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: 10494264
• 负责人: Michael Isaac Goran
• 金额: $ 88.82万
• 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/10494264
• 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; Latino Population; 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.

拉丁美洲人尤其容易受到多种慢性疾病的影响，包括肥胖、2 型糖尿病 (T2D)、 非酒精性脂肪肝病 (NAFLD) 和血脂异常，这从生命早期就开始了。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。过去 20 年我们在拉丁裔婴儿和儿童方面的工作发现了 3 这些生命早期出现的慢性疾病的反复危险因素：1）配方奶喂养而不是 母乳喂养以及配方奶类型（即添加糖的配方奶）； 2）早期引入糖加甜 饮料和果汁 (SSB/J)，以及 3) 环境暴露于空气污染。尽管如此，之前在年轻人中的工作 拉丁裔儿童仅限于根据身高和体重评估肥胖结果，缺乏可靠的依据 肥胖和未来慢性病风险的其他亚临床标志物的测量。另外，之前没有研究过 在更广泛的环境因素和社会因素的背景下全面审查了这些风险因素 健康决定因素（SDOH）可能会加剧其对健康结果的影响。我们提出一个 对拉丁裔儿童进行的综合研究，旨在考察生命早期营养、接触 环境毒素和 SDOH 对 5 岁慢性病风险的亚临床标志物的影响。我们将利用2 由 Goran 博士（R01DK110793；R01DK109161）领导的 NIH 资助的出生队列，已经彻底 描述了来自洛杉矶县的拉丁裔婴儿的早期暴露情况，并在 生命的最初 2 年。我们将结合这些队列并收集 5 岁时的新结果指标 疾病的早​​期社会、环境和营养决定因素 (ELSEND) 研究。在ELSEND，我们将 使用稳健的亚临床进展标记物收集 190 名 5 岁儿童的后续措施 疾病，包括通过磁共振成像（MRI）、肝脏脂肪对脂肪分布进行非侵入性评估 通过 MRI 和弹性成像进行纤维化，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 社会和结构因素，例如社区和建筑环境。该项目将解决 以下目标： 1) 评估早期营养和/或接触环境毒素是否与儿童有关 5 岁时的生长发育和/或慢性病风险； 2) 评估食品环境和更广泛的 SDOH 是否 与疾病的亚临床标志物相关，以及它们是否加剧营养不良和/或 环境毒素。此外，通过结合所有 3 个中心项目的儿童数据，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 对南加州 530 名儿童的慢性病进行了研究，并探讨 3 个不同家庭的疗效是否 基于的干预措施受到个人和/或社区层面环境因素的影响。