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Community Health and Neuropathy: Nutritional and Environmental Links in Zambia (CHANNELZ)

社区健康和神经病：赞比亚的营养和环境联系 (CHANNELZ)

基本信息

批准号：
10360583
负责人：
Michelle Powell Kvalsund
金额：
$ 16.76万
依托单位：
UNIVERSITY OF ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-05 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10360583
关键词：
Adult Africa South of the Sahara Age Area Clinic Clinical Clinical Trials Communicable Diseases Communities Community Health Complex Data Development Diabetes Mellitus Diagnostic Dietary Factors Dietary Intervention Dietary intake Distal Environment Epidemiologic Methods Etiology Factor Analysis Folic Acid Folic Acid Deficiency Food Foot Ulcer Foundations Functional disorder Future Gender Goals HIV HIV Seronegativity Health Policy Health care facility Healthcare Homocysteine Household Individual Intervention Intervention Studies Knowledge Lead Link Maize Malnutrition Manihot Manuscripts Mentorship Metabolic Methodology Micronutrients Modeling Morbidity - disease rate Nature Neurologic Neurologist Neuropathy Nutritional Observational Study Outcome Assessment Pathogenicity Patient Care Pattern Peer Review Persons Phenotype Plasma Polyneuropathy Population Population Analysis Pragmatic clinical trial Predisposition Prevalence Province Quality of life Recurrence Research Research Training Risk Risk Factors Rural Sampling Scientific Advances and Accomplishments Structure Surveys Thiamine Thiamine Deficiency Time Validation Vitamin B 12 Vitamin B 12 Deficiency Zambia axonopathy base case control chronic pain comorbidity comparative design dietary experience falls food insecurity global health health care settings improved limb amputation member micronutrient deficiency neurotoxic nutrient deprivation nutrition population based public health intervention regional difference rural residence screening sex skills

项目摘要

Project Summary/Abstract The overarching goals of this project are to advance knowledge of the complex pathophysiology of distal symmetric polyneuropathies (DSP) and frame future interventions for nutritional neuropathies in Zambia through: 1) assessment of population-based estimates and risk factors for DSP in Zambia’s maize and cassava staple food zones; 2) comparison of population-based estimates and risk factors to previous clinic- based data from the same maize-staple districts; 3) and assessing the odds of specific micronutrient deficiencies among DSP cases and age, gender, and HIV-matched controls from the same districts. To accomplish these goals, Dr. Kvalsund will focus on acquisition of additional expertise and experience in the following key areas: 1) advanced epidemiological methods and analysis; 2) clinical trials methodologies, 3) global health policy; 4) neuropathy outcome assessments; and 5) HIV and nutrition. The needed skills will be achieved through structured mentorship, coursework, and pragmatic clinical trials and health policy experiences. The research-training plan will provide Dr. Kvalsund with the additional proficiency necessary to undertake future intervention research aimed at reducing nutrition-associated neurologic morbidity in Zambia and advancing scientific knowledge of the pathophysiologic mechanisms that generate DSP as a common phenotype. The central hypothesis is that the high rate of DSP previously observed in clinic populations in Zambia is equally prevalent outside healthcare settings owing to common endemic infectious diseases and their neurotoxic treatments, food insecurity and low dietary diversity, recurrent nutritional challenges, specific micronutrient deficiencies and their interactions, and possibly other unidentified latent factors. We hypothesize that folate-deficiency will be highly associated with DSP in Zambian communities, as has been documented in clinic populations, and may warrant a targeted public health intervention given the preventable nature and range of other neurologic morbidities also associated with folate deficiencies. The specific aims are to: 1) Determine population-based DSP estimates in Zambia; 2) Compare and contrast DSP estimates and risk factors with those from clinical settings in Zambia; 3) to consider the relative contributions of urbanicity, agroecological/staple food zone, and specific micronutrient deficiencies on DSP prevalence; and 4) Evaluate for latent environmental or toxico-dietary factors as contributors to DSP in this environment. The research is expected to provide the foundation for future R-01 intervention and observational research and to improve scientific understanding of how diverse etiologies, multiple exposures and interactions lead to a common clinicopathologic DSP phenotype, which remains poorly understood to date.

项目概要/摘要该项目的总体目标是增进对远端复杂病理生理学的了解对称性多发性神经病（DSP）并制定赞比亚营养性神经病的未来干预措施通过： 1) 对赞比亚玉米和玉米中 DSP 的基于人群的估计和风险因素进行评估木薯主食区； 2) 基于人群的估计和危险因素与之前临床的比较- 基于相同玉米主食地区的数据； 3）并评估特定微量营养素的可能性 DSP 病例以及同一地区的年龄、性别和 HIV 匹配对照之间存在缺陷。到为了实现这些目标，Kvalsund 博士将专注于获取以下方面的额外专业知识和经验：以下重点领域：1）先进的流行病学方法和分析； 2) 临床试验方法，3) 全球卫生政策； 4) 神经病变结果评估； 5) 艾滋病毒和营养。所需的技能将是通过结构化指导、课程作业以及务实的临床试验和卫生政策来实现经验。研究培训计划将为 Kvalsund 博士提供必要的额外熟练程度开展未来干预研究，旨在减少赞比亚与营养相关的神经系统发病率并推进病理生理机制的科学知识，使 DSP 成为一种常见的治疗方法。表型。核心假设是，之前在 2019 年临床人群中观察到的 DSP 发生率很高。由于常见的地方性传染病和他们的神经毒性治疗、粮食不安全和饮食多样性低、反复出现的营养挑战、特定的微量营养素缺乏及其相互作用，以及可能的其他未识别的潜在因素。我们假设叶酸缺乏与赞比亚社区的 DSP 高度相关，正如文献中所记录的诊所人群，鉴于其可预防性和可能需要有针对性的公共卫生干预一系列其他神经系统疾病也与叶酸缺乏有关。具体目标是：1）确定赞比亚基于人口的 DSP 估算； 2) 比较和对比 DSP 估计和风险与赞比亚临床环境中的因素相结合； 3）考虑城市化的相对贡献，农业生态/主食区以及特定微量营养素缺乏对 DSP 患病率的影响； 4) 评估潜在的环境或有毒饮食因素作为该环境中 DSP 的贡献者。该研究是预计将为未来的 R-01 干预和观察研究提供基础，并改善对不同病因、多重暴露和相互作用如何导致共同症状的科学理解临床病理 DSP 表型，迄今为止仍知之甚少。