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

基本信息

批准号：
10626721
负责人：
Jorge Eduardo Chavarro
金额：
$ 64.58万
依托单位：
HARVARD PILGRIM HEALTH CARE, INC.
依托单位国家：
美国
项目类别：
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/10626721
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

项目摘要

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.

项目概要/摘要此应用程序响应 PA-17-091：生育状态作为整体健康的标志在育龄期间，许多女性会经历体重大幅增加、骨密度下降和肌肉质量和心脏代谢健康恶化，每一个都预示着晚年的发病率和死亡率。女性在此生命阶段经历过一次或多次怀孕，并且很大一部分女性（高达 1/3），包括许多曾经成功怀孕并怀孕过的人都经历过生育能力低下或不孕。不孕症的定义是在无保护性交 12 个月后无法怀孕，因此是一种越来越多的证据表明，生育能力是育龄成年人中最常见的情况。相关特征预测未来的健康风险，包括体重过度增加、骨质疏松症、心血管疾病疾病（CVD）和2型糖尿病。我们提出的项目的总体目标是检验我们的假设，即有证据表明生育能力受损的女性围绝经期会出现更不利的身体成分、骨骼健康和心脏代谢结果。提出前瞻性纵向队列研究设计作为实现拟议目标的最佳方法。我们将利用 Project Viva 的数据，该项目是一个由超过 1000 名社会人口组成的高度参与的现有群体我们已经从不同的女性那里收集了有关体重、饮食和其他健康的详细信息行为从 1999 年至 2002 年入学时开始，并自此不断更新。暴露情况是通过经过验证的自我报告、临床或研究措施进行评估的，其中包括若干项生育力的时间更新标记：受孕周期和产次；不孕症诊断和治疗；多囊卵巢综合征 (PCOS) 的诊断以及睾酮的测量（睾酮的定义） PCOS 的特征；以及抗苗勒氏管激素 (AMH) 的水平，这是卵巢储备的客观标志。结果包括身体成分指标（脂肪、瘦肉和骨量）、心血管健康和代谢健康状况，并将在亲自研究访问中使用黄金标准措施进行评估。研究开始时，我们还严格收集了一系列广泛的行为、健康措施、环境因素、社会和家庭经历。拟议的一系列调查结果将为女性生殖系统的临床护理提供信息围绝经期数年、筛查和长期随访指南以及未来研究该提案提供了一个利用现有优秀数据和优先事项的绝佳机会。资源，包括 5 年项目期内 20 多年的高质量前瞻性评估。