Birth Weight, Postnatal Growth, Blood Pressure and Subclinical Cardiovascular Dis

描述（由申请人提供）：虽然低出生体重与晚年不同阶段血压（BP）水平升高之间的关系已经得到很好的确定，但出生体重与从儿童到成年的BP变化之间的关系尚未得到充分研究。此外，产前和产后的生长，血压和心血管（C-V）结构和功能的亚临床变化之间的复杂关系需要阐明。本研究的具体目的是：1）证明出生体重、纵向肥胖指标和血压之间的相互关系（水平和变异性）从儿童期到成年期在黑人和白色个人，和2）以确定出生体重与血压的影响（变异性和水平）和出生后生长对成年期C-V结构和功能亚临床变化的影响（动脉壁厚度、血管硬度和左心室结构和功能）。将使用来自博加卢萨心脏研究的可用纵向数据库检查这些具体目标，该研究是一项长期的基于社区的双胞胎（65%白色，35%黑人）研究，研究从儿童期开始的C-V疾病自然史。用于横断面分析的拟议研究队列I由6，458名具有出生体重、生长参数和青春期前、青春期和成年期血压数据的个体组成;用于纵向分析的队列II由1，695名具有出生体重数据和儿童期至少3次和成年期至少3次血压连续测量数据的个体组成;队列III由1，194名具有出生体重、儿童期以来血压系列测量和成年期C-V系统亚临床变化数据的个体组成。长期血压水平将被测量为从儿童到成年的连续血压测量得出的曲线下面积。将使用纵向BP测量值计算4个BP变异性指标（年龄相关趋势、年龄预测值周围的偏差、平均值偏差和年变异率）。路径分析（线性结构方程建模）将按生长期以及使用长期BP水平和变异性指标进行横断面分析。将应用交互回归模型沿着主成分分析来检查出生体重、肥胖测量和BP对C-V系统亚临床变化的联合作用。这项研究的结果将为高血压发展的“胎儿起源”提供进一步的见解。加深我们对产前和产后生长、血流动力学和晚年亚临床C-V疾病之间关系的了解，对于改善产前护理和制定从生命早期开始的预防成人C-V疾病的策略具有重要意义。 公共卫生相关性：低出生体重是婴儿出生前生长受限的一个指标，与成人心脏病、糖尿病和高血压有关。这项研究的发现对改善产前护理和制定早期预防成人心脏病的策略具有重要意义。

DESCRIPTION (provided by applicant): Although the relationship between low birth weight and elevated blood pressure (BP) levels at various stages in later life has been well established, the association of birth weight with BP variations from childhood to adulthood has not been fully examined. In addition, the complex relationships among prenatal and postnatal growth, BP and subclinical changes of cardiovascular (C-V) structure and function need to be elucidated. The Specific Aims of the proposed research are 1) to demonstrate the inter-relationships among birth weight, longitudinal obesity measures and BP (levels and variability) from childhood to adulthood in black and white individuals, and 2) to determine the effect of birth weight in conjunction with BP (variability and levels) and postnatal growth on adulthood subclinical changes of C-V structure and function (arterial wall thickness, vascular stiffness and left ventricular structure and function). These specific aims will be examined using available longitudinal database from the Bogalusa Heart Study, a long-term biracial (65% white, 35% black) community-based study of the Natural History of C-V Disease beginning in childhood. The proposed study Cohort I for cross-sectional analyses consists of 6,458 individuals who have data on birth weight, growth parameters and BP in preadolescence, adolescence and adulthood; Cohort II for longitudinal analyses consists of 1,695 individuals who have data on birth weight and serial measurements of BP obtained at least 3 times each in childhood and at least 3 times in adulthood; Cohort III consists of 1,194 individuals who have data on birth weight, serial measurements of BP since childhood and subclinical changes of C-V system in adulthood. Long- term BP levels will be measured as the area under the curve derived from serial BP measurements from childhood to adulthood. Four BP variability measures (age-related trend, deviations around age-predicted values, deviations from mean and yearly rate of variability) will be calculated using longitudinal BP measurements. Path analysis (linear structural equation modeling) will be performed cross-sectionally by growth periods as well as using long-term BP level and variability measures. Interaction regression models along with principal components analysis will be applied to examine the joint effect of birth weight, obesity measures and BP on subclinical changes of C-V system. Findings from this research will provide further insights into the "fetal origins" of the development of hypertension. Deepening our understanding of the relationships among prenatal and postnatal growth, hemodynamics and subclinical C-V disease later in life has important implications for improving prenatal care and developing strategies beginning early in life to prevent adult C-V disease from hypertension. PUBLIC HEALTH RELEVANCE: Low birth weight is an indicator of baby growth restriction before birth and associated with adult heart disease, diabetes and hypertension. The findings from this research have important implications for improving prenatal care and developing strategies beginning early to prevent adult heart disease.