Poor nutritional practices contribute inordinately to the major diseases affecting public health and hence the health care economy. Among these are obesity (recently classified as a disease in itself) as well as heart disease, hypertension, stroke, diabetes, and likely, some forms of cancer. While weight loss has been a focus of trials aimed at improving disease risk, studies such as the recent report of the NIH Look Ahead trial have failed to demonstrate that diet-induced weight loss reduces disease outcome (in this case, cardiovascular disease). Notably, in the New England Journal of Medicine editorial accompanying this report (July 11, 2013), it was stated that "different and novel strategies [will be needed] to maintain initially large effects on weight and other risk factors over a period of several years".
To address this need, we propose developing and implementing an innovative family and community-based nutrition counseling and skills training program that is informed by our separate experiences with adults and children, but will now aim at working with families in a more integrated approach. This novel program affords the opportunity to evaluate genetic and cultural influences on metabolic health and nutritional needs; to generate and apply new knowledge regarding effective and individualized nutritional guidance; and to evaluate the effectiveness of this approach vs. conventional practices on specific health-related outcomes (e.g., adiposity, blood pressure, metabolic profiles).
Our proposed Bay Area Nutrition and Health Initiative (BANHI) will recruit families - as defined by at least one adult and one biological child - into a comprehensive clinical research program that provides regular health assessments, education and skills training, including mindfulness and food preparation, and a unique plan for long-term follow-up (at least 5 years). Key features of BANHI are: 1) it teaches skills to the unit, i.e. the family, which can most effectively implement behavior change; 2) it is simultaneously preventive and therapeutic; 3) it targets the lifespan, including the perinatal period; 4) it creates a research cohort that will be an invaluable resource for studies in the laboratory and the clinic aimed at increasing knowledge and evaluating the efficacy of therapies (nutritional and other) aimed at reducing risk of chronic disease and 5) it has the potential to generate laboratory and clinical data, as well as a biobank of archived samples, that may be used by investigators to understand the basis for inter-individual variation in disease risk and responses to dietary modifications.
Importantly, the BANHI embraces the entire translational spectrum (T1-T4) with participation of researchers, clinicians, and public health experts. It capitalizes on the combined scientific and core resources as well as expertise of Children’s Hospital & Research Center Oakland and UCSF (e.g. Clinical Research Services, Community Engaged Research and Participant Recruitment Services), as well as the UC Berkeley School of Public Health. CHRCO, in particular, has access to a large number of at-risk families with diverse racial, ethnic, and cultural backgrounds that would benefit from this program. Furthermore, potential partnerships with other health organizations, including the Ethnic Health Institute at Alta Bates Summit Medical Center and La Clinica de la Raza, will allow for the Initiative to expand its reach to an even greater number of families of underserved communities throughout the Bay Area. BAHNI may serve as a model for other academic medical centers and national guidelines committed to achieving long-lasting improvements in the risk of nutrition-related chronic disease.
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