The Effect of Behavioral and Physiological Factors on Obesity Risk in Children

描述(由申请者提供)：多尔西博士是一名致力于预防儿童肥胖的独立研究员。1998年至2001年，作为纽约儿童医院的儿科住院医生，多尔西博士意识到，她对营养、体力活动和其他决定体重增加的生理过程的了解有限，导致她没有做好帮助超重患者的准备。同样令人不安的是，能够指导临床实践的研究很少，也缺乏有效的预防肥胖的干预措施。这种临床需求激发了她进行研究的兴趣，以提高临床医生解决导致肥胖的行为、生理和环境因素的能力，并改进儿童肥胖预防的努力。2001年至2006年，多尔西博士在罗伯特·伍德·约翰逊临床学者项目和研究医学项目(耶鲁医学院的博士项目)中的培训和研究经验为她提供了坚实的研究方法基础。作为一名研究员，她接受了研究、研究设计和生物统计学方面的正规教育，并有在临床人群中进行研究的经验，使用加速计进行直接运动监测，以评估超重和非超重儿童的身体活动行为。该奖项的支持将允许多尔西博士通过课程作业、指导和研究进行额外的培训，以了解体育活动和身体健康与儿童肥胖的关系。多尔西博士和克鲁姆霍尔茨博士已经召集了一群不同的导师和顾问来帮助她进行培训，提出研究项目，并指导她的职业发展。这个指导团队分为赞助者和顾问监督委员会。这些人中的每一个都有与多尔西博士短期和长期职业目标相关的专业知识。拟议的项目将在纽约的NYORC和纽黑文的耶鲁医学院两个校区进行。多尔西博士将在每个网站都有一名共同导师、顾问和合作者。自2006年以来，她一直在这两个校区成功地工作。多西博士住在纽约市，乘坐通勤列车往返于纽约和纽黑文之间非常方便，定期与导师会面，并在这两个地点开展研究活动。这一成功将在本申请书中建议的培训期间继续下去。这项拟议研究的总体目标是确定运动测试和体力活动监测在临床环境中支持肥胖预防的潜在效用。这项工作将确定体力活动监测和运动测试是否可以在儿科诊所环境中进行，以及这些工具是否可以帮助临床医生确定哪些儿童在他们的实践中面临最大的肥胖风险。通过横断面分析，多尔西博士将展示运动测试的表现如何与直接测量的体力活动水平以及身体成分的临床测量之间的关系。她将使用纵向分析来确定运动测试的表现和/或直接测量的体力活动水平是否可以预测一年内腰围或BMI SD值的变化。研究参与者将是体重指数超过年龄和性别50%的非肥胖7至9岁儿童，以确定儿童肥胖风险增加的早期临床指标。这项研究将专注于居住在城市中心的拉美裔和非裔美国儿童的临床人群，那里肥胖和相关的共病疾病，如糖尿病，最为普遍。迫切需要解决这些人口中肥胖率高的问题，并有机会在这些因素没有得到很好描述的儿童中增加关于体育活动和健康的知识。在未来，这些结果将被用于设计干预措施，改善少数民族人口和儿科保健环境中的肥胖预防。这个拟议的项目将建立在多尔西博士之前的研究基础上，该研究涉及使用直接运动监测，在该研究中，她开发了一种分析8-10岁儿童运动数据的新方法。这种新的方法识别剧烈的身体活动，并表征儿童进行的活动的次数、他们的长度(分钟)和他们的平均运动强度(计数)。多尔西博士还研究了这些模式与儿童肥胖的关系。该奖项的支持将使多尔西博士能够将这一研究经验与运动生理学、身体成分评估、社会和心理流行病学、了解健康差距、医疗保健环境中的表现改善以及应用新医疗技术和治疗策略的成本效益分析等方面的新培训结合起来。最终，她将把这些方法和工具转化为临床应用，以改进初级保健和社区环境中儿童的预防战略。五年后，多尔西博士将成为一名独立研究员，在评估促进肥胖的生理和行为因素，以及这些因素如何以不同方式和不同程度影响儿童成长过程中，拥有丰富的专业知识。她在未来五到十年内完成的研究将为临床环境中干预措施的设计和评估提供信息，并与更大的公共政策倡议合作，以降低儿童肥胖率。

DESCRIPTION (provided by applicant): Dr. Dorsey is pursuing a career as an independent researcher focused on the prevention of obesity in children. As a pediatric resident at the Children's Hospital of New York, from 1998 to 2001, Dr. Dorsey realized that her limited knowledge of nutrition, physical activity, and other physiological processes that determine weight gain left her ill prepared to help her overweight patients. Equally troubling were the paucity of research that could guide clinical practice and the absence of effective interventions for the prevention of obesity. This clinical need sparked her interest in conducting research to improve the clinician's ability to address the behavioral, physiological, and environmental factors that lead to obesity, and improve efforts at obesity prevention in children. Dr. Dorsey's training and research experiences in the Robert Wood Johnson Clinical Scholars Program and the Investigative Medicine Program (a doctoral program at Yale School of Medicine) from 2001 to 2006 provided her with a strong foundation in research methodology. As a fellow she received formal education in research study design and biostatistics as well as experience conducting research in clinical populations using direct motion monitoring with accelerometers to assess physical activity behaviors in overweight and non-overweight children. Support from this award will allow Dr. Dorsey to pursue additional training through coursework, mentorship, and research to understand how physical activity and physical fitness relate to adiposity in children. Drs. Dorsey and Krumholz have assembled a group of diverse mentors and advisors to assist her with training, the proposed research projects, and guide her career development. This mentorship team is divided into Sponsors and an Oversight Committee of advisors. Each of these individuals has expertise related to Dr. Dorsey's short-term and long-term career goals. The proposed project will be conducted across two campuses, NYORC in New York and