A multilevel and structural equation modeling approach to understand longitudinal growth, obesity, and cardiometabolic risk among Samoan children

用于了解萨摩亚儿童纵向生长、肥胖和心脏代谢风险的多层次结构方程建模方法

• 批准号: 9758934
• 负责人: Courtney Cheu Lin Choy
• 金额: $ 4.5万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9758934
• 关键词: 4 year old; 7 year old; 9 year old; Address; Age; Australia; Behavior; Behavioral; Biological; Blood Pressure; Body Composition; Body fat; Body mass index; Child; Childhood; Community Actions; Data; Data Analyses; Development; Diet; Dietary intake; Disease; Disease Marker; Dual-Energy X-Ray Absorptiometry; Elderly; Environment; Epidemiology; Equation; Ethnic group; Etiology; Fatty acid glycerol esters; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Growth; Growth and Development function; High Prevalence; Household; Individual; Intervention; Investments; Learning; Life; Longitudinal cohort study; Measurement; Measures; Methodology; Mind; Modeling; Mothers; New Zealand; Nutritional; Obesity; Outcome; Overweight; Pacific Island Americans; Pacific Islands; Pathway interactions; Peripheral; Physical activity; Population; Prediabetes syndrome; Prevalence; Prevention; Prevention strategy; Preventive Intervention; Procedures; Research; Resources; Risk; Risk Factors; Risk Marker; Samoa; Samoan; Socioeconomic Status; Structure; Thinness; Time; Training; Work; biobehavior; boys; cardiometabolic risk; cardiometabolism; cohort; design; diabetic; economic impact; experience; girls; global health; health disparity; improved; insight; multilevel analysis; obesity development; obesity in children; obesity prevention; obesity risk; obesity treatment; psychosocial; public health relevance; societal costs

PROPOSAL SUMMARY Despite considerable investments in prevention and treatment of obesity in children, prevalence continues to increase with catastrophic individual and societal costs. Pacific Islanders are among the most at risk, with obesity prevalence rising disproportionately faster among Pacific Islanders compared to other ethnic groups. Obesity prevention strategies are clearly needed, but a) the early determinants of obesity among Pacific Islanders are poorly understood, and b) for optimal efficacy, it is necessary to first understand both the age at which elevated cardiometabolic risk markers are established and the periods of growth that are most sensitive to environmental or behavioral risk factors during childhood. As such, we established the Ola Tuputupua’e “Growing Up” cohort in Samoa; the first longitudinal cohort study of children among the Pacific Island nations. To date, the cohort includes 450 children and their biological mothers with serial anthropometric measurements from 2015 (2-4 years old) and 2017-2018 (3.5-7 years old). Cross-sectional findings from the study demonstrate that this cohort is ideal for research focused on childhood obesity given the high prevalence and early emergence of cardiometabolic risk. The objective of this proposal is to develop a comprehensive model of childhood obesity development in Samoa that 1) describes growth and body composition during a critical age period for obesity development, 2) captures influences of individual and household factors and the age periods during which growth is most sensitive to them, and 3) quantifies the influence of longitudinal growth on cardiometabolic disease markers. We will focus on body mass index (BMI) to assess growth over time, diet and physical activity as modifiable individual-level factors, and household urbanicity and socioeconomic status as structural household- level factors. We plan to collect data in 2019 from the same children (5.5-9 years old) to provide a third time point for analysis, utilize newly collected dual energy-x-ray absorptiometry body composition data, and employ longitudinal modeling approaches to address the following specific aims: 1) Use multilevel modeling to identify individual and household-level factors associated with childhood BMI trajectories, 2) Use multilevel modeling to assess the association of childhood BMI trajectories with (a) body composition (b) blood pressure, and (c) glycosylated hemoglobin at 5.5-9 years old, and 3) Use structural equation modeling to assess the direct and indirect effect of individual-and household-level factors on childhood BMI and body composition. This research will be among the first to use a longitudinal, multilevel design to examine the time-fixed and time-varying effects of individual and household-level factors on growth, body composition, and cardiometabolic disease markers among children in the Pacific Island nations. The findings will likely apply to other settings and enhance our understanding of the range of bio-behavioral-environmental etiologic pathways of obesity onset and cardiometabolic risk development during childhood to concretely inform intervention strategies.

提案摘要 尽管在预防和治疗儿童肥胖方面投入了大量资金，但患病率仍持续上升 随着灾难性的个人和社会成本的增加。太平洋岛民是肥胖风险最高的人群之一 与其他族裔群体相比，太平洋岛民的患病率上升速度要快得多。肥胖 显然需要采取预防策略，但是 a) 太平洋岛民肥胖的早期决定因素是 知之甚少，b）为了获得最佳疗效，有必要首先了解升高的年龄 建立心脏代谢风险标记以及对环境最敏感的生长期 或儿童时期的行为危险因素。因此，我们建立了 Ola Tuputupua’e“成长”队列 在萨摩亚；第一个针对太平洋岛国儿童的纵向队列研究。迄今为止，该队列 包括 2015 年（2-4 岁）以来的 450 名儿童及其亲生母亲进行了一系列人体测量 旧）和2017-2018（3.5-7岁）。该研究的横断面调查结果表明，该群体 鉴于儿童肥胖症的高患病率和早期出现，是关注儿童肥胖症的研究的理想选择 心脏代谢风险。该提案的目标是开发儿童肥胖的综合模型 萨摩亚的发展，1) 描述了肥胖关键年龄阶段的生长和身体成分 发展，2）捕捉个人和家庭因素以及成长年龄阶段的影响 对它们最敏感，并且3）量化纵向生长对心脏代谢疾病的影响 标记。我们将重点关注体重指数（BMI）来评估随时间、饮食和身体活动的增长情况 可改变的个人层面的因素，以及家庭城市化和社会经济地位作为结构性家庭 水平因素。我们计划在 2019 年收集同一儿童（5.5-9 岁）的数据，以提供第三个时间点 进行分析时，利用新收集的双能 X 射线吸收测定身体成分数据，并采用 纵向建模方法可实现以下具体目标：1）使用多级建模来识别 与儿童 BMI 轨迹相关的个人和家庭层面的因素，2) 使用多层次模型 评估儿童 BMI 轨迹与 (a) 身体成分 (b) 血压和 (c) 的关联 5.5-9 岁的糖化血红蛋白，以及 3) 使用结构方程模型评估直接和 个人和家庭因素对儿童体重指数和身体成分的间接影响。这项研究 将是最早使用纵向、多层次设计来检查固定时间和时变效应的人之一 个人和家庭层面因素对生长、身体成分和心脏代谢疾病标志物的影响 太平洋岛国的儿童中。研究结果可能适用于其他环境并增强我们的能力 了解肥胖发生的生物行为环境病因途径的范围 儿童时期心脏代谢风险的发展，为干预策略提供具体信息。