Identifying Risk for Diabetes and Heart Disease in Women: A Study of African-American, African and White Federal Employees and Contractors

识别女性糖尿病和心脏病的风险：针对非裔美国人、非洲人和白人联邦雇员和承包商的研究

• 批准号: 9356248
• 负责人: Anne Sumner
• 金额: $ 31.85万
• 依托单位: NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9356248
• 关键词: Accounting; Acculturation; Acute; Adipose tissue; African; African American; Age; Anemia; Area; Body fat; Cardiovascular Diseases; Clinical Protocols; Contractor; Data Set; Diabetes Mellitus; Diet; Disease; District of Columbia; Early Intervention; Employee; Enrollment; Ensure; Ethnic Origin; Exercise; Family history of; Fasting; Fatty acid glycerol esters; Federal Government; Genetic; Glucose; Goals; Guidelines; Health; Health Insurance; Heart Diseases; Hepatic; High Prevalence; Hyperinsulinism; Immigrant; Insulin; Insulin Resistance; Insurance Coverage; Intravenous; Knowledge; Lead; Life Style; Non-Insulin-Dependent Diabetes Mellitus; Nutritional; Occupational; Oral; Participant; Pathway interactions; Physical activity; Population; Positioning Attribute; Prediabetes syndrome; Primary Prevention; Psychosocial Factor; Race; Recruitment Activity; Resources; Risk Factors; Socioeconomic Status; Testing; Therapeutic; Triglycerides; Visceral; Vitamin D; Woman; Women' s Health; Work; bone health; cardiometabolic risk; cohort; collaborative environment; diabetes risk; diagnostic screening; disorder prevention; efficacy testing; ethnic difference; fasting glucose; glucose production; health care availability; health difference; health disparity; health literacy; high risk; improved; indexing; insulin secretion; insulin sensitivity; low socioeconomic status; metropolitan; novel; primary outcome; proctolin; racial difference; response; screening; socioeconomics; trend

The Federal Women Study is an active clinical protocol aimed at recruiting 360 federal employees and contractors working in the Washington DC metropolitan area. One hundred and nine women (56% African-American, 17% African immigrant and 31% white) have been screened (age 449, range 24-62 years). Thirty percent of women had anemia and this was the most common reason that screened women were not enrolled. Among the enrolled women, the three groups are well matched by race/ethnicity for key socio-economic and demographic risk factors such as educational attainment, family history of diabetes and physical activity. Yet, we have already identified pre-diabetes in 39% of women (42% African-American, 13% African immigrant and 29% white). Therefore, this cohort reflects women who are at high risk for diabetes and heart disease and an excellent group in which to (a) test the efficacy of existing screening tests and (b) understand the pathophysiological progression of cardiometabolic disease by race/ethnicity. As current cardiometabolic screening tests are centered on triglyceride and fasting glucose concentrations, we have employed two approaches to examine these risk factors. The Relationship of Triglycerides with Insulin Resistance and Hyperinsulinemia This study will compare by race/ethnicty and continent of origin, the relationship of triglyceride concentration to key cardiometabolic risk factors, specifically diet, physical activity, insulin resistance (and hyperinsulinemia) and hepatic fat content. We have found so far that consistent with our hypothesis, fasting triglyceride concentrations are lowest in African immigrant and highest in white women (AI: 5312 vs. AA: 6733 vs. WW: 8334 mg/dL, P<0.01) with a trend for lower insulin sensitivity index (AI: 3.11.7 vs. AA: 2.51.6 vs. WW: 3.42.2 mU/L-1min-1, P=0.20) and greater acute insulin response to glucose (AI: 895528 vs. AA: 959790 vs. WW: 561429 mU/L, P=0.07) in African-American women. Analysis of the relationship of hepatic fat content with insulin resistance is underway. In regard to total percent fat there were no differences by race/ethnicity but differences in body fat distribution were clear, specifically visceral adipose tissue (VAT) volume (VAT; AI: 4836 vs. AA: 8642 vs. WW: 11854 cm3, P=0.001). To further characterize the contribution of insulin secretion, insulin clearance and prandial gut factors to race/ethnic differences in hyperinsulinemia, we are comparing insulin response to oral, intravenous and prandial glucose loads. Preliminary findings suggest racial differences in early postprandial glucose response. African descent women have paradoxically greater postprandial insulin concentrations but lower glucose response and we are exploring further the quantitative contribution of incretin concentrations to hyperinsulinemia. We plan to continue recruitment and look forward to an expanded dataset with interim analyses of our primary outcome variable, triglyceride concentration, with key modifying factors (diet composition, physical activity, insulin sensitivity indices and hepatic fat). These analyses should provide population-specific evidence which elucidate important pathophysiological pathways and ultimately lead to enhanced screening and diagnostic guidelines which have the potential to minimize diabetes related health disparities worldwide.

