Western Diet as an Independent Predictor of Asthma Prevalence and Morbidity

描述（由申请人提供）：哮喘是一种常见的呼吸系统疾病，在美国发病率越来越高。发病率和死亡率极高，在贫穷的少数民族人群中，哮喘患病率高得不成比例。总体而言，哮喘患病率的上升趋势与向西方饮食模式的转变同步，其典型特征是摄入更多加工食品（如肉类和精制谷物）、6-多不饱和脂肪酸（PUFAs）、高脂肪乳制品以及含糖甜点和饮料。迄今为止，大多数饮食和哮喘研究都集中在个别维生素、矿物质和脂肪酸上。结果各不相同，补充剂试验显示混合或阴性结果。考虑到人类饮食中各成分之间相互作用的复杂性，人们对哮喘患者的营养成分可能在食物和饮食模式中协同作用而不是孤立作用的概念越来越感兴趣。越来越多的证据表明，富含水果、蔬菜、全谷物、n3-PUFAs和抗氧化剂的饮食可能是一种“呼吸系统健康”的饮食，但还需要证实性的研究。一个相反的问题是，是否存在不利于哮喘恶化的饮食。假设：如上所述，西方饮食模式将与美国成人哮喘发病率增加显著且独立相关。哮喘和西方饮食模式之间的独立联系将在两个不同的队列中进行评估：(1)社区动脉粥样硬化风险（ARIC），这是一个来自美国四个社区的大型队列，(2)主要是贫穷的非裔美国人，巴尔的摩市内城队列，作为吸气研究的一部分进行前瞻性评估，这是一个成年哮喘患者进行综合环境和人口特征的队列。提出了两个新的目标。(1)通过一项大型前瞻性美国流行病学队列研究，探讨西方饮食模式与哮喘患病率和发病率之间的关系。将与ARIC研究人员合作，确定西方饮食模式对ARIC哮喘患病率、症状、药物使用和住院治疗的影响，这些研究人员先前在队列中定义了“西方”和“谨慎”饮食模式；本研究中未解决的问题。(2)研究西方饮食模式与哮喘发病率之间的关系，研究对象为70名城市、主要是非裔美国人哮喘成年人。一份巴尔的摩特定的定量食物频率问卷，24小时饮食回顾，以及详细的人体测量测量（将饮食的影响与肥胖的影响分开），将被添加到父母方案中。个体的饮食模式与哮喘有关

DESCRIPTION (provided by applicant): Asthma is a common respiratory disease of increasing prevalence in the Unites States. Morbidity and mortality rates are extreme, and the prevalence of asthma is disproportionately high in poor, minority populations. Rising asthma prevalence overall has trended in parallel to transition to a Western diet pattern, typified by higher intakes of processes foods (e.g. meats and refined grains), n6-polyunsaturated fatty acids (PUFAs), high fat dairy products, and sugary desserts and drinks. Most diet and asthma research to date has focused on individual vitamins, minerals, and fatty acids. Results vary, and supplement trials have demonstrated mixed or negative results. Given the complex nature of human diet with interaction between components, there is increased interest in the concept that nutrients in asthmatics may act synergistically in foods and diet patterns, rather than in isolatio. Emerging evidence suggests that a diet high in fruit, vegetable, whole grain, n3-PUFAs, and antioxidant intake may be a "respiratory healthy" diet but confirmatory studies are needed. A countering question is whether there exists an unfavorable diet that worsens asthma. Proposed hypothesis: A Western dietary pattern, as defined above, will be significantly and independently associated with increased asthma morbidity in US adults. Independent links between asthma and a Western dietary pattern will be evaluated in two distinct cohorts: (1) the Atherosclerosis Risk in Communities (ARIC) a large cohort with participants from four communities across the US, and (2) a primarily poor, African-American, inner city Baltimore City cohort prospectively evaluated as part of the INHALE Study, a cohort of adult asthmatics undergoing comprehensive environmental and demographic characterization. Two novel aims are proposed. (1) To investigate the association between Western dietary pattern and asthma prevalence and morbidity in a large, prospective, US epidemiologic cohort study. A collaborative effort with ARIC investigators who have previously defined "Western" and "prudent" dietary patterns in the cohort will be employed to determine effects of Western diet pattern on asthma prevalence, symptoms, medications use, and hospitalizations in ARIC; questions otherwise unaddressed in this cohort. (2) To investigate the association between Western dietary pattern and asthma morbidity among a cohort of 70 urban, primarily African-American asthmatic adults in the INHALE Study. A Baltimore-specific quantitative food frequency questionnaire, 24-hour dietary recalls, and detailed anthropometric measures (to isolate the effects of diet from those of obesity), will be added to the parent protocol. Individual dietary pattern will be linked to asthma symptoms, hospitalizations, and medication use while controlling for potential covariates. This two-population approach will allow us to identify significant effects of diet, a potentially modifiable risk factor, on asthma prevalence and morbidity in both a large, US cohort and a smaller cohort of high-risk individuals. Study results will inform the need for dietary interventios aimed at improving asthma health outcomes.