Promotion of Exclusive Breastfeeding in Children with Sickle Cell Disease for Improved Health Outcomes

促进镰状细胞病儿童纯母乳喂养以改善健康状况

• 批准号: 10693377
• 负责人: Brandi Pernell
• 金额: $ 16.98万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10693377
• 关键词: 2 year old; 5 year old; Academy; Acceleration; Address; Admission activity; Adolescent; Adult; Affect; African American; African American population; African ancestry; Age; Alabama; American; Anti-Inflammatory Agents; Antioxidants; Asthma; Behavior; Biological; Biological Markers; Blood Circulation; Blood Vessels; Blood specimen; Breast Feeding; Breastfed infant; C-reactive protein; Cardiovascular Diseases; Certification; Cessation of life; Chest Pain; Child; Chocolate; Chronic; Chronic Disease; Clinical Trials Design; Communities; Complement; Critical Care; DNA; Diagnosis; Diet; Disease; Drops; Dyspnea; Education; Erythrocytes; Ethnic Population; Event; Exclusive Breastfeeding; Exposure to; Feasibility Studies; Fever; Fostering; Future; Goals; Health; Healthy People 2020; Hemoglobin; Hemolysis; High Prevalence; Home visitation; Hospitalization; Human; Human Milk; Hypoxia; Immunologics; Individual; Infant; Infiltration; Inflammation; Inflammatory; Inherited; Interleukin-8; Intervention; Intervention Trial; Knowledge; Lactation consultant; Lead; Leadership; Length; Life; Life Style; Longevity; Low income; Medial; Milk; Mothers; Neonatal Screening; Nitric Oxide; Nutritional; Obesity; Observational Study; Organ; Outcome; Oxidative Stress; Pain; Pathogenesis; Pathologic Processes; Pathway interactions; Pediatrics; Persons; Physical activity; Physiological; Population; Prevalence; Prevention strategy; Property; Public Health; Publishing; Randomized, Controlled Trials; Recommendation; Reporting; Research; Risk; Running; Science; Services; Severity of illness; Sickle Cell; Sickle Cell Anemia; Statistical Data Interpretation; Stress; Structure; Supplementation; Support Groups; Testing; Thoracic Radiography; Training; Vascular Endothelium; Woman; World Health Organization; acute care; acute chest syndrome; airway inflammation; breast pump; cell community; community engaged research; community organizations; comorbidity; design; experience; feasibility testing; fighting; health organization; healthspan; high risk population; immunoregulation; improved; improved outcome; indexing; infancy; inflammatory marker; inflammatory modulation; lifestyle factors; lung health; novel marker; peer coaching; peer support; programs; protective effect; racial population; recruit; role model; screening program; standard of care; support network; surveillance data; telomere; trend

ABSTRACT Sickle cell disease (SCD) is an inherited red blood cell disorder that predominantly affects individuals of African descent. The physiologic hallmarks of SCD include chronic red blood cell hemolysis, oxidative stress, inflammation, vascular damage and end-organ damage. These physiologic sequelae lead to unpredictable vaso occlusive complications, such as pain and acute chest syndrome (ACS). Human breastmilk contains antioxidant, anti-inflammatory and immune-modulating properties proven to be protective against chronic inflammatory conditions, such as asthma, obesity and cardiovascular disease. The lasting impacts of human breastmilk have been demonstrated in adolescent and adult studies, wherein individuals that were breastfed as infants had lower levels of biological markers of inflammation in their bloodstream. Interestingly, breastmilk has even been demonstrated to be protective against the erosion of telomeres – which are the protective caps of DNA and established markers of oxidative stress and inflammation. The American Academy of Pediatrics and World Health Organization recommend exclusive breastfeeding (EBF) for the first 6 months of life, followed by 1 to 2 years of breastfeeding with nutritious supplementation. However, despite these recommendations and the well- established protective benefits of EBF, the gap between Healthy People 2020 breastfeeding goals and current rates of EBF is widest amongst African American women compared to all other racial and ethnic groups. Furthermore, the protective effects of EBF have never been explored in SCD. Several studies have noted a lack of breastfeeding role models and support networks as barriers to EBF among African American women. One community-based organization located in Birmingham (Alabama) — the Chocolate Milk Mommies —, specifically addresses these barriers through online and in-person education and support groups, certified lactation consultant services, free breast pump rentals for low-income mothers and a home visitation and peer- mentoring program. Chocolate Milk Mommies specifically targets African American mothers, given the lower rates of breastfeeding in this population. This group achieved a 6-month EBF rate of 83% in 2019, far exceeding state and national trends. Given the pervasive oxidative stress and inflammation in SCD, and the consequent risk for pain and poor lung health, it is essential to test the protective benefits of EBF and establish effective EBF- promoting interventions among this high risk population. The aims for this project are to: 1) test the association between EBF exposure and SCD complications, 2) test the association between EBF exposures and biological markers of oxidative stress and inflammation, and 3) pilot the feasibility to recruit and retain 20 mothers of children with SCD to a community-based EBF program (the Chocolate Milk Mommies) for ≥6 months, which will inform a future larger randomized controlled trial. The long-term goal for this research is to establish the protective benefits of breastfeeding in SCD and improve overall health outcomes through the promotion of EBF.

