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

摘要 众所周知，粮食不安全与成人代谢和心血管疾病有关。然而，有 是我们知识上的差距；特别是缺乏对影响出现的因素的研究 儿童和青少年时期粮食不安全造成的心脏代谢风险。更好的理解 粮食不安全的时间和严重程度对儿童心脏代谢健康（CMH）的作用， 粮食不安全与 CMH 之间的机制/途径，以及缓冲或加剧这种情况的因素 需要风险来为干预措施的制定提供信息，以预防儿童日后发生心脏代谢疾病 谁的粮食不安全。这项前瞻性研究的主要目的是了解心脏代谢风险如何 因儿童时期的粮食不安全而产生，并确定可进行干预的可塑因素，以缓冲负面影响 粮食不安全对青少年 CMH 的健康影响。我们将利用已建立的群体 来自低收入家庭的种族/族裔多样化儿童 (n=627) 参与前瞻性、 检查儿童肥胖差异的纵向研究（HL126171：Berge PI）。调查与生态 暂时评估（EMA）数据已经收集，包括粮食不安全措施， 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）和父母在两个时间点（~24 相隔几个月），年龄为 5-10 岁。针对 11-16 岁儿童提出的新措施将包括：(1) CMH（Life's 身体成分、代谢和心血管功能的 7 种简单且最科学的测量方法， 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) 由家庭、学校代表、社区组织和医疗保健提供者组成的焦点小组， 确定干预目标并完善政策，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) 确定家庭粮食不安全的影响（即严重程度、 儿童/青少年 CMH 的时间安排； (2) 确定粮食不安全与 CMH 之间的机制/途径； (3) 评估儿童行为、父母因素和资源获取对关系的影响程度 粮食不安全与 CMH 之间； (4) 使用混合方法（生物标志物、焦点小组、EMA、GIS）， 前瞻性地研究整个童年时期家庭粮食不安全的动态（例如严重程度、时间安排） 和青春期，并确定家庭、社区、学校和青少年层面的风险和保护因素 社区为干预和政策制定提供信息。这种方法是创新的，因为它代表了 摆脱现状，关注粮食不安全何时以及如何出现心脏代谢风险 童年时期以及缓冲或加剧这种风险的多层次因素，以及显着的 因为预计这将对干预措施的发展产生影响，以预防未来的心脏代谢 来自粮食不安全家庭的青少年的疾病。

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.