The impact of COVID-19 pandemic-related stressors on childhood obesity and cardiometabolic risk

项目摘要/摘要 新冠肺炎疫情对本已高得令人无法接受的儿童肥胖率产生了令人担忧的影响， 新出现的证据表明，传统的儿科体重管理方法一直是 自大流行爆发以来，效果明显下降。因为儿童时期的肥胖更有可能是 在成年期间持续存在，患有肥胖症和其他慢性病的儿童更有可能患有 严重的新冠肺炎需要住院治疗，儿童肥胖率的惊人上升势在必行 除非采取有效的干预措施，否则将对人口健康产生广泛和长期的影响。然而， 我们对儿童肥胖率急剧上升的独特驱动因素知之甚少，也知道体重指数 增长将持续下去，并成为终生的。我们对缓解这种情况的保护性因素知之甚少。 风险，因为一些年轻人不会出现肥胖/心脏代谢健康恶化，或者可能很快恢复 风险敞口。我们的目标是揭示与大流行相关的生物行为途径 应激源驱动儿童肥胖和心脏代谢风险，并确定保护因素和干预措施 旨在减轻这一流行病对儿童健康的长期影响的目标。拟议的研究提供了一种 独特的、对时间敏感的机会，前瞻性地检查由 确定影响体重指数和心脏代谢健康轨迹的因素。我们将利用 建立了种族/民族多样化儿童(60%是拉丁裔)的纵向队列，这些儿童主要来自 收入家庭，在2-4岁时登记(U01HD068890)，并每年跟踪到 年龄7-11岁(R01HD090059)。强调这一群体、机构的及时性、独特性和重要性 成分、心血管和代谢功能、神经内分泌、氧化应激和炎症 生物标志物和健康行为是在大流行开始之前获得的(n=338)。在图形上绘制 过去5个时间点(包括大流行之前)的丰富纵向数据历史，我们 提议增加两次新的数据收集浪潮(队列开始后7年和8年，2至3年后) 大流行开始时)儿童将达到10-14岁，这是一个重要的发展窗口 肥胖和心脏新陈代谢印记。将测量与大流行相关的多个级别的压力源， 除了压力激活、肥胖和心脏新陈代谢健康的黄金标准生物学指标外， 目的健康行为测量和亲子调查。我们的具体目标集中在确定 引导有效童年所需的途径、亲子因素和邻里/社区环境 大流行后的肥胖干预措施，减少对健康的不利影响 脆弱和未得到充分研究的人群。

Project Summary/Abstract The COVID-19 pandemic has had an alarming impact on already unacceptably high childhood obesity rates, and emerging evidence shows that traditional approaches to pediatric weight management have been markedly less effective since the onset of the pandemic. As obesity during childhood is much more likely to be sustained during adulthood, and children with obesity and other chronic conditions are more likely to have severe forms of COVID-19 requiring hospitalization, this alarming increase in childhood obesity rates is poised to have a broad and long-term impact on population health unless effective interventions are implemented. Yet, we know very little about the unique drivers of this dramatic increase in childhood obesity and whether BMI increases will persist and become lifelong. We know even less about the protective factors that mitigate this risk, as some youth will not develop obesity/worsening cardiometabolic health or may recover quickly despite risk exposures. Our goals are to uncover the biobehavioral pathways through which pandemic-related stressors drive childhood obesity and cardiometabolic risk, and to identify protective factors and intervention targets to mitigate the long-term impact of the pandemic on children’s health. The proposed research offers a unique, time-sensitive opportunity to prospectively examine the impact of multilevel stressors brought on by the pandemic to identify factors influencing BMI and cardiometabolic health trajectories. We will leverage an established longitudinal cohort of racially/ethnically diverse children (60% Latino) from predominantly low- income households, who were enrolled at 2-4 years of age (U01HD068890) and followed annually through ages 7-11 (R01HD090059). Underscoring the timeliness, uniqueness, and significance of this cohort, body composition, cardiovascular and metabolic functioning, neuroendocrine, oxidative stress, and inflammatory biomarkers, and health behaviors were obtained just prior to the onset of the pandemic (n=338). Drawing on a rich history of longitudinal data over 5 previous timepoints including immediately prior to the pandemic, we propose to add two new waves of data collection (7- and 8-years after inception of the cohort, 2-3 years post- onset of the pandemic) when children will be 10-14 years of age, an important developmental window of obesity and cardiometabolic imprinting. Multiple levels of pandemic-related stressors will be measured, alongside gold standard biological measures of stress activation, adiposity and cardiometabolic health, objective health behavior measures, and parent-child surveys. Our specific aims focus on identifying the pathways, parent-child factors, and neighborhood/community contexts needed to guide effective childhood obesity interventions in the aftermath of the pandemic and reduce adverse health consequences among vulnerable and understudied populations.