The Impact of Military Blast Exposures on Metabolic Abnormalities in Post 9/11 Veterans

军事爆炸暴露对 9/11 事件后退伍军人代谢异常的影响

• 批准号: 10400028
• 负责人: Dora Lendvai
• 金额: $ 2.08万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10400028
• 关键词: Acute; Adult; Affect; Afghanistan; Age; Air; Animals; Anxiety; Area; Body mass index; Brain; Cellular Structures; Center for Translational Science Activities; Clinical; Clinical Data; Collaborations; Complex; Conflict (Psychology); Data; Data Analyses; Development; Diffuse; Disease; Disease Progression; Environment; Exercise; Explosion; Exposure to; Face; Foundations; Funding; General Population; Glucose; Glycosylated hemoglobin A; Health; Healthcare; Injury; Insulin; Insulin Resistance; Intervention; Iraq; Lead; Link; Logistic Regressions; Longitudinal Studies; Longitudinal cohort; Mediating; Mediation; Mental Depression; Mental disorders; Metabolic; Metabolic Diseases; Military Personnel; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Nursing Research; Obesity; Organ; Outcome; Pain; Participant; Pathology; Pathway interactions; Patients; Population; Post-Traumatic Stress Disorders; Prediabetes syndrome; Prevalence; Prevention; Psychological Factors; Psychophysiologic Disorders; Questionnaires; Recording of previous events; Regression Analysis; Regulation; Reporting; Research; Research Methodology; Review Literature; Risk; Risk Factors; Sampling; Series; Shock; Sleep; Sleep disturbances; Structure; Substance Use Disorder; Symptoms; Training; Traumatic Brain Injury; Veterans; Veterans Health Administration; Weight Gain; Work; blast exposure; brain cell; brain tissue; cohort; combat; depressive symptoms; experience; long-term sequelae; military injury; military service; military veteran; obese person; obesity risk; peer; post 9/11; post-traumatic stress; prevent; primary outcome; psychologic; secondary outcome; service member; skill acquisition; stress disorder; systematic review; Acute; Adult; Affect; Afghanistan; Age; Air; Animals; Anxiety; Area; Body mass index; Brain; Cellular Structures; Center for Translational Science Activities; Clinical; Clinical Data; Collaborations; Complex; Conflict (Psychology); Data; Data Analyses; Development; Diffuse; Disease; Disease Progression; Environment; Exercise; Explosion; Exposure to; Face; Foundations; Funding; General Population; Glucose; Glycosylated hemoglobin A; Health; Healthcare; Injury; Insulin; Insulin Resistance; Intervention; Iraq; Lead; Link; Logistic Regressions; Longitudinal Studies; Longitudinal cohort; Mediating; Mediation; Mental Depression; Mental disorders; Metabolic; Metabolic Diseases; Military Personnel; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Nursing Research; Obesity; Organ; Outcome; Pain; Participant; Pathology; Pathway interactions; Patients; Population; Post-Traumatic Stress Disorders; Prediabetes syndrome; Prevalence; Prevention; Psychological Factors; Psychophysiologic Disorders; Questionnaires; Recording of previous events; Regression Analysis; Regulation; Reporting; Research; Research Methodology; Review Literature; Risk; Risk Factors; Sampling; Series; Shock; Sleep; Sleep disturbances; Structure; Substance Use Disorder; Symptoms; Training; Traumatic Brain Injury; Veterans; Veterans Health Administration; Weight Gain; Work; blast exposure; brain cell; brain tissue; cohort; combat; depressive symptoms; experience; long-term sequelae; military injury; military service; military veteran; obese person; obesity risk; peer; post 9/11; post-traumatic stress; prevent; primary outcome; psychologic; secondary outcome; service member; skill acquisition; stress disorder; systematic review

