ABSTRACT
Dr. Joseph Kindler, PhD, is a nutritional bone biologist from the University of Georgia. His long-term career goal
is to lead an independent research program aimed at developing dietary interventions to minimize the burden of
bone disease in people with cystic fibrosis (CF). This K01 is critical for Dr. Kindler to achieve his long-term career
goal. First, he will receive hands-on training in randomized controlled trials. He will work closely with his Primary
Mentor from Emory University, who is leading a NIDDK trial testing the effects of a low-added sugar CF diet on
glucose control in adults with CF. He will also complete coursework in clinical trial design and statistical methods.
Second, he will receive focused training in CF diet standards-of-care and nutrition-related complications,
primarily by participating in the Emory CF Scholar’s Program, which includes journal clubs, grand rounds, lab
meetings, and clinical observation. Third, he will expand his knowledge-base and technical skillset in bone
biomarkers, including bone turnover markers and novel imaging-based biomarkers from high-resolution
peripheral quantitative computed tomography (HR-pQCT). Dr. Kindler will complete guided readings, attend
international scientific meetings and workshops focused on biomarkers of bone metabolism and HR-pQCT
methods, complete hands-on training in HR-pQCT, and interact closely with Mentors that have expertise in bone
metabolism and imaging. Finally, he will become proficient in R01 grant writing through courses and interactions
with Mentors. These training goals dovetail with the research aims, which will test the overall hypothesis that
consuming an anti-diabetes, low-added sugar diet will improve bone health in people with CF. First, he will
assess the associations between added sugar intake and bone health outcomes, and second, he will compare
effects of a low-added sugar CF diet vs. a standard high-added sugar CF diet on bone turnover in adults with
CF. As a possible mechanism of action, involvement of gut “incretin” hormones will also be studied. This research
plan is guided by Dr. Kindler’s preliminary data on effects of diet and sub-clinical glucose dysregulation on bone
health, and involvement of entero-endocrinopathies in CF-related bone deficits. We hypothesize that first,
increased added sugar intake will associate with poorer bone health outcomes cross-sectionally and second,
that the low-added sugar diet group will have improved bone turnover compared to the high-added sugar diet
group due to the bone-augmenting effects of incretin hormones. These aims will be accomplished by leveraging
data from prior and ongoing studies conducted through Emory’s CF Center of Excellence, which is supported by
an NIDDK P30 Center Core Grant and an NIDDK R01 randomized controlled food provision trial aimed at
preventing diabetes in people with CF. Achieving the proposed training and research goals will propel Dr. Kindler
toward securing R01 funding to study long-term effects of diet modification targeting the gut-bone axis on
minimizing the burden of bone disease in CF. In turn, Dr. Kindler will be poised to achieve his long-term goal of
leading a successful NIH-funded independent research program on nutritional bone biology in CF.