Primer Grants

Methods to reduce the burden of obesity and type 2 diabetes in Aotearoa are desperately needed, with obesity one of the greatest predisposing factors for type 2 diabetes as well as heart disease, and certain cancers. One promising intervention is a structured programme of a period of rapid weight loss, followed by supported weight-loss maintenance called DiRECT.

DiRECT has been successfully applied in the UK, where its broader uptake is now being phased in throughout the country. The trial will determine if the DiRECT approach is accepted and useful in Aotearoa. The trial is conducted from Te Kāika Health, a Māori Health Provider and medical practice of 5200 Māori, Pacific, refugee, and low-income clientele in South Dunedin. Acceptability outcomes in this pilot trial will enable us to tweak the international intervention to be relevant to Pacific and Māori.

Findings

The DiRECT programme led to a 6.9 kg average weight loss after three months, which was largely maintained at 12 months. This compared to the standard weight loss programme, which led to a smaller weight loss of 0.8kg after three months and 2.3kg after 12 months. 

Participants found early and rapid weight loss motivating: “You see results quickly, and those results motivate you to keep going.” 

The study was an overall positive experience, preparing participants for long-term lifestyle change: “This study’s just allowed me to actually hone in on that long-term lifestyle change as opposed to quick fixes.”

A nationwide trial is now planned and has potential for impacting national guidelines.

Cardiovascular disease (CVD) risk for Māori people with diabetes is 30% higher than other ethnic groups, and Māori and Pacific people have a disproportionately higher CVD burden. Investing in early and more accurate means to identify people at high CVD risk, so that targeted and timely interventions can be administered, will benefit the community, and reduce the medical, economic and social burden.

The carotid-femoral pulse wave velocity (cf-PWV), a global measure of arterial stiffness, is well established as an additional, independent predictor of CVD events. A preliminary study estimated the normative PWV values in the NZ population. However, Māori and Pacific participants, who have the highest rate of CVD and poorest outcomes, were under-represented. This feasibility study aims to address the past limitations, by focusing on co-design of the research with Māori and Pacific communities and by conducting a pilot study to assess the recruitment rate and other practical aspects of data collection.

Findings

The study incorporated Kaupapa Māori and Pasifika frameworks throughout. The study measured the PWV values in 10 healthy Māori and Pacific New Zealanders, as well as height, weight and blood pressure. Although participants had higher blood pressure than the “healthy” range their mean PWV values were within the range of healthy as per European normative values. The pilot data indicated that the current “blanket” criteria used when determining the risk of CVD may not be appropriate for all within the Aotearoa New Zealand population. 

Feedback from participants was generally positive as they spoke of a mana-enhancing interaction with team members. Participants were also willing to invite extended family and friends to participate if the study is expanded.

This study is a starting point for future studies to refine the use of PWV for CVD risk prediction, with larger sample sizes and including other cardiovascular risk predictors. The protocols developed in this study via co-design with participants will ensure that Māori and Pacific Peoples are well represented should PWV become a nationally recognised risk factor.

It is well over a hundred years since the invention of the electrocardiogram (ECG), yet shortcomings in the diagnosis and monitoring of heart disease incorporating this technology have not been satisfactorily addressed, until now. We will develop a novel ECG system that utilises our innovative AI software platform and a portable ECG patch to monitor heart rate for up to 96 hours continuously. This platform can detect heart abnormalities and disease more efficiently than conventional ECG and prevent errors by eliminating the need for manual reading and interpretation. We will be able to provide cardiovascular disease (CVD) patients with convenient and remote real-time diagnosis and monitoring that they can access regardless of their location in New Zealand. This funding will support recruitment of Māori for the study to ensure that the technology we are developing works for them. 

Findings

Over sixty Māori participants trialled the ECG wearable device. Overall, the ECG device and AI platform was well received by most participants, who appreciated the concept and usability, and the team will work on improvements to overcome the issues identified. 

Two Māori summer research students, Mr Rawiri Manley (funded by Pūtahi Manawa) and Ms Hine Ngatai, worked with Community Engagement Lead, Misty Edmonds, on the Māori community engagement and participant enrolment for their research projects. 

The long-duration ECG data collected will reduce bias in the training of the AI so that it can reliably diagnose heart disease in Aotearoa New Zealand’s diverse patient population. 

The team is now planning a study incorporating an improved ECG wearable and AI to screen for atrial fibrillation in potential participants in the community and at hospitals. This project has led to a Health Research Council Health Delivery Research Career Development Award for Assoc. Prof. Zhao. The new award will support further development of the AI platform for diagnosing atrial fibrillation and identifying patients most suitable for ablation treatment, in collaboration with Professor Martin Stiles at Waikato Hospital.

Hypertension disproportionally impacts Māori and this funding is enabling us to work in partnership with Māori healthcare providers, iwi, patients and whānau to ensure our approach to using heat therapy is accessible and culturally-appropriate

The aim of this project is threefold:

1. To determine the optimal dosage of heat therapy (bathing duration and water temperature) for lowering blood pressure.
2. To further investigate the physiological mechanisms driving this change.
3. To examine how heat therapy might improve non-physical aspects of hauora.

Findings

The study found that each immersion led to a clinically meaningful decrease in systolic blood pressure which occurred irrespective of duration of exposure or water temperature. In follow-up interviews, although many participants highlighted the physical benefits, many commented on the hinengaro (mental), wairua (spiritual) and whānau (family) hauora (health) benefits of water. 

This work has led to two further studies. One is a study investigating if hypotensive benefits can be achieved with home-style bath or lower leg bathing. Heart Otago funded a Cook Island Māori student to initiate data collection for these studies as part of a summer studentship. As the study showed that thermoneutral immersion is effective for reducing 24-hour blood pressure the student is now inspired to investigate the effect of lagoon style bathing on blood pressure in her home community (Rarotonga).

This funding has also led to Associate Investigator Dr Brendon Roxburgh receiving a $160,000 Lottery Health Research Grant to conduct a randomised controlled trial investigating heat therapy vs exercise on 24-hour blood pressure. The results and feedback from the ongoing co-design process funded by this research have helped with the study design for this.

The focus of the project was to investigate a DNA variant in a gene that is found at a high frequency in Māori and Pacific people and has been linked to lower blood pressure but increased risk of kidney failure in the setting of type 2 diabetes.

Findings

The researchers generated a rat with the equivalent gene variant and found that it shows lower systolic blood pressure, as expected from the human studies. Unexpectedly, they also found that the rats drink and urinate much more than the control rats. Based on these new findings, the researchers suspect that the Vasopressin hormone system is perturbed (which is involved in regulating water balance in the body) and this is now under further investigation.

Since being awarded this project, the team were successful in getting a Health Research Council project grant and Maurice Wilkins Centre funding to continue this work. A research partnership has been established with Ngāti Porou Oranga and knowledge is disseminated locally by Ngāti Porou Oranga newsletters and their public-facing website. 

This primer grant facilitated a collaboration with Dr Nikki Earle see if there was an association between the rs1800795-C gene and acute coronary syndrome outcomes in Māori and Pacific peoples. The project also helped facilitate bidirectional knowledge transfer between the research team and Tangaroa College staff and students. Tangaroa College is low decile South Auckland high school that has predominantly Māori and Pacific students. Through this grant the research team engaged with Tangaroa through several programmes including delivering a metabolic disease-related module to a senior science class, hosting Tangaroa College students for a day at the University of Auckland and running a scientific study design workshop.