Physical Activity and Diet in the Prevention of Obesity in Men and Women

描述（由申请人提供）：美国日益增长的肥胖流行病提高了其在所有年龄段的一级预防的重要性;然而，预防工作通常集中在儿科环境中基于社区的干预研究或已经超重或肥胖的成人中的临床干预研究。肥胖症通常在成年期发展，需要更好地了解预防成年期肥胖症的长期策略。流行病学文献中关于总体力活动以外的特定类型或强度的体力活动以及可能与成年中后期肥胖和长期体重增加相关的饮食模式的文献有限。因此，本修订提案响应了PA-06 - 256（肥胖症探索性/开发性临床研究赠款），并寻求在两项现有的男性和女性大型前瞻性队列研究中将偶发性肥胖症开发为新终点。哈佛校友健康研究包括12,805名年龄在55岁的男性，他们在1988年完成了一份基线调查问卷，沿着10年，妇女健康研究包括39,876名年龄在45岁的妇女，基线信息在1992年，随访超过12年，以了解肥胖和长期体重增加的发展。在本提案中，我们将仔细评估身体活动、缺乏身体活动和饮食在预防成人发病性肥胖和最初非肥胖男性和女性长期体重增加中的作用。我们的第一个主要目标是在长期随访中检查缺乏身体活动是否与肥胖风险增加或体重增加有关。我们还将检查身体活动的类型（例如步行和其他常见的运动形式），频率和强度（例如中度，剧烈）。其次，我们将确定特定的饮食因素（例如西方与谨慎的饮食模式，水果和蔬菜，纤维，碳水化合物，乳制品和酒精）是否与肥胖或体重增加的风险增加有关。最后，我们将确定是否存在中间临床因素，如高血压、糖尿病、高胆固醇血症或父母肥胖史（仅适用于男性），是否改变了上述相关性。我们有很好的能力来评估我们的假设，得出有临床意义的结论，关于不同类型和强度的体力活动，久坐行为和饮食因素在肥胖的一级预防中的作用。随着这些队列中成人发病肥胖和长期体重增加的成功发展，我们希望这项提案将导致更大的R01赠款，更大的范围来检查身体活动，身体不活动，饮食和相关生物标志物和遗传因素的其他方面，以确定有前途的机制和预防成人肥胖的创新方法。公共卫生相关性：在美国日益增长的肥胖症流行加剧了我们对如何预防成人肥胖症的理解的需要。我们正在回应PA-06 - 256（肥胖症探索性/发展性临床研究赠款），以在两项现有的大型前瞻性队列研究（哈佛校友健康研究和妇女健康研究）中将成人发病肥胖症作为一个新的终点。我们将仔细评估身体活动、缺乏身体活动和饮食在预防最初非肥胖的中年和老年男性和女性成人发病性肥胖和长期体重增加中的作用。从这一提议中产生的临床相关结果将有助于在这两项大型队列研究中将肥胖作为一个可行的终点，并为将研究扩展到肥胖一级预防中的其他机制相关生物标志物、遗传因素和风险因素提供了机会。

DESCRIPTION (provided by applicant): The growing obesity epidemic in the US has heightened the importance of its primary prevention across all ages; however, prevention efforts generally focus upon community-based intervention studies in pediatric settings or clinical intervention studies among already overweight or obese adults. Obesity commonly develops during adulthood and necessitates an improved understanding of long- term strategies to prevent adult-onset obesity. The epidemiologic literature is limited regarding specific types or intensities of physical activity beyond total physical activity, as well as dietary patterns that may be associated with the development of obesity and long-term weight gain during middle and late adulthood. Therefore, this revised proposal responds to PA-06-256 (Exploratory/Developmental Clinical Research Grants in Obesity) and seeks to develop incident obesity as a new endpoint within two large existing prospective cohort studies of men and women. The Harvard Alumni Health Study includes 12,805 men aged e55 years who completed a baseline questionnaire in 1988 along with 10 years of follow-up, and the Women's Health Study consists of 39,876 women aged e45 years with baseline information in 1992 plus more than 12 years of follow-up for the development of obesity and long-term weight gain. In this proposal, we will carefully evaluate the roles of physical activity, physical inactivity, and diet in the prevention of adult-onset obesity and long-term weight gain in initially non- obese men and women. Our first primary aim will examine whether physical inactivity is associated with an increased risk of becoming obese or greater increases in body weight during long-term follow- up. We will also examine the type (e.g. walking and other common forms of exercise), frequency, and intensity (e.g. moderate, vigorous) of physical activity. Second, we will determine whether specific dietary factors (e.g. Western versus prudent dietary patterns, fruits and vegetables, fiber, carbohydrates, dairy products, and alcohol) are associated with an increased risk of becoming obese or greater increases in body weight. Finally, we will determine whether the above associations are modified by the presence or absence of intermediate clinical factors such as hypertension, diabetes, hypercholesterolemia, or parental history of obesity (available in men only). We have excellent power to assess our hypotheses to draw clinically meaningful conclusions regarding the role of different types and intensities of physical activity, sedentary behaviors, and dietary factors in the primary prevention of obesity. With the successful development of adult-onset obesity and long-term weight gain in these cohorts, we hope this proposal will lead to larger R01 grants with greater scope to examine additional aspects of physical activity, physical inactivity, diet, and related biomarkers and genetic factors to identify promising mechanisms and innovative approaches for the prevention of obesity in adults. PUBLIC HEALTH RELEVANCE: Project Narrative The growing obesity epidemic in the US has heightened the need to improve our understanding of how to prevent adult-onset obesity. We are responding to PA-06-256 (Exploratory/Developmental Clinical Research Grants in Obesity) to develop adult-onset obesity as a new endpoint in two large existing prospective cohort studies, the Harvard Alumni Health Study and the Women's Health Study. We will carefully evaluate the roles of physical activity, physical inactivity, and diet in the prevention of adult-onset obesity and long-term weight gain in initially non-obese middle-aged and older men and women. The clinically relevant results generated from this proposal will help establish obesity as a viable endpoint in these two large cohort studies and provide an opportunity to expand research to other mechanistically relevant biomarkers, genetic factors, and risk factors in the primary prevention of obesity.