1 00:00:06,139 --> 00:00:07,006 >> GOOD MORNING. 2 00:00:07,006 --> 00:00:09,075 OR I SHOULD ALSO SAY GOOD 3 00:00:09,075 --> 00:00:11,644 AFTERNOON OR GOOD EVENING TO 4 00:00:11,644 --> 00:00:13,813 SOME OF YOU LOCATED IN A 5 00:00:13,813 --> 00:00:15,815 DIFFERENT PART OF THE GLOBE. 6 00:00:15,815 --> 00:00:16,849 I'M DR. QING LU. 7 00:00:16,849 --> 00:00:20,053 A PROGRAM DIRECTOR IN THE 8 00:00:20,053 --> 00:00:23,456 DIVISION OF LUNG DISEASE. 9 00:00:23,456 --> 00:00:25,858 WELCOME YOU TO PARTICIPATE IN 10 00:00:25,858 --> 00:00:30,063 THE TWO-DAY WORKSHOP TITLED 11 00:00:30,063 --> 00:00:33,499 ADVANCING NUTRITION RESEARCH TO 12 00:00:33,499 --> 00:00:36,536 PROMOTE RESPIRATORY HEALTH IN A 13 00:00:36,536 --> 00:00:44,077 WILL ADULTS. 14 00:00:44,077 --> 00:00:46,446 I'M VERY EXCITED TO REPORT THERE 15 00:00:46,446 --> 00:00:49,715 WERE MORE THAN 500 PEOPLE WHO 16 00:00:49,715 --> 00:00:51,517 HAVE REGISTERED FOR THIS 17 00:00:51,517 --> 00:00:51,784 WORKSHOP. 18 00:00:51,784 --> 00:00:55,621 THIS WORKSHOP IS ALSO BEING LIVE 19 00:00:55,621 --> 00:00:58,191 STREAMED AND THE NIH VIDEO CAST 20 00:00:58,191 --> 00:00:59,292 AND RECORDED. 21 00:00:59,292 --> 00:01:02,628 THE RECORDINGS WILL BE AVAILABLE 22 00:01:02,628 --> 00:01:06,833 IN THE VIDEO CAST ON-LINE 23 00:01:06,833 --> 00:01:08,768 REPORTS ONE WEEK FROM TODAY. 24 00:01:08,768 --> 00:01:13,406 BEFORE I IN TOE INTRODUCE MY 25 00:01:13,406 --> 00:01:15,842 DIVISION * DIRECTOR I WOULD LIKE 26 00:01:15,842 --> 00:01:19,412 TO THANK ALL OF OUR COCHAIRS FOR 27 00:01:19,412 --> 00:01:20,346 THEIR EXTRAORDINARY WORK ON THE 28 00:01:20,346 --> 00:01:21,981 PLANNING OF THIS WORKSHOP. 29 00:01:21,981 --> 00:01:25,284 I WOULD ALSO LIKE TO EXPRESS OUR 30 00:01:25,284 --> 00:01:27,720 GRATITUDE TO ALL MODERATORS AND 31 00:01:27,720 --> 00:01:30,890 SPEAKERS FOR YOUR INSIGHTS AND 32 00:01:30,890 --> 00:01:32,125 CONTRIBUTIONS TO THIS IMPORTANT 33 00:01:32,125 --> 00:01:32,558 EVENT. 34 00:01:32,558 --> 00:01:37,530 I WANT TO THANK OUR AUDIENCE 35 00:01:37,530 --> 00:01:41,067 PARTICULARLY THOSE WHO HAVE 36 00:01:41,067 --> 00:01:42,602 OVERCOME CHALLENGING TIME ZONE 37 00:01:42,602 --> 00:01:45,238 DIFFERENCES. 38 00:01:45,238 --> 00:01:52,145 I WOULD LIKE TO ALSO LIKE TO 39 00:01:52,145 --> 00:01:55,581 THANK THE SUPPORT TEAM FOR THEIR 40 00:01:55,581 --> 00:01:55,982 ASSISTANCE. 41 00:01:55,982 --> 00:01:57,884 LAST BUT NOT LEAST I WOULD LIKE 42 00:01:57,884 --> 00:02:00,753 TO THANK OUR DIVISION LEADERSHIP 43 00:02:00,753 --> 00:02:02,889 AND OUR PLANNING COMMUNITY 44 00:02:02,889 --> 00:02:04,290 MEMBERS FOR THEIR SUPPORT. 45 00:02:04,290 --> 00:02:06,959 THE GOAL OF THIS WORKSHOP IS TO 46 00:02:06,959 --> 00:02:09,395 BRING TOGETHER 47 00:02:09,395 --> 00:02:10,830 MULTI-DISCIPLINARY RESEARCHERS 48 00:02:10,830 --> 00:02:13,833 INCLUDING NUTRITION AND DIETARY 49 00:02:13,833 --> 00:02:18,237 SCIENCE EXPERTS AND THE DATA 50 00:02:18,237 --> 00:02:19,906 SCIENTISTS TO DISCUSS THE 51 00:02:19,906 --> 00:02:21,707 CURRENT STATE OF SCIENCE 52 00:02:21,707 --> 00:02:25,144 REGARDING NUTRITION AND THE DIET 53 00:02:25,144 --> 00:02:27,346 IN RESPIRATORY HEALTH AND 54 00:02:27,346 --> 00:02:29,815 DISEASE AND IDENTIFY GAPS AND 55 00:02:29,815 --> 00:02:30,750 CHALLENGES AND OPPORTUNITIES. 56 00:02:30,750 --> 00:02:33,386 THANK YOU FOR YOUR 57 00:02:33,386 --> 00:02:33,920 PARTICIPATION. 58 00:02:33,920 --> 00:02:37,356 WE LOOK FORWARD TO A SUCCESSFUL 59 00:02:37,356 --> 00:02:39,559 WORKSHOP AND YOUR ACTIONABLE 60 00:02:39,559 --> 00:02:42,061 RECOMMENDATIONS. 61 00:02:42,061 --> 00:02:49,602 NOW LET US WELCOME THE DIRECTOR 62 00:02:49,602 --> 00:02:54,440 DIRECTOR. 63 00:02:54,440 --> 00:02:55,908 >> THANK YOU VERY MUCH AND IT'S 64 00:02:55,908 --> 00:02:58,144 REALLY A PLEASURE TO HAVE AN 65 00:02:58,144 --> 00:02:59,612 OPPORTUNITY TO SAY A FEW WORDS 66 00:02:59,612 --> 00:03:02,014 TO KICK OFF THIS WORKSHOP. 67 00:03:02,014 --> 00:03:05,017 IT'S REALLY WONDERFUL TO SEE SO 68 00:03:05,017 --> 00:03:06,485 MANY PARTICIPANTS THAT HAVE 69 00:03:06,485 --> 00:03:08,254 SIGNED UP FOR THIS IMPORTANT 70 00:03:08,254 --> 00:03:12,091 WORKSHOP. 71 00:03:12,091 --> 00:03:14,894 THAT DEMONSTRATES THE LEVEL OF 72 00:03:14,894 --> 00:03:16,062 INTEREST AND THE ENTHUSIASM AND 73 00:03:16,062 --> 00:03:17,597 THE IMPORTANCE OF THE TOPIC THAT 74 00:03:17,597 --> 00:03:19,599 IS BEING ADDRESSED. 75 00:03:19,599 --> 00:03:21,801 AND IT'S WONDERFUL TO HAVE IT 76 00:03:21,801 --> 00:03:25,171 DONE IN A VIRTUAL FORMAT. 77 00:03:25,171 --> 00:03:27,073 WE WOULD LOVE TO BE ABLE TO SEE 78 00:03:27,073 --> 00:03:30,042 YOU ALL FACE TO FACE TO SEE MANY 79 00:03:30,042 --> 00:03:31,811 THAT WE'VE WORKED WITH IN THE 80 00:03:31,811 --> 00:03:33,246 PAST BUT THAT IS NOT POSSIBLE 81 00:03:33,246 --> 00:03:37,250 AND I THINK THE HYBRID OR THE 82 00:03:37,250 --> 00:03:38,684 VIRTUAL PLATFORM GIVES US AN 83 00:03:38,684 --> 00:03:41,454 OPPORTUNITY TO REALLY ENGAGE A 84 00:03:41,454 --> 00:03:44,690 VERY WIDE RANGE OF INDIVIDUALS, 85 00:03:44,690 --> 00:03:46,792 STAKEHOLDERS, EXPERTS WHO CAN 86 00:03:46,792 --> 00:03:48,694 CONTRIBUTE TO OUR UNDERSTANDING 87 00:03:48,694 --> 00:03:51,430 OF WHERE WE ARE WITH ADVANCING 88 00:03:51,430 --> 00:03:53,532 NUTRITION RESEARCH TO PROMOTE 89 00:03:53,532 --> 00:03:53,966 RESPIRATORY HEALTH. 90 00:03:53,966 --> 00:03:56,502 SO, ITS GREAT TO SEE YOU AND 91 00:03:56,502 --> 00:03:59,071 HAPPY TO SEE SUCH A DIVERSE AND 92 00:03:59,071 --> 00:04:00,773 INCLUSIVE PANEL. 93 00:04:00,773 --> 00:04:02,341 THAT'S ONE OF THE THINGS THAT 94 00:04:02,341 --> 00:04:04,243 WE'RE PROUD OF THAT WE TRY TO 95 00:04:04,243 --> 00:04:06,112 MAKE SURE THAT WE HEAR FROM ALL 96 00:04:06,112 --> 00:04:09,248 VOICES AND THAT WE LISTEN TO ALL 97 00:04:09,248 --> 00:04:10,583 SECTORS OF THE COMMUNITY AS WE 98 00:04:10,583 --> 00:04:12,818 TO THESE WORKSHOPS AND WE THINK 99 00:04:12,818 --> 00:04:14,353 ABOUT WHERE WE'LL TAKE THEM 100 00:04:14,353 --> 00:04:15,054 NEXT. 101 00:04:15,054 --> 00:04:25,765 7 YOU HEARD A LITTLE BIT FR QING 102 00:04:27,400 --> 00:04:32,371 ALREADY. 