The Impact of Military Blast Exposures on Metabolic Abnormalities in Post 9/11 Veterans

项目总结 超过44%的后9/11退伍军人，那些曾在伊拉克和阿富汗服役并接受医疗保健的人 通过退伍军人健康管理局，他们是肥胖的(BMI&GT；30)。这一肥胖率超过了观察到的 在普通公众中，为什么会出现这种现象仍然存在疑问。肥胖是一种独立的风险 会导致更严重的代谢异常，并可能导致血糖失调、胰岛素抵抗(IR) 和2型糖尿病。虽然9/11事件后退伍军人肥胖的风险是复杂的，但兵役伤害(如 如创伤性脑损伤、军事后心理障碍(例如，创伤后应激障碍 [创伤后应激障碍]、抑郁、焦虑和物质使用障碍[SUD])和躯体后遗症(睡眠障碍和 疼痛)已被认为是这一资深队列中肥胖的独特预测指标。最近的证据也 表明暴露在反复的，通常是近距离爆炸中所造成的损害 部署到9/11军事冲突后也可能影响新陈代谢健康。 因此，本项目的目的是：(1)确定军事爆炸暴露之间的联系 (服兵役期间在100米内有任何爆炸经历，而不是没有爆炸)和代谢异常 (2)研究心理因素(创伤后应激障碍， 抑郁、焦虑和物质使用障碍)和躯体因素(睡眠障碍和疼痛) 911事件后退伍军人样本中的代谢异常。 使用脑外伤和应激障碍(区域)翻译研究中心进行的纵向研究 队列的基线样本(n=573)和系统审查得出的概念框架 文献方面，我们将进行横断面、二次数据分析，以完成研究目标。我们将使用 从TRADS参与者那里收集经过验证的问卷和临床数据，并进行单变量、双变量 和Logistic回归分析，以及使用反事实方法的一系列中介分析。 拟议的培训计划包括严格的量化技能发展、学术工作、团队 合作和其他活动，为支持这一点的护理研究方法提供坚实的基础 与911事件后的退伍军人一起学习。 该项目的预期结果包括更好地了解军事爆炸的影响 9·11事件后退伍军人关键代谢异常暴露与军后心身因素 会影响这些关系的强度。这项研究的结果将为临床治疗提供重要的启示。 代谢异常，特别是肥胖、糖代谢紊乱和胰岛素抵抗的防治 后911退伍军人。

PROJECT SUMMARY Over 44% of post 9/11 veterans, those who served in Iraq and Afghanistan and receive healthcare through the Veterans Health Administration, are obese (BMI>30). This obesity rate exceeds what is observed in the general public, and questions remain as to why this phenomenon occurs. Obesity is an independent risk factor for more serious metabolic abnormalities, and can lead to glucose dysregulation, insulin resistance (IR) and type 2 diabetes. While the risk for obesity in post 9/11 veterans is complex, military service injuries (such as traumatic brain injuries [TBIs]), post-military psychological disorders (e.g.; post-traumatic stress disorder [PTSD], depressive, anxiety and substance use disorders [SUD]) and somatic sequalae (sleep disturbance and pain) have been suggested as unique predictors of obesity in this veteran cohort. Recent evidence also suggests that damages sustained from exposure to repeated, and often close-range blast explosions during deployment to post 9/11 military conflicts may also impact metabolic health. Therefore, the purpose of this project is: (1) to identify associations between military blast exposures (experience of any blasts within 100m vs. no blast during military service) and metabolic abnormalities (obesity, glucose dysregulation and IR); and (2) to examine the mediating effect of psychological (PTSD, depressive, anxiety and substance use disorders) and somatic factors (sleep disturbance and pain) on metabolic abnormalities in a sample of post 9/11 veterans. Using the Translational Research Center for TBI and Stress Disorders (TRACTS) ongoing longitudinal cohort’s baseline sample (n=573) and a conceptual framework derived from a systematic review of the literature, we will conduct a cross-sectional, secondary data analysis to complete the study aims. We will use validated questionnaires and clinical data collected from TRACTS participants and conduct univariate, bivariate and logistic regression analyses, as well as a series of mediation analyses using the counterfactual approach. The proposed training plan includes rigorous quantitative skills development, scholarly work, team collaboration and other activities to provide a strong foundation in nursing research methods to support this study with post 9/11 veterans. The expected outcomes of this project include better understanding the impact of military blast exposure on key metabolic abnormalities in post 9/11 veterans and the post-military psycho-somatic factors that affect the strength of these relationships. Results of this study will provide important clinical implications for the prevention and treatment of metabolic abnormalities, especially obesity, glucose dysregulation and IR in post 9/11 veterans.