Morning Serum Cortisol Is Uniquely Associated with Cardiometabolic Risk Independent of Body Composition in Latino Adolescents.

Background: Alterations in morning serum cortisol (MSC) have been associated with higher cardiometabolic risk. This finding has been documented primarily in populations with overweight or obesity; however, it has not been clearly established if obesity plays a requisite role in this relationship. This study seeks to extend earlier findings by examining whether body composition measures alter the relationship between MSC with glucose and insulin markers, blood pressure, and lipid parameters in Latino youth in middle adolescence. Methods: This cross-sectional study included 196 healthy adolescents (130F/66M; mean age: 16.4 ± 0.6 years; 95% Latino; mean body mass index, BMI: 24.3 ± 5.7) from Los Angeles, California. Morning cortisol, glucose, insulin, glycated hemoglobin, and lipids (triglycerides and high-density lipoprotein cholesterol) were assessed from a fasting blood sample. Sitting systolic and diastolic blood pressure was averaged from duplicate measures. Body composition measures included BMI and waist circumference, which were used as proxies for total body and abdominal adiposity, respectively. Triplicate measurements of weight and height were averaged for calculation of BMI; age- and sex-specific BMI z-score was used to classify into normal BMI or overweight/obese BMI status. Waist circumference was measured in duplicate and the average was used to classify participants into two strata: normal/healthy waist circumference (<90th percentile for age, sex, and ethnicity) and high waist circumference (≥90th percentile). Results: The primary findings were that higher MSC was associated with higher fasting glucose and systolic blood pressure after adjusting for age, sex, and BMI z-score (and/or waist circumference). BMI status or waist circumference status did not alter these relationships. Main Conclusion: Our results suggest that the relationships between hypothalamic-pituitary-adrenal axis function and certain cardiometabolic risk factors may be independent of adiposity. Future research is warranted to discover the contributors and underlying mechanisms of these relationships in adolescent populations. ClinicalTrials.gov identifier: NCT02088294.

Rapid Decline in ß-Cell Function and Increasing Adiposity Are Associated With Conversion to Type 2 Diabetes in At-Risk Latino Youth.

Youth-onset type 2 diabetes (T2D) is becoming increasingly prevalent, especially among Latino youth, and there is limited information on its pathophysiology and causative factors. Here, we describe findings from a longitudinal cohort study in 262 Latino children with overweight/obesity at risk of developing T2D with annual measures of oral and intravenous glucose tolerance (IVGTT), body composition, and fat distribution. Logistic binomial regression was used to identify significant predictors in those who developed T2D compared with matched control participants, and mixed-effects growth models were used to compare rates of change in metabolic versus adiposity measures between groups. Overall conversion rate to T2D at year 5 was 2% (n = 6). Rate of decline in disposition index (DI), measured with an IVGTT, over 5 years was three times higher in case patients (-341.7 units per year) compared with the extended cohort (-106.7 units per year) and 20 times higher compared with control participants (-15.2 units per year). Case patients had significantly higher annual increases in fasting glucose, hemoglobin A1c (HbA1c), waist circumference, and trunk fat, and there was an inverse correlation between rate of decline in DI and rates of increase in adiposity measures. T2D development in at-risk Latino youth is associated with a substantial and rapid decrease in DI that is directly correlated with increases in fasting glucose, HbA1c, and adiposity. ARTICLE HIGHLIGHTS: Youth-onset type 2 diabetes is becoming increasingly prevalent, especially among Latino youth, and there is limited information on its pathophysiology and causative factors. Overall conversion rate to type 2 diabetes over 5 years was 2%. In youth who converted to type 2 diabetes, disposition index decreased rapidly by 85% compared with that in patients who did not convert during the study period. There was an inverse correlation between rate of decline in disposition index and rates of increase in various adiposity measures.

Imagine HEALTH: Changes in diurnal salivary cortisol patterns following a 12-week guided imagery RCT lifestyle intervention in predominantly Latino adolescents.