103 00:04:32,371 --> 00:04:35,775 I ALSO WANT TO MAKE SURE I DO 104 00:04:35,775 --> 00:04:40,313 RECOGNIZE DR. JUN MA AND 105 00:04:40,313 --> 00:04:42,415 DR. VANESSA GARCIA-LARSEN WHO 106 00:04:42,415 --> 00:04:46,819 HAVE WORKED CLOSELY WITH QING 107 00:04:46,819 --> 00:04:46,986 TOO. 108 00:04:46,986 --> 00:04:49,855 TO HAVE A SUPER AGENDA TO BRING 109 00:04:49,855 --> 00:04:51,691 FORWARD OUR CURRENT STATE OF 110 00:04:51,691 --> 00:04:53,025 KNOWLEDGE AND WHERE WE'RE GOING 111 00:04:53,025 --> 00:04:55,961 WITH THIS AREA. 112 00:04:55,961 --> 00:04:58,431 I'LL JUST -- I DON'T WANT TO 113 00:04:58,431 --> 00:05:00,733 TAKE TOO MUCH TIME -- BUT I 114 00:05:00,733 --> 00:05:02,735 DON'T THINK THERE IS ANY NEED TO 115 00:05:02,735 --> 00:05:03,936 HIGHLIGHT TO THIS GROUP THE 116 00:05:03,936 --> 00:05:06,138 IMPORTANCE AND THE BURDEN OF 117 00:05:06,138 --> 00:05:07,840 CHRONIC LUNG DISEASE WORLDWIDE 118 00:05:07,840 --> 00:05:11,510 AND I THINK THAT IS HAS BEEN 119 00:05:11,510 --> 00:05:14,113 EMPHASIZED BY THE WIDE RANGE OF 120 00:05:14,113 --> 00:05:14,547 PARTICIPANTS. 121 00:05:14,547 --> 00:05:16,415 THIS IS NOT JUST A LOCAL 122 00:05:16,415 --> 00:05:17,049 PROBLEM. 123 00:05:17,049 --> 00:05:19,485 AND I HOPE THAT EVERYBODY 124 00:05:19,485 --> 00:05:21,153 RECOGNIZES THAT THIS IS AN AREA 125 00:05:21,153 --> 00:05:24,790 THAT WE DIDN'T JUST YESTERDAY 126 00:05:24,790 --> 00:05:26,459 DECIDE UH-HO WHAT IS GOING ON 127 00:05:26,459 --> 00:05:30,196 WITH NUTRITION IN A VARIETY OF 128 00:05:30,196 --> 00:05:32,898 DIFFERENT AREAS OF NUTRITION AS 129 00:05:32,898 --> 00:05:34,300 IT RELATES TO THE LUNG. 130 00:05:34,300 --> 00:05:36,635 I THINK WE'VE HAD A HISTORY OF 131 00:05:36,635 --> 00:05:37,737 SUPPORTING RESEARCH IN THIS 132 00:05:37,737 --> 00:05:38,604 AREA. 133 00:05:38,604 --> 00:05:40,940 BUT NOW WE WANT TO REALLY FOCUS 134 00:05:40,940 --> 00:05:44,677 A BIT MORE ON HOW NUTRITION AND 135 00:05:44,677 --> 00:05:46,245 DIET IMPACTS RESPIRATORY HEALTH 136 00:05:46,245 --> 00:05:48,781 AND THE PREVALENCE OF CHRONIC 137 00:05:48,781 --> 00:05:50,583 LUNG DISEASES PARTICULARLY IN 138 00:05:50,583 --> 00:05:53,052 VULNERABLE POPULATIONS INCLUDING 139 00:05:53,052 --> 00:05:56,989 THOSE THAT ARE SOCIO 140 00:05:56,989 --> 00:05:59,558 ECONOMICALLY DISADVANTAGED. 141 00:05:59,558 --> 00:06:02,094 A LITTLE BIT MORE OF AN EMPHASIS 142 00:06:02,094 --> 00:06:03,295 ON LUNG HEALTH. 143 00:06:03,295 --> 00:06:06,065 A LITTLE LESS SO ON LOOKING AT 144 00:06:06,065 --> 00:06:07,800 NUTRITION AS IT RELATES TO 145 00:06:07,800 --> 00:06:10,169 DISEASE BECAUSE WE HAVE LOOKED 146 00:06:10,169 --> 00:06:11,771 AT THAT IN THE PAST. 147 00:06:11,771 --> 00:06:13,572 SO AS YOU HEARD THE PURPOSE IS 148 00:06:13,572 --> 00:06:15,775 TO BRING TOGETHER THIS 149 00:06:15,775 --> 00:06:16,542 MULTI-DISCIPLINARY GROUP. 150 00:06:16,542 --> 00:06:21,247 WE HAVE NUTRITIONIST, DIETARY 151 00:06:21,247 --> 00:06:22,148 SCIENCE EXPERTS. 152 00:06:22,148 --> 00:06:24,717 PEOPLE FROM PULMONARY AND DATA 153 00:06:24,717 --> 00:06:27,686 SCIENCE AND WE WANT TO ENGAGE A 154 00:06:27,686 --> 00:06:28,687 VERY BROAD COMMUNITY. 155 00:06:28,687 --> 00:06:30,990 NOT JUST THOSE THAT WE TALK TO 156 00:06:30,990 --> 00:06:33,325 ALL THE TIME BUT THOSE THAT WE 157 00:06:33,325 --> 00:06:35,327 OFTEN DON'T TALK TO MUCH SO WE 158 00:06:35,327 --> 00:06:36,996 CAN BRING YOU TOGETHER BECAUSE 159 00:06:36,996 --> 00:06:40,199 THIS WILL POTENTIALLY SPARK NEW 160 00:06:40,199 --> 00:06:42,334 IDEAS AND COLLABORATIONS AND NEW 161 00:06:42,334 --> 00:06:44,036 WAYS TO PROMOTE THIS AREA. 162 00:06:44,036 --> 00:06:46,939 IT'S BRINGING IN THE NEW 163 00:06:46,939 --> 00:06:49,375 EXPERTISE THAT WILL LIKELY BRING 164 00:06:49,375 --> 00:06:51,644 US NEW ADVANCES RELATED TO 165 00:06:51,644 --> 00:06:52,978 RESPIRATORY HEALTH AND THE ROLE 166 00:06:52,978 --> 00:06:55,481 OF NUTRITION AND DIET IN THAT. 167 00:06:55,481 --> 00:06:58,717 SO WE WANT TO LOOK AT CRITICAL 168 00:06:58,717 --> 00:06:59,151 KNOWLEDGE GAPS. 169 00:06:59,151 --> 00:07:00,886 KEY CHALLENGES. 170 00:07:00,886 --> 00:07:01,754 BARRIERS AND OPPORTUNITIES. 171 00:07:01,754 --> 00:07:04,190 I HAVE TO SAY THAT IN GENERAL 172 00:07:04,190 --> 00:07:06,525 IT'S VERY TEMPTING TO DO TWO 173 00:07:06,525 --> 00:07:07,526 THINGS. 174 00:07:07,526 --> 00:07:10,830 ONE IS TO TELL NIH HOW TO DO ITS 175 00:07:10,830 --> 00:07:11,464 BUSINESS. 176 00:07:11,464 --> 00:07:13,599 USE THIS MECHANISM OR THAT 177 00:07:13,599 --> 00:07:14,333 MECHANISM. 178 00:07:14,333 --> 00:07:15,901 DO A WORKSHOP HERE. 179 00:07:15,901 --> 00:07:17,636 THAT IS OKAY. 180 00:07:17,636 --> 00:07:19,638 SPEND SOME TIME ON THAT BUT NOT 181 00:07:19,638 --> 00:07:21,841 MUCH BECAUSE THAT IS WHAT WE DO. 182 00:07:21,841 --> 00:07:24,343 WHAT WE'RE HERE TO DO SO WE'LL 183 00:07:24,343 --> 00:07:25,311 FIGURE THAT OUT. 184 00:07:25,311 --> 00:07:27,746 BUT WHAT WE NEED IS THE 185 00:07:27,746 --> 00:07:29,548 SCIENTIFIC CONTENT AND ONCE WE 186 00:07:29,548 --> 00:07:31,317 HAVE THAT THEN WE'RE ABLE TO 187 00:07:31,317 --> 00:07:33,552 REALLY DECIDE HOW TO BEST 188 00:07:33,552 --> 00:07:35,054 ADVANCE THAT SCIENCE. 189 00:07:35,054 --> 00:07:37,623 THE SECOND THING THAT YOU LIKE 190 00:07:37,623 --> 00:07:41,694 TO DO IS GIVE US A LAUNDRY LIST. 191 00:07:41,694 --> 00:07:44,230 SOMETIMES 10, 20-50 IDEAS. 192 00:07:44,230 --> 00:07:46,465 THAT IS ALL IMPORTANT AND USEFUL 193 00:07:46,465 --> 00:07:48,701 BUT I WOULD HAVE TO SAY AS YOU 194 00:07:48,701 --> 00:07:50,269 SUMMARIZE THE WORKSHOP AT THE 195 00:07:50,269 --> 00:07:51,937 END OF THE DAY TO THINK ABOUT 196 00:07:51,937 --> 00:07:54,707 WHAT WOULD BE THE COUPLE ONE TO 197 00:07:54,707 --> 00:07:57,710 TWO THINGS THAT IF YOU DO THOSE 198 00:07:57,710 --> 00:07:59,278 THINGS YOU WOULD REALLY ADVANCE 199 00:07:59,278 --> 00:08:00,112 THE FIELD. 200 00:08:00,112 --> 00:08:02,581 YOU MAY REVOLUTIONIZE THE WAY WE 201 00:08:02,581 --> 00:08:03,215 LOOK AT IT. 202 00:08:03,215 --> 00:08:05,451 WE MAY REALLY OPEN THE DOOR TO 203 00:08:05,451 --> 00:08:06,685 SPUR ON NEW RESEARCH. 204 00:08:06,685 --> 00:08:09,121 SO, ITS REALLY GOOD THAT YOU 205 00:08:09,121 --> 00:08:12,992 TALK ABOUT IT IN A VERY 206 00:08:12,992 --> 00:08:13,259 BROADWAY. 207 00:08:13,259 --> 00:08:16,028 TRY NOT TO GET TOO DEEP INTO THE 208 00:08:16,028 --> 00:08:17,796 RABBIT HOLES AND BRING IT BACK 209 00:08:17,796 --> 00:08:20,466 AT THE END SO THAT THERE IS AN 210 00:08:20,466 --> 00:08:22,034 OPPORTUNITY FOR US TO REALLY 211 00:08:22,034 --> 00:08:23,802 UTILIZE THE OUTPUT FROM THIS 212 00:08:23,802 --> 00:08:24,470 WORKSHOP. 213 00:08:24,470 --> 00:08:25,971 THE ONE THING THAT WE CAN TELL 214 00:08:25,971 --> 00:08:29,275 YOU AND I KNOW THAT THE COCHAIRS 215 00:08:29,275 --> 00:08:32,011 WILL DO THEIR BEST TO PUBLISH 216 00:08:32,011 --> 00:08:33,112 THIS WORKSHOP. 217 00:08:33,112 --> 00:08:35,614 WE REALLY TRY HARD TO GET IT 218 00:08:35,614 --> 00:08:37,550 INTO A JOURNAL SO THAT EVERYONE 219 00:08:37,550 --> 00:08:39,118 CAN BENEFIT FROM THE OUTPUT OF 220 00:08:39,118 --> 00:08:40,052 YOUR DISCUSSIONS. 