Pao-Hwa Lin

Overview:


My research interest lies generally in the area of dietary patterns and chronic diseases including hypertension using controlled feeding study and lifestyle intervention designs.

Two major controlled feeding clinical trials that I was involved in include the Dietary Approaches to Stop Hypertension (DASH) Study and the Dietary Approaches to Stop Hypertension-Sodium (DASH-Sodium) Study. In addition to being an active member for the diet committee for DASH, I also function as the chair of the diet committee for the DASH-Sodium study.  I am familiar with the development and operation of a controlled feeding study, which means the process of study design, development of questionnaire/forms for data collection/monitoring, development of quality assurance procedure, and data analysis.

I've also helped with the design and implementation of the lifestyle behavioral intervention program for the Hypertension Improvement Project (HIP), PREMIER clinical trial, Weight Loss Maintenance trial (WLM), ENCORE study, and the Cell Phone Intervention for You (CITY) trial.

Key words: Diet, controlled feeding study, mineral, blood pressure, nutrition.

Positions:

Associate Professor in Medicine

Medicine, Nephrology
School of Medicine

Member of Duke Molecular Physiology Institute

Duke Molecular Physiology Institute
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 1990

University of Texas at Austin

Grants:

Cellphone Intervention Trial for Young Adults (CITY)

Administered By
Medicine, Nephrology
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Facility and Web-based Approaches to Lifestyle Change in Resistant Hypertension

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Lifestyle, CVD Risk and Cognitive Impairment

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Identifying Strategies for Effective Weight Management in Diverse Interventions

Administered By
Medicine, Nephrology
Awarded By
University of Pittsburgh
Role
Principal Investigator
Start Date
End Date

CAPS1 and CAPS2 clinical trial

Administered By
Medicine, Nephrology
Role
Principal Investigator
Start Date
End Date

Publications:

Nutrition, lifestyle, and hypertension

© 2019 Elsevier Ltd. All rights reserved. Hypertension is a major risk factor for coronary heart disease, stroke, and premature death and a leading risk factor for global disease burden. Prevalence for those 18 years and older in the United States has remained around 29% since 1999 with little improvement. Further, approximately one-third of U.S. adults have prehypertension, which is also associated with a graded, increased risk of cardiovascular disease and progression to hypertension. The overall evidence that diet modification can prevent and treat hypertension is strong. The current national guideline of lifestyle modification for blood pressure control includes the DASH eating pattern, sodium reduction, weight loss, increased physical activity, and moderate consumption of alcohol. Concurrent adherence to several recommendations is likely to hold the greatest promise for preventing and treating hypertension and has been shown to be feasible. In addition to addressing unresolved nutritional hypotheses, future research should focus on strategies to motivate and maintain lifestyle changes long term for blood pressure control. At both the population and individual levels, success in dietary and lifestyle intervention relies on multiple levels of support ranging from clinicians to government agencies to private institutes and industries. In particular, partnering with industry to improve the nutritional quality of the food supply, such as reducing sodium, sugar, and saturated and trans fat content of processed foods, and promoting foods and nutrients consistent with the DASH dietary pattern will play a critical role in implementing dietary and lifestyle modifications. Consistent efforts to educate and promote adherence to dietary and lifestyle guidelines by dietetic and other health care professionals are also instrumental to the prevention and management of hypertension.
Authors
Lin, PH; Tyson, CC; Batch, BC; Svetkey, LP
MLA Citation
Lin, P. H., et al. “Nutrition, lifestyle, and hypertension.” Nutrition in the Prevention and Treatment of Disease, 2017, pp. 625–55. Scopus, doi:10.1016/B978-0-12-802928-2.00028-X.
URI
https://scholars.duke.edu/individual/pub1434679
Source
scopus
Published Date
Start Page
625
End Page
655
DOI
10.1016/B978-0-12-802928-2.00028-X

Metabolomic effects of androgen deprivation therapy treatment for prostate cancer.