OBJECTIVE: Alterations in diurnal salivary cortisol patterns have been linked to adverse metabolic health outcomes. We have previously shown that stress-reduction guided imagery (GI) can reduce salivary cortisol levels acutely. We now ask whether addition of GI into a 12-week lifestyle intervention designed to improve eating and physical activity behaviors can alter diurnal salivary cortisol patterns and perceived stress. METHODS: 232 adolescent participants (ages 14-17 years) were cluster randomized by school into one of four intervention arms: non-intervention Control (C; n = 51), Lifestyle (LS; n=61), Stress-Reduction GI (SRGI; n = 55), and Lifestyle Behavior GI (LBGI; n = 65). LS group received one nutrition and one physical activity class per week after-school for 12 weeks. SRGI and LBGI groups received same LS classes plus an additional weekly GI session. Salivary cortisol was assessed pre- and post-intervention on 3 days, 3 times daily, at awakening, 30-minutes post-awakening, and in the evening to determine Cortisol Awakening Response (CAR) and Diurnal Cortisol Slope (DCS). Perceived Stress Scale (PSS) was administered pre- and post-intervention. Mixed effects modeling was used for intent-to-treat analysis and sensitivity analysis was used for those participants adherent to intervention protocol. RESULTS: Analysis of 208 subjects with complete data showed a small between-group increase in CAR in LBGI vs C (p = 0.045, d=0.24), with no significant group differences among other intervention arms. There were no between group differences in change in DCS or change in PSS after 12-weeks. Amongst adherent participants, LBGI showed a small-moderate increase in CAR (p = 0.03, d=0.37), and moderate-large reduction in PSS (p = 0.02, d=-0.66) compared to C. There were no other between group differences in CAR, DCS, or PSS. CONCLUSION: LBGI led to an increase in CAR, and in adherent subjects, a decrease in PSS, suggesting GI may be a mind-body intervention that can affect both objective and subjective measures of the stress response. Whether changes in cortisol patterns in this population affect measures of mental or physical health remains to be determined.

Mind- and Body-Based Interventions Improve Glycemic Control in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis.

Aims/Hypothesis: Only 51% of patients with type 2 diabetes achieve the hemoglobin A1c (HbA1c) <7% target. Mind and body practices have been increasingly used to improve glycemic control among patients with type 2 diabetes, but studies show inconsistent efficacy. The authors conducted a systematic review and meta-analysis to assess the association between mind and body practices, and mean change in HbA1c and fasting blood glucose (FBG) in patients with type 2 diabetes. Methods: The authors conducted a literature search of Ovid MEDLINE, Embase, and ClinicalTrials.gov seeking through June 10, 2022, published articles on mind and body practices and type 2 diabetes. Two reviewers independently appraised full text of articles. Only intervention studies were included. Reviewers extracted data for meta-analysis. Restricted maximum likelihood random-effects modeling was used to calculate the mean differences and summary effect sizes. The authors assessed heterogeneity using Cochran's Q and I2 statistics. Funnel plots were generated for each outcome to gauge publication bias. Weighted linear models were used to conduct study-level meta-regression analyses of practice frequency. Results: The authors identified 587 articles with 28 meeting the inclusion criteria. A statistically significant and clinically relevant mean reduction in HbA1c of -0.84% (95% confidence interval [CI]: -1.10% to -0.58%; p < 0.0001) was estimated. Reduction was observed in all intervention subgroups: mindfulness-based stress reduction: -0.48% (95% CI: -0.72% to -0.23%; p = 0.03), qigong: -0.66% (95% CI: -1.18% to -0.14%; p = 0.01), and yoga: -1.00% (95% CI: -1.38% to -0.63%; p < 0.0001). Meta-regression revealed that for every additional day of yoga practice per week, the raw mean HbA1c differed by -0.22% (95% CI: -0.44% to -0.003%; p = 0.046) over the study period. FBG significantly improved following mind and body practices, with overall mean difference of -22.81 mg/dL (95% CI: -33.07 to -12.55 mg/dL; p < 0.0001). However, no significant association was found between the frequency of weekly yoga practice and change in FBG over the study period. Conclusions/Interpretation: Mind and body practices are strongly associated with improvement in glycemic control in patients with type 2 diabetes. The overall mean reduction in HbA1c and FBG was clinically significant, suggesting that mind and body practices may be an effective, complementary nonpharmacological intervention for type 2 diabetes. Additional analyses revealed that the mean decrease in HbA1c was greater in studies requiring larger number of yoga practice sessions each week.