221 00:08:40,052 --> 00:08:42,488 WE WILL HAVE EXECUTIVE SUMMARIES 222 00:08:42,488 --> 00:08:43,789 ON THE WEBSITE. 223 00:08:43,789 --> 00:08:47,560 NUMBER ONE OUTPUT WILL 224 00:08:47,560 --> 00:08:48,994 DEFINITELY BE SOME TYPE OF 225 00:08:48,994 --> 00:08:50,696 PUBLICATION AND THEN WE'LL SEE 226 00:08:50,696 --> 00:08:52,731 WHERE WE CAN GO. 227 00:08:52,731 --> 00:08:55,601 IT'S DEPENDENT ON A LOT OF 228 00:08:55,601 --> 00:08:57,536 THINGS BUT WE'LL LOOK AT THIS 229 00:08:57,536 --> 00:08:58,470 CAREFULLY. 230 00:08:58,470 --> 00:09:02,975 WE WOULD NOT DO THIS WORKSHOP IF 231 00:09:02,975 --> 00:09:05,844 WE DIDN'T THINK THERE WERE SOME 232 00:09:05,844 --> 00:09:07,179 GAPS. 233 00:09:07,179 --> 00:09:09,615 AND WE'RE GOING TO TRY TO FILL 234 00:09:09,615 --> 00:09:10,249 THOSE GAPS. 235 00:09:10,249 --> 00:09:13,552 HOW TO ADVANCE NUTRITION, DIET 236 00:09:13,552 --> 00:09:16,789 RESEARCH AND PROMOTE RESPIRATORY 237 00:09:16,789 --> 00:09:19,325 HEALTH. 238 00:09:19,325 --> 00:09:22,394 SO AGAIN I WANT TO THANK YOU FOR 239 00:09:22,394 --> 00:09:23,128 PARTICIPATING. 240 00:09:23,128 --> 00:09:25,030 TAKING TIME OUT OF YOUR VERY 241 00:09:25,030 --> 00:09:29,735 BUSY SCHEDULES AND ALSO OUR 242 00:09:29,735 --> 00:09:35,207 COCHAIRS JUN AND VANESSA. 243 00:09:35,207 --> 00:09:37,876 AND FROM ALL OF OUR STAFF IN THE 244 00:09:37,876 --> 00:09:38,377 LUNG DIVISION. 245 00:09:38,377 --> 00:09:44,350 THANK YOU AGAIN FOR 246 00:09:44,350 --> 00:09:46,685 PARTICIPATING AND I KNOW ALL OF 247 00:09:46,685 --> 00:09:48,420 US WILL BENEFIT GREATLY. 248 00:09:48,420 --> 00:09:50,956 I'LL STOP THERE. 249 00:09:50,956 --> 00:09:56,729 I'M HAPPY TO TAKE QUESTIONS. 250 00:09:56,729 --> 00:09:59,732 I'LL TURN IT BACK OVER TO YOU 251 00:09:59,732 --> 00:10:01,100 QING. 252 00:10:01,100 --> 00:10:06,805 >> THANK YOU, DR. KILEY. 253 00:10:06,805 --> 00:10:11,610 DR. ALAN DAVIS. 254 00:10:11,610 --> 00:10:16,181 YOU'RE MUTED. 255 00:10:16,181 --> 00:10:18,017 I THINK I CANNOT HEAR YOU. 256 00:10:18,017 --> 00:10:20,586 I'M GOING TO CONTINUE YOU. 257 00:10:20,586 --> 00:10:22,287 YOU MAY PUT YOUR QUESTION IN THE 258 00:10:22,287 --> 00:10:23,822 CHAT. 259 00:10:23,822 --> 00:10:28,260 SO NOW I WOULD LIKE TO WELCOME, 260 00:10:28,260 --> 00:10:33,732 INTRODUCE OUR WORKSHOP COCHAIRS. 261 00:10:33,732 --> 00:10:36,335 DR. JUN MA. 262 00:10:36,335 --> 00:10:38,137 A DISTINGUISHED PROFESSOR OF 263 00:10:38,137 --> 00:10:45,844 MEDICINE DIRECTOR OF THE -- -- 264 00:10:45,844 --> 00:10:46,078 PROGRAM. 265 00:10:46,078 --> 00:10:47,713 AND -- IN THE DEPARTMENT OF 266 00:10:47,713 --> 00:10:52,084 MEDICINE AT THE UNIVERSITY OF 267 00:10:52,084 --> 00:10:53,485 ILLINOIS CHICAGO. 268 00:10:53,485 --> 00:10:56,955 DR. MA IS SPECIALIZED IN 269 00:10:56,955 --> 00:10:59,625 RANDOMIZED CLINICAL TRIAL AND 270 00:10:59,625 --> 00:11:00,559 TRANSLATIONAL BEHAVIORAL 271 00:11:00,559 --> 00:11:01,727 MEDICINE. 272 00:11:01,727 --> 00:11:06,699 SHE HAS LED 16 EFFICACY -- 273 00:11:06,699 --> 00:11:12,471 TRIALS IN BEHAVIORAL. 274 00:11:12,471 --> 00:11:15,240 WHO HAVE MULTIPLE CHRONICLE 275 00:11:15,240 --> 00:11:20,112 CONDITIONS SUCH AS OBESITY AND 276 00:11:20,112 --> 00:11:20,345 ASTHMA. 277 00:11:20,345 --> 00:11:23,415 SHE HAS HAD NUMEROUS LEADERSHIP 278 00:11:23,415 --> 00:11:23,849 POSITION. 279 00:11:23,849 --> 00:11:28,454 YOU CAN SEE THE FULL DETAILS IN 280 00:11:28,454 --> 00:11:32,591 HER BIOIN THE BOOKLET. 281 00:11:32,591 --> 00:11:37,529 DR. VANESSA GARCIA-LARSEN. 282 00:11:37,529 --> 00:11:44,670 SHE ALSO IS ASSOCIATE PROFESSOR 283 00:11:44,670 --> 00:11:48,640 IN THE NATIONAL HOUSE -- JOHN 284 00:11:48,640 --> 00:11:51,276 HOP SKINS. 285 00:11:51,276 --> 00:12:01,854 SHE WAS TRAINED * IN NUTRITION. 286 00:12:13,232 --> 00:12:15,501 HER EVIDENCE BASED RESEARCH 287 00:12:15,501 --> 00:12:19,171 SHOWING THAT -- DIET DURING 288 00:12:19,171 --> 00:12:21,273 PREGNANCY IS LINKED TO 289 00:12:21,273 --> 00:12:24,676 ALLERGIES, RESPIRATOR OTHER 290 00:12:24,676 --> 00:12:26,578 DISEASE HAS INFORMED 291 00:12:26,578 --> 00:12:28,647 INTERNATIONAL -- GUIDELINES. 292 00:12:28,647 --> 00:12:30,716 YOU CAN ALSO SEE DETAILS OF HER 293 00:12:30,716 --> 00:12:33,485 BIOIN THE BOOKLET. 294 00:12:33,485 --> 00:12:35,420 I WELCOME YOU. 295 00:12:35,420 --> 00:12:36,889 PLEASE TAKE IT AWAY. 296 00:12:36,889 --> 00:12:38,924 >> THANK YOU, DR. LU. 297 00:12:38,924 --> 00:12:40,125 HELLO, EVERYONE. 298 00:12:40,125 --> 00:12:42,461 PLEASE ALLOW ME TO ADD MY 299 00:12:42,461 --> 00:12:44,463 WELCOME TO YOU ALL FOR 300 00:12:44,463 --> 00:12:46,031 PARTICIPATING IN THIS VERY 301 00:12:46,031 --> 00:12:48,967 IMPORTANT AND TIMELY WORKSHOP. 302 00:12:48,967 --> 00:12:52,971 I WANT TO FIRST THANK DR. KILEY 303 00:12:52,971 --> 00:12:55,374 AND DR. LU FOR YOUR KIND AND 304 00:12:55,374 --> 00:12:56,108 INSPIRING WORDS. 305 00:12:56,108 --> 00:12:58,544 I WANT TO THANK YOU THE OTHER 306 00:12:58,544 --> 00:13:00,012 MEMBERS OF THE PLANNING 307 00:13:00,012 --> 00:13:01,914 COMMITTEE FOR YOUR LEADERSHIP 308 00:13:01,914 --> 00:13:04,783 AND INSIGHT TO FURTHER ELEVATE 309 00:13:04,783 --> 00:13:06,585 THE IMPORTANCE OF NUTRITIONAL 310 00:13:06,585 --> 00:13:07,820 RESEARCH IN RESPIRATORY HEALTH 311 00:13:07,820 --> 00:13:10,689 AND DISEASE AND TO SHINE A 312 00:13:10,689 --> 00:13:12,558 SPOTLIGHT ON THIS CRITICAL TOPIC 313 00:13:12,558 --> 00:13:14,860 BY SUPPORTING THIS WORKSHOP. 314 00:13:14,860 --> 00:13:24,169 I FEEL VERY PRIVILEGED -- AND I 315 00:13:24,169 --> 00:13:27,472 ESPECIALLY AM GRATEFUL FOR 316 00:13:27,472 --> 00:13:29,074 HAVING DONE SO IN PARTNERSHIP 317 00:13:29,074 --> 00:13:30,909 WITH MY COCHAIR. 318 00:13:30,909 --> 00:13:33,979 I VERY MUCH LOOK FORWARD TO THE 319 00:13:33,979 --> 00:13:35,447 PRESENTATIONS FROM SOME OF OUR 320 00:13:35,447 --> 00:13:38,517 BEST SCIENTISTS AND CLINICIANS 321 00:13:38,517 --> 00:13:42,721 IN THE FIELD AND INTELLECTUALLY 322 00:13:42,721 --> 00:13:47,259 STIMULATING DISCUSSIONS OVER THE 323 00:13:47,259 --> 00:13:48,427 NEXT TWO DAYS. 324 00:13:48,427 --> 00:13:50,829 I TURN IT OVER TO YOU VANESSA. 325 00:13:50,829 --> 00:13:53,165 >> THANK YOU. 326 00:13:53,165 --> 00:13:56,702 THANK YOU SO MUCH, DR. MA AND I 327 00:13:56,702 --> 00:13:59,905 WOULD ALSO LIKE TO EXTEND MY 328 00:13:59,905 --> 00:14:01,340 THANKS FOR THE OPPORTUNITY TO 329 00:14:01,340 --> 00:14:03,575 HAVE THIS WORKSHOP AND TO 330 00:14:03,575 --> 00:14:06,345 DISCUSS THE RESEARCH PRIORITIES 331 00:14:06,345 --> 00:14:08,413 FOR RESPIRATORY HEALTH. 