Identifying Risk for Diabetes and Heart Disease in Women: A Study of African-American, African and White Federal Employees and Contractors

识别女性糖尿病和心脏病的风险：针对非裔美国人、非洲人和白人联邦雇员和承包商的研究

• 批准号: 9356248
• 负责人: Anne Sumner
• 金额: $ 31.85万
• 依托单位: NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9356248
• 关键词: Accounting; Acculturation; Acute; Adipose tissue; African; African American; Age; Anemia; Area; Body fat; Cardiovascular Diseases; Clinical Protocols; Contractor; Data Set; Diabetes Mellitus; Diet; Disease; District of Columbia; Early Intervention; Employee; Enrollment; Ensure; Ethnic Origin; Exercise; Family history of; Fasting; Fatty acid glycerol esters; Federal Government; Genetic; Glucose; Goals; Guidelines; Health; Health Insurance; Heart Diseases; Hepatic; High Prevalence; Hyperinsulinism; Immigrant; Insulin; Insulin Resistance; Insurance Coverage; Intravenous; Knowledge; Lead; Life Style; Non-Insulin-Dependent Diabetes Mellitus; Nutritional; Occupational; Oral; Participant; Pathway interactions; Physical activity; Population; Positioning Attribute; Prediabetes syndrome; Primary Prevention; Psychosocial Factor; Race; Recruitment Activity; Resources; Risk Factors; Socioeconomic Status; Testing; Therapeutic; Triglycerides; Visceral; Vitamin D; Woman; Women' s Health; Work; bone health; cardiometabolic risk; cohort; collaborative environment; diabetes risk; diagnostic screening; disorder prevention; efficacy testing; ethnic difference; fasting glucose; glucose production; health care availability; health difference; health disparity; health literacy; high risk; improved; indexing; insulin secretion; insulin sensitivity; low socioeconomic status; metropolitan; novel; primary outcome; proctolin; racial difference; response; screening; socioeconomics; trend

The Federal Women Study is an active clinical protocol aimed at recruiting 360 federal employees and contractors working in the Washington DC metropolitan area. One hundred and nine women (56% African-American, 17% African immigrant and 31% white) have been screened (age 449, range 24-62 years). Thirty percent of women had anemia and this was the most common reason that screened women were not enrolled. Among the enrolled women, the three groups are well matched by race/ethnicity for key socio-economic and demographic risk factors such as educational attainment, family history of diabetes and physical activity. Yet, we have already identified pre-diabetes in 39% of women (42% African-American, 13% African immigrant and 29% white). Therefore, this cohort reflects women who are at high risk for diabetes and heart disease and an excellent group in which to (a) test the efficacy of existing screening tests and (b) understand the pathophysiological progression of cardiometabolic disease by race/ethnicity. As current cardiometabolic screening tests are centered on triglyceride and fasting glucose concentrations, we have employed two approaches to examine these risk factors. The Relationship of Triglycerides with Insulin Resistance and Hyperinsulinemia This study will compare by race/ethnicty and continent of origin, the relationship of triglyceride concentration to key cardiometabolic risk factors, specifically diet, physical activity, insulin resistance (and hyperinsulinemia) and hepatic fat content. We have found so far that consistent with our hypothesis, fasting triglyceride concentrations are lowest in African immigrant and highest in white women (AI: 5312 vs. AA: 6733 vs. WW: 8334 mg/dL, P<0.01) with a trend for lower insulin sensitivity index (AI: 3.11.7 vs. AA: 2.51.6 vs. WW: 3.42.2 mU/L-1min-1, P=0.20) and greater acute insulin response to glucose (AI: 895528 vs. AA: 959790 vs. WW: 561429 mU/L, P=0.07) in African-American women. Analysis of the relationship of hepatic fat content with insulin resistance is underway. In regard to total percent fat there were no differences by race/ethnicity but differences in body fat distribution were clear, specifically visceral adipose tissue (VAT) volume (VAT; AI: 4836 vs. AA: 8642 vs. WW: 11854 cm3, P=0.001). To further characterize the contribution of insulin secretion, insulin clearance and prandial gut factors to race/ethnic differences in hyperinsulinemia, we are comparing insulin response to oral, intravenous and prandial glucose loads. Preliminary findings suggest racial differences in early postprandial glucose response. African descent women have paradoxically greater postprandial insulin concentrations but lower glucose response and we are exploring further the quantitative contribution of incretin concentrations to hyperinsulinemia. We plan to continue recruitment and look forward to an expanded dataset with interim analyses of our primary outcome variable, triglyceride concentration, with key modifying factors (diet composition, physical activity, insulin sensitivity indices and hepatic fat). These analyses should provide population-specific evidence which elucidate important pathophysiological pathways and ultimately lead to enhanced screening and diagnostic guidelines which have the potential to minimize diabetes related health disparities worldwide.

