The Impact of Combined Hormonal Contraceptive Use on Weight Loss in Pre-Menopausal Women Enrolled in a Behavioral Weight Loss Trial

项目摘要/摘要 美国6100万育龄(15-44岁)女性中有近一半超重或 肥胖，使他们及其后代面临更高的不良健康后果风险。值得注意的是，15%-20%的 育龄妇女使用联合激素避孕药(CHC)，包括联合雌激素和 黄体酮口服丸、透皮贴片或阴道环。虽然到目前为止的研究还没有证明 CHC与体重增加之间的联系，目前还没有研究评估CHC对女性减肥的影响 那些积极减肥的超重/肥胖患者。初步数据显示，CHC的使用可能 在行为减肥计划中对减肥产生负面影响，CHCs用户的体重减少6公斤 非用户。这个有指导的F32提案的总体目标是评估CHC使用对体重的影响 超重/肥胖绝经前妇女的减重、饮食依从性和体力活动依从性 登记参加正在进行的行为减肥试验(R01 DK111622)。总体假设是，CHC使用将 在一年内减少对饮食的坚持和较低的体重减轻，但在坚持 爸。在目标1中，将比较CHC使用者和非使用者之间体重和成分的变化。在……里面 目标2，将使用这些客观测量来比较不同组之间对饮食和PA的坚持程度 参数。在探索性目标3中，我们将评估CHC的使用对饮食行为、相关激素的影响 饥饿和饱腹感、粪便微生物区系和能量消耗的组成部分(EE)。申请人，通知 Zaman医学博士，目前是内分泌学研究员三年级，他的长期目标是建立一个研究生涯 在女性健康和肥胖医学的接口上，开发更有效的肥胖治疗方法 处于生育年龄的妇女。以她以前的研究经验为基础，发展一系列研究 与她的导师不同，扎曼博士和她的导师团队开发了一种全面的培训 计划。主要的培训目标包括：1)获得进一步的减肥干预试验经验， 2)发展自由生活能量摄入和饮食行为评估的研究技能；3)发展 评估自由生活的EE和PA的研究技能，4)扩大知识库的影响 生殖激素对能量平衡的影响，5)评估CHC使用对肠道微生物群的影响，6)促进 在定量数据分析和统计方面的技能，以及7)成熟的职业发展技能， 和出版效率。这项研究和培训将在一位经验丰富的 科罗拉多大学安舒茨医学院的导师团队--这个环境将为Dr。 扎曼有获得宝贵技能和专业知识的绝佳机会。成功完成本建议书 将产生几个第一次创作的出版物，并将生成支持 竞争激烈的K23应用。这份F32提案将既是一个极好的培训机会，也是一个原创 和有意义的科学贡献，开启了扎曼博士作为一名学术内科科学家的职业生涯。

PROJECT SUMMARY/ABSTRACT Nearly half of the 61 million women of reproductive age (15-44 years) in the United States are overweight or obese, placing them and their offspring at elevated risk for adverse health outcomes. Notably, 15-20% of reproductive-age women use combined hormonal contraceptives (CHCs), including the combined estrogen and progestin oral pill, transdermal patch, or vaginal ring. While studies to date have not demonstrated a conclusive link between CHCs and weight gain, no studies have evaluated the impact of CHCs on weight loss in women with overweight/obesity who are actively trying to lose weight. Preliminary data suggests that CHC use may adversely impact weight loss within a behavioral weight loss program, with CHCs users losing 6 kg less than non-users. The overall objective of this mentored F32 proposal is to evaluate the impact of CHC use on weight loss, dietary adherence, and physical activity (PA) adherence in pre-menopausal women with overweight/obesity enrolled in an ongoing behavioral weight loss trial (R01 DK111622). The overall hypothesis is that CHC use will be associated with reduced adherence to diet and lower weight loss at 1 year, but no difference in adherence to PA. In Aim 1, changes in body weight and composition will be compared between CHC users and non-users. In Aim 2, adherence to diet and PA will be compared between groups using objective measures of these parameters. In Exploratory Aim 3, we will evaluate the impact of CHC use on eating behaviors, hormones related to hunger and satiety, stool microbiota, and components of energy expenditure (EE). The applicant, Adnin Zaman MD, is currently a third year endocrinology fellow whose long-term goal is to establish a research career at the interface of women’s health and obesity medicine, and to develop more effective obesity treatments for reproductive-aged women. To build upon her previous research experience and develop a line of research distinct from that of her mentor, Dr. Zaman and her mentorship team have developed a comprehensive training plan. The primary training objectives include 1) gaining further experience with weight loss interventional trials, 2) developing research skills in the assessment of free-living energy intake and eating behaviors, 3) developing research skills in the assessment of free-living EE and PA, 4) expanding knowledge base in the impact of reproductive hormones on energy balance, 5) evaluating the impact of CHC use on gut microbiome, 6) enhancing skills in quantitative data analysis and statistics, and 7) maturing professional development skills, grantsmanship, and publication productivity. This research and training will take place under the guidance of an experienced mentorship team at the University of Colorado Anschutz Medical Campus – an environment that will provide Dr. Zaman exceptional opportunities to gain valuable skills and expertise. Successful completion of this proposal will result in several first-authored publications and will generate critical preliminary data needed to support a competitive K23 application. This F32 proposal will serve as both a superb training opportunity and as an original and meaningful scientific contribution to launch Dr. Zaman’s career as an academic physician-scientist.