Author Interviews, Johns Hopkins, Kidney Disease, Nutrition, Race/Ethnic Diversity / 21.11.2016
Barriers to Healthful Eating Linked to More Rapid Kidney Function Decline
MedicalResearch.com Interview with:
[caption id="attachment_29753" align="alignleft" width="80"]
Dr. Deidra Crews[/caption]
Deidra C. Crews, MD, ScM, FASN, FACP
Associate Professor of Medicine, Division of Nephrology
Associate Vice Chair for Diversity and Inclusion, Department of Medicine
Director, Doctoral Diversity Program
Johns Hopkins University School of Medicine
Baltimore MD 21224
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Studies suggest that dietary patterns influence risk of kidney function decline. Barriers may hinder urban African Americans' following healthful diets that could mitigate their increased risk of kidney function decline.
In this study, we characterized contextual barriers to healthful eating among urban African Africans with hypertension and examined the association of these barriers to kidney function decline over 1 year. We examined the presence of healthy foods in neighborhood stores of study participants.
We also assessed them for food insecurity (the inability to afford nutritionally adequate and safe foods), directly observed and documented the presence of fruits and vegetables in their homes, and examined their fruit and vegetable intake via questionnaire.
Dr. Deidra Crews[/caption]
Deidra C. Crews, MD, ScM, FASN, FACP
Associate Professor of Medicine, Division of Nephrology
Associate Vice Chair for Diversity and Inclusion, Department of Medicine
Director, Doctoral Diversity Program
Johns Hopkins University School of Medicine
Baltimore MD 21224
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Studies suggest that dietary patterns influence risk of kidney function decline. Barriers may hinder urban African Americans' following healthful diets that could mitigate their increased risk of kidney function decline.
In this study, we characterized contextual barriers to healthful eating among urban African Africans with hypertension and examined the association of these barriers to kidney function decline over 1 year. We examined the presence of healthy foods in neighborhood stores of study participants.
We also assessed them for food insecurity (the inability to afford nutritionally adequate and safe foods), directly observed and documented the presence of fruits and vegetables in their homes, and examined their fruit and vegetable intake via questionnaire.
Dr. Sirry Alang[/caption]
Sirry Alang PhD
Assistant professor of sociology and anthropology
Lehigh University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Discrepancies exist between how some Black populations perceive depression and how depression is conceptualized within research and clinical settings. African Americans are exposed to a lot of stress from structural racism, yet, they perceive themselves to be resilient. The context of stress from discrimination and beliefs about depression inform how they express psychological distress. Depression is thought of as a weakness that is inconsistent with notions of strength in the community. Although depression was expressed through classic depressive symptoms such as feeling hopeless, loss of sleep, and losing interests in activities, symptom like anger, agitation, and the frantic need for human interaction were considered to be indicative of depression. Anger, agitation, and the frantic need for human interaction are not consistent with how depression is defined in the latest manual for psychiatric diagnosis- the DSM-V.
Dr. Gregory Marcus[/caption]
Gregory M Marcus, MD, MAS, FACC, FAHA, FHRS
Director of Clinical Research
Division of Cardiology
Endowed Professor of Atrial Fibrillation Research
University of California, San Francisco
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We and others have previously demonstrated that, despite the observation that African Americans on average exhibit more risk factors for atrial fibrillation, they demonstrate a substantially reduced risk of the disease. This suggests that, if we could understand the mechanism underlying this apparent paradox, we might learn something fundamentally important to atrial fibrillation that would be relevant to treating or preventing the disease regardless of race.
Building on our previous work demonstrating that, among African Americans, more European ancestry (determined by genomic testing) was a statistically significant predictor of atrial fibrillation, we sought to identify the gene(s) that might underlie this observation. The analysis took two forms.
First, we examined if any differences among several well-established single nucleotide polymorphisms (SNP) associated with atrial fibrillation might mediate the race-atrial fibrillation relationship. One such SNP statistically mediated (rs10824026) up to about a third of the race-atrial fibrillation relationship. It’s important to mention that a causal relationship cannot be proven here.
Perhaps more remarkable was the observation that the disease-associated alleles of the SNPs most closely associated with atrial fibrillation in multiple studies were actually significantly more common among African Americans, pointing to the complex nature of both the race-atrial fibrillation relationship as well as the genetics of atrial fibrillation.
