Early Life Precusors of Chronic Disease

项目概要（见说明）：成人慢性病是当今工业化国家和发展中国家的主要公共卫生问题。虽然通常与老年人的衰老和健康有关，但越来越多的证据表明，在美国，慢性病开始于年轻时。该子项目汇集了计划项目调查人员的互补和全面的专业知识，将Wave V计划项目中收集的各种多层次数据与早期纵向Add Health数据进行创新性协作整合：1）记录年轻人中临床前慢性疾病风险和弗兰克疾病的患病率，以及2）评估支持健康与疾病发展起源（DOHaD）范式中的三种慢性疾病出现的生命过程模型的证据，包括潜在效应生命过程模型，累积模型，和Pathways Life Course模型。添加健康数据是唯一适合于解决这些目标，因为该研究包括一个大的，多样化的，具有代表性的样本与丰富的重复测量（调查和生物标志物为基础）的健康和健康行为，纵向表征的社会和物理环境，以及经验信息从妊娠整个生命过程。描述性分析将包括衍生（例如，BMI）和构造变量（例如，非稳态负荷），并根据关键人口统计学（如生物性别、种族/民族、SES和地理区域）记录慢性疾病风险的人群水平以及疾病的发病率和患病率。评估DOHaD模型将需要多种方法来解决各自的假设，包括结构方程模型和潜在类增长模型，以按类型对特定于响应者的轨迹进行聚类。模型将包括个别随时间变化的风险指标和累积风险的综合指数。这些目标的完成将通过将年轻成人的健康和疾病风险与妊娠、儿童和青少年期间发生的身体和社会暴露联系起来，改变关于导致慢性病的叠加和互动途径的知识，对预防和干预工作产生重要影响。

PROJECT SUMMARY (See instructions): Adult chronic disease is the major public health problem of both the industrialized and developing world today. Although typically associated with aging and health of the elderly, there is mounting evidence that chronic conditions are beginning at younger ages in the US. This subproject brings together complementary and comprehensive expertise of program project investigators in an innovative collaborative integration of the diverse multilevel data collected in the Wave V Program Project with earlier longitudinal Add Health data: 1) to document the prevalence of preclinical chronic disease risk and frank disease in young adulthood, and 2) to evaluate evidence supporting three life course models of chronic disease emergence within the Developmental Origins of Health and Disease (DOHaD) paradigm, including the Latent Effects Life Course Model, the Cumulative Model, and the Pathways Life Course Model. Add Health data are uniquely suited to address these aims because the study encompasses a large, diverse, representative sample with rich repeated measures (survey and biomarker based) of health and health behavior, longitudinal characterization of social and physical environments, and experiential information from gestation across the life course. Descriptive analyses will include production of derived (e.g., BMI) and constructed variables (e.g., allostatic load) from Wave V and earlier waves, and documentation of population levels of chronic disease risk and incidence and prevalence of disease according to key demographics such as biological sex, race/ethnicity, SES, and geographical region. Evaluating DOHaD models will entail multiple approaches suited to address their respective hypotheses, including structural equation modeling and latent class growth models to cluster respondent-specific trajectories by type. Models will incorporate individual time-varying risk indicators and aggregated indices of cumulative risk. Completion of these aims will transform knowledge on the additive and interactive pathways leading to chronic disease by linking young adult health and disease risk to physical and social exposures that occur during gestation, childhood, and adolescence, with vital implications for prevention and intervention efforts.