Increasing diversity, equity, and inclusion in the fields of nutrition and obesity: A road map to equity in academia

Research shows that a diverse faculty improves academic, clinical, and research outcomes in higher education. Despite that, persons in minority groups, usually categorized by race or ethnicity, are underrepresented in academia (URiA). The Nutrition Obesity Research Centers (NORCs), supported by the National Institute of Diabetes and Digestive and Kidney Diseases, hosted workshops on five separate days in September and October 2020. NORCs convened these workshops to identify barriers and facilitators for diversity, equity, and inclusion (DEI) and provide specific recommendations to improve DEI within obesity and nutrition for individuals from URiA groups. Recognized experts on DEI presented each day, after which the NORCs conducted breakout sessions with key stakeholders who engage in nutrition and obesity research. The breakout session groups included early-career investigators, professional societies, and academic leadership. The consensus from the breakout sessions was that glaring inequities affect URiA in nutrition and obesity, particularly related to recruitment, retention, and advancement. Recommendations from the breakout sessions to improve DEI across academia focused on six themes: (1) recruitment, (2) retention, (3) advancement, (4) intersectionality of multiple challenges (e.g., being Black and a woman), (5) funding agencies, and (6) implementation of strategies to address problems related to DEI.

Increasing diversity, equity, and inclusion in the fields of nutrition and obesity: A roadmap to equity in academia

Research shows that a diverse faculty improves academic, clinical, and research outcomes in higher education. Despite that, persons in minority groups, usually categorized by race or ethnicity, are underrepresented in academia (URiA). The Nutrition Obesity Research Centers (NORCs), supported by the NIDDK, hosted workshops on five separate days in September and October 2020. NORCs convened these workshops to identify barriers and facilitators for diversity, equity, and inclusion (DEI) and provide specific recommendations to improve DEI within obesity and nutrition for individuals from URiA groups. Recognized experts on DEI presented each day, after which the NORCs conducted breakout sessions with key stakeholders who engage in nutrition and obesity research. The breakout session groups included early-career investigators, professional societies, and academic leadership. The consensus from the breakout sessions was that glaring inequities affect URiA in nutrition and obesity, particularly related to recruitment, retention, and advancement. Recommendations from the breakout sessions to improve DEI across the academe focused on six themes: (1) recruitment, (2) retention, (3) advancement, (4) intersectionality of multiple challenges (e.g., being Black and a woman), (5) funding agencies, and (6) implementation of strategies to address problems related to DEI.

Validity of dual-energy x-ray absorptiometry for estimation of visceral adipose tissue and visceral adipose tissue change after surgery-induced weight loss in women with severe obesity

OBJECTIVE

Reliable and simple methods to quantify visceral adipose tissue (VAT) and VAT changes are needed. This study investigated the validity of dual-energy x-ray absorptiometry (DXA) compared with magnetic resonance imaging (MRI) for estimating VAT cross sectionally and longitudinally after surgery-induced weight loss in women with severe obesity.

METHODS

Women with obesity (n = 36; mean age 43 [SD 10] years; 89% White) with DXA and MRI before bariatric surgery (T0) at 12 (T12) and 24 months (T24) post surgery were included. CoreScan (GE Healthcare, Chicago, Illinois) estimated VAT from 20% of the distance between the top of the iliac crest and the base of the skull. MRI VAT (total VAT) was measured from the base of the heart to the sacrum/coccyx on a whole-body scan.

RESULTS

Mean DXA VAT was 45% of MRI VAT at T0, 46% at T12, and 68% at T24. DXA underestimated change in MRI VAT between T0 and T12 by 26.1% (0.81 kg, p = 0.03) and by 71.7% (0.43 kg, p < 0.001) between T12 and T24. The relationship between DXA VAT and MRI VAT differed between T12 and T24 (p value for interaction = 0.03).

CONCLUSIONS

CoreScan lacks validity for comparing VAT across individuals or for estimating the size of changes within individuals; however, within the limits of measurement error, it may provide a useful indicator of whether some VAT change has occurred within an individual.

Diet Quality of Mothers of Children in NYC Head Start Is Not Associated With Child Adiposity

Objectives

To assess whether maternal diet quality, measured when child was between ages 3 and 5, is associated with child overweight/obesity at ages 3 to 5.

