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 胃癌是全球第五大常见癌症，每年导致 78 万人死亡。在美国， 在西南地区的美洲印第安人 (AI) 中继续观察到胃癌的巨大负担 阿拉斯加原住民。西南部的纳瓦霍族部落胃癌发病率较高 与该地区的一般人群相比，可能是由于幽门螺杆菌（H. 幽门螺杆菌）感染和其他影响因素，例如饮食。产生毒力不同的幽门螺杆菌菌株 幽门螺杆菌与胃癌之间存在因果关系。特别是细胞毒素—— 相关基因 A (cagA) 及其致病岛共同发挥作用，将 CagA 蛋白传递到宿主细胞中 促进炎症和胃癌。饮食中盐和加工肉类含量高，水果和肉类含量低 蔬菜还与改变胃的保护层和增强表达有关 的cagA。因此，了解幽门螺杆菌和饮食对于预防胃癌的作用至关重要。尽管 幽门螺杆菌感染有多种治疗方案，但由于患者的不同，它们并不总是成功。 依从性和临床水平的障碍，进一步导致持续感染和增加费用。然而， 纳瓦霍族的治疗失败情况尚不清楚。我的方法使我能够利用我以前的 与人工智能部落合作确定胃癌危险因素并确定减少胃癌风险的策略的经验 他们。我将在使用纳瓦霍医疗系统的成年人中实施我的研究。我的目标有两个—— 折叠。首先，在博士前F99阶段，我将确定患病率、毒力和饮食相关性 纳瓦霍成年人中幽门螺杆菌感染的情况。二、在博士后K00阶段，我会表征风险 幽门螺杆菌再感染的因素以及患者接受幽门螺杆菌治疗的经历。为了实现这些 为了实现目标，我将利用我之前进行健康评估的经验来执行一项横断面的评估 通过健康和饮食调查来测量幽门螺杆菌感染、cagA 毒力基因状态和饮食的研究 粪便标本的实验室分析（F99）。然后，我将利用我在幽门螺杆菌和以前获得的专业知识 确定幽门螺杆菌再感染风险和治疗依从性障碍的定性研究经验 使用定量和定性研究方法（K00）。我将通过以下方式检验我的假设 目标：AIM 1：测试幽门螺杆菌感染，尤其是 cagA 基因，在纳瓦霍成年人中非常普遍 与其他非人工智能人群相比，高盐、加工肉类和低蔬菜的饮食 与幽门螺杆菌感染风险相关。目标 2：测试患者的慢性健康状况是否与幽门螺杆菌相关。 幽门螺杆菌再感染风险，并获取有关患者层面和机构层面治疗障碍的信息 坚持。我提出的研究将阐明人们对胃癌危险因素的理解 纳瓦霍族是一个疾病负担较高的群体，目标是制定干预措施以改善 癌症结果，与 NCI 和 NIH 的使命保持一致。