332 00:14:08,413 --> 00:14:10,082 I'M DELIGHTED TO SEE YOU ALL 333 00:14:10,082 --> 00:14:11,884 HERE AND LOOK FORWARD TO THE 334 00:14:11,884 --> 00:14:13,118 INTERACTIONS WE'RE GOING TO HAVE 335 00:14:13,118 --> 00:14:14,720 OVER THE NEXT TWO DAYS. 336 00:14:14,720 --> 00:14:17,489 OUR FIRST SPEAKER IS PROFESSOR 337 00:14:17,489 --> 00:14:19,858 PETER BURNEY. 338 00:14:19,858 --> 00:14:22,961 CAN WE PUT UP THE FIRST SLIDE OF 339 00:14:22,961 --> 00:14:25,831 THE PRESENTATION. 340 00:14:25,831 --> 00:14:27,232 THANK YOU. 341 00:14:27,232 --> 00:14:29,034 SO PROFESSOR PETER BURNEY IS A 342 00:14:29,034 --> 00:14:34,439 WORLD EXPERT IN RESPIRATORY 343 00:14:34,439 --> 00:14:42,180 EPIDIMENIOLOGY. 344 00:14:42,180 --> 00:14:47,486 HE -- -- AND THIS WAS FOLLOWED 345 00:14:47,486 --> 00:14:49,154 BY SPECIALIST TRAINING IN 346 00:14:49,154 --> 00:14:51,490 PUBLIC HEALTH IN ST. THOMAS' 347 00:14:51,490 --> 00:14:52,691 HOSPITAL. 348 00:14:52,691 --> 00:14:54,593 HE WAS A PROFESSOR AT THE SCHOOL 349 00:14:54,593 --> 00:14:57,329 OF HIGH KEEP AND PUBLIC HEALTH 350 00:14:57,329 --> 00:14:58,931 AT JOHNS HOPKINS UNIVERSITY AND 351 00:14:58,931 --> 00:15:02,567 HE WAS ALSO PROFESSOR OF PUBLIC 352 00:15:02,567 --> 00:15:05,003 HEALTH MEDICINE -- PRIMARY CARE 353 00:15:05,003 --> 00:15:07,572 AND PUBLIC HEALTH SCIENCES AT 354 00:15:07,572 --> 00:15:13,278 KING COLLEGE LONDON UNTIL 2006 355 00:15:13,278 --> 00:15:16,248 WHEN HE MOVED. 356 00:15:16,248 --> 00:15:18,984 HE WAS PRINCIPLE INVESTIGATOR OF 357 00:15:18,984 --> 00:15:28,093 THE WIDELY RECOGNIZED EUROPEAN - 358 00:15:28,093 --> 00:15:34,032 EUROPEAN RESPIRATORY HEALTH. 359 00:15:34,032 --> 00:15:36,902 FROM 2006 HE WAS PRINCIPLE 360 00:15:36,902 --> 00:15:39,738 INVESTIGATOR -- THE BOLD STUDY. 361 00:15:39,738 --> 00:15:42,307 THIS IS THE LARGEST 362 00:15:42,307 --> 00:15:44,776 INTERNATIONAL STUDY BASED ON THE 363 00:15:44,776 --> 00:15:47,245 PREVALENCE AND RISK FACTORS. 364 00:15:47,245 --> 00:15:49,214 THANK YOU, DR. BURNEY FOR 365 00:15:49,214 --> 00:15:50,949 JOINING US TODAY. 366 00:15:50,949 --> 00:15:55,954 >> OKAY. 367 00:15:55,954 --> 00:15:57,723 VANESSA, THANK YOU VERY MUCH FOR 368 00:15:57,723 --> 00:15:59,624 THE INVITATION TO COME TO THIS 369 00:15:59,624 --> 00:16:03,528 VERY EXCITING PROGRAM OF WORK. 370 00:16:03,528 --> 00:16:06,531 WHICH I THINK WE'RE ALL GOING TO 371 00:16:06,531 --> 00:16:08,300 LEARN A GREAT DEAL FROM. 372 00:16:08,300 --> 00:16:14,206 IF I COULD HAVE THE FIRST SLIDE. 373 00:16:14,206 --> 00:16:16,008 YES AND THE NEXT. 374 00:16:16,008 --> 00:16:18,076 I'VE GOT A VERY LARGE TOPIC AS 375 00:16:18,076 --> 00:16:20,045 YOU CAN SEE SO I THINK WE'LL 376 00:16:20,045 --> 00:16:22,981 PRESS ON. 377 00:16:22,981 --> 00:16:25,350 SO I'LL START WITH ASTHMA. 378 00:16:25,350 --> 00:16:27,452 ASTHMA IS PROBABLY OF ALL OF THE 379 00:16:27,452 --> 00:16:28,820 CONDITIONS I'M GOING TO TALK 380 00:16:28,820 --> 00:16:31,990 ABOUT THE MOST RESEARCHED. 381 00:16:31,990 --> 00:16:34,426 IT STILL DOESN'T HAVE A VERY 382 00:16:34,426 --> 00:16:36,061 PRECISE DEFINITION. 383 00:16:36,061 --> 00:16:38,063 THE GENERAL DEFINITION GIVEN 384 00:16:38,063 --> 00:16:42,734 HERES ONE THAT IS USUALLY -- 385 00:16:42,734 --> 00:16:44,636 SATISFIES MOST PEOPLE BUT WHEN 386 00:16:44,636 --> 00:16:46,938 IT COMES TO DEFINING WHAT ASTHMA 387 00:16:46,938 --> 00:16:49,408 IS AND FINDING A TEST FOR 388 00:16:49,408 --> 00:16:51,410 WHETHER SOMEONE HAS ASTHMA THERE 389 00:16:51,410 --> 00:16:53,245 IS A LOT OF DISAGREEMENT. 390 00:16:53,245 --> 00:16:55,480 THERE ARE A LOT OF DIFFERENT 391 00:16:55,480 --> 00:16:57,015 TEST AVAILABLE AND THEY COME UP 392 00:16:57,015 --> 00:16:59,885 WITH SLIGHTLY DIFFERENT ANSWERS. 393 00:16:59,885 --> 00:17:06,792 NEXT SLIDE. 394 00:17:06,792 --> 00:17:13,832 SO SEVERAL DECADES AGO NOW DAVID 395 00:17:13,832 --> 00:17:16,568 -- RECOGNIZED THAT PEOPLE WHO 396 00:17:16,568 --> 00:17:21,440 CAME FROM VERY LARGE FAMILIES 397 00:17:21,440 --> 00:17:25,410 WERE MUCH LESS LIKELY TO HAVE 398 00:17:25,410 --> 00:17:29,081 HAYFEVER AND THIS SLIDE SHOWS 399 00:17:29,081 --> 00:17:30,482 THE SAME. 400 00:17:30,482 --> 00:17:34,086 A STUDY IN YOUNG ADULTS. 401 00:17:34,086 --> 00:17:36,321 AND YOU'LL SEE EXACTLY THE SAME 402 00:17:36,321 --> 00:17:37,189 THING. 403 00:17:37,189 --> 00:17:40,592 THE RED BARS REPRESENT 404 00:17:40,592 --> 00:17:45,230 DECREASING EVENTS OF HAYFEVER AS 405 00:17:45,230 --> 00:17:51,136 YOU GET TO LARGER SIZES. 406 00:17:51,136 --> 00:17:56,842 IF YOU PUT IN POSITIVE SKIN 407 00:17:56,842 --> 00:17:58,877 TESTS FOR ALLERGENS YOU WOULD 408 00:17:58,877 --> 00:18:02,080 GET THE SAME KIND OF BAR CHART 409 00:18:02,080 --> 00:18:05,383 BUT NOTICE WHEN YOU LOOK AT THE 410 00:18:05,383 --> 00:18:08,687 GREEN BARS THOSE OR FOR 411 00:18:08,687 --> 00:18:09,788 SHORTNESS OF BREATH AND THAT IS 412 00:18:09,788 --> 00:18:11,623 A PRETTY GOOD QUESTION. 413 00:18:11,623 --> 00:18:15,360 IF YOU'RE GOING TO DIAGNOSIS MAY 414 00:18:15,360 --> 00:18:17,596 THAT COMES PRETTY CLOSE TO WHAT 415 00:18:17,596 --> 00:18:19,698 PEOPLE THINK OF AS ASTHMA. 416 00:18:19,698 --> 00:18:21,833 AND THERE YOU SEE THE TREND IS 417 00:18:21,833 --> 00:18:24,469 IN THE OPPOSITE DIRECTION AND 418 00:18:24,469 --> 00:18:26,238 YOU CAN SEE THAT IN LOTS OF 419 00:18:26,238 --> 00:18:30,075 OTHER PLACES AND IT'S IMPORTANT 420 00:18:30,075 --> 00:18:32,177 BECAUSE WHEN YOU GO TO 421 00:18:32,177 --> 00:18:37,215 LOW-INCOME COUNTRIES THEY HAVE 422 00:18:37,215 --> 00:18:42,087 MUCH LESS A TOPIC WHEEZE AND 423 00:18:42,087 --> 00:18:44,489 HYPER RESPONSIVENESS. 424 00:18:44,489 --> 00:18:48,126 THAT IS LESS OF A PROBLEM BUT IT 425 00:18:48,126 --> 00:18:49,794 BECOMES INCREASINGLY A PROBLEM 426 00:18:49,794 --> 00:18:51,630 AS PEOPLE MOVE INTO THE CITIES. 427 00:18:51,630 --> 00:18:55,800 SO THAT IS AN ISSUE FOR LOOKING 428 00:18:55,800 --> 00:18:57,269 AT THE GENERAL DISTRIBUTION OF 429 00:18:57,269 --> 00:19:00,372 DISEASE. 430 00:19:00,372 --> 00:19:03,441 SO IF YOU WANT TO KNOW ABOUT THE 431 00:19:03,441 --> 00:19:05,343 DISTRIBUTION OF ASTHMA IN THE 432 00:19:05,343 --> 00:19:07,245 WORLD THE GLOBAL ASTHMA NETWORK 433 00:19:07,245 --> 00:19:09,347 IS PROBABLY THE MOST UP-TO-DATE 434 00:19:09,347 --> 00:19:10,849 PLACE TO LOOK FOR THIS. 435 00:19:10,849 --> 00:19:17,556 AND YOU'LL SEE IN THIS MAP THAT 436 00:19:17,556 --> 00:19:21,826 ASTHMA IN ADULTS ALSO REALLY 437 00:19:21,826 --> 00:19:26,698 PRETTY UNCOMMON IN ACROSS ASIA 438 00:19:26,698 --> 00:19:31,937 AND IN SU SUB AFRICA. 