联邦妇女研究是一项积极的临床协议，旨在招募360名在华盛顿大都市区工作的联邦雇员和承包商。109名妇女（56%为非洲裔美国人，17%为非洲移民，31%为白色人）接受了筛查（年龄449岁，范围24-62岁）。30%的女性患有贫血，这是筛查女性未入选的最常见原因。在登记的妇女中，这三个群体在关键的社会经济和人口风险因素（如教育程度、糖尿病家族史和体育活动）方面的种族/族裔匹配良好。然而，我们已经在39%的女性中发现了糖尿病前期（42%的非洲裔美国人，13%的非洲移民和29%的白色）。 因此，该队列反映了糖尿病和心脏病高风险女性，并且是一个极好的组，可以（a）测试现有筛查试验的有效性和（B）了解不同人种/种族的心脏代谢疾病的病理生理学进展。由于目前的心脏代谢筛查试验集中在甘油三酯和空腹血糖浓度，我们采用了两种方法来检查这些危险因素。 甘油三酯与胰岛素抵抗及高胰岛素血症的关系 本研究将按人种/种族和原籍大陆比较甘油三酯浓度与关键心脏代谢风险因素的关系，特别是饮食、体力活动、胰岛素抵抗（和高胰岛素血症）和肝脏脂肪含量。到目前为止，我们发现与我们的假设一致，空腹甘油三酯浓度在非洲移民中最低，在白色妇女中最高（AI：5312 vs. AA：6733 vs. WW：8334 mg/dL，P<0.01），胰岛素敏感性指数有降低趋势（AI：3.11.7 vs. AA：2.51.6 vs. WW：3.42.2 mU/L-1 min-1，P=0.20）和对葡萄糖的更大急性胰岛素反应（AI：895528 vs. AA：959790 vs. WW：561429 mU/L，P=0.07）。 肝脏脂肪含量与胰岛素抵抗的关系分析正在进行中。关于总脂肪百分比，人种/种族之间没有差异，但体脂分布差异明显，特别是内脏脂肪组织（VAT）体积（VAT; AI：4836 vs. AA：8642 vs. WW：11854 cm 3，P=0.001）。 为了进一步描述胰岛素分泌、胰岛素清除率和餐时肠道因素对高胰岛素血症人种/种族差异的贡献，我们比较了胰岛素对口服、静脉和餐时葡萄糖负荷的反应。初步研究结果表明，早期餐后血糖反应存在种族差异。非裔女性餐后胰岛素浓度较高，但血糖反应较低，我们正在进一步探索肠促胰岛素浓度对高胰岛素血症的定量贡献。我们计划继续招募，并期待着一个扩展的数据集，对我们的主要结局变量甘油三酯浓度进行中期分析，以及关键的修正因素（饮食组成，体力活动，胰岛素敏感性指数和肝脏脂肪）。 这些分析应提供人群特异性证据，阐明重要的病理生理学途径，并最终导致加强筛查和诊断指南，有可能最大限度地减少全球糖尿病相关的健康差异。