OMEGA COPD Trial

OMEGA COPD试验总结 慢性阻塞性肺疾病（COPD）是美国的主要死因， 低收入社区的患病率、发病率和死亡率较高。饮食摄入不足，尤其是 ω-3多不饱和脂肪酸摄入量低，是低收入社区的常见问题， 与呼吸系统疾病人群的不良结局相关。我们和其他人已经证明， 由较低的omega-3摄入量定义的饮食与更差的COPD呼吸结果相关。因为omega-3 通过饮食获得的多不饱和脂肪酸负责肺和全身的仲裁 通过类二十烷酸途径的炎症，ω-3摄入也可能是对抗炎症的关键保护剂。 与COPD呼吸系统发病率相关的促炎性暴露的副作用。我们的团队进一步 研究表明，室内空气颗粒物（PM）水平与个人呼吸道疾病的发病率有关 事实上，低omega-3饮食可能会增加污染物暴露对COPD的不利影响， 呼吸道疾病不幸的是，患有COPD的低收入个体通常有omega-3摄入量的饮食 水平远低于建议水平，除了相对较高的室内PM暴露水平，导致 呼吸不良的风险增加。一种饮食干预，旨在增加摄入欧米茄-3， 食物来源，在这一弱势群体中有可能产生很大影响。在这个建议中，我们将测试一种饮食 以富含omega-3的食物为基础的干预措施，目的是改善呼吸系统健康（目标1）， 对抗环境暴露对低收入成年COPD患者的不良影响（目标2）。的 干预措施将克服低收入社区的几个常见营养障碍：粮食不安全（a 将提供代金券），食品获取和新鲜食品供应（送货上门，并从一系列 健康的食物选择），并支持实现和维持饮食变化（定期接触饮食 健康教练培训，以支持围绕健康食品选择的个人行为，并提供文化- 关于营养和食物准备的知情教育）。通过定性方法（目标3），我们还将 探讨干预措施的障碍和促进因素，以优化未来实施的可持续性 战略布局研究结果将全面阐述循证营养干预措施的影响， COPD健康，并为其他慢性疾病的饮食干预提供了框架 影响到易受影响的低收入人群。积极的结果将受到现有基础设施的支持， 领先的全国食品杂货配送服务，支持扩大健康食品的获取， 这是一个可持续性和研究之外的传播平台，并具有直接的政策影响。

OMEGA COPD Trial SUMMARY Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States, with significantly higher prevalence, morbidity, and mortality in lower income communities. Poor dietary intake, and in particular low omega-3 polyunsaturated fatty acid intake, is a common problem in low-income communities and has been associated with adverse outcomes in populations with respiratory disease. We, and others, have shown that a diet defined by lower omega-3 intake is associated with worse COPD respiratory outcomes. Because omega-3 polyunsaturated fatty acids obtained through diet are responsible for arbitration of pulmonary and systemic inflammation through the eicosanoid pathway, omega-3 intake may also be a critical protector against the adverse effects of pro-inflammatory exposures related to COPD respiratory morbidity. Our group has further demonstrated that indoor air particulate matter (PM) levels are linked to worse respiratory morbidity in individuals with COPD, and indeed a diet low in omega-3 likely augments the adverse effects of pollutant exposure on respiratory morbidity. Unfortunately, low-income individuals with COPD often have diets with omega-3 intake levels well below recommended levels in addition to relatively high levels of indoor PM exposures, leading to heightened risk of poor respiratory outcomes. A dietary intervention, designed to increase intake of omega-3 in food sources, has the potential for high-impact within this vulnerable group. In this proposal, we will test a dietary intervention based in omega-3 rich foods, with the aim of improving respiratory health (Aim 1), and protecting against the adverse effects of environmental exposures (Aim 2) in low income adults with COPD. The intervention will overcome several common nutritional barriers in low-income communities: food insecurity (a voucher will be provided), food access and fresh food availability (home delivery and choice from a range of healthy food options), and support in achieving and sustaining dietary change (regular contact with a dietary health coach trained to support personal behaviors surrounding healthy food choices and provide culturally- informed education around nutrition and food preparation). Through qualitative methods (Aim 3), we will also explore barriers and facilitators of the intervention in order to optimize sustainability of future implementation strategies. Results will comprehensively address the impact of an evidence-based nutrition intervention on COPD health, and provide a framework for dietary intervention within other chronic diseases disproportionately impacting susceptible, low-income populations. Positive results will be buoyed by existing infrastructure within a leading national grocery delivery service supportive of expanding access to healthy foods, providing a ready platform for sustainability and dissemination beyond the study and with immediate policy implications.