The Effects of Early Psychosocial Deprivation on Cardiometabolic Risk in Early Adulthood

项目总结/摘要 布加勒斯特早期干预项目（BEIP）-唯一的随机对照试验（RCT）比较福斯特 从幼儿保育到幼儿机构保育，旨在解决有关人的基本问题， 发展以及何时以及如何对早期遭受严重心理社会剥夺的儿童进行干预。 BEIP已经确定了在大型机构中长大对精神病理学和大脑的影响 然而，迄今为止，对更广泛的健康后果的理解仍然未知。我们 建议对22岁的BEIP参与者进行新的评估，以提供有关心脏代谢风险的数据 因素和健康行为，及时回答有关严重早期忽视的长期影响的问题， 以及随后能够减弱或放大的社会经历和生物风险因素 健康风险，因为这些人进入成年期，心血管风险的关键时期。这项建议 利用现有的重复评估，从参与者是婴儿和幼儿时，仍然生活在 机构，随机化后照顾如常或寄养安置，并通过16岁。我们建议 对22岁的BEIP参与者进行身体健康评估，通过临床检查，实验室检查， 和自我报告的健康行为。我们将评估六个结果领域：1）身体大小，脂肪和脂肪分布; 2)血压; 3）基于血清的代谢风险标志物; 4）炎性生物标志物，5）端粒长度， 和6）自我报告的健康行为，包括睡眠，身体活动，酒精和烟草的使用，以及饮食。在 目标1，我们将研究早期机构化和寄养干预对儿童的长期影响。 心脏代谢风险。在目标2中，我们将评估压力反应性在以下方面的调节作用： 从童年中期到成年期的青春期和端粒磨损对早期 机构化和寄养对青年期心脏代谢风险的影响。在目标3中，我们将确定 机构养育和寄养对压力性生活事件与家庭关系的调节作用 心脏代谢风险。我们的总体假设是，在生命早期严重忽视会产生负面影响， 青年期心脏代谢健康以及随后的社会经历和生物风险 一些因素可以缓和这一趋势。我们的建议是创新的，因为RCT设计提供了无与伦比的 有机会测试早期心理社会剥夺和后来的剥夺如何形成早期心脏代谢风险。 成年我们的研究结果将提供迄今为止最全面的研究， 早期剥夺和寄养对心脏代谢风险和相关健康行为的影响。这项建议是 重要的是，预计它将为与数百万接受机构照料的儿童有关的政策提供信息， 世界范围内针对遭受最普遍形式的儿童虐待、忽视的儿童的临床实践。

Project Summary/Abstract The Bucharest Early Intervention Project (BEIP)—the only randomized controlled trial (RCT) comparing foster care to institutional care for young children—was designed to address essential questions about human development and when and how to intervene with children exposed to early severe psychosocial deprivation. The BEIP has identified the effects of being raised in large institutions in life on psychopathology and brain structure and function, yet, to date, understanding of the broader health consequences remain unknown. We propose a new assessment of BEIP participants at age 22 years to provide data regarding cardiometabolic risk factors and health behaviors to answer timely questions about the long-term impact of severe early neglect, and the subsequent social experiences and biological risk factors capable of attenuating or amplifying later health risk as these individuals enter adulthood, a key time period for cardiovascular risk. This proposal leverages existing repeated assessments from when the participants were infants and toddlers still living in institutions, after randomization to care as usual or foster care placement, and through age 16. We propose to conduct physical health assessments of BEIP participants at age 22, via clinical examinations, laboratory tests, and self-reported health behaviors. We will assess six outcome domains: 1) body size, fat, and fat distribution; 2) blood pressure; 3) serum-based metabolic risk markers; 4) inflammatory biomarkers, 5) telomere length, and 6) self-reported health behaviors, including sleep, physical activity, alcohol and tobacco use, and diet. In Aim 1, we will examine the long-term effects of early institutionalization and the foster care intervention on cardiometabolic risk in young adulthood. In Aim 2, we will evaluate the moderating effects of stress reactivity in adolescence and telomere attrition from mid-childhood to adulthood on the associations between early institutionalization and foster care on cardiometabolic risks in young adulthood. In Aim 3, we will determine the moderating effects of institutional rearing and foster care on the associations between stressful life events and cardiometabolic risk. Our overarching hypothesis is that severe neglect in early life will negatively impact cardiometabolic wellbeing in young adulthood and that subsequent social experiences and biological risk factors can moderate this trajectory. Our proposal is innovative as the RCT design provides an unparalleled opportunity to test how early psychosocial deprivation and later caregiving shape cardiometabolic risk in early adulthood. Our results will provide the most comprehensive examination to date of the long-term impact of early deprivation and foster care on cardiometabolic risks and related health behaviors. This proposal is significant as it is expected to inform policies pertaining to millions of children exposed to institutional care worldwide and clinical practices for children exposed to the most prevalent form of child maltreatment, neglect.