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

拉丁美洲人不成比例地受到多种慢性疾病的影响，包括肥胖症，2型糖尿病（T2 D）， 非酒精性脂肪性肝病（NAFLD）和血脂异常，这些都始于生命早期。理解和 考虑到与这些疾病相关的临床和公共卫生负担，消除这些差异是国家的优先事项。 共存的慢性疾病。我们在过去20年中对拉丁裔婴儿和儿童的研究发现， 这些慢性疾病在生命早期出现的反复风险因素：1）配方奶粉喂养，而不是 母乳喂养，以及配方奶类型（即，添加糖的配方）; 2）早期引入糖甜化 饮料和果汁（SSB/J），和3）环境暴露于空气污染。尽管如此，在年轻的工作， 拉丁裔儿童仅限于根据身高和体重评估肥胖结果， 肥胖和未来慢性病风险的其他亚临床标志物的措施。此外，之前没有研究 在更广泛的环境因素和社会因素的背景下， 健康决定因素（SDOH）可能会加剧其对健康结果的影响。我们提出了一个 在拉丁美洲儿童的全面研究，以检查早期生活营养的贡献，接触 环境毒素和SDOH对5岁时慢性疾病风险的亚临床标志物的影响。我们将利用2 由Goran博士领导的NIH资助的出生队列（R 01 DK 110793; R 01 DK 109161），已经彻底 在来自洛杉矶县的拉丁裔婴儿中， 人生的第一个2 Y我们将联合收割机合并这些队列，并在建议的5岁时收集新的结果指标 早期生活的社会，环境和疾病的营养决定因素（ELSEND）研究。在ELSEND，我们将 收集190名5岁儿童的随访指标，使用稳健的进行性亚临床标志物， 疾病，包括通过磁共振成像（MRI）对脂肪分布的非侵入性评估，肝脏脂肪 通过MRI和弹性成像检测血糖和纤维化，通过动态血糖监测（CGM）检测血糖调节 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，如邻里和建筑环境。该项目将解决 （1）评估早期营养和/或暴露于环境毒素是否与儿童健康有关。 5岁时的生长和/或慢性疾病风险; 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，如果它们加剧了营养不良的不良影响，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 研究社会和环境暴露与儿童饮食与风险因素之间的关联， 在南加州的530名儿童慢性疾病，并探讨是否有3个不同的家庭的疗效- 基于基础的干预措施受到个人和/或社区一级环境因素的影响。

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.