A lifecourse approach to women's cardiometabolic and bone health: from fertility to perimenopause

女性心脏代谢和骨骼健康的生命全程方法：从生育到围绝经期

• 批准号: 10728449
• 负责人: Jorge Eduardo Chavarro
• 金额: $ 18.43万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-10 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10728449
• 关键词: Address; Adult; Age; American Heart Association; Anthropometry; Behavior; Biological Markers; Blood Pressure; Body Composition; Bone Density; Cardiovascular Diseases; Cessation of life; Characteristics; Child; Child Health; Clinical; Complex; Conceptions; Data; Diabetes Mellitus; Diagnosis; Diet; Early identification; Elderly; Enrollment; Environmental Risk Factor; Family; Fasting; Fatty acid glycerol esters; Feedback; Fertility; Funding; Future; Gestational Diabetes; Glucose; Goals; Gravidity; Guidelines; Hand; Hand Strength; Health; Health behavior; Height; High Density Lipoprotein Cholesterol; Hour; Hypertension; Impairment; Infertility; Inflammation; Insulin; Intervention; Investigation; Life; Life Cycle Stages; Linear Regressions; Lipids; Logistic Regressions; Longitudinal Studies; Longitudinal cohort study; Longterm Follow-up; Maternal Health; Measurement; Measures; Mediating; Menopause; Metabolic; Metabolic syndrome; Methods; Modeling; Modernization; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; OGTT; Obesity; Osteoporosis; Outcome; Outcome Assessment; Patient Self-Report; Perimenopause; Perinatal; Persons; Plasma; Polycystic Ovary Syndrome; Postpartum Period; Predisposition; Pregnancy; Pregnancy Complications; Research; Research Design; Research Priority; Resources; Risk; Risk Factors; Roentgen Rays; Series; Statistical Data Interpretation; Testing; Testosterone; Thinness; Time; Triglycerides; Unsafe Sex; Update; Visit; Weight; Weight Gain; Woman; adipokines; bone health; bone mass; bone turnover; cardiometabolic risk; cardiometabolism; cardiovascular health; causal model; clinical care; cohort; disability; early pregnancy; excessive weight gain; experience; fasting glucose; follow-up; gestational weight gain; high risk; mortality; mullerian-inhibiting hormone; muscle form; ovarian reserve; parity; pregnancy hypertension; preventive intervention; prospective; recruit; reduced muscle mass; reproductive; screening; social; sociodemographics; standard measure; subfertility; waist circumference

Project Summary/Abstract This application is responsive to PA-17-091: Fertility Status as a Marker for Overall Health Across their reproductive years, many women experience substantial weight gain, declines in bone density and muscle mass, and worsening cardiometabolic health, each predicting later life morbidity and mortality. Most women have one or more pregnancies during this lifestage, and a large subset of women (up to 1/3), including many who have successfully conceived and carried a previous pregnancy, experience subfertility or infertility. Infertility, defined as the inability to conceive after 12 months of unprotected intercourse, is thus one of the most common conditions among reproductive age adults. A growing body of evidence suggests that fertility- related characteristics predict future health risks including excess weight gain, osteoporosis, cardiovascular disease (CVD), and type 2 diabetes mellitus. The overall goal of our proposed project is to test our hypothesis that women with evidence of impaired fertility will have more adverse body composition, bone health, and cardiometabolic outcomes in perimenopause. We propose a prospective longitudinal cohort study design as the optimal approach to address the proposed aims. We will leverage data from Project Viva, a highly engaged existing cohort of over 1000 socio-demographically diverse women from whom we have already collected detailed information on weight, diet, and other health behaviors beginning at enrollment in 1999-2002, and updated continually since. Exposures are assessed with validated self-reported, clinical, or research measures and will include several time-updated markers of fertility: cycles to conception; gravidity and parity; infertility diagnoses and treatments; diagnosis of polycystic ovary syndrome (PCOS) as well as measurement of testosterone, a defining characteristic of PCOS; and levels of anti-Müllerian hormone (AMH), an objective marker of ovarian reserve. Outcomes include markers of body composition (fat, lean, and bone mass), cardiovascular health, and metabolic health and will be assessed using gold-standard measures at an in-person research visit. Since study inception, we have also rigorously collected data on a wide set of behaviors, health measures, environmental factors, and social and family experiences. Results from the proposed series of investigations will inform clinical care for women from the reproductive years through perimenopause, guidelines regarding screening and long-term follow-up, and future research priorities. This proposal provides an exceptional opportunity to leverage outstanding existing data and resources and include over 20 years of high quality prospective assessments within a 5-year project period.

项目摘要/摘要 该申请对PA-17-091的响应敏感：生育状况作为整体健康的标记 在繁殖年份中，许多女性体重增加，骨密度下降和 肌肉质量和令人担忧的心脏代谢健康，每个人都可以预测以后的生命发病率和死亡率。最多 妇女在这种生命期间有一个或多个妊娠，其中大部分女性（最多1/3），包括 许多成功构思并怀孕的人，经历了不育或不育。 因此，不育症被定义为在12个月未经保护的性交后无法受孕，因此是 生殖年龄成年人中最常见的条件。越来越多的证据表明生育能力 相关特征预测未来的健康风险，包括体重增加过多，骨质疏松症，心血管 疾病（CVD）和2型糖尿病。 我们提议的项目的总体目标是检验我们的假设，即有生育能力证据的妇女 在末期中将具有更多不良身体组成，骨骼健康和心脏代谢结果。 提出一种前瞻性纵向队列研究设计，作为解决拟议目的的最佳方法。 我们将利用Project Viva的数据，这是一个高度参与1000多个社会人口统计学的人口 我们已经收集了有关体重，饮食和其他健康的详细信息的多样化女性 行为始于1999 - 2002年的入学人数，从那以后不断更新。 通过经过验证的自我报告，临床或研究措施评估暴露措施，并将包括几个 肥沃的时间标记：概念的周期；急性和平等；不育诊断和治疗； 诊断多囊卵巢综合征（PCOS）以及睾丸激素的测量 PCOS的特征；卵巢储备的客观标志物和抗穆勒激素（AMH）的水平。 结果包括身体成分（脂肪，瘦和骨骼质量），心血管健康和 代谢健康，将在亲自研究访问中使用金标准测量进行评估。自从 研究成立，我们还严格收集了有关广泛行为，健康措施， 环境因素以及社会和家庭经验。 拟议的一系列调查的结果将为复制品女性的临床护理提供信息 通过围绝经期的几年，有关筛查和长期随访的指南以及未来的研究 优先事项。该提案提供了一个极好的机会，可以利用未偿还的现有数据和 资源，包括超过20年的高质量预期评估。