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Principal Investigator: JOSIEMER MATTEI
Organization: HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH
Fiscal Year: 2024
Award: $1,884,576
Funding agency: National Heart Lung and Blood Institute
PROJECT SUMMARY
Access to sufficient, high-quality, and safe food and nutrition is a fundamental human right. Lacking this
denotes food insecurity (FI), becoming a significant societal and public health crisis. FI increases the risk of
type 2 diabetes and cardiovascular disease. Yet, there is insufficient evidence on the causal link and potential
mediating mechanisms between FI and cardiometabolic disease (CMD). Posited pathways are neuroendocrine
factors, dietary factors, such as dysfunctional eating or specific fats like trans fats or ceramides, and positive or
negative psychological factors. But few studies have investigated these pathways. It is also unclear how
persistent vs. transient FI influences CMD. Moreover, the impact of food procurement decisions on FI and diet
quality has been barely studied. These gaps are largely due to scant comprehensive longitudinal studies,
leading key agencies to call for rigorous research on the mechanisms linking FI and CMD in vulnerable groups.
Due to social and cardiovascular-related inequities, compounded by vulnerability to climate-change events,
FI prevalence in the US territory of Puerto Rico (PR) is 33.2%, three times the US prevalence. This makes PR a
pressing case and an ideal setting to study contributors to - and health consequences of - FI. With the goal of
elucidating the complex pathways connecting FI and CMD, in 2018 we established PROSPECT: Puerto Rico
Observational Study of Psychosocial, Environmental, and Chronic disease Trends (R01-HL143792), a
longitudinal cohort of adults aged 30-75 y. PROSPECT includes a thorough clinical examination and collects
blood, urine, saliva, and hair samples to assess CMD, and validated psychosocial measures, a food frequency
questionnaire, geocoded food access metrics, and the USDA Food Security Survey Module. Our reports show
that 73% of participants have abdominal obesity, 61% have high blood pressure, 33% have FI, and 53% receive
the Nutrition Assistance Program. We propose to renew PROSPECT to assess CMD at 4y and 6y post-baseline,
screen for transient FI between visits, and analyze circulating fatty acids and novel biomarkers. We will enrich
representation from rural areas and men, key CVD factors, with 500 new participants. Over 6y, we aim to
determine associations between persistent and transient FI and CMD, directly or via neuroendocrine markers;
identify dietary and psychosocial mechanisms linking FI and CMD; and identify food procurement factors
associated with FI and diet. Exploratory analysis will georeference climate change indicators with FI.
PROSPECT leverages an established interdisciplinary team, a thorough dataset, multiple timepoints to
examine complex pathways, novel biomarkers, and original analysis of FI and climate-change events. We have
already produced pivotal publications, action-oriented initiatives, ancillary studies, and a biorepository and
research infrastructure in PR. This renewal will enhance our unique cohort and generate compelling results
that will advance science by elucidating mechanisms between FI and CMD, serving as model for other groups,
and will inform food-related and psychosocial programs to alleviate FI and CMD inequities in PR and beyond.