439 00:19:31,937 --> 00:19:35,073 THERE ARE SOME HOTSPOTS IN NORTH 440 00:19:35,073 --> 00:19:37,175 AMERICA BUT THIS IS THE ANSWER 441 00:19:37,175 --> 00:19:38,443 TO A QUESTION. 442 00:19:38,443 --> 00:19:40,812 HAVE YOU EVER HAD ASTHMA? 443 00:19:40,812 --> 00:19:43,615 AND YOU CAN TAKE FROM THAT WHAT 444 00:19:43,615 --> 00:19:45,283 YOU LIKE. 445 00:19:45,283 --> 00:19:47,586 IT'S A START BUT IT'S PROBABLY 446 00:19:47,586 --> 00:19:49,854 NOT A VERY DETAILED 447 00:19:49,854 --> 00:19:51,790 UNDERSTANDING OF WHAT IS MEANT 448 00:19:51,790 --> 00:19:54,759 BY THE DISTRIBUTION OF ASTHMA 449 00:19:54,759 --> 00:19:57,062 WHICH BRINGS ME TO THE NEXT 450 00:19:57,062 --> 00:19:59,097 SLIDE TO THE NEXT CONDITION 451 00:19:59,097 --> 00:20:01,666 WHICH IS CHRONIC BRONCHITIS. 452 00:20:01,666 --> 00:20:05,537 NOW THIS IS KNOWN AS THE ENGLISH 453 00:20:05,537 --> 00:20:06,972 DISEASE AND THOUGHT TO BE VERY 454 00:20:06,972 --> 00:20:07,939 IMPORTANT. 455 00:20:07,939 --> 00:20:10,609 SO IT'S ACTUALLY WITHIN FOR A 456 00:20:10,609 --> 00:20:15,046 VERY LONG TIME -- * IN TERMS OF 457 00:20:15,046 --> 00:20:18,783 A QUESTIONNAIRE AND THAT WAS THE 458 00:20:18,783 --> 00:20:21,119 BRITISH MEDICAL RESEARCH COUNCIL 459 00:20:21,119 --> 00:20:22,954 QUESTION THAT WAS DEVELOPED IN 460 00:20:22,954 --> 00:20:24,522 THE 1960s. 461 00:20:24,522 --> 00:20:26,891 IT'S BEEN CARRIED OVER INTO THE 462 00:20:26,891 --> 00:20:33,265 QUESTIONNAIRE -- LOTS OF OTHER 463 00:20:33,265 --> 00:20:35,166 INTERNATIONAL SURVEYS HAVE USED 464 00:20:35,166 --> 00:20:36,501 THE SAME FORMULA. 465 00:20:36,501 --> 00:20:39,804 IT IS NOT HOWEVER THOUGHT TO BE 466 00:20:39,804 --> 00:20:40,572 SO IMPORTANT. 467 00:20:40,572 --> 00:20:42,007 NEXT SLIDE. 468 00:20:42,007 --> 00:20:46,845 AND THAT IS BECAUSE OF STUDIES 469 00:20:46,845 --> 00:20:49,714 DONE BY CHARLES FLETCHER AND 470 00:20:49,714 --> 00:20:53,084 RICHARD PETER WHO REALLY SHOWED 471 00:20:53,084 --> 00:20:59,457 THAT CHRONIC -- DOES NOT LEAD ON 472 00:20:59,457 --> 00:21:01,226 TO OBSTRUCTION AND THAT IF YOU 473 00:21:01,226 --> 00:21:03,228 WANT TO KNOW WHAT IS GOING TO 474 00:21:03,228 --> 00:21:05,330 HAPPEN TO SOMEONE IN THE NEXT 20 475 00:21:05,330 --> 00:21:07,766 YEARS YOU REALLY WANT TO KNOW 476 00:21:07,766 --> 00:21:10,935 WHAT THEIR LUNG FUNCTION IS. 477 00:21:10,935 --> 00:21:15,106 MOOSE AS SECRETION ADDS * VERY 478 00:21:15,106 --> 00:21:15,874 LITTLE TO THAT. 479 00:21:15,874 --> 00:21:18,209 BUT THE ONE WARNING WE RATHER 480 00:21:18,209 --> 00:21:22,314 IGNORE THE CONDITION AND YOU SEE 481 00:21:22,314 --> 00:21:23,615 FROM THIS SLIDE WHICH IS TAKEN 482 00:21:23,615 --> 00:21:27,285 FROM THE LONDON STUDY LOOKING AT 483 00:21:27,285 --> 00:21:31,022 THE CHANGE IN QUALITY OF LIFE, 484 00:21:31,022 --> 00:21:33,024 PHYSICAL HEALTH SCALE OF THE 485 00:21:33,024 --> 00:21:34,926 SHORT FORM 12 QUESTIONNAIRE AND 486 00:21:34,926 --> 00:21:40,198 YOU'LL SEE THAT IT'S ACTUALLY 487 00:21:40,198 --> 00:21:41,900 MORE INFLUENTIAL IN TERMS OF 488 00:21:41,900 --> 00:21:43,635 QUALITY OF LIFE. 489 00:21:43,635 --> 00:21:51,810 AND IT'S MORE OR LESS -- TO AN 490 00:21:51,810 --> 00:21:53,611 ADDITIONAL 30 YEARS OF LIFE. 491 00:21:53,611 --> 00:21:56,381 WE DON'T MEASURE IT IN THE SAME 492 00:21:56,381 --> 00:21:58,049 WAY AND MAYBE WE SHOULD PAY A 493 00:21:58,049 --> 00:21:59,317 LITTLE BIT MORE ATTENTION TO IT 494 00:21:59,317 --> 00:22:03,655 IN THE FUTURE. 495 00:22:03,655 --> 00:22:08,860 WHICH BRINGS ME ON TO COPD AND 496 00:22:08,860 --> 00:22:10,929 CHRONIC AIRFLOW OBSTRUCTION. 497 00:22:10,929 --> 00:22:13,832 AGAIN A DIAGNOSIS MADE BY A 498 00:22:13,832 --> 00:22:14,065 DOCTOR. 499 00:22:14,065 --> 00:22:15,734 THERE HAVE BEEN LOTS OF PEOPLE 500 00:22:15,734 --> 00:22:17,736 WHO HAVE WRITTEN ESSAYS TRYING 501 00:22:17,736 --> 00:22:19,938 TO DEFINE IT. 502 00:22:19,938 --> 00:22:22,674 IT'S UNDEFINED. 503 00:22:22,674 --> 00:22:26,311 BUT WHAT WE DO HAVE IS CHRONIC 504 00:22:26,311 --> 00:22:28,346 AIRFLOW OBSTRUCTION AND THAT IS 505 00:22:28,346 --> 00:22:32,317 MORE OR LESS ESTABLISHED NOW 506 00:22:32,317 --> 00:22:38,857 THAT WE USE THE FEV ONE FVC 507 00:22:38,857 --> 00:22:40,024 RATIO. 508 00:22:40,024 --> 00:22:45,163 SO, THAT IS PRETTY CLEAR. 509 00:22:45,163 --> 00:22:49,067 NOW THE -- THE FIRST THING THAT 510 00:22:49,067 --> 00:22:58,276 WE KNOW ABOUT THIS IS THAT IT'S 511 00:22:58,276 --> 00:23:00,178 STRONGLY ASSOCIATED WITH SMOKING 512 00:23:00,178 --> 00:23:02,614 AND HERE YOU'LL SEE FOR WOMEN 513 00:23:02,614 --> 00:23:05,850 AND FOR MEN THAT THE RESPONSE 514 00:23:05,850 --> 00:23:09,454 INCREASES IN RELATIVE RISK AS 515 00:23:09,454 --> 00:23:14,993 THE YEARS OF LIFE INCREASE. 516 00:23:14,993 --> 00:23:18,096 SO THE DISTRIBUTION OF THE 517 00:23:18,096 --> 00:23:21,499 DISEASE IS VERY WIDE. 518 00:23:21,499 --> 00:23:25,236 SO IT GOES FROM LESS THAN 5% IN 519 00:23:25,236 --> 00:23:29,874 COLUMBIA AND MEXICO TO VERY HIGH 520 00:23:29,874 --> 00:23:34,913 LEVELS OVER 15% IN CAPETOWN. 521 00:23:34,913 --> 00:23:37,348 BUT MORE IMPORTANT THAN THAT IS 522 00:23:37,348 --> 00:23:42,520 THE RED LINE WHICH SHOWS THE 523 00:23:42,520 --> 00:23:44,255 PERCENT UNDER DIAGNOSIS. 524 00:23:44,255 --> 00:23:46,057 SO IF YOU ASK PEOPLE DO THEY 525 00:23:46,057 --> 00:23:49,127 HAVE COPD THEY ALMOST ALL SAY 526 00:23:49,127 --> 00:23:52,831 NO. 527 00:23:52,831 --> 00:23:55,266 THE HONORABLE EXCEPTION IS IN 528 00:23:55,266 --> 00:23:58,837 KENTUCKY IN THE USA WHERE 50% OF 529 00:23:58,837 --> 00:24:01,706 PEOPLE RECOGNIZED THAT THEY HAVE 530 00:24:01,706 --> 00:24:02,907 COPD. 531 00:24:02,907 --> 00:24:05,276 EVERYWHERE ELSE IT'S ON AVERAGE 532 00:24:05,276 --> 00:24:11,616 LESS THAN 20%. 533 00:24:11,616 --> 00:24:13,852 WHICH BRINGS US TO THE NEXT 534 00:24:13,852 --> 00:24:19,691 PUZZLE WITH CHRONIC AIRFLOW 535 00:24:19,691 --> 00:24:20,625 DISEASE. 536 00:24:20,625 --> 00:24:22,327 THE MORTALITY RATES DON'T RELATE 537 00:24:22,327 --> 00:24:23,194 TO SMOKING. 538 00:24:23,194 --> 00:24:26,631 ON THE LEFT YOU'VE GOT THE 539 00:24:26,631 --> 00:24:30,735 MORTALITY RATE ON THE Y AXIS AND 540 00:24:30,735 --> 00:24:33,037 THE PREVALENCE OF SIG RUT 541 00:24:33,037 --> 00:24:34,405 CONSUMPTION ON THE X AXIS AND 542 00:24:34,405 --> 00:24:36,307 THERE IS NO RELATIONSHIP BETWEEN 543 00:24:36,307 --> 00:24:37,909 THE TWO. 544 00:24:37,909 --> 00:24:40,678 IN FACT ACTUALLY THERE IS A 545 00:24:40,678 --> 00:24:42,447 NEGATIVE ASSOCIATION WHICH IS A 546 00:24:42,447 --> 00:24:43,648 BIT WORRYING. 