Predictors Linking Obesity and the Gut Microbiome (the PROMISE Study): Protocol and Recruitment Strategy for a Cross-Sectional Study on Pathways That Affect the Gut Microbiome and Its Impact on Obesity.

BACKGROUND: The prevalence of obesity has increased substantially over recent decades and is associated with considerable health inequalities. Although the causes of obesity are complex, key drivers include overconsumption of highly palatable, energy-dense, and nutrient-poor foods, which have a profound impact on the composition and function of the gut microbiome. Alterations to the microbiome may play a critical role in obesity by affecting energy extraction from food and subsequent energy metabolism and fat storage. OBJECTIVE: We report the study protocol and recruitment strategy of the PRedictors linking Obesity and the gut MIcrobiomE (PROMISE) study, which characterizes the gut microbiome in 2 populations with different metabolic disease risk (Pacific and European women) and different body fat profiles (normal and obese). It investigates (1) the role of gut microbiome composition and functionality in obesity and (2) the interactions between dietary intake; eating behavior; sweet, fat, and bitter taste perception; and sleep and physical activity; and their impact on the gut microbiome, metabolic and endocrine regulation, and body fat profiles. METHODS: Healthy Pacific and New Zealand (NZ) European women aged between 18 and 45 years from the Auckland region were recruited for this cross-sectional study. Participants were recruited such that half in each group had either a normal weight (body mass index [BMI] 18.5-24.9 kg/m2) or were obese (BMI ≥30.0 kg/m2). In addition to anthropometric measurements and assessment of the body fat content using dual-energy x-ray absorptiometry, participants completed sweet, fat, and bitter taste perception tests; food records; and sleep diaries; and they wore accelerometers to assess physical activity and sleep. Fasting blood samples were analyzed for metabolic and endocrine biomarkers and DNA extracted from fecal samples was analyzed by shotgun sequencing. Participants completed questionnaires on dietary intake, eating behavior, sleep, and physical activity. Data were analyzed using descriptive and multivariate regression methods to assess the associations between dietary intake, taste perception, sleep, physical activity, gut microbiome complexity and functionality, and host metabolic and body fat profiles. RESULTS: Of the initial 351 women enrolled, 142 Pacific women and 162 NZ European women completed the study protocol. A partnership with a Pacific primary health and social services provider facilitated the recruitment of Pacific women, involving direct contact methods and networking within the Pacific communities. NZ European women were primarily recruited through Web-based methods and special interest Facebook pages. CONCLUSIONS: This cross-sectional study will provide a wealth of data enabling the identification of distinct roles for diet, taste perception, sleep, and physical activity in women with different body fat profiles in modifying the gut microbiome and its impact on obesity and metabolic health. It will advance our understanding of the etiology of obesity and guide future intervention studies involving specific dietary approaches and microbiota-based therapies. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618000432213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370874. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/14529.

Understanding Pasifika youth and the obesogenic environment, Auckland and Wellington, New Zealand.

AIM: In New Zealand, the burden of obesity is greatest among Pacific people, especially in children and adolescents. We investigated the factors of the obesogenic environment that were indigenous to Pasifika youths' social-cultural context, their food purchasing behaviours, and associated anthropometric measures. METHODS: An exploratory study of 30 Pasifika youth aged 16-24 years in Wellington and Auckland, New Zealand. RESULTS: A large proportion of the participants were obese (mean body mass index: 31.0kg/m2; waistto-hip ratio: 0.84; waist-to-height ratio: 0.6), suggesting that the future health and wellbeing trajectory of the studied Pasifika youth is poor. Purchasing behaviours of food and snacks over a 7-day period provided meaningful insights that could be a useful future research tool to examine the role of their physical environment on food access and availability. CONCLUSIONS: From this exploratory study, we highlight the following: (i) the future health trajectory of Pasifika youth is poor. Developing the youths' healthy lifestyle knowledge may lend itself to developing culturally relevant intervention programmes; (ii) identifying the enablers and barriers within the Pasifika ontext of an obesogenic environment can provide very useful information; (iii) use of spatial analysis using purchased food receipts adds to the current knowledge base of obesity-related research, although this was an exploratory investigation. We need to address these highlights if we are to reverse the trend of obesity for this population.

An evaluation of a pictorial asthma medication plan for Pacific children.

BACKGROUND: The burden of asthma falls disproportionately on children from New Zealand's Pacific communities. Guidelines recommend pictorial resources but these have not been evaluated in this population. AIMS: Evaluate a pictorial asthma medication plan focusing on regular 'everyday' inhaler use and a signs and symptoms sheet for Pacific children; the primary outcome measure was continued use of resources after 6 months. METHODS: Resources were provided to families with face-to-face education at a general practice or inpatient setting in West Auckland. A questionnaire about the resources was completed after 6 weeks, and an audit regarding use after 6 months. RESULTS: Data from 48 children were analysed (Samoan, n=31); 45 English and 22 first language versions (Samoan, Tongan, Tuvaluan) were used; median time to questionnaire completion was 48 days. The pictorial asthma medication plan was acceptable to families, effective at reinforcing the importance of 'everyday' inhalers, and a reminder for regular use; the signs and symptoms sheets were informative and improved self-efficacy; 93% of families were using the resources after 6 months. An increase in 'everyday' inhaler use was observed after education. CONCLUSION: The resources were effective at improving inhaler knowledge and supporting symptom recognition. A 'less-is-more' approach, pictorial format, and first language availability are characteristics that may benefit other ethnicities.