Infant diet and cardiometabolic risk among children born preterm

早产儿的婴儿饮食和心脏代谢风险

• 批准号: 10716587
• 负责人: Mandy Brown Belfort
• 金额: $ 75.31万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-23 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10716587
• 关键词: 2 year old; 5 year old; Acceleration; Address; Age; American Heart Association; Biological Markers; Biometry; Birth; Brain; C-reactive protein; Cardiology; Cardiometabolic Disease; Child; Childhood; Chronic; Clinical; Clinical Trials; Collaborations; Conceptions; Data; Development; Developmental Process; Diabetes Mellitus; Diet; Discipline of obstetrics; Disease; Endocrinology; Energy Intake; Ensure; Exhibits; Fatty acid glycerol esters; Fetal Development; Fetus; Future; Glucose; Goals; Growth; Health; Hospitalization; Hospitals; Human Milk; Hypertension; Impairment; Individual; Infant; Insulin; Intake; Intervention; Intervention Trial; Leptin; Life; Life course epidemiology; Lipids; Macronutrients Nutrition; Malnutrition; Measures; Metabolic syndrome; Monitor; Morbidity - disease rate; Neonatal Intensive Care Units; Neonatology; Nutrient; Nutritional Support; Obesity; Outcome; Participant; Pattern; Physiology; Population; Pregnancy; Premature Infant; Preventive; Proteins; Randomized, Controlled Trials; Recommendation; Recording of previous events; Research; Risk Factors; Serum; Survivors; Testing; Third Pregnancy Trimester; Visit; Vulnerable Populations; Weight Gain; Work; adiponectin; blood pressure reduction; cardiometabolic risk; cardiometabolism; cardiovascular health; clinical care; cohort; design; dietary; early childhood; experience; extreme prematurity; follow-up; fortification; improved; infant nutrition; infant outcome; innovation; meetings; metabolomics; modifiable risk; neonatal care; neurodevelopment; obesity risk; obstetric care; point of care; postnatal; protein intake; public health relevance; standard of care; targeted delivery; theories; young adult

Project Summary / Abstract Each year, over 63,000 U.S. infants are born very preterm, prior to 32 weeks of gestation. With >90% now surviving to discharge due to better obstetrical and neonatal intensive care unit (NICU) management, the present challenge is to reduce short- and long-term morbidities experienced by survivors, including the two- to four-fold increased risk of obesity, diabetes, hypertension, and metabolic syndrome that manifest by young adulthood. The Developmental Origins of Health and Disease (DOHaD) framework posits that chronic conditions result from adverse exposures during vulnerable developmental stages known as “critical” or “sensitive” periods. Of particular importance is the first 1000 days of life, when key developmental processes set the stage for lifelong health. Very preterm infants are an especially vulnerable population, as they require NICU support for 2-4 months after birth, coinciding with the 3rd trimester – an established sensitive period for programming of obesity and cardiometabolic risk. In this context, the most highly modifiable and relevant exposure is diet during the NICU hospitalization, which may contribute to the accelerated accretion of fat mass relative to fat-free mass. Hospitalized very preterm infants typically experience impaired weight gain, stunted linear growth, and excess fat accretion relative to the typical fetus. To offset these issues and support brain development, dietary fortification of human milk is provided as standard of care. However, the consequences of dietary fortification for cardiometabolic health in this population are poorly understood. This proposal seeks to uncover the extent to which diet-based interventions that promote physical growth and brain development during a sensitive period may also contribute to cardiometabolic risk. We will study 130 infants born 24-31 weeks of gestation who are participating in the Nourish Study (R01HD097327l; PI: Belfort), an ongoing randomized controlled trial testing the effect of individually targeted human milk fortification vs. standard of care during the NICU hospitalization. By extending follow-up of this cohort and adding cardiometabolic biomarkers at 2 and 5 years of age, we have a unique opportunity to investigate how macronutrient and energy delivery during a sensitive period contributes to, or protects from, cardiometabolic risk during childhood. We are further poised to address key questions about NICU growth patterns in relation to cardiometabolic health in this population. Findings from this work have strong potential to impact clinical care by informing dietary strategies during a sensitive window in development to optimize lifelong health for a vulnerable population.

项目概要/摘要 每年，超过 63,000 名美国婴儿在妊娠 32 周之前就早产了，目前比例超过 90%。 由于产科和新生儿重症监护病房 (NICU) 管理更好，患者得以出院 目前的挑战是减少幸存者经历的短期和长期发病率，包括两到 年轻人患肥胖、糖尿病、高血压和代谢综合征的风险增加四倍 健康与疾病的发育起源（DOHaD）框架认为，慢性疾病 因脆弱发育阶段（称为“关键”或“危险”）的不利暴露而导致的状况 “敏感”期特别重要的是生命的前 1000 天，这是关键的发育过程。 为终生健康奠定基础 极早产儿是特别脆弱的人群，因为他们需要。 出生后 2-4 个月的新生儿重症监护室 (NICU) 支持，恰逢妊娠第三期——一个既定的敏感期 在这种情况下，肥胖和心脏代谢风险的规划是最具可修改性和相关性的。 NICU住院期间暴露的饮食可能会加速脂肪量的增加 相对于无脂肪体重，住院的早产儿通常会出现体重增加受损、发育迟缓的情况。 相对于典型胎儿的线性生长和过多的脂肪堆积来抵消这些问题并支持大脑。 发展中，母乳膳食强化被作为标准护理提供，然而，其后果也随之而来。 该提案寻求的膳食强化对心脏代谢健康的影响知之甚少。 揭示基于饮食的干预措施在多大程度上促进身体生长和大脑发育 我们将研究 130 名 24-31 岁出生的婴儿。 参加滋养研究（R01HD097327l；PI：贝尔福特）的妊娠周数，这是一项正在进行的研究 随机对照试验测试单独针对性母乳强化与标准母乳强化的效果 NICU 住院期间的护理 通过延长该队列的随访并增加心脏代谢。 2 岁和 5 岁时的生物标志物，我们有一个独特的机会来研究宏量营养素和能量如何 在敏感时期分娩有助于或预防儿童时期的心脏代谢风险。 进一步准备解决有关 NICU 增长模式与心脏代谢健康相关的关键问题 这项工作的结果有很大潜力通过告知饮食来影响临床护理。 在敏感的发展窗口期制定战略，以优化弱势群体的终身健康。