The Impact of Stress and Resilience on Obesity-related Metabolic Complications in Adolescents

项目摘要 青少年的肥胖率很高，这些青少年患代谢性疾病的风险更大。 比他们瘦的同龄人更复杂。代谢功能差与更差的健康结果相关， 医疗保健费用和其他健康合并症;然而，并非所有肥胖青年都发生代谢性疾病， 并发症与白色青年相比，黑人青年的代谢并发症较少， 是肥胖率最高的国家之一了解减缓贫困进展的独特保护因素 代谢健康是必要的，以减少不利的健康结果和提高生活质量的人。 肥胖青少年。因此，本研究的具体目标是：1）研究不同性别的儿童在 没有代谢并发症的肥胖黑人青少年之间基于体重和种族的耻辱 （OMC-）和匹配的黑人青少年谁有肥胖与至少2代谢并发症（OMC 2+）; 2)评估OMC-和OMC 2+之间生理应激和心理应激的差异 探讨OMC-和OMC 2+青少年心理弹性的差异。我们将使用一个 采用病例对照横断面设计，对100名护理人员和黑人进行访谈调查。 美国中南部有和没有代谢并发症的青少年。我们将研究两组 肥胖黑人青年（11-17岁）（定义为腰围≥第90百分位数）。OMC- 一组将包括50名患有肥胖症的青少年，他们的血压、胆固醇、血糖 和肝功能OMC 2+组将包括50名患有两种或两种以上代谢紊乱的肥胖青少年。 并发症（即，高血压、甘油三酯升高、低高密度脂蛋白（HDL）、胰岛素 抵抗力和/或肝功能受损）与OMC相匹配-按年龄和性别划分的青年。定量调查将 检查照顾者和青年报告的体重和种族为基础的耻辱，心理压力和弹性。 将通过唾液皮质醇（昼夜和觉醒反应）评估生理应激。我们将获得 代谢功能数据，包括：血压、甘油三酯、HDL、稳态模型评估 胰岛素抵抗（HOMA-IR）和肝功能。鉴于已知与研究结果变量的关联，我们 将获得收入，身体/心理健康和饮食摄入量的措施，以及措施， 身体活动和睡眠模式。这项创新的研究将有助于该领域的 了解为什么一些黑人青年还没有表现出代谢并发症，而其他人。而 遗传因素可能占这些变异的27%，生物心理社会因素尚未得到充分研究。 因此，通过研究这一罕见的OMC青少年群体，我们将获得相关可变因素的数据， 到一个受肥胖影响最严重的社区。获得的知识将作为R 01赠款的试验数据， 制定基于实力、基于文化的干预措施，旨在减少健康差距， 保持肥胖黑人青年的代谢健康。

PROJECT SUMMARY Rates of obesity are high in adolescents, with these youth at greater risk for developing metabolic complications than their lean peers. Poor metabolic function is associated with worse health outcomes, higher health care costs, and other health comorbidities; however, not all youth with obesity develop metabolic complications. Black youth have fewer metabolic complications compared to White youth, despite having among the highest rates of obesity. Understanding unique protective factors that slow the progression to poor metabolic health is necessary for reducing adverse health outcomes and improving the quality of life of adolescents with obesity. Thus, the specific aims of the proposed research are: 1) to examine differences in weight- and race-based stigma between Black adolescents who have obesity without metabolic complications (OMC-) and matched Black adolescents who have obesity with at least 2 metabolic complications (OMC2+); 2) to evaluate differences in physiological stress and psychological stress between OMC- and OMC2+ adolescents; and 3) to explore differences in resilience between OMC- and OMC2+ adolescents. We will use a case-control cross-sectional design to conduct 100 interviewer-administered surveys with caregivers and Black adolescents with and without metabolic complications in the US Midsouth. We will examine two groups of Black youth (aged 11-17) with obesity (defined as having a waist circumference ≥90th percentile). The OMC- group will include 50 adolescents with obesity who have optimal levels of blood pressure, cholesterol, glucose, and liver function. The OMC2+ group will include 50 adolescents with obesity who have two or more metabolic complications (i.e., high blood pressure, elevated triglycerides, low high density lipoprotein (HDL), insulin resistance, and/or impaired liver function) matched to OMC- youth by age and sex. Quantitative surveys will examine caregiver and youth reports of weight- and race-based stigma, psychological stress, and resilience. Physiological stress will be assessed via salivary cortisol (diurnal and awakening response). We will obtain data on metabolic function including: blood pressure, triglycerides, HDL, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and liver function. Given known associations with study outcome variables, we will obtain measures of income, physical/mental health, and dietary intake, and as well as measures of physical activity and sleep patterns via actigraphy. This innovative study will contribute to the field's understanding of why some Black youth are not yet exhibiting metabolic complications while others are. While genetic factors may account for ~27% of these variations, biopsychosocial factors have been underexplored. Thus, by studying this rare group of OMC- adolescents, we will obtain data on mutable factors that are relevant to a community most impacted by obesity. Knowledge gained will serve as pilot data for an R01 grant to develop a strength-based, culturally-informed intervention aimed at decreasing health disparities and maintaining metabolic health among Black youth with obesity.