Early Environmental Stressors and Emerging Cardiometabolic Risk

项目总结/摘要 在理解途径、时机、风险和保护因素方面存在根本性的差距， 将早期环境压力转化为儿童时期出现的心脏代谢风险。改进 了解早期环境压力源引起新兴失调的途径， 心脏代谢过程，儿童期观察到影响的时间以及保护因素 促进恢复力，是必要的，以优化干预措施，以防止心血管疾病的发展， 代谢性疾病拟议的研究将使用534个独特的队列来解决这一知识差距 参加一项两组随机对照肥胖症研究的种族/民族多样的低收入儿童 预防试验，并从2-4岁开始随访[NET-Works试验（U 01 HD 068890; 舍伍德/法国PI），COPTR联盟（儿童肥胖预防和治疗研究， NIH/NHLBI/DCVS/PPSP）]。这项前瞻性研究的目的是描述 在这个7-9岁的高危儿童队列中， 可塑性因素，减轻了早期环境应激对后期心脏代谢的有害影响， 风险环境压力源（客观和感知的邻里和家庭）的最新措施 环境），儿童和父母的行为模式（儿童健康行为的金标准测量， 执行功能技能和养育因素）和生理介质（头发中的皮质醇水平 样本），已经在幼儿期的四个时间点获得。年龄的新测量 7-9将允许对心脏代谢风险进行最前沿的评估，包括心血管和 代谢参数、身体组成、青春期阶段和氧化应激/炎症。具体来说， 研究将（1）检查儿童的健康行为，执行功能， 幼儿期的父母教养方式缓冲了早期环境压力源与 新出现的心脏代谢风险，（2）检查HPA轴调节是否在新出现的途径上 心脏代谢风险，并确定儿童和父母因素发挥缓冲作用的程度 通过调节儿童的皮质醇水平，以及（3）探讨是否参与多层次的行为 肥胖预防干预可以增强儿童健康行为的缓冲作用， 功能和养育因素对心脏代谢风险的影响， 因素这种做法是创新的，因为它代表了对现状的实质性偏离， 关注早期环境应激源在心脏病发作期间引起心脏代谢风险的途径， 童年中期和缓冲这种风险的保护因素，重要的是， 对优化生活在压力大的早期环境中的幼儿的干预措施有直接的影响 预防心血管和代谢疾病。

Project Summary/Abstract There is a fundamental gap in understanding the pathways, timing, and risk and protective factors that translate early environmental stressors into emerging cardiometabolic risk during childhood. Improved knowledge of the pathways through which early environmental stressors give rise to emerging dysregulation in cardiometabolic processes, the timing during childhood when impacts are observed, and the protective factors that foster resilience, is necessary to optimize interventions to prevent the development of cardiovascular and metabolic diseases. The proposed study will address this knowledge gap using a unique cohort of 534 racially/ethnically diverse, low income children who participated in a two-arm randomized controlled obesity prevention trial and have been followed since 2-4 years of age [The NET-Works Trial (U01HD068890; Sherwood/French PIs), part of the COPTR consortium (Child Obesity Prevention and Treatment Research, NIH/NHLBI/DCVS/PPSP)]. The goal of this prospective study is to characterize the emergence of dysregulation in cardiometabolic processes in this high-risk cohort of children at 7-9 years of age, and identify malleable factors that mitigate the deleterious impact of early environmental stressors on later cardiometabolic risk. State-of-the-art measures of environmental stressors (objective and perceived neighborhood and home environment), child and parent behavior patterns (gold standard measures of children's health behaviors, executive functioning skills, and parenting factors) and physiological mediators (cortisol levels from hair samples), have already been obtained at four time points during early childhood. New measurements at ages 7-9 will allow the most cutting-edge assessment of cardiometabolic risk, including cardiovascular and metabolic parameters, body composition, pubertal stage, and oxidative stress/inflammation. Specifically, this study will (1) examine whether longitudinal patterns of children's health behavior, executive functioning, and parenting practices during early childhood buffer the relationship between early environmental stressors and emerging cardiometabolic risk, (2) examine whether HPA-axis regulation is on the pathway to emerging cardiometabolic risk, and determine the extent to which child and parenting factors exert a buffering effect through modulating children's cortisol levels, and (3) explore whether participation in a multi-level behavioral obesity prevention intervention can enhance the buffering effects of children's health behaviors, executive functioning, and parenting factors on cardiometabolic risk by altering the trajectories of these modifiable factors. This approach is innovative, because it represents a substantial departure from the status quo by focusing on the pathways through which early environmental stressors give rise to cardiometabolic risk during middle childhood and the protective factors which buffer against this risk, and significant because it is expected to have direct implications for optimizing interventions for young children living in stressful early environments to prevent cardiovascular and metabolic diseases.