联邦妇女研究是一项积极的临床协议，旨在招募华盛顿特区大都会地区工作的360名联邦雇员和承包商。已经筛选了一百九名妇女（56％的非裔美国人，17％的非洲移民和31％的白人）（年龄449岁，范围24 - 62年）。 30％的女性患有贫血，这是筛查女性未入学的最常见原因。在注册妇女中，这三个群体与关键的社会经济和人口危险因素（例如教育程度，糖尿病家族史和体育锻炼家族史）相吻合。但是，我们已经确定了39％的妇女（42％的非裔美国人，13％的非洲移民和29％的白人）的糖尿病前期。 因此，该队列反映了患有糖尿病和心脏病的高风险的女性，以及（a）测试现有筛查测试功效的出色群体，以及（b）通过种族/族裔了解心脏代谢疾病的病理生理进展。由于当前的心脏代谢筛查测试以甘油三酸酯和禁食葡萄糖浓度为中心，因此我们采用了两种方法来检查这些危险因素。 甘油三酸酯与胰岛素抵抗和高胰岛素血症的关系 这项研究将比较种族/人口化的原产地，甘油三酸酯浓度与关键心脏代谢危险因素的关系，特别是饮食，身体活动，胰岛素抵抗（和高胰岛素血症）和肝脂肪含量。到目前为止，我们已经发现与我们的假设一致，禁食甘油三酸酯的浓度在非洲移民中最低，白人女性最高（AI：5312 vs. AA：6733 vs. WW：8334 mg/dl，p <0.01），趋势降低了胰岛素敏感性Index（AI：3.11.7 vss.2.7 v.51：aa aa aa aa aa aa aa aa aa aa aa a a a a a a a aa：aa：6733 vs. ww：8334 mg/dl. 0.01）。 MU/L-1MIN-1，p = 0.20）和对葡萄糖的急性胰岛素反应更大（AI：895528 vs. AA：959790与WW：561429 MU/L，P = 0.07）在非洲裔美国妇女中。 正在进行对肝脂肪含量与胰岛素抵抗的关系的分析。关于总脂肪百分比，种族/种族没有差异，但是人体脂肪分布的差异是明显的，特别是内脏脂肪组织（VAT）体积（VAT； AI：AI：4836 vs. AA：8642：8642 vs. ww：11854 cm3，p = 0.001）。 为了进一步表征胰岛素分泌的贡献，胰岛素清除率和奶油肠道因素对高胰岛素血症的种族/族裔差异，我们正在比较胰岛素对口服，静脉注射和巧妙的葡萄糖负荷的反应。初步发现表明餐后早期葡萄糖反应的种族差异。非洲血统的妇女在餐后胰岛素浓度较高，但葡萄糖反应较低，我们正在进一步探索降量蛋白浓度对高胰岛素血症的定量贡献。我们计划继续招募，并期待扩展的数据集，并通过对主要结果变量，甘油三酸酯浓度进行临时分析以及关键的修饰因素（饮食组成，体育锻炼，胰岛素敏感性指数和肝脂肪）。 这些分析应提供特定于人群的证据，以阐明重要的病理生理途径，并最终导致增强的筛查和诊断准则，这些准则有可能最大程度地减少与糖尿病相关的健康差异。