Risk of Chronic Diseases in Young Adults Born Preterm: Relationship With Inflammation and Oxidative Stress Biomarkers.
Condition: Prematurity; Extreme
MeSH terms: Inflammation; Chronic Disease
Study type: Observational [Patient Registry]

Summary: 
      The purpose of the HAPI project is to study the overall health of preterm infants once they
      reach adulthood. The investigators would like to compare the health of adults born preterm
      with that of adults born full-term. They would also like to find the early signs, or
      biomarkers, of chronic diseases such as high blood pressure, diabetes, osteoporosis, and
      chronic lung diseases.

      Such biomarkers would allow for early diagnosis and prevention. Furthermore, the
      investigators would like to understand why some people born preterm are more likely to
      develop chronic disease. They believe that inflammation and oxidative stress may play a part.
      Oxidative stress is present when the body is not able to defend itself against oxygen-derived
      products that can damage our cells.

      To carry out this study, the investigators will examine 6 aspects of the health: (1) heart
      and circulation, (2) kidneys, (3) lungs, (4) metabolism - sugars and fats in the blood, (5)
      bones, and (6) eyes.
    

Detailed description: 
      The participants, from both groups will spend a whole day at St. Justine's hospital. Upon
      arrival after an overnight fast, vital signs and anthropometric measures are taken. Then
      blood and urine are obtained as well and a pregnancy test is performed for women. After
      inserting a intravenous catheter, around 55 mL of blood is taken and sent to the biochemistry
      department and to our laboratory. A oral glucose tolerance test is also performed with blood
      sampling over 2hours.

      Then a renal and carotid ultrasounds, as well as a osteodensitometry test (bone mineral
      density and body muscle/fat composition) are done. Ophtalmology exam is realized by
      ophtalmologist, including visual acuity, contrast and fundus photograph, then the
      participants are provided with a standardized light lunch.

      A thorough cardiac ultrasound, as well as assessment of major arteries (aorta, carotid,
      brachial) structure and function are performed. Pulmonary function tests are done before a
      fitness test for VO2 max, and repeated with bronchodilatator after the fitness test.

      Prior to leaving, participants are given a ambulatory blood pressure monitor for them to
      carry for 24 consecutive hours over the following 2 days.

      Prior to the study day, participants are sent questionnaires to be filled in advance by
      themselves and by each of their parent. During the study day, other questionnaires regarding
      their lifestyles and medical condition are also filled. Overall, information is obtained
      about:

      (1) Socio-economic status: Occupation, education level and income of participant and parents.
      (2) Family history: Parental health (including maternal pregnancies) and familial (1st and
      2nd degree) premature history of cardiovascular diseases (CVD), type-2 diabetes, chronic
      pulmonary or renal diseases. (3) Personal medical history: Current medication use (including
      anti-inflammatory medications), medical history, current symptoms, and growth parameters from
      birth to present (according to medical records and child health care booklet), age at
      menarche.

      (4) Health-related behaviors: (a) regular physical activities (Minnesota and Huet validated
      questionnaires) (b) Smoking and alcohol consumption. (c) Diet assessed through the validated
      and self-administered 73-item Food Frequency Questionnaire (FFQ). (d) SF-36 Health Survey.

      In addition to the study protocol, the subjects are invited to contribute extra biosamples to
      our blood (3 ml) and urine (1 ml) biobank.
    

Intervention name(s): preterm birth
Intervention type(s): Other
Intervention description(s): The study compares young adult subjects born premature (< 29 weeks) versus term (-> 37 weeks)
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        All adults born at GA<29 wks at CHU Sainte-Justine, the Royal Victoria Hospital, and the
        Jewish General Hospital, Montreal, in 1987-97. For each EPT subject, a friend control
        matched on sex is selected to control in part for lifestyle and social factors (e.g. diet,
        physical activity, health care visits), and environmental exposure that may affect
        inflammatory status and disease risk. Indeed, given the known link between lower
        socio-economic status, lifestyle habits and CVD risk factors, and that women from lower SES
        and with poor lifestyle behaviors are at increased risk to deliver prematurely, a friend
        control, who is more likely to have evolved in a similar milieu, will allow us to better
        isolate the effect of preterm birth on studied outcomes from socio-environmental factors.
      
Biospecimen description: 
      The team collected the blood and urine of the participants. They kept whole blood and urine
      the the biobank. The group also isolated the plasma and serum to perform assays.
    
Keywords: extremely preterm; young adults; CVD risks factors; inflammation; chronic health conditions; term