PERSONAL UTILITY: EXAMINING THE EFFECTS OF GENOMIC RISK KNOWLEDGE ON MOTIVATION TOWARD DIET AND PHYSICAL ACTIVITY BEHAVIOR CHANGES

The National Institutes of Health and the Centers for Disease Control and Prevention have jointly indicated urgency in researching the use of personal genomics in the assessment of disease prevention. One research priority is the use of genomic information in behavior change research for reducing the risk for common chronic disease (e.g., cardiovascular disease—CVD). Research suggests improvements in motivation toward behavior change with counseling based on one gene (genetic counseling) and even better outcomes with counseling based on two or more genes (genomic or polygenetic counseling). Currently, little is known about the effect of genetic or genomic counseling in minority populations. This study examines whether genomic-risk knowledge increases motivation towards diet and physical activity changes to reduce CVD-risk in African-American participants from a rural, low-income county in eastern North Carolina. To meet this goal, we conducted three inter-related research projects. First, focus groups were conducted with African-Americans and Whites to assess community needs and wants regarding a genomics project (n=35). Findings indicated community interest in participation and interest in receiving personalized genomic results. Second, intervention messages on the return of personalized CVD genomic-risk were developed following the principles of The Protection Motivation Theory and Leventhal’s Common Sense Model. Messages were tested within the target population for comprehension and acceptance (n=32). Using a 2-arm randomized controlled trial design, returning CVD genomic results were compared to an attention control group in sixty-two (n=62) African-Americans. The primary outcome was the difference in motivation towards diet and physical activity at 1-month follow-up compared using a general linear regression model. There were no significant between- or within-group results (p=0.51). There was significant within-group moderation by genomic-risk category for the intervention group. Those with low genomic CVD-risk self-reported increased motivation towards diet and physical activity (0.31 ± 0.18, p=0.09), and increased weekly consumption of fruit and vegetables (1.34 ± 0.36, p=0.001). Those with average genomic CVD-risk self-reported less motivation and no change in fruit and vegetable consumption. Findings suggest that genomic-risk knowledge may impact the perceived threat of CVD, but more research needs to be done to better understand the best use for this approach.Doctor of Philosoph

Associations between Maternal Cadmium Exposure with Risk of Preterm Birth and Low Birth Weight: Effect of Mediterranean Diet Adherence on Affected Prenatal Outcomes

Prenatal cadmium exposure at non-occupational levels has been associated with poor birth outcomes. The intake of essential metals, such as iron and selenium, may mitigate cadmium exposure effects. However, at high levels, these metals can be toxic. The role of dietary patterns rich in these metals is less studied. We used a linear and logistic regression in a cohort of 185 mother–infant pairs to assess if a Mediterranean diet pattern during pregnancy modified the associations between prenatal cadmium exposure and (1) birth weight and (2) preterm birth. We found that increased cadmium exposure during pregnancy was associated with lower birth weight (β = −210.4; 95% CI: −332.0, −88.8; p = 0.008) and preterm birth (OR = 0.11; 95% CI: 0.01, 0.72; p = 0.04); however, these associations were comparable in offspring born to women reporting high adherence to a Mediterranean diet (β = −274.95; 95% CI: −701.17, 151.26; p = 0.20) and those with low adherence (β = −64.76; 95% CI: −359.90, 230.37; p = 0.66). While the small sample size limits inference, our findings suggest that adherence to a Mediterranean dietary pattern may not mitigate cadmium exposure effects. Given the multiple organs targeted by cadmium and its slow excretion rate, larger studies are required to clarify these findings

Rural African American Women With Severe Obesity: A Cross-Sectional Analysis of Lifestyle Behaviors and Psychosocial Characteristics

