Lifecourse Approach to Developmental Repercussions of Environmental Agents on Metabolic and Respiratory Health (LA DREAMERs)

摘要 背景：产前饮食可能导致代谢改变（例如，胰岛素抵抗）， 影响胎儿编程和随后的出生体重，这是发育受损的已知决定因素， 发病率和慢性疾病风险，如晚年肥胖1。产前总饮食，如在饮食模式中 (DP)，特别是与空腹血糖相关，空腹血糖是饮食和血糖之间的中间变量。 出生体重与出生体重相关2。然而，这些发现是特定于 主要是非西班牙裔白色女性，限制了对其他人群的普遍性， 西班牙裔/拉丁裔妇女有不成比例的更大风险有不良的出生结果， 儿童肥胖3.具体目标：1）在一个种族/族裔多样化的混合社区中得出产前诊断结果。 使用RRR与妊娠期体重增加（GWG）和空腹血浆交替使用的两个队列的样本 葡萄糖（FG）作为中间响应变量，并基于更高的负载来表征所得DP 2）在按以下因素分层的组中，使用目标1中的RRR方法确定DP的种族/民族差异： 种族/民族，并将种族/民族特异性DP与组合样品中衍生的DP进行比较; 3）确定 无论是种族/民族特异性产前DP（目标2），还是来自种族/民族多样性汇总的 样本（目标1），更好地预测出生体重和大胎龄（LGA），通过比较如何以及他们 预测这些种族/民族群体的结果。方法：使用来自两个ECHO的现有数据 怀孕队列，MyPyramid等效食物组每日摄入量将在两个或多个 自动自我管理的24小时饮食回忆，并用作降秩回归的输入变量 一种模型，旨在推导出食物的线性组合，最大限度地解释两个中间变量的变化。 反应变量（GWG和FG）假设是产前饮食和胎儿发育之间的因果关系。 关注的结果（目标1）。此外，DP将根据高负荷食物进行表征。相同的 目标1的方法将用于按人种/种族（非西班牙裔白色、西班牙裔/拉丁裔）分层的目标2。DP 种族/民族的差异将基于类似食物组的较高食物组因子负荷（>0.20）。 在每个人种/种族组中，两组多变量线性回归（出生体重）和logistic回归 (LGA)将对相关协变量进行调整。第一套模型将包括从以下方面得出的DP： 第二组将包括每个种族/族裔群体中目标1的发展点，而第二组将包括每个种族/族裔群体中目标2的发展点。 种族/民族团体。定性比较的幅度和强度之间的关联集 将进行每个人种/种族组的DP，以确定是否存在有意义的差异， 种族/民族特异性DP和来自混合人群的DP之间的出生体重预测。 意义和影响：了解种族/民族的饮食差异可能有助于解释 出生结果和儿童肥胖的早期标志，并为产前饮食建议提供信息。

ABSTRACT Background: Prenatal diet may contribute to metabolic alterations (e.g., insulin resistance) that could influence fetal programming and, subsequently, birth weight, a known determinant of impaired development, morbidity, and chronic disease risk such as obesity later in life1. Prenatal overall diet, as in a dietary pattern (DP), derived particularly in relevance to fasting plasma glucose, an intermediate variable between diet and birth weight, was found to be associated with birth weight2. These findings, however, are specific to predominantly non-Hispanic white women, limiting generalizability of findings to other populations such as Hispanic/Latina women who are at disproportionately greater risk of having adverse birth outcomes and children with childhood obesity3. Specific aims: 1) Derive prenatal DPs in a racially/ethnically diverse pooled sample from the two cohorts using RRR alternately with gestational weight gain (GWG) and fasting plasma glucose (FG) as intermediate response variables and characterize resulting DPs based on higher-loading foods; 2) Identify racial/ethnic differences in DPs by using the RRR approach in Aim 1 in groups stratified by race/ethnicity and compare racial/ethnic-specific DPs with DPs derived in the combined sample; 3) Determine whether racial/ethnic-specific prenatal DPs (Aim 2), versus those derived in a racially/ethnically diverse pooled sample (Aim 1), better predict birth weight and large-for-gestational age (LGA) by comparing how well they predict the outcomes within these racial/ethnic groups. Methods: Using existing data from two ECHO pregnancy cohorts, MyPyramid Equivalent food group daily intakes will be averaged across two or more Automated Self-Administered 24-hr dietary recalls and used as input variables in a reduced-rank regression model designed to derive linear combinations of foods that maximally explain the variability in two intermediate response variables (GWG and FG) hypothesized to be on the causal pathway between prenatal diet and the outcomes of interest (Aim 1). Additionally, DPs will be characterized based on higher-loading foods. The same approach from Aim 1 will be used in Aim 2 stratified by race/ethnicity (non-Hispanic white, Hispanic/Latina). DP differences by race/ethnicity will be based on higher food group factor loadings (>0.20) for similar food groups. In each racial/ethnic group, two sets of multivariable linear regression (birth weight) and logistic regression (LGA) adjusted for relevant covariates will be performed. The first set of models will include DPs derived from Aim 1 in each racial/ethnic group, while the second set will include DPs derived from Aim 2 in each racial/ethnic group. Qualitative comparisons between magnitude and strength of associations between sets of DPs in each racial/ethnic group will be performed to determine whether there are meaningful differences in prediction of birth weight between racial/ethnic-specific DPs and those derived from a mixed population. Significance and impact: Understanding dietary differences by race/ethnicity may help explain disparities in birth outcomes and early markers of childhood obesity and inform prenatal dietary recommendations.