Madres para la Salud (Mothers for Health)

描述(申请人提供)：与怀孕相关的体重增加和出生后未能减肥导致西班牙裔妇女超重和肥胖的发展，他们的患病率超过70%。最近的证据表明，肥胖与全身和脂肪组织炎症有关，这可以促进肥胖相关慢性疾病的发展，并有助于产后抑郁症的发展。尽管运动对体重的有益作用已经得到证实，但女性在育龄期间往往参与较少的体育活动。此外，超重、肥胖、体力活动和随后的风险(如炎症过程或产后抑郁症)相互作用的机制尚不清楚。这项拟议的研究旨在测试一种名为“Madres parla Salud”[健康母亲]的社会支持干预措施，以探索一种特定于文化的计划的有效性，该计划使用“一次又一次”的身体活动来影响久坐不动的西班牙裔女性的体脂、脂肪组织炎症和产后抑郁症状的变化。这一创新计划有可能促进我们对适度增加的体力活动和特定健康结果之间的关系的理解。这项研究的目的是：1)检验Madres Parla Salud在减少以下方面的远期结局的有效性：(A)体脂(B)全身和脂肪组织炎症以及(C)产后西班牙裔妇女与注意对照组相比，在控制饮食摄入量后6个月和12个月的产后抑郁症状；2)测试社会支持和步行的中间结果，以及环境因素调节因素是否影响体脂的变化；全身和脂肪组织炎症；研究对象包括：(1)产后6个月和12个月拉美裔妇女的产后抑郁症状；(3)决定步行即刻结果(每周步行分钟)与以下远端结局变化之间的关系：(A)体脂(B)全身和脂肪组织炎症以及(C)产后抑郁症状。一项前瞻性随机对照试验将指导这项研究。研究对象为140名久坐不动的西班牙裔女性，年龄在18-35岁之间，产后6周至6个月之间。参与者将被随机分配到干预组或注意力控制组。干预组将每周步行一次，并与推动者一起支持干预。注意力控制组将收到健康通讯和后续电话。数据将在基线、3个月、6个月、9个月和12个月收集，使用问卷、脂肪组织活检、血液样本和用于DEXA身体扫描的子集样本，以及客观和自我报告的步行依从性测量。干预的有效性将通过比较两组的混合模型方差分析(ANOVA)、结构方程建模(SEM)以及评估步行与体脂减少之间的关系来评估。这一结果将对寻求改善拉美裔女性长期健康状况的女性健康提供者具有重要意义。与公共健康相关：拟议的项目测试了一种干预措施，可以在分娩后融入拉美裔妇女的日常生活。这项干预将在步行活动中使用文化敏感的策略和有计划的支持，以减少体脂和产后抑郁症状，同时改善与过量体脂相关的细胞过程。

DESCRIPTION (provided by applicant): Pregnancy-associated weight gain and failure to lose weight after birth contributes to the development of overweight and obesity in Hispanic women, who have prevalence rates exceeding 70%. Recent evidence shows that obesity is associated with systemic and fat tissue inflammation which can facilitate the development of obesity-related chronic diseases and contributes to the development of postpartum depression. Despite the well-established beneficial effects of exercise on weight, women tend to underparticipate in physical activity during the childbearing years. Further, the mechanisms underpinning the interplay of overweight, obesity, physical activity, and subsequent risk such as inflammatory processes or postpartum depression are not clear. The proposed study seeks to test a social support intervention, "Madres para la Salud" [Mothers for Health], to explore the effectiveness of a culturally specific program using "bouts" of physical activity to effect changes in body fat, fat tissue inflammation, and postpartum depression symptoms in sedentary Hispanic women. This innovative program has the potential to advance our understanding of the relationship between moderate increases in physical activity and specific health outcomes. The study aims are to:1) Examine the effectiveness of the Madres para la Salud for reducing the distal outcomes in: (a) body fat (b) systemic and fat tissue inflammation and (c) PPD symptoms among postpartum Hispanic women compared with an attention control group, at 6 and 12 months, after controlling for dietary intake; 2) Test whether the theoretical mediators, intermediate outcomes, of social support and walking, and environmental factor moderators, affect changes in body fat; systemic and fat tissue inflammation; and PPD symptoms among postpartum Hispanic women at 6 and 12 months, and 3) Determine the relationship between the immediate outcome of walking (minutes walked per week) and change in the distal outcomes of: (a) body fat (b) systemic and fat tissue inflammation and (c) PPD symptoms. A prospective, randomized controlled trial will guide the study. A sample of 140 sedentary Hispanic women, 18-35 years, and between 6 weeks and 6 months following childbirth will be used. Participants will be randomly assigned to the intervention or attention-control group. The intervention group will have weekly walking sessions and support interventions with Promotoras. The attention-control group will receive health newsletters and follow-up phone calls. Data will be gathered at baseline, 3, 6, 9, and 12 months using questionnaires, fat tissue biopsies, blood samples, and a subset sample for DEXA body scans, as well as objective and self-report measures of walking adherence. The intervention's effectiveness will be evaluated using a mixed models analysis of variance (ANOVA) comparing the two groups, structural equation modeling (SEM), and evaluating the relationship between walking and body-fat loss. The results will have significance for women's health providers who seek to improve the long-term health of Hispanic women. PUBLIC HEALTH RELEVANCE: The proposed project tests an intervention that can be integrated into the daily lives of Hispanic women following childbirth. The intervention will use culturally sensitive strategies and planned supports during walking activities to decrease body fat and postpartum depression symptoms, while improving the cellular processes related to excess body fat.