Terms: <21+ years old><5-HT><5-Hydroxytryptamine><5HT><Abdominal obesity><Active Follow-up><Address><Adrenaline><Adult><Adult Human><Adult-Onset Diabetes Mellitus><Aeroseb-HC><Ancillary Study><Android fat distribution><Androstenolone><Behavior><Biological><Birth><Blood><Blood Plasma><Blood Reticuloendothelial System><Budgets><COVID-19><CV-19><Cardiometabolic Disease><Cardiometabolic Disorder><Cardiovascular><Cardiovascular Body System><Cardiovascular Diseases><Cardiovascular Organ System><Cardiovascular system><Central obesity><Centripetal obesity><Ceramides><Cetacort><Chronic Disease><Chronic Illness><Church><Complex><Coronavirus Infectious Disease 2019><Cort-Dome><Cortef><Cortenema><Cortisol><Cortispray><Cortril><DHEA><Data><Data Bases><Data Set><Databases><Dehydroisoandrosterone><Dermacort><Diabetes Mellitus><Diet><Dietary Factors><Dietary Practices><Disasters><Dopamine><Droughts><Dyslipidemias><Eating><Eating Behavior><Eldecort><Enrollment><Enteramine><Epinephrine><Event><Face><Fats><Fatty Acids><Fatty acid glycerol esters><Fishes><Food><Food Access><Food Analyses><Food Analysis><Food Intake><Frequencies><Friends><Goals><Hair><Health><Heart Vascular><Hippophaine><Household><Human Rights><Hunger><Hurricane><Hydrocortisone><Hydrocortone><Hydroxytyramine><Hypertension><Hytone><Industrialization><Inequity><Insulin Resistance><Ketosis-Resistant Diabetes Mellitus><Levarterenol><Levonorepinephrine><Link><Long-term cohort><Longitudinal Studies><Longitudinal cohort><Longterm cohort><Maturity-Onset Diabetes Mellitus><Measures><Mediating><Mental Depression><Modeling><NIDDM><Neuroendocrine><Neuroendocrine System><Neurosecretory Systems><Non-Insulin Dependent Diabetes><Non-Insulin-Dependent Diabetes Mellitus><Noninsulin Dependent Diabetes><Noninsulin Dependent Diabetes Mellitus><Noradrenaline><Norepinephrine><Nutracort><Nutritional><Obesity><Observation research><Observation study><Observational Study><Observational research><Participant><Parturition><Pathway interactions><Persons><Physiologic><Physiological><Plasma><Plasma Serum><Policies><Population><Prasterone><Prevalence><Price><Proctocort><Productivity><Psychological Factors><Psychosocial Assessment and Care><Psychosocial Factor><Public Health><Publications><Puerto Rico><Questionnaires><Rain><Reporting><Research><Research Infrastructure><Research Resources><Resources><Reticuloendothelial System, Serum, Plasma><Rewards><Risk><Risk Factors><Rural><Saliva><Sampling><Science><Scientific Publication><Security><Serotonin><Slow-Onset Diabetes Mellitus><Social support><Stable Diabetes Mellitus><Stress><Survey Instrument><Surveys><T2 DM><T2D><T2DM><Therapeutic Dehydroepiandrosterone><Therapeutic Epinephrine><Trans Fats><Trans Fatty Acids><Truncal obesity><Type 2 Diabetes Mellitus><Type 2 diabetes><Type II Diabetes Mellitus><Type II diabetes><US Department of Agriculture><USDA><United States><United States Department of Agriculture><Urine><Vascular Hypertensive Disease><Vascular Hypertensive Disorder><Visit><Vulnerable Populations><active followup><adiposity><adult onset diabetes><adulthood><aged><biobank><biologic><biorepository><cardiometabolic><cardiometabolism><cardiovascular disorder><chronic disorder><circulatory system><climate change><climatic changes><clinical exam><clinical examination><cohort><coping><coronavirus disease 2019><coronavirus disease-19><coronavirus infectious disease-19><corpulence><data access><data base><dehydroepiandrosterone><depression><diabetes><dietary><dietary pattern><diets><enroll><experience><faces><facial><follow up><follow-up><followed up><followup><food insecurity><food security><global climate change><high blood pressure><hyperpiesia><hyperpiesis><hypertensive disease><hypertensive disorder><indexing><insulin resistant><insulin tolerance><ketosis resistant diabetes><long-term study><longitudinal outcome studies><longterm study><male><man><maturity onset diabetes><men><new marker><novel biomarker><novel marker><nutrition><nutritious><pathway><pricing><programs><psychologic><psychological><psychosocial><psychosocial assessment><psychosocial care><psychosocial studies><psychosocial support><psychosocial variables><rainfall><recruit><resilience><resilient><rural area><rural location><rural region><screening><screenings><sex><social><social support network><tool><trend><tropical cyclone><type 2 DM><type II DM><type two diabetes><visceral obesity><vulnerable group><vulnerable individual><vulnerable people>