Effects of Group-delivered Stress-reduction Guided Imagery on Salivary Cortisol, Salivary Amylase, and Stress Mood in Urban, Predominantly Latino Adolescents.

OBJECTIVES: To determine acute effects of stress-reduction guided imagery delivered in group format on stress biomarkers salivary cortisol and salivary amylase, and on self-reported stress mood, in healthy, predominantly Latino adolescents. STUDY DESIGN: 111 adolescent participants (94% Latino), a subset from a large, randomized controlled lifestyle intervention to improve obesity-related health behaviors, received either 4 weekly lifestyle education sessions (Lifestyle group; LS) or the same weekly lifestyle education sessions plus an additional weekly stress-reduction guided imagery session delivered in group format (Guided imagery group; GI). Salivary cortisol, salivary amylase, and self-reported stress moods were assessed before and after sessions on intervention weeks 3 and 4. Statistics: Linear mixed effects models examined within- and between-session and group differences in pre- to post-session changes. RESULTS: Both groups showed decreases in salivary cortisol, 5% decrease in LS group and 32% in GI group (within-group differences all P < .05), with between-group difference in salivary cortisol of moderate size (P = .05; Cohen's d = .44). Within the GI group alone, salivary cortisol decrease was similar following either the lifestyle or GI sessions (P = .64). There were no statistically significant amylase changes within or between groups. All 5 individual stress moods declined by 27% to 46% in the GI group (all P < .05), while only 1 of the 5 declined in LS group. CONCLUSIONS: Group stress-reduction guided imagery reduces the stress biomarker salivary cortisol, as well as reducing subjective stress mood states, making it a viable modality for large scale stress-reduction interventions.

The Acute Relationship between Affective States and Stress Biomarkers in Ethnic Minority Youths.

Background: Whether affective states acutely predict the hypothalamic-pituitary-adrenal (HPA) axis activities and whether energy balance-related behaviors moderate the affect-HPA axis relationship in obese youths are not well-understood. Methods: 87 mostly obese (94.3% obese) minority adolescents (mean: 16.3 ± 1.2 years old; 56.8% Latino and 43.2% African American) participated in a randomized crossover trial in an observation laboratory, where they received either high-sugar/low-fiber (HSLF) or low-sugar/high-fiber (LSHF) meals first and then crossed over in the next visit 2-4 weeks later. During each visit, they rated five affective states and provided a saliva sample every 30 min for the first 5 h and wore a waist-worn accelerometer. The association between the affect ratings and cortisol levels in the subsequent 30 min and the moderation effect of energy balance-related behavior were examined using multilevel models. Results: Within-person negative affect (ß = 0.02, p = 0.0343) and feeling of panic (ß = 0.007, p = 0.004) were acutely related to the subsequent cortisol level only during the HSLF condition. The time spent in moderate-to-vigorous physical activity did not moderate the acute relationship between affect and the subsequent cortisol level. Conclusions: Negative affect could be acutely related to heightened HPA axis activities in youths, but only when they were exposed to meals with high sugar and low fiber content. These results suggest that the meals' sugar and fiber content may modulate HPA axis reactivity to negative affect in youths.

The mediating role of emotional eating in the relationship between perceived stress and dietary intake quality in Hispanic/Latino adolescents.