PurposeTo examine differences in lifestyle behavioral and psychosocial factors between rural African American women with Class 3 obesity and those with overweight, and Class 1-2 obesity.DesignCross-sectional study.SettingRural Southeastern United States.SubjectsParticipants included 289 African American women with a mean age of 56 years, 66% with a high school education or less, and a mean body mass index (BMI) of 38.6 kg/m2; 35% (n = 102) were classified with Class 3 obesity.MeasuresWe objectively measured height, weight, and physical activity steps/day. Self-reported dietary and physical activity behaviors, general health-related quality of life, mental health, and social support were measured with validated surveys.AnalysisChi-Square analysis for categorical variables and analysis of variance (ANOVA) – via multiple linear regression – for continuous variables.ResultsThere were no significant demographic differences between BMI groups, except for age, where women with Class 3 obesity were on average younger (51 vs 58 y, P < .001). Although dietary behaviors did not differ significantly between groups, we observed significant group differences in self-reported and objective measures of physical activity. The age-adjusted difference in means for self-reported total physical activity minutes/wk. was 91 minutes, with women categorized with Class 3 obesity reporting significantly fewer weekly minutes than those with overweight/Class 1-2 obesity (64.3 vs 156.4 min/wk. respectively, P < .01). Among psychosocial variables, only in the physical component scores of health-related quality of life did we find significant group differences – lower physical well-being among women with Class 3 obesity compared to those with overweight/Class 1-2 obesity (P = .02).ConclusionFor African American women with Class 3 obesity living in rural setting, these findings suggest behavioral weight loss interventions may need to target physical activity strategies that address physical, psychosocial, and environmental barriers

Clomifene and Assisted Reproductive Technology in Humans Are Associated with Sex-Specific Offspring Epigenetic Alterations in Imprinted Control Regions

Children conceived with assisted reproductive technology (ART) have an increased risk of adverse outcomes, including congenital malformations and imprinted gene disorders. In a retrospective North Carolina-based-birth-cohort, we examined the effect of ovulation drugs and ART on CpG methylation in differentially methylated CpGs in known imprint control regions (ICRs). Nine ICRs containing 48 CpGs were assessed for methylation status by pyrosequencing in mixed leukocytes from cord blood. After restricting to non-smoking, college-educated participants who agreed to follow-up, ART-exposed (n = 27), clomifene-only-exposed (n = 22), and non-exposed (n = 516) groups were defined. Associations of clomifene and ART with ICR CpG methylation were assessed with linear regression and stratifying by offspring sex. In males, ART was associated with hypomethylation of the PEG3 ICR [&beta;(95% CI) = &minus;1.46 (&minus;2.81, &minus;0.12)] and hypermethylation of the MEG3 ICR [3.71 (0.01, 7.40)]; clomifene-only was associated with hypomethylation of the NNAT ICR [&minus;5.25 (&minus;10.12, &minus;0.38)]. In female offspring, ART was associated with hypomethylation of the IGF2 ICR [&minus;3.67 (&minus;6.79, &minus;0.55)]. Aberrant methylation of these ICRs has been associated with cardiovascular disease and metabolic and behavioral outcomes in children. The results suggest that the increased risk of adverse outcomes in offspring conceived through ART may be due in part to altered methylation of ICRs. Larger studies utilizing epigenome-wide interrogation are warranted

Using Community-Based Participatory Research Principles to Develop More Understandable Recruitment and Informed Consent Documents in Genomic Research

<div><p>Background</p><p>Heart Healthy Lenoir is a transdisciplinary project aimed at creating long-term, sustainable approaches to reduce cardiovascular disease risk disparities in Lenoir County, North Carolina using a design spanning genomic analysis and clinical intervention. We hypothesized that residents of Lenoir County would be unfamiliar and mistrustful of genomic research, and therefore reluctant to participate; additionally, these feelings would be higher in African-Americans.</p><p>Methodology</p><p>To test our hypothesis, we conducted qualitative research using community-based participatory research principles to ensure our genomic research strategies addressed the needs, priorities, and concerns of the community. African-American (n = 19) and White (n = 16) adults in Lenoir County participated in four focus groups exploring perceptions about genomics and cardiovascular disease. Demographic surveys were administered and a semi-structured interview guide was used to facilitate discussions. The discussions were digitally recorded, transcribed verbatim, and analyzed in ATLAS.ti.</p><p>Results and Significance</p><p>From our analysis, key themes emerged: transparent communication, privacy, participation incentives and barriers, knowledge, and the impact of knowing. African-Americans were more concerned about privacy and community impact compared to Whites, however, African-Americans were still eager to participate in our genomic research project. The results from our formative study were used to improve the informed consent and recruitment processes by: 1) reducing misconceptions of genomic studies; and 2) helping to foster participant understanding and trust with the researchers. Our study demonstrates how community-based participatory research principles can be used to gain deeper insight into the community and increase participation in genomic research studies. Due in part to these efforts 80.3% of eligible African-American participants and 86.9% of eligible White participants enrolled in the Heart Healthy Lenoir Genomics study making our overall enrollment 57.8% African-American. Future research will investigate return of genomic results in the Lenoir community.</p></div