Nutrition and Metabolic Status in Youth with Type 1 DM: SEARCH Ancillary Study

描述（由申请人提供）： 营养被认为是儿童糖尿病（DM）日常治疗的基石。然而，关于营养因素在青年诊断的1型（T1）DM自然史中的作用知之甚少，包括细胞衰退的进展和心血管疾病（CVD）风险因素的出现。拟议的工作是CDC/DDT和NIH/NIDDK资助的青年糖尿病项目的辅助研究，该项目是一项正在进行的多中心观察性研究，针对0-19岁青年诊断的糖尿病。采用横断面和纵向设计，营养辅助研究（SNAS）的总体目标是检查营养因素与1）胰岛素分泌缺陷的进展和2）1型糖尿病青年中CVD危险因素的存在的相关性。与PAR-07-024的目标一致，SNAS是ESTA第2阶段所述目标的自然延伸，其重点是DM类型相关特征的演变，包括胰岛素分泌缺陷，以及DM长期并发症的风险因素的演变。从研究数据来看，青少年DM福尔斯的饮食摄入量远远低于营养建议。此外，与未患糖尿病的青年相比，1型糖尿病青年中CVD危险因素的患病率升高。为了严格检验营养因素作为1型糖尿病青年代谢状态的决定因素，我们建议1）通过问卷调查获得婴儿喂养史的新数据，2）获得选定营养生物标志物的新实验室检测结果（血浆生育酚、维生素D、镁和脂肪酸），使用来自研究参与者的储存样本，以及3）进行饮食评估子研究，以提高我们适当构建统计模型的能力，以解决饮食数据中的测量误差。具体目标1是评估营养因素作为保留β-call功能的潜在决定因素，在大约1140名经阳性DM自身抗体证实的1型DM青年中。特定目标1的受试者将在2002 - 2005年诊断为糖尿病，空腹C肽数据可从正在进行的研究中纵向获得。此外，这些年轻人的一个子集将有β细胞功能纵向测量混合餐刺激C肽。具体目标2是评估营养因素与心血管疾病的危险因素，在大约2415青年1型糖尿病流行于2001年或事件在2002 - 2005年，使用横向和纵向分析。结果将为营养建议和未来的糖尿病青年营养干预临床试验提供独特的信息。本项目包括所有的现场。我们的多学科团队由伊丽莎白·迈耶-戴维斯博士领导，她是饮食和糖尿病方面的知名专家，曾指导过最初的糖尿病饮食评估。

DESCRIPTION (provided by applicant): Nutrition is considered a cornerstone of day-to-day treatment of childhood diabetes mellitus (DM). However, little is known regarding the role of nutritional factors in the natural history of diagnosed Type 1 (T1) DM in youth, including progression of ¿-cell decline and the emergence of cardiovascular disease (CVD) risk factors. The proposed work is an ancillary study to the CDC/DDT and NIH/NIDDK funded SEARCH for Diabetes in Youth project, which is an ongoing multi-center, observational study of DM diagnosed in youth age 0-19 years. Using both cross-sectional and longitudinal designs, the overall goal of the SEARCH Nutrition Ancillary Study (SNAS) is to examine associations of nutritional factors with 1) the progression of insulin secretion defects, and 2) the presence of CVD risk factors in youth with Type 1 DM. Consistent with the objective of PAR-07-024, SNAS is a natural extension of the stated aims of SEARCH Phase 2, which focuses on the evolution of DM type-related characteristics including insulin secretion defects, and the evolution of risk factors for long term complications of DM. From SEARCH data, dietary intake in adolescents with DM falls far short of nutrition recommendations. Moreover, the prevalence of CVD risk factors is elevated among youth with Type 1 DM, compared to youth without DM. To rigorously examine nutritional factors as determinants of metabolic status of youth with Type 1 DM, we propose to 1) obtain new data on history of infant feeding practices by questionnaire, and 2) obtain new laboratory test results on selected nutrient biomarkers (plasma tocopherols, vitamin D, magnesium, and fatty acids) using stored samples from SEARCH participants, and 3) conduct a Diet Assessment Sub-study to advance our capacity to appropriately construct statistical models to address measurement error in dietary data. Specific Aim 1 is to evaluate nutritional factors as potential determinants of preserved beta call function in approximately 1140 youth with Type 1 DM confirmed by positive DM autoantibodies. Subjects for Specific Aim 1 will have had diabetes diagnosed in 2002 - 2005, with fasting C-peptide data available longitudinally from the ongoing SEARCH study. Additionally, a subset of these youth will have beta cell function measured longitudinally as mixed meal stimulated C-peptide. Specific Aim 2 is to evaluate nutritional factors in relation to CVD risk factors in approximately 2415 youth with Type 1 DM prevalent in 2001 or incident in 2002 - 2005, using both crosssectional and longitudinal analyses. Results will uniquely inform nutrition recommendations and future clinical trials of nutrition interventions for youth with DM. All SEARCH sites are included in this project. Our multidisciplinary team is led by Dr Elizabeth Mayer-Davis, a well-recognized expert in diet and diabetes who directed the original SEARCH diet assessment.