Obesity rates have steadily increased over the past three decades, and large racial/ethnic disparities in childhood obesity rates-specifically for Hispanic/Latino youth-highlight the major need for identifying and examining key mechanisms of obesogenic behaviors for this at-risk population. This study investigates the relationship between stress and dietary quality in Hispanic/Latino adolescents and seeks to determine the mediating role of emotional eating as a behavioral mechanism. Baseline data from 169 adolescents enrolled in the Imagine HEALTH trial were used to investigate these relationships. Perceived stress and emotional eating were assessed with age-validated questionnaires, and dietary quality was measured via 24-hour recall dietary assessments (later calculated as individual Healthy Eating Index-2015 scores). Nonparametric bootstrapping was used to test the primary hypothesis that emotional eating partially or fully mediates the relationship between perceived stress and dietary quality in this sample, and to test the significance of the mediating effect. Results indicate that emotional eating partially mediates the relationship between perceived stress and dietary quality. The total effect of perceived stress scores on dietary quality scores was -0.24 (p = .006); the direct effect of perceived stress scores on dietary quality scores (controlling for emotional eating scores) was -0.16 (p = .107), and the mediating (indirect) effect of emotional eating was -0.09 (p = .001). The proportion of mediation was 0.36 (36%) (p = .008). This study identifies an important mechanism of obesogenic behavior and can be used to inform future obesity prevention and intervention strategies tailored for the Hispanic/Latino adolescent population.

Imagine HEALTH: Randomized Controlled Trial of a Guided Imagery Lifestyle Intervention to Improve Obesity-Related Lifestyle Behaviors in Predominantly Latinx Adolescents.

Introduction: To determine the effects of a novel lifestyle intervention combining lifestyle behavioral education with the complementary-integrative health modality of guided imagery (GI) on dietary and physical activity behaviors in adolescents. The primary aim of this study was to determine the incremental effects of the lifestyle education, stress reduction GI (SRGI), and lifestyle behavior GI (LBGI) components of the intervention on the primary outcome of physical activity lifestyle behaviors (sedentary behavior, light, moderate, and vigorous physical activity), as well as dietary intake behaviors, at the completion of the 12-week intervention. The authors hypothesized that the intervention would improve obesity-related lifestyle behaviors. Materials and Methods: Two hundred and thirty-two adolescent participants (aged 14-17 years, sophomore or junior year of high school) were cluster randomized by school into one of four intervention arms: nonintervention Control (C), Lifestyle education (LS), SRGI, and LBGI. After-school intervention sessions were held two (LS) or three (SRGI, LBGI) times weekly for 12 weeks. Physical activity (accelerometry) and dietary intake (multiple diet recalls) outcomes were assessed pre- and postintervention. Primary analysis: intention-to-treat (ITT) mixed-effects modeling with diagonal covariance matrices; secondary analysis: ad hoc subgroup sensitivity analysis using only those participants adherent to protocol. Results: ITT analysis showed that the Healthy Eating Index (HEI) increased in the LS group compared with C (p = 0.02), but there was no additional effect of GI. Among adherent participants, sedentary behavior was decreased stepwise relative to C in SRGI (d = -0.73, p = 0.004) > LBGI (d = -0.59, p = 0.04) > LS (d = -0.41, p = 0.07), and moderate + vigorous physical activity was increased in SRGI (d = 0.58, p = 0.001). Among adherent participants, the HEI was increased in LS and SRGI, and glycemic index reduced in LBGI. Conclusions: While ITT analysis was negative, among adherent participants, the Imagine HEALTH lifestyle intervention improved eating habits, reduced sedentary activity, and increased physical activity, suggesting that GI may amplify the role of lifestyle education alone for some key outcomes. Clinical Trials.gov ID: NCT02088294.

Guided Imagery Council: Feasibility, Acceptability, and Preliminary Effects of a Novel Group-Based Lifestyle Intervention in Predominantly Latino Adolescents.

