Common and distinct early environmental influences on cardiometabolic and respiratory health: Mechanisms and methods

早期环境对心脏代谢和呼吸系统健康的常见和独特影响：机制和方法

• 批准号: 9355742
• 负责人: Kenneth P. Kleinman
• 金额: $ 241.43万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-21 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9355742
• 关键词: Address; Adolescence; Adult; Age; Air Pollution; Allergens; Area; Asthma; Attention; Back; Behavioral; Biological; Biological Markers; Birth; Boston; Characteristics; Chemicals; Child; Child Nutrition; Child health care; Childhood; Childhood Asthma; Chronic; Collaborations; Complex; Conceptions; DNA Methylation; Data; Development; Diet; Dyspnea; Early Intervention; Environment; Environmental Exposure; Environmental Risk Factor; Etiology; Evolution; Exposure to; Feedback; Fetus; Functional disorder; Genes; Genetic; Goals; Health; Home environment; Hormones; Household; Individual; Intervention; Lead; Life; Longevity; Measures; Mediation; Metals; Methods; Modernization; Modification; Mothers; Nature; Neighborhoods; Obesity; Obstruction; One-Step dentin bonding system; Outcome; Outcome Measure; Passive Smoking; Pathway interactions; Patient Self-Report; Persons; Pharmaceutical Preparations; Phenotype; Physical environment; Policies; Pregnancy; Prevention; Preventive Intervention; Productivity; Quality of life; Questionnaires; Recruitment Activity; Resolution; Respiratory Signs and Symptoms; Respiratory physiology; Risk; Risk Factors; School-Age Population; Science; Skin; Sleep; Social Environment; Societies; Source; Statistical Methods; Symptoms; System; Techniques; Teenagers; Testing; Time; Violence; Visit; Weight Gain; cohort; cost; early adolescence; early childhood; early life exposure; effective intervention; experience; feeding; follow-up; health care service utilization; infancy; innovation; insight; intervention effect; maternal depression; models and simulation; mother nutrition; multidisciplinary; novel; offspring; prenatal; prevent; racism; resilience; respiratory; respiratory health; response; social; spatiotemporal; stressor; tv watching

Project Summary/Abstract Obesity and asthma are the two most common chronic conditions in children. Obesity is a risk factor for asthma as well as for dyspnea not associated with airflow obstruction. Reciprocally, asthma symptoms and some asthma medications may increase risk of excess weight gain. Because no effective cures exist, and because both conditions are often established before school age, early life prevention is critical. Yet our ability to identify the most promising environmental or behavioral targets for prevention has been hampered by the fact that many exposures may be difficult to measure, often overlap and interact, and rarely occur at a single point in time. Individuals may vary in their sensitivity to exposures because of genetic or other factors. Furthermore, obesity and asthma themselves are not static – each may first emerge in early childhood, later childhood, adolescence, or adulthood; once present they may persist, remit, or worsen; and the two outcomes may interact. Sophisticated analytic approaches are needed to handle the complex natures of both longitudinal birth cohort data as well as of the questions themselves. To this end, we propose this project, which is grounded in our large Boston-area Project Viva pre-birth cohort. We recruited mothers in early pregnancy, and have followed them and their children at frequent in-person visits (after delivery and at infancy, early childhood, mid-childhood, and the nearly completed early teen visits) as well as via annual questionnaires. Building on the outcomes we have already assessed from birth through early adolescence, we now propose to characterize adiposity and cardiometabolic health measures as well as lung function and respiratory symptoms into the mid-teen years. Using state of the art statistical methods, we will address the early life environmental exposures that, singly and as mixtures, influence the separate and co-evolution of obesity, asthma and related dysfunctions. We will refine exposure measures, characterize outcome trajectories, and disentangle confounding, mediation and moderation in associations of exposures with outcomes. Finally, we will use agent based simulation models that will draw from but also go beyond the results from our own cohort, to identify optimal levers for effective intervention, incorporating multiple levels of action from physiologogy all the way up to policy. We will contribute the data, measures, and methods we refine within our cohort to the larger ECHO enterprise, as well as findings to be followed up in the large synthetic cohort with its diversity representative of children nationwide.

项目总结/摘要 肥胖和哮喘是儿童中最常见的两种慢性疾病。肥胖是一个危险因素， 哮喘以及与气流阻塞无关的呼吸困难。哮喘症状和 一些哮喘药物可能会增加体重过度增加的风险。因为没有有效的治疗方法， 由于这两种情况往往在学龄前就已形成，因此，生命早期预防至关重要。然而我们的能力 确定最有希望的环境或行为目标的预防一直受到阻碍， 事实上，许多风险可能难以衡量，往往重叠和相互作用，很少发生在一个单一的 时间点由于遗传或其他因素，个人对暴露的敏感性可能有所不同。 此外，肥胖和哮喘本身并不是一成不变的--每一种都可能首先出现在儿童早期， 儿童期、青春期或成年期;一旦出现，可能会持续、缓解或恶化;两种结果 可以互动。需要复杂的分析方法来处理这两个纵向 出生队列数据以及问题本身。 为此，我们提出了这个项目，这是基于我们的大型波士顿地区的项目Viva出生前队列。 我们招募了怀孕早期的母亲，并对她们和她们的孩子进行了频繁的亲自访问 （分娩后以及婴儿期、幼儿期、幼儿中期和几乎完成的青少年早期访视） 通过年度问卷调查。基于我们从出生到现在已经评估过的结果， 在青春期早期，我们现在建议描述肥胖和心脏代谢健康指标，以及 肺功能和呼吸道症状一直持续到青少年中期 使用最先进的统计方法，我们将解决生命早期的环境暴露， 作为混合物，影响肥胖、哮喘和相关功能障碍的单独和共同进化。我们将 完善暴露措施，描述结果轨迹，并理清混杂因素、中介因素和 适度的接触与结果的关联。最后，我们将使用基于代理的仿真模型 这将借鉴但也超越了我们自己的队列的结果，以确定有效的最佳杠杆 干预，包括从生理学到政策的多层次行动。我们将 将我们在队列中改进的数据、度量和方法贡献给更大的ECHO企业， 作为将在具有儿童多样性代表性的大型合成队列中进行随访的结果， 全国范围