Diet, physical activity and cardiometabolic health in Malaysian adolescents: from epidemiology to intervention

在马来西亚，青少年肥胖率正在上升，非传染性疾病，如2型糖尿病和心血管疾病，占死亡人数的三分之二。虽然对欧洲和美国人群的研究发现，特定的生活方式因素可能会导致青少年更胖、更不健康，但我们还没有全面了解导致马来西亚这些问题的原因。在这项研究中，我们将研究不同的生活方式因素，如所吃的食物、进食的时间或频率、身体活动、久坐行为及其时间或地点，如何结合在一起，创造一个整体的行为模式评分，表明青少年是否健康。我们之前发现，与单一因素相比，多种因素的组合对健康更重要。对健康结果的初步分析将集中在肥胖、血压以及血液样本中低密度脂蛋白胆固醇、脂肪和葡萄糖的含量。我们还计划使用一种新的、可重复的实验室技术，即代谢组学，来测量血液中233种不同的成分，这些成分表明了一系列代谢过程。这将帮助我们比以往更详细地了解行为是如何通过代谢途径改善心血管健康的。当我们更多地了解从生活方式到疾病的途径时，我们就能更好地预测谁能保持健康，谁不能。在这项研究中，我们的目标之一是找到与保持健康代谢和降低未来心血管疾病风险相关的主要行为。然后我们会研究如何通过干预来改变这些行为。这项研究之所以成为可能，是因为一项针对1361多名青少年的大型研究，名为“我的心”。MyHeARTs的目的是确定哪些因素最能预测健康状况，以便及早发现和预防2型糖尿病和心血管疾病。“我的心”项目始于2012年，收集了来自马来西亚3个地区15所城市和农村学校的1361名青少年的行为和健康信息，2016年刚刚完成了第三次后续行动。参与者提供了他们的饮食、活动和其他健康行为的详细报告，以及13岁、15岁和17岁时的身体成分、身体健康和血液样本的测量结果，我们将在这项研究中使用这些数据。我们感兴趣的是，在参与者出现心血管疾病或糖尿病的明显症状之前，生活方式行为的组合是否能准确地预测他们在青春期的血液化学特征的变化。最后，在这个项目中，我们为改善青少年代谢健康奠定了基础。我们将与青少年和学校工作人员讨论他们如何采取我们在MyHeART中发现的对健康很重要的行为。然后，我们将利用他们的观点与已知的行为改变方法相结合，鼓励健康的生活方式和预防疾病，这将在资源有限的国家，如马来西亚发挥作用。

In Malaysia the prevalence of obesity among adolescents is increasing and non-communicable diseases, like type 2 diabetes and cardiovascular disease, account for two out of three deaths. While research in European and US-based populations has found that particular lifestyle factors might cause adolescents to be fatter and less fit we do not have a complete picture of what causes these problems in Malaysia. In this study we are going to look at how different lifestyle factors, like foods eaten, timing or frequency of eating, physical activity, sedentary behaviours and their timing or location, combine together to create an overall behavioural pattern score that indicates whether adolescents have good health. We've previously found that a combination of factors is more important for health compared with single factors alone. Initial analysis of health outcomes will focus on obesity, blood pressure, and how much LDL cholesterol, fats and glucose are in blood samples. We also plan to use a new, reproducible laboratory technique, known as metabolomics, to measure 233 different components of blood that indicate a range of metabolic processes. This will help us find out in much more detail than ever before how behaviour leads to better cardiovascular health via metabolic pathways. When we know more about the pathway that leads from lifestyle to disease we will be better able to predict who will stay healthy and who will not. In this study, one of our aims is to find the main behaviours related to keeping a healthy metabolism and reducing the risk of cardiovascular disease in the future. We'll then work out how these behaviours can changed by an intervention.This research is possible because of a large study of over 1361 adolescents, called MyHeARTs. The aim of MyHeARTs was to identify which factors best predict health to enable the early detection and prevention of type 2 diabetes and cardiovascular disease. MyHeARTs started in 2012, collecting information on the behaviour and health of 1361 adolescents from 15 urban and rural schools in 3 regions of Malaysia and has just completed a third follow-up in 2016. The participants have provided detailed reports of their diet, activity, and other health behaviours as well as measurements of body composition, physical fitness and blood samples at age 13, 15 and 17, which we will use for this study. We are interested to see whether combinations of lifestyle behaviours can accurately predict changes in the blood chemical profile of participants as they progress through adolescence before they develop clear symptoms of cardiovascular disease or diabetes.Finally, within this project we lay the foundations for improving adolescents' metabolic health. We will talk to adolescents and school staff about how they could adopt the behaviours we found were important for health in MyHeART. We will then use their views paired with known methods of behaviour change to encourage a healthy lifestyle and prevent disease that will work in countries, like Malaysia, where resources are limited.