BACKGROUND: The combination of higher stress and higher obesity rates suggests that Latino youth in the United States may be a population at particular risk for obesity-related adverse health outcomes. The objective of this article is to describe the feasibility, acceptability, and quantitative stress-related outcomes of a 6-week pilot lifestyle intervention using guided imagery (GI) council in order to reduce risk factors for obesity-related disease. METHODS: Seventeen urban, adolescents (12 females/5 males, 16 Latino, age 17 ± 1 years, grades 9-12, body mass index 22 ± 4) participated in the 6-week, after-school pilot intervention. The intervention consisted of three, 75-minute after-school sessions delivered weekly for 6 weeks. The 3 weekly sessions included 1 session each of nutrition education, physical activity education and practice, and GI delivered in council, a facilitated group process based on indigenous practices. Feasibility and acceptability were assessed by attendance and qualitative exit interview. Stress outcomes included salivary cortisol and perceived stress. RESULTS: The pilot intervention was found to be feasible to deliver in an after-school setting. The GI and council group format were well liked. A 31% reduction in salivary cortisol was observed following the stress-reduction GI sessions. Diurnal cortisol patterns did not change across the intervention, but change in perceived stress was correlated with change in cortisol awakening response. CONCLUSIONS: The intervention was feasible to deliver and highly acceptable. Acute reduction in salivary cortisol was seen following group GI, while no change was seen in daily cortisol patterns. These results support the development of a full 12-week intervention using GI council to reduce obesity-related disease risk.

Protocol for the Imagine HEALTH Study: Guided imagery lifestyle intervention to improve obesity-related behaviors and salivary cortisol patterns in predominantly Latino adolescents.

Innovative lifestyle interventions are needed to reduce type 2 diabetes risk in adolescents. This report describes the protocol of the Imagine HEALTH cluster randomized control trial, that tests an intervention based in Self-Determination Theory (SDT) and uses lifestyle education combined with the mind-body, complementary health modality of guided imagery (GI), to address obesity prevention and treatment in predominantly Latino adolescents. The primary aim is to determine the unique effects of each of the three major components of the 12-week lifestyle intervention (lifestyle education, stress reduction guided imagery, and lifestyle behavior guided imagery) compared to control on primary outcomes of physical activity (accelerometry), dietary intake (3-day recall), and stress biomarker levels (salivary cortisol). Secondary aims assess changes compared to controls in psychosocial outcomes (stress, well-being, depression), diabetes-related metabolic outcomes (adiposity, insulin resistance), maintenance of outcome changes for one year post-intervention, and SDT-based mediation of intervention effects. The development and rationale for each of the intervention components, study design, and outcome measurement processes are described. Adolescent participants recruited from four urban schools are cluster randomized by school into one of four arms of the 12-week (3-month) intervention, followed by 6 months of maintenance and 6 months of no contact. Outcome measures are assessed at the end of each period (3-, 9-, and 15-months). Results to date show successful recruitment of 97% of the target study population. Future results will demonstrate the effects of this integrative intervention on primary and secondary outcome measures in adolescents at risk for lifestyle-related metabolic disease.

Diabetes Empowerment Council: Integrative Pilot Intervention for Transitioning Young Adults With Type 1 Diabetes.

BACKGROUND: The transition of young adults with type 1 diabetes (T1D) from pediatric to adult care is challenging and frequently accompanied by worsening of diabetes-related health. To date, there are no reports which prospectively assess the effects of theory-based psycho-behavioral interventions during the transition period neither on glycemic control nor on psychosocial factors that contribute to poor glycemic control. Therefore, the overall aim of this study was to develop and pilot test an integrative group intervention based on the underlying principles of self-determination theory (SDT), in young adults with T1D. METHODS: Fifty-one young adults with T1D participated in an education and case management-based transition program, of which 9 took part in the Diabetes Empowerment Council (DEC), a 12-week holistic, multimodality facilitated group intervention consisting of "council" process based on indigenous community practices, stress-reduction guided imagery, narrative medicine modalities, simple ritual, and other integrative modalities. Feasibility, acceptability, potential mechanism of effects, and bio-behavioral outcomes were determined using mixed qualitative and quantitative methods. RESULTS: The intervention was highly acceptable to participants, though presented significant feasibility challenges. Participants in DEC showed significant reductions in perceived stress and depression, and increases in general well-being relative to other control participants. Reduction in perceived stress, independent of intervention group, was associated with reductions in hemoglobin A1C. A theoretical model explaining the effects of the intervention included the promotion of relatedness and autonomy support, 2 important aspects of SDT. CONCLUSIONS: The DEC is a promising group intervention for young adults with T1D going through transition to adult care. Future investigations will be necessary to resolve feasibility issues, optimize the multimodality intervention, determine full intervention effects, and fully test the role of the underlying theoretical model of action.ClinicalTrials.gov Registration Number NCT02807155; Registration date: June 15, 2016 (retrospectively registered).

