Madres para la Salud (Mothers for Health)

描述（由申请人提供）：怀孕相关的体重增加和出生后未能减肥有助于西班牙裔妇女超重和肥胖的发展，其患病率超过70%。最近的证据表明，肥胖与全身和脂肪组织炎症有关，炎症可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公认，但女性在生育期间往往运动量不足。此外，超重、肥胖、体育活动和随后的风险（如炎症过程或产后抑郁）之间相互作用的机制尚不清楚。这项拟议的研究旨在测试一种社会支持干预，“Madres para la Salud”[母亲健康]，以探索一种文化特定计划的有效性，该计划使用“几次”体育活动来影响久坐不动的西班牙裔妇女体内脂肪、脂肪组织炎症和产后抑郁症状的变化。这一创新项目有可能促进我们对适度增加体育活动与特定健康结果之间关系的理解。该研究的目的是：1)在控制饮食摄入后的6个月和12个月，与注意对照组相比，研究Madres para la Salud在减少(a)体脂(b)全身和脂肪组织炎症和(c)产后西班牙裔妇女PPD症状的远端结局方面的有效性；2)检验社会支持和步行的理论中介、中间结果、环境因素调节因子是否影响体脂的变化；全身和脂肪组织炎症；以及3)确定步行的直接结果（每周步行分钟）与远端结果变化之间的关系：(a)体脂(b)全身和脂肪组织炎症(c) PPD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名年龄在18-35岁、产后6周到6个月久坐不动的西班牙女性。参与者将被随机分配到干预组或注意力控制组。干预小组将每周进行一次步行会议，并与Promotoras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、6、9和12个月收集，使用问卷调查、脂肪组织活检、血液样本和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混合模型方差分析（ANOVA）比较两组，结构方程模型（SEM）和评估步行与体脂减少之间的关系来评估。研究结果将对寻求改善西班牙裔妇女长期健康的妇女保健提供者具有重要意义。公共卫生相关性：拟议的项目测试了一种干预措施，可以融入西班牙裔妇女分娩后的日常生活。干预将使用文化敏感策略和步行活动期间有计划的支持，以减少体脂和产后抑郁症状，同时改善与体脂过多相关的细胞过程。

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.