• No results found

Assessing Knowledge of the Microbiome’s Role in Obesity Prevention within Minority Communities: Protocol to Guide Focus Group Research

N/A
N/A
Protected

Academic year: 2020

Share "Assessing Knowledge of the Microbiome’s Role in Obesity Prevention within Minority Communities: Protocol to Guide Focus Group Research"

Copied!
24
0
0

Loading.... (view fulltext now)

Full text

(1)

Assessing Knowledge of the Microbiome’s Role in Obesity Prevention within Minority Communities: Protocol to Guide Focus Group Research

By: Monique A. Pardo-Montez

Senior Honors Thesis School of Nursing

University of North Carolina at Chapel Hill

May 1, 2020

Approved:

Eric Hodges PhD, Thesis Advisor

(2)

Abstract

Background: Disparities in the prevalence of obesity in ethnic minority populations are apparent in early preschool years. Emerging evidence states that the early life gut microbiome is an important regulator of the biologic pathways contributing to the development of obesity.

Furthermore, manipulating the gut microbiota may be a viable intervention leading to weight loss and obesity prevention.

Purpose: The aim of this protocol is to guide the development of qualitative research in order to assess minority communities’ understanding of the early life microbiome and its role in obesity prevention.

Methods: This study will be carried out through collaboration with the FYI: Feeding Your Infant study, Dr. Eric Hodges’ TraCS 2k grant-funded project. Research goals are to reach out to minority communities through a process called intervention mapping to understand whether there is a community interest in obesity prevention in infancy and toddlerhood. The intersection of these two studies is an effective way to garner data about feeding experiences, obesity concerns, and potential interventions. Knowledge of the microbiome will be assessed in four different focus groups: two Latinx and two African American groups with five people attending each group. The location of the focus groups will be in Durham and Sanford, North Carolina.

Conclusions: Data from the integration of this and the FYI study will provide insights regarding efforts to enhance participation among minority families in a planned NIH R01 obesity

prevention trial.

Keywords: obesity, prevention, minority, Latinx, African American, gut microbiome,

microbiota, focus group

(3)

Background Obesity Epidemic in Minority Populations

Obesity is a major public health concern and is the leading cause of morbidity and mortality in the United States (Byrd, Toth, & Stanford, 2018). A higher prevalence of obesity is observed in ethnic minority populations, such as African American and Latinx communities.

Factors which contribute to the high rates of obesity among these populations are genetic predispositions, dietary intake, physical activity, psychological factors, stress, income, and discrimination (Byrd et al., 2018). By 2030, a projected 65 million additional adults will be diagnosed with obesity causing a much larger health and economic burden (Wang, McPherson, Marsh, Gortmaker, and Brown, 2011). To prevent the alarming rise in obesity, steps must be taken to address this disparity.

Interventions steered towards mitigating obesity in the pediatric population could combat the burgeoning obesity epidemic. Infants with either overweight or obesity have a substantial risk remaining so as they grow to become adults (Baird et al., 2005). Left unaddressed, it can lead to the development of many other co-morbidities like type 2 diabetes mellitus, dyslipidemia, cardiovascular disease, anxiety, and depression (Kumar & Kelly, 2017). Therefore, a child’s early years are an important period for obesity prevention to impede the development of obesity in adult years (Blake-Lamb et al., 2016).

Narrowing the obesity epidemic requires a paradigm shift that widens our conceptual lens

to examine solutions prior to the diagnosis of obesity. Since ethnic minorities have especially

high rates of obesity, prevention efforts will need to be culturally tailored to address the unique

needs of these specific populations (Byrd et al., 2018). For example, obesity prevention or

reduction involves lifestyle modifications through behavioral change (Chan & Woo, 2010). Not

(4)

only understanding what parents are feeding their children, but how they are being fed can provide insight into obesity risk. Better understanding how individual cultures approach meal times can offer greater insight to planning prevention efforts (Birch, Savage, Ventura, 2007).

Measures to improve nutrition quality should be a critical driver in shifting the

underlying public health paradigm. One of the many factors affecting obesity is diet, specifically a Western-style diet. High in animal protein and fat, high in refined carbohydrates, and low in plant-derived fiber, phytochemicals, and fermented foods, a Western diet has not only been associated with obesity but a rapid rise in inflammatory-related diseases, including

cardiometabolic and intestinal disease (Mohammadkhah, Simpson, Patterson, & Ferguson, 2018).

