SEARCH Nutrition Ancillary Study 2

描述(由申请人提供)：研究记录了患有1型糖尿病(T1 DM)和2型糖尿病(T2 DM)的年轻人中出现的大血管和微血管疾病。关于营养因素在这些并发症的出现中所起的作用，人们知之甚少。这项拟议的研究是Search Nutrition辅助研究(SNAS1；由NIH/NIDDK资助)的继续，也是Search in Young糖尿病项目(Search；CDC/DDT和NIH/NIDDK资助)的辅助。搜索包括从2002年至今的20岁时诊断的糖尿病事件病例，并进行基线研究访问。搜索队列研究包括对2002-2006年和2008年被诊断为糖尿病的患者进行后续研究访问，糖尿病持续时间为5年。SNAS1的目的包括在基线访问时确定与β细胞功能相关的营养因素和青年T1 DM患者的心血管(CVD)危险因素。SNAS2是SNAS1的自然延伸，将使用横断面和纵向设计研究营养因素与患有T1 DM和T2 DM的青年大血管和微血管并发症的相关性。基线和队列研究访问的暴露数据将包括血浆营养生物标记物(脂肪酸、维生素D和E)，以及纳入测量误差模型的食物频率问卷数据。我们将分别在患有T1 DM(n=2,710)和T2 DM(n=435)的青年中解决以下目标：目标1：评估选定的营养因素与亚临床心血管疾病标记物(脉搏波速度、增大指数和视网膜血管直径)的关系，假设特定的饱和脂肪酸(SFA)、单不饱和脂肪酸(MUFA)和多不饱和脂肪酸(PUFA)、n-3/n-6 PUFA的比例、维生素D和E、纤维、果糖和饮食模式(地中海停止高血压的饮食方法，统计得出的饮食模式)将与这些标记物相关。目的2：评估选定的营养因素与糖尿病视网膜病变(DR)标志物的关系，假设维生素D和E、多不饱和脂肪酸和饮食结构将与Dr呈负相关。目的3：评估选定的营养因素与糖尿病肾病(DKD；尿液)标志物的关系 白蛋白：肌酐比值[UACR]和估计肾小球滤过率[EGFR])及其进展(UACR)，假设特定的SFA、多不饱和脂肪酸、维生素D和E以及饮食结构将与DKD相关。SNAS2研究利用并扩展了来自有史以来最大的糖尿病青年队列之一的数据，以回答有关营养和糖尿病并发症的关键研究问题。此外，这项研究将使用增强的和新颖的分析方法来检查这些高度临床相关的问题。这些结果将为青少年糖尿病患者的营养建议提供参考，并为临床试验提供急需的科学基础，采用营养方法来降低大血管和微血管并发症的风险。

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.