Impact of Lifestyle on Cardiovascular and Metabolic Risk Factors in Trauma Exposed Post-9/11 Veterans

心脏代谢性疾病(如2型糖尿病或心血管疾病)是致残的主要原因， 美国的死亡率，尤其是退伍军人的死亡率。创伤后应激障碍(PTSD)-a 许多退伍军人及其家人的显著健康担忧-与心脏代谢风险的增加有关 疾病和过早死亡。这种关系的确切机制尚不完全清楚。 然而，最近的研究表明，被诊断为创伤后应激障碍会增加患高血压、血脂异常的风险。 和肥胖，所有这些都是心脏代谢性疾病的已知预测因素。更好地理解 可改变的因素(例如，生活方式)影响创伤后应激障碍与心脏代谢健康和功能之间的联系 将有助于开发新的康复非药物干预措施(例如，锻炼) 患有创伤后应激障碍的退伍军人的心脏代谢性疾病和残疾。体力活动(PA)和饮食是很有前途的 可改变的生活方式因素的例子。例如，有规律的PA和健康的饮食极大地降低了患心脏病的风险 心脏代谢性疾病通过许多途径，如降低血压，血脂， 肥胖，并通过促进血糖控制。简单地说，所有新的2型糖尿病病例中有80%是 归因于缺乏运动和不良饮食。低心肺适合度(CRF)也是导致 因心血管疾病导致残疾和死亡的风险。尽管存在明显的价值和潜在的影响， 很少有研究考察PA与饮食、心脏代谢健康和心脏功能之间的关系 患有创伤后应激障碍的退伍军人。这是一个关键的研究缺口。缺乏体力活动和不良饮食会增加患糖尿病的风险 心脏代谢性疾病和创伤后应激障碍可能会加剧这种风险。患有创伤后应激障碍的退伍军人经常久坐不动 做出不健康的饮食选择，使他们陷入患心脏代谢性疾病的完美风暴 以及相关的残疾。这个项目的目的是检查几个可修改但 研究不足的生活方式因素(即PA和饮食质量)对心脏代谢健康和功能指标的影响 在911事件后的退伍军人中。该项目的目标是：目标1：将巴勒斯坦权力机构的参与作为一种机制进行审查 将创伤后应激障碍与9/11后退伍军人的心脏代谢健康和功能联系起来。我会纵向评估 250组受试者的创伤后应激障碍诊断、PA、心脏代谢健康和随时间变化的功能之间的关系 参与者。H1-1：完全自我报告PA将调解创伤后应激障碍对心脏代谢健康的影响 随着时间的推移，低PA会增加创伤后应激障碍对心脏代谢的有害影响 健康和正常运作。H1-2：动脉压强度将缓和体力活动对心脏代谢的影响 健康和正常运作。补充目标1A：验证PA的自我报告临床测量的使用 与通过加速度计获得的客观测量结果进行比较。PA的客观测量并不常见 退伍军人管理局提供者可获得或可行的(例如，时间限制)。至关重要的是，快速自我报告PA 措施准确地反映了退伍军人的PA。我会将自我报告的临床PA测量的数据与 客观测量PA/久坐时间(即加速计时)、CRF、心脏代谢健康、功能和 100名9·11后退伍军人创伤后应激障碍症状严重程度调查H1a-1：PA意志的自我报告和客观测量 具有显著的关联性。H1a-2：自我报告和客观测量的PA/久坐时间都将是 与慢性肾功能衰竭、心脏代谢健康、功能和创伤后应激障碍症状严重程度有关。 目的2：检查饮食质量作为联系创伤后应激障碍与心脏代谢健康和功能的机制 在911事件后的退伍军人中。我将纵向评估创伤后应激障碍的诊断、饮食质量、 200名受试者的心脏代谢健康和随时间推移的功能。H2：自我报告膳食摄入量 将调节创伤后应激障碍对心脏代谢健康和功能的影响，随着时间的推移，不良饮食将 增加创伤后应激障碍对心脏代谢健康和功能的有害影响。

Cardiometabolic disease (e.g., type 2 diabetes or cardiovascular disease) is a leading cause of disability and mortality in the United States, and especially so among Veterans. Posttraumatic stress disorder (PTSD) – a salient health concern for many Veterans and their families – is linked to an increased risk of cardiometabolic disease and premature mortality. The precise mechanisms of this relationship are not fully understood. However, recent research suggests that a diagnosis of PTSD increases the risk for hypertension, dyslipidemia and obesity, all of which are known predictors of cardiometabolic disease. A better understanding of what modifiable factors (e.g., lifestyle) influence the link between PTSD and cardiometabolic health and functioning will aid in the development of novel rehabilitative nonpharmacological interventions (e.g., exercise) for cardiometabolic disease and disability in Veterans with PTSD. Physical activity (PA) and diet are promising examples of modifiable lifestyle factors. For instance, regular PA and a healthy diet strongly reduce the risk for cardiometabolic disease through numerous pathways, such as reductions in blood pressure, blood lipids, adiposity, and by promoting blood glucose control. Simply put, 80% of all new cases of type 2 diabetes are attributed to physical inactivity and poor diet. Low cardiorespiratory fitness (CRF) is also a critical factor in the risk for disability and mortality due to cardiovascular disease. Despite the clear value and potential impact, there is little research examining relationships between PA and diet, cardiometabolic health, and functioning in Veterans with PTSD. This is a critical research gap. Physical inactivity and poor diet increase the risk of cardiometabolic disease and PTSD likely compounds this risk. Veterans with PTSD often lead sedentary lives and make unhealthy dietary choices placing them in a perfect storm for developing cardiometabolic disease and related disability. The purpose of this project is to examine the influence of several modifiable yet understudied lifestyle factors (i.e., PA and diet quality) on indicators of cardiometabolic health, and functioning in post-9/11 Veterans. The aims of this project are: Aim 1: To examine PA participation as a mechanism linking PTSD to cardiometabolic health and functioning in post-9/11 Veterans. I will longitudinally assess associations between PTSD diagnosis, PA, cardiometabolic health, and functioning over time in 250 TRACTS participants. H1-1: Total self-report PA will mediate the effects of PTSD on cardiometabolic health and functioning over time, such that lower PA will increase the detrimental effect of PTSD on cardiometabolic health and functioning. H1-2: PA intensity will moderate the effect physical activity has on cardiometabolic health and functioning. Supplemental Aim 1A: To validate the use of a self-report clinical measure of PA against objective measure obtained via accelerometry. Objective measurement of PA is not often accessible or feasible for VA providers (e.g., time constraints). It is essential that quick self-report PA measures accurately reflect the PA of Veterans. I will compare data from a self-report clinical PA measure to objectively measured PA/sedentary time (i.e., accelerometry), CRF, cardiometabolic health, functioning, and PTSD symptom severity in 100 post-9/11 Veterans. H1A-1: Self-report and objective measurement of PA will be significantly correlated. H1A-2: Both self-report and objectively measured PA/sedentary time will be associated with CRF, cardiometabolic health, functioning, and PTSD symptom severity. Aim 2: To examine diet quality as a mechanism linking PTSD to cardiometabolic health and functioning in post-9/11 Veterans. I will longitudinally assess associations between PTSD diagnosis, diet quality, cardiometabolic health, and functioning over time in 200 TRACTS participants. H2: Self-report dietary intake will mediate the effects of PTSD on cardiometabolic health and functioning over time, such that a poor diet will increase the detrimental effect of PTSD on cardiometabolic health and functioning.