Public health efforts to reduce the obesity epidemic have been met with opposition. For example, the beverage industry’s active opposition towards the sugar-sweetened beverage tax despite evidence that consumption of sugary beverages is an important modifiable risk factor for overweight and obesity (Madsen, Krieger, & Morales, 2019; Eykelenboom et al., 2019). The food industry seeks to maximize profit by strategizing to promote the normalization of carbohydrate rich, high-fat foods (Chan et al., 2010). More research needs to be conducted to better understand how to combat the emerging obesity epidemic and mitigate the increasing racial disparity (Byrd et al., 2018).

Microbiome Role in Metabolic Response

A new body of knowledge has emerged detailing the role the human microbiome plays in

obesity. The human microbiome is a composite of bacteria, fungi, and other microbes, also

termed probiotics, that reside on or in the human body assisting with a variety of cellular

functions that help maintain homeostasis (Al-Assal, Martinez, Torrinhas, Cardinelli, &

(5)

Waitzberg, 2018). The term microbiome refers to the collection of genes derived from the microbiota, the beneficial microorganisms existing within the human body (Al-Assal et al., 2018). Interestingly, the estimated gene content of the microbiome falls between 2-20 million and far exceeds the number of human genes, about 20,000, by a factor of 100 (Knight et al., 2017). The impact of this enormous number of microbial genes on human biology is profound.

Unlike the human genome, which is difficult to alter and is fixed at birth, the human microbiome is highly malleable. It is the portion of genetic system that can be changed and potentially used for novel therapies to address a variety of disorders including obesity (Knight et al., 2017).

There is a strong association between the composition of the gut ecosystem and obesity (Davis, 2017). Reduced diversity and/or alterations in the proportion of bacterial phylums, specifically Bacteroidies and Firmicutes, in the gut suggest that differences in caloric extraction from food may be determined by the microbiota (Riva et al. 2017). Studies with mice have concluded that the microbiome’s ability to harvest additional energy from complex

carbohydrates can lead to an increase in caloric intake (Davis, 2017). A Norwegian cohort study found an association between the infant gut microbiome and later BMI (Stanislawski et al.,2018).

This study deduced that differences in the microbiota precede overweight/obesity and a better understanding the development of the microbiome can help to identify at risk youth. Identifying the microbiome as a key player in the diagnosis of obesity may help develop more targeted early obesity prevention efforts (Stanislawski et al., 2018).

One intervention that can maintain or reshape the microbiome is the consumption of a

plant-based, fiber rich foods (Valdes, Walter, Segal, & Spector, 2018). The composition of the

intestinal microbiota is strongly affected by dietary intake. Specific foods and dietary patterns

can influence the abundance of different types of bacteria in the gut (Xu & Knight, 2015). The

(6)

gut microbiota provide essential functions for the fermentation of non-digestible carbohydrates (Valdes et al., 2018). Fermentation of plant-based fibers, in turn, produces metabolites called short chain fatty acids (SCFA) which prevent microbial imbalances, regulate fat metabolism, and reduce inflammation. SCFA are essential for the development of a healthy gut as they are vital source of energy for the cells lining the colon (Valdes et al., 2018).

Low fiber intake, as seen in Western-style diets, reduces production of SCFA and shifts the gastrointestinal microbiota to metabolize less favorable nutrients, leading to metabolic disturbances and the formation of detrimental byproducts (Valdes et al., 2018). This chain of events can trigger a systemic inflammatory response contributing to the metabolic disturbances observed in obesity (Davis, 2017). Because dietary habits are the main contributor to the diversity of the human gut microbiota, altering its composition through the implementation of high fiber foods may be a solution to preventing early childhood obesity (Al-Assal et al., 2018).

Introduction Honors Project

For my honors project, I will assess the knowledge of the microbiome’s role in obesity prevention within minority communities, specifically the Latinx and African American

populations. This study will be carried out through collaboration with the FYI: Feed Your Infant study, enabling me to conduct research alongside experts who have been working with infant feeding and minority populations. Their expertise provides me with mentorship and training to develop an understanding of how my research question can best be answered: what do minority populations know of the microbiome and its role in obesity prevention?

Collaborating with Dr. Eric Hodges, the Primary Investigator, on his grant-funded project

will facilitate my ability to reach out to minority communities to better understand their interest

(7)

in obesity prevention in infancy and toddlerhood. Through the integration of these two projects, I will be able to act as community liaison for participant recruitment, co-moderate a focus group in Spanish, participate in data collection, and assist with data analysis. Ultimately, my goal is to produce research that can bring meaningful change to a population of people in need.

FYI: Study Feeding Your Infant

The objective of the FYI study is to learn from focus groups of African American and Latinx parents about experiences surrounding feeding practices, obesity risk concerns, and responsive feeding awareness. Data suggests obesity risk extends beyond what a child is eating and into the manner in which they are fed (Birch et al., 2007). Dr. Hodges’ FYI study looks into the concept of responsive feeding to better understand how children are fed. Responsive feeding is defined as a match between an infant’s communication of hunger and satiety and the

caregiver’s awareness, accurate interpretation, and developmentally appropriate response to this communication (DiSantis, Hodges, Johnson, and Fisher, 2011). Focus groups will further discuss the participates’ thoughts about proposed interventions (e.g. mindful eating behaviors, sign language, the microbiome, and nutritional requirements). The results of this study will be used to inform an R01 obesity prevention trial.

Purpose and Aims of Protocol

By further understanding health disparities specific to obesity in minority population,

interventions can be formed benefiting this population of people. One of the many factors that

has been link to the development of obesity is diet. Understanding how diet not only contributes

to caloric intake, but also how it affects the development of the microbiome can identify other

mechanisms contributing to the pathogenesis of obesity. My honors project will address a small

(8)

component of this underlying problem – the assessment of community knowledge in regards to the microbiome. This protocol addresses these specific aims:

1. Lay the ground work for the development of qualitative research through my honors project. In order to assess the minority communities understanding of the early life microbiome and its role in obesity prevention, clearly defining my role as co-

moderator, the role of the moderator, and what will be said is essential to attain accurate data.

2. Guide the implementation of my honors project and its intersection with the FYI study. This protocol will delineate steps that have already been taken in the development of data collection and analysis, and steps that will need to be taken for the completion of both my honors project and the FYI study.

Methods Design

My honors project is embedded within the FYI study’s focus group design. A focus group is a qualitative approach to gain an in-depth understanding of social issues (Nyumba, Wilson, Derrick, & Mukherjee, 2017). The objective for using this research design is to obtain data from a purposely selected group of individuals rather than from a statistically representative sample of broader population (Nyumba et al., 2017). Through a process called intervention mapping, we will be engaging key stakeholders and community members in the planning process resulting in more effective culturally tailored interventions.

As we seek to find better ways to deliver effective health promoting interventions, the participants will be asked about their thoughts of several different types of interventions

regarding obesity prevention, the microbiome will be among those. Questions asked throughout

(9)

this in-person focus group will allow for a better analysis of the community’s knowledge of the microbiome. If participates are unaware of the microbiome’s role, an explanation will be provided on what it is and how it relates to obesity prevention.

Prior to the session beginning, a questionnaire will be provided to capture

sociodemographic characteristics, feeding methods, parity, and other influential factors affecting infant feeding. The focus groups will be audio-recorded and the audio will be transcribed

through UNC Odum Institute. The two Latinx groups will be conducted in Spanish, both the moderator and co-moderate are fluent. A certified Spanish interpreter will interpret the 90 minute recording into an English audio recording; then, those results will be transcribed. A designated note-taker will be present for all four focus groups to provide verbatim notes, start/end the digital recording, and keep time for the moderator.

Funding for this project has been acquired through NC TraCS 2K grant, a 2,000 dollar grant assisting researchers in implementing a proposed study. The majority of the funding is being allocated to participant compensation and data transcription. The amount each participant will receive is fifty dollars for approximately ninety minutes of their time. There will be a total of twenty participants (n=20) split among four groups; each group will have five participants. In order to accommodate any additional needs, funding for childcare and refreshments have been taken into consideration.

Setting and Sample

The locations where the focus groups will be held are in Sanford and Durham, North

Carolina. According to the United States Census Bureau, about 26.1% of Sanford’s population is

Latinx while 39.3% percent of Durham’s population is African American (2018). Not only do

these two locations have a large minority population, our longstanding relationships within these

(10)

communities allow for greater participation from the minority community and community stakeholders. The location for the Latinx focus groups will be at a free, private facility owned by the Steven Center. The African American focus group will be held in the Durham County Library. These locations are easy to access and have a designated childcare area. We recognize that by providing these locations we will be able to convenience the target sample. The target sample includes Latinx and African American mothers/primary-caregivers of children ranging from infants to toddlers up to age 3 years.