Methods

Baseline data from the Endotoxin Obesity and Asthma longitudinal study were used for these analyses. 380 African American and Hispanic mothers of children attending NYC Head Start answered a food frequency questionnaire (FFQ) about their own intake and a demographic questionnaire about themselves and child. FFQ data were converted to Healthy Eating Index (HEI)-2015 total scores (higher scores suggest better diet quality). Anthropometric measurements (weight, height, skinfolds, and waist circumference) were obtained from children. BMI, triceps and subscapular z-scores, and weight-to-height ratio (WHtR) were calculated.

Results

Mean HEI total score at baseline was 64.3 ± 8.7 of 100 (considered a “D” grade or poor diet quality), but 69.8 ± 8.6 for Dominican and 60.2 ± 6.5 for Mexican mothers. Children were 50% female, 25% Mexican, 18% Dominican, 19% African American, 15% Puerto Rican and 23% Other. Mean age was 49 months. 52% of children fell below the 85th percentile for BMI, 20% between 85th and 95th, and 28% above the 95th percentile. Mother's HEI-2015 total score was not associated with child's BMI z-score (p = 0.830), child's triceps z-score (p = 0.77), child's subscapular z-score (p = 0.29), or child's WHtR (p = 0.83). More weight loss attempts by the mother (p = 0.03) and child's birthplace in (vs. outside) the United States (p = 0.01) were associated with higher BMI z-scores. Mexican ethnicity was associated with greater triceps z-scores (p = 0.03). Child's age was positively associated with subscapular z-score (p = 0.02). Child's age (p &lt; 0.001) and Mexican ethnicity (p &lt; 0.001) were associated with greater WHtR.

Conclusions

Maternal diet quality was not associated with child adiposity; however, mother's weight loss attempts, child's age and being born in the US, and a child being identified as Mexican were related did. A novel maternal characteristic, number of weight loss attempts, and several child characteristics suggest targets for intervention.

Funding Sources

National Heart, Lung, and Blood Institute; National Institute of Diabetes and Digestive and Kidney Diseases.

The moderating role of the built environment in prenatal lifestyle interventions

This study examined whether the neighborhood built environment moderated gestational weight gain (GWG) in LIFE-Moms clinical trials. Participants were 790 pregnant women (13.9 weeks' gestation) with overweight or obesity randomized within four clinical centers to standard care or lifestyle intervention to reduce GWG. Geographic information system (GIS) was used to map the neighborhood built environment. The intervention relative to standard care significantly reduced GWG (coefficient = 0.05; p = 0.005) and this effect remained significant (p < 0.03) after adjusting for built environment variables. An interaction was observed for presence of fast food restaurants (coefficient = -0.007; p = 0.003). Post hoc tests based on a median split showed that the intervention relative to standard care reduced GWG in participants living in neighborhoods with lower fast food density 0.08 [95% CI, 0.03,0.12] kg/week (p = 0.001) but not in those living in areas with higher fast food density (0.02 [-0.04, 0.08] kg/week; p = 0.55). Interaction effects suggested less intervention efficacy among women living in neighborhoods with more grocery/convenience stores (coefficient = -0.005; p = 0.0001), more walkability (coefficient -0.012; p = 0.007) and less crime (coefficient = 0.001; p = 0.007), but post-hoc tests were not significant. No intervention x environment interaction effects were observed for total number of eating establishments or tree canopy. Lifestyle interventions during pregnancy were effective across diverse physical environments. Living in environments with easy access to fast food restaurants may limit efficacy of prenatal lifestyle interventions, but future research is needed to replicate these findings.

High-Resolution Three-Dimensional Photonic Scan-Derived Equations Improve Body Surface Area Prediction in Diverse Populations

OBJECTIVE

Equations for predicting body surface area (BSA) produce flawed estimates, especially for individuals with obesity. This study aimed to compare BSA measured by a three-dimensional photonic scanner (3DPS) with BSA predicted by six commonly cited prediction equations and to develop new prediction equations if warranted.

METHODS

The 3DPS was validated against manual measurements by breadth caliper for body thicknesses measured at three anatomical sites on a mannequin. BSA was derived from 3DPS whole-body scans of 67 males and 201 females, aged 18 to 83 years, with BMI between 17.8 and 77.8 kg/m² and varied races/ethnicities.

