Growth in Childhood and Cardiometabolic Risk in Nepal

描述（由申请人提供）：项目摘要/摘要经历胎儿生长受限的婴儿的适当生长模式尚不清楚。来自发达国家的数据表明，儿童期的快速增长可能会使个人在以后的生活中患慢性病的风险增加。然而，在许多营养不良的环境中，在生命的头两年内赶上增长有很大的好处。然而，在某些情况下，早期加速增长对未来患慢性病的风险有负面影响。因此，追赶性增长的时机是有意义的，特别是在经历营养过渡的人口中，婴儿和儿童营养不良与成人营养过剩并存。拟定次要分析的总体目标是确定南亚农村人群中青少年和青壮年（17 - 14岁）从出生到婴儿期和儿童期的生长模式（线性和重量），该模式与超重、肥胖和心血管疾病和胰岛素抵抗的早期风险因素相关。我们假设，在尼泊尔农村人口中，有心脏代谢风险的婴儿和儿童的生长模式与没有这种风险的婴儿和儿童的生长模式有显着差异。为了进行二次分析，我们将结合联合收割机对5，574名受试者在婴儿期和儿童期进行的一系列人体测量，这些受试者在20世纪90年代参加了两项维生素A补充试验，最近在青少年和年轻人时进行了复查和检查。我们在2006-2007年完成的一项随访研究中评估了超重和高脂肪、高血压、血脂异常和胰岛素抵抗，以检查营养干预对生长、发育和心脏代谢风险的长期影响。在进行补充试验和后续研究时，收集了大量关于社会经济、人口统计、饮食、生活方式和健康因素的数据。为了解决拟议研究的具体目标，将使用纵向人体测量数据来表征从出生到青春期/成年早期的儿童生长轨迹模式，这些模式与使用随机效应模型的心脏代谢风险相关。目前的分析将是一个显着的贡献，更好地表征儿童生长和心脏代谢的风险，在世界上的一个地区，有一个高发病率的胎儿生长受限和生长迟缓的儿童和日益流行的心血管疾病和糖尿病的成年。 公共卫生相关性：在高收入环境中，婴儿期生长缓慢，随后在儿童后期生长加速与心血管疾病和晚年死亡的风险有关。我们提出的二次分析，使用来自尼泊尔的纵向数据，将探讨与青春期/成年期心脏代谢风险标志物相关的早期生命的生长模式。

DESCRIPTION (provided by applicant): Project Summary/Abstract The appropriate pattern of growth among infants that experience fetal growth restriction is not well understood. Data from developed countries suggest that rapid growth in childhood may place individuals at an elevated risk of later life chronic disease. However, there are substantial benefits to catch-up growth within the first two years of life in many malnourished settings. In some settings, early accelerated growth, however, is shown to have negative consequences on future risk of chronic diseases. Thus, the timing of catch up growth is of relevance, especially in populations experiencing nutrition transition, with concurrent undernutrition in infants and children and overnutrition among adults. The overall goal of the proposed secondary analysis is to determine the pattern of growth (linear and ponderal) from birth through infancy and childhood that is associated with overweight, adiposity, and early risk factors of cardiovascular disease and insulin resistance among adolescents and young adults (1714 years) in a rural South Asian population. We hypothesize that patterns of growth in infancy and childhood among those with a cardiometabolic risk will differ significantly from those without this risk in this rural Nepali population. In order to conduct this secondary analysis we will combine serial anthropometric measurements taken among 5,574 subjects during infancy and childhood during their participation in two vitamin A supplementation trials in the 1990's who were recently revisited and examined as adolescents and young adults. Overweight and high adiposity, high blood pressure, dyslipidemia, and insulin resistance were assessed in a follow-up study that we recently completed in 2006-2007 to examine long term effects of the nutrient interventions on growth, development, and cardometabolic risk. Data on a large number of socioeconomic, demographic, dietary, life style and health factors were collected, both at the time when the supplementation trial was carried out as well as at the time of the follow-up study. To address the specific aims of the proposed study, longitudinal anthropometric data will be used to characterize patterns of child growth trajectories from birth through adolescence/early adulthood that are associated with cardiometabolic risk using random effects models. The present analysis will be a significant contribution to the literature by better characterizing child growth and cardiometabolic risk in a region of the world where there is a high incidence of fetal growth restriction and growth faltering in childhood and a growing epidemic of cardiovascular disease and diabetes in adulthood. PUBLIC HEALTH RELEVANCE: Project Narrative Slow growth in infancy followed by accelerated growth in later childhood has been associated with risk of cardiovascular disease and death in later life in high income settings. Our proposed secondary analyses, using longitudinal data from Nepal, will explore patterns of growth in early life that are associated with markers of cardiometabolic risk in adolescence/adulthood.