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

军事爆炸暴露对 9/11 事件后退伍军人代谢异常的影响

• 批准号: 10400028
• 负责人: Dora Lendvai
• 金额: $ 2.08万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10400028
• 关键词: Acute; Adult; Affect; Afghanistan; Age; Air; Animals; Anxiety; Area; Body mass index; Brain; Cellular Structures; Center for Translational Science Activities; Clinical; Clinical Data; Collaborations; Complex; Conflict (Psychology); Data; Data Analyses; Development; Diffuse; Disease; Disease Progression; Environment; Exercise; Explosion; Exposure to; Face; Foundations; Funding; General Population; Glucose; Glycosylated hemoglobin A; Health; Healthcare; Injury; Insulin; Insulin Resistance; Intervention; Iraq; Lead; Link; Logistic Regressions; Longitudinal Studies; Longitudinal cohort; Mediating; Mediation; Mental Depression; Mental disorders; Metabolic; Metabolic Diseases; Military Personnel; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Nursing Research; Obesity; Organ; Outcome; Pain; Participant; Pathology; Pathway interactions; Patients; Population; Post-Traumatic Stress Disorders; Prediabetes syndrome; Prevalence; Prevention; Psychological Factors; Psychophysiologic Disorders; Questionnaires; Recording of previous events; Regression Analysis; Regulation; Reporting; Research; Research Methodology; Review Literature; Risk; Risk Factors; Sampling; Series; Shock; Sleep; Sleep disturbances; Structure; Substance Use Disorder; Symptoms; Training; Traumatic Brain Injury; Veterans; Veterans Health Administration; Weight Gain; Work; blast exposure; brain cell; brain tissue; cohort; combat; depressive symptoms; experience; long-term sequelae; military injury; military service; military veteran; obese person; obesity risk; peer; post 9/11; post-traumatic stress; prevent; primary outcome; psychologic; secondary outcome; service member; skill acquisition; stress disorder; systematic review

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.

项目摘要 超过44%的9/11后退伍军人，那些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，肥胖（BMI>30）。这一肥胖率超过了观察到的 在一般公众中，问题仍然是为什么会出现这种现象。肥胖是一个独立的风险 更严重的代谢异常的因素，并可导致血糖失调，胰岛素抵抗（IR） 和2型糖尿病。虽然9/11后退伍军人肥胖的风险很复杂，但兵役伤害（如 创伤性脑损伤[TBI]），军事后心理障碍（例如;创伤后应激障碍 [PTSD]，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）被认为是该退伍军人队列中肥胖的独特预测因子。最近的证据也 这表明，由于暴露在反复的，往往是近距离的爆炸中， 9/11军事冲突后的部署也可能影响代谢健康。 因此，本项目的目的是：（1）识别军事爆炸暴露之间的关联 （在100米范围内有任何爆炸的经历与在服兵役期间没有爆炸的经历）和代谢异常 （肥胖、血糖失调和IR）;和（2）检查心理（PTSD， 抑郁、焦虑和物质使用障碍）和躯体因素（睡眠障碍和疼痛） 9/11后退伍军人样本中的代谢异常 使用TBI和应激障碍转化研究中心（TRACTS）正在进行的纵向 队列的基线样本（n=573）和一个概念框架，来自一个系统性的审查， 文献，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TRACTS参与者中收集的有效问卷和临床数据，并进行单变量、双变量 和逻辑回归分析，以及一系列使用反事实方法的调解分析。 拟议的培训计划包括严格的定量技能发展，学术工作，团队合作， 合作和其他活动，以提供护理研究方法的坚实基础，以支持这一点 研究9/11事件后的退伍军人 该项目的预期成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退役后心身因素 影响这些关系的强度。这项研究的结果将提供重要的临床意义， 预防和治疗代谢异常，特别是肥胖、葡萄糖调节异常和IR， 9/11后的老兵