Effects of Anti-Inflammatory Diet on Pulmonary Function in Pediatric Asthma

描述(申请人提供)：哮喘影响了近10%的美国儿童，导致每年仅治疗费用就超过30亿美元。在多项横断面研究中，哮喘与肥胖和营养质量高度相关，尽管这种联系的机制仍然是推测的。在成人哮喘患者中进行的有限的干预性研究依赖于行为调整，报告称，通过限制热量摄入和富含抗氧化剂和omega-3脂肪酸的饮食，哮喘控制有所改善。根据观察分析和喂养研究，低血糖指数和高纤维饮食可能会减少全身炎症，但这种饮食策略尚未在这一人群中进行研究。节食 利用多种食物的抗炎特性可能会改善肺功能，但这一策略在很大程度上仍未得到测试，特别是在儿童中。该项目的具体目的是评估低血糖负荷和富含纤维、水果、蔬菜、豆类和omega-3脂肪酸的饮食(在该建议中被确定为“抗炎饮食”)对消瘦和超重的哮喘儿童患者的肺功能的影响。主要终点将是饮食干预后一秒内用力呼气量的变化。次要结果将包括额外的肺活量测量，呼出的一氧化氮的分数，以及对有症状的哮喘控制的评估。此外，我们还将确定饮食与肺功能相关的潜在生理机制，包括全身和脂肪特异性炎症、胰岛素敏感性和肠道微生物组组成的变化。40名年龄在10-18岁，患有中度到重度持续性哮喘的患者将被随机分为抗炎饮食和习惯性饮食两组，分别接受6周的抗炎饮食和6周的交叉饮食。这两种饮食都是等卡路里的，并保持体重，以将饮食组成的影响与已知的 减肥。在干预期间，膳食将通过与LYFE Kitchen(伊利诺伊州芝加哥)的新型合作直接送到受试者的家中，保持对宏量和微量营养素含量的仔细控制。在习惯性饮食期间，参与者将食用自己准备的饭菜。如果成功，这项研究将有助于从机制上理解哮喘，并可能为开发一种新的、安全的、易于翻译的哮喘治疗方法提供信息。未来的研究将1)证实在更大和更异质的人群中的结果；2)将研究结果转化为可持续的干预措施；3)进一步探索饮食干预与肺功能相关的潜在机制。

DESCRIPTION (provided by applicant): Asthma affects nearly 10% of American children, resulting in treatment costs alone in excess of $3 billion annually. Asthma is highly correlated with obesity and quality of nutritional in multiple cross-sectional studies, although the mechanism of this association remains speculative. Limited interventional studies in adults with asthma, relying on behavioral modification, report improvements in asthma control with caloric restriction and diets enriched with antioxidants and omega-3 fatty acids. Low glycemic index and high fiber diets may decrease systemic inflammation, according to observational analyses and feeding studies, but this dietary strategy has not been investigated in this population. A diet harnessing the anti-inflammatory properties of multiple foods may improve pulmonary function, yet this strategy remains largely untested, especially in children. The specific aim of this projec is to evaluate the effects of a diet that is low in glycemic load and abundant in fiber, fruits, vegetables, legumes and omega-3 fatty acids (identified in this proposal as the "anti-inflammatory diet") on pulmonary function in lean and overweight pediatric patients with asthma. The primary endpoint will be change in forced expiratory volume in one second in response to the diet intervention. Secondary outcomes will include additional spirometry measures, fraction of exhaled nitric oxide, and assessment of symptomatic asthma control. In addition, we will identify potential physiological mechanisms relating diet with lung function, including changes in systemic and adipose-specific inflammation, insulin sensitivity, and intestinal microbiome composition. Forty patients, age 10-18 years, with moderate to severe persistent asthma will be randomized to receive an anti-inflammatory diet versus habitual diet for 6 weeks, with crossover to the opposite diet for an additional 6 weeks. Both diets will be isocaloric and weight maintaining, to isolate the effects of the dietary composition from the known beneficial effects of weight loss. During the intervention period, meals will be delivered directly to subjects' homes through a novel collaboration with LYFE Kitchen (Chicago, IL), maintaining careful control of macro- and micronutrient content. During the habitual diet, participants will consume self-prepared meals. If successful, this study will contribute to a mechanistic understanding of asthma, and could inform the development of a novel, safe and easily translatable approach to asthma management. Future studies would 1) confirm the results in larger and more heterogeneous populations; 2) translate findings into sustainable interventions and 3) further explore the underlying mechanisms relating dietary intervention to lung function.