The Development of Early Childhood Obesity in Children Born Preterm

早产儿早期肥胖的发展

• 批准号: 9112267
• 负责人: Sarah Keim
• 金额: $ 7.48万
• 依托单位: RESEARCH INST NATIONWIDE CHILDREN'S HOSP
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-22 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9112267
• 关键词: 3 year old; Age; Anxiety; Attention; Birth; Body mass index; Cardiovascular Diseases; Caring; Child; Clinical; Coupled; Data; Data Set; Development; Diagnosis; Elderly; Ensure; Environment; Epidemic; Evidence based intervention; Family; Future; Goals; Growth; Individual; Intervention; Knowledge; Length; Life; Longitudinal Studies; Low Birth Weight Infant; Measures; Medical; Medical Records; Mental Depression; Mission; Modeling; Nature; Neonatal; Obesity; Overweight; Patients; Pediatric Hospitals; Population; Premature Birth; Premature Infant; Prevalence; Prevention; Prevention strategy; Provider; Public Health; Quality of life; Records Controls; Research; Risk; Sampling; Small for Gestational Age Infant; Statistical Methods; Stress; Testing; Time; United States National Institutes of Health; Visit; Weight; base; body system; burden of illness; clinical care; clinical practice; cohort; cost; early childhood; evidence base; innovation; kindergarten; obesity in children; obesity prevention; obesogenic; patient population; pediatric patients; premature; prevent; programs; psychosocial; public health relevance; research clinical testing; screening; social; socioeconomics; tool

 DESCRIPTION (provided by applicant): Facilitating catch-up growth and preventing growth faltering is a major component of clinical care for children born preterm to at least age two. However, our preliminary data suggest that obesity is a major, under- recognized problem in the preterm population and likely emerges differently than for children born at term. Obesity has harmful consequences for children born preterm, far greater than the consequences for children born at term. Without knowledge to fill gaps about the extent, nature, and timing of obesity development and how consistently obesity is recognized in clinical care, tailored prevention strategies cannot be developed to help clinicians and families promote adequate growth while preventing excess growth among preterm children. The long-term goal, which will be the subject of a subsequent R01 application, is to develop evidence-based strategies tailored to preterm children to guide clinicians and families in preventing overweight and obesity. The objective of the study proposed in this R03 application, which is the next step towards that goal, is to apply cutting edge statistical methods to determine the prevalence and timing of the development of overweight and obesity in early childhood among preterm children, as compared to term children, to identify optimal intervention windows, and to document the extent of under-recognition of obesity during clinical care in a longitudinal sample of more than 16,000 children. The central hypothesis is: as compared to children born at term, growth trajectories will differ most especially before age 3 among preterm children but overweight and obesity will be nearly as prevalent by ages 4-6, and that obese children born preterm will be less likely to have an obesity diagnosis. The hypothesis was formulated based on data from historic low birth weight cohorts and our preliminary data. The rationale for the proposed study is to support the development of evidence-based interventions targeting sensitive periods to prevent overweight and obesity in children born preterm. The hypothesis will be tested by pursuing two specific aims: 1) Identify critical windows for obesity prevention by characterizing growth trajectories from birth to age 6 for children born preterm, and contrasting these with trajectories for children born at term, to compare the prevalence and timing of the development of overweight and obesity, and 2) Determine the extent of obesity under-diagnosis among children born preterm, as compared to children born at term. The approach will be a longitudinal study of more than 16,000 children from birth to age 6, patients of primary and subspecialty care providers at a major free-standing children's hospital. The proposed research is innovative because it will apply state-of-the-art analytic tools to model growth trajectories in a modern sample, using a detailed, research-ready longitudinal growth dataset based in a very large pediatric patient population, including children born preterm and at term, with an average of more than 13 measures before age six. The proposed research is significant because it is the next step in devising strategies to help clinicians and families promote healthy growth in children born preterm while preventing obesity.

 描述（由申请人提供）：促进追赶性生长和防止生长迟缓是早产至至少两岁儿童的临床护理的一个主要组成部分。然而，我们的初步数据表明，肥胖是一个主要的、未被充分认识的问题。早产儿的情况可能与足月出生的儿童不同 肥胖对早产儿的有害后果远远大于足月儿出生的后果。以及如何由于肥胖在临床护理中得到了一致认可，因此无法制定量身定制的预防策略来帮助 Newton 和家庭促进充分生长，同时防止早产儿过度生长。长期目标（将成为后续 R01 应用的主题）是开发。为早产儿量身定制的循证策略，指导天主教徒和家庭预防超重和肥胖。R03 申请中提出的研究目标是应用尖端统计方法来确定患病率，这是实现该目标的下一步。以及超重和肥胖发生的时间与足月儿童相比，早产儿的童年早期，以确定最佳干预窗口，并记录在超过 16,000 名儿童的纵向样本的护理过程中对肥胖临床认识不足的程度。对于足月出生的儿童，生长轨迹差异最大，尤其是在早产儿 3 岁之前，但超重和肥胖在 4-6 岁时几乎同样普遍，并且早产儿肥胖诊断的可能性较小。曾是根据历史低出生体重群体的数据和我们的初步数据制定的，该研究的基本原理是支持针对敏感期预防早产儿超重和肥胖的循证干预措施的制定。该假设将得到检验。追求两个具体目标：1) 通过描述早产儿从出生到 6 岁的生长轨迹，并将其与儿童的轨迹进行对比，确定预防肥胖的关键窗口 足月出生的儿童，比较超重和肥胖的发生率和时间，以及 2) 与足月出生的儿童相比，确定早产儿肥胖诊断不足的程度。该方法将是一项纵向研究。一家大型独立儿童医院的初级和亚专科护理人员的患者超过 16,000 名从出生到 6 岁的儿童。拟议的研究具有创新性，因为它将应用最先进的分析工具来模拟生长。使用基于大量儿科患者群体（包括早产儿和足月儿）的详细的、可用于研究的纵向生长数据集，在现代样本中绘制轨迹，在 6 岁之前平均测量超过 13 项。因为这是制定战略的下一步，帮助忠诚者和家庭促进早产儿的健康成长，同时预防肥胖。