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, 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 & Neurosciences
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 & Neurosciences
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
Awarded By
Institute for Medical Research, Inc.
Role
Principal Investigator
Start Date
End Date

Publications:

Cerebrovascular Function, Vascular Risk, and Lifestyle Patterns in Resistant Hypertension.

<h4>Background</h4>Impaired cerebrovascular reactivity (CVR) and blunted cerebral hemodynamic recruitment are thought to be important mechanisms linking hypertension to cerebrovascular and cognitive outcomes. Few studies have examined cardiovascular or dietary correlates of CVR among hypertensives.<h4>Objective</h4>To delineate associations between cardiometabolic risk, diet, and cerebrovascular functioning among individuals with resistant hypertension from the TRIUMPH trial (n = 140).<h4>Methods</h4>CVR was assessed by examining changes in tissue oxygenation (tissue oxygenation index [TOI] and oxygenated hemoglobin [HBO2]) using functional near-infrared spectroscopy (fNIRS) during a breath holding test, a standardized CVR assessment to elicit a hypercapnic response. Participants also underwent fNIRS during three cognitive challenge tasks. Vascular function was assessed by measurement of brachial artery flow-mediated dilation and hyperemic flow response. Cardiometabolic fitness was assessed from peak VO2 on an exercise treadmill test and body mass index. Dietary patterns were quantified using the DASH eating score. Cognitive function was assessed using a 45-minute test battery assessing Executive Function, Processing Speed, and Memory.<h4>Results</h4>Greater levels fitness (B = 0.30, p = 0.011), DASH compliance (B = 0.19, p = 0.045), and lower obesity (B = -0.30, p = 0.004), associated with greater changes in TOI, whereas greater flow-mediated dilation (B = 0.19, p = 0.031) and lower stroke risk (B = -0.19, p = 0.049) associated with greater HBO2. Similar associations were found for cerebral hemodynamic recruitment, and associations between CVR and cognition were moderated by duration of hypertension.<h4>Conclusion</h4>Impaired CVR elevated cardiometabolic risk, obesity, vascular function, and fitness among hypertensives.
Authors
Smith, PJ; Sherwood, A; Hinderliter, AL; Mabe, S; Tyson, C; Avorgbedor, F; Watkins, LL; Lin, P-H; Kraus, WE; Blumenthal, JA
MLA Citation
Smith, Patrick J., et al. “Cerebrovascular Function, Vascular Risk, and Lifestyle Patterns in Resistant Hypertension.Journal of Alzheimer’S Disease : Jad, vol. 87, no. 1, Jan. 2022, pp. 345–57. Epmc, doi:10.3233/jad-215522.
URI
https://scholars.duke.edu/individual/pub1512851
PMID
35275539
Source
epmc
Published In
Journal of Alzheimer'S Disease : Jad
Volume
87
Published Date
Start Page
345
End Page
357
DOI
10.3233/jad-215522

Low Carbohydrate Diets and Estimated Cardiovascular and Metabolic Syndrome Risk in Prostate Cancer.

PURPOSE: A low carbohydrate diet (LCD) was shown to suggestively slow prostate cancer (PC) growth. In noncancer patients, LCDs improve metabolic syndrome (MetS) without weight loss. However, concerns about negative impact on cardiovascular disease (CVD) risk remain. The objective of this secondary analysis is to determine the impact of an LCD on risk of MetS and estimated CVD risk in patients with PC. MATERIALS AND METHODS: Pooled data were analyzed from 2 randomized trials testing LCD vs control on 1) preventing insulin resistance after starting hormone therapy (CAPS1) and 2) slowing PC growth in recurrent PC after failed primary treatment (CAPS2). Both trials included a usual care control vs LCD intervention in which patients were instructed to limit carbohydrate intake to ≤20 gm/day, and in CAPS1 only, to walk for ≥30 minutes/day for ≥5 days/week. MetS components (hypertension, high triglycerides, low high-density lipoprotein cholesterol, central obesity and diabetes), 10-year CVD risk estimated using the Framingham Score with either body mass index (BMI) or lipids, and remnant cholesterol were compared between arms using mixed models adjusting for trial. RESULTS: LCD resulted in a significantly reduced risk of MetS (p=0.004) and remnant cholesterol (p <0.001). Moreover, LCD resulted in significantly lower estimated CVD risk using BMI (p=0.002) over the study with no difference in estimated CVD risk using lipids (p=0.14). CONCLUSIONS: LCD resulted in a significantly reduced risk of MetS and remnant cholesterol, and a significantly lower estimated CVD risk using BMI. By comparison, there was no difference in estimated CVD risk using lipids. Study limitations include small sample size, short followup, and inability to distinguish effects of carbohydrate restriction and weight loss. Long-term studies are needed to confirm this finding.
Authors
Freedland, SJ; Howard, LE; Ngo, A; Ramirez-Torres, A; Csizmadi, I; Cheng, S; Mack, A; Lin, P-H
MLA Citation
Freedland, Stephen J., et al. “Low Carbohydrate Diets and Estimated Cardiovascular and Metabolic Syndrome Risk in Prostate Cancer.J Urol, vol. 206, no. 6, Dec. 2021, pp. 1411–19. Pubmed, doi:10.1097/JU.0000000000002112.
URI
https://scholars.duke.edu/individual/pub1489381
PMID
34259565
Source
pubmed
Published In
The Journal of Urology
Volume
206
Published Date
Start Page
1411
End Page
1419
DOI
10.1097/JU.0000000000002112