Procedures Research Collaboration

My interest in producing microbiome research lies with the existing data underlining the microbiome’s role in human health and disease. The microbiome plays a large role in

metabolism. Fully capturing how body processes work synergistically with the endogenous microbiota may provide some insight to the increasing prevalence of chronic disease (Knight et al., 2017). Although this field of research is still emerging, work towards microbiome-based interventions for treating disease and supporting health are advancing. As the nursing profession moves forward, work towards making the microbiome more visible in practice, education, and policy should be a mainstay of this and any healthcare profession.

Dr. Hodges has been invested in researching the role of caregiver/infant-toddler dyadic

responsiveness during feeding with a primary interest in early childhood obesity prevention. In

his previous R21 research grant, fewer African American and Latinx families participated in the

study. Conducting the FYI study collects the needed data to better understand interventions that

can impact the minority community. This study will bridge the results of his R21 research with

(11)

the design of a R01 obesity prevention trial by containing more relevant input from those he hopes to serve through his research.

Forming a collaboration with Dr. Hodges to complete my honors project fulfills multiple purposes:

1. A desire to promulgate microbiome research for the betterment of the nursing profession and community health. As the largest health care workforce, nurses have a profound impact on patient outcomes. Exposing nurses to microbiome research may have a much larger benefit on community health.

2. Aligning with the needs of the FYI study. Since I am a bicultural and bilingual, I have many connections within the Latinx community in Sanford. In addition, I was raised in Sanford for many years and know key community stakeholders who are willing to assist in the development of this research.

3. Acquiring a better understanding of the grant-approval/research process. As I transition into the Hillman Scholar’s PhD in Nursing program, learning how to collaborate on and effectively carry out research is essential.

This collaboration has allowed me to contribute my voice to an ongoing scholarly dialogue. It has taken me to various new campus departments to better understand the grant approval process and into the community where a positive impact can be made.

Human Subjects Research Approval. As a part of this collaboration, the Institutional

Review Board (IRB) approval for my honors project was submitted in conjunction with the

parent study. We applied for approval from the University of North Carolina at Chapel Hill

(UNC) IRB. In preparation for this, various documents had to be translated into Spanish prior to

IRB submission. These documents included the: consent forms, phone/email scripts, interview

(12)

guide, and demographic questions. Once I finished a draft of the translations, they were sent to a certified Spanish interpreter for review and returned prior to IRB submission.

We anticipated this research study would be expedited, yet after our first submission the IRB requested several changes be made. Based on the study procedures, they concluded that discussions around unhealthy feeding practices may cause a degree of discomfort. Therefore, an expedited non-exempt review would be more appropriate. As a result of the global pandemic, IRB approval will be resubmitted once the moratorium on human subject research has been lifted. Some of the study personnel will have changed as a result of the date being prolonged. An updated list of personnel will be submitted once human subject research can resume.

The IRB also requires that Collaborative Institutional Training Initiative (CITI) Program training be completed for any person who comes in contact with human subjects. For the

exception of personnel that are not currently students or faculty at UNC, the majority of research team have completed this training. Because of the changes attributed to COVID-19, anyone added to this research as personnel will have CITI training prior to the next IRB submission.

In regards to consent, we will inform participants prior to the start of the focus group discussion that participation in the focus group confirms their consent to participate in the study.

As participants in focus groups, we will advise participants individually about the inability to maintain anonymity at the time of data collection due to the nature of focus groups, but that all data collected will be deidentified. Additionally, participants will be reminded of their volunteer status, assured confidentiality at focus group sessions, and notified that they are free to leave at any time.

Training

(13)

Focus Group Training. UNC’s Odum Institute offers qualitative research class to better familiarize researchers on organizing, budgeting, and moderating a focus group. After attending this one day course, I received feedback from the instructors on how to best structure the focus groups moderated in Spanish. Originally, we had planned to have simultaneous interpretation – meaning the focus groups would be conducted in English and a certified interpreter would either interpret what the moderator or participant is has said as they are speaking. Based on the

instructors’ recommendations, completing the focus group entirely in Spanish then having a certified interpreter record an English interpretation would be the best use of our time.