PROJECT SUMMARY Over 44% of post 9/11 veterans, those who served in Iraq and Afghanistan and receive healthcare through the Veterans Health Administration, are obese (BMI>30). This obesity rate exceeds what is observed in the general public, and questions remain as to why this phenomenon occurs. Obesity is an independent risk factor for more serious metabolic abnormalities, and can lead to glucose dysregulation, insulin resistance (IR) and type 2 diabetes. While the risk for obesity in post 9/11 veterans is complex, military service injuries (such as traumatic brain injuries [TBIs]), post-military psychological disorders (e.g.; post-traumatic stress disorder [PTSD], depressive, anxiety and substance use disorders [SUD]) and somatic sequalae (sleep disturbance and pain) have been suggested as unique predictors of obesity in this veteran cohort. Recent evidence also suggests that damages sustained from exposure to repeated, and often close-range blast explosions during deployment to post 9/11 military conflicts may also impact metabolic health. Therefore, the purpose of this project is: (1) to identify associations between military blast exposures (experience of any blasts within 100m vs. no blast during military service) and metabolic abnormalities (obesity, glucose dysregulation and IR); and (2) to examine the mediating effect of psychological (PTSD, depressive, anxiety and substance use disorders) and somatic factors (sleep disturbance and pain) on metabolic abnormalities in a sample of post 9/11 veterans. Using the Translational Research Center for TBI and Stress Disorders (TRACTS) ongoing longitudinal cohort’s baseline sample (n=573) and a conceptual framework derived from a systematic review of the literature, we will conduct a cross-sectional, secondary data analysis to complete the study aims. We will use validated questionnaires and clinical data collected from TRACTS participants and conduct univariate, bivariate and logistic regression analyses, as well as a series of mediation analyses using the counterfactual approach. The proposed training plan includes rigorous quantitative skills development, scholarly work, team collaboration and other activities to provide a strong foundation in nursing research methods to support this study with post 9/11 veterans. The expected outcomes of this project include better understanding the impact of military blast exposure on key metabolic abnormalities in post 9/11 veterans and the post-military psycho-somatic factors that affect the strength of these relationships. Results of this study will provide important clinical implications for the prevention and treatment of metabolic abnormalities, especially obesity, glucose dysregulation and IR in post 9/11 veterans.

项目摘要 超过44％的9/11后退伍军人，在伊拉克和阿富汗服役并获得医疗保健的退伍军人 通过退伍军人卫生管理局是肥胖（BMI> 30）。这种肥胖率超过了观察到的 在公众中，关于这种现象会发生的原因仍然存在。肥胖是一种独立的风险 更严重的代谢异常的因素，并可能导致葡萄糖失调，胰岛素抵抗（IR） 和2型糖尿病。虽然9/11后退伍军人的肥胖风险很复杂，但兵役伤害（此类 作为创伤性脑损伤[TBI]），后军事心理疾病（例如；创伤后应激障碍 [PTSD]，抑郁，动画和药物使用障碍[SUD]）和体序（睡眠障碍和 疼痛已被认为是该老兵队列中肥胖的独特预测指标。最近的证据 表明从暴露暴露到重复和经常近距离爆炸爆炸而受到的损害 部署在9/11军事冲突后也可能影响代谢健康。 因此，该项目的目的是：（1）确定军事爆炸之间的关联 （在兵役期间与没有爆炸范围内的任何爆炸的经验）和代谢异常 （肥胖，葡萄糖失调和IR）； （2）检查心理学的中介作用（PTSD， 抑郁，动画和药物使用障碍）和躯体因素（睡眠障碍和疼痛） 9/11后退伍军人样本中的代谢异常。 使用持续纵向的TBI和应力障碍（区域）转化研究中心 队列的基线样本（n = 573）和一个概念框架，该概念框架从对 文献，我们将进行横断面的二级数据分析以完成研究目的。我们将使用 经过验证的问卷和从参与者收集的临床数据并进行单变量双变量 和逻辑回归分析以及使用反事实方法进行的一系列调解分析。 拟议的培训计划包括严格的定量技能发展，科学工作，团队 合作和其他活动，为护士研究方法提供强大的基础来支持这一点 与9/11后退伍军人一起学习。 该项目的预期结果包括更好地了解军事爆炸的影响 在9/11后退伍军人和后军事心理因素中，关键代谢异常的暴露 这会影响这些关系的力量。这项研究的结果将为 代谢异常的预防和治疗，尤其是肥胖，葡萄糖失调和IR 邮政9/11退伍军人。