Finally, leveraging the ancestral relationships, we performed a genome wide admixture mapping study with the hope of reducing the penalty for multiple hypothesis testing incurred in conventional genome wide association studies. While several loci revealed associations with atrial fibrillation with small p values, none met our criteria for genome wide significance.
Dr. Luisa Borrell[/caption]
Luisa N. Borrell, DDS, PhD
Professor
Department of Epidemiology & Biostatistics
Graduate School of Public Health & Health Policy
City University of New York
MedicalResearch.com: What is the background for this study?
Dr. Borrell: Racial/ethnic disparities in birth outcomes in the United States are well documented, with non-Hispanic Black women exhibiting the worst outcomes. Several hypotheses have been proposed as explanation to this finding such as the weathering hypothesis and cumulative or chronic experiences of social inequality and racism. However, these hypotheses have only accounted for the stress burden associated with the mother’s race/ethnicity, as her race/ethnicity has been the sole information used to determine the child’s race/ethnicity, ignoring the possible stress associated with the father’s race/ethnicity. We used NYC birth- and death-linked data from 2000 to 2010 to examine the added effect of paternal race/ethnicity on adverse birth outcomes (low birth weight [LBW], small for gestational age [SGA], preterm births, and infant mortality [IM]) among NYC women.
Dr. George Howard[/caption]
George Howard, Dr.P.H.
Professor of biostatistics
Birmingham School of Public Health
University of Alabama
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Howard: What has been known for many decades is that death rates from stroke are much higher in the black than white population, particularly between the ages of 45 – 65 (or maybe even a little older). These racial differences in stroke are among the greatest disparities for any disease, clearly it is a priority to reduce this disparity.
However, there are two reasons more blacks could die from a disease:
1) more blacks get the disease, or
2) once you get the disease, it is more likely to kill blacks.
The implications of knowing which of these is the major contributor is profound. If the driving force is more blacks are having more stroke, then we need to focus out attention on activities before stroke occur. For example, prevention of the greater prevalence of hypertension and diabetes in blacks, and also reducing the differences in the control of blood pressure and glucose. However, if the driving force is a higher chance of death in blacks once stroke occur, then we need to focus on the disparities in how black stroke patients are cared for compared to white stroke patients. That is, the former requires community-based efforts, while the latter requires hospital-based efforts.
What we found was that nearly all the difference was that blacks are having more strokes ... not that they are more likely to die once stroke occurs.
Dr. Zhenmei Zhang[/caption]
Zhenmei Zhang, Ph.D.
Associate Professor
Department of Sociology
Michigan State University
East Lansing, MI48824
MedicalResearch.com: What is the background for this study?
Dr. Zhang: Blacks are especially hard hit by cognitive impairment and dementia. Recent estimates of dementia prevalence and incidence were substantially higher for blacks than whites. Reducing racial/ethnic disparities in dementia has been identified as a national priority by the National Alzheimer’s Project Act, which was signed into law by President Obama in 2011. So I really want to contribute to the ongoing discussion of the origins and pathways through which racial disparities in cognitive impairment is produced. If we have a better understanding of the factors contributing to racial disparities in cognitive impairment in later life, more effective interventions can be conducted to reduce the racial disparities.
Dr. Robert Wong[/caption]
Robert Wong, M.D., M.S.
Attending Physician, Gastroenterology & Hepatology
Director, GI Education & Research
Highland Hospital I A member of Alameda Health System
Oakland, CA
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Wong: Colorectal cancer is a leading cause of morbidity and mortality in the United States. Early diagnosis through implementation of effective screening and surveillance programs leads to earlier staged tumor at time of diagnosis, which increases the treatment opportunities and improves overall survival. However, disparities in access to effective screening and surveillance can impair timely diagnosis and lead to advanced disease, limited treatment options and poor outcomes. The current study evaluated race/ethnicity-specific disparities in colorectal cancer epidemiology at a large urban safety net hospital and observed African American patients had significantly more advanced cancer stage at the time of diagnosis. Our study observed that African Americans were over 5 times more likely to have advanced stage 3-4 colon cancer at time of diagnosis compared with non-Hispanic white patients with colon cancer. While these findings are likely multifactorial, it sheds important light on race/ethnicity-specific disparities in colorectal cancer epidemiology and helps target future education and research to improve outcomes.