RESULTS

Width and depth measurements by 3DPS and caliper were within 1%, except for hip, with an error of 1.8%. BSA_3DPS differed from BSA predicted by each equation (P < 0.05), except for males by DuBois and DuBois (P = 0.60), Tikuisis (P = 0.27), and Yu (P = 0.45) and for females by Tikuisis (P = 0.70). The combined and sex-specific equations obtained by regressing ln(BSA) on ln(weight in kilograms [W]) and ln(height in meters [H]) are as follows (R² and SEE correspond to ln[BSA]): combined, BSA_3DPS  = 0.03216 × W^0.4904  × H^0.3769 , R²  = 0.982, SEE = 0.021; males, BSA_3DPS  = 0.01624 × W^0.4725  × H^0.5231 ; and females, BSA_3DPS  = 0.01522 × W^0.4921  × H^0.5231 , R² = 0.986, SEE = 0.019.

CONCLUSIONS

New height and weight BSA equations improve BSA estimation in individuals with BMI ≥ 40 and in African Americans, Hispanic Americans, and Asian Americans.

Ripple Effect of Lifestyle Interventions During Pregnancy on Untreated Partners' Weight

OBJECTIVE

Weight-loss interventions have a positive "ripple effect" on untreated partners' weight, but ripple effects in pregnancy are unknown. The objective of this study was to determine whether prenatal lifestyle interventions that reduce gestational weight gain in pregnant women have a positive ripple effect on untreated partners' weight.

METHODS

Two clinical trials with the same outcome measures randomly assigned pregnant women to a lifestyle intervention or usual care. Untreated partners were randomly assigned according to their pregnant partner's group allocation and were assessed at study entry (~13 weeks' gestation), 35 weeks' gestation, and 6 and 12 months after delivery.

RESULTS

A total of 122 partners (100% male, 23% Hispanic, 82% married, and 48% with obesity) were randomly assigned to the intervention (n = 59) or usual care (n = 63). There was no intervention or intervention-by-time interaction effect on partner weight (P = 0.795). Partner weight changes were not statistically significant (P = 0.120) from study entry to 35 weeks' gestation (mean 0.19 kg; 95% CI: -0.73 to 1.24) or to 12 months after delivery (mean 0.82 kg; 95% CI: -0.26 to 1.91).

CONCLUSIONS

There was no evidence of a ripple effect on partner weight. In a self-selected sample, partners of pregnant women appeared not to experience sympathy weight gain.

Abstract A16: Promoting colorectal cancer screening in urban, minority populations with community health workers

Background: Colorectal cancer (CRC) is the third most common cancer and cause of cancer-related death in the United States. Screening prevents not only mortality but also the occurrence of CRC. Our group reaches out to and educates members of our predominantly low-income Hispanic and African American community about cancer treatment, research, and prevention by establishing partnerships with community-based organizations (CBOs) and training community health workers (CHWs). In 2010, we learned that relatively few CBO clients had been screened or intended to be screened for CRC, and that the CHWs also were not well informed about CRC.

Methods: We developed an enhanced training program about CRC for CHWs and their clients. We renewed two of our CBO partnerships, added one more, retrained some previously trained CHWs, and recruited and trained CHWs from the new CBO. We developed a new pre- and post-training 10-question instrument to evaluate what the CHWs already knew and what they learned from our training. We compared the CHWs' average scores (proportions of correct answers) before and after the training. Further training was conducted to reinforce CHWs' knowledge. Using focus groups and community-based participatory research methods with the CHWs, we then developed two educational interventions that the CHWs will implement in the coming months.

Results: Fifteen CHWs were trained or retrained. Most of the participating CHWs had previously received our training. All of them answered at least 6 of the 10 questions correctly both before and after the training, but average scores improved from 75% correct before the training to 82% correct afterwards.

Next steps: Each CHW will educate 20 clients (n=300) aged 50+ years about CRC screening and attempt to schedule them for screening. In the two intervention groups, we will compare proportions of clients who receive CRC screening. Results will be disseminated to the community in our quarterly community newsletter, a report to the CBOs, and a press release to the local media.

Citation Format: Martha Sanchez, Maxine Ashby-Thompson, Judith S. Jacobson, Patricia Hepburn, Victor E. Grann. Promoting colorectal cancer screening in urban, minority populations with community health workers. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A16.