547 00:24:43,648 --> 00:24:45,850 ON THE RIGHT-HAND SIDE YOU'LL 548 00:24:45,850 --> 00:24:48,386 SEE SOMETHING RATHER SIMILAR. 549 00:24:48,386 --> 00:24:50,855 THESE ARE THE MORTALITY RATES 550 00:24:50,855 --> 00:24:54,659 FROM THE COAD ACROSS THE CENTURY 551 00:24:54,659 --> 00:24:59,931 THE 20th CENTURY FROM 552 00:24:59,931 --> 00:25:00,532 12901-1991. 553 00:25:00,532 --> 00:25:03,001 THE RATES ARE REALLY HIGH AT THE 554 00:25:03,001 --> 00:25:05,136 BEGINNING OF THE CENTURY AND 555 00:25:05,136 --> 00:25:08,806 THIS IS ON A LARGE SCALE. 556 00:25:08,806 --> 00:25:13,978 THEM YOU GET A REALLY STEEP 557 00:25:13,978 --> 00:25:16,981 DECLINE BETWEEN BEFORE YOU GET 558 00:25:16,981 --> 00:25:20,919 AN UP TICK AGAIN AND A SECOND 559 00:25:20,919 --> 00:25:25,790 PEEK IN AROUND 1960-1970 AND 560 00:25:25,790 --> 00:25:28,226 THEN THE DECLINE STARTS AGAIN. 561 00:25:28,226 --> 00:25:30,962 THAT IS NOT AT ALL WHAT SEE WITH 562 00:25:30,962 --> 00:25:32,130 SMOKING. 563 00:25:32,130 --> 00:25:34,265 THAT DIDN'T GET STARTED UNTIL 564 00:25:34,265 --> 00:25:37,869 AFTER THE FIRST WORLD WAR IN 565 00:25:37,869 --> 00:25:39,170 ENGLAND. 566 00:25:39,170 --> 00:25:45,076 SO THAT IS A PUZZLE. 567 00:25:45,076 --> 00:25:46,044 NEXT SLIDE. 568 00:25:46,044 --> 00:25:48,846 NEXT SLIDE. 569 00:25:48,846 --> 00:25:52,383 SO I'LL GET ON TO SOMETHING WE 570 00:25:52,383 --> 00:25:54,018 CALL SMALL LUNG SYNDROME WHICH 571 00:25:54,018 --> 00:25:58,590 YOU CAN DEFINE AS A LOW TOTAL 572 00:25:58,590 --> 00:25:59,891 LUNG CAPACITY. 573 00:25:59,891 --> 00:26:08,032 THAT IS GENERALLY -- LOWER 574 00:26:08,032 --> 00:26:09,434 LEVELS THAN NORMAL BECAUSE THAT 575 00:26:09,434 --> 00:26:11,069 IS THE INFORMATION THAT WE 576 00:26:11,069 --> 00:26:14,672 MOSTLY HAVE FROM SURVEYS. 577 00:26:14,672 --> 00:26:17,842 RESTRICTION IS MUCH MORE 578 00:26:17,842 --> 00:26:19,644 STRONGLY ASSOCIATED WITH 579 00:26:19,644 --> 00:26:20,578 MORTALITY. 580 00:26:20,578 --> 00:26:25,850 A MUCH BETTER PREDICTOR THAN A 581 00:26:25,850 --> 00:26:36,227 LA-- LOW FB1. 582 00:26:40,198 --> 00:26:44,702 IT'S ALSO MAYBE RELEVANT TO THE 583 00:26:44,702 --> 00:26:49,641 MEETING IT'S ALSO ASSOCIATED 584 00:26:49,641 --> 00:26:52,176 WITH -- AND WITH CARDIOVASCULAR 585 00:26:52,176 --> 00:26:53,978 DISEASE WHICH AIRWAY OBSTRUCTION 586 00:26:53,978 --> 00:27:00,518 IS NOT IN SPITE OF SOME PARTS OF 587 00:27:00,518 --> 00:27:02,787 THE COUNTRY. 588 00:27:02,787 --> 00:27:05,857 IN THESE TWO PICTURES YOU SEE 589 00:27:05,857 --> 00:27:07,325 SOMETHING A LITTLE BIT DIFFERENT 590 00:27:07,325 --> 00:27:10,328 FROM WHAT I SHARED THE LAST TIME 591 00:27:10,328 --> 00:27:13,965 WHEN I SHOWED RESULTS FROM COAD 592 00:27:13,965 --> 00:27:15,166 AGAINST SMOKING. 593 00:27:15,166 --> 00:27:17,235 THAT SHOWED NO REAL ASSOCIATION. 594 00:27:17,235 --> 00:27:18,903 HERE ON THE LEFT-HAND SIDE 595 00:27:18,903 --> 00:27:22,540 YOU'VE GOT THE SAME GRAPH REALLY 596 00:27:22,540 --> 00:27:25,843 WITH MORTALITY BY COUNTRY ON THE 597 00:27:25,843 --> 00:27:29,080 Y AXIS BUT THIS TIME THE GROSS 598 00:27:29,080 --> 00:27:30,715 NATIONAL INCOME PER CAPITA ALONG 599 00:27:30,715 --> 00:27:34,218 THE X AXIS AND YOU CAN SEE THAT 600 00:27:34,218 --> 00:27:39,991 THERE IS A HUGE INCREASE AS THE 601 00:27:39,991 --> 00:27:43,194 GROSS NATIONAL INCOME PER CAPITA 602 00:27:43,194 --> 00:27:48,166 FALLS BELOW $15,000 A YEAR. 603 00:27:48,166 --> 00:27:50,134 AND ON THE RIGHT-HAND SIDE YOU 604 00:27:50,134 --> 00:27:52,270 SEE A SIMILAR PICTURE BUT THIS 605 00:27:52,270 --> 00:27:53,838 TIME IT'S LOOKING AT THE 606 00:27:53,838 --> 00:28:00,078 PREVALENCE OF A LOW -- AGAIN 607 00:28:00,078 --> 00:28:01,646 BELOW THE LIMITS OF NORMAL AND 608 00:28:01,646 --> 00:28:04,415 YOU SEE THE PICTURE IS ALMOST 609 00:28:04,415 --> 00:28:07,018 IDENTICAL. 610 00:28:07,018 --> 00:28:08,152 SUGGESTING THAT IT'S THIS THAT 611 00:28:08,152 --> 00:28:11,689 IS CAUSING WHATEVER CALLS THE 612 00:28:11,689 --> 00:28:14,726 EPIDEMIC IS VOAD. 613 00:28:14,726 --> 00:28:16,594 -- COAD. 614 00:28:16,594 --> 00:28:17,195 *. 615 00:28:17,195 --> 00:28:26,504 RESEARCH QUESTIONS -- I'VE TAKEN 616 00:28:26,504 --> 00:28:32,176 DR. KILEY'S ADVICE. 617 00:28:32,176 --> 00:28:36,614 SO WHAT COMPONENTS OF URBAN LIFE 618 00:28:36,614 --> 00:28:38,516 INCREASE THE RISK OF LUNG 619 00:28:38,516 --> 00:28:38,983 DISEASE. 620 00:28:38,983 --> 00:28:41,385 I THINK THAT IS IMPORTANT AS 621 00:28:41,385 --> 00:28:43,788 PEOPLE MOVE FROM RURAL AREAS TO 622 00:28:43,788 --> 00:28:44,255 URBAN AREAS. 623 00:28:44,255 --> 00:28:47,058 THEY GET A LOT OF ADVANTAGES. 624 00:28:47,058 --> 00:28:49,427 BUT THEY DO GET ANOTHER 625 00:28:49,427 --> 00:28:52,396 DISADVANTAGE WHICH IS THE LUNG 626 00:28:52,396 --> 00:28:55,133 DISEASE INCREASES IN RISK. 627 00:28:55,133 --> 00:28:59,637 WHY DO LOW-INCOME COUNTRIES HAVE 628 00:28:59,637 --> 00:29:04,075 LOW LEVELS OF ATOPY AND SMALL 629 00:29:04,075 --> 00:29:05,877 LUNG SIZE? 630 00:29:05,877 --> 00:29:11,816 AND WHAT LINKS SMALL LUNGS WITH 631 00:29:11,816 --> 00:29:13,918 CARDIOMETABOLIC CO-MORBIDITIES. 632 00:29:13,918 --> 00:29:17,088 AND WITH THAT I'LL STOP. 633 00:29:17,088 --> 00:29:23,494 AND TAKE ANY QUESTIONS. 634 00:29:23,494 --> 00:29:25,596 >> THANK YOU SO MUCH PROFESSOR 635 00:29:25,596 --> 00:29:26,230 BURNEY. 636 00:29:26,230 --> 00:29:31,202 I THINK WE CAN INVITE -- 637 00:29:31,202 --> 00:29:32,703 COLLEAGUES TO PUT QUESTIONS IN 638 00:29:32,703 --> 00:29:36,307 THE CHAT BOX AND THERE WILL BE A 639 00:29:36,307 --> 00:29:37,942 DISCUSSION IN A LITTLE WHILE. 640 00:29:37,942 --> 00:29:39,010 THANK YOU. 641 00:29:39,010 --> 00:29:43,080 NEXT SLIDE, PLEASE. 642 00:29:43,080 --> 00:29:43,514 THANK YOU. 643 00:29:43,514 --> 00:29:46,250 SO I'M GOING TO FOLLOW-UP NOW 644 00:29:46,250 --> 00:29:48,820 WITH PROVIDING YOU WITH ANOTHER 645 00:29:48,820 --> 00:29:53,157 VIEW OF NUTRITION RESEARCH AND 646 00:29:53,157 --> 00:29:54,258 RESPIRATORY HEALTH AND DISEASE 647 00:29:54,258 --> 00:29:56,928 AND THE OVER-ALL GOALS WE EXPECT 648 00:29:56,928 --> 00:29:59,297 TO ACHIEVE IN THE NEXT TWO DAYS. 649 00:29:59,297 --> 00:30:03,868 NEXT PLEASE. 