Otherwise, the length of time and flow of the focus group may be affected. In addition, the moderator roles have changed. I have become co-moderator while the interpreter will be moderating.

Moderator Training. For the Spanish speaking focus groups, the moderator will be trained using the materials obtained from the Odum Institute class to better explain this form of qualitative research. In focus group research, the moderator takes more of a peripheral role in discussions (Nyumba et al., 2017). Moderators control the dynamics of the discussion between participants and not between the researcher and participants. This type of guided discussion used in focus groups differs from interviews. Instead of taking on the role of investigator, the

moderator ensures the productivity of the conversation while maintaining neutral in their verbal and non-verbal communication. If the group begins to deviate from the topic or if one participant dictates the conversation, the moderator must step in and tactfully steer the conversation

(Nyumba et al., 2017).

Frank Montez will be moderating the Spanish focus groups. Although he does not have

any prior experience moderating, he has substantial experience in public speaking and guiding

(14)

group discussions. Additionally, he has over a decade of experience as certified interpreter for the Duke Health system and a privately owned company. Moderator training will start after the completion of his CITI training. We will discuss the Spanish interview guide that was created by Dr. Hodges and conduct practice sessions to sharpen his skills.

Funding

The specific requests were made for transportation and interpretation services equaled a rounded total of $300. Since the communities we are reaching out to determine the location of the focus groups, I will be traveling to Sanford, North Carolina to reach out to the Latinx communities. Considering I will have to commute between Chapel Hill and Sanford to recruit and co-moderate these focus groups, I will be traveling 72 miles from Chapel Hill to the hosting facility in Sanford and back home. Calculating University reimbursement at 57.5 cents per mile and my need to travel to the location four times (twice to recruit and twice for the focus group), the total amount requested is $165.60.

The certified interpreter that will be interpreting the audio recording is Sary Ayala. Hiring a certified interpreter to listen to the recordings once the focus group has been completed avoids interruptions that may have been caused by instantaneous interpretation. These changes will help make the flow of communication as natural as possible. In order to collect the necessary data for analysis of my honors project, the data must be in English so that it can be transcribed. The cost of hiring an interpreter is set at $50 per hour. The total time to collect the needed data to

complete the analysis for my portion of this project is 80 minutes out of 180 minutes. Assuming it take twice the time to interpret the data (160 minutes), the cost of contracting an interpreter is

$134.

(15)

I was approved for funding through the Tom and Elizabeth Long Excellence Fund for Honors administered by Honors Carolina. The additional funding helped to counterbalance the structural changes made to the grant and provided us with a less costly solution. Simultaneous interpretation would have been a time consuming endeavor further increasing the cost of transcription services. Transcription is a business service that converts speech into a written or electronic text document. The length of time a transcriber spends on the recording increases the cost, and transcription is already one of the more costly budgeted serves on the grant.

Community Stakeholders

Stakeholders have been defined as individuals, organizations, or communities that have a direct interest in the process and outcomes of a project, research, or policy endeavor (Boaz, Hanney, Borst, O’Shea, and Kok, 2018). Stakeholder engagement is an important pathway to creating impact. Establishing connections within the community is fundamental to the success of this research. I have reached out to the director of the Stevens Center to explain the value

conducting obesity prevention research. The Stevens Center has been a key community stakeholder in our ability to secure a meeting location for the two Latinx focus groups.

As a research assistant, I have been assigned the task of finding a primary meeting location, finding participant recruitment, and moderating two focus groups for the development of the Latinx research groups. Other stakeholders involved in this project pertain to the

development of the African American focus groups. Dr. Hodges has contacted the leader of a formal breastfeeding group called Mahogany Milk who will be assisting in the development of the focus groups in Durham. As research moves forward more we may identify more key community stakeholders willing to be involved in our research efforts.

Community Outreach

(16)

The success of this research is contingent upon our ability to connect with people and partners. Families will be recruited through a variety of means, including email listservs, in- person interactions with study personnel, social media postings to local parenting groups, publicly posted flyers, and contact through local church leaders. I will contact those who have demonstrated interest via email to request a phone conversation. During the phone conversation, potential participants’ eligibility and interest will be assessed. To ensure all research subjects are correctly informed of the research, an email and phone script have been created in English and Spanish. Telephone consent will be offered the participant if they meet inclusion criteria and express an interest in participating. Any contact information provided throughout the recruitment process will be entered into a password protected contact database to maintain participant confidentiality.