Longitudinal Associations Between Ambient Air Pollution With Insulin Sensitivity, ß-Cell Function, and Adiposity in Los Angeles Latino Children.

Evidence suggests that ambient air pollution (AAP) exposure may contribute to the development of obesity and type 2 diabetes. The objective of this study was to determine whether exposure to elevated concentrations of nitrogen dioxide (NO2) and particulate matter with aerodynamic diameter <2.5 (PM2.5) had adverse effects on longitudinal measures of insulin sensitivity (SI), ß-cell function, and obesity in children at high risk for developing diabetes. Overweight and obese Latino children (8-15 years; n = 314) were enrolled between 2001 and 2012 from Los Angeles, CA, and followed for an average of 3.4 years (SD 3.1 years). Linear mixed-effects models were fitted to assess relationships between AAP exposure and outcomes after adjusting for covariates including body fat percent. Higher NO2 and PM2.5 were associated with a faster decline in SI and a lower SI at age 18 years, independent of adiposity. NO2 exposure negatively affected ß-cell function, evidenced by a faster decline in disposition index (DI) and a lower DI at age 18 years. Higher NO2 and PM2.5 exposures over follow-up were also associated with a higher BMI at age 18 years. AAP exposure may contribute to development of type 2 diabetes through direct effects on SI and ß-cell function.

Clinical and Psychosocial Outcomes of a Structured Transition Program Among Young Adults With Type 1 Diabetes.

PURPOSE: We identified and treated young adults with type 1 diabetes who had been lost to follow-up during their transfer from pediatric to adult care, comparing their clinical, psychosocial, and health care utilization outcomes to participants receiving continuous care (CC) throughout the transition to adult care. METHODS: Individuals in their last year of pediatric care (CC group, n = 51) and individuals lost to follow-up in the transfer to adult care ("lapsed care" [LC] group, n = 24) were followed prospectively for 12 months. All participants were provided developmentally tailored diabetes education, case management, and clinical care through a structured transition program. RESULTS: At baseline, LC participants reported lapses in care of 11.6 months. Compared with CC participants, they had higher hemoglobin A1C (A1C; p = .005), depressive symptoms (p = .05), incidence of severe hypoglycemia (p = .005), and emergency department visits (p = .004). At 12-month follow-up, CC and LC participants did not differ on the number of diabetes care visits (p = .23), severe hypoglycemia (no events), or emergency department visits (p = .22). Both groups' A1C improved during the study period (CC: p = .03; LC: p = .02). LC participants' depressive symptoms remained elevated (p = .10), and they reported a decline in life satisfaction (p = .007). There was greater loss to follow-up in the LC group (p = .04). CONCLUSIONS: Our study suggests that, for young adults with a history of lapses in care, a structured transition program is effective in lowering A1C, reducing severe hypoglycemia and emergency department utilization, and improving uptake of routine diabetes care. Loss to follow-up and psychosocial concerns remain significant challenges in this population.

Built Environment Associations with Adiposity Parameters among Overweight and Obese Hispanic Youth.

