Very little is known about the pathways that link broad environmental factors to health behaviors, and then to cardiometabolic risk across the lifecycle, taking into account the complex mediation and moderation by diet, activity, and weight over time. The primary reasons for this lack of understanding are: 1) insufficient high- quality, longitudinal exposure data;2) lack of data in populations undergoing rapid changes in environments and outcomes, with enough variability to observe changes;and 3) insufficient use of complex statistical models to allow examination of each piece of the time-dependent, complex system. The China Health and Nutrition Survey (CHNS), an NIH-funded study of more than 11,000 individuals followed over 20 years, provides high- quality longitudinal data and captures the dramatic emergence of obesity, hypertension, insulin resistance, type 2 diabetes and cardiovascular disease in parallel with urbanization during the past two decades. The proposed study takes advantage of these unique data to examine patterns of change in communities characterized by different levels of urbanization over time. Using sophisticated structural models we propose to examine the complex pathways through which community-, household- and individual-level factors affect diet and physical activity, then the rate, degree and timing of weight gain and ultimately, cardiometabolic risk across the lifecycle. China is uniquely positioned to answer these questions given its high prevalence of cardiometabolic risk factors at relatively low BMI and at younger ages, and the relatively higher abdominal obesity and high rates of insulin resistance in Asians. We capitalize on a vast array of longitudinal anthropometry, blood pressure and detailed behavioral, socioeconomic and environmental information as well as newly collected fasting blood samples for cardiometabolic biomarkers. Our objectives include: 1) developing a longitudinal, structural model to investigate how community, household and individual factors influence: (a) energy-related diet and physical activity behaviors, (b) weight and waist circumference and (c) blood pressure over 20 years;and 2) extend the same multilevel, pathway-based analyses (Aims 1a-1c) to markers of dyslipidemia, insulin resistance and sensitivity, and inflammation. The proposed research will inform prevention and treatment strategies to optimize the effectiveness of cardiometabolic risk reduction efforts, with greater understanding of the role of broader societal, economic and environmental contexts in populations at risk.

Public Health Relevance

China is a rapidly modernizing country experiencing substantial burden in hypertension, diabetes and cardiometabolic risk, providing a unique model for examining development of risk. The objective of the proposed research is to understand the multiple pathways from environment, behavior and biology to cardiometabolic risk across the lifecycle in order to inform efforts to mitigate early development of disease risk across the globe.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL108427-02
Application #
8432044
Study Section
Special Emphasis Panel (ZRG1-PSE-M (03))
Program Officer
Boyington, Josephine
Project Start
2012-03-01
Project End
2016-02-28
Budget Start
2013-03-01
Budget End
2014-02-28
Support Year
2
Fiscal Year
2013
Total Cost
$683,504
Indirect Cost
$219,320
Name
University of North Carolina Chapel Hill
Department
Nutrition
Type
Schools of Public Health
DUNS #
608195277
City
Chapel Hill
State
NC
Country
United States
Zip Code
27599
Inoue, Yosuke; Howard, Annie Green; Thompson, Amanda L et al. (2018) Secular change in the association between urbanisation and abdominal adiposity in China (1993-2011). J Epidemiol Community Health 72:484-490
Spracklen, Cassandra N; Shi, Jinxiu; Vadlamudi, Swarooparani et al. (2018) Identification and functional analysis of glycemic trait loci in the China Health and Nutrition Survey. PLoS Genet 14:e1007275
Zhang, Jiguo; Wang, Huijun; Wang, Zhihong et al. (2018) Prevalence and stabilizing trends in overweight and obesity among children and adolescents in China, 2011-2015. BMC Public Health 18:571
Inoue, Yosuke; Howard, Annie Green; Thompson, Amanda L et al. (2017) The association between urbanization and reduced renal function: findings from the China Health and Nutrition Survey. BMC Nephrol 18:160
Dong, Fei; Howard, Annie Green; Herring, Amy H et al. (2017) Longitudinal associations of away-from-home eating, snacking, screen time, and physical activity behaviors with cardiometabolic risk factors among Chinese children and their parents. Am J Clin Nutr 106:168-178
Spracklen, Cassandra N; Chen, Peng; Kim, Young Jin et al. (2017) Association analyses of East Asian individuals and trans-ancestry analyses with European individuals reveal new loci associated with cholesterol and triglyceride levels. Hum Mol Genet 26:1770-1784
Dong, F; Howard, A G; Herring, A H et al. (2017) Concordance of haemoglobin A1c, blood pressure and C-reactive protein between children and their parents in Chinese households. Pediatr Obes 12:422-430
Winglee, Kathryn; Howard, Annie Green; Sha, Wei et al. (2017) Recent urbanization in China is correlated with a Westernized microbiome encoding increased virulence and antibiotic resistance genes. Microbiome 5:121
Wang, Zhihong; Adair, Linda S; Cai, Jianwen et al. (2017) Diet Quality Is Linked to Insulin Resistance among Adults in China. J Nutr 147:2102-2108
Wang, Z; Gordon-Larsen, P; Siega-Riz, A M et al. (2017) Sociodemographic disparity in the diet quality transition among Chinese adults from 1991 to 2011. Eur J Clin Nutr 71:486-493

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