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

拉美裔人不成比例地受到多种慢性病的影响，包括肥胖、2型糖尿病(T2D)、 非酒精性脂肪性肝病(NAFLD)和血脂异常，这在生命早期就开始了。了解和 鉴于与此相关的临床和公共卫生负担，消除这些差距是国家的优先事项 并存的慢性病。我们在过去20年中对拉丁裔婴儿和儿童的研究发现，3 这些在生命早期出现的慢性疾病的复发风险因素：1)配方奶喂养，而不是 母乳喂养，以及配方奶粉类型(即添加糖的配方奶粉)；2)早期引入加糖 饮料和果汁(SSB/J)，以及3)环境暴露于空气污染。尽管如此，杨格之前的工作 拉丁裔儿童仅限于根据身高和体重来评估肥胖结果，缺乏健壮的能力 测量肥胖和其他亚临床标记的未来慢性病风险。此外，没有事先的研究 在更广泛的环境因素和社会背景下全面审查了这些风险因素 健康决定因素(SDOH)可能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一项综合研究，以检查早期生活营养的贡献，接触 环境毒素和SDOH在5岁时对慢性病风险的亚临床标记物。我们将利用2 由Goran博士领导的NIH资助的出生队列(R01DK110793；R01DK109161)，已经完全 描述了洛杉矶县拉丁裔婴儿早期暴露的特征，并在 人生的头两年。我们将结合这些群体，并在5岁时收集新的结果衡量标准 早期生活社会、环境和营养疾病决定因素(ELSEND)研究。在ELSEND，我们将 使用稳健的亚临床进展性标记物收集190名5岁儿童的随访测量 疾病，包括磁共振成像(MRI)对脂肪分布的非侵入性评估，肝脏脂肪 通过核磁共振和弹性成像检测血糖和纤维化，并通过连续血糖监测(CGM)进行血糖调节 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，如邻里和建筑环境。该项目将解决 以下目标：1)评估早期营养和/或环境毒素暴露是否与儿童有关 5岁时的生长和/或慢性病风险；2)评估食物环境和更广泛的SDOH是否 与疾病的亚临床标志有关，如果它们加剧了营养不良和/或 环境毒素。此外，通过合并所有3个中心项目中儿童的数据，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系 对南加州530名儿童的慢性病进行调查，并探索3种不同家庭-- 以个人和/或社区为基础的干预措施受到个人和/或社区环境因素的影响。

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.