Yale School of Medicine in New Haven. Dr. Dorsey will have a co mentor, advisors and collaborators at each site. She has been successfully working across the two campuses since 2006. Dr. Dorsey lives in New York City and travels between New York and New Haven with ease using the commuter train, meeting regularly with mentors and conducts research activities at both sites. This success will continue over the training period proposed in this application. The overall goal of the proposed research is to determine the potential utility of exercise testing and physical activity monitoring to support obesity prevention in clinical settings. This work will establish whether physical activity monitoring and exercise testing can be administered in a pediatric clinic setting and whether these tools can help clinicians identify which children in their practices are at greatest risk of obesity. Using a cross-sectional analysis, Dr. Dorsey will demonstrate how performance on exercise tests relates to directly measured physical activity levels and to clinical measures of body composition. She will use a longitudinal analysis to determine whether performance on exercise tests and/or directly measured physical activity levels predict changes in waist circumference or BMI SD values over 1-year. Study participants will be non-obese 7 - to 9- year old children with a body mass index above the 50th percentile for age and gender in order to identify early clinical indicators of increased risk of obesity in children. This research will be focused on clinical populations of Latino and African-American children living in urban centers where obesity and related co-morbid diseases such as diabetes mellitus are most prevalent. There is an urgent need to address the high prevalence of obesity in these populations, and an opportunity to increase knowledge regarding physical activity and fitness among children in whom these factors have not been well described. In the future, these results will be used to design interventions that improve obesity prevention in minority populations and in pediatric healthcare settings. The proposed project will build on Dr. Dorsey's previous research involving the use of direct motion monitoring in which she developed a novel method for analyzing motion data in 8-10-year old children. This new approach identifies bouts of vigorous physical activity, and characterizes the number of bouts children perform, their length (minutes), and their average motion intensity (counts). Dr. Dorsey also examined how these patterns relate to obesity in children. Support from this award will allow Dr. Dorsey to combine this research experience with new training in exercise physiology, assessment of body composition, social and psychological epidemiology, understanding health disparities, performance improvement in healthcare settings, and cost benefit analysis for the application of new medical technologies and treatment strategies. Ultimately she will translate these methods and tools for clinical application to improve prevention strategies for children in primary care and community settings. In five years Dr. Dorsey will be an independent researcher with substantial expertise in the assessment of the physiological and behavioral factors that promote obesity and how these factors affect children in different ways and to different degrees during their development. The research she completes in the next five to ten years will inform the design and evaluation of interventions both within clinical settings and in collaboration with larger public policy initiatives to reduce the prevalence of obesity in children.