OMEGA COPD Trial

欧米茄慢性阻塞性肺病试验总结 慢性阻塞性肺疾病(COPD)是美国主要的死亡原因， 低收入社区的患病率、发病率和死亡率更高。饮食摄入不足，尤其是 低omega-3多不饱和脂肪酸摄入量是低收入社区的常见问题，一直以来 与患有呼吸道疾病的人群的不良后果有关。我们和其他人已经表明， 低omega-3摄入量定义的饮食与较差的COPD呼吸结局相关。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 通过二十烷类化合物途径的炎症，omega-3的摄入也可能是预防 促炎暴露的不良反应与COPD呼吸道发病率有关。我们的团队已经进一步 证明室内空气颗粒物(PM)水平与个人更严重的呼吸道发病率有关 对于慢性阻塞性肺疾病，确实低omega-3饮食可能会增加污染物暴露对 呼吸道疾病。不幸的是，低收入的慢性阻塞性肺病患者的饮食中经常摄入omega-3。 水平远低于建议水平，此外室内PM暴露水平相对较高，导致 增加了不良呼吸结局的风险。饮食干预，旨在增加欧米茄-3的摄入量 食物来源，有可能在这一弱势群体中产生高度影响。在这项提案中，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，目的是改善呼吸健康(目标1)，并保护 针对低收入成人慢性阻塞性肺病患者环境暴露的不利影响(目标2)。这个 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(送货上门和从一系列选择中进行选择 健康食品选择)，以及支持实现和维持饮食变化(定期接触饮食 健康教练接受培训，支持个人围绕健康食物选择的行为，并提供文化上的- 关于营养和食品准备的知情教育)。通过定性方法(目标3)，我们还将 探讨干预的障碍和促进者，以优化未来执行工作的可持续性 战略。结果将全面解决循证营养干预对 COPD健康，并为其他慢性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鼓舞 领先的全国食品杂货递送服务支持扩大健康食品的获取，提供 可持续发展和传播的平台，超出研究范围，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.