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代谢和心血管疾病有关。但 是我们知识上的差距;特别是缺乏研究调查影响出现的因素， 儿童和青少年时期食物不安全对心脏代谢的风险。更好地理解 粮食不安全的时间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，以及缓冲或加剧这一问题的因素 风险需要告知干预措施的发展，以预防儿童中的晚期心脏代谢疾病 谁是粮食不安全。这项前瞻性研究的主要目的是了解心脏代谢风险 儿童期粮食不安全引起的问题，并确定可进行干预的可塑性因素， 食物不安全对青少年CMH健康影响我们将利用现有的 来自低收入家庭的种族/民族多样性儿童（n=627）参加了一项前瞻性研究， 检查儿童肥胖差异的纵向研究（HL 126171：Berge PI）。调查和生态 已经收集了瞬时评估数据，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、身体活动）和父母行为（例如，喂养方式、应激、应对方式）在两个时间点（~24 5-10岁时。针对11-16岁儿童提出的新措施将包括：（1）CMH（Life's 简单7和国家的科学措施的身体组成，代谢和心血管功能， 氧化应激和炎症（即，（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。具体地说， 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，严重性， （2）确定粮食不安全与CMH之间的机制/途径;（3） 评估子女行为、父母因素和资源获取对关系的影响程度 粮食不安全和CMH之间的关系;（4）使用混合方法（生物标志物，焦点小组，EMA，GIS）， 前瞻性地检查动态（例如，严重程度、时间） 和青春期，并确定在家庭，邻里，学校和 社区为干预和政策制定提供信息。这种方法是创新的，因为它代表了一种 通过关注粮食不安全何时以及如何产生心脏代谢风险， 以及缓冲或加剧这一风险的多层次因素， 因为它预计将对干预发展产生影响，以防止未来的心脏代谢紊乱。 来自粮食无保障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.