Focus Groups

Dr. Hodges has developed seven neutral, open-ended questions each of which is focused on one aspect of the topic. The fourth question in his interview guide asks about familiarity with and thoughts about possible topics to improve responsive feeding. The question then branches into seven parts, each part relating to knowledge around interventions. Considering the

microbiome’s impact on metabolic processes, questions around awareness of its presence and function will be ascertained among all the other interventions.

I will be specifically asking, “What do you know of the human microbiome, microbiota, and/or probiotics are?” The follow up to this question will be an explanation describing what it is and why it is important to obesity prevention. The explanation will be:

“The human microbiome plays a very important role in your health by helping the body

function properly. There are many different types of beneficial microorganisms that live

(17)

inside of you, mainly in our gut. These microorganisms are also called microbiota and they all populate the human body. Of these, bacteria are the most well-known. We mainly get our microbiota from the foods that we eat. The more plant-based, fiber rich foods we consume the healthier our microbiome becomes. When we consume a high-fat, high- sugar diet, the balance of microorganisms change. These changes can contribute to weight gain and even obesity. The microbes in our guts can begin to produce additional energy increasing caloric intake. Alternatively, a healthy microbiome has the ability to maintain human health and prevent disease.”

After providing this explanation, I would like to ask a follow up question of, “what are your thoughts on consuming more plant-based fiber?” My goal for asking any follow up questions is to see if they understood my explanation and to ask questions that will elicit a quality response.

Data Analysis

A benefit of conducting focus groups is that is a more economical, fast, and efficient method for obtaining data from multiple participants (Onwuegbuzie, Dickinson, Leech, Zoran, 2009). Interactions that occur among the participants can yield more important results. To best capture these results, the focus groups will be audio-taped and a verbatim transcription will be created through IRB approved transcriptionists through the UNC Odum Institute. Transcription of recorded data is taking verbal data into a written form that allows the research to review the data visually and to share it with team member for analysis and validation (Gray, Groves, Sutherland, 2017).

Additionally, we will have a note-taker strategically prepare their notes to add participant seating identifiers, use the first-three-words technique, and cover a variety of nonverbal

observations. Sketching a focus group seating plan is important for the note-taker to identifying

(18)

the information from the discussion as accurately as possible. The note-taker will record each participants name and then assign each participant a number (1-5) based on their seating.

Knowing the seating arrangement provides for a better understanding of the transcription. The first-three-words technique is used to know which participant has contributed to the conversation and what contribution they have made. Transcriptions do not provide this data as the transcriber cannot identify who has made a comment. Many participants may use nonverbal communication to respond to each other’s comments or questions. Only a detailed note-taker can provide

nonverbal data and participant identifying data without the use of a video recording. The combination of using an auditory transcription and a note-taker will yield richer results.

Results

Results from my honors project will be utilized to better understand community needs regarding microbiome education. I hypothesize that the Latinx communities will have some understanding of microbes and their functions, but do not know the coined terms “microbiome”

or “microbiota.” Many Latinx cultures are have been exposed to some form of fermentation. For example, the Salvadorian culture has a chopped cabbage and vegetable dish called Curtido that would be prepared through fermentation. It is commonly eaten in Central America. Many Latinx cultures have depended on bacterial fermentation for the preservation of food. Although many people in the Latinx communities my not have a full understand the biological underpinnings the microbiome, traditional cultural dietary practices utilize these microorganisms as a form of preservation and nourishment.

I hypothesize that the African American community will have heard the coined term

“probiotics” because of its widespread commercial availability in the United States, yet do not

have a full understanding its implications on human health. The population of people that will be

(19)

asked about awareness of the microbiome are a group of African American breastfeeding mothers that attend Mahogany Milk. Because breastmilk contains live bacterial cultures, these women may have a baseline understanding of the mother’s contribution to the development of the infant microbiome. I am curious to know if the effect of Western media has had an effect on participants’ perception of the microorganisms. Western cultures often project a negative perspective that microbes are infectious rather than beneficial. Once these results are obtained and analyzed, this honors project may catalyze the development of another community-based project as I transition into a PhD in Nursing program.

