Project 1: Obesity and adverse dietary patterns as susceptibility factors to pollutant exposure in urban COPD.

项目 1：肥胖和不良饮食模式作为城市慢性阻塞性肺病污染物暴露的易感因素。

• 批准号: 8994762
• 负责人: Nadia N Hansel
• 金额: $ 14.84万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8994762
• 关键词: Adult; Affect; Air; Air Pollutants; Air Pollution; Antioxidants; Appalachian Region; Area; Baltimore; Body Composition; Body fat; Body mass index; Carotene; Catchment Area; Cause of Death; Chronic Obstructive Airway Disease; Cities; Collaborations; Communities; Complex; Consumption; Data; Diet; Dietary Practices; Dietary intake; Disease; Disease Outcome; Dual-Energy X-Ray Absorptiometry; Eating; Environment; Exposure to; Fatty acid glycerol esters; Food; Frequencies; Gold; Habits; Health; Health Food; Health Services Accessibility; High Prevalence; Home environment; Hospitalization; Household; Income; Individual; Indoor Air Pollution; Indoor environment; Inflammation; Intervention; Lead; Literature; Low Income Population; Low income; Lung Inflammation; Lung diseases; Measures; Methods; Morbidity - disease rate; Nitrogen Dioxide; Nutrient; Obesity; Observational Study; Obstructive Lung Diseases; Outcome; Particulate Matter; Pattern; Phenotype; Pollution; Poverty; Predisposition; Prevalence; Progressive Disease; Public Health; Quality of life; Questionnaires; Research; Research Infrastructure; Research Personnel; Resources; Risk; Role; Rural; Rural Community; Scanning; Serum; Skinfold Thickness; Smoker; Smoking; Socioeconomic Status; Structure; Symptoms; Testing; Therapeutic; Time; Tocopherols; United States; Vitamin D; Vitamins; experience; health care service utilization; health disparity; high risk; improved; indexing; inner city; low socioeconomic status; lung injury; novel; nutrition; pollutant; programs; public health priorities; respiratory

Project Summary Chronic obstructive pulmonary disease (COPD) is a progressive disease affecting approximately fifteen million people in the US. COPD prevalence and morbidity is increased in individuals from low income households. Our research group has shown that indoor air pollutant concentrations (particulate matter (PM) and nitrogen dioxide (NO2)) are higher in lower income homes compared to higher income homes. In addition, increased pollutant concentrations in homes of former smokers with COPD are associated with respiratory morbidity, including increased respiratory symptoms, worse quality of life and increased risk of exacerbations and health care utilization. Though there are several factors that coalesce in poor environments that contribute to COPD morbidity or increase susceptibility to pollution exposure we will focus on obesity and dietary intake because: 1) the literature and our preliminary data strongly support the role of obesity and poor diet in contributing to COPD outcomes and susceptibility to air pollution, 2) both factors are prevalent in low-income urban settings therefore positive results are likely to have great potential for significant public health impact, 3) at the individual level, indoor air, diet and obesity are modifiable, unlike other factors such as outdoor air or access to healthcare, and 4) the hypotheses being tested in this application are highly novel. Obesity is traditionally defined by BMI alone, however, the phenotype of obesity as a disease is complex and heterogeneous and it is increasingly recognized that BMI is an imprecise measure of body composition. Given the importance of understanding these highly prevalent susceptibility factors for adverse COPD outcomes, we will use skin fold thickness and DEXA scanning, considered the “gold standard” for the assessment of adiposity, in order to determine whether we can improve our ability to identify susceptible individuals, compared to the use of BMI alone. In addition, we will assess dietary patterns by food frequency questionnaire (FFQ) and assessment of serum vitamin and anti-oxidant levels in an observational study of 120 former smokers with moderate to severe COPD from a catchment area in Baltimore with a high proportion of low-income households. We aim to determine whether elevated fat mass and body composition (ie. higher trunk to total fat ratio) increases susceptibility to indoor pollution in low-income adults with COPD (Specific Aim #1); and whether adverse dietary patterns (Specific Aim #2a) and vitamin or nutrient antioxidant levels (Specific Aim #2b) lead to heightened susceptibility to indoor air pollution contributing to adverse health outcomes in COPD. Our study aims build upon a well-established infrastructure of investigators with complementary areas of expertise. Our study findings may identify several potential intervention strategies to reduce the harmful effects of PM and NO2 exposure in adults with COPD in low income populations. With COPD being the third leading cause of death in the US, developing strategies to reduce morbidity is an important public health priority.

项目摘要 慢性阻塞性肺疾病（COPD）是一种影响约1500万人的进行性疾病 美国的人。低收入家庭的COPD患病率和发病率增加。 我们的研究小组已经表明，室内空气污染物浓度（颗粒物（PM）和氮 二氧化物（NO2））在低收入家庭中比高收入家庭高。此外，增加 患有COPD的前吸烟者家中的污染物浓度与呼吸道疾病有关， 包括呼吸道症状增加、生活质量下降以及病情加重和健康风险增加 护理利用率虽然有几个因素在恶劣的环境中合并，导致COPD 我们将重点关注肥胖和饮食摄入，因为： 1)文献和我们的初步数据强烈支持肥胖和不良饮食在促进 COPD结果和对空气污染的易感性，2）这两个因素在低收入城市环境中普遍存在 因此，积极的结果很可能具有重大公共卫生影响的巨大潜力，3）在 个人水平、室内空气、饮食和肥胖是可以改变的，不像其他因素，如室外空气或获得 医疗保健，以及4）在本申请中测试的假设是高度新颖的。传统上，肥胖 然而，肥胖症作为一种疾病的表型是复杂和异质的， 越来越多的人认识到BMI是一种不精确的身体成分测量方法。鉴于必须 了解这些COPD不良结局的高度流行的易感因素，我们将使用皮肤褶皱 厚度和DEXA扫描，被认为是评估肥胖的“金标准”，以便 确定与使用BMI相比，我们是否可以提高识别易感个体的能力 一个人此外，我们还将通过食物频率问卷（FFQ）和 一项对120名中重度吸烟者的观察性研究中的血清维生素和抗氧化剂水平 来自巴尔的摩低收入家庭比例较高的集水区的COPD。我们的目标是 确定是否升高的脂肪量和身体成分（即，较高的躯干与总脂肪的比例）增加 低收入成年COPD患者对室内污染的易感性（具体目标#1）;以及 饮食模式（具体目标#2a）和维生素或营养素抗氧化剂水平（具体目标#2b）导致 对室内空气污染的敏感性增加，导致COPD的不良健康结果。我们的研究 目标是建立在具有互补专门知识领域的调查人员的完善基础设施之上。我们 研究结果可以确定几种潜在的干预策略，以减少PM的有害影响， 低收入人群中成年COPD患者的NO2暴露。慢性阻塞性肺病是第三大病因， 在美国，制定降低发病率的战略是一项重要的公共卫生优先事项。