Chapter 9: Lifestyle interventions for blood pressure control in children and adolescents

Preface. Hypertension is a major risk factor for coronary heart disease, stroke, and premature death, and it affects approximately one-third of adults in the United States. Approximately, another one-third of the adults in the United States have&nbsp;...
Authors
Dolinsky, DH; Baker-Smith, CM; Czinn, AE; Milazzo, AS; Armstrong, SC
MLA Citation
Dolinsky, D. H., et al. “Chapter 9: Lifestyle interventions for blood pressure control in children and adolescents.” Nutrition, Lifestyle Factors, and Blood Pressure, edited by P. H. Lin and L. P. Svetkey, CRC Press, 2012.
URI
https://scholars.duke.edu/individual/pub1106823
Source
manual
Published Date

Weight loss via a low-carbohydrate diet improved the intestinal permeability marker, zonulin, in prostate cancer patients.

BACKGROUND: Accumulating evidence suggest that gut microbiota may impact urologic health including prostate cancer (PC), potentially via affecting intestinal permeability (IP). Studies have indicated that disrupted IP may be improved by healthy diets and weight loss. In the Carbohydrate and Prostate Study 2 (CAPS2) clinical trial, which showed that a low-carbohydrate diet (LCD) reduced weight significantly in men with PC and suggestively slowed PC disease progression, we explored the impact of LCD on an IP marker, zonulin and an inflammation marker, high sensitivity C-reactive protein (hsCRP). METHODS: CAPS2 was a 6-month randomized controlled trial testing a LCD intervention vs. control on PC progression using prostate-specific antigen doubling time (PSADT) as the marker. All 45 participants had prior primary PC treatment, PSADT >3 and <36 months, and body mass index (BMI) ≥24 kg/m2. RESULTS: At 6-month, zonulin decreased in the LCD arm (median -8.3%, IQR -16.6, 0.3%) while the control increased slightly (median 1.4%, IQR -3.0, 13.3%; p = .014). No changes were observed in hsCRP. Linear regression models showed that weight change was significantly associated with log(PSADT) such that the greater the weight loss, the longer the PSADT(p = .003). There was a similar inverse trend between change in zonulin and log(PSADT) (p = .050). Nevertheless, the mediation analysis showed that zonulin was not a significant intermediary mechanism of the effect of weight change on PSADT (p = .3). CONCLUSION: Future studies are merited to examine further the potential association of IP with inflammation and to clarify if improvement in IP is associated with decreased PC progression. Trial registration: NCT01763944. KEY MESSAGESGut microbiota may impact urologic health including prostate cancer, potentially via affecting intestinal permeability.Weight loss significantly improved intestinal permeability in prostate cancer patients.Improvement in intestinal permeability was associated with slowed prostate cancer progression as indicated by the PSA doubling time.
Authors
Lin, P-H; Howard, L; Freedland, SJ
MLA Citation
Lin, Pao-Hwa, et al. “Weight loss via a low-carbohydrate diet improved the intestinal permeability marker, zonulin, in prostate cancer patients.Ann Med, vol. 54, no. 1, Dec. 2022, pp. 1221–25. Pubmed, doi:10.1080/07853890.2022.2069853.
URI
https://scholars.duke.edu/individual/pub1520431
PMID
35486445
Source
pubmed
Published In
Ann Med
Volume
54
Published Date
Start Page
1221
End Page
1225
DOI
10.1080/07853890.2022.2069853

Microbiota responses to different prebiotics are conserved within individuals and associated with habitual fiber intake.

BACKGROUND: Short-chain fatty acids (SCFAs) derived from gut bacteria are associated with protective roles in diseases ranging from obesity to colorectal cancers. Intake of microbially accessible dietary fibers (prebiotics) lead to varying effects on SCFA production in human studies, and gut microbial responses to nutritional interventions vary by individual. It is therefore possible that prebiotic therapies will require customizing to individuals. RESULTS: Here, we explored prebiotic personalization by conducting a three-way crossover study of three prebiotic treatments in healthy adults. We found that within individuals, metabolic responses were correlated across the three prebiotics. Individual identity, rather than prebiotic choice, was also the major determinant of SCFA response. Across individuals, prebiotic response was inversely related to basal fecal SCFA concentration, which, in turn, was associated with habitual fiber intake. Experimental measures of gut microbial SCFA production for each participant also negatively correlated with fiber consumption, supporting a model in which individuals' gut microbiota are limited in their overall capacity to produce fecal SCFAs from fiber. CONCLUSIONS: Our findings support developing personalized prebiotic regimens that focus on selecting individuals who stand to benefit, and that such individuals are likely to be deficient in fiber intake. Video Abstract.
Authors
Holmes, ZC; Villa, MM; Durand, HK; Jiang, S; Dallow, EP; Petrone, BL; Silverman, JD; Lin, P-H; David, LA
MLA Citation
Holmes, Zachary C., et al. “Microbiota responses to different prebiotics are conserved within individuals and associated with habitual fiber intake.Microbiome, vol. 10, no. 1, July 2022, p. 114. Pubmed, doi:10.1186/s40168-022-01307-x.
URI
https://scholars.duke.edu/individual/pub1532403
PMID
35902900
Source
pubmed
Published In
Microbiome
Volume
10
Published Date
Start Page
114
DOI
10.1186/s40168-022-01307-x