Rationale and design of the Heart-to-Heart study: A church-based intervention to reduce blood pressure in African Americans.

Heart-to-Heart (H2H) is a church-based behavioral cluster randomized trial to measure the effectiveness of a lifestyle education program for reducing blood pressure (BP) in African American adults with uncontrolled BP. Design and implementation of this study were informed by our ALIVE pilot study conducted with church pastors and leaders using a community-based participatory research methodology. The current study employs a cross-over design in which all participants receive two 6-month programs in different orders: the intervention arm receives the H2H program first, followed by a financial education program, and the comparator arm receives the programs in the reverse order. Approximately 34 churches will be randomized with the aim of including at least 272 participants across churches. The H2H program consists of 24 weekly dietitian-led diet and lifestyle virtual education sessions, 12 Bible studies taught by the church pastor reinforcing positive dietary behaviors from a biblical perspective, daily self-monitoring of BP, and, as needed, one-on-one support from a community health worker to assist with medication adherence. The Money Smart program consists of 14 financial education sessions and 12 Bible studies teaching the biblical basis of good financial management over a 6-month period. The primary outcome measure is systolic BP at 6 months with a follow-up at 12 months. Secondary outcome measures include medication adherence, Dietary Approaches to Stop Hypertension (DASH) diet adherence, self-efficacy for hypertension self-care, social support for eating a healthy diet, hypertension and nutrition knowledge, beliefs about medicines, barriers to medication use, depression, and financial knowledge and behaviors.

Beneficial effects of resistant starch on laxation in healthy adults.

OBJECTIVE: This randomized, double-blind crossover trial evaluated the effects of a type 3 novel resistant starch (RS) versus wheat bran (WB) on faecal weight, frequency, and consistency in healthy adults. METHODS: Following a 14-day baseline period during which subjects (n=14) consumed low-fibre (<2 g) test products, participants were assigned to receive 25 g RS or WB fibre daily for 14 days, then crossed over to the opposite treatment after a 7-day washout. RESULTS: Daily faecal output increased from 128.8+/-68.7 g at baseline to 164.2+/-88.4 g with RS and 194.5+/-92.0 g with WB (both P<0.02 versus baseline). No significant differences among the three conditions were observed for bowel movement frequency. Faecal consistency ratings were increased with WB (P=0.001), but unchanged with RS. CONCLUSIONS: Dietary RS and WB increase faecal output in healthy adults.

Green tea catechin consumption enhances exercise-induced abdominal fat loss in overweight and obese adults.

This study evaluated the influence of a green tea catechin beverage on body composition and fat distribution in overweight and obese adults during exercise-induced weight loss. Participants (n = 132 with 107 completers) were randomly assigned to receive a beverage containing approximately 625 mg of catechins with 39 mg caffeine or a control beverage (39 mg caffeine, no catechins) for 12 wk. Participants were asked to maintain constant energy intake and engage in >or=180 min/wk moderate intensity exercise, including >or=3 supervised sessions per week. Body composition (dual X-ray absorptiometry), abdominal fat areas (computed tomography), and clinical laboratory tests were measured at baseline and wk 12. There was a trend (P = 0.079) toward greater loss of body weight in the catechin group compared with the control group; least squares mean (95% CI) changes, adjusted for baseline value, age, and sex, were -2.2 (-3.1, -1.3) and -1.0 (-1.9, -0.1) kg, respectively. Percentage changes in fat mass did not differ between the catechin [5.2 (-7.0, -3.4)] and control groups [-3.5 (-5.4, 1.6)] (P = 0.208). However, percentage changes in total abdominal fat area [-7.7 (-11.7, -3.8) vs. -0.3 (-4.4, 3.9); P = 0.013], subcutaneous abdominal fat area [-6.2 (-10.2, -2.2) vs. 0.8 (-3.3, 4.9); P = 0.019], and fasting serum triglycerides (TG) [-11.2 (-18.8, -3.6) vs. 1.9 (-5.9, 9.7); P = 0.023] were greater in the catechin group. These findings suggest that green tea catechin consumption enhances exercise-induced changes in abdominal fat and serum TG.

An after-school obesity prevention program for African-American girls: the Minnesota GEMS pilot study.

OBJECTIVE: This paper describes the development of an after-school obesity-prevention program for African-American girls, and presents findings from a 12-week pilot trial conducted by the University of Minnesota. This study was part of the GEMS project, created to test interventions designed to reduce excess weight gain in African-American girls. DESIGN: Two-arm parallel group, randomized controlled trial. Measures were taken at baseline and at 12 weeks follow up. SETTING: An after-school community program. PARTICIPANTS: Fifty-four African-American girls, 8- to 10-years of age, and their parents/caregivers. INTERVENTION: The after-school intervention was conducted twice a week for 12 weeks, and focused on increasing physical activity and healthy eating. A family component was also included. Girls in the control group received a program over 12 weeks unrelated to nutrition and physical activity. OUTCOMES: Measures included height and weight (body mass index), percent body fat (DEXA), physical activity, assessed using a CSA accelerometer and self-report, two 24-hour dietary recalls, and psycho-social and demographic variables. Parental data included demographic and psycho-social characteristics, and dietary measures. Additionally, process evaluation data on the intervention were collected. RESULTS: Recruitment goals were met. After adjustment for baseline level, follow-up BMI did not differ between the treatment groups, an expected finding, given that this was a pilot study. At 12 weeks follow up, differences between the intervention and control groups were in the hypothesized direction of change for most variables, among both the girls and their parents. Process evaluation results demonstrated that the program was well attended, and well received, by girls and parents. CONCLUSIONS: An after-school obesity prevention program for low-income African-American girls is a promising model for future efforts.