The Effect of Diet on Indicators of Metabolic Syndrome

Libby Terrell (student researcher) and Mrs. Stutzman (adult sponsor)

Purpose:
The purpose of this study is to investigate the effect of replacing dietary carbohydrate with saturated fatty
acids, monounsaturated fatty acids, and omega-3 polyunsaturated fatty acids. Triglycerides and body mass
index will be measured as indicators of risk of developing diseases associated with Metabolic Syndrome.

What is Metabolic Syndrome?

Metabolic syndrome is defined as a group of conditions that increases risk of developing heart disease,
diabetes, cancer, and other diseases. Indicators of Metabolic Syndrome include dislipidemia, which is
characterized by high levels of triglycerides, low levels of HDL cholesterol, and high levels of small,
dense LDL; hypertension; insulin resistance or hyperinsulinemia; and abdominal obesity.

Procedure:
1. 30 participants will be randomized into a control group and an experimental group, each with 15
participants.
2. Participants of both groups will be asked to complete one dietary recall survey prior to the
experimental period using ASA24-2016 software. ASA24 provides photographs of foods and
serving sizes to aid participants with reporting the correct serving sizes, which has been shown to
increase recording accuracy.
3. All participants will complete a pre-survey to determine age, sex, and frequency, duration, and
intensity of exercise.
4. Prior to experimentation, the registered school nurse will measure all participants’ fasting whole
blood triglyceride levels and I will measure BMI to establish baseline measurements. ​A
fingerstick is necessary to test blood triglyceride levels.
5. Participants in the experimental group will then be asked to adopt the DARIMS (Dietary
Approaches to Rising Incidence of Metabolic Syndrome) diet. Participants in the control group
will be asked not to change their diets.
6. Each week, all participants will be asked to complete one scheduled survey to record food intake
on Saturdays.
7. After 28 days, all participants’ whole blood triglyceride levels and BMI will be measured once
again by the registered school nurse using the same methods and devices.
8. All participants will complete a post-survey to determine changes in frequency, duration, and
intensity of exercise.

Requirements for participation

Participants must meet the following criteria:
1. Participants must not have cardiovascular disease, diabetes, prediabetes, hypertension, cancer,
endothelial dysfunction, or another disease that would put him or her at risk when dieting.
2. Participants must not be pregnant or lactating.

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 3. Participants must not be taking statins, blood pressure medication, endothelial function
medication, or any other medication that could interfere with triglyceride or weight
measurements.

Calendar
As soon as you express to me your interest in participating, I will find a time to visit you in school before
Winter break.
● I will assign you an ID and password for use in logging in to the survey website and for recording
test results.
● We will find you a date and time for the pre- and post-experimental testing sessions.
● I will have you sign a consent form.
January 5-6:​ participants will find out which group they are in (experimental or control)
January 7-11:​ testing session 1, pre-experimental general survey, experimental group begins dieting
January 21-25:​ midpoint check-in with experimental group
February 4-8:​ testing session 2, post survey
All Sundays Jan 6-Feb 3​ All participants will complete dietary recall surveys.

About Testing
You will be able to sign up for testing before school on either Monday, Tuesday, Wednesday,
Thursday, or Friday. The blood-triglyceride test requires an 8-hour fasting period. ​You may
drink water, but please refrain from eating or drinking anything else on the morning of the
testing. Please arrive promptly at ​Nurse Stutsman’s office at the time you have signed up for. I
will have you complete a pre- or post-experimental general survey, I will collect your consent
form, I will measure your height and weight, and then Nurse Stutsman will measure your
triglyceride levels. ​A fingerstick is necessary to measure triglycerides. ​The total testing period
will take about ten minutes.

