Examining Pathways Between Food Insecurity and Cardiometabolic Health in Diverse Children and Adolescents

摘要 众所周知，食物不安全与成年人的新陈代谢和心血管疾病有关。然而，在那里 是我们知识上的差距；具体地说，是缺乏研究影响 儿童和青春期食物不安全带来的心脏代谢风险。更好地理解 食物不安全的时机和严重程度对儿童心脏代谢健康的作用 粮食不安全和CMH之间的机制/途径，以及缓冲或加剧这种情况的因素 需要风险来为干预发展提供信息，以预防儿童中后来的心脏代谢性疾病 他们的食物不安全。这项前瞻性研究的主要目的是了解心脏代谢风险 由于儿童时期的食物不安全而产生，并找出可延展的因素进行干预，以缓冲负面影响 食物不安全对青少年CMH的健康影响。我们将利用现有的一批 来自低收入家庭(n=627)的种族/民族多样化的儿童参加未来的 儿童肥胖差异的纵向研究(HL126171：Berge Pi)。调查与生态 已经收集了瞬时评估(EMA)数据，包括粮食不安全的衡量标准， 家庭环境(例如，食物环境，家庭功能)，儿童健康行为(例如，饮食质量， 睡眠、体力活动)和父母行为(例如，进食习惯、压力、应对)在两个时间点(~24小时) 相隔几个月)，5-10岁。在11-16岁时提出的新措施将包括：(1)CMH(Life‘s 简单的身体成分、新陈代谢和心血管功能的7项最先进的测量方法， 氧化应激和炎症(即细胞因子))，(2)地理信息服务(GIS)数据，以及(3) 与家庭、学校代表、社区组织和医疗保健提供者组成的焦点小组 确定干预目标和细化政策，以减少粮食不安全对健康的有害影响。具体来说， 这项最先进的研究将：(1)确定暴露于家庭粮食不安全的影响(即严重程度， 时机)关于儿童/青少年CMH；(2)确定粮食不安全和CMH之间的机制/途径；(3) 评估子行为、父母因素和对资源的访问对关系的影响程度 粮食不安全和CMH之间的关系；以及(4)使用混合方法(生物标记物、焦点小组、环境影响评估、地理信息系统)， 前瞻性地检查整个童年时期家庭食品不安全的动态(例如，严重性、时机) 和青春期，并确定家庭、邻居、学校和家庭层面的风险和保护因素 社区为干预和政策制定提供信息。这种方法具有创新性，因为它代表了一种 通过关注心脏代谢风险何时以及如何从食物不安全中脱颖而出 在儿童时期以及缓冲或加剧这种风险的多层次因素，以及显著的 因为它有望对预防未来心脏新陈代谢的干预发展产生影响 粮食不安全家庭的青少年中的疾病。

ABSTRACT Food insecurity is known to be associated with metabolic and cardiovascular disease in adults. However, there is a gap in our knowledge; specifically a lack of studies investigating factors that influence the emergence of cardiometabolic risks from food insecurity during childhood and adolescence. An improved understanding of the role of timing and severity of food insecurity on children’s cardiometabolic health (CMH), the mechanisms/pathways between food insecurity and CMH, and the factors that buffer against or exacerbate this risk are needed to inform intervention development to prevent later cardiometabolic disease amongst children who are food insecure. The main objective of this prospective study is to understand how cardiometabolic risk arises from food insecurity during childhood and identify malleable factors for intervention to buffer the negative health impact of food insecurity on adolescent’s CMH. We will leverage an established cohort of racially/ethnically diverse children from low-income households (n=627) participating in a prospective, longitudinal study examining childhood obesity disparities (HL126171: Berge PI). Survey and ecological momentary assessment (EMA) data have already been collected, including measures of food insecurity, household environment (e.g., food environment, family functioning), child health behavior (e.g., diet quality, sleep, physical activity) and parent behaviors (e.g., feeding practices, stress, coping) at two time points (~24 months apart) at ages 5-10. New measures proposed at ages 11-16 will include: (1) measures of CMH (Life’s Simple 7 and state-of-the-science measures of body composition, metabolic and cardiovascular function, oxidative stress and inflammation (i.e., cytokines)), (2) Geographical Information Services (GIS) data, and (3) focus groups with families, school representatives, community organizations, and healthcare providers to identify intervention targets and refine policies to reduce harmful health effects of food insecurity. Specifically, this state-of-the art study will: (1) determine the impact of exposure to household food insecurity (i.e., severity, timing) on child/adolescent CMH; (2) identify mechanisms/pathways between food insecurity and CMH; (3) evaluate the extent to which child behaviors, parent factors, and access to resources impact the relationship between food insecurity and CMH; and (4) using mixed-methodologies (biomarkers, focus groups, EMA, GIS), prospectively examine the dynamics (e.g., severity, timing) of household food insecurity throughout childhood and adolescence, and identify risk and protective factors at the level of the family, neighborhood, school, and community to inform intervention and policy development. This approach is innovative because it represents a departure from the status quo by focusing on when and how cardiometabolic risk emerges from food insecurity during childhood and the multi-level factors which buffer against or exacerbate this risk, and significant because it is expected to have implications for intervention development to prevent future cardiometabolic diseases among adolescents from food insecure households.