OBJECTIVE: The purpose of this cross-sectional study was to establish neighborhood built environment correlates of adiposity as measured by dual x-ray absorptiometry (DXA). The utility and methodological gains of using this measure for built environment research was further investigated by comparing model fit across parallel models on BMI z-scores and waist circumference. METHODS: Pre-existing data collected from 2001-2001 on 576 overweight and obese Hispanic youth were compiled with built environment data, and 2000 Census data for analyses conducted in 2012. Walking-distance buffers were built around participants' residential locations. Variables for park space, food access, walkability, and neighborhood socio-cultural aspects were entered into a multivariate regression model predicting percent body fat. Parallel models were built for BMI z-score, and waist circumference. RESULTS: Significant associations were found between percent body fat and supermarket access for boys, and percent body fat and increased park space and decreased neighborhood linguistic isolation for girls. Neighborhood socio-cultural characteristics accounted for more variance in obesity compared to BMI z-score or waist circumference. CONCLUSION: Park access, food environment, and neighborhood socio-cultural characteristics are independent contributors to body fat in children, and the contribution of these risks differs by gender. There are incremental gains to using a more accurate measure of body fat in built environment obesity studies.

Changes in Bone Biomarkers, BMC, and Insulin Resistance Following a 10-Week Whole Body Vibration Exercise Program in Overweight Latino Boys.

PURPOSE: With the childhood obesity epidemic, efficient methods of exercise are sought to improve health. We tested whether whole body vibration (WBV) exercise can positively affect bone metabolism and improve insulin/glucose dynamics in sedentary overweight Latino boys. METHODS: Twenty Latino boys 8-10 years of age were randomly assigned to either a control (CON) or 3 days/wk WBV exercise (VIB) for 10-wk. RESULTS: Significant increases in BMC (4.5 ± 3.2%; p=0.01) and BMD (1.3 ± 1.3%; p<0.01) were observed for the VIB group when compared to baseline values. For the CON group BMC significantly increased (2.0 ± 2.2%; p=0.02), with no change in BMD (0.8 ± 1.3%; p=0.11). There were no significant between group changes in BMC or BMD. No significant change was observed for osteocalcin and (collagen type I C-telopeptide) CTx for the VIB group. However, osteocalcin showed a decreasing trend (p=0.09) and CTx significantly increased (p<0.03) for the CON group. This increase in CTx was significantly different between groups (p<0.02) and the effect size of between-group difference in change was large (-1.09). There were no significant correlations between osteocalcin and measures of fat mass or insulin resistance for collapsed data. CONCLUSION: Although bone metabolism was altered by WBV training, no associations were apparent between osteocalcin and insulin resistance. These findings suggest WBV exercise may positively increase BMC and BMD by decreasing bone resorption in overweight Latino boys.

Temporal relationships between adipocytokines and diabetes risk in Hispanic adolescents with obesity.

OBJECTIVE: Circulating cytokines are frequently cited as contributors to insulin resistance in children with obesity. This study examined whether circulating adipocytokines, independent of adiposity, predicted pubertal changes in insulin sensitivity (SI), insulin secretion (AIR), and ß-cell function in high-risk adolescents. METHODS: 158 Hispanic adolescents with overweight or obesity were followed for a median of 4 years. Adipocytokines were measured using Luminex technology. SI, AIR, and the disposition index were derived from an intravenous glucose tolerance test and minimal modeling. Total fat mass was measured by DXA and visceral adipose tissue (VAT) by MRI. RESULTS: Surprisingly, mean IL-8, IL-1ß, IL-6, and TNF-α decreased between 5% and 6.5% per year from baseline (P < 0.001). Despite the general temporal trends, gaining 1-SD of VAT was associated with a 2% and 5% increase in MCP-1 and IL-8 (P < 0.05). In addition, a 1-SD higher MCP-1 or IL-6 concentration at baseline was associated with a 16% and 21% greater decline in SI during puberty vs. prepuberty (P < 0.05). CONCLUSIONS: Several adipocytokines decreased during adolescence and were weakly associated with VAT and lower SI during puberty. Circulating adipocytokines have relatively limited associations with pubertal changes in diabetes risk; however, the consistent findings with MCP-1 warrant further investigation.

Let's Empower and Prepare (LEAP): Evaluation of a Structured Transition Program for Young Adults With Type 1 Diabetes.

