Birth Weight, Postnatal Growth, Blood Pressure and Subclinical Cardiovascular Dis

描述(申请人提供)：尽管低出生体重和晚年不同阶段血压升高之间的关系已经得到很好的证实，但出生体重与从童年到成年的血压变化之间的联系还没有得到充分的研究。此外，出生前和出生后生长发育、血压和心血管(C-V)结构和功能的亚临床变化之间的复杂关系还需要阐明。这项研究的具体目的是：1)证明黑人和白人从童年到成年的出生体重、纵向肥胖测量和血压(水平和变异性)之间的相互关系；2)确定出生体重和血压(变异性和水平)以及出生后生长对成年后C-V结构和功能(动脉壁厚度、血管僵硬和左心室结构和功能)亚临床变化的影响。这些具体目标将使用Bogalusa心脏研究中可用的纵向数据库进行检查，该研究是一项长期的混血(65%白人，35%黑人)社区研究，从儿童开始对C-V疾病的自然历史进行研究。建议的横断面分析研究队列I由6,458人组成，他们有青春期前、青春期和成年期的出生体重、生长参数和血压数据；纵向分析队列II由1,695人组成，他们有出生体重数据和连续测量血压的数据，每个人在儿童时期至少测量3次，成年后至少测量3次；队列III由1,194人组成，他们有出生体重、童年以来的连续血压测量和成年期C-V系统的亚临床变化。长期的血压水平将根据从儿童到成年的一系列血压测量得出的曲线下面积进行测量。将使用纵向BP测量来计算四个BP变异性指标(与年龄相关的趋势、与年龄预测值的偏差、与平均值的偏差和年变异性)。通径分析(线性结构方程建模)将按生长期以及使用长期BP水平和变异性指标进行横截面分析。应用交互回归模型和主成分分析来检验出生体重、肥胖测量和血压对C-V系统亚临床变化的联合影响。这项研究的发现将为进一步深入了解高血压的“胎儿起源”提供依据。加深我们对出生前和出生后发育、血流动力学与晚年亚临床C-V病之间关系的了解，对于改进产前保健和制定早期预防成人C-V病的策略具有重要意义。 与公共卫生相关：低出生体重是婴儿出生前生长受限的指标，并与成人心脏病、糖尿病和高血压有关。这项研究的发现对改善产前护理和制定早期预防成人心脏病的策略具有重要意义。

DESCRIPTION (provided by applicant): Although the relationship between low birth weight and elevated blood pressure (BP) levels at various stages in later life has been well established, the association of birth weight with BP variations from childhood to adulthood has not been fully examined. In addition, the complex relationships among prenatal and postnatal growth, BP and subclinical changes of cardiovascular (C-V) structure and function need to be elucidated. The Specific Aims of the proposed research are 1) to demonstrate the inter-relationships among birth weight, longitudinal obesity measures and BP (levels and variability) from childhood to adulthood in black and white individuals, and 2) to determine the effect of birth weight in conjunction with BP (variability and levels) and postnatal growth on adulthood subclinical changes of C-V structure and function (arterial wall thickness, vascular stiffness and left ventricular structure and function). These specific aims will be examined using available longitudinal database from the Bogalusa Heart Study, a long-term biracial (65% white, 35% black) community-based study of the Natural History of C-V Disease beginning in childhood. The proposed study Cohort I for cross-sectional analyses consists of 6,458 individuals who have data on birth weight, growth parameters and BP in preadolescence, adolescence and adulthood; Cohort II for longitudinal analyses consists of 1,695 individuals who have data on birth weight and serial measurements of BP obtained at least 3 times each in childhood and at least 3 times in adulthood; Cohort III consists of 1,194 individuals who have data on birth weight, serial measurements of BP since childhood and subclinical changes of C-V system in adulthood. Long- term BP levels will be measured as the area under the curve derived from serial BP measurements from childhood to adulthood. Four BP variability measures (age-related trend, deviations around age-predicted values, deviations from mean and yearly rate of variability) will be calculated using longitudinal BP measurements. Path analysis (linear structural equation modeling) will be performed cross-sectionally by growth periods as well as using long-term BP level and variability measures. Interaction regression models along with principal components analysis will be applied to examine the joint effect of birth weight, obesity measures and BP on subclinical changes of C-V system. Findings from this research will provide further insights into the "fetal origins" of the development of hypertension. Deepening our understanding of the relationships among prenatal and postnatal growth, hemodynamics and subclinical C-V disease later in life has important implications for improving prenatal care and developing strategies beginning early in life to prevent adult C-V disease from hypertension. PUBLIC HEALTH RELEVANCE: Low birth weight is an indicator of baby growth restriction before birth and associated with adult heart disease, diabetes and hypertension. The findings from this research have important implications for improving prenatal care and developing strategies beginning early to prevent adult heart disease.