Emergence of Cardiometabolic Risk Across the Lifecycle in China

描述（由申请人提供）：考虑到饮食、活动和体重随时间推移的复杂调解和调节，对将广泛的环境因素与健康行为联系起来，然后与整个生命周期的心脏代谢风险联系起来的途径知之甚少。缺乏理解的主要原因是：1）缺乏高质量的纵向暴露数据; 2）缺乏环境和结果快速变化的人群数据，这些数据具有足够的可变性来观察变化; 3）没有充分使用复杂的统计模型来检查依赖时间的复杂系统的每一部分。中国健康与营养调查（CHNS）是一项由美国国立卫生研究院（NIH）资助的研究，对11，000多人进行了20多年的跟踪调查，提供了高质量的纵向数据，并捕捉了过去20年中与城市化并行的肥胖、高血压、胰岛素抵抗、2型糖尿病和心血管疾病的急剧出现。拟议的研究利用这些独特的数据来研究随着时间的推移，以不同城市化水平为特征的社区的变化模式。使用复杂的结构模型，我们建议研究社区，家庭和个人层面的因素影响饮食和体育活动的复杂途径，然后是体重增加的速度，程度和时间，最终是整个生命周期的心脏代谢风险。中国在回答这些问题方面具有独特的优势，因为亚洲人在相对较低的BMI和较年轻的年龄中心脏代谢危险因素的患病率较高，腹部肥胖和胰岛素抵抗的发生率相对较高。我们利用大量的纵向人体测量，血压和详细的行为，社会经济和环境信息，以及新收集的空腹血液样本进行心脏代谢生物标志物。我们的目标包括：1）开发一个纵向结构模型，以调查社区、家庭和个人因素如何影响：（a）20年内与能量相关的饮食和体力活动行为，（B）体重和腰围，以及（c）血压; 2）将相同的多水平、基于路径的分析（目标1a-1c）扩展到血脂异常、胰岛素抵抗和敏感性以及炎症的标志物。拟议的研究将为预防和治疗策略提供信息，以优化心脏代谢风险降低工作的有效性，更好地了解更广泛的社会，经济和环境背景在风险人群中的作用。 公共卫生相关性：中国是一个快速现代化的国家，在高血压、糖尿病和心脏代谢风险方面承受着巨大的负担，为检查风险的发展提供了独特的模式。拟议研究的目的是了解整个生命周期中从环境、行为和生物学到心脏代谢风险的多种途径，以便为缓解地球仪早期疾病风险的努力提供信息。

DESCRIPTION (provided by applicant): Very little is known about the pathways that link broad environmental factors to health behaviors, and then to cardiometabolic risk across the lifecycle, taking into account the complex mediation and moderation by diet, activity, and weight over time. The primary reasons for this lack of understanding are: 1) insufficient high- quality, longitudinal exposure data; 2) lack of data in populations undergoing rapid changes in environments and outcomes, with enough variability to observe changes; and 3) insufficient use of complex statistical models to allow examination of each piece of the time-dependent, complex system. The China Health and Nutrition Survey (CHNS), an NIH-funded study of more than 11,000 individuals followed over 20 years, provides high- quality longitudinal data and captures the dramatic emergence of obesity, hypertension, insulin resistance, type 2 diabetes and cardiovascular disease in parallel with urbanization during the past two decades. The proposed study takes advantage of these unique data to examine patterns of change in communities characterized by different levels of urbanization over time. Using sophisticated structural models we propose to examine the complex pathways through which community-, household- and individual-level factors affect diet and physical activity, then the rate, degree and timing of weight gain and ultimately, cardiometabolic risk across the lifecycle. China is uniquely positioned to answer these questions given its high prevalence of cardiometabolic risk factors at relatively low BMI and at younger ages, and the relatively higher abdominal obesity and high rates of insulin resistance in Asians. We capitalize on a vast array of longitudinal anthropometry, blood pressure and detailed behavioral, socioeconomic and environmental information as well as newly collected fasting blood samples for cardiometabolic biomarkers. Our objectives include: 1) developing a longitudinal, structural model to investigate how community, household and individual factors influence: (a) energy-related diet and physical activity behaviors, (b) weight and waist circumference and (c) blood pressure over 20 years; and 2) extend the same multilevel, pathway-based analyses (Aims 1a-1c) to markers of dyslipidemia, insulin resistance and sensitivity, and inflammation. The proposed research will inform prevention and treatment strategies to optimize the effectiveness of cardiometabolic risk reduction efforts, with greater understanding of the role of broader societal, economic and environmental contexts in populations at risk. PUBLIC HEALTH RELEVANCE: China is a rapidly modernizing country experiencing substantial burden in hypertension, diabetes and cardiometabolic risk, providing a unique model for examining development of risk. The objective of the proposed research is to understand the multiple pathways from environment, behavior and biology to cardiometabolic risk across the lifecycle in order to inform efforts to mitigate early development of disease risk across the globe.