direct effects of social support for exercise on physical activity and of self-efficacy for sugar-sweetened beverages on diet quality. CONCLUSIONS: Results do not support the hypothesis that the psychosocial constructs decisional balance, self-efficacy and social support were the theoretical mechanisms by which the Delta Body and Soul III intervention influenced changes in diet quality and physical activity.

Low rate of initiation and short duration of breastfeeding in a maternal and infant home visiting project targeting rural, Southern, African American women.

BACKGROUND: Despite the benefits of breastfeeding for both infant and mother, rates in the United States remain below Healthy People 2020 breastfeeding objectives. This paper describes breastfeeding outcomes of the Delta Healthy Sprouts participants during gestational and postnatal periods. Of specific interest was whether breastfeeding intent, knowledge, and beliefs changed from the early to late gestational period. Additionally, analyses were conducted to test for associations between breastfeeding initiation and breastfeeding intent, knowledge and beliefs as well as sociodemographic characteristics and other health measures. METHODS: Eighty-two pregnant women were enrolled in this project spanning three Mississippi counties. Participants were randomly assigned to one of two treatment groups. Because both groups received information about breastfeeding, breastfeeding outcomes were analyzed without regard to treatment assignment. Hence participants were classified into two groups, those that initiated breastfeeding and those that did not initiate breastfeeding. Generalized linear mixed models were used to test for significant group, time, and group by time effects on breastfeeding outcomes. RESULTS: Breastfeeding knowledge scores increased significantly from baseline to late gestational period for both groups. Across time, breastfeeding belief scores were higher for the group that initiated breastfeeding as compared to the group that did not breastfeed. Only 39% (21 of 54) of participants initiated breastfeeding. Further, only one participant breastfed her infant for at least six months. Breastfeeding intent and beliefs as well as pre-pregnancy weight class significantly predicted breastfeeding initiation. CONCLUSIONS: Our findings indicate that increasing knowledge about and addressing barriers for breastfeeding were insufficient to empower rural, Southern, primarily African American women to initiate or continue breastfeeding their infants. Improving breastfeeding outcomes for all socioeconomic groups will require consistent, engaging, culturally relevant education that positively influences beliefs as well as social and environmental supports that make breastfeeding the more accepted, convenient, and economical choice for infant feeding. TRIAL REGISTRATION: clinicaltrials.gov NCT01746394. Registered 5 December 2012.

Engagement indicators predict health changes in a lifestyle intervention.

OBJECTIVE: To evaluate the utility of several participant engagement indicators for predicting health changes in a church-based lifestyle intervention shown effective for improving dietary, physical activity, and clinical outcomes. METHODS: Descriptive indicators were constructed using 2 participant engagement measures - education session attendance (EDA) and exercise class attendance (EXA) - separately and combined. Relationships of 6 engagement indicators to health outcomes were tested using generalized linear mixed models. RESULTS: EDA predicted 5 dietary and 1 clinical outcome, whereas EXA predicted one physical activity and one clinical outcome. The combined indicator predicted the same 7 outcomes. CONCLUSION: Use of single engagement indicators specific to each intervention component is advocated for predicting relevant health outcome.

A church-based pilot study designed to improve dietary quality for rural, lower Mississippi Delta, African American adults.

We piloted a 6-month, church-based, behavioral intervention, Delta Body and Soul (DBS), for African American (AA) adults in the Lower Mississippi Delta (LMD). DBS was designed to improve overall dietary quality in LMD AA adults. The intervention included six once monthly group-based educational sessions implemented by trained church members. Program implementation, session attendance, congregational feedback, and baseline and post-intervention, demographic, health, behavioral, and clinical parameters were assessed. Participants were predominately AA, female, and overweight or obese. Retention rate was 79 %. High adherence, defined as attendance at four or more educational sessions, was associated with dietary quality improvement and reduced blood glucose. Implementation of the DBS pilot intervention was feasible and may result in dietary quality and clinical improvements.

Delta Healthy Sprouts: a randomized comparative effectiveness trial to promote maternal weight control and reduce childhood obesity in the Mississippi Delta.

INTRODUCTION: Excessive and inadequate gestational weight gain can complicate a woman's pregnancy and put her and her child at risk for poor delivery and birth outcomes. Further, feeding and activity habits established early in life can significantly impact the development of childhood obesity. METHODS: The on-going Delta Healthy Sprouts Project is a randomized, controlled, comparative trial testing the efficacy of two Maternal, Infant, and Early Childhood Home Visiting programs on weight status and health behaviors of 150 mothers and their infants residing in the rural Mississippi Delta region of the United States. Women are enrolled in their second trimester of pregnancy and randomized to one of two treatment arms. The control arm curriculum is based on Parents as Teachers, an evidence based approach to increase parental knowledge of child development and improve parenting practices. The experimental arm, labeled Parents as Teachers Enhanced, builds upon the control curriculum by including culturally tailored nutrition and physical activity components specifically designed for the gestational and postnatal periods. We hypothesize that, as compared to the control arm, the experimental arm will be more effective in preventing inappropriate gestational weight gain, reducing postnatal weight retention, and decreasing infant obesity rates. We also will evaluate mother and child dietary and physical activity outcomes, breastfeeding initiation and continuation, and child feeding practices. CONCLUSION: The Delta Healthy Sprouts Project tests a novel, combined approach to maternal weight management and childhood obesity prevention in pregnant women and their children at high risk for obesity and chronic disease.

Psychosocial predictors of diet and physical activity in African-Americans: results from the Delta Body and Soul effectiveness trial, 2010-2011.

PURPOSE: To examine associations among psychosocial constructs of behavior change and postintervention changes in diet and physical activity (PA). DESIGN: Quasi-experimental with cluster (church) treatment assignment. SETTING: Churches (n = 8) in a rural, southern region of the United States. SUBJECTS: A total of 403 African-American adults participating in the Delta Body and Soul study. INTERVENTION: Six-month diet and PA intervention consisting of monthly didactic educational sessions with specific emphasis on increasing consumption of fruits, vegetables, and whole grains, and decreasing consumption of added sugars. Self-directed PA was promoted throughout the intervention. MEASURES: Validated surveys for all dietary, PA, and psychosocial measures. ANALYSIS: Secondary analysis using generalized linear mixed models to test for significant intervention effects on psychosocial constructs and for significant associations between changes in psychosocial constructs and changes in diet and PA outcomes after controlling for covariates. RESULTS: Intervention effects were apparent for several dietary psychosocial constructs (improvements ranging from .5 to 2.0 points), but only one PA construct (decisional balance for exercise). Changes in psychosocial constructs, including self-efficacy, social support, and decisional balance, were significant predictors of dietary outcome changes (model coefficients ranging from .03 to .42), but not PA changes. CONCLUSION: Understanding which psychosocial constructs predict improvements in dietary and PA behaviors helps inform theoretical mechanisms of action and identify social and behavioral processes to target in faith-based interventions.