Nutrition and Physical Activity Assessment Study (NPAAS)

描述（申请人提供）：R 01 CA 119171的竞争性更新，“营养和身体活动评估研究”（NPAAS），继续关注生物标志物的使用，以评估和比较突出的营养和身体活动评估方法的测量特性，以及在妇女健康倡议（WHI）的研究中使用生物标志物校准的营养消耗和活动相关能量消耗（AREE）估计值绝经后妇女的队列。我们的目标是：1）进行对照喂养研究，以开发其他营养素和食物的生物标志物，2）使用正在进行和拟议的NPAAS研究阶段的生物标志物，在整个WHI队列中开发生物标志物校准的营养素消耗和AREE估计值，用于疾病相关性研究。我们将招募150名年龄在60-80岁之间的妇女，在WHI西雅图现场中心登记，进入高度个性化控制饮食的喂养研究，每个妇女的饮食设计接近她通常的食物消费模式。妇女将在2周的喂养期内接受所有食物和饮料。我们将获得24小时尿源性营养指标，包括氮（蛋白质）、果糖、蔗糖（糖）、烷基间苯二酚（全谷物）和1-和3-甲基组氨酸（肉类）;和血液来源的营养措施，包括类胡萝卜素（水果和蔬菜），1-和3 -生育酚（脂肪和油）、磷脂脂肪酸（脂肪和油）和叶酸（水果和蔬菜）。生物标志物评价将包括评估尿液和血液测量的能力，以及研究受试者特征，以解释喂养研究期间提供的营养物质和食物的变化。总能量消耗（TEE）将使用双标记水方案测量，静息能量消耗（REE）将使用间接量热法测量，0. 9 TEE-REE作为AREE的客观测量。我们将为每种营养素/食物或具有合适生物标志物的活动测量开发校准方程，通过使用NPAAS项目两个阶段中妇女的标本和数据对相应自我报告测量的生物标志物进行回归分析。合适的生物标志物将可用于总能量、蛋白质、来自蛋白质的能量百分比以及用于总活动相关能量消耗。我们将在WHI队列中应用这些校准方程，使用食物频率问卷和多日食物记录来产生校准的消费估计值，并使用WHI活动问卷来产生校准的AREE估计值。这些校准的估计值将与广泛的临床结局（例如，癌症、心血管疾病、糖尿病、虚弱、肥胖等）。这项工作解决了饮食和身体活动流行病学研究的根本差距，在国家和国际肥胖流行病的背景下，以及在许多相关的慢性病发病率和死亡率。 公共卫生相关性：饮食和身体活动模式在保持体重和整体健康（预防肥胖相关疾病）方面具有重要作用。然而，由于以前在这一领域的研究一直相互矛盾，公共卫生运动和卫生保健提供者的饮食和体育活动的指示通常缺乏特异性和力量。缺乏令人信服的数据来支持生活方式相关疾病风险降低工作的一个主要原因是，用于收集饮食和身体活动数据的工具和方法可能包含重大的系统性偏差。这项研究将开发和使用血液和尿液中的生物标志物来校准自我报告的饮食和身体活动，并将检查绝经后妇女校准的癌症，心血管疾病和糖尿病“暴露”的关系。

DESCRIPTION (provided by applicant): This competing renewal of R01 CA119171, "Nutrition and Physical Activity Assessment Study" (NPAAS), continues to focus on the use of biomarkers to evaluate and compare measurement properties of prominent nutritional and physical activity assessment methods, and on the use of biomarker-calibrated nutrient consumption and activity-related energy expenditure (AREE) estimates in studies in Women's Health Initiative (WHI) cohorts of postmenopausal women. Our aims are: 1) To conduct a controlled feeding study to develop biomarkers for additional nutrients and foods, and 2) To use biomarkers from the ongoing and proposed NPAAS study phases to develop biomarker-calibrated nutrient consumption and AREE estimates, throughout the WHI cohorts for use in disease-association studies. We will recruit 150 women, in the age range 60-80 y, enrolled in the WHI Seattle Field Center, into a feeding study of a highly individualized controlled diet, with each woman's diet designed to approximate her usual food consumption patterns. Women will receive all foods and beverages during the 2-week feeding period. We will obtain 24-h urine-derived nutritional measures, including nitrogen (protein), fructose, sucrose (sugars), alkylresorcinols (whole grains) and 1- and 3- methylhistidine (meat); and blood-derived nutritional measures, including carotenoids (fruits & vegetables), 1- and 3 -tocopherols (fats & oils), phospholipid fatty acids (fats & oils), and folate (fruits & vegetables) at the beginning and end of the 2-week feeding period. Biomarker evaluation will include an assessment of the ability of urine and blood measures, and study subject characteristics to explain variation in nutrients and foods provided during the feeding study. Total energy expenditure (TEE) will be measured using a doubly-labeled water protocol, as will resting energy expenditure (REE) using indirect calorimetry with 0.9TEE-REE as objective measure of AREE. We will develop calibration equations for each nutrient/food or activity measure having a suitable biomarker, by regression analysis of the biomarker on corresponding self-report measures using specimens and data from the women in both NPAAS project phases. Suitable biomarkers will be available for total energy, protein, percent of energy from protein, and for total activity-related energy expenditure. We will apply these calibration equations in the WHI cohorts using a food-frequency questionnaire and multiple-day food record to produce calibrated consumption estimates and using a WHI activity questionnaire to produce calibrated AREE estimates. These calibrated estimates will be related to the subsequent incidence of a broad range of clinical outcomes (e.g., cancer, cardiovascular disease, diabetes, frailty, obesity, etc) among the 161,808 women in the WHI cohorts. This work addresses fundamental gaps in diet and physical activity epidemiology research, in the context of national and international obesity epidemics, and in much related chronic disease morbidity and mortality. PUBLIC HEALTH RELEVANCE: Dietary and physical activity patterns have an important role in maintaining body weight and overall health (in preventing obesity-related diseases). However, because previous research in this area has been conflicting, public health campaigns and health care provider instructions for diet and physical activity typically lack specificity and force. A major reason for the lack of convincing data to support lifestyle-related disease risk- reduction efforts is that the tools and methods used to gather data on diet and physical activity may incorporate major systematic biases. This study will develop and use biomarkers in blood and urine to calibrate self- reported diet and physical activity and will examine the relationship of calibrated 'exposures' to cancer, cardiovascular disease, and diabetes in postmenopausal women.