Childhood Origins for Cardiac Structure and Function

描述（由申请人提供）：儿童肥胖的流行已经影响到这个国家的儿童和青少年，导致这些年龄组的高血压患病率增加。对费尔斯纵向研究（FLS）数据集的分析表明，儿童期血压升高可以准确地追踪到成年期，儿童期血压升高，即使在被认为是正常的范围内——从国家疾病控制与预防中心生长图表（2000）的第70到95百分位——也能准确地预测成年期的高血压和代谢综合征。鉴于肥胖和高血压之间的密切联系，以及高血压与心脏结构和功能异常之间的联系，确定儿童期肥胖是否预示着今后生活中心脏结构和/或功能的异常，对公共卫生具有重要意义。我们准备询问FLS数据集的一部分来解决这个问题。FLS数据集的相关部分包括750名同意接受成人超声心动图研究的参与者从出生到成年的连续人体测量和血压测量，以及从8岁到成年的身体成分测量。分层和聚类纵向建模程序将应用于这一独特的系列测量，以阐明儿童肥胖、血压、成熟速度和异常心脏结构和功能之间的关系。我们计划调查的具体目标包括确定儿童血压、体型和身体组成对(1)血压、(2)心脏结构和(3)心脏功能的影响，这些影响在几十年后的成年人中是相同的。我们分析了750多个超声心动图研究，从中得出左室质量指数（LVMI）、室间隔厚度（IVST）和相对壁厚（RWT）的结构测量，以及射血分数（EF）和左室缩短分数（LVSF）的功能测量。这些建议的分析有可能量化成年期高血压和心脏结构和功能异常的风险，给出儿童和青少年时期的身体大小、身体组成和血压的一定值，即使这些值在目前接受的正常值范围内。如果我们在儿童中发现了预测高血压和/或成人心脏结构和功能异常的生物标志物，那么可以更彻底地评估具有这些生物标志物的儿童，并在发生不可逆转的病理变化之前提供生活方式和/或药物干预。相反，我们提出的分析也有可能确定儿童和青少年时期的一组体型、身体组成和血压范围，这些范围与以后的高血压或心脏结构和功能异常无关，并且可以用来预测没有心脏结构或功能异常的正常成年期。

DESCRIPTION (provided by applicant): The epidemic of childhood obesity that has affected children and adolescents in this country has led to an increased prevalence of hypertension in these age groups. Analyses of the Fels Longitudinal Study (FLS) data set have shown that elevated blood pressure in childhood tracks into adulthood with fidelity and that elevated blood pressure in childhood, even within the range considered to be normal---from the 70th to the 95thpercentiles of the National CDC growth charts (2000)---accurately predict hypertension and the metabolic syndrome in adulthood. In view of the close association of obesity and hypertension and of the association of hypertension with abnormalities of cardiac structure and function, it would be of public health importance to ascertain if childhood obesity predicts abnormalities of cardiac structure and/or function later in life. We are poised to interrogate a portion of the FLS data set to address this question. The pertinent portion of the FLS data set includes serial anthropometric and blood pressure measurements from birth---and body composition measurements from age eight years---through adulthood in 750 participants who consented to undergo echocardiographic studies as adults. Hierarchical and cluster longitudinal modeling procedures will be applied to this unique set of serial measurements to elucidate the relationships between childhood obesity, blood pressure, tempo of maturation, and abnormal cardiac structure and function. The specific aims that we plan to investigate include ascertaining the effects of children's blood pressure, body size, and body composition on (1) blood pressure, (2) cardiac structure, and (3) cardiac function in the same subjects decades later as adults. We have available for analysis more than 750 echocardiographic studies from which to derive the structural measurements of left ventricular mass index (LVMI), interventricular septal thickness (IVST), and relative wall thickness (RWT) and the functional measurements of ejection fraction (EF) and left ventricular shortening fraction (LVSF). These proposed analyses have the potential to quantify risk for hypertension and abnormalities of cardiac structure and function in adulthood given certain values for body size, body composition, and blood pressure in childhood and adolescence, even if these values fall within currently accepted normal values. If we identify biomarkers in children that predict hypertension, and/or abnormal cardiac structure and function in adults, then children with these biomarkers can be evaluated more thoroughly and offered lifestyle and/or pharmacologic interventions before irreversible pathologic changes have occurred. Conversely, our proposed analyses also have the potential to identify a set of ranges of body size, body composition, and blood pressure in childhood and adolescence which are not associated with hypertension or abnormal cardiac structure and function later in life and which can be used to predict a normotensive adulthood, free of cardiac structural or functional abnormalities.