Infant diet and cardiometabolic risk among children born preterm

早产儿的婴儿饮食和心脏代谢风险

基本信息

批准号：
10716587
负责人：
Mandy Brown Belfort
金额：
$ 75.31万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-23 至 2028-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10716587
关键词：
2 year old 5 year old Acceleration Address Age American Heart Association Biological Markers Biometry Birth Brain C-reactive protein Cardiology Cardiometabolic Disease Child Childhood Chronic Clinical Clinical Trials Collaborations Conceptions Data Development Developmental Process Diabetes Mellitus Diet Discipline of obstetrics Disease Endocrinology Energy Intake Ensure Exhibits Fatty acid glycerol esters Fetal Development Fetus Future Glucose Goals Growth Health Hospitalization Hospitals Human Milk Hypertension Impairment Individual Infant Insulin Intake Intervention Intervention Trial Leptin Life Life course epidemiology Lipids Macronutrients Nutrition Malnutrition Measures Metabolic syndrome Monitor Morbidity - disease rate Neonatal Intensive Care Units Neonatology Nutrient Nutritional Support Obesity Outcome Participant Pattern Physiology Population Pregnancy Premature Infant Preventive Proteins Randomized, Controlled Trials Recommendation Recording of previous events Research Risk Factors Serum Survivors Testing Third Pregnancy Trimester Visit Vulnerable Populations Weight Gain Work adiponectin blood pressure reduction cardiometabolic risk cardiometabolism cardiovascular health clinical care cohort design dietary early childhood experience extreme prematurity follow-up fortification improved infant nutrition infant outcome innovation meetings metabolomics modifiable risk neonatal care neurodevelopment obesity risk obstetric care point of care postnatal protein intake public health relevance standard of care targeted delivery theories young adult

项目摘要

Project Summary / Abstract Each year, over 63,000 U.S. infants are born very preterm, prior to 32 weeks of gestation. With >90% now surviving to discharge due to better obstetrical and neonatal intensive care unit (NICU) management, the present challenge is to reduce short- and long-term morbidities experienced by survivors, including the two- to four-fold increased risk of obesity, diabetes, hypertension, and metabolic syndrome that manifest by young adulthood. The Developmental Origins of Health and Disease (DOHaD) framework posits that chronic conditions result from adverse exposures during vulnerable developmental stages known as “critical” or “sensitive” periods. Of particular importance is the first 1000 days of life, when key developmental processes set the stage for lifelong health. Very preterm infants are an especially vulnerable population, as they require NICU support for 2-4 months after birth, coinciding with the 3rd trimester – an established sensitive period for programming of obesity and cardiometabolic risk. In this context, the most highly modifiable and relevant exposure is diet during the NICU hospitalization, which may contribute to the accelerated accretion of fat mass relative to fat-free mass. Hospitalized very preterm infants typically experience impaired weight gain, stunted linear growth, and excess fat accretion relative to the typical fetus. To offset these issues and support brain development, dietary fortification of human milk is provided as standard of care. However, the consequences of dietary fortification for cardiometabolic health in this population are poorly understood. This proposal seeks to uncover the extent to which diet-based interventions that promote physical growth and brain development during a sensitive period may also contribute to cardiometabolic risk. We will study 130 infants born 24-31 weeks of gestation who are participating in the Nourish Study (R01HD097327l; PI: Belfort), an ongoing randomized controlled trial testing the effect of individually targeted human milk fortification vs. standard of care during the NICU hospitalization. By extending follow-up of this cohort and adding cardiometabolic biomarkers at 2 and 5 years of age, we have a unique opportunity to investigate how macronutrient and energy delivery during a sensitive period contributes to, or protects from, cardiometabolic risk during childhood. We are further poised to address key questions about NICU growth patterns in relation to cardiometabolic health in this population. Findings from this work have strong potential to impact clinical care by informing dietary strategies during a sensitive window in development to optimize lifelong health for a vulnerable population.

项目摘要 /摘要每年，超过63,000名美国婴儿出生于妊娠32周之前。现在> 90％由于更好的产科和新生儿重症监护病房（NICU）管理而生存，因此目前的挑战是减少因生存所经历的短期和长期疾病，包括两到包括肥胖，糖尿病，高血压和代谢综合征的风险增加了四倍。成年。健康与疾病（DOHAD）框架的发展起源认为在脆弱的发育阶段不良暴露阶段被称为“关键”或 “敏感”时期。尤其重要的是生命的前1000天，关键的发展过程为终身健康奠定了基础。非常早产的婴儿是一个特别脆弱的人群，因为他们需要 NICU出生后2-4个月的支持，与三个月相吻合 - 已建立的敏感时期肥胖和心脏代谢风险的编程。在这种情况下，最高度修改和相关的暴露于NICU住院期间的节食，这可能有助于加速脂肪的积聚相对于无脂肪质量。住院的非常早产的婴儿通常会体重增加，发育不良线性生长和相对于典型胎儿的过量积聚。抵消这些问题并支持大脑开发，作为护理标准提供人牛奶的饮食强化。但是，后果对该人群中心脏代谢健康的饮食防御力的理解很少。该建议寻求揭示促进身体生长和大脑发展的基于饮食的干预措施的程度在敏感时期，也可能导致心脏代谢风险。我们将研究130名24-31岁出生的婴儿妊娠几周，他们正在进行Nourish研究（R01HD097327L； PI：Belfort）随机对照试验测试单独针对的人牛奶强化与标准的效果在NICU住院期间护理。通过扩展该队列的随访并添加心脏代谢在2岁和5岁时的生物标志物，我们有一个独特的机会来研究大量营养素和能量在敏感时期内的分娩有助于或保护儿童时期的心脏代谢风险。我们进一步毒化以解决与心脏代谢健康有关的NICU增长模式的关键问题这个人口。这项工作的发现具有强大的潜力，可以通过告知饮食来影响临床护理在开发中敏感窗口中的策略，以优化脆弱人群的终身健康。