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

项目摘要 慢性阻塞性肺疾病(COPD)是一种进行性疾病，影响约1500万人 美国人。来自低收入家庭的个人的COPD患病率和发病率增加。 我们的研究小组表明，室内空气污染物浓度(颗粒物(PM)和氮 与高收入家庭相比，低收入家庭的二氧化碳(NO2)含量更高。此外，增加了 患有慢性阻塞性肺病的前吸烟者家中的污染物浓度与呼吸道发病率有关， 包括呼吸道症状增加、生活质量下降以及病情恶化和健康风险增加 护理利用情况。尽管在恶劣的环境中有几个因素共同作用于慢性阻塞性肺病 发病率或对污染暴露的易感性我们将重点关注肥胖和饮食摄入量，因为： 1)文献和我们的初步数据有力地支持了肥胖和不良饮食在 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，积极的结果很可能对公共卫生产生重大影响，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非常新颖的。传统上，肥胖是 然而，仅由BMI定义，肥胖作为一种疾病的表型是复杂和不同的，而且它是 越来越多的人认识到，BMI是身体成分的不精确衡量标准。鉴于……的重要性 为了了解这些COPD不良结局的高度流行的易感因素，我们将使用皮肤皱纹 厚度和DXA扫描被认为是评估肥胖症的“黄金标准”，以便 确定与使用体重指数相比，我们是否可以提高识别易感人群的能力 独自一人。此外，我们将通过食物频率问卷(FFQ)和评估 120例中重度吸烟者血清维生素和抗氧化水平的观察研究 来自巴尔的摩低收入家庭比例较高的集水区的慢性阻塞性肺病。我们的目标是 确定增加的脂肪质量和身体成分(即较高的躯干与总脂肪比率)会增加 低收入成人慢性阻塞性肺病患者对室内污染的易感性(具体目标1)；以及是否不利 饮食模式(特定目标#2a)和维生素或营养抗氧化剂水平(特定目标#2b)会导致 对室内空气污染的易感性增加，从而导致COPD患者的不良健康后果。我们的研究 AIMS以完善的调查人员基础设施为基础，这些调查人员具有互补的专业领域。我们的 研究结果可能会确定几种潜在的干预策略，以减少PM和 低收入人群中成年慢性阻塞性肺病患者的NO2暴露。慢性阻塞性肺病是第三大病因 在美国，制定减少发病率的战略是一项重要的公共卫生优先事项。

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.