Androgen deprivation therapy (ADT) is the main treatment strategy for men with metastatic prostate cancer (PC). However, ADT is associated with various metabolic disturbances, including impaired glucose tolerance, insulin resistance and weight gain, increasing risk of diabetes and cardiovascular death. Much remains unknown about the metabolic pathways and disturbances altered by ADT and the mechanisms. We assessed the metabolomic effects of ADT in the serum of 20 men receiving ADT. Sera collected before (baseline), 3 and 6 months after initiation of ADT was used for the metabolomics and lipidomics analyses. The ADT-associated metabolic changes were identified by univariable and multivariable statistical analysis, ANOVA, and Pearson correlation. We found multiple key changes. First, ADT treatments reduced the steroid synthesis as reflected by the lower androgen sulfate and other steroid hormones. Greater androgen reduction was correlated with higher serum glucose levels, supporting the diabetogenic role of ADT. Second, ADT consistently decreased the 3-hydroxybutyric acid and ketogenesis. Third, many acyl-carnitines were reduced, indicating the effects on the fatty acid metabolism. Fourth, ADT was associated with a corresponding reduction in 3-formyl indole (a.k.a. indole-3-carboxaldehyde), a microbiota-derived metabolite from the dietary tryptophan. Indole-3-carboxaldehyde is an agonist for the aryl hydrocarbon receptor and regulates the mucosal reactivity and inflammation. Together, these ADT-associated metabolomic analyses identified reduction in steroid synthesis and ketogenesis as prominent features, suggesting therapeutic potential of restricted ketogenic diets, though this requires formal testing. ADT may also impact the microbial production of indoles related to the immune pathways. Future research is needed to determine the functional impact and underlying mechanisms to prevent ADT-linked comorbidities and diabetes risk.
Authors
Chi, J-T; Lin, P-H; Tolstikov, V; Oyekunle, T; Chen, EY; Bussberg, V; Greenwood, B; Sarangarajan, R; Narain, NR; Kiebish, MA; Freedland, SJ
MLA Citation
Chi, Jen-Tsan, et al. “Metabolomic effects of androgen deprivation therapy treatment for prostate cancer.Cancer Med, Mar. 2020. Pubmed, doi:10.1002/cam4.3016.
URI
https://scholars.duke.edu/individual/pub1436182
PMID
32232974
Source
pubmed
Published In
Cancer Medicine
Published Date
DOI
10.1002/cam4.3016

Longer Term Effects of Diet and Exercise on Neurocognition: 1-Year Follow-up of the ENLIGHTEN Trial.

OBJECTIVES: To evaluate the longer term changes in executive functioning among participants with cardiovascular disease (CVD) risk factors and cognitive impairments with no dementia (CIND) randomized to a diet and exercise intervention. DESIGN: A 2 (Exercise) × 2 (Dietary Approaches to Stop Hypertension [DASH] eating plan) factorial randomized clinical trial. SETTING: Academic tertiary care medical center. PARTICIPANTS: Volunteer sample of 160 older sedentary adults with CIND and at least one additional CVD risk factor enrolled in the ENLIGHTEN trial between December 2011 and March 2016. INTERVENTIONS: Six months of aerobic exercise (AE), DASH diet counseling, combined AE + DASH, or health education (HE) controls. MEASUREMENTS: Neurocognitive battery recommended by the Neuropsychological Working Group for Vascular Cognitive Disorders including measures of executive function, memory, and language/verbal fluency. Secondary outcomes included the Clinical Dementia Rating-Sum of Boxes (CDR-SB), Six-Minute Walk Distance (6MWD), and CVD risk including blood pressure, body weight, and CVD medication burden. RESULTS: Despite discontinuation of lifestyle changes, participants in the exercise groups retained better executive function 1 year post-intervention (P = .041) compared with non-exercise groups, with a similar, albeit weaker, pattern in the DASH groups (P = .054), without variation over time (P's > .867). Participants in the exercise groups also achieved greater sustained improvements in 6MWD compared with non-Exercise participants (P < .001). Participants in the DASH groups exhibited lower CVD risk relative to non-DASH participants (P = .032); no differences in CVD risk were observed for participants in the Exercise groups compared with non-Exercise groups (P = .711). In post hoc analyses, the AE + DASH group had better performance on executive functioning (P < .001) and CDR-SB (P = .011) compared with HE controls. CONCLUSION: For participants with CIND and CVD risk factors, exercise for 6 months promoted better executive functioning compared with non-exercisers through 1-year post-intervention, although its clinical significance is uncertain. J Am Geriatr Soc 68:559-568, 2020.
Authors
Blumenthal, JA; Smith, PJ; Mabe, S; Hinderliter, A; Welsh-Bohmer, K; Browndyke, JN; Doraiswamy, PM; Lin, P-H; Kraus, WE; Burke, JR; Sherwood, A
MLA Citation
Blumenthal, James A., et al. “Longer Term Effects of Diet and Exercise on Neurocognition: 1-Year Follow-up of the ENLIGHTEN Trial.J Am Geriatr Soc, vol. 68, no. 3, Mar. 2020, pp. 559–68. Pubmed, doi:10.1111/jgs.16252.
URI
https://scholars.duke.edu/individual/pub1422327
PMID
31755550
Source
pubmed
Published In
Journal of the American Geriatrics Society
Volume
68
Published Date
Start Page
559
End Page
568
DOI
10.1111/jgs.16252

