The Development of Early Childhood Obesity in Children Born Preterm

 描述(由申请人提供)：促进追赶生长和防止生长迟缓是早产到两岁以上儿童临床护理的主要组成部分。然而，我们的初步数据表明，肥胖是早产儿中一个严重的、被忽视的问题，而且出现的方式可能与足月出生的儿童不同。肥胖对早产儿童的有害影响远远大于对足月出生儿童的影响。如果没有知识来填补肥胖发展的程度、性质和时机以及在临床护理中如何持续识别肥胖的空白，就无法制定量身定制的预防策略来帮助临床医生和家庭促进适当的发育，同时防止早产儿过度发育。长期目标，这将是后续R01应用的主题，是开发为早产儿量身定做的循证策略，以指导临床医生和家庭预防超重和肥胖。R03申请中提出的这项研究是实现这一目标的下一步，其目的是应用尖端统计方法来确定早产儿与足月儿童相比在幼儿期超重和肥胖的患病率和发展时间，确定最佳干预窗口，并在超过16,000名儿童的纵向样本中记录在临床护理过程中对肥胖认识不足的程度。核心假设是：与足月出生的儿童相比，早产儿的生长轨迹差异最大，特别是在3岁之前，但超重和肥胖在4-6岁时几乎同样普遍，早产肥胖儿童诊断为肥胖的可能性较小。这一假设是基于历史低出生体重队列的数据和我们的初步数据提出的。这项拟议研究的基本原理是支持制定针对敏感期的循证干预措施，以预防早产儿超重和肥胖。这一假说将通过追求两个具体目标来检验：1)通过描述早产儿从出生到6岁的生长轨迹，并将这些轨迹与儿童的生长轨迹进行对比，确定预防肥胖的关键窗口 (2)与足月出生的儿童相比，确定早产儿童的肥胖诊断不足的程度。该方法将对超过16,000名从出生到6岁的儿童进行纵向研究，这些儿童是一家主要独立儿童医院的初级和专科护理提供者的患者。这项拟议的研究具有创新性，因为它将应用最先进的分析工具来模拟现代样本中的增长轨迹，使用详细的、可供研究的纵向增长数据集，该数据集基于非常大的儿科患者群体，包括早产和足月出生的儿童，平均在6岁之前测量超过13项指标。这项拟议的研究意义重大，因为它是制定策略的下一步，旨在帮助临床医生和家庭在预防肥胖的同时促进早产儿童的健康成长。

 DESCRIPTION (provided by applicant): Facilitating catch-up growth and preventing growth faltering is a major component of clinical care for children born preterm to at least age two. However, our preliminary data suggest that obesity is a major, under- recognized problem in the preterm population and likely emerges differently than for children born at term. Obesity has harmful consequences for children born preterm, far greater than the consequences for children born at term. Without knowledge to fill gaps about the extent, nature, and timing of obesity development and how consistently obesity is recognized in clinical care, tailored prevention strategies cannot be developed to help clinicians and families promote adequate growth while preventing excess growth among preterm children. The long-term goal, which will be the subject of a subsequent R01 application, is to develop evidence-based strategies tailored to preterm children to guide clinicians and families in preventing overweight and obesity. The objective of the study proposed in this R03 application, which is the next step towards that goal, is to apply cutting edge statistical methods to determine the prevalence and timing of the development of overweight and obesity in early childhood among preterm children, as compared to term children, to identify optimal intervention windows, and to document the extent of under-recognition of obesity during clinical care in a longitudinal sample of more than 16,000 children. The central hypothesis is: as compared to children born at term, growth trajectories will differ most especially before age 3 among preterm children but overweight and obesity will be nearly as prevalent by ages 4-6, and that obese children born preterm will be less likely to have an obesity diagnosis. The hypothesis was formulated based on data from historic low birth weight cohorts and our preliminary data. The rationale for the proposed study is to support the development of evidence-based interventions targeting sensitive periods to prevent overweight and obesity in children born preterm. The hypothesis will be tested by pursuing two specific aims: 1) Identify critical windows for obesity prevention by characterizing growth trajectories from birth to age 6 for children born preterm, and contrasting these with trajectories for children born at term, to compare the prevalence and timing of the development of overweight and obesity, and 2) Determine the extent of obesity under-diagnosis among children born preterm, as compared to children born at term. The approach will be a longitudinal study of more than 16,000 children from birth to age 6, patients of primary and subspecialty care providers at a major free-standing children's hospital. The proposed research is innovative because it will apply state-of-the-art analytic tools to model growth trajectories in a modern sample, using a detailed, research-ready longitudinal growth dataset based in a very large pediatric patient population, including children born preterm and at term, with an average of more than 13 measures before age six. The proposed research is significant because it is the next step in devising strategies to help clinicians and families promote healthy growth in children born preterm while preventing obesity.