Conclusion

Racial and ethnic minorities have especially high rates of obesity (Byrd et al., 2018). The differences in prevalence arise from a complex interplay of genetic, socioeconomic, lifestyle, and environmental factors (Caprio et al., 2008). The current model for obesity treatment is limited in helping minority communities (Byrd et al., 2018). Obesity prevention efforts will need to be culturally tailored to address the unique needs of each specific population to prevent obesity. An effective means of preventing obesity in adulthood is addressing its development in infancy and toddlerhood (Caprio et al., 2008).

Considering that obesity is a multifactorial disease, understanding the role the

microbiome plays in the obesity prevention algorithm can have large implications for pediatric

health (Davis, 2016). One mechanism for treating obesity is through dietary interventions that

can modulate the health of the microbiome (Valdes et al., 2018). The consumption of plant-

based, high fiber foods allows the growth of beneficial gut microbes that help nourish the gut

lining and reduce inflammation (Valdes et al., 2018). Better understanding the development of

(20)

the early infant microbiome and how diet influence its change may help identify those who are at risk for developing obesity in adulthood (Stanislawski et al., 2018).

The development of my honors project in conjunction with the FYI study seeks to better understand interventions that can mitigate this growing obesity epidemic. The FYI study further investigates feeding practices in minority communities and how responsive feeding can be best utilized as an intervention. My honors project gathers a baseline understanding of the

microbiome and its function in obesity prevention. The collaboration between these two studies

is mutually beneficial in reaching out to minority communities. The exact steps taken throughout

this research partnership have been delineated throughout this protocol.

(21)

References:

Al-Assal, K., Martinez, A. C., Torrinhas, R. S., Cardinelli, C., & Waitzberg, D. (2018). Gut microbiota and obesity. Clinical Nutrition Experimental, 20, 60-64.

doi:https://doi.org/10.1016/j.yclnex.2018.03.001

Baird, J., Fisher, D., Lucas, P., Kleijnen, J., Roberts, H., & Law, C. (2005). Being big or growing fast: systematic review of size and growth in infancy and later obesity. British Medical Journal, 331(7522), 929. doi:10.1136/bmj.38586.411273.E0

Birch, L., Savage, J. S., & Ventura, A. (2007). Influences on the Development of Children's Eating Behaviours: From Infancy to Adolescence. Canadian Journal of Dietetic Practice and Research : a publication of Dietitians of Canada, 68(1), s1-s56.

Blake-Lamb, T. L., Locks, L. M., Perkins, M. E., Woo Baidal, J. A., Cheng, E. R., & Taveras, E.

M. (2016). Interventions for Childhood Obesity in the First 1,000 Days A Systematic Review. American Journal of Preventive Medicine, 50(6), 780-789.

doi:10.1016/j.amepre.2015.11.010

Byrd, A. S., Toth, A. T., & Stanford, F. C. (2018). Racial Disparities in Obesity Treatment.

Current Obesity Reports, 7(2), 130-138. doi:10.1007/s13679-018-0301-3

Caprio, S., Daniels, S. R., Drewnowski, A., Kaufman, F. R., Palinkas, L. A., Rosenbloom, A. L.,

& Schwimmer, J. B. (2008). Influence of race, ethnicity, and culture on childhood obesity: implications for prevention and treatment: a consensus statement of Shaping America's Health and the Obesity Society. Diabetes Care, 31(11), 2211-2221.

doi:10.2337/dc08-9024

(22)

Chan, R. S. M., & Woo, J. (2010). Prevention of overweight and obesity: how effective is the current public health approach. International Journal of Environmental Research and Public Health, 7(3), 765-783. doi:10.3390/ijerph7030765

Davis, C. D. (2016). The Gut Microbiome and Its Role in Obesity. Nutrition today, 51(4), 167- 174. doi:10.1097/NT.0000000000000167

DiSantis, K. I., Hodges, E. A., Johnson, S. L., & Fisher, J. O. (2011). The role of responsive feeding in overweight during infancy and toddlerhood: a systematic review. International Journal of Obesity (London), 35(4), 480-492. doi:10.1038/ijo.2011.3

Eykelenboom, M., van Stralen, M. M., Olthof, M. R., Schoonmade, L. J., Steenhuis, I. H. M., Renders, C. M., & Consortium, P. E. N. (2019). Political and public acceptability of a sugar-sweetened beverages tax: a mixed-method systematic review and meta-analysis.

