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

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

PSA - Zoe Charalambous

Administered By
Medicine, Nephrology
Awarded By
Institute for Medical Research, Inc.
Role
Principal Investigator
Start Date
End Date

Dietary Acid Load, Subclinical Acidosis and Outcomes in Chronic Kidney Disease

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

Publications:

Correction: Public interest in dietary supplements for prostate cancer prevention (Prostate Cancer and Prostatic Diseases, (2021), 24, 1, (58-60), 10.1038/s41391-020-0257-8)

In the original version of this article unfortunately contained a mistake. The spelling of Stephen J. Freedland name was incorrect. The original article has been corrected.
Authors
Patel, DN; Kuhlmann, P; Lin, PH; Freedland, SJ
MLA Citation
Patel, D. N., et al. “Correction: Public interest in dietary supplements for prostate cancer prevention (Prostate Cancer and Prostatic Diseases, (2021), 24, 1, (58-60), 10.1038/s41391-020-0257-8).” Prostate Cancer and Prostatic Diseases, Jan. 2021. Scopus, doi:10.1038/s41391-021-00410-8.
URI
https://scholars.duke.edu/individual/pub1487819
Source
scopus
Published In
Prostate Cancer and Prostatic Diseases
Published Date
DOI
10.1038/s41391-021-00410-8

Effects of Lifestyle Modification on Patients With Resistant Hypertension: Results of the TRIUMPH Randomized Clinical Trial.

BACKGROUND: Although lifestyle modifications generally are effective in lowering blood pressure (BP) among patients with unmedicated hypertension and in those treated with 1 or 2 antihypertensive agents, the value of exercise and diet for lowering BP in patients with resistant hypertension is unknown. METHODS: One hundred forty patients with resistant hypertension (mean age, 63 years; 48% female; 59% Black; 31% with diabetes; 21% with chronic kidney disease) were randomly assigned to a 4-month program of lifestyle modification (C-LIFE [Center-Based Lifestyle Intervention]) including dietary counseling, behavioral weight management, and exercise, or a single counseling session providing SEPA (Standardized Education and Physician Advice). The primary end point was clinic systolic BP; secondary end points included 24-hour ambulatory BP and select cardiovascular disease biomarkers including baroreflex sensitivity to quantify the influence of the baroreflex on heart rate, high-frequency heart rate variability to assess vagally mediated modulation of heart rate, flow-mediated dilation to evaluate endothelial function, pulse wave velocity to assess arterial stiffness, and left ventricular mass to characterize left ventricular structure. RESULTS: Between-group comparisons revealed that the reduction in clinic systolic BP was greater in C-LIFE (-12.5 [95% CI, -14.9 to -10.2] mm Hg) compared with SEPA(-7.1 [-95% CI, 10.4 to -3.7] mm Hg) (P=0.005); 24-hour ambulatory systolic BP also was reduced in C-LIFE (-7.0 [95% CI, -8.5 to -4.0] mm Hg), with no change in SEPA (-0.3 [95% CI, -4.0 to 3.4] mm Hg) (P=0.001). Compared with SEPA, C-LIFE resulted in greater improvements in resting baroreflex sensitivity (2.3 ms/mm Hg [95% CI, 1.3 to 3.3] versus -1.1 ms/mm Hg [95% CI, -2.5 to 0.3]; P<0.001), high-frequency heart rate variability (0.4 ln ms2 [95% CI, 0.2 to 0.6] versus -0.2 ln ms2 [95% CI, -0.5 to 0.1]; P<0.001), and flow-mediated dilation (0.3% [95% CI, -0.3 to 1.0] versus -1.4% [95% CI, -2.5 to -0.3]; P=0.022). There were no between-group differences in pulse wave velocity (P=0.958) or left ventricular mass (P=0.596). CONCLUSIONS: Diet and exercise can lower BP in patients with resistant hypertension. A 4-month structured program of diet and exercise as adjunctive therapy delivered in a cardiac rehabilitation setting results in significant reductions in clinic and ambulatory BP and improvement in selected cardiovascular disease biomarkers. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02342808.
Authors
Blumenthal, JA; Hinderliter, AL; Smith, PJ; Mabe, S; Watkins, LL; Craighead, L; Ingle, K; Tyson, C; Lin, P-H; Kraus, WE; Liao, L; Sherwood, A
MLA Citation
Blumenthal, James A., et al. “Effects of Lifestyle Modification on Patients With Resistant Hypertension: Results of the TRIUMPH Randomized Clinical Trial.Circulation, vol. 144, no. 15, Oct. 2021, pp. 1212–26. Pubmed, doi:10.1161/CIRCULATIONAHA.121.055329.
URI
https://scholars.duke.edu/individual/pub1497196
PMID
34565172
Source
pubmed
Published In
Circulation
Volume
144
Published Date
Start Page
1212
End Page
1226
DOI
10.1161/CIRCULATIONAHA.121.055329

Impact of Low Carbohydrate Diet on Self-Report Fatigue and Weakness in Prostate Cancer Patients.

Authors
Lin, P-H; Howard, L; Freedland, SJ
MLA Citation
Lin, Pao-Hwa, et al. “Impact of Low Carbohydrate Diet on Self-Report Fatigue and Weakness in Prostate Cancer Patients.The Journal of Urology, vol. 206, no. 3, Sept. 2021, pp. 499–501. Epmc, doi:10.1097/ju.0000000000001780.
URI
https://scholars.duke.edu/individual/pub1478662
PMID
33819069
Source
epmc
Published In
The Journal of Urology
Volume
206
Published Date
Start Page
499
End Page
501
DOI
10.1097/ju.0000000000001780

Effect of Bicarbonate on Net Acid Excretion, Blood Pressure, and Metabolism in Patients With and Without CKD: The Acid Base Compensation in CKD Study.

