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

项目摘要/摘要 布加勒斯特早期干预项目(BEIP)--比较FOSTER的唯一随机对照试验(RCT) 对幼儿的机构照顾--旨在解决有关人类的基本问题 发展以及何时和如何干预处于早期严重心理社会剥夺中的儿童。 BEIP已经确定了在生活中的大型机构中长大对精神病理学和大脑的影响 然而，到目前为止，对更广泛的健康后果的了解仍不清楚。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，及时回答关于严重早期忽视的长期影响的问题， 以及随后的社会经历和生物风险因素能够在以后减弱或放大 随着这些人进入成年期--心血管风险的关键时期--健康风险。这项建议 利用参与者还是婴儿和蹒跚学步的孩子时的现有重复评估 机构，在随机分配到照常护理或寄养护理安置后，一直到16岁。我们建议 对22岁的BEIP参与者通过临床检查、实验室测试、 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)基于血清的代谢危险标志物；4)炎症生物标志物；5)端粒长度， 6)自我报告的健康行为，包括睡眠、体育活动、烟酒使用和饮食。在……里面 目标1，我们将检验早期制度化和寄养干预的长期影响 青年时期的心脏代谢风险。在目标2中，我们将评估应激反应在 青春期与儿童期中期至成年期端粒磨损的关系 青壮年心脏代谢风险的制度化和寄养。在目标3中，我们将确定 机构养育和寄养对应激性生活事件与生活事件之间关系的调节作用 心脏代谢风险。我们最重要的假设是，早期生活中的严重忽视会产生负面影响。 青壮年的心脏代谢健康以及随后的社会经历和生物学风险 各种因素可以缓和这一轨迹。我们的建议是创新的，因为RCT设计提供了无与伦比的 测试早期心理社会剥夺和后来的照顾如何在早期形成心脏代谢风险的机会 成人期。我们的结果将提供迄今为止最全面的关于 心脏代谢风险及相关健康行为的早期剥夺和寄养。这项建议是 具有重要意义，因为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 在世界范围内和临床实践中，儿童面临最普遍的虐待儿童形式--忽视。

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.