Nutrition and Metabolic Status in Youth with Type 1 DM: SEARCH Ancillary Study

描述(由申请人提供)： 营养被认为是儿童糖尿病(DM)日常治疗的基石。然而，关于营养因素在青年确诊的1型糖尿病自然病程中的作用，包括细胞衰退的进展和心血管疾病(CVD)危险因素的出现，人们知之甚少。这项拟议的工作是CDC/DDT和NIH/NIDDK资助的青年糖尿病搜索项目的辅助研究，该项目是一项正在进行的针对0-19岁青年糖尿病诊断的多中心观察性研究。采用横断面和纵向设计，Search Nutrition辅助研究(SNAS)的总体目标是检查营养因素与1)胰岛素分泌缺陷的进展，以及2)1型糖尿病青年心血管危险因素的存在之间的关系。与PAR-07-024的目标一致，SNAS是搜索第二阶段所述目标的自然延伸，该阶段侧重于糖尿病类型相关特征的演变，包括胰岛素分泌缺陷，以及糖尿病长期并发症的风险因素的演变。从搜索数据来看，患有糖尿病的青少年的饮食摄入量远远低于营养建议。此外，与非糖尿病青年相比，患有1型糖尿病的青年的心血管危险因素的患病率更高。为了严格检验营养因素作为1型糖尿病青少年代谢状态的决定因素，我们建议1)通过问卷调查获得有关婴儿喂养习惯的新数据，2)使用搜索参与者的存储样本获得选定营养生物标记物(血浆生育酚、维生素D、镁和脂肪酸)的新实验室测试结果，3)进行饮食评估分研究，以提高我们适当构建统计模型以解决饮食数据测量错误的能力。具体目的1是评估营养因素作为潜在的决定因素，在大约1140名经DM自身抗体阳性确诊的1型糖尿病青年中保留β-呼叫功能。特定目标1的受试者将在2002-2005年间被诊断为糖尿病，从正在进行的搜索研究中纵向获得空腹C肽数据。此外，这些年轻人中的一部分将进行β细胞功能的纵向测量，即混合膳食刺激的C肽。具体目标2是使用横断面和纵向分析，评估大约2415名2001年1型糖尿病流行或2002-2005年发病的青年的营养因素与心血管危险因素的关系。研究结果将为青少年糖尿病患者的营养建议和未来的营养干预临床试验提供独特的信息。所有搜索网站都包括在这个项目中。我们的多学科团队由伊丽莎白·迈尔-戴维斯博士领导，她是一位公认的饮食和糖尿病专家，指导了最初的搜索饮食评估。

DESCRIPTION (provided by applicant): Nutrition is considered a cornerstone of day-to-day treatment of childhood diabetes mellitus (DM). However, little is known regarding the role of nutritional factors in the natural history of diagnosed Type 1 (T1) DM in youth, including progression of ¿-cell decline and the emergence of cardiovascular disease (CVD) risk factors. The proposed work is an ancillary study to the CDC/DDT and NIH/NIDDK funded SEARCH for Diabetes in Youth project, which is an ongoing multi-center, observational study of DM diagnosed in youth age 0-19 years. Using both cross-sectional and longitudinal designs, the overall goal of the SEARCH Nutrition Ancillary Study (SNAS) is to examine associations of nutritional factors with 1) the progression of insulin secretion defects, and 2) the presence of CVD risk factors in youth with Type 1 DM. Consistent with the objective of PAR-07-024, SNAS is a natural extension of the stated aims of SEARCH Phase 2, which focuses on the evolution of DM type-related characteristics including insulin secretion defects, and the evolution of risk factors for long term complications of DM. From SEARCH data, dietary intake in adolescents with DM falls far short of nutrition recommendations. Moreover, the prevalence of CVD risk factors is elevated among youth with Type 1 DM, compared to youth without DM. To rigorously examine nutritional factors as determinants of metabolic status of youth with Type 1 DM, we propose to 1) obtain new data on history of infant feeding practices by questionnaire, and 2) obtain new laboratory test results on selected nutrient biomarkers (plasma tocopherols, vitamin D, magnesium, and fatty acids) using stored samples from SEARCH participants, and 3) conduct a Diet Assessment Sub-study to advance our capacity to appropriately construct statistical models to address measurement error in dietary data. Specific Aim 1 is to evaluate nutritional factors as potential determinants of preserved beta call function in approximately 1140 youth with Type 1 DM confirmed by positive DM autoantibodies. Subjects for Specific Aim 1 will have had diabetes diagnosed in 2002 - 2005, with fasting C-peptide data available longitudinally from the ongoing SEARCH study. Additionally, a subset of these youth will have beta cell function measured longitudinally as mixed meal stimulated C-peptide. Specific Aim 2 is to evaluate nutritional factors in relation to CVD risk factors in approximately 2415 youth with Type 1 DM prevalent in 2001 or incident in 2002 - 2005, using both crosssectional and longitudinal analyses. Results will uniquely inform nutrition recommendations and future clinical trials of nutrition interventions for youth with DM. All SEARCH sites are included in this project. Our multidisciplinary team is led by Dr Elizabeth Mayer-Davis, a well-recognized expert in diet and diabetes who directed the original SEARCH diet assessment.