RATIONALE & OBJECTIVE: Patients with CKD are at elevated risk of metabolic acidosis due to impaired net acid excretion (NAE). Identifying early markers of acidosis may guide prevention in chronic kidney disease (CKD). This study compared NAE in participants with and without CKD, as well as the NAE, blood pressure (BP), and metabolomic response to bicarbonate supplementation. STUDY DESIGN: Randomized order, cross-over study with controlled feeding. SETTING & PARTICIPANTS: Participants consisted of 8 patients with CKD (estimated glomerular filtration rate 30-59mL/min/1.73m2 or 60-70mL/min/1.73m2 with albuminuria) and 6 patients without CKD. All participants had baseline serum bicarbonate concentrations between 20 and 28 mEq/L; they did not have diabetes mellitus and did not use alkali supplements at baseline. INTERVENTION: Participants were fed a fixed-acid-load diet with bicarbonate supplementation (7 days) and with sodium chloride control (7 days) in a randomized order, cross-over fashion. OUTCOMES: Urine NAE, 24-hour ambulatory BP, and 24-hour urine and plasma metabolomic profiles were measured after each period. RESULTS: During the control period, mean NAE was 28.3±10.2 mEq/d overall without differences across groups (P=0.5). Urine pH, ammonium, and citrate were significantly lower in CKD than in non-CKD (P<0.05 for each). Bicarbonate supplementation reduced NAE and urine ammonium in the CKD group, increased urine pH in both groups (but more in patients with CKD than in those without), and increased; urine citrate in the CKD group (P< 0.2 for interaction for each). Metabolomic analysis revealed several urine organic anions were increased with bicarbonate in CKD, including 3-indoleacetate, citrate/isocitrate, and glutarate. BP was not significantly changed. LIMITATIONS: Small sample size and short feeding duration. CONCLUSIONS: Compared to patients without CKD, those with CKD had lower acid excretion in the form of ammonium but also lower base excretion such as citrate and other organic anions, a potential compensation to preserve acid-base homeostasis. In CKD, acid excretion decreased further, but base excretion (eg, citrate) increased in response to alkali. Urine citrate should be evaluated as an early and responsive marker of impaired acid-base homeostasis. FUNDING: National Institute of Diabetes and Digestive and Kidney Diseases and the Duke O'Brien Center for Kidney Research. TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT02427594.
Authors
Tyson, CC; Luciano, A; Modliszewski, JL; Corcoran, DL; Bain, JR; Muehlbauer, M; Ilkayeva, O; Pourafshar, S; Allen, J; Bowman, C; Gung, J; Asplin, JR; Pendergast, J; Svetkey, LP; Lin, P-H; Scialla, JJ
MLA Citation
Tyson, Crystal C., et al. “Effect of Bicarbonate on Net Acid Excretion, Blood Pressure, and Metabolism in Patients With and Without CKD: The Acid Base Compensation in CKD Study.Am J Kidney Dis, vol. 78, no. 1, July 2021, pp. 38–47. Pubmed, doi:10.1053/j.ajkd.2020.10.015.
URI
https://scholars.duke.edu/individual/pub1478203
PMID
33810868
Source
pubmed
Published In
Am J Kidney Dis
Volume
78
Published Date
Start Page
38
End Page
47
DOI
10.1053/j.ajkd.2020.10.015

Urine and Plasma Metabolome of Healthy Adults Consuming the DASH (Dietary Approaches to Stop Hypertension) Diet: A Randomized Pilot Feeding Study.

We aimed to identify plasma and urine metabolites altered by the Dietary Approaches to Stop Hypertension (DASH) diet in a post-hoc analysis of a pilot feeding trial. Twenty adult participants with un-medicated hypertension consumed a Control diet for one week followed by 2 weeks of random assignment to either Control or DASH diet. Non-missing fasting plasma (n = 56) and 24-h urine (n = 40) were used to profile metabolites using untargeted gas chromatography/mass spectrometry. Linear models were used to compare metabolite levels between the groups. In urine, 19 identifiable untargeted metabolites differed between groups at p < 0.05. These included a variety of phenolic acids and their microbial metabolites that were higher during the DASH diet, with many at false discovery rate (FDR) adjusted p < 0.2. In plasma, eight identifiable untargeted metabolites were different at p < 0.05, but only gamma-tocopherol was significantly lower on DASH at FDR adjusted p < 0.2. The results provide insights into the mechanisms of benefit of the DASH diet.
Authors
Pourafshar, S; Nicchitta, M; Tyson, CC; Svetkey, LP; Corcoran, DL; Bain, JR; Muehlbauer, MJ; Ilkayeva, O; O'Connell, TM; Lin, P-H; Scialla, JJ
MLA Citation
Pourafshar, Shirin, et al. “Urine and Plasma Metabolome of Healthy Adults Consuming the DASH (Dietary Approaches to Stop Hypertension) Diet: A Randomized Pilot Feeding Study.Nutrients, vol. 13, no. 6, May 2021. Pubmed, doi:10.3390/nu13061768.
URI
https://scholars.duke.edu/individual/pub1484323
PMID
34067295
Source
pubmed
Published In
Nutrients
Volume
13
Published Date
DOI
10.3390/nu13061768