650 00:30:03,868 --> 00:30:10,007 AND NEXT. 651 00:30:10,007 --> 00:30:10,508 NEXT. 652 00:30:10,508 --> 00:30:11,175 THANK YOU. 653 00:30:11,175 --> 00:30:15,046 THE TWO OVER-ALL GOALS THAT WE 654 00:30:15,046 --> 00:30:16,814 HAVE SET OUT FOR THIS WORKSHOP 655 00:30:16,814 --> 00:30:19,784 ARE FIRST OF ALL TO ADVANCE 656 00:30:19,784 --> 00:30:21,552 NUTRITION RESEARCH TO PROMOTE 657 00:30:21,552 --> 00:30:22,920 RESPIRATORY HEALTH AND TO AID IN 658 00:30:22,920 --> 00:30:26,023 THE PREVENTION AND MANAGEMENT OF 659 00:30:26,023 --> 00:30:28,693 DISEASES IN ADULTS WITH CHRONIC 660 00:30:28,693 --> 00:30:29,827 RESPIRATORY CONDITIONS AND ALSO 661 00:30:29,827 --> 00:30:32,096 TO DISCUSS THE CURRENT STATE OF 662 00:30:32,096 --> 00:30:33,965 SCIENCE REGARDING NUTRITION AND 663 00:30:33,965 --> 00:30:36,334 DIET AND RESPIRATORY HEALTH AND 664 00:30:36,334 --> 00:30:38,336 DISEASES AND TO IDENTIFY 665 00:30:38,336 --> 00:30:40,771 CRITICAL RESEARCH GAPS, 666 00:30:40,771 --> 00:30:47,111 CHALLENGES AND OPPORTUNITIES. 667 00:30:47,111 --> 00:30:50,081 NOW NUTRITION IS A LIFESTYLE 668 00:30:50,081 --> 00:30:52,283 RELATED FACTOR AND HAS THE 669 00:30:52,283 --> 00:30:55,820 POTENTIAL TO INFLUENCE A NUMBER 670 00:30:55,820 --> 00:31:00,391 OF NONCOMMUNICABLE DISEASES. 671 00:31:00,391 --> 00:31:02,760 I'M USING LUNG FUNCTION AND IF 672 00:31:02,760 --> 00:31:04,862 WE CAN PRESERVE LUNG FUNCTION 673 00:31:04,862 --> 00:31:06,831 THROUGH HEALTHY DIETS AND 674 00:31:06,831 --> 00:31:08,399 HEALTHY LIFESTYLES I THINK WE'RE 675 00:31:08,399 --> 00:31:14,805 GOING TO EFFECTIVELY MULTIPLY 676 00:31:14,805 --> 00:31:18,576 THE -- BUT WE DON'T EAT FOODS IN 677 00:31:18,576 --> 00:31:21,112 ISOLATION AND WHAT WE EAT IS 678 00:31:21,112 --> 00:31:22,980 HEAVILY INFLUENCED BY OUR 679 00:31:22,980 --> 00:31:25,216 ENVIRONMENT AND A NUMBER OF 680 00:31:25,216 --> 00:31:26,717 SOCIOECONOMIC FACTORS AS WELL. 681 00:31:26,717 --> 00:31:28,452 SO IT'S A COMPLEX PICTURE. 682 00:31:28,452 --> 00:31:31,555 WE HAVE A VERY AMBITIOUS AGENDA 683 00:31:31,555 --> 00:31:37,862 THAT IS GOING TO TRY TO HELP. 684 00:31:37,862 --> 00:31:42,667 NOW THERE ARE A NUMBER OF RISK 685 00:31:42,667 --> 00:31:44,568 FACTORS THAT HAVE BEEN WELL 686 00:31:44,568 --> 00:31:46,337 ESTABLISHED FOR THE RISK OF 687 00:31:46,337 --> 00:31:48,773 CHRONIC RESPIRATORY DISEASES. 688 00:31:48,773 --> 00:31:52,076 I'M USING THE EXAMPLE OF COPD 689 00:31:52,076 --> 00:31:55,713 BECAUSE IT IS THE THIRD CAUSE OF 690 00:31:55,713 --> 00:31:59,317 DEATH WORLDWIDE. 691 00:31:59,317 --> 00:32:01,085 TOBACCO IS ACKNOWLEDGED AS AN 692 00:32:01,085 --> 00:32:04,922 IMPORTANT RISK FACTOR BUT ALSO 693 00:32:04,922 --> 00:32:09,160 EXPOSURE TO FUMES OR CHEMICALS. 694 00:32:09,160 --> 00:32:13,464 INDOOR AIR POLLUTION. 695 00:32:13,464 --> 00:32:18,002 LIFE EVENTS ARE INVOLVED IN THE 696 00:32:18,002 --> 00:32:22,406 RISK PARTICULARLY -- AND 697 00:32:22,406 --> 00:32:25,977 FREQUENT OR SEVERE INFECTIONS 698 00:32:25,977 --> 00:32:28,946 DURING CHILDHOOD AND ALSO TO A 699 00:32:28,946 --> 00:32:30,948 SMALLER EXTENT GENETIC 700 00:32:30,948 --> 00:32:34,352 CONDITIONS. 701 00:32:34,352 --> 00:32:36,787 BUT WE DON'T SEE NUTRITION AS 702 00:32:36,787 --> 00:32:39,290 LISTED AS ONE OF THE TRADITIONAL 703 00:32:39,290 --> 00:32:41,192 RISK FACTORS AND I THINK THAT IS 704 00:32:41,192 --> 00:32:43,761 WHY THIS WORKSHOP IS SO 705 00:32:43,761 --> 00:32:44,028 IMPORTANT. 706 00:32:44,028 --> 00:32:46,097 AND I'M GOING TO PRESENT THREE 707 00:32:46,097 --> 00:32:48,099 SCENARIOS WHERE WE USUALLY CAN 708 00:32:48,099 --> 00:32:50,735 SEE DIFFERENT CLASSES OF RISK 709 00:32:50,735 --> 00:32:52,403 FACTORS FOR POOR LUNG FUNCTION 710 00:32:52,403 --> 00:32:55,239 AND EVENTUALLY COPD. 711 00:32:55,239 --> 00:32:58,743 THE FIRST ONE IS FAILURE TO FULL 712 00:32:58,743 --> 00:33:00,644 LUNG GROWTH WHICH HAPPENS IN 713 00:33:00,644 --> 00:33:02,213 ADULTS AS INDICATED IN THE 714 00:33:02,213 --> 00:33:04,315 YELLOW LINE WITH THE RED ARROW 715 00:33:04,315 --> 00:33:06,984 AND THE MAIN RISK FACTORS ARE 716 00:33:06,984 --> 00:33:11,822 LOW BIRTH RATE, EARLY 717 00:33:11,822 --> 00:33:13,591 INFECTIONS, RESPIRATORY 718 00:33:13,591 --> 00:33:16,460 INFECTIONS AND SECONDHAND 719 00:33:16,460 --> 00:33:18,029 TOBACCO SMOKE AND THERE IS A 720 00:33:18,029 --> 00:33:28,539 GROWING BODY -- THAT SHOWS -- 721 00:33:29,173 --> 00:33:35,046 TIED TO NUTRITIONALLY POOR WITH 722 00:33:35,046 --> 00:33:36,280 OBTAINING LOWER LUNG FUNCTION. 723 00:33:36,280 --> 00:33:42,186 THE SECOND SCENARIO REFERS TO 724 00:33:42,186 --> 00:33:44,422 THE RAPID DECLINE IN LUNG 725 00:33:44,422 --> 00:33:53,064 FUNCTION. 726 00:33:53,064 --> 00:33:56,567 THEY HAVE A DECLINE AND WHAT HAS 727 00:33:56,567 --> 00:34:00,604 BEEN DEMONSTRATED ARE ACTIVE 728 00:34:00,604 --> 00:34:02,840 SMOKING BUT ALSO SECONDHAND 729 00:34:02,840 --> 00:34:13,651 SMOKING TO, TAM TUBERCULOSIS * D 730 00:34:13,918 --> 00:34:20,624 EVIDENCE THAT IN FLENSES. 731 00:34:20,624 --> 00:34:21,258 *. 732 00:34:21,258 --> 00:34:24,261 THE WORST CASE SCENARIO WE REFER 733 00:34:24,261 --> 00:34:27,364 TO INDIVIDUALS WHO HAVE BOTH 734 00:34:27,364 --> 00:34:28,232 PROBLEMS. 735 00:34:28,232 --> 00:34:32,570 THEY CAN ACHIEVE THE MAXIMUM 736 00:34:32,570 --> 00:34:33,938 LEVEL OF LUNG FUNCTION AND THEY 737 00:34:33,938 --> 00:34:38,309 HAVE A DECLINE AND HERE WE SEE A 738 00:34:38,309 --> 00:34:45,082 COMBINATION OF RISK FACTORS. 739 00:34:45,082 --> 00:34:47,418 ALSO POLLUTION AND SOCIAL 740 00:34:47,418 --> 00:34:49,220 DETERMINANTS OF HEALTH INCLUDING 741 00:34:49,220 --> 00:34:52,389 POVERTY AND GENDER DISPARITIES. 742 00:34:52,389 --> 00:34:53,924 AND OF COURSE NUTRITION HAS A 743 00:34:53,924 --> 00:34:59,597 LOT TO DO WITH THOSE TWO. 744 00:34:59,597 --> 00:35:03,267 NOW THE GOOD THING ABOUT COPD IS 745 00:35:03,267 --> 00:35:05,669 THAT IT'S PREVENTABLE AND THIS 746 00:35:05,669 --> 00:35:07,872 HAS BEEN RECOGNIZED BY THE WORLD 747 00:35:07,872 --> 00:35:11,108 HEALTH ORGANIZATION AND ALSO BY 748 00:35:11,108 --> 00:35:12,543 SEVERAL INTERNATIONAL SCIENTIFIC 749 00:35:12,543 --> 00:35:13,744 RESPIRATORY SOCIETIES AND 750 00:35:13,744 --> 00:35:16,647 THEREFORE THERE IS A HUGE 751 00:35:16,647 --> 00:35:20,618 OPPORTUNITY HERE FOR TO IDENTIFY 752 00:35:20,618 --> 00:35:22,753 WAYS IN WHICH -- SUCH AS 753 00:35:22,753 --> 00:35:27,925 NUTRITION CAN AFFECT CHANGE AND 754 00:35:27,925 --> 00:35:34,698 MODIFY CHANGE. 755 00:35:34,698 --> 00:35:40,070 NOW WE HAVE -- LOADS OF EXPERTS 756 00:35:40,070 --> 00:35:50,314 IN THIS ROOM. 757 00:35:51,315 --> 00:35:52,483 I DON'T SEE MY SLIDES. 758 00:35:52,483 --> 00:35:53,651 NO. 759 00:35:53,651 --> 00:35:56,053 ANTOINE, THANK YOU. 760 00:35:56,053 --> 00:35:58,589 SO THE DIFFERENT WAYS IN WHICH 761 00:35:58,589 --> 00:36:00,791 WE CAN EXAMINE THE ASSOCIATION. 762 00:36:00,791 --> 00:36:03,994 THIS IS A TRADITIONAL OR CLASSIC 763 00:36:03,994 --> 00:36:05,496 DEPICTION OF THE WAY IN WHICH 764 00:36:05,496 --> 00:36:09,133 UNHEALTHY FOODS AND MORE HEALTHY 765 00:36:09,133 --> 00:36:10,467 FOODS MIGHT INFLUENCE LUNG 766 00:36:10,467 --> 00:36:11,435 HEALTH. 