The International Journal of Behavioral Nutrition and Physical Activity, 16(1), 78-78.

doi:10.1186/s12966-019-0843-0

Gray, J.R. Groves, S.K., & Sutherland, S. (2017). The practice of nursing research: appraisal, synthesis, and generation of evidence, 8th ed. St. Louis, MO: Elsevier.

Knight, R., Callewaert, C., Marotz, C., Hyde, E. R., Debelius, J. W., McDonald, D., & Sogin, M.

L. (2017). The Microbiome and Human Biology. Annual Review of Genomics and Human Genetics, 18(1), 65-86. doi:10.1146/annurev-genom-083115-022438

Kumar, S., & Kelly, A. S. (2017). Review of Childhood Obesity: From Epidemiology, Etiology,

and Comorbidities to Clinical Assessment and Treatment. Mayo Clinic Proceddings,

92(2), 251-265. doi:10.1016/j.mayocp.2016.09.017

(23)

Madsen, K. A., Krieger, J., & Morales, X. (2019). Sugar-Sweetened Beverage Taxes: Emerging Evidence on a New Public Health Policy. Journal of the American Medical Aossociation, 321(18), 1777-1779. doi:10.1001/jama.2019.5344

Mohammadkhah, A. I., Simpson, E. B., Patterson, S. G., & Ferguson, J. F. (2018). Development of the Gut Microbiome in Children, and Lifetime Implications for Obesity and

Cardiometabolic Disease. Children (Basel, Switzerland), 5(12), 160.

doi:10.3390/children5120160

Onwuegbuzie, A. J., Dickinson, W. B., Leech, N. L., & Zoran, A. G. (2009). A Qualitative Framework for Collecting and Analyzing Data in Focus Group Research. International Journal of Qualitative Methods, 8(3), 1-21. doi:10.1177/160940690900800301

Riva, A., Borgo, F., Lassandro, C., Verduci, E., Morace, G., Borghi, E., & Berry, D. (2017).

Pediatric obesity is associated with an altered gut microbiota and discordant shifts in Firmicutes populations. Environmental Microbiol, 19(1), 95-105. doi:10.1111/1462- 2920.13463

United states census bureau. (2018). North carolina population demographics. Census.gov.

Retrieved March 15, 2020, from

https://www.census.gov/quickfacts/fact/table/chapelhilltownnorthcarolina,durhamcitynort hcarolina,sanfordcitynorthcarolina/INC110218

Valdes, A. M., Walter, J., Segal, E., & Spector, T. D. (2018). Role of the gut microbiota in nutrition and health. British Medical Journal, 361, k2179. doi:10.1136/bmj.k2179 Wang, Y. C., McPherson, K., Marsh, T., Gortmaker, S. L., & Brown, M. (2011). Health and

economic burden of the projected obesity trends in the USA and the UK. Lancet,

378(9793), 815-825. doi:10.1016/s0140-6736(11)60814-3

(24)

Xu, Z., & Knight, R. (2015). Dietary effects on human gut microbiome diversity. British Journal

of Nutrition, 113 Suppl(Suppl 0), S1-5. doi:10.1017/s0007114514004127

References

Related documents

The reasons for higher adherence rate among participants in present study might be due to, that ART center at New Civil Hospital, Surat is functioning

Performance met- rics show that for all stability classes (convective, neutral, and stable scenarios), the footprint parameterisation is able to predict the footprints simulated by

The National Conservation Trust Fund for Natural Resources (NCTF) was established to carry out activities related to conservation efforts such as

The research focus of this dissertation is on advancing the development and application of ambient ionization mass spectrometry methodology and technology to the

Although the complete research measures the blended course’s effectiveness from a number of different perspectives including, how different types of learners (visual, verbal,

The present study employed the techniques of correlation analysis (CA), principal component analysis (PCA), agglomerative hierarchical cluster analysis (AHCA) and

No part of this document may be reproduced in any form or by any means, electronic, mechanical, photocopying and recording or otherwise without the prior written permission

Secondary efficacy end-points included: Patient’s Assessment of Ankle Pain VAS value on day 7; Patient’s and Physician’s Global Assessment of Ankle Injury on days 4 and 7; time