Testing dates and times:

Option 1 Option 2 Option 3 Option 4 Option 5

Pretest Mon, Jan 7 Tues, Jan 8 Wed, Jan 9 Thurs, Jan 10 Fri, Jan 11

Post test Mon, Feb 4 Tues, Feb 5 Wed, Feb 6 Thurs, Feb 7 Fri, Feb 8
Available time slots are: 7:55, 8:00, 8;05, 8:10, 8:15, 8:20, 8:25, 8:30
If you forget what time you signed up for, please contact me.

About the recall surveys

Starting Sunday, January 6, all participants will be completing dietary recall surveys every Sunday. Recall
surveys are always completed to record your food intake ​the day before​​. So, for the first recall survey on

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Sunday, January 6, you will be recording what you ate on Saturday, January 5. You will need to finish the
survey by 11:59 on the night of Sunday, January 6.
To complete a survey, go to ​https://asa24.nci.nih.gov/ or search “asa24” in Google. It will also be
available on the study website. You will have to log in to the ASA24 website with the login information I
give you. The website will give instructions for completing the surveys; the surveys take around 15
minutes to complete. The survey is split into three sections:
1. “Report meals and snacks”-- you will record the mealtimes when you ate throughout the day (i.e.
breakfast, lunch, snack, and dinner)
2. “Find foods and drinks”-- you will add foods and drinks to the mealtimes you have already reported
3. “Add details”-- you will answer questions concerning portion sizes and cooking methods
Important note: If you used cooking oil/fat, ​please report the cooking oil/fat separately from the food
that you cooked in it​​. You will be reporting the cooking fat in the “Find foods and drinks” portion of the
survey. Once you get to the “Add details” portion of the survey, the survey will ask if you cooked certain
foods with cooking fat. But, you should have already reported the oil/fat separately. So, instead, please
select “no fat or oil used.” The reason for doing this is because the question in the “Add details” section
asks what cooking fat was used gives an option for “oil” but does not specify which type of oil. So, for
increased specificity, I am having you record this separately.

About the diet

I will be randomizing patients into an experimental and control group, with 15 participants in
each group. I will contact you to tell you what group you are in over the weekend of ​Saturday,
January 5 to Sunday, January 6​​. I will also remind you what group you are in when you come
in for testing.
If you are in the experimental group, I will post a copy of the diet plan to the study website that
same weekend. I will also give you a paper copy when you come in for testing. If you have any
questions regarding the specifics of the diet, please ask me anytime.
Participants in the experimental group will start the diet the ​day after their first testing session.

Pre- and Post-experimental General Surveys

The pre- and post-experimental general surveys will record exercise frequency, duration, and intensity.

Mid-point Check-in
During the week of January 21-25, I will send a dietary assessment to the participants in the experimental
group. See below for the format:

Goal Second survey results Third survey results

Daily carbohydrate
consumption in grams

Percentage of calories

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 coming from linoleic
acid (omega-6
polyunsaturated fat)

Identification/Login Information
Both food intake and medical testing data will be reported anonymously using identification numbers. I
will give you an ID number and password for use on the ASA24 survey website. This will be the same ID
number that I will record your BMI and triglyceride measurements with. If you forget your password,
contact me.

Consent Form
Before any testing or surveying can begin, I must collect a consent form from you. I will have you sign
the form when I give you your ID and login. I will also link it on the website if you want to take a look at
it first.

Snow Day Plan

If we have a snow day on any one of the testing days, the people who missed their testing will be moved
to Monday of the following week. If we have more than one snow day, the second snow day will be
moved to Tuesday of the following week, the third day to Wednesday, etc. As we approach the weeks of
testing, if there is a chance of snow interfering with a test date, I will create a google doc with an alternate
schedule.

Remind Service
Many of you are familiar with Remind. I strongly urge you to join my remind so that I can text you to
remind you about surveys and testing dates. To join the Remind, text ​@g3e98g​​ to 81010

Study Website
Access the study website at ​https://darims.weebly.com

Contact Information
Libby Terrell: (434) 326-7111 ​egtn6@k12albemarle.org
Mrs. Stutzman: ​(434)882-4248 ​cstutzman@k12albemarle.org