The current pandemic of obesity and insulin resistance across the lifespan presents an immense public health challenge. Human observational studies and fecal transplantation studies in animal models (both largely focused on adults) have found an interconnection among obesity, insulin resistance, and the microbiota. Because epidemiology points to childhood origins for the genesis of obesity, there is a critical need to understand the mechanisms of pediatric obesity and to develop tools for its prediction, prevention, and treatment. Children with severe obesity mimic adult phenotypes in their development of metabolic and cardiovascular risk, and yet are at the earliest stages of disease with fewer and less severe co-morbid conditions. Thus children with obesity present a unique opportunity and an ideal population in which to garner deeper insights into the obesity-associated microbiome. To enable such insights, the objective of this proposal is to establish a comprehensive research resource to define mechanisms underlying microbial regulation of host metabolism in adolescents with obesity (ages 12-18 yrs) before and after weight loss intervention. The proposed research leverages Duke?s unique and well-established intervention program for pediatric obesity and insulin resistance. Our prior studies have applied metabolomic technology to reveal that blood metabolites such as branched chain amino acids (BCAA) are negatively associated with insulin sensitivity following adult weight loss interventions, and we have used gnotobiotic mice to demonstrate their positive association with microbiota-mediated weight gain. Our preliminary studies indicate that BCAA and related metabolites are also associated with insulin resistance and weight gain in adolescents. Our central hypothesis is that human gut bacteria control host weight gain and insulin resistance in adolescents by modifying host metabolism. This hypothesis will be tested in two specific aims:
Aim 1. Develop a resource to define associations between intestinal microbiota and a severely obese population of adolescents enrolled in an outpatient weight management intervention program.
Aim 2. Define the molecular mechanisms by which human intestinal bacteria regulate metabolic traits linked to pediatric obesity. Completion of this work will provide three key resources for broad use by the scientific community: (1) a clinical sample, microbiota strain, and data repository from a unique pediatric weight management intervention cohort, (2) a comprehensive suite of robust genetic, molecular profiling, and phenotyping technologies that will yield unique insights into the microbial communities that control body weight and responses to obesity intervention, and (3) insights into molecular mechanisms by which BCAA and other identified microbial products influence metabolic health during childhood and adolescence. These new resources, technologies, and mechanistic insights will have a positive impact by advancing the long-term objective of reducing adolescent obesity and developing effective, durable therapeutics.

Public Health Relevance

Obesity has reached epidemic proportions in the US and is typically rooted in childhood. The proposed research is relevant to public health because it will produce a human adolescent obesity clinical resource and bring together leading technologies and scientific expertise to understand how the intestinal microbes associated with adolescent obesity participate in the disease and its treatment. The proposed research directly serves the mission of the NIH by providing a high value clinical sample and microbiological resource to aid the broader scientific community and by generating scientific knowledge about human health and disease.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Resource-Related Research Projects (R24)
Project #
Application #
Study Section
Special Emphasis Panel (ZDK1)
Program Officer
Karp, Robert W
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Duke University
Schools of Medicine
United States
Zip Code
Tsoi, Ryan; Wu, Feilun; Zhang, Carolyn et al. (2018) Metabolic division of labor in microbial systems. Proc Natl Acad Sci U S A 115:2526-2531
McGarrah, Robert W; Crown, Scott B; Zhang, Guo-Fang et al. (2018) Cardiovascular Metabolomics. Circ Res 122:1238-1258
Lee, Anna J; Wang, Shangying; Meredith, Hannah R et al. (2018) Robust, linear correlations between growth rates and ?-lactam-mediated lysis rates. Proc Natl Acad Sci U S A 115:4069-4074
Zaengle-Barone, Jacqueline M; Jackson, Abigail C; Besse, David M et al. (2018) Copper Influences the Antibacterial Outcomes of a ?-Lactamase-Activated Prochelator against Drug-Resistant Bacteria. ACS Infect Dis 4:1019-1029
Armstrong, S C; Puhl, R; Skinner, A C et al. (2018) Person-first language in pediatric obesity research. Pediatr Obes 13:130
White, Phillip J; McGarrah, Robert W; Grimsrud, Paul A et al. (2018) The BCKDH Kinase and Phosphatase Integrate BCAA and Lipid Metabolism via Regulation of ATP-Citrate Lyase. Cell Metab 27:1281-1293.e7
Skinner, Asheley Cockrell; Ravanbakht, Sophie N; Skelton, Joseph A et al. (2018) Prevalence of Obesity and Severe Obesity in US Children, 1999-2016. Pediatrics 141:
David, Lawrence A (2018) Toward Personalized Control of Human Gut Bacterial Communities. mSystems 3: