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

摘要 背景：产前饮食可能会导致代谢改变(例如，胰岛素抵抗)，从而可能 影响胎儿程序，并随后影响出生体重，这是发育受损的已知决定因素， 发病率，以及晚年肥胖等慢性病风险1。产前整体饮食，如在饮食模式中 (Dp)，特别是与空腹血糖相关，是饮食和饮食之间的中间变量 出生体重，被发现与出生体重有关。然而，这些发现是特定于 主要是非西班牙裔白人女性，限制了研究结果对其他人群的普适性，如 西班牙裔/拉丁裔妇女有不良生育结局的风险高得不成比例，以及 患有儿童肥胖症的儿童。具体目标：1)在种族/民族多元化的池中获得产前DPS 来自两个队列的样本交替使用RRR和孕期体重增加(GWG)和空腹血浆 作为中间反应变量的葡萄糖(Fg)和基于较高负荷的结果DPS的特征 食物；2)通过在目标1中使用RRR方法确定DPS中的种族/民族差异，按以下分组 种族/民族，并将种族/民族特定的DPS与组合样本中得出的DPS进行比较；3)确定 是否特定于种族/民族的产前DPS(目标2)，与那些来自种族/民族多样化的池中的DPS 样本(目标1)，更好地预测出生体重和大胎龄(LGA)，通过比较它们有多好 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，我的金字塔等值食物组每天的摄入量将平均为两个或更多 自动自我管理24小时饮食召回，并在降阶回归中用作输入变量 用来推导食物的线性组合的模型，最大限度地解释了两种中间体的可变性 反应变量(GWG和FG)假设在产前饮食和 感兴趣的结果(目标1)。此外，DPS将以高负荷食物为基础。相同 目标1的方法将用于按种族/民族(非西班牙裔白人、西班牙裔/拉丁裔)分层的目标2。dp 种族/民族的差异将基于相似食物组较高的食物组因素负荷(&gt；0.20)。 在每个种族/民族中，两组多变量线性回归(出生体重)和Logistic回归 将执行经相关协变量调整的(LGA)。第一套模型将包括派生自 每个种族/民族群体的目标1，而第二套将包括每个群体的目标2派生的DPS 种族/民族群体。两组之间关联性的大小和强度的定性比较 将在每个种族/民族群体中进行DPS，以确定在 种族/民族特定的DPS和来自混合人群的DPS之间出生体重的预测。 意义和影响：了解不同种族/民族的饮食差异可能有助于解释 出生结局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.