A lifecourse approach to women's cardiometabolic and bone health: from fertility to perimenopause

项目摘要/摘要 此应用程序响应PA-17-091：生育状态作为总体健康的标记 在整个生育年龄段，许多女性都会经历体重大幅增加、骨密度下降和 肌肉质量和心脏代谢健康恶化，每一项都预示着晚年的发病率和死亡率。多数 妇女在这种生活方式中有一次或多次怀孕，还有一大部分妇女(多达三分之一)，包括 许多成功受孕并怀孕的人经历了亚生育或不孕。 不孕不育，定义为在无保护措施的性交12个月后无法怀孕，因此是 在育龄成年人中最常见的情况。越来越多的证据表明生育能力-- 相关特征预测未来的健康风险，包括超重、骨质疏松症、心血管疾病 心血管疾病(CVD)和2型糖尿病。 我们提议的项目的总体目标是测试我们的假设，即有生育能力受损证据的女性 在围绝经期会有更多不良的身体成分、骨骼健康和心脏代谢结果。我们 提出前瞻性纵向队列研究设计，作为解决所提出目标的最佳方法。 我们将利用来自Project Viva的数据，Project Viva是一个高度参与的现有队列，有1000多名社会人口 我们已经从她们那里收集了关于体重、饮食和其他健康的详细信息 行为从1999-2002年注册时开始，此后不断更新。 暴露是通过经过验证的自我报告、临床或研究措施进行评估的，并将包括几个 生育力的时间更新标记：受孕周期；妊娠和产次；不孕症的诊断和治疗； 多囊卵巢综合征(PCOS)的诊断以及睾酮的测定，这是一个定义 多囊卵巢综合征的特征；以及抗苗勒氏激素(AMH)水平，这是卵巢储备的客观标志。 结果包括身体成分(脂肪、瘦肉和骨量)、心血管健康和 并将在面对面的研究访问中使用黄金标准衡量标准进行评估。自.以来 在研究开始时，我们还严格收集了一系列行为、健康指标、 环境因素，以及社会和家庭经历。 拟议的一系列调查的结果将为生殖健康妇女的临床护理提供信息 围绝经期数年，筛查和长期随访指南，以及未来研究 优先事项。此建议提供了一个利用现有优秀数据的绝佳机会， 资源，并包括5年项目期内20多年的高质量预期评估。

Project Summary/Abstract This application is responsive to PA-17-091: Fertility Status as a Marker for Overall Health Across their reproductive years, many women experience substantial weight gain, declines in bone density and muscle mass, and worsening cardiometabolic health, each predicting later life morbidity and mortality. Most women have one or more pregnancies during this lifestage, and a large subset of women (up to 1/3), including many who have successfully conceived and carried a previous pregnancy, experience subfertility or infertility. Infertility, defined as the inability to conceive after 12 months of unprotected intercourse, is thus one of the most common conditions among reproductive age adults. A growing body of evidence suggests that fertility- related characteristics predict future health risks including excess weight gain, osteoporosis, cardiovascular disease (CVD), and type 2 diabetes mellitus. The overall goal of our proposed project is to test our hypothesis that women with evidence of impaired fertility will have more adverse body composition, bone health, and cardiometabolic outcomes in perimenopause. We propose a prospective longitudinal cohort study design as the optimal approach to address the proposed aims. We will leverage data from Project Viva, a highly engaged existing cohort of over 1000 socio-demographically diverse women from whom we have already collected detailed information on weight, diet, and other health behaviors beginning at enrollment in 1999-2002, and updated continually since. Exposures are assessed with validated self-reported, clinical, or research measures and will include several time-updated markers of fertility: cycles to conception; gravidity and parity; infertility diagnoses and treatments; diagnosis of polycystic ovary syndrome (PCOS) as well as measurement of testosterone, a defining characteristic of PCOS; and levels of anti-Müllerian hormone (AMH), an objective marker of ovarian reserve. Outcomes include markers of body composition (fat, lean, and bone mass), cardiovascular health, and metabolic health and will be assessed using gold-standard measures at an in-person research visit. Since study inception, we have also rigorously collected data on a wide set of behaviors, health measures, environmental factors, and social and family experiences. Results from the proposed series of investigations will inform clinical care for women from the reproductive years through perimenopause, guidelines regarding screening and long-term follow-up, and future research priorities. This proposal provides an exceptional opportunity to leverage outstanding existing data and resources and include over 20 years of high quality prospective assessments within a 5-year project period.