Childhood Obesity and Type 2 Diabetes Trends: A Life Course Analysis

描述(由申请人提供)：这项建议将为Joyce Lee博士提供分析技能和研究经验，使他成为一名在一生中专注于肥胖症和2型糖尿病的独立研究员。Lee博士将在她作为儿科内分泌学家和儿科卫生服务研究员的独特培训的基础上，通过一项高级课程计划，专注于流行病学、应用建模和儿童健康政策方面的量化技能。她卓有成效的指导团队包括William Herman博士，医学博士，公共卫生硕士和Gary Freed博士，医学博士和公共卫生硕士，以及密歇根糖尿病研究和培训中心、儿童健康评估和研究单位以及密歇根大学公共卫生学院等资源。在这个项目中，Lee博士提出了一种新的生命过程方法，以了解儿童肥胖对2型糖尿病风险的长期后果。随着时间的推移，儿童肥胖率正在加快，肥胖率和肥胖度大幅增加，肥胖症的发病也更早。尽管有这一趋势，但基于人群的研究表明，儿童的T2D比率尚未大幅增加，这可能反映了从肥胖开始到T2D发展的潜伏期，这一潜伏期可以持续10年以上。因此，儿童肥胖的流行可能会导致年轻人中T2D的大幅增加，这是非常令人担忧的，因为较长病程的心血管并发症和终末期并发症的发生率较高。在这项建议中，Lee博士将使用年龄-时期-队列分析来评估年轻成年人中儿童肥胖和T2D之间的流行病学联系，并将研究BMI超标程度和早年肥胖持续时间如何影响T2D开始时的比率和年龄。然后，她将开发一个状态转换模型，以预测T2D的未来趋势，这是最近儿童肥胖症增加的原因。最后，她将从流行病学研究和国家过渡模型中确定她的发现的政策含义，以确定并优先考虑儿童健康政策和卫生保健提供方面的变化，以解决儿童肥胖问题，将其作为一种慢性病风险因素，从儿童时期开始，一直延伸到成年。

DESCRIPTION (provided by applicant): This proposal will provide Dr. Joyce Lee with the analytic skills and research experience for becoming an independent researcher focused on obesity and type 2 diabetes over the life course. Dr. Lee will build on her unique training as a pediatric endocrinologist and pediatric health services researcher with a program of advanced coursework focused on quantitative skills in epidemiology, applied modeling, and child health policy. Her accomplished mentoring team includes Dr. William Herman, MD, MPH, and Dr. Gary Freed MD, MPH, and resources such as the Michigan Diabetes Research and Training Center, the Child Health Evaluation and Research Unit, and the School of Public Health at the University of Michigan. With this project, Dr. Lee proposes a novel life course approach for understanding the long-term consequences of childhood obesity with regard to type 2 diabetes risk. Rates of childhood obesity are accelerating over time, with large increases in prevalence and magnitude of obesity, as well as earlier onset of obesity. Despite this trend, population-based studies suggest that rates of T2D among children have not yet increased substantially, which may reflect the latency period between the onset of obesity and the development of T2D, which can last upwards of 10 years of more. Therefore, the epidemic of childhood obesity may result in large increases in T2D among young adults, which is of great concern due to higher rates of cardiovascular and end-stage complications from a longer duration of disease. In this proposal, Dr. Lee will evaluate the epidemiologic link between childhood obesity and T2D among young adults using age-period-cohort analyses, and will examine how both degree of excess BMI and duration of obesity early in life affect the rate and age at onset of T2D. She will then develop a state transition model to project future trends in T2D which account for recent increases in childhood obesity. Finally she will identify the policy implications of her findings from the epidemiologic studies and the state transition model to identify and prioritize changes in child health policy and health care delivery needed for addressing childhood obesity as a chronic disease risk factor originating in childhood and extending into adulthood.