Differential impacts of water insecurity on diet and body composition throughout the life course

项目摘要/摘要 不可靠地获得所有家庭使用的安全和充足的水(即水不安全)是一个常见的问题，但 对公共卫生问题研究不足。尽管水本身就是一种关键的营养物质，对农业生产至关重要 减少肠道病原体暴露的生产、食品制备和卫生做法，很少有研究 研究了水不安全在营养方面的作用；大多数人只考虑水质。一个更全面的 水不安全的概念化可以揭示水的可获得性、可靠性、 而适量会影响饮食和健康。 水的不安全给烹调营养密集型食物带来了很大的障碍，这往往需要 相当多的水要变得可口和安全地饮用。定性研究报告说，水 不安全限制了母乳喂养的持续时间，并削弱了照顾者准备首选母乳喂养的能力 补充食品。经历过水不安全的人也更有可能用水取代水 含糖饮料，似乎会增加体重，增加超重和肥胖的风险。 拟议的项目试图通过检查差异的程度来扩展这一形成工作 在整个生命过程中，暴露在水不安全的环境中会影响饮食质量和身体成分。 需要一种混合的方法来全面了解水不安全是如何在 这会影响家庭的营养水平，进而影响营养福祉。因此，拟议的项目将使用 定性数据补充来自2个现有队列研究的定量数据，这些研究全面测量了 厄瓜多尔圣克里斯托巴尔岛婴儿、儿童、青少年和成年人的水不安全和饮食 在菲律宾宿务。具体地说，该项目旨在定性地描述水的可获得性问题， 可获得性和使用对食品生产、购买和制备的影响(目标1)。多层次建模将是 用于评估家庭用水不安全是否损害儿童饮食质量(目标2)和纵向 将应用结构方程模型来评估家庭用水不安全状况的变化 早期发育影响肥胖(目标3)。 该项目将利用先进的统计程序解决该领域内公认的知识差距问题 将水的不安全状况建模为多维、时变的暴露。这项工作的发现具有 有可能揭示解决日益严重的营养不良负担的新目标。此外，建议的 严格的营养和流行病学课程，以及来自水和水领域思想领袖的指导 营养学专业将为申请人在全球营养学领域的学术生涯做好准备。

PROJECT SUMMARY/ABSTRACT Unreliable access to safe and sufficient water for all household uses (i.e., water insecurity) is a common but understudied public health issue. Although water is itself a critical nutrient that is essential for agricultural production, food preparation, and hygienic practices that reduce exposure to enteric pathogens, few studies have examined the role of water insecurity in nutrition; most consider water quality only. A more holistic conceptualization of water insecurity could reveal important pathways by which water accessibility, reliability, and adequacy impact diet and health. Water insecurity presents substantial barriers to cooking nutrient-dense foods, which often require considerable water to be made palatable and safe for consumption. Qualitative studies have reported that water insecurity limits breastfeeding duration and undermines the ability of caregivers to prepare preferred complementary foods. Individuals experiencing water insecurity are also more likely to substitute water with sugar-sweetened beverages, plausibly contributing to weight gain and increased risk of overweight and obesity. The proposed project seeks to expand upon this formative work by examining the extent to which differential exposure to water insecurity impacts diet quality and body composition throughout the life course. A mixed-methods approach is required to comprehensively understand how water insecurity manifests at the household level and subsequently impacts nutritional well-being. The proposed project will therefore use qualitative data to complement quantitative data from 2 existing cohort studies that comprehensively measured water insecurity and diet among infants, children, adolescents, and adults on San Cristóbal Island, Ecuador and in Cebu, Philippines. Specifically, the project aims to qualitatively describe how issues with water availability, accessibility, and use impact food production, purchase, and preparation (Aim 1). Multi-level modeling will be used to assess whether household water insecurity undermines child diet quality (Aim 2) and longitudinal structural equation modeling will be applied to evaluate how changes in household water insecurity throughout early development impact adiposity (Aim 3). The project will address a recognized knowledge gap within the field by using advanced statistical procedures to model water insecurity as a multidimensional, time-varying exposure. Findings from this work have the potential to reveal new targets for addressing the growing burden of malnutrition. Additionally, the proposed rigorous curriculum in nutrition and epidemiology, as well as mentorship from thought leaders in the water and nutrition sectors, will prepare the applicant for an academic career in global nutrition.