Patient-oriented research in early life origins of CVD

慢性疾病的生命过程方法提出，不仅在成年生活中起作用，而且从受孕开始起作用的因素对终身健康产生影响。在这一领域比较公开的发现是低出生体重与成人心血管疾病死亡率、发病率和血压等危险因素之间的联系。这些新的调查导致了一系列令人兴奋的研究问题和机会，涉及潜在的机制，产前和产后决定因素的关系，以及对临床医学和公共卫生的影响。这项拟议的K24奖将使吉尔曼博士和他的学员在未来五年集中精力研究这一领域，这不仅是该领域本身的关键时期，也是扩大他在这一领域做出重大贡献的潜力和培养下一代以患者为导向的研究人员的关键时期。本提案的具体目标是：1。研究项目以检查母亲妊娠期蛋白质摄入量，胎盘激素活性和后代血压之间的关系。该项目将利用正在进行的美国国立卫生研究院资助的孕妇及其后代前瞻性队列研究（Viva项目）提供的基础设施。2. 为初级临床研究人员的培训和提升提供一个滋养的专业环境，他们将在慢性疾病生命过程方法领域进行和分析来自Viva项目和其他正在进行的以患者为导向的研究的数据。主要焦点将放在怀孕和婴儿期决定因素的领域：a.儿童心血管危险因素，主要是血压；b.儿童早期哮喘；c.儿童和青少年肥胖的发展。

The lifecourse approach to chronic disease proposes that factors operating not only in adult life, but also from conception, have impact on lifelong health. Among the more publicized findings in this area are associations between lower birth weight and adult cardiovascular disease mortality, incidence, and risk factors such as blood pressure. These newer investigations have led to a series of exciting research questions and opportunities concerning underlying mechanisms, relations of pre- and post-natal determinants, and implications for clinical medicine and public health. This proposed K24 award will allow Dr. Gillman and his mentees to focus intensively on this area of research for the next five years, a critical period not only for the field itself, but also for expanding his potential for significant contributions and for nurturing the next generation of patient-oriented researchers in this field. The specific aims of this proposal are 1. Research project to examine associations among maternal gestational protein intake, placental hormone activity, and blood pressure in the offspring. This project will take advantage of the infrastructure provided by an ongoing NIH-funded prospective cohort study of pregnant women and their offspring (Project Viva). 2. To provide a nourishing professional environment for the training and advancement of beginning clinical researchers, who will conduct and analyze data from Project Viva and other ongoing patient-oriented research studies in the area of the lifecourse approach to chronic disease. Major foci will be in the areas of pregnancy and infancy determinants of a. childhood cardiovascular risk factors, chiefly blood pressure, b. asthma in early childhood, and c. development of obesity in childhood and adolescence.