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Arasu K, Chang CY, Wong SY, Ong SH, Yang WY, Chong MHZ, Mavinkurve M, Khoo EJ, Chinna K, Weaver CM, Chee WSS. Design and strategies used for recruitment and retention in a double blind randomized controlled trial investigating the effects of soluble corn fiber on bone indices in pre-adolescent children (PREBONE-Kids study) in Malaysia. Contemp Clin Trials Commun 2021; 22:100801. [PMID: 34195468 PMCID: PMC8233130 DOI: 10.1016/j.conctc.2021.100801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background Recruitment and retention in longitudinal nutrition intervention studies among children is challenging and scarcely reported. This paper describes the strategies and lessons learned from a 1-year randomized double-blind placebo-controlled trial among pre-adolescent children on the effects of soluble corn fiber (SCF) on bone indices (PREBONE-Kids). Methods Participants (9–11 years old) were recruited and randomized into 4 treatment groups (600 mg calcium, 12 g SCF, 12 g SCF plus 600 mg calcium and placebo). Interventions were consumed as a fruit-flavored powdered drink for 1-year. School-based recruitment was effective due to support on study benefits from parents and teachers, peer influence and a 2-weeks study run-in for participants to assess their readiness to commit to the study protocol. Retention strategies focused on building rapport through school-based fun activities, WhatsApp messaging, providing health screening and travel reimbursements for study measurements. Compliance was enhanced by providing direct on-site school feeding and monthly non-cash rewards. Choice of 2 flavors for the intervention drinks were provided to overcome taste fatigue. Satisfaction level on the manner in which the study was conducted was obtained from a voluntary sub-set of participants. Results The study successfully enrolled 243 participants within 6 months and retained 82.7% of the participants at the end of 1 year, yielding a drop-out rate of 17.3%. Compliance to the intervention drink was 85% at the start and remained at 78.7% at the end of 1 year. More than 95% of the participants provided good feedback on intervention drinks, rapport building activities, communication and overall study conduct. Conclusion Successful strategies focused on study benefits, rapport building, frequent communication using social media and non-cash incentives helped improved compliance and retention rate. The lessons learned to maintain a high retention and compliance rate in this study provide valuable insights for future studies in a similar population. PREBONE-Kids contributes to evidence on the effect of soluble corn fiber on bone indices in pre-adolescent Asian children. School-based recruitment, study nature, perceived benefits and study run-in were effective strategies for recruitment. Rapport building, direct on-site feeding and rewarding protocol adherence were critical for good retention and compliance.
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Key Words
- 25-OHD, serum 25-hydroxyvitamin D
- BAP, bone-specific alkaline phosphatase
- BMC, bone mineral content
- BMD, bone mineral density
- CTX, carboxy-terminal collagen crosslinks
- Calcium
- Compliance
- DXA, dual-energy X-ray absorptiometry
- MET, total metabolic equivalent
- OC, osteocalcin
- P1NP, procollagen type 1 amino-terminal propeptide
- PBM, peak bone mass
- Pre-adolescent children
- SCF, soluble corn fibre
- Soluble corn fiber
- Study retention
- iPTH, intact parathyroid hormone
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Affiliation(s)
- Kanimolli Arasu
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Chung Yuan Chang
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Soon Yee Wong
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Shu Hwa Ong
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Wai Yew Yang
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Megan Hueh Zan Chong
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Meenal Mavinkurve
