Patient-oriented research in early life origins of CVD

慢性病的生命过程方法提出，不仅在成人生活中起作用的因素，而且从受孕开始，都会对终身健康产生影响。在这一领域更广为人知的发现是，较低的出生体重与成人心血管疾病死亡率、发病率和血压等危险因素之间的关系。这些较新的研究导致了一系列令人兴奋的研究问题和机会，涉及潜在机制、产前和产后决定因素的关系，以及对临床医学和公共卫生的影响。这项拟议的K24奖项将使吉尔曼博士和他的受训者能够在未来五年集中精力从事这一领域的研究，这不仅是该领域本身的关键时期，也是扩大他做出重大贡献和培养该领域下一代以患者为导向的研究人员的潜力的关键时期。这项建议的具体目标是1。研究项目，以检查母亲孕蛋白摄入量、胎盘激素活性和子代血压之间的关系。该项目将利用美国国立卫生研究院资助的对孕妇及其后代进行的前瞻性队列研究(Viva项目)提供的基础设施。2.为初级临床研究人员的培训和发展提供有利的专业环境，他们将在慢性病的生命过程方法领域进行和分析来自Project Viva和其他正在进行的以患者为导向的研究的数据。主要焦点将放在以下领域：A.儿童心血管危险因素的孕期和婴儿期决定因素，主要是血压；B.儿童早期哮喘；以及C.儿童和青少年肥胖症的发展。

The lifecourse approach to chronic disease proposes that factors operating not only in adult life, but also from conception, have impact on lifelong health. Among the more publicized findings in this area are associations between lower birth weight and adult cardiovascular disease mortality, incidence, and risk factors such as blood pressure. These newer investigations have led to a series of exciting research questions and opportunities concerning underlying mechanisms, relations of pre- and post-natal determinants, and implications for clinical medicine and public health. This proposed K24 award will allow Dr. Gillman and his mentees to focus intensively on this area of research for the next five years, a critical period not only for the field itself, but also for expanding his potential for significant contributions and for nurturing the next generation of patient-oriented researchers in this field. The specific aims of this proposal are 1. Research project to examine associations among maternal gestational protein intake, placental hormone activity, and blood pressure in the offspring. This project will take advantage of the infrastructure provided by an ongoing NIH-funded prospective cohort study of pregnant women and their offspring (Project Viva). 2. To provide a nourishing professional environment for the training and advancement of beginning clinical researchers, who will conduct and analyze data from Project Viva and other ongoing patient-oriented research studies in the area of the lifecourse approach to chronic disease. Major foci will be in the areas of pregnancy and infancy determinants of a. childhood cardiovascular risk factors, chiefly blood pressure, b. asthma in early childhood, and c. development of obesity in childhood and adolescence.