Exercise Strategy to Prevent Pediatric Type 2 Diabetes

预防儿童 2 型糖尿病的运动策略

• 批准号: 6622495
• 负责人: DAN M COOPER
• 金额: $ 114.35万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-03-15 至 2009-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6622495
• 关键词: adolescence (12-20); biomarker; blood glucose; body composition; child (0-11); clinical research; clinical trials; cooperative study; developmental nutrition; diabetes education; diabetes mellitus; diabetes risk; disease /disorder prevention /control; exercise; glucose tolerance test; health behavior; health education; human subject; human therapy evaluation; insulin sensitivity /resistance; medical complication; nutrition education; nutrition related tag; patient oriented research; photon absorptiometry; physical fitness; questionnaires; schools

The overall aim of this research is to introduce an innovative approach to increase physical activity in schools, and thereby, decrease risk factors for type 2 diabetes in children and adolescents. Since very little is known about the fundamental interrelationships among fitness, body composition, and physiological markers of glucose homeostasis in growing children, the research is also aimed at filling key gaps in this knowledge base. The Specific Aims of the proposal are to develop, implement, and test the effectiveness of: a school-based physical activity enhancement program, Fitness Laboratory On Wheels (FLOW); and a complementary school-based teacher/student education program to enhance physical activity and reduce sedentary behaviors. A prospective, repeated-measures, exercise-intervention/control study is planned. The intervention will span the 7th and 8th grades with an additional two-year follow-up. To test the specific effects of the exercise program per se, but recognizing as well, the role of diet in ameliorating the risk of type 2 diabetes, a nutrition education program will be implemented in both control and exercise intervention schools. The following hypotheses will be tested: the two-year intervention will lead to (1) Improved insulin sensitivity and/or improved recovery from the natural fall in insulin sensitivity that occurs during puberty; (2) An increase in physical fitness by at least 10% (accounting for natural growth and development) and enhanced physical activity behaviors; (3) Improvement in anatomic markers of type 2 diabetes risk; (4) Improvement in novel biochemical markers associated with diabetes risk; and (5) A sustained ;improvement in these variables for at least 2 years following the intervention. Major outcome variables include: "traditional" markers of glucose homeostasis - fasting insulin and glucose (all subjects) and insulin sensitivity, glucose effectiveness, and acute insulin response (sub-study with frequently sampled intravenous glucose tolerance test - FSIVGTT); novel markers of type 2 diabetes risk - growth hormone binding protein (GHBP), insulin-like growth factor binding protein-1 (IGFBP-1), and tumor-necrosis factor-alpha (TNF-alpha); peak oxygen uptake from ergometer exercise tests; body composition by dual x-ray absorptiometry (DEXA); and psychosocial tests of exercise-associated behaviors. A physiological assessment protocol that would be both feasible and fun for the majority of volunteers was successfully pilot tested. It was demonstrated that in a single morning, groups of children can be transported from a target school to an available clinical research center and comfortably undergo a testing strategy called "BEDD" [(1) fasting blood sampling, (2) exercise testing, (3) DEXA measurements of body composition, and (4) diet recall]. Power analysis based on fasting insulin levels in healthy children suggests that a multi-center study (3-4 centers with 4-5 schools per center) would be needed to achieve these aims.

这项研究的总体目的是引入一种创新的方法来增加学校的体育锻炼，从而减少儿童和青少年2型糖尿病的危险因素。由于对成长中的儿童的健身，身体成分和生理标志物之间的基本相互关系知之甚少，因此该研究还旨在填补这一知识库中的关键差距。该提案的具体目的是开发，实施和测试：以学校为基础的体育活动增强计划，车轮上的健身实验室（Flow）；以及以学校为基础的教师/学生教育计划，以增强体育活动并减少久坐的行为。计划了一项前瞻性，重复测量，锻炼/对照研究。干预措施将跨越7年级和8年级，并进行两年的随访。为了测试运动计划本身的具体影响，但也认识到，饮食在改善2型糖尿病风险中的作用，在控制和运动干预学校中将实施营养教育计划。将测试以下假设：两年的干预将导致（1）提高胰岛素敏感性和/或改善在青春期期间发生的胰岛素敏感性中自然下降的恢复； （2）将身体适应性提高至少10％（占自然生长和发展）和增强的体育锻炼行为； （3）改善2型糖尿病风险的解剖标记； （4）改善与糖尿病风险相关的新型生化标志物； （5）干预后至少2年的这些变量的持续改进。主要结果变量包括：葡萄糖稳态的“传统”标记 - 禁食胰岛素和葡萄糖（所有受试者）和胰岛素敏感性，葡萄糖有效性和急性胰岛素反应（经常采样的静脉内葡萄糖耐受性测试 - FSIVGGTT）； 2型糖尿病风险 - 生长激素结合蛋白（GHBP），胰岛素样生长因子结合蛋白-1（IGFBP-1）和肿瘤 - 不良因子因子-Alpha（TNF-Alpha）的新颖标志物；测试测试的峰值氧气吸收；双重X射线吸收法（DEXA）的身体组成；以及与运动相关行为的社会心理测试。对于大多数志愿者来说，一种生理评估方案既可行又有趣。已经证明，在一个早晨，可以将一组儿童从目标学校运送到可用的临床研究中心，并舒适地接受了一种称为“ BEDD”的测试策略[（1）禁食血液采样，（2）运动测试，（3）DEXA的身体组成测量值，以及（4）饮食回忆。基于健康儿童禁食胰岛素水平的功率分析表明，要实现这些目标，需要进行多中心研究（每个中心4-5所学校中心）。