A multilevel and structural equation modeling approach to understand longitudinal growth, obesity, and cardiometabolic risk among Samoan children

用于了解萨摩亚儿童纵向生长、肥胖和心脏代谢风险的多层次结构方程建模方法

• 批准号: 9925647
• 负责人: Courtney Cheu Lin Choy
• 金额: $ 4.55万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9925647
• 关键词: 4 year old; 7 year old; 9 year old; Address; Age; Australia; Behavior; Behavioral; Biological; Blood Pressure; Body Composition; Body fat; Body mass index; Child; Childhood; Community Actions; Data; Data Analyses; Development; Diet; Dietary intake; Disease; Disease Marker; Dual-Energy X-Ray Absorptiometry; Elderly; Environment; Epidemiology; Equation; Ethnic group; Etiology; Fatty acid glycerol esters; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Growth; Growth and Development function; High Prevalence; Household; Individual; Intervention; Investments; Learning; Life; Longitudinal cohort study; Measurement; Measures; Methodology; Mind; Modeling; Mothers; New Zealand; Nutritional; Obesity; Outcome; Overweight; Pacific Island Americans; Pacific Islands; Pathway interactions; Peripheral; Physical activity; Population; Prediabetes syndrome; Prevalence; Prevention; Prevention strategy; Preventive Intervention; Procedures; Research; Resources; Risk; Risk Factors; Risk Marker; Samoa; Samoan; Socioeconomic Status; Structure; Thinness; Time; Training; Work; biobehavior; boys; cardiometabolic risk; cardiometabolism; cohort; design; diabetic; economic impact; experience; girls; global health; health disparity; improved; insight; multilevel analysis; obesity development; obesity in children; obesity prevention; obesity risk; obesity treatment; psychosocial; public health relevance; societal costs

PROPOSAL SUMMARY Despite considerable investments in prevention and treatment of obesity in children, prevalence continues to increase with catastrophic individual and societal costs. Pacific Islanders are among the most at risk, with obesity prevalence rising disproportionately faster among Pacific Islanders compared to other ethnic groups. Obesity prevention strategies are clearly needed, but a) the early determinants of obesity among Pacific Islanders are poorly understood, and b) for optimal efficacy, it is necessary to first understand both the age at which elevated cardiometabolic risk markers are established and the periods of growth that are most sensitive to environmental or behavioral risk factors during childhood. As such, we established the Ola Tuputupua’e “Growing Up” cohort in Samoa; the first longitudinal cohort study of children among the Pacific Island nations. To date, the cohort includes 450 children and their biological mothers with serial anthropometric measurements from 2015 (2-4 years old) and 2017-2018 (3.5-7 years old). Cross-sectional findings from the study demonstrate that this cohort is ideal for research focused on childhood obesity given the high prevalence and early emergence of cardiometabolic risk. The objective of this proposal is to develop a comprehensive model of childhood obesity development in Samoa that 1) describes growth and body composition during a critical age period for obesity development, 2) captures influences of individual and household factors and the age periods during which growth is most sensitive to them, and 3) quantifies the influence of longitudinal growth on cardiometabolic disease markers. We will focus on body mass index (BMI) to assess growth over time, diet and physical activity as modifiable individual-level factors, and household urbanicity and socioeconomic status as structural household- level factors. We plan to collect data in 2019 from the same children (5.5-9 years old) to provide a third time point for analysis, utilize newly collected dual energy-x-ray absorptiometry body composition data, and employ longitudinal modeling approaches to address the following specific aims: 1) Use multilevel modeling to identify individual and household-level factors associated with childhood BMI trajectories, 2) Use multilevel modeling to assess the association of childhood BMI trajectories with (a) body composition (b) blood pressure, and (c) glycosylated hemoglobin at 5.5-9 years old, and 3) Use structural equation modeling to assess the direct and indirect effect of individual-and household-level factors on childhood BMI and body composition. This research will be among the first to use a longitudinal, multilevel design to examine the time-fixed and time-varying effects of individual and household-level factors on growth, body composition, and cardiometabolic disease markers among children in the Pacific Island nations. The findings will likely apply to other settings and enhance our understanding of the range of bio-behavioral-environmental etiologic pathways of obesity onset and cardiometabolic risk development during childhood to concretely inform intervention strategies.

提案摘要 尽管在预防和治疗儿童的肥胖症方面进行了大量投资，但患病率仍在继续 随着灾难性的个人和社会成本的增加。太平洋岛民是最有风险的人，肥胖 与其他族裔相比，太平洋岛民的患病率上升的速度不成比例地不成比例。肥胖 显然需要预防策略，但是a）太平洋岛民肥胖的早期决定者是 理解不佳，b）为了获得最佳效率，有必要首先了解升高的年龄 建立了心脏代谢风险标记，并且对环境最敏感的增长周期 或童年时期的行为风险因素。因此，我们建立了ola tuputupua’e“成长”队列 在萨摩亚；太平洋岛国国家儿童的首次纵向队列研究。迄今为止，队列 包括450名儿童及其生物母亲，具有串行人体测量的2015年（2 - 4年） 旧）和2017-2018（3.5-7岁）。研究的横截面发现表明该队列是 鉴于高流行和早期出现，专注于儿童肥胖的研究的理想选择 心脏代谢风险。该提议的目的是开发一个儿童对象的综合模型 萨摩亚的发展1）描述肥胖症关键时期内的生长和身体成分 发展，2）捕获个人和家庭因素的影响以及年龄增长的年龄 对它们最敏感，3）量化纵向生长对心脏代谢疾病的影响 标记。我们将专注于体重指数（BMI），以评估随着时间的推移，饮食和体育锻炼的生长 可修改的个人级别因素，家庭城市化和社会经济地位作为结构性家庭 - 水平因素。我们计划在2019年从同一儿童（5.5-9岁）收集数据，以提供第三个时间点 进行分析，利用新收集的双能X射线绝对epipiementry身体组成数据，并采用 纵向建模方法来解决以下特定目的：1）使用多级建模来识别 与儿童BMI轨迹相关的个人和家庭水平因素，2）使用多级建模 评估儿童期BMI轨迹与（a）身体成分（b）血压的关联，以及（c） 5.5-9岁的糖基化血红蛋白，3）使用结构方程建模来评估直接和 个人和家庭水平因素对儿童BMI和身体成分的间接影响。这项研究 将是最早使用纵向，多级设计来检查及时且随时间变化的效果的人之一。 关于生长，身体成分和心脏代谢疾病标志物的个人和家庭水平因素 在太平洋岛国的儿童中。这些发现可能适用于其他设置并增强我们的 了解肥胖开始和 儿童期的心脏代谢风险发展具有具体的干预策略。