Weight, Diet, Genes and CVD Risk Factors (Hypertension and Diabetes)

简介（申请人提供）：心血管疾病（CVD）是世界上发病率和死亡率的主要原因（1- 3）。高血压和糖尿病是两种主要的CVD危险因素，是遗传和环境因素共同作用下的复杂疾病（4-8）。很少有研究考察这些因素之间的相互作用，如果有的话，也很少有研究考察它们对亚洲发展中国家人口的影响，这些国家正受到肥胖水平不断上升和食物环境迅速变化的困扰（9,10）。信息差距可能是由于缺乏足够深入和详细的以人口为基础的研究。从纵向研究中得出的饮食和肥胖趋势的信息缺乏，遗传数据也不充分，特别是在体质指数阈值较低的亚洲人中（11,12）。目的和方法：该研究旨在通过宿务纵向健康和营养调查（CLHNS）了解体重史、饮食模式和遗传变异如何独立和共同影响菲律宾成年妇女（2007年年龄38至71岁）的血压和空腹血糖，该调查是一项正在进行的社区研究，从1983年开始对2000多名妇女（及其婴儿）进行研究。这是一个独特的数据集，不仅包含这些妇女丰富的遗传信息，还包含自基线以来获得的饮食和人体测量数据、最近的血压（1998-2007年）和空腹血糖（2005年）测量数据，以及在24年全国范围内快速的社会经济变化中收集的其他个人、家庭和社区层面的数据。具体来说，我们将使用多元回归方法确定：(a)体重史（即超重持续时间）对高血压和/或糖尿病风险的影响；(b)饮食模式（通过聚类分析确定）与高血压和/或糖尿病之间的关联；(c)高血压和糖尿病的独立性和共发性，以及它们与体重和饮食模式的关系；(d)基因变异对高血压和糖尿病的影响，重点关注先前关联研究中与高血压或糖尿病相关的基因变异。此外，该研究将探索遗传变异、超重史和饮食模式对高血压或糖尿病的影响之间的显著相互作用。公共卫生相关性：本研究将检查遗传易感性和可改变因素（如体重和饮食模式）对高血压和糖尿病（两种主要心血管疾病（CVD）危险因素）风险的独立和联合影响。菲律宾的人口和健康趋势是亚洲其他发展中国家的典型，这些国家与心血管疾病有关的发病率和死亡率普遍存在，而且还在增加。因此，研究导致菲律宾人患高血压和糖尿病的机制可以提供关键信息，为这些人群提供更有针对性的预防措施，有可能缩小全球健康差距。

DESCRIPTION (provided by applicant): Cardiovascular diseases (CVD) are the leading causes of morbidity and mortality in the world (1- 3). Hypertension and diabetes, two of the major CVD risk factors, are complex diseases caused by the combined actions of genetic and environmental factors (4-8). Few studies have examined the interaction of these factors and fewer, if any, have looked at their effects in populations of developing Asian countries that are plagued with increasing levels of obesity and rapidly changing food environments (9, 10). The information gap may be due to the lack of population-based studies with adequate depth and detail. There is a paucity of information on dietary and adiposity trends derived from longitudinal studies and there are inadequate genetic data, especially among Asians who tend to develop CVD risk factors at lower body mass index thresholds (11, 12). Aims and Methods: The proposed study aims to understand how weight history, dietary patterns, and genetic variants independently and jointly affect blood pressure and fasting glucose among adult Filipino women (ages 38 to 71 yr in 2007) using the Cebu Longitudinal Health and Nutrition Survey (CLHNS), an ongoing community-based study of over 2000 women (and their infants) which began in 1983. This is a unique dataset that contains not only rich genetic information on these women but also dietary and anthropometric measurements obtained since baseline, recent blood pressure (1998-2007) and fasting glucose (2005) measurements, and other individual-, household-, and community-level data collected over a span of 24 years of rapid country-wide socio-economic changes. Specifically, using multivariate regression methods we will determine the: (a) effect of weight history (i.e. duration of overweight) on the risk of having hypertension and/or diabetes; (b) association between dietary patterns (identified through cluster analysis) and hypertension and/or diabetes; (c) independence and co-occurrence of hypertension and diabetes and how these relate to weight and dietary patterns; and (d) effects of genetic variants on hypertension and diabetes, focusing on gene variants that have been associated with hypertension or diabetes by previous association studies. Further, the study will explore significant interaction of effects among genetic variants, overweight history and dietary patterns in affecting hypertension or diabetes. PUBLIC HEALTH RELEVANCE: This study will examine the independent and combined effects of genetic predisposition and modifiable factors such as weight and dietary patterns on the risks of having hypertension and diabetes, two major cardiovascular disease (CVD) risk factors. The demographic and health trends in the Philippines exemplify those of other developing Asian countries where CVD-related morbidities and deaths are prevalent and increasing. Thus, studying the mechanisms that can lead to the development of hypertension and diabetes among Filipinos can provide critical information that may guide more tailored prevention efforts for these populations, potentially narrowing global health disparities.