抽象的 镰状细胞病 (SCD) 是一种遗传性红细胞疾病，主要影响非洲人 血统。 SCD 的生理学特征包括慢性红细胞溶血、氧化应激、炎症、血管 损伤和终末器官损伤。这些生理后遗症会导致不可预测的血管闭塞并发症， 例如疼痛和急性胸部综合症（ACS）。母乳含有抗氧化、抗炎和 免疫调节特性已被证明可以预防慢性炎症，例如 哮喘、肥胖和心血管疾病。人类母乳的持久影响 青少年和成人研究表明，婴儿时期接受母乳喂养的个体的出生率较低 血液中炎症生物标志物的水平。有趣的是，母乳甚至被 被证明可以防止端粒的侵蚀——端粒是 DNA 的保护帽， 建立了氧化应激和炎症的标志物。美国儿科学会和世界 卫生组织建议在生命的前 6 个月内进行纯母乳喂养 (EBF)，然后是 1 至 2 个月 多年母乳喂养并补充营养。然而，尽管有这些建议和良好的 确定了 EBF 的保护性益处、健康人群 2020 母乳喂养目标与当前母乳喂养目标之间的差距 与所有其他种族和族裔群体相比，非洲裔美国女性的 EBF 比率最高。 此外，EBF 在 SCD 中的保护作用从未被探索过。多项研究指出 缺乏母乳喂养榜样和支持网络是非洲裔美国女性进行 EBF 的障碍。 位于伯明翰（阿拉巴马州）的一个社区组织——巧克力牛奶妈妈—— 通过在线和面对面的教育和支持小组专门解决这些障碍，经过认证 哺乳咨询服务、为低收入母亲提供免费吸奶器租赁以及家访和同伴互访 辅导计划。鉴于费率较低，巧克力牛奶妈妈专门针对非裔美国母亲 该人群中母乳喂养的情况。该集团在 2019 年实现了 6 个月 EBF 率 83%，远超国家规定 和国家趋势。鉴于 SCD 中普遍存在的氧化应激和炎症，以及随之而来的风险 对于疼痛和肺部健康状况不佳，有必要测试 EBF 的保护作用并建立有效的 EBF- 促进对这一高危人群的干预。该项目的目标是：1）测试关联 EBF 暴露与 SCD 并发症之间的关系，2) 测试 EBF 暴露与生物学之间的关联 氧化应激和炎症标志物，以及 3) 试点招募和留住 20 名母亲的可行性 患有 SCD 的儿童参加社区 EBF 计划（巧克力牛奶妈妈）至少 6 个月， 将为未来更大规模的随机对照试验提供信息。这项研究的长期目标是建立 母乳喂养对 SCD 的保护作用，并通过促进 EBF 改善整体健康结果。