Thousands of sixth-graders in 42 middle schools nationwide, including six middle schools in Oregon, will take part in a three-year, type 2 diabetes prevention study this fall sponsored by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), a component of the National Institutes of Health (NIH). Oregon Health & Science University researchers co-designed the study and will conduct the research in Oregon.
The study, known as HEALTHY, will evaluate whether changes in school food services, behavior-based education, and physical education (PE) classes, along with activities that encourage healthy behaviors, can lower risk factors for type 2 diabetes. The sixth-graders will continue to participate in the study through their eighth-grade year.
"This state-of-the-art, comprehensive program for middle schools has been developed through a coordinated effort of teams of national experts at eight universities and the National Institutes of Health. The programs have been tested in systematic fashion during pilot programs to ensure the greatest chance for success," said Linn Goldberg, M.D., OHSU's principal investigator for HEALTHY, professor of medicine and head of the Division of Health Promotion and Sports Medicine in the OHSU School of Medicine; and director, OHSU Center for Health Promotion Research.
Oregon schools participating in the study are: Wy'east (Hood River District), French Prairie (Woodburn District), Parrish (Salem School District), Waldo (Salem School District), Reynolds (Reynolds School District) and HB Lee (Reynolds School District).
The schools will be randomly assigned to one of two groups: a "program" group that will implement HEALTHY'S changes in food service and physical education, or a comparison group that will continue to offer food choices and PE programs typically found in middle schools nationwide.
Program schools will receive new, state-of-the-art exercise equipment, physical education trainers and funds for food services. They will have healthier choices from the cafeteria and vending machines, including lower-fat, higher-fiber foods; more fruits and vegetables; and drinks with no added sugar. They also will experience longer, more intense periods of physical activity, as well as schoolwide health campaigns and promotional activities, and peer-led activities that promote long-term healthy behaviors.
Comparison schools will receive health screenings at the beginning and end of the study, and compensation for their time, effort and participation.
After 2 1/2 years, students in both the program and comparison schools will be tested for diabetes risk factors, including blood sugar, insulin and lipid levels (cholesterol and triglycerides). Their fitness level, blood pressure, height, weight and waist circumference also will be measured, along with surveys about their health.
"The alarming rise in obesity and type 2 diabetes in all age groups poses a major public health crisis for this country. This important study is one component of a multi-faceted research agenda to address this dual epidemic, which threatens the health of our youth and the vitality of our health care system," said NIH Director Elias A. Zerhouni, M.D.
In planning the HEALTHY study, researchers relied on the results of six pilot studies, one of which was conducted by OHSU in partnership with Beaverton's Aloha Park K-8 School.
In one of the six pilot studies, about half of eighth-graders in 12 schools were found to be overweight or at risk for overweight. Few had diabetes, but about 41 percent had abnormally high readings of fasting blood sugar, pointing to a much higher risk of developing type 2 diabetes.
Results from the HEALTHY study are expected in 2009. HEALTHY is part of a broad research initiative called STOPP T2D, Studies to Treat or Prevent Pediatric Type 2 Diabetes, which seeks to improve the treatment and prevention of type 2 diabetes in youth. The American Diabetes Association (ADA) co-sponsors HEALTHY, and the Institute for Public Health and Water Research supports the study through a grant to the ADA.
Other OHSU Co-Investigator researchers working on the project are: Diane Elliot, M.D., professor of medicine (health promotion and sports medicine); Kerry Kuehl, M.D., Dr.P.H., assistant professor of medicine (health promotion and sports medicine); Esther Moe, Ph.D., M.P.H., research assistant professor of medicine (health promotion and sports medicine); Diane Stadler, Ph.D., R.D., L.D., research assistant professor and bionutritionist; Jean-Baptiste Roullet, Ph.D., research associate professor of surgery (vascular surgery); Cheryl Hanna, M.D, Department of Pediatrics. Lynn DeBar, Ph.D., M.P.H., at the Kaiser Permanente Center for Health Research, Portland, also is working on this project.
Other universities participating in HEALTHY are: Baylor College of Medicine, University of California at Irvine, University of North Carolina at Chapel Hill, Temple University, University of Pittsburgh Medical Center, University of Texas Health Science Center at San Antonio and George Washington University.
ABOUT TYPE 2 DIABETES
Type 2 diabetes is closely linked to being overweight, inactive and having a family history of diabetes, according to the NIDDK. Nearly two-thirds of American adults are overweight or obese, with a body mass index (BMI) of 25 or more. Among youth aged 2 to 19, 17 percent are overweight with a BMI at the 95th percentile or more for their age and gender -- triple the rate in 1980. About the same percentage of youth have a BMI between the 85th percentile and 95th percentile for their age and gender, putting them at risk for becoming overweight.
The NIDDK reports that nearly 21 million people in the United States have diabetes, the most common cause of blindness, kidney failure, and amputations in adults, and a major cause of heart disease and stroke. Type 2 diabetes accounts for up to 95 percent of all diabetes cases in adults, and about one-third of those affected don't know they have it, experts say.
Oregon Health & Science University is the state's only health and research university, and only academic health center. As Portland's largest employer and the fourth largest in Oregon (excluding government), OHSU's size contributes to its ability to provide many services and community support activities not found anywhere else in the state. It serves more than 184,000 patients, and is a conduit for learning for more than 3,900 students and trainees. OHSU is the source of more than 200 community outreach programs that bring health and education services to each county in the state.
As a leader in research, OHSU earns $274 million annually in research funding. The institution serves as a catalyst for the region's bioscience industry and is an incubator of discovery, averaging one new breakthrough or innovation every four days. OHSU disclosed 101 inventions in 2005 alone, and has helped start 57 new spinoff companies, most of which are based in Oregon. For more information, visit www.ohsu.edu.
The NIDDK conducts and supports research in diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe, and disabling conditions affecting Americans. For more information about NIDDK and its programs, see www.niddk.nih.gov.