This proposal will provide Dr. Joyce Lee with the analytic skills and research experience for becoming an independent researcher focused on obesity and type 2 diabetes over the life course. Dr. Lee will build on her unique training as a pediatric endocrinologist and pediatric health services researcher with a program of advanced courseworkfocused on quantitative skills in epidemiology, applied modeling, and child health policy. Her accomplished mentoring team includes Dr. William Herman, MD, MPH, and Dr. Gary Freed MD, MPH, and resources such as the Michigan Diabetes Research and Training Center, the Child Health Evaluation and Research Unit, and the School of Public Health at the University of Michigan. With this project, Dr. Lee proposes a novel life course approach for understanding the long-term consequences of childhood obesity with regard to type 2 diabetes risk. Rates of childhood obesity are accelerating over time, with large increases in prevalence and magnitude of obesity, as well as earlier onset of obesity. Despite this trend, population-based studies suggest that rates of T2D among children have not yet increased substantially, which may reflect the latency period between the onset of obesity and the development of T2D, which can last upwards of 10 years of more. Therefore, the epidemic of childhood obesity may result in large increases in T2D among young adults, which is of great concern due to higher rates of cardiovascular and end-stage complications from a longer duration of disease. In this proposal, Dr. Lee will evaluate the epidemiologic link between childhood obesity and T2D among young adults using age-period-cohort analyses, and will examine how both degree of excess BMI and duration of obesity early in life affect the rate and age at onset of T2D. She will then develop a state transition model to project future trends in T2D which account for recent increases in childhood obesity. Finally she will identify the policy implications of her findings from the epidemiologic studies and the state transition model to identify and prioritize changes in child health policy and health care delivery needed for addressing childhood obesity as a chronic disease risk factor originating in childhood and extending into adulthood.
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