Race/Ethnic Specific Association Between Anthropometry, Liver Fat and Incident Type 2 Diabetes: Evidence from The Multi-Ethnic Study of Atherosclerosis

项目摘要 在美国，每七个成年人中就有一个患有2型糖尿病(T2D)，如果目前的趋势继续下去，预计T2D 到2050年，患病率可能会上升到三分之一的成年人。此外，这种健康的负担 这种疾病对美国少数民族的影响不成比例；而目前T2D的患病率在 白人的比例为22%，黑人和西班牙裔的比例为22%。肥胖是T2D的强烈风险因素，这种影响的部分原因是 推测是由于非酒精性脂肪性肝病(NAFLD)的发展。然而，到目前为止， 目前尚不清楚肥胖是通过肝脏脂肪对T2D的发展起作用的。当前种族/特定种族 建立了使用人体测量(例如，体重指数)来识别肥胖的指南 白人和亚裔人口。然而，对于美国黑人和西班牙裔，缺乏针对种族/民族的指导方针 主要是因为证据仅限于横断面研究的结果。我们建议 为了验证肥胖与T2D的关系在不同的临床相关性上是否明显的假设 黑人和西班牙裔与白人的人体测量值比较。此外，我们建议估计 肝脏脂肪在人体测量和T2D之间的中介作用。 这项拟议的研究利用了来自动脉粥样硬化多种族研究的丰富的纵向数据 (MESA)，一项针对6814名白人、黑人、西班牙裔和中国成年人的队列研究，自 公元2000年。基线数据将使用几种人体测量方法来识别肥胖，并确定肥胖的程度 使用计算机断层扫描诊断脂肪肝。在随后的四个月中，对事件T2D的个人进行了跟踪 后续的考试访问。比例风险回归将被用来估计特定种族的关联 人体测量和事件T2D之间的关系；将使用多变量线性回归分析来评估种族- 人体测量和基线时肝脏脂肪之间的特定关联；我们将使用相反的 概率加权比例风险回归估计肥胖对T2D的中介作用 肝脏脂肪。 先前关于黑人和西班牙裔人群的人体测量和T2D之间的相关性的研究是 受横断面研究设计的限制，或缺乏多种族群体来评估T2D的异质性 种族/民族之间的风险。相比之下，我们的建议是创新的，通过在一个大的， 多种族/民族群体的特征良好的未来队列。这项提议的重要性得到了体现。 在研究不足的黑人和西班牙裔人群中，T2D的患病率要高得多。 跨学科的培训环境，肥胖和T2D流行病学领域的专家指导， 健康差异和流行病学方法，将为申请者提供一个平台，在其中他可以加强 作为T2D未来的独立研究员，他的培训目标和对慢性病领域的贡献 预防流行病学。 好了！

Project Summary In the US, one in seven adults has type 2 diabetes (T2D), and if current trends continue, it is projected that T2D prevalence can rise to as high as one in three adults by the year 2050. Furthermore, the burden of this health condition disproportionately affects US ethnic minorities; whereas the current T2D prevalence is 11% among Whites, it is 22% among Blacks and Hispanics. Obesity is a strong risk factor for T2D and part of this effect is hypothesized to be due to the development of non-alcoholic fatty liver disease (NAFLD). However, the extent to which adiposity acts on the development of T2D through liver fat is unknown. Current race/ethnic-specific guidelines for the identification of obesity using body anthropometry (e.g. body mass index) are established for White and Asian populations. However, race/ethnic-specific guidelines are lacking for US Black and Hispanic populations, primarily because evidence has been limited to findings from cross-sectional studies. We propose to test the hypothesis that the obesity-T2D relationship will be evident at different clinically relevant anthropometric values among Blacks and Hispanics compared to Whites. In addition, we propose to estimate the mediating effect of liver fat on the association between anthropometry and T2D. The proposed investigation leverages the rich longitudinal data from the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort study of 6,814 White, Black, Hispanic and Chinese adults that have been followed since the year 2000. Baseline data will identify obesity using several anthropometric measures, and to identify the degree of fatty liver using Computed Tomography scans. Individuals were followed for incident T2D in four subsequent follow-up exam visits. Proportional hazards regression will be used to estimate race-specific associations between anthropometry and incident T2D; multivariable linear regression analyses will be used to evaluate race- specific associations between anthropometric measurements and liver fat at baseline; and we will use inverse probability weighted proportional hazards regression to estimate the mediating effect of obesity on T2D through liver fat. Prior studies of the association of anthropometric measures and T2D in Black and Hispanic populations were limited by their cross-sectional study design, or lacked multi-ethnic groups to evaluate heterogeneity of the T2D risk between race/ethnic groups. In contrast, our proposal is innovative by evaluating this association in a large, well-characterized prospective cohort of multi-racial/ethnic groups. The significance of the proposal is reflected in the much higher prevalence of T2D in the understudied Black and Hispanic populations. The interdisciplinary training environment, expert mentorship in the fields of obesity and T2D epidemiology, health disparities and epidemiologic methods, will provide the applicant a platform in which he can strengthen his training goals and contribute to the field of chronic disease as a future independent researcher in T2D prevention epidemiology. !