Dynamics and Health Consequences of Obesity between Infancy and Young Adulthood in the United States

项目摘要 相关性：在美国，大约1/3的成年人和1/5的儿童和青少年肥胖， 弱势群体受到的影响尤为严重。在生命早期体重迅速过度增加， 转化为持续性肥胖，这可能反过来与一些健康问题的早期发生有关。 并发症因此，肥胖时间的差异可能是种族、民族、社会经济和 在人的一生中，健康方面的区域差距会扩大。答：我们的研究将测量动态 儿童期、青春期和成年早期的体重状况，并将这些动态与随后的 健康成果。我们的研究的一个关键贡献是谨慎和明智地使用统计技术， 联合收割机将现有的高质量国家纵向队列合并为一个超过90 000人的综合队列， 从出生到55岁，反映了最近的经历。目标：1）估计总体和亚群 肥胖的动态，包括肥胖发作的年龄和时间、年龄特异性发病率、肥胖持续时间和 强度，体重波动和累积暴露于不健康的体重。2)计算子群体 当代美国儿童、青少年和青年时期高BMI的累积暴露 同伙3)估计在生命的前几十年暴露于高BMI之间的个体关联， 成人健康，特别是糖尿病，心血管，代谢和胃肠道疾病和生活质量， 量化生命早期肥胖动力学对健康的影响。4)估计肥胖差异的贡献 动态在生命早期的差异，在其他健康结果的种族，社会经济地位和城市群体。第五章） 开发一个模拟模型，模拟减少儿童肥胖对国家肥胖负担的影响。 成人疾病和疾病差异。设计：我们将把7个数据集整合成一个全国性的数据集- 代表性的合成队列。我们将使用最近测试的方法来模拟多个维度， 重量动力学我们将估计肥胖的平均年数，以及对肥胖的持续测量。 BMI年我们将个人的肥胖史与健康并发症联系起来，使用添加剂，持续时间，峰值 BMI和体重变化模型。我们将分别评估服务不足的种族-民族， SES和农村人口，并将使用分解方法来量化这些因素的贡献。 健康状况的差异。我们将开发一个“宏观模拟”，使我们能够评估 儿童和青少年关键时期肥胖发生率的降低对全国患病率的影响 成年期的肥胖、成年期的健康并发症以及种族、民族、社会经济和城市化 肥胖和其他慢性病的差异。意义：建立一个综合的国家 队列研究解决了缺乏全国代表性数据来跟踪从儿童到成年的肥胖问题。 成年我们的研究将提供第一套全面的估计暴露于肥胖的过程中， 生命的最初几十年及其对健康的贡献以及生命周期中健康状况的差异。

PROJECT SUMMARY RELEVANCE: About 1/3 of adults and 1/5 of children and adolescents in the U.S. are obese, with socially disadvantaged individuals being disproportionately affected. Rapid, excessive weight gain in early life often translates into persistent obesity, which may be in turn be associated with earlier onset of several health complications. Differences in obesity timing thus may be a vital way in which race-ethnic, socioeconomic and regional disparities in health widen over the life course. OBJECTIVES: Our study will measure the dynamics of weight status during childhood, adolescence, and young adulthood and link these dynamics with subsequent health outcomes. A key contribution of our study is the careful and judicious use of statistical techniques to combine existing high-quality national longitudinal cohorts into a synthetic cohort of over 90,0000, followed from birth to age 55, reflective of recent experiences. AIMS: 1) Estimate the overall and sub-population dynamics of obesity, including the age and timing of obesity onset, age-specific incidence, obesity duration and intensity, weight fluctuations, and cumulative exposure to unhealthy weight. 2) Calculate the sub-population cumulative exposure to high BMI during childhood, adolescence and young adulthood for contemporary U.S. cohorts. 3) Estimate individual associations between exposure to high BMI across the first decades of life and adult health, specifically diabetes, cardiovascular, metabolic, and gastrointestinal diseases and quality of life, to quantify the health effects of early-life obesity dynamics. 4) Estimate the contribution of disparities in obesity dynamics early in life to disparities in other health outcomes across race-ethnic, SES, and urbanicity groups. 5) Develop a simulation to model the effects of interventions to reduce childhood obesity on national burdens of adult disease and disparities in disease. DESIGN: We will integrate 7 datasets into a single nationally- representative synthetic cohort. We will use recently-tested approaches to model multiple dimensions of weight dynamics. We will estimate the average number of years spent obese, as well as a continuous measure of BMI-years. We will link an individual’s obesity history with health complications using additive, duration, peak BMI, and weight change models. We will evaluate obesity dynamics separately in underserved race-ethnic, SES, and rural populations and will use decomposition approaches to quantify the contributions of these dynamic to disparities in health conditions. We will develop a “macro-simulation” that allows us to assess the impact of reductions in obesity incidence at key points in childhood and adolescence on the national prevalence of obesity in adulthood, health complications in adulthood, and race, ethnic, socioeconomic and urbanicity disparities in obesity and other chronic conditions. SIGNIFICANCE: The creation of a synthetic national cohort addresses the critical absence of nationally representative data to track obesity from childhood into adulthood. Our research will provide the first comprehensive set of estimates of exposure to obesity during the first decades of life and their contribution to health and disparities in health over the lifespan.