SEARCH Nutrition Ancillary Study 2

描述（由申请人提供）：研究记录了1型（T1DM）和2型糖尿病（T2DM）青年中出现的大血管和微血管疾病。我们对营养因素在这些并发症中所起的作用知之甚少。拟议的研究是SEARCH营养辅助研究（SNAS1；资助NIH/NIDDK）的延续，并辅助SEARCH for Diabetes in Youth项目（SEARCH； CDC/DDT和NIH/NIDDK资助）。检索包括2002年至今<20岁诊断的糖尿病病例，并进行基线研究访问。SEARCH队列研究包括对2002-2006年和2008年诊断为糖尿病且糖尿病持续时间为50年的SEARCH参与者进行随访研究访问。SNAS1的目的包括在基线访问时确定与T1DM青年患者β细胞功能和心血管（CVD）危险因素相关的营养因子。SNAS2是SNAS1的自然延伸，将通过横断面和纵向设计研究营养因子与青年T1DM和T2DM患者大血管和微血管并发症的关系。来自基线和队列研究访问的暴露数据将包括血浆营养生物标志物（脂肪酸、维生素D和E），以及包含测量误差模型的食物频率问卷的数据。我们将分别在患有1型糖尿病（n= 2710）和2型糖尿病（n=435）的青少年中解决以下目标：目标1：为了评估与亚临床CVD标志物（脉搏波速度、增强指数和视网膜血管直径）相关的选定营养因子，假设特定的饱和（SFA）、单不饱和（MUFA）和多不饱和脂肪酸（PUFA）、n-3与n-6 PUFA的比例、维生素D和E、纤维、果糖和饮食模式（饮食方法来阻止高血压，地中海，一种统计衍生的饮食模式）将与这些标志物相关。目的2：评估选定的营养因子与糖尿病视网膜病变（DR）标志物的关系，假设维生素D和E、PUFA和饮食模式与DR呈负相关。目的3：评估选定的营养因子与糖尿病肾病（DKD；尿）标志物的关系

DESCRIPTION (provided by applicant): Research has documented the emergence of macrovascular and microvascular disease among youth with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Little is known about the role of nutritional factors in the emergence of these complications. The proposed study is a continuation of the SEARCH Nutrition Ancillary Study (SNAS1; funded NIH/NIDDK), and ancillary to the SEARCH for Diabetes in Youth project (SEARCH; CDC/DDT and NIH/NIDDK funded). SEARCH includes incident DM cases diagnosed when <20 years of age, from 2002-present, and has a baseline research visit. The SEARCH Cohort study includes a follow-up research visit for SEARCH participants with DM diagnosed in 2002-2006 and 2008 with DM duration >5 years. The aims of SNAS1 included identification of nutritional factors associated with beta cell function and cardiovascular (CVD) risk factors in youth with T1DM at the baseline visit. SNAS2 is a natural extension of SNAS1 and will examine the associations of nutritional factors with macro- and microvascular complications in youth with T1DM and T2DM using cross-sectional and longitudinal designs. Exposure data from the baseline and Cohort Study visits will include plasma nutrient biomarkers (fatty acids, vitamins D and E), and data from a food frequency questionnaire incorporating measurement error modeling. We will address the following aims separately among youth with T1DM (n=2,710) and T2DM (n=435): Aim 1: To evaluate selected nutritional factors in relation to markers of subclinical CVD (pulse wave velocity, augmentation index, and retinal vessel diameter), hypothesizing that specific saturated (SFA), monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA), the ratio of n-3 to n-6 PUFA, vitamins D and E, fiber, fructose, and dietary patterns (Dietary Approaches to Stop Hypertension, Mediterranean, a statistically derived dietary pattern) will be associated with these markers. Aim 2: To evaluate selected nutritional factors in relation to markers of diabetic retinopathy (DR), hypothesizing tha vitamins D and E, PUFA, and dietary patterns will be inversely associated with DR. Aim 3: To evaluate selected nutritional factors in relation to markers of diabetic kidney disease (DKD; urine albumin:creatinine ratio [UACR]) and estimated glomerular filtration rate [eGFR]) and its progression (UACR), hypothesizing that specific SFA, PUFA, vitamins D and E, and dietary patterns will be associated with DKD. The SNAS2 study leverages and expands data from one of the largest cohort of youth with DM ever assembled to answer critical research questions regarding nutrition and DM complications. Additionally, this study will employ enhanced and novel analytic methods to examine these highly clinically relevant questions. Results will inform nutrition recommendations for youth with DM and provide the much needed scientific basis for clinical trials employing nutritional approaches to reduce risk of macro- and microvascular complications.