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: 9925647
• 负责人: Courtney Cheu Lin Choy
• 金额: $ 4.55万
• 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/9925647
• 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症方面投入了大量资金， 增加了灾难性个人和社会代价。太平洋岛民是最危险的人群之一， 与其他族裔群体相比，太平洋岛民的流行率上升得更快。肥胖 预防策略显然是必要的，但a）太平洋岛民肥胖的早期决定因素是 人们对此知之甚少，以及B）为了获得最佳疗效，有必要首先了解升高的年龄 建立了心脏代谢风险标志物，并确定了对环境最敏感的生长期。 或儿童时期的行为危险因素。因此，我们建立了奥拉·图图图普阿“成长”队列 这是对太平洋岛屿国家儿童进行的第一次纵向队列研究。迄今为止， 包括450名儿童和他们的亲生母亲，从2015年开始进行连续人体测量（2-4岁 2017-2018年（3.5-7岁）。研究的横截面结果表明，该队列是 理想的研究集中在儿童肥胖的高患病率和早期出现的， 心脏代谢风险。这项建议的目的是建立一个全面的儿童肥胖模型 萨摩亚的一项发展，1）描述了肥胖关键年龄段的生长和身体组成 发展，2）捕捉个人和家庭因素的影响，以及生长的年龄段 对它们最敏感，3）量化纵向生长对心脏代谢疾病的影响 标记。我们将重点关注身体质量指数（BMI），以评估随着时间的推移，饮食和体力活动的增长， 可改变的个人层面因素，以及作为结构性家庭的家庭城市化和社会经济地位， 水平因素。我们计划在2019年从相同的儿童（5.5-9岁）中收集数据，以提供第三个时间点 为了进行分析，利用新收集的双能X射线吸收测定法身体成分数据， 纵向建模方法，以解决以下具体目标：1）使用多层次建模，以确定 与儿童BMI轨迹相关的个人和家庭层面因素，2）使用多水平建模， 评估儿童BMI轨迹与（a）身体成分（B）血压和（c） 5 -9岁时的糖化血红蛋白，以及3）使用结构方程模型来评估直接和 个人和家庭水平因素对儿童BMI和身体成分的间接影响本研究 将是第一个使用纵向，多水平设计来检查时间固定和时间变化的影响 个体和家庭水平因素对生长、身体组成和心脏代谢疾病标志物的影响 在太平洋岛国的儿童中。这些发现可能适用于其他环境，并提高我们的 了解肥胖发病的生物-行为-环境病因学途径的范围， 儿童期的心脏代谢风险发展，以具体告知干预策略。