- Department of Paediatrics, School of Medicine, International Medical University, Jalan Rasah, 70300, Seremban, Negeri Sembilan, Malaysia
| | - Erwin Jiayuan Khoo
- Department of Paediatrics, School of Medicine, International Medical University, Jalan Rasah, 70300, Seremban, Negeri Sembilan, Malaysia
| | - Karuthan Chinna
- Faculty of Health & Medical Sciences, School of Medicine, Taylor's University, No 1, Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia
| | | | - Winnie Siew Swee Chee
- Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
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Yumol JL, Wakefield CB, Sacco SM, Sullivan PJ, Comelli EM, Ward WE. Bone development in growing female mice fed calcium and vitamin D at lower levels than is present in the AIN-93G reference diet. Bone Rep 2018; 8:229-38. [PMID: 29955642 DOI: 10.1016/j.bonr.2018.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/09/2018] [Accepted: 05/17/2018] [Indexed: 12/31/2022] Open
Abstract
Background The AIN-93G reference (REF) diet is used to allow the comparison within and between studies of different research groups but its levels of vitamin D (vit D) and calcium (Ca) may be higher than required for healthy bone structure and bone mineral density (BMD). Objective To determine if lower dietary levels of Ca (3.5, 3 or 2.5 g Ca/kg diet) at 1 of 2 levels of vit D (100 or 400 IU/kg diet) supports similar development of bone structure and BMD compared to AIN-93G reference (REF) diet in female CD-1 mice at 2 and 4 months of age. Methods Within a trial, weanling female mice (n = 12–15/group) were randomized to 1 of 4 diets until necropsy at 4 months of age: Trial 1: 100 IU vit D/kg + 3.5, 3 or 2.5 g Ca/kg diet or 1000 IU vit D/kg + 5 g Ca/kg diet (REF); and Trial 2: 400 IU vit D/kg + 3.5, 3 or 2.5 g Ca/kg diet or 1000 IU vit D/kg + 5 g/kg diet (REF). At age 2 and 4 months, in vivo bone structure and BMD were assessed using micro-computed tomography (μCT) at the proximal and midpoint tibia. At age 4 months, lumbar vertebra 4 (L4) and mandible structure were analyzed ex vivo, femur strength at midpoint and neck was assessed and serum 25(OH)D3 and PTH were quantified. Results For Trial 1 (100 IU vit D/kg), there were no differences in tibia structure at age 2 and 4 months nor L4 or mandible structure or femur strength at the midpoint or neck at 4 months of age despite lower serum 25(OH)D3 among all groups compared to REF. For Trial 2 (400 IU vit D/kg), mice fed 2.5 g Ca/kg diet had lower (p < 0.05) Ct.Ar/Tt.Ar and Ct.Th at the tibia midpoint compared to REF. Furthermore, Ct.Th. was greater in REF and 3.5 g Ca/kg diet compared to 2.5 g Ca/kg diet at age 2 but not 4 months of age. At L4, BV/TV was lower (p < 0.05) in the 3 g Ca/kg diet group compared to REF at age 4 months. There were no differences among groups for serum 25(OH)D3 or femur strength at the midpoint or neck. Serum PTH was not elevated compared to REF in either Trial. Conclusion Lowering both dietary vit D (100 IU/kg) and Ca (2.5 g/kg) in AIN-93G diet did not result in differences in bone development of female CD-1 mice at early adulthood. Translational relevance of bone studies conducted using the AIN-93G diet may be affected by its high vit D and Ca content.
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Key Words
- AIN93G
- ANOVA, analysis of variance
- BMC, bone mineral content
- BMD, bone mineral density
- BV/TV, percent bone volume
- Bone mineral density
- Bone structure
- Ca, calcium
- Calcium
- Conn.Dn, connectivity density
- Ct.Ar/Tt.Ar, cortical area fraction
- Ct.Th, cortical thickness
- DA, degree anisotropy
- Ec.Pm, endocortical perimeter
- Ecc, mean eccentricity
- ISO, isoflavones
- L4, lumbar vertebrae 4
- Ma.Ar, medullary area
- Micro-computed tomography
- P, phosphorus
- PBM, peak bone mass
- PTH, parathyroid hormone
- Ps.Pm, periosteum perimeter
- REF, AIN-93G reference diet
- ROI, region of interest
- SEM, standard error mean
- Tb.N, trabecular number
- Tb.Sp, trabecular separation
- Tb.Th, trabecular thickness
- Vitamin D
- vit D, vitamin D
- μCT, micro computed tomography
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