OBJECTIVE: To evaluate the efficacy of a structured transition program compared with usual care in improving routine follow-up, clinical, and psychosocial outcomes among young adults with type 1 diabetes. RESEARCH DESIGN AND METHODS: Eighty-one young adults in their last year of pediatric care were recruited from three clinics. Intervention group (IG) participants (n = 51) received a structured transition program incorporating tailored diabetes education, case management, group education classes, and access to a newly developed young adult diabetes clinic and transition website. Control group (CG) participants (n = 30) received usual care. The primary outcome was the number of routine clinic visits. Secondary outcomes included glycemic control, hypoglycemia, health care use, and psychosocial well-being. Assessments were conducted at baseline, and 6 and 12 months. RESULTS: Limitations in CG follow-up prevented direct comparisons of adult care visits; however, at the 12-month follow-up among IG participants discharged from pediatric care (n = 32), 78% had one or more adult visits. Among IG participants, the total number of clinic visits did not differ between those who transitioned and those who remained in pediatric care (3.0 ± 1.24 vs. 3.11 ± 0.94, P = 0.74). IG compared with CG participants had improved glycemic control (-0.40 ± 1.16% vs. 0.42 ± 1.51% [4.4 ± 12.7 mmol/mol vs. 4.6 ± 16.5 mmol/mol], P = 0.01), incidence of severe hypoglycemia (0.0% vs. 16%, P = 0.02), and global well-being (P = 0.02) at 12 months. CONCLUSIONS: A structured transition program was successful in facilitating transition to adult care without a decrease in clinical follow-up. Compared with usual care, the transition program facilitated improvements in glycemic control, hypoglycemia, and psychosocial well-being.

Fasting, post-OGTT challenge, and nocturnal free fatty acids in prediabetic versus normal glucose tolerant overweight and obese Latino adolescents.

Type 2 diabetes risk and its relationship to free fatty acid (FFA) exposure and visceral fat by prediabetes status in minority adolescents have yet to be explored. Therefore, the objective of this study was to examine the association of circulating FFA under varying conditions with prediabetes in Latino adolescents and to determine the relative relationships of FFA and visceral adiposity to insulin sensitivity, secretion, and ß-cell function. Overweight or obese, but otherwise healthy Latino adolescent males and females (n = 164, 14.2 ± 2.5 years), were recruited for assessment of prediabetes, abdominal fat, and FFA levels taken at a fasting state (FFAF), during an OGTT (FFAOGTT), and overnight (FFANOCTURNAL). Prediabetic adolescents had a higher FFAF than those with normal glucose tolerance when controlling for age, sex, pubertal status, total percent body fat, and visceral fat. FFAOGTT and FFANOCTURNAL did not differ between participants with prediabetes and those with normal glucose tolerance after adjusting for covariates. Visceral fat was independently related to insulin sensitivity and secretion in pubertal adolescents; however, in post-pubertal adolescents, FFAF and visceral fat were both independent and negatively related to ß-cell function. These results support a plausible progression of the lipotoxicity theory of diabetes development during the pubertal transition.

Comparing glycemic indicators of prediabetes: a prospective study of obese Latino Youth.

OBJECTIVE: One hour (1-hr) glucose during an oral glucose tolerance test (OGTT) is an emerging biomarker for type 2 diabetes. We compared the predictive power of 1-hr glucose to traditional glycemic markers for prospectively identifying prediabetes in youth. RESEARCH DESIGN AND METHODS: Obese normoglycemic Latino youth (N = 116) were assessed at baseline for glycated hemoglobin (HbA1c), fasting, 1-hr, and 2-hr glucose during an OGTT and were followed for up to 8 yr for the development of prediabetes. Receiver operating characteristic (ROC) curves were used and a multivariable prediction model was developed. RESULTS: The area under the 1-hr glucose ROC curve was the most powerful predictor of prediabetes over time [0.73, 95% confidence interval (CI) = 0.64-0.83]. However, combining all indicators into a single model was superior to individual marker models (0.77, 95% CI = 0.690.86). CONCLUSIONS: These results further support the utility of 1-hr glucose during an OGTT as a prospective marker of diabetes risk in youth.