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

项目总结 相关性：在美国，大约三分之一的成年人和五分之一的儿童和青少年患有肥胖症， 处于不利地位的个人受到不成比例的影响。早期生活中体重快速、过度增加通常 转化为持续性肥胖，这可能反过来与几种健康状况的较早发病有关 并发症。因此，肥胖时间的差异可能是种族-民族、社会经济和 健康方面的地区差异在整个生命过程中不断扩大。目标：我们的研究将测量动态 儿童、青春期和青年时期的体重状况，并将这些动态与随后的 健康结果。我们研究的一个重要贡献是谨慎和明智地使用统计技术来 将现有的高质量国家纵向队列合并为超过9万人的合成队列，随后 从出生到55岁，反映了最近的经历。目标：1)估计总体和亚群体 肥胖症的动态，包括肥胖症开始的年龄和时间、特定年龄的发病率、肥胖期和 强度、体重波动和累积暴露于不健康体重。2)计算子种群 当代美国儿童、青春期和青壮年期间高BMI的累积暴露 一群人。3)估计在出生后头几十年暴露于高BMI和 成人健康，特别是糖尿病、心血管疾病、代谢和胃肠道疾病以及生活质量 量化早期肥胖动态对健康的影响。4)估计肥胖症差异的贡献 生命早期的动态变化对种族、社会经济地位和城市化群体其他健康结果的差异。5) 开发一个模拟模型，模拟减少儿童肥胖的干预措施对国家负担的影响 成人疾病和疾病差异。设计：我们将把7个数据集整合到一个全国范围内- 具有代表性的合成队列。我们将使用最近测试的方法来模拟多个维度 体重动力学。我们将估计肥胖的平均年数，以及持续测量 体重指数年。我们将使用加法、持续时间、峰值将个人的肥胖史与健康并发症联系起来 体重指数和体重变化模型。我们将单独评估在服务不足的种族中的肥胖动态-种族， 社会经济和农村人口，并将使用分解方法来量化这些 卫生条件差异的动态变化。我们将开发一个“宏观模拟”，使我们能够评估 儿童期和青春期肥胖率下降对全国患病率的影响 成年期肥胖、成年期健康并发症，以及种族、民族、社会经济和城市化 肥胖症和其他慢性病的差异。意义：创造一个综合的国家 Cohort解决了严重缺乏具有全国代表性的数据来跟踪儿童肥胖的问题 成人期。我们的研究将提供第一套全面的肥胖风险估计。 生命的最初几十年及其对健康的贡献，以及在一生中健康方面的差异。

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.