Revamping the 'renal' diet: using foods to control phosphorus physiology.

Authors
Scialla, JJ; Lin, P-H
MLA Citation
Scialla, Julia J., and Pao-Hwa Lin. “Revamping the 'renal' diet: using foods to control phosphorus physiology.Nephrol Dial Transplant, vol. 34, no. 10, Oct. 2019, pp. 1619–22. Pubmed, doi:10.1093/ndt/gfz019.
URI
https://scholars.duke.edu/individual/pub1370777
PMID
30805628
Source
pubmed
Published In
Nephrol Dial Transplant
Volume
34
Published Date
Start Page
1619
End Page
1622
DOI
10.1093/ndt/gfz019

DASH Diet and Blood Pressure Among Black Americans With and Without CKD: The Jackson Heart Study.

BACKGROUND: The Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure (BP) more effectively in blacks compared to other US racial subgroups. Considering chronic kidney disease (CKD) raises BP through complex mechanisms, DASH may affect BP differently among blacks with and without CKD. We compared the association of DASH accordance to BP and prevalent hypertension among blacks with and without CKD. METHODS: Our study involved 3,135 black Americans enrolled in the Jackson Heart Study (2000-2004) with diet and office BP data. Using linear models adjusted for demographics, health behaviors, and clinical factors, we determined the association of a modified DASH score (excluding sodium intake, ranging from 0 to 8 with increasing DASH accordance) with BP. We performed tests for interaction between DASH score and CKD status. RESULTS: Among participants (mean age: 55 years; hypertension: 60%; CKD: 19%), the median DASH score was similar among participants with and without CKD (1.0 [interquartile range (IQR): 0.5-2] and 1.0 [IQR: 0.5-1.5]). CKD status modified the association of the DASH score with systolic BP (SBP) and diastolic BP (DBP; P interactions were 0.06 and <0.01). Among participants without CKD, SBP and DBP were not associated with the DASH score (-0.4 [95% confidence interval: -1.0, 0.1] mm Hg and -0.1 [-0.4, 0.2] mm Hg per one unit higher DASH score). Among participants with CKD, one unit higher DASH score was associated with lower SBP by 1.6 (0.5, 2.6) mm Hg and lower DBP by 0.9 (0.3, 1.5) mm Hg. CONCLUSIONS: Despite low DASH scores overall, better DASH accordance was associated with lower BP among Black Americans with CKD.
Authors
Tyson, CC; Davenport, CA; Lin, P-H; Scialla, JJ; Hall, R; Diamantidis, CJ; Lunyera, J; Bhavsar, N; Rebholz, CM; Pendergast, J; Boulware, LE; Svetkey, LP
MLA Citation
Tyson, Crystal C., et al. “DASH Diet and Blood Pressure Among Black Americans With and Without CKD: The Jackson Heart Study.Am J Hypertens, vol. 32, no. 10, Sept. 2019, pp. 975–82. Pubmed, doi:10.1093/ajh/hpz090.
URI
https://scholars.duke.edu/individual/pub1393463
PMID
31187128
Source
pubmed
Published In
Am J Hypertens
Volume
32
Published Date
Start Page
975
End Page
982
DOI
10.1093/ajh/hpz090