Assessing Helicobacter pylori and Diet to Develop Cancer Interventions in American Indian Communities in the Southwest

评估幽门螺杆菌和饮食以制定西南部美洲印第安社区的癌症干预措施

• 批准号: 10654916
• 负责人: Dornell Pete
• 金额: $ 9.04万
• 依托单位: FRED HUTCHINSON CANCER CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-04 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10654916
• 关键词: Accounting; Adherence; Adult; Affect; Alaska; Alaska Native; Alleles; American Indians; Antibiotic Resistance; Antigens; Arizona; Awareness; Behavioral; Canada; Cancer Intervention; Cells; Cessation of life; Chronic; Clinic; Clinical Data; Communities; Cross-Sectional Studies; Cytotoxin; Development; Diet; Diet Surveys; Dietary Practices; Disease; East Asian; Environmental Risk Factor; Exposure to; Food; Frequencies; Future; General Population; Genes; Genotype; Goals; Grain; Gram-Negative Bacteria; Health; Health Surveys; Healthcare Systems; Helicobacter Infections; Helicobacter pylori; High Prevalence; Incidence; Individual; Infection; Inflammation; International; Intervention; Interview; Inuits; Laboratories; Learning; Link; Malignant Neoplasms; Measures; Mission; Mucous Membrane; Native-Born; Navajo; Nested Case-Control Study; New Mexico; Outcome; Pathogenicity; Pathogenicity Island; Patients; Pattern; Persons; Phase; Population; Population Group; Prevalence; Prevention; Processed Meats; Production; Proteins; Public Health; Qualitative Research; Questionnaires; Reporting; Research; Risk; Risk Factors; Role; Sodium Chloride; Stomach; Testing; Time; Treatment Failure; Tribes; United States; United States National Institutes of Health; Vegetables; Virulence; Virulence Factors; Work; barrier to care; base; burden of illness; cancer health disparity; chronic infection; compliance behavior; design; dietary; experience; fruits and vegetables; gastric cancer prevention; health assessment; high salt diet; improved; infection risk; malignant stomach neoplasm; member; pre-doctoral; stool sample; success; surveillance data; treatment adherence

PROJECT ABSTRACT Gastric cancer is the fifth most common cancer worldwide, accounting for 780,000 deaths annually. In the US, a substantial burden of gastric cancer continues to be observed in American Indians (AI) in the Southwest and Alaska Natives. The Navajo Nation, a tribe in the Southwest, is experiencing higher incidence of gastric cancer compared to the general population in the region, possibly due to high prevalence of Helicobacter pylori (H. pylori) infection and other contributing factors, like diet. H. pylori strains that vary in the production of virulence factors have been credited with the causal link between H. pylori and gastric cancer. In particular, cytotoxin- associated gene A (cagA) and its pathogenicity island function together to deliver CagA proteins into host cells to promote inflammation and gastric cancer. Diets high in salt and processed meats, and low in fruits and vegetables were further associated with altering the protective lining of the stomach and enhancing expression of cagA. Thus, it is essential to understand the role of H. pylori and diet for gastric cancer prevention. While various treatment options for H. pylori infection are available, they are not always successful due to patient adherence and clinic level barriers, further leading to persistent infection and added expense. However, treatment failures in the Navajo Nation are unknown. My approach allows me to leverage my previous experience working with AI tribes to determine risk factors for gastric cancer and identify strategies to reduce them. I will implement my research among adults using the Navajo healthcare system. My objectives are two- fold. First, in the predoctoral F99 phase, I will determine the prevalence, virulence, and dietary correlates of H. pylori infection among Navajo adults. Second, in the postdoctoral K00 phase, I will characterize risk factors for H. pylori reinfection and patient experiences with H. pylori treatment. To achieve these objectives, I will use my previous experience in conducting health assessments to execute a cross-sectional study to measure H. pylori infection, cagA virulence gene status, and diet through health and diet surveys and laboratory analysis of stool specimens (F99). Then, I will use my gained expertise in H. pylori and previous experience with qualitative research to determine H. pylori reinfection risk and barriers to treatment adherence using quantitative and qualitative research approaches (K00). I will test my hypotheses through the following aims: AIM 1: Test that H. pylori infections, particularly with the cagA gene, are highly prevalent in Navajo adults compared to other non-AI populations, and that diets high in salt, processed meats, and low in vegetables are associated with H. pylori infection risk. AIM 2: Test that patient chronic health conditions are associated with H. pylori reinfection risk, and obtain information about patient-level and institutional level barriers to treatment adherence. My proposed research will elucidate an understanding of risk factors for gastric cancer among the Navajo, a population experiencing a high disease burden, with the goal of developing interventions to improve cancer outcomes, in alignment with the mission of the NCI and NIH.

项目摘要 胃癌是全球第五大癌症，每年占780,000人死亡。在美国， 在西南的美洲印第安人（AI）中，胃癌的重大负担仍在 阿拉斯加原住民。纳瓦霍民族（Navajo Nation）是西南部的一个部落，正在经历更高的胃癌发病率 与该地区的一般人群相比，可能是由于幽门螺杆菌的高患病率（H. 幽门螺杆菌感染和其他促成因素，例如饮食。幽门螺杆菌菌株在毒力的产生中有所不同 幽门螺杆菌与胃癌之间的因果关系已被认为是因素。特别是，细胞毒素 - 相关的基因A（CAGA）及其致病性岛功能共同将CAGA蛋白传递到宿主细胞中 促进炎症和胃癌。饮食高盐和加工肉，水果低的饮食 蔬菜与改变胃的保护性衬里进一步相关并增强表达 卡加。因此，必须了解幽门螺杆菌和饮食对预防胃癌的作用。尽管 可以提供各种幽门螺杆菌感染的治疗选择 依从性和临床水平障碍，进一步导致持续感染并增加了费用。然而， 纳瓦霍民族的治疗失败尚不清楚。我的方法使我能够利用我以前的 与AI部落合作以确定胃癌的危险因素并确定减少策略的经验 他们。我将使用Navajo Healthcare系统在成年人中实施研究。我的目标是两个 折叠。首先，在肠道五期，我将确定患病率，毒力和饮食相关性 纳瓦霍人成年人中幽门螺杆菌感染。第二，在博士后K00阶段，我将表征风险 幽门螺杆菌再感染和幽门螺杆菌治疗的患者经历的因素。实现这些 目标，我将利用以前进行健康评估的经验来执行横断面 研究幽门螺杆菌感染，CAGA毒力基因状况以及饮食的研究， 粪便标本的实验室分析（F99）。然后，我将在幽门螺杆菌和以前的幽门螺杆菌中使用我获得的专业知识 具有定性研究的经验，以确定幽门螺杆菌的再感染风险和治疗依从性的障碍 使用定量和定性研究方法（K00）。我将通过以下来检验我的假设 目的：目标1：测试幽门螺杆菌感染，尤其是CAGA基因，在纳瓦霍人的成年人中非常普遍 与其他非AI人群相比，盐，加工肉和蔬菜低的饮食是 与幽门螺杆菌感染风险相关。 AIM 2：测试患者慢性健康状况与H有关。 幽门螺杆菌再感染风险，并获取有关患者级和机构水平治疗障碍的信息 坚持。我提出的研究将阐明对胃癌危险因素的理解 纳瓦霍人是疾病负担高的人口，目的是制定干预措施以改善 与NCI和NIH的任务保持一致的癌症结果。