Early Life Social, Environmental, and Nutritional Determinants of Disease (ELSEND)

疾病的早​​期社会、环境和营养决定因素 (ELSEND)

• 批准号: 10437271
• 负责人: Michael Isaac Goran
• 金额: $ 93.06万
• 依托单位: CHILDREN'S HOSPITAL OF LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10437271
• 关键词: Address; Adverse effects; Affect; Age; Air Pollutants; Air Pollution; Attenuated; Behavioral; Biological; Birth; Breast Feeding; California; Child; Childhood; Chronic; Chronic Disease; Clinical; Communities; County; Data; Diet; Dietary Intervention; Disease; Disease Marker; Dyslipidemias; Environment; Environmental Exposure; Environmental Risk Factor; Enzymes; Exposure to; Family; Fatty acid glycerol esters; Fibrosis; Food Access; Funding; Future; Glycosylated hemoglobin A; Growth; Health; Height; Individual; Infant; Intervention; Juice; Latino; Life; Lipids; Liver; Los Angeles; Magnetic Resonance Imaging; Maternal Health; Measures; Mothers; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Nutritional; Obesity; Outcome; Outcome Measure; Parents; Pregnancy; Progressive Disease; Public Health; Risk; Risk Factors; Toxic Environmental Substances; Toxin; Treatment Efficacy; United States National Institutes of Health; Update; Weight; Work; base; blood glucose regulation; built environment; cohort; comparative efficacy; disorder risk; disparity elimination; early life exposure; early-life nutrition; elastography; feeding; follow-up; food environment; glucose monitor; glycemic control; health disparity; improved; indexing; intervention effect; mother nutrition; non-alcoholic fatty liver disease; nutrition; obesity in children; randomized trial; social; social health determinants; social structure; socioenvironmental factor; sugar; sweetened beverage

Latinos are disproportionately affected by multiple chronic diseases, including obesity, type 2 diabetes (T2D), non-alcoholic fatty liver disease (NAFLD), and dyslipidemia, and this begins in early life. Understanding and eliminating these disparities is a national priority given the clinical and public health burden associated with these co-existing chronic diseases. Our work over the last 20 years in Latino infants and children has identified 3 recurring risk factors for these chronic diseases that emerge early in life: 1) formula feeding rather than breastfeeding, as well as formula type (i.e., formula with added sugar); 2) early introduction of sugar sweetened beverages and juices (SSB/J), and 3) environmental exposure to air pollution. Despite this, prior work in young Latino children is limited to assessment of obesity outcomes based on height and weight and lacks robust measures of adiposity and other sub-clinical markers of future chronic disease risk. In addition, no prior study has holistically examined these risk factors in the context of broader environmental factors and social determinants of health (SDOH) that may exacerbate their impact on health outcomes. We propose a comprehensive study in Latino children to examine the contributions of early-life nutrition, exposure to environmental toxins, and SDOH on subclinical markers of chronic disease risk at 5y of age. We will leverage 2 NIH-funded birth cohorts led by Dr. Goran (R01DK110793; R01DK109161), which have already thoroughly characterized early-life exposures in Latino infants from Los Angeles County, with repeated assessments in the first 2y of life. We will combine these cohorts and collect new outcome measures at 5y of age in the proposed Early Life Social, Environmental, and Nutritional Determinants of Disease (ELSEND) study. In ELSEND, we will collect follow-up measures from 190 children at 5y of age using robust subclinical markers of progressive disease, including non-invasive assessments of fat distribution by magnetic resonance imaging (MRI), liver fat and fibrosis by MRI and elastography, and blood glucose regulation by continuous glucose monitoring (CGM) over 7 days. We will update nutritional information and current and cumulative environmental exposures (air pollution, CalEnviroScreen Index), and will collect new data on broader SDOH, including geospatial assessments of social and structural factors such as the neighborhood and built environment. This project will address the following aims: 1) Assess whether early nutrition and/or exposure to environmental toxins is associated with child growth and/or risk for chronic disease at age 5y; 2) Assess if the food environment and broader SDOH is associated with subclinical markers of disease and if they exacerbate the adverse effects of poor nutrition and/or environmental toxins. In addition, by combining data from children across all 3 Center projects, we will also examine the associations between social and environmental exposures and childhood diet with risk factors for chronic disease in 530 children across Southern California, and explore whether the efficacy of 3 different family- based interventions is impacted by individual and/or community level environmental factors.

拉丁美洲人受多种慢性疾病的影响不成比例，包括肥胖症，2型糖尿病（T2D）， 非酒精性脂肪肝病（NAFLD）和血脂异常，这始于早期。理解和 鉴于与这些相关的临床和公共卫生负担，消除这些差异是国家优先事项 并存的慢性疾病。在过去20年中，我们在拉丁裔婴儿和儿童中的工作已经确定了3 这些慢性疾病生命早期出现的这些慢性疾病的反复出现的危险因素：1）配方奶粉而不是 母乳喂养以及配方类型（即添加糖的配方）； 2）早期引入糖加糖 饮料和果汁（SSB/J）和3）环境暴露于空气污染。尽管如此，在Young中的先前工作 拉丁裔儿童仅限于根据身高和体重评估肥胖结果，并且缺乏强大的 未来慢性疾病风险的肥胖度和其他亚临床标记的度量。另外，没有事先研究 在更广泛的环境因素和社会的背景下，整体检查了这些危险因素 健康的决定因素（SDOH）可能会加剧其对健康结果的影响。我们提出了一个 在拉丁裔儿童中进行的全面研究，以研究早期营养的贡献，暴露于 环境毒素和SDOH在5岁时的慢性疾病风险的亚临床标记上。我们将利用2 由Goran博士（R01DK110793; R01DK109161）领导的NIH资助的出生队列，这些人已经彻底地 特征是洛杉矶县拉丁裔婴儿的早期生活暴露，并反复评估 生命的第一个2y。我们将在拟议的年龄5岁时结合这些队列并收集新的结果指标 早期生活的社会，环境和营养决定因素（ELSEND）研究。在Elsend，我们将 使用强大的渐进式亚临床标记从190名儿童收集190名儿童的后续措施 疾病，包括通过磁共振成像（MRI），肝脂肪对脂肪分布的无创评估 通过MRI和弹性图和连续葡萄糖监测（CGM）调节血糖的纤维化以及血糖调节 超过7天。我们将更新营养信息以及当前和累积的环境暴露（空气 污染，Calenviroscreen指数），并将收集有关更广泛的SDOH的新数据，包括地理空间评估 社会和结构性因素，例如邻里和建筑环境。该项目将解决 以下目的：1）评估早期营养和/或暴露于环境毒素是否与儿童有关 5岁时慢性病的生长和/或风险； 2）评估食物环境和更广泛的SDOH是 与疾病的亚临床标记有关，并加剧营养不良和/或的不利影响 环境毒素。此外，通过结合所有3个中心项目的儿童的数据，我们还将 检查社会和环境暴露与儿童饮食与危险因素之间的关联 南加州530名儿童的慢性疾病，探索3个不同家族的功效是否存在 基于干预措施受个人和/或社区级别的环境因素的影响。