Emergence of Cardiometabolic Risk Across the Lifecycle in China

中国全生命周期心脏代谢风险的出现

• 批准号: 8234652
• 负责人: PENNY GORDON-LARSEN
• 金额: $ 72.81万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-01 至 2016-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8234652
• 关键词: Accounting; Address; Adolescence; Adolescent; Adult; Affect; Age; Anthropometry; Asians; Behavior; Behavioral; Biological Markers; Biological Models; Biology; Blood Pressure; Blood specimen; Cardiovascular Diseases; Central obesity; Child; China; Communities; Complex; Country; Data; Development; Diabetes Mellitus; Diet; Dietary Factors; Dietary Sodium; Dimensions; Disease; Dyslipidemias; Economics; Effectiveness; Energy Intake; Environment; Environmental Risk Factor; Fasting; Fatty acid glycerol esters; Funding; Health; Health Surveys; Health behavior; Heterogeneity; High Prevalence; Household; Hypertension; Individual; Inflammation; Insulin Resistance; Knowledge; Link; Measures; Mediation; Methods; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Nutrition Surveys; Obesity; Outcome; Overweight; Pathway interactions; Pattern; Phenotype; Physical activity; Population; Populations at Risk; Positioning Attribute; Prevalence; Prevention; Prevention strategy; Research; Risk; Risk Factors; Risk Reduction; Role; Sodium; Statistical Models; Structural Models; System; Time; Translating; United States National Institutes of Health; Urbanization; Visit; Weight; Weight Gain; Weights and Measures; age group; base; disorder risk; environmental change; experience; follow-up; high risk; innovation; insulin sensitivity/resistance; low socioeconomic status; middle age; multilevel analysis; sex; social; socioeconomics; treatment strategy; waist circumference; young adult

DESCRIPTION (provided by applicant): Very little is known about the pathways that link broad environmental factors to health behaviors, and then to cardiometabolic risk across the lifecycle, taking into account the complex mediation and moderation by diet, activity, and weight over time. The primary reasons for this lack of understanding are: 1) insufficient high- quality, longitudinal exposure data; 2) lack of data in populations undergoing rapid changes in environments and outcomes, with enough variability to observe changes; and 3) insufficient use of complex statistical models to allow examination of each piece of the time-dependent, complex system. The China Health and Nutrition Survey (CHNS), an NIH-funded study of more than 11,000 individuals followed over 20 years, provides high- quality longitudinal data and captures the dramatic emergence of obesity, hypertension, insulin resistance, type 2 diabetes and cardiovascular disease in parallel with urbanization during the past two decades. The proposed study takes advantage of these unique data to examine patterns of change in communities characterized by different levels of urbanization over time. Using sophisticated structural models we propose to examine the complex pathways through which community-, household- and individual-level factors affect diet and physical activity, then the rate, degree and timing of weight gain and ultimately, cardiometabolic risk across the lifecycle. China is uniquely positioned to answer these questions given its high prevalence of cardiometabolic risk factors at relatively low BMI and at younger ages, and the relatively higher abdominal obesity and high rates of insulin resistance in Asians. We capitalize on a vast array of longitudinal anthropometry, blood pressure and detailed behavioral, socioeconomic and environmental information as well as newly collected fasting blood samples for cardiometabolic biomarkers. Our objectives include: 1) developing a longitudinal, structural model to investigate how community, household and individual factors influence: (a) energy-related diet and physical activity behaviors, (b) weight and waist circumference and (c) blood pressure over 20 years; and 2) extend the same multilevel, pathway-based analyses (Aims 1a-1c) to markers of dyslipidemia, insulin resistance and sensitivity, and inflammation. The proposed research will inform prevention and treatment strategies to optimize the effectiveness of cardiometabolic risk reduction efforts, with greater understanding of the role of broader societal, economic and environmental contexts in populations at risk. PUBLIC HEALTH RELEVANCE: China is a rapidly modernizing country experiencing substantial burden in hypertension, diabetes and cardiometabolic risk, providing a unique model for examining development of risk. The objective of the proposed research is to understand the multiple pathways from environment, behavior and biology to cardiometabolic risk across the lifecycle in order to inform efforts to mitigate early development of disease risk across the globe.

描述（由申请人提供）：考虑到将广泛的环境因素与健康行为联系起来，然后与整个生命周期中的心脏代谢风险联系起来的途径，考虑到饮食，活动和体重随着时间的推移的复杂调解和节制。缺乏理解的主要原因是：1）高质量，纵向暴露数据不足； 2）缺乏正在经历环境和结果快速变化的人群中的数据，并且有足够的可变性来观察变化； 3）不充分使用复杂的统计模型来检查每个时间依赖的复杂系统。 《中国健康与营养调查》（CHNS）是一项由NIH资助的研究，对超过20年的12个个人进行了一项研究，可提供高质量的纵向数据，并捕获了肥胖，高血压，胰岛素抵抗，2型糖尿病和心血管疾病的急剧出现，在过去的两年中，与城市化相关的城市化。拟议的研究利用这些独特的数据来检查社区变化模式，其特征是随着时间的流逝，城市化水平的不同。我们建议使用复杂的结构模型来检查社区，家庭和个人水平因素影响饮食和体育锻炼的复杂途径，然后体重增加的速度，程度和时机，最终在整个生命周期中，心脏代谢风险。鉴于在BMI相对较低和年轻时，中国的心脏代谢危险因素的高流行以及相对较高的腹部肥胖和亚洲人的胰岛素抵抗率较高，因此中国是可以回答这些问题的独特位置。我们利用大量的纵向人体测量法，血压以及详细的行为，社会经济和环境信息以及新收集的用于心脏代谢生物标志物的禁食血样。我们的目标包括：1）开发一个纵向的结构模型，以研究社区，家庭和个人因素如何影响：（a）与能量有关的饮食和体育锻炼行为，（b）体重和腰围以及（c）20年的血压； 2）将相同的基于途径的分析（AIMS 1A-1C）扩展到血脂异常，胰岛素抵抗和敏感性以及炎症的标记。拟议的研究将为预防和治疗策略提供信息，以优化降低心脏代谢风险的效力，并更了解更广泛的社会，经济和环境环境在风险中的人群中的作用。 公共卫生相关性：中国是一个快速现代化的国家，在高血压，糖尿病和心脏代谢风险中承受着重大负担，为检查风险发展提供了独特的模型。拟议的研究的目的是了解从环境，行为和生物学到整个生命周期心脏代谢风险的多种途径，以便为减轻全球疾病风险的早期发展而努力。