SEARCH Nutrition Ancillary Study 2

描述（由申请人提供）：研究记录了1型糖尿病（T1 DM）和2型糖尿病（T2 DM）青年中大血管和微血管疾病的出现。关于营养因素在这些并发症中的作用知之甚少。这项拟议的研究是糖尿病营养辅助研究（SNAS 1;由NIH/NIDDK资助）的延续，也是青年糖尿病研究项目（CDC/DDT和NIH/NIDDK资助）的辅助。糖尿病研究包括2002年至今20岁以下诊断的糖尿病病例，并进行基线研究访视。队列研究包括对2002-2006年和2008年诊断为DM且DM持续时间>5年的参与者进行随访研究。SNAS 1的目的包括确定与基线访视时T1 DM青年患者β细胞功能和心血管（CVD）风险因素相关的营养因素。SNAS 2是SNAS 1的自然延伸，将采用横断面和纵向设计研究营养因素与T1 DM和T2 DM青年大血管和微血管并发症的相关性。来自基线和队列研究访视的暴露数据将包括血浆营养生物标志物（脂肪酸、维生素D和E）以及来自纳入测量误差建模的食物频率问卷的数据。我们将在T1 DM（n= 2，710）和T2 DM（n=435）青年患者中分别实现以下目标：目标1：评价与亚临床CVD标志物相关的选定营养因素（脉搏波速度，增强指数和视网膜血管直径），假设特定饱和脂肪酸（SFA），单不饱和脂肪酸（MUFA）和多不饱和脂肪酸（PUFA），n-3与n-6PUFA的比率、维生素D和E、纤维、果糖和饮食模式（停止高血压的饮食方法，地中海，统计学推导的饮食模式）将与这些标记物相关。目标二：目的3：评价与糖尿病肾病（DKD;尿蛋白）标志物相关的营养因素，并假设维生素D和E、多不饱和脂肪酸（PUFA）和饮食模式与糖尿病视网膜病变（DR）呈负相关。 白蛋白：肌酐比[UACR]）和估计的肾小球滤过率[eGFR]）及其进展（UACR），假设特定SFA、PUFA、维生素D和E以及饮食模式将与DKD相关。SNAS 2研究利用并扩展了有史以来最大的糖尿病青年队列之一的数据，以回答有关营养和糖尿病并发症的关键研究问题。此外，本研究将采用增强和新颖的分析方法来研究这些高度临床相关的问题。研究结果将为糖尿病青少年提供营养建议，并为采用营养方法降低大血管和微血管并发症风险的临床试验提供急需的科学依据。

DESCRIPTION (provided by applicant): Research has documented the emergence of macrovascular and microvascular disease among youth with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Little is known about the role of nutritional factors in the emergence of these complications. The proposed study is a continuation of the SEARCH Nutrition Ancillary Study (SNAS1; funded NIH/NIDDK), and ancillary to the SEARCH for Diabetes in Youth project (SEARCH; CDC/DDT and NIH/NIDDK funded). SEARCH includes incident DM cases diagnosed when <20 years of age, from 2002-present, and has a baseline research visit. The SEARCH Cohort study includes a follow-up research visit for SEARCH participants with DM diagnosed in 2002-2006 and 2008 with DM duration >5 years. The aims of SNAS1 included identification of nutritional factors associated with beta cell function and cardiovascular (CVD) risk factors in youth with T1DM at the baseline visit. SNAS2 is a natural extension of SNAS1 and will examine the associations of nutritional factors with macro- and microvascular complications in youth with T1DM and T2DM using cross-sectional and longitudinal designs. Exposure data from the baseline and Cohort Study visits will include plasma nutrient biomarkers (fatty acids, vitamins D and E), and data from a food frequency questionnaire incorporating measurement error modeling. We will address the following aims separately among youth with T1DM (n=2,710) and T2DM (n=435): Aim 1: To evaluate selected nutritional factors in relation to markers of subclinical CVD (pulse wave velocity, augmentation index, and retinal vessel diameter), hypothesizing that specific saturated (SFA), monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA), the ratio of n-3 to n-6 PUFA, vitamins D and E, fiber, fructose, and dietary patterns (Dietary Approaches to Stop Hypertension, Mediterranean, a statistically derived dietary pattern) will be associated with these markers. Aim 2: To evaluate selected nutritional factors in relation to markers of diabetic retinopathy (DR), hypothesizing tha vitamins D and E, PUFA, and dietary patterns will be inversely associated with DR. Aim 3: To evaluate selected nutritional factors in relation to markers of diabetic kidney disease (DKD; urine albumin:creatinine ratio [UACR]) and estimated glomerular filtration rate [eGFR]) and its progression (UACR), hypothesizing that specific SFA, PUFA, vitamins D and E, and dietary patterns will be associated with DKD. The SNAS2 study leverages and expands data from one of the largest cohort of youth with DM ever assembled to answer critical research questions regarding nutrition and DM complications. Additionally, this study will employ enhanced and novel analytic methods to examine these highly clinically relevant questions. Results will inform nutrition recommendations for youth with DM and provide the much needed scientific basis for clinical trials employing nutritional approaches to reduce risk of macro- and microvascular complications.