The Development of Early Childhood Obesity in Children Born Preterm

 描述（由申请人提供）：促进追赶性生长和预防生长迟缓是早产至至少两岁儿童临床护理的主要组成部分。然而，我们的初步数据表明，肥胖是一个主要的，未被认识到的问题，在早产人口和可能出现不同于足月出生的儿童。肥胖对早产儿的危害远远大于对足月儿的危害。如果不了解肥胖发展的程度、性质和时间以及临床护理中如何一致地认识到肥胖，就无法制定有针对性的预防策略，以帮助临床医生和家庭促进适当的生长，同时防止早产儿过度生长。长期目标，这将是随后的R 01申请的主题，是制定针对早产儿的循证策略，以指导临床医生和家庭预防超重和肥胖。本R 03申请中提出的研究目标是，与足月儿相比，应用最先进的统计方法来确定早产儿在幼儿期超重和肥胖的发生率和时间，以确定最佳干预窗口，并记录在超过16，000名儿童的纵向样本中临床护理期间对肥胖症认识不足的程度。核心假设是：与足月出生的儿童相比，早产儿童的生长轨迹将不同，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，并且早产的肥胖儿童将不太可能被诊断为肥胖。该假设是根据历史低出生体重队列的数据和我们的初步数据制定的。这项研究的基本原理是支持针对敏感时期的循证干预措施的发展，以防止早产儿超重和肥胖。该假设将通过追求两个具体目标进行测试：1）通过描述早产儿童从出生到6岁的生长轨迹，并将其与儿童的轨迹进行对比，确定预防肥胖的关键窗口 足月出生的儿童，比较超重和肥胖的发生率和时间，以及2）确定早产儿与足月出生儿童相比，肥胖诊断不足的程度。该方法将是一项纵向研究，涉及16，000多名从出生到6岁的儿童，他们是一家大型独立儿童医院的初级和专科护理提供者的患者。拟议的研究是创新的，因为它将应用最先进的分析工具来模拟现代样本中的生长轨迹，使用基于非常大的儿科患者人群的详细的，研究就绪的纵向生长数据集，包括早产儿和足月儿，平均超过13个测量在6岁之前。这项拟议中的研究意义重大，因为它是制定策略的下一步，以帮助临床医生和家庭促进早产儿的健康成长，同时预防肥胖。

 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.