Cardiac Risk in Obese African-American Adolescents

描述（由申请人提供）：儿童肥胖的患病率在过去20年中翻了一番，非洲裔（AA）青少年受影响的可能性几乎是白人的两倍。肥胖是包括心血管疾病（CVD）在内的无数慢性疾病的风险因素，估计全国用于肥胖的费用为926亿美元。肥胖症造成的疾病负担对少数群体的影响尤为严重。其有害的后遗症不仅限于成年期，一些超重的青年表现出心血管（CVR）因素和2型糖尿病（T2 DM）。我们的初步数据表明，超重的严重程度增加CVR因素和AA青少年葡萄糖耐受不良的风险;然而，并非所有超重的AA青少年都表现出CVR因素或葡萄糖耐受不良，这表明其他因素介导了肥胖的后果。这项横断面的探索性研究评估了五个相互关联的因素（超重的严重程度和分布，胰岛素抵抗，心肺功能，饮食和家族史），以确定超重AA青少年心血管风险和葡萄糖耐受不良的预测因子。我们将纳入新出现的CVR因素[创造性蛋白（CRP）、纤溶酶原激活物抑制剂-1（派-1）、纤维蛋白原和同型半胱氨酸水平、脂蛋白a和脂蛋白大小]，以及已确定的CVR因素[标准血脂谱、口服葡萄糖耐量试验（OGTT）期间确定的糖尿病状态、静息血压和吸烟状态]，以建立100名超重AA青少年的CVR谱。还将检查自我报告的体力活动与心肺功能和空腹与动态OGTT衍生的胰岛素抵抗指数的预测价值。将使用Kendall’s Tau检查自变量与葡萄糖代谢指标和CVR特征的相关性。将根据葡萄糖不耐受和CVR特征的自变量列表开发针对性别和坦纳分期进行调整的预测模型。 本研究将阐明超重AA青少年CVR和葡萄糖耐受不良的预测因素，帮助临床医生将研究结果转化为评估超重AA青少年的临床指南，并为制定干预措施以减轻肥胖并发症提供进一步的指导。未来的研究将纳入基因分型以及当前研究中确定的预测因子，以预测多种族人群的风险，并包括对参与者的纵向随访，以跟踪CVR的变化。我们的长期目标是根据这项探索性研究中确定的变量制定有针对性的干预措施，以减轻肥胖的后果，并预防青年人发生CVD和T2 DM。

DESCRIPTION (provided by applicant): The prevalence of childhood obesity has doubled in the last 20 years, with African-African (AA) adolescents being almost twice as likely to be affected as Caucasians. Obesity is a risk factor for a myriad of chronic diseases, including cardiovascular disease (CVD), with an estimated $92.6 billion dollars spent nationally on obesity. The disease burden engendered by obesity disproportionately affects minorities. Its harmful sequelae are not limited to adulthood, with some overweight youth exhibiting cardiovascular (CVR) factors and type 2 diabetes (T2DM). Our preliminary data suggest that severity of overweight increases CVR factors and risk of glucose intolerance in AA adolescents; however, not all overweight AA adolescents exhibit CVR factors or glucose intolerance, suggesting that additional factors mediate the consequences of obesity. This cross-sectional, exploratory study assesses five interrelated factors (overweight severity and distribution, insulin resistance, cardiorespiratory fitness, diet, and family history) to determine predictors of cardiovascular risk and glucose intolerance in overweight AA adolescents. We will incorporate emerging CVR factors [Creative protein (CRP), plasminogen activator inhibitor type-1 (PAI-1), fibrinogen, and homocysteine level, lipoprotein a, and lipoprotein size], as well as established CVR factors [standard lipid profile, diabetes status determined during oral glucose tolerance test (OGTT), resting blood pressure, and smoking status] to develop a CVR profile of 100 overweight AA adolescents. The predictive value of self-reported measures of physical activity vs. cardiorespiratory fitness and fasting vs. dynamic OGTT-derived indices of insulin resistance will also be examined. The association of independent variables with measures of glucose metabolism and the CVR profile will be examined using Kendall's Tau. Prediction models, adjusted for gender and Tanner stage, will be developed from the list of independent variables for glucose intolerance and the CVR profile. This study will elucidate predictors of CVR and glucose intolerance in overweight AA adolescents, aid clinicians in transforming research findings into clinical guidelines for assessment of overweight AA youth, and provide further direction for development of interventions to mitigate the complications of obesity. Future studies will incorporate genotyping as well as predictors identified in the current study to predict risk in a multiethnic population, and include longitudinal follow-up of participants to track changes in CVR. Our long-term goal is to develop targeted interventions based on variables identified in this exploratory study tomitigate the consequences of obesity and prevents development of CVD and T2DM in youth.