Asthma, allergy, and IgE levels in NYC head start children

BACKGROUND

Among preschool-age children in New York City neighborhoods with high asthma hospitalization rates, we analyzed the associations of total immunoglobulin E (IgE), specific IgE to common indoor allergens, and allergy symptoms with asthma.

METHODS

Parents of children in New York City Head Start programs were asked to complete a questionnaire covering demographic factors, health history (including respiratory conditions), lifestyle, and home environment. Children's serum samples were analyzed for total IgE and specific IgE antibodies to cockroach, dust mite, mouse, and cat allergens by immunoassay. Logistic regression was used to model the association between asthma and IgE, controlling for age, gender, ethnicity/national origin, BMI, parental asthma, smokers in the household, and allergy symptoms (e.g., runny nose, rash).

RESULTS

Among 453 participating children (mean age 4.0+/-0.5 years), 150 (33%) met our criteria for asthma. In our multivariable logistic regression models, children with asthma were more likely than other children to be sensitized to each allergen, to be sensitized to any of the four allergens (OR=1.6, 95% CI 1.0-2.6), or to be in the highest quartile of total IgE (OR=3.1, 95% CI 1.5-6.4). Allergy symptoms based on questionnaire responses were independently associated with asthma (OR=3.7, 95% CI 2.3-5.9).

CONCLUSIONS

Among preschool-aged urban children, asthma was associated with total IgE and sensitization to cat, mouse, cockroach, and dust mite allergens. However, allergy symptoms were more prevalent and more strongly associated with asthma than was any allergen-specific IgE; such symptoms may precede elevated specific IgE or represent a different pathway to asthma.

Physical activity and asthma symptoms among New York City Head Start Children

The coincidence of both an obesity epidemic and an asthma epidemic among children in the United States has suggested that childhood overweight and sedentary lifestyles may be risk factors for asthma development. We therefore conducted a study of those factors among children enrolled in Head Start Centers located in areas of New York City with high asthma hospitalization rates. Data were gathered from 547 children through an intensive home visit, and physical activity was measured on 463 children using the Actiwatch accelerometer. Data on allergy and asthma symptoms and demographic variables were obtained from parents' responses to a questionnaire and complete data were available from 433 children. Overall physical activity was highest in warmer months, among boys, among children whose mothers did not work or attend school, and among children of mothers born in the United States. Activity was also positively associated with the number of rooms in the home. The season in which the activity data were collected modified many of the associations between demographic predictor variables and activity levels. Nearly half the children were above the range considered healthy weight. In cross-sectional analyses, before and after control for demographic correlates of physical activity, asthma symptoms were not associated with physical activity in this age group. Comparing the highest quartile of activity to the lowest, the odds ratio for asthma was 0.91 (95% CI = 0.46, 1.80). However, the novel associations with physical activity that we have observed may be relevant to the obesity epidemic and useful for planning interventions to increase physical activity among preschool children living in cities in the northern United States.

Early respiratory infections and asthma among New York City Head Start children

BACKGROUND

Respiratory infections in neonates have been found to predict wheeze among young children. We hypothesized that among preschool children from low-income minority communities in New York City, current asthma would be associated with a history of respiratory infection in the first few months after their birth.

METHODS

We asked parents of children in New York City Head Start centers (preschool programs for children of low-income families) to respond to a questionnaire covering demographic factors, lifestyle, home environment, and health history, including a detailed history of respiratory conditions. We used logistic regression to model the association of asthma and asthma severity with history of respiratory infections, controlling for gender, ethnicity, family history of asthma, and other factors.

RESULTS

Among 1,022 children (mean age 4+/- 0.6 years) whose parents provided information about their health history, 359 (35%) met our criteria for asthma. Overall, 22% had had a cold by 6 months and 17% an ear infection by 8 months of age. In multivariable models, children with asthma had had more colds (OR = 2.8, 95% confidence interval [CI] 1.4-6.0) and ear infections (OR = 3.4, 95% CI 1.7-6.9) in the past year than other children. Associations of respiratory infections with emergency department use for asthma (as a measure of severity) were similar. In models that did not control for infections in the past year, ages at first cold and first ear infection were associated with asthma and emergency department visits in the past year.

CONCLUSIONS

In this sample of preschool children, respiratory infections were common and were associated with asthma and health care utilization for asthma exacerbations. If these findings are confirmed, preventive measures among children who develop such infections at a very early age should be explored to help reduce the burden of asthma in this age group.