A prospective cohort study to determine the role of obesity in diverticulitis

项目摘要 结肠憩室炎是一种常见疾病（每10万人年209例）， 十亿美元的医疗保健支出每年。憩室炎是手术的主要适应症， 入院和门诊就诊，妇女的疾病负担更大。绝经后妇女 与年龄相近的绝经前妇女相比， 年龄相仿的男人。这种差异的原因尚不清楚，但可能是由于代谢变化相关 更年期。更年期与代谢综合征的所有组成部分的发展有关 包括内脏脂肪积聚、致动脉粥样硬化性血脂异常、胰岛素抵抗和高血压。虽然 是肥胖增加憩室炎风险的令人信服的证据，但这种关联的机制尚不清楚。 我们认为代谢综合征可以解释这种关联。建立代谢综合征在 憩室炎风险将从根本上重新定义这种疾病，并开辟新的研究路线，利用现有的 目前用于治疗代谢综合征的疗法。月经激素疗法 不能预防绝经后代谢功能障碍，并与心血管疾病风险增加有关。 事件，特别是在妇女与预先存在的代谢综合征。在有限的工作中，更年期激素 治疗的使用也与憩室炎风险的增加有关。基于现有的高质量 证据和我们自己的初步数据，拟议的应用旨在证明，代谢 综合征和临床前肥胖生物标志物在憩室炎中起作用。我们的核心假设是， 憩室炎是一种代谢性疾病。我们计划使用一个大型的、持续的、前瞻性的队列来检验这一假设 研究（姐妹研究）由国家环境健康科学研究所进行。这个成熟的群体 在美国和波多黎各的50，884名妇女中， 随访观察憩室炎事件、标准化数据收集和详细的协变量，包括 生殖特征拟议研究的目的是：1）前瞻性地确定 代谢综合征（高血压、2型糖尿病、血脂异常和向心性肥胖）与 憩室炎，2）前瞻性确定绝经期激素治疗与事件之间的关联 绝经后妇女憩室炎，和3）前瞻性地确定肥胖- 与偶发憩室炎相关的血清生物标志物。这是一种治疗憩室炎的新方法， 与当前的模式不同，并为多种新的医疗和行为模式创造了潜力。 憩室炎的治疗和预防策略。了解绝经期妇女 激素治疗和偶发性憩室炎创造了立即改变激素处方的可能性 治疗妇女的风险增加，并将产生重要的见解的生物机制 潜在憩室炎

PROJECT SUMMARY Colonic diverticulitis is a common (209 cases per 100,000 person-years) disease that is responsible for $5.5 billion dollars in health care expenditures annually. Diverticulitis is a leading indication for operations, hospital admissions, and ambulatory visits, with a greater burden of disease in women. Postmenopausal age women are at highest risk of developing diverticulitis when compared to either similar age premenopausal women or similar age men. The reason for this disparity is unknown but may be due to metabolic changes associated with menopause. Menopause is associated with the development of all components of metabolic syndrome including visceral fat accumulation, atherogenic dyslipidemia, insulin resistance, and hypertension. While there is compelling evidence that obesity increases diverticulitis risk, the mechanism for this association is unclear. We believe metabolic syndrome explains this association. Establishing a role for metabolic syndrome in diverticulitis risk would radically redefine this disease and open new lines of research to utilizing existing therapies that are currently used for the treatment of metabolic syndrome. Menopausal hormone therapy does not prevent postmenopausal metabolic dysfunction and is associated with an increased risk of cardiovascular events, particularly in women with preexisting metabolic syndrome. In limited work, menopausal hormone therapy use has also been associated with increased diverticulitis risk. Building on existing, high-quality evidence and our own preliminary data, the proposed application aims to demonstrate that metabolic syndrome and preclinical obesity biomarkers play a role in diverticulitis. Our central hypothesis is that diverticulitis is a metabolic disease. We plan to test this hypothesis using a large, ongoing, prospective cohort study (Sister Study) conducted by the National Institute of Environmental Health Sciences. This mature cohort of 50,884 women in the U.S. and Puerto Rico is well characterized with archived blood samples, sufficient follow up to observe incident diverticulitis, standardized data collection, and detailed covariates including reproductive characteristics. The aims of the proposed study are 1) to prospectively determine the association between metabolic syndrome (hypertension, type 2 diabetes, dyslipidemia, and central obesity) and incident diverticulitis, 2) to prospectively determine the association between menopausal hormone therapy and incident diverticulitis in postmenopausal women, and 3) to prospectively determine the association between obesity- related serum biomarkers in relation to incident diverticulitis. This is a novel approach to diverticulitis that diverges from the current paradigm and creates the potential for multiple new medical and behavioral strategies for diverticulitis treatment and prevention. Understanding the association between menopausal hormone therapy and incident diverticulitis creates the possibility of immediate change in prescribing hormone therapy to women at increased risk and will generate important insights into the biological mechanisms underlying diverticulitis.