Pre- and peri-natal predictors of childhood obesity

描述（由申请人提供）：预防肥胖是研究人员、临床医生和政策制定者的首要任务。甚至幼儿也未能幸免于这种流行病，幼儿肥胖不仅会导致短期发病，而且还会导致后期肥胖及其不良后果。因此，确定在生命早期甚至出生前就存在的可改变的肥胖决定因素至关重要。在R01 HD34568的竞争延续中，我们的总体目标是研究产前饮食和激素因素、婴儿喂养和出生后生长在7岁时肥胖相关结局发生中的作用。主要研究结果将是通过双x线吸收仪（DXA）和血浆脂联素水平评估总脂肪量和局部脂肪量。这项研究将扩展和扩大Viva项目前五年的工作，Viva项目是一项对孕妇及其子女的前瞻性纵向研究。虽然一些研究调查了出生体重与后来肥胖的关系，但出生体重只是一个短暂的标志，是出生前众多决定因素的一个整体。在本建议中，我们将“超越出生体重”，重点关注产前的两种内分泌因素。糖皮质激素和瘦素。以及母亲摄入长链多不饱和脂肪酸，这可能与后代肥胖的发展有关。母乳喂养在预防肥胖方面的作用在21世纪具有新的紧迫性。在这项研究中，我们将通过仔细控制社会文化因素的潜在混淆和评估可能的机制，包括行为和代谢影响，来解决母乳喂养与后来肥胖相关结果之间流行病学关联的有效性。我们还将讨论婴儿生长加速与后期肥胖之间的关联在多大程度上可以归因于产前的代谢途径或婴儿喂养实践。作为Viva项目的一部分，通过对最初在产前招募的参与者进行随访至7岁，该项目旨在研究产前和围产期发生的事件，这些事件对儿童肥胖的发展至关重要。这项研究的结果有望解开肥胖早期起源中一些棘手的流行病学问题，并为原始肥胖预防开辟新的潜在途径。

DESCRIPTION (provided by applicant): Obesity prevention is a top priority of researchers, clinicians, and policy makers. Even young children have not been spared this epidemic, and obesity in young children leads not only to short-term morbidity but also to later obesity and its adverse consequences. Thus it is critical to identify modifiable determinants of obesity that exist very early in life, even before birth. In this proposed competing continuation of R01 HD34568, our overall goal is to examine the roles of prenatal dietary and hormonal factors, infant feeding, and postnatal growth in the genesis of adiposity-related outcomes at the age of 7 ears. The main study outcomes will be total and regional fat mass assessed by dual x-ray absorptiometry (DXA), and plasma adiponectin levels. This study will extend and amplify a body of work from the first five years of funding for Project Viva, a prospective longitudinal study of pregnant women and their children. While some studies have examined associations of birth weight with later obesity, birth weight is but a momentary marker, an integral of numerous determinants operating before birth. In this proposal, we will "go beyond birth weight" to focus on two endocrine factors operating prenatally. glucocorticoids and leptin. as well as maternal intake of long- chain polvunsaturated fatty acids, that could be involved in the development of obesity in the offspring. The role of breastfeeding in obesity prevention has taken on new urgency in the 21st century. In this study, we will address the validity of epidemiologic associations between breastfeeding and later adiposity-related outcomes, both by carefully controlling for potential confounding by sociocultural factors and by evaluating plausible mechanisms, including behavioral and metabolic effects. We will also address the extent to which any associations of accelerated infant growth with later adiposity can be ascribed to metabolic pathways operating prenatally or to infant feeding practice. By following to age 7 years participants originally recruited prenatally and followed prospectively as part of Project Viva, the proposed project is uniquely poised to examine events occurring in the pre- and peri-natal period as critical to the development of obesity in childhood. The results of this study promise to unravel some knotty epidemiologic issues in the early origins of obesity, and to open up new potential avenues for primordial obesity prevention.