Early Life Exposures And Development Of Non-communicable Diseases In Adolescence: The Drakenstein Child Health Study

非传染性疾病是全球健康不良和过早死亡的一个主要原因，在低收入和中等收入国家造成的负担特别大。这些疾病包括许多常见疾病，包括呼吸系统疾病，如哮喘和慢性阻塞性肺病、心脏病、肥胖症、糖尿病和精神疾病。在低收入和中等收入国家，与高收入国家相比，这些疾病发生的年龄更早，而且更为严重。来自高收入国家的研究表明，这些疾病的根源在于儿童时期，它们在整个生命历程中的发展轨迹是从幼儿期一直到青春期和成年期。与高收入国家相比，非洲的负担和对其发展产生不利影响的接触类型，如肺炎、结核病、香烟烟雾、生物质接触、过敏原或紧张程度，有很大不同。然而，尽管非洲受影响的人数众多，非传染性疾病的严重程度更高，而且有许多有害的环境暴露，但没有关于非洲与这些疾病发展有关的早期生活因素的数据。青春期是非传染性疾病出现的重要时期，在此期间，高风险行为（例如吸烟）和感染风险（例如结核病）增加等行为或暴露可能影响疾病的发展。重要的是，青春期是一个我们可以干预以改善终身健康的时期。然而，对低收入和中等收入国家，特别是非洲青少年的非传染性疾病或早期生活决定因素的研究非常有限。确定这些疾病对于制定预防这些疾病和减轻其负担的方法至关重要。在独特的南非出生队列——德拉肯斯坦儿童健康研究——的基础上，我们希望建立一个资源，详细研究非洲青少年的非传染性疾病，并帮助世界各地的研究人员获取许多有价值的数据集。为了实现这一目标，在我们对1000对母子的研究中，我们收集了怀孕和童年期间传染病和非传染性接触的详细测量数据，存储了他们的生物样本，并完成了从出生到8岁的健康重复测量。我们现在建议跟踪参与者度过青春期的关键时期，从9岁到15岁，以测量广泛领域的健康状况（呼吸系统疾病、心脏病、肥胖、糖尿病、心理健康），并评估持续暴露。我们将通过这段时间收集生物样本，添加到现有的存储库中，以使许多未来的研究能够解决这些疾病如何发展的机制。我们将整合和验证不同的数据集，使它们易于访问和重用，从而提高它们的全球价值。这将为非传染性疾病的研究创造独一无二的资源，在低收入和中等收入国家绝无仅有。我们将汇集英国、南非和澳大利亚的顶尖专家，通过合作和培训建设非洲的研究能力。我们的总体愿景是为制定干预战略提供信息，以减少非传染性疾病的风险，并在青春期和成年期这一关键时期改善健康。这对于制定新的战略非常重要，减轻疾病负担，预防健康不良和过早死亡，这是一个迫切需要的领域。

Non-communicable diseases are a major cause of ill health and premature death globally, with a particularly large burden in low- and middle-income countries. These include many common diseases, including respiratory disorders such as asthma and chronic obstructive pulmonary disease, heart disease, obesity, diabetes and mental illness. In low- and middle-income countries, these diseases occur at an earlier age and are more severe compared to high-income countries. Studies from high-income countries have shown that the roots of these diseases lie in childhood, and that their development through the life course tracks from early childhood into adolescence and adulthood. The burden and the type of exposures which adversely affect their development, such as pneumonia, tuberculosis, cigarette smoke, biomass exposure, allergens or intense level of stress, are very different in Africa compared to high-income countries. However, despite the high number of affected people and higher severity of non-communicable diseases, as well as many harmful environmental exposures, there are no data on early-life factors associated with their development in Africa. Adolescence is an important period during which non-communicable diseases emerge and in which behaviours or exposures such as heightened risk-taking (for example smoking) and increased risk of infections (such as TB) may affect disease development. Importantly, adolescence is a period in which we may intervene to improve lifetime health. However, there are very limited studies on non-communicable diseases or early-life determinants in adolescents in low- and middle-income countries, especially in Africa. Identifying these is crucial to develop ways to prevent these diseases and reduce their burden. Building on a unique South African birth cohort, the Drakenstein Child Health study, we wish to establish a resource for detailed study of non-communicable diseases in African adolescents and help researchers around the world to access many valuable datasets. To achieve this, in our study of 1000 mother-child pairs, we collected detailed measures of infectious diseases and non-infectious exposures through pregnancy and childhood, stored their biological samples, and completed repeated measurements of health from birth to age 8 years. We now propose to follow participants through the critical period of adolescence from 9 to 15 years of age, to measure heath status across broad domains (respiratory, heart disease, obesity, diabetes, mental health), and assess ongoing exposures. We will collect biological samples through this time, adding to the existing repository to enable many future studies to address mechanisms of how these diseases develop. We will consolidate and verify different data sets, so that they can be easily accessed and reused, thereby enhancing their global value. This will create a unique resource unparalleled anywhere in low- and middle-income countries, for study of non-communicable diseases. We will bring together leading UK, South African and Australian experts, building African research capacity through collaborations and training. Our overall vision is to inform the development of intervention strategies to reduce the risk of non-communicable diseases and improve health during the key period of adolescence and into adulthood. This will be very important for the development of new strategies reduce disease burden, prevent ill health and premature death, an area of critical need.