767 00:36:11,435 --> 00:36:13,837 WE KNOW CERTAIN DIETARY PATTERNS 768 00:36:13,837 --> 00:36:15,806 AND FOOD CAN BE UNHEALTHY 769 00:36:15,806 --> 00:36:21,011 BECAUSE THEY CONTAIN HIGH ENERGY 770 00:36:21,011 --> 00:36:23,914 DEPS FOODS. 771 00:36:23,914 --> 00:36:26,917 PROCESSED MEATS AND LOW IN 772 00:36:26,917 --> 00:36:28,419 ANTIOXIDANTS. 773 00:36:28,419 --> 00:36:31,622 ON THE OTHER HAND DIETS THAT ARE 774 00:36:31,622 --> 00:36:34,925 RICH IN FRUITS, VEGETABLES AND 775 00:36:34,925 --> 00:36:39,563 FIBER AND ALSO REACHING 776 00:36:39,563 --> 00:36:41,098 ANTIOXIDANTS HAVE THE POTENTIAL 777 00:36:41,098 --> 00:36:43,334 TO PROTECT THE LUNGS FROM A 778 00:36:43,334 --> 00:36:45,536 NUMBER OF ENVIRONMENT AM INSULTS 779 00:36:45,536 --> 00:36:49,373 AND OF COURSE THE MOST 780 00:36:49,373 --> 00:36:50,374 TRADITIONALLY RECOGNIZED 781 00:36:50,374 --> 00:36:56,847 MECHANISMS ARE INFLAMMATION, 782 00:36:56,847 --> 00:36:58,916 OXIDATED STRESS AND DEPRESSION. 783 00:36:58,916 --> 00:37:02,686 AND THERE ARE SEVERAL OTHERS 784 00:37:02,686 --> 00:37:05,222 THAT NUTRITION CAN INFLUENCE 785 00:37:05,222 --> 00:37:15,466 THOSE. 786 00:37:15,466 --> 00:37:17,735 THERE ARE ALSO MINIMAL 787 00:37:17,735 --> 00:37:20,771 PROPERTIES OF NUTRIENTS IN 788 00:37:20,771 --> 00:37:23,407 RELATION TO LUNG HEALTH. 789 00:37:23,407 --> 00:37:25,175 MINERALS, AND VITAMINS ALL OF 790 00:37:25,175 --> 00:37:28,145 WHICH ARE GOING TO BE COVERED 791 00:37:28,145 --> 00:37:31,148 HAVE BEEN DEMONSTRATED TO HAVE A 792 00:37:31,148 --> 00:37:32,816 NUMBER OF PROPERTIES THAT CAN 793 00:37:32,816 --> 00:37:36,453 PROTECT THE AIRWAYS FROM 794 00:37:36,453 --> 00:37:38,889 OXIDATIVE STRESS AND A NUMBER OF 795 00:37:38,889 --> 00:37:41,659 OTHER INSULTS THAT CAN AFFECT 796 00:37:41,659 --> 00:37:42,726 LUNG HEALTH. 797 00:37:42,726 --> 00:37:44,928 THERE IS ALSO RECENT INTEREST IN 798 00:37:44,928 --> 00:37:48,165 UNDERSTANDING A BIT MORE THE 799 00:37:48,165 --> 00:37:52,469 AXIS AND HOW THE GUT MICROBIOME 800 00:37:52,469 --> 00:37:56,640 CAN INFLUENCE. 801 00:37:56,640 --> 00:38:01,478 NOW WHAT DO WE KNOW ABOUT THE 802 00:38:01,478 --> 00:38:02,646 EPIDEMILOGICAL RESEARCH? 803 00:38:02,646 --> 00:38:04,848 IT'S RESTRICT TO HIGH INCOME 804 00:38:04,848 --> 00:38:06,283 COUNTRIES. 805 00:38:06,283 --> 00:38:08,452 THERE IS ONE STUDY FROM THE 806 00:38:08,452 --> 00:38:11,855 EARLY 2000s THAT WAS THE FIRST 807 00:38:11,855 --> 00:38:18,228 STUDY THAT SUBJECT THAT DIETARY 808 00:38:18,228 --> 00:38:23,033 FLAVONOIDS MIGHT BE RELATED. 809 00:38:23,033 --> 00:38:27,438 WE DO KNOW FROM LONGITUDINAL 810 00:38:27,438 --> 00:38:29,106 SURVEYS THAT IT MIGHT BE 811 00:38:29,106 --> 00:38:31,241 ASSOCIATED WITH THE SLOWER 812 00:38:31,241 --> 00:38:35,112 DECLINE OF LUNG FUNCTION. 813 00:38:35,112 --> 00:38:38,816 THERE IS VERY LITTLE EVIDENCE -- 814 00:38:38,816 --> 00:38:40,918 -- PARTICULARLY FROM 815 00:38:40,918 --> 00:38:44,955 DISADVANTAGED POPULATIONS. 816 00:38:44,955 --> 00:38:47,391 COPD IS NOT AN EASY OUTCOME TO 817 00:38:47,391 --> 00:38:48,959 DEFINE SO WE HAVE SEVERAL 818 00:38:48,959 --> 00:38:51,829 CHALLENGES THERE AND OF COURSE 819 00:38:51,829 --> 00:38:53,831 WHEN WE TALK ABOUT THIS WE HAVE 820 00:38:53,831 --> 00:38:58,235 THE HUGE CHALLENGE OF HOW DO WE 821 00:38:58,235 --> 00:39:02,139 MEASURE IT. 822 00:39:02,139 --> 00:39:06,009 SO HERE I'VE SELECTED THREE 823 00:39:06,009 --> 00:39:07,378 EXAMPLES FROM OBSERVATIONAL 824 00:39:07,378 --> 00:39:09,346 STUDIES IN THE U.S. THAT ARE 825 00:39:09,346 --> 00:39:10,047 REPRESENTATIVE OF THE GENERAL 826 00:39:10,047 --> 00:39:12,616 POPULATION OF ADULTS IN THIS 827 00:39:12,616 --> 00:39:16,453 COUNTRY AND ALL OF THESE STUDIES 828 00:39:16,453 --> 00:39:19,656 HAVE EXAMINED WAYS IN WHICH DIET 829 00:39:19,656 --> 00:39:21,058 MIGHT BE ASSOCIATED. 830 00:39:21,058 --> 00:39:23,394 AND WHAT WE KNOW SO FAR FROM THE 831 00:39:23,394 --> 00:39:26,096 NATIONAL HEALTH AND NUTRITION 832 00:39:26,096 --> 00:39:27,598 EXAMINATION SURVEY AND THE 833 00:39:27,598 --> 00:39:30,601 STUDIES THAT HAVING A BEEN DIET 834 00:39:30,601 --> 00:39:34,872 QUALITY AND HIGHER INTAKE IN 835 00:39:34,872 --> 00:39:38,876 FLAVONOIDS IS ASSOCIATED WITH 836 00:39:38,876 --> 00:39:41,478 BETTER LUNG FUNCTION. 837 00:39:41,478 --> 00:39:45,916 AND ON THE OTHER HAND PROCESSED 838 00:39:45,916 --> 00:39:50,854 FOOD IS ASSOCIATED WITH LOWER 839 00:39:50,854 --> 00:39:52,156 LUNG FUNCTION. 840 00:39:52,156 --> 00:39:54,725 SPECIFIC DIETARY PATTERNS ARE 841 00:39:54,725 --> 00:40:00,664 ALSO ASSOCIATED WITH VARYING -- 842 00:40:00,664 --> 00:40:10,507 OF COPD. 843 00:40:10,507 --> 00:40:13,710 NOW THE DIFFICULTIES ASSESSING 844 00:40:13,710 --> 00:40:15,479 DIETARY INTAKE AND THIS IS A 845 00:40:15,479 --> 00:40:17,648 HUGE CHALLENGE IF WE WANT TO 846 00:40:17,648 --> 00:40:19,883 PROGRESS THE SCIENTIFIC AGENDA 847 00:40:19,883 --> 00:40:21,819 ON THE RESEARCH DEDICATED TO 848 00:40:21,819 --> 00:40:23,320 NUTRITION AND RESPIRATORY 849 00:40:23,320 --> 00:40:23,754 DISEASES. 850 00:40:23,754 --> 00:40:28,091 WE NEED TO ADDRESS THE ISSUE OF 851 00:40:28,091 --> 00:40:33,997 INTERNATIONAL COMPRABILITY. 852 00:40:33,997 --> 00:40:37,301 WE ARE ABLE TO GRADE THE 853 00:40:37,301 --> 00:40:40,270 EVIDENCE -- WE NEED TO ADDRESS A 854 00:40:40,270 --> 00:40:42,272 NUMBER OF BIASES RELATED TO THE 855 00:40:42,272 --> 00:40:45,275 COLLECTION OF DATA. DIET IS 856 00:40:45,275 --> 00:40:47,144 MULTI-CULTURAL AND SOMETIMES WE 857 00:40:47,144 --> 00:40:51,949 SEE HUGE VARIATIONS. 858 00:40:51,949 --> 00:40:55,452 AND WE NEED TO ACCOUNT FOR 859 00:40:55,452 --> 00:40:58,856 CULTURE SPECIFICITY. 860 00:40:58,856 --> 00:41:02,593 THE OLD FASHIONED METHODS REMAIN 861 00:41:02,593 --> 00:41:05,496 RELIABLE BUT WE NEED TO IMPROVE 862 00:41:05,496 --> 00:41:07,831 THE WAY IN WHICH WE MEASURE THE 863 00:41:07,831 --> 00:41:12,069 DIET AND INCREASE THE PRECIS 864 00:41:12,069 --> 00:41:14,705 PRECISIONS. 865 00:41:14,705 --> 00:41:18,141 SO ALL IN ALL THE EVIDENCE 866 00:41:18,141 --> 00:41:20,677 SUGGEST THAT WHAT WE EAT MIGHT 867 00:41:20,677 --> 00:41:24,815 BE ASSOCIATED WITH ASTHMA, LUNG 868 00:41:24,815 --> 00:41:30,153 FUNCTION AND COPD. 869 00:41:30,153 --> 00:41:32,155 THE EVIDENCE COMES PRESENT FROM 870 00:41:32,155 --> 00:41:33,123 HIGH INCOME COUNTRIES. 871 00:41:33,123 --> 00:41:35,158 WE HAVE SOME PROMISING RESULTS 872 00:41:35,158 --> 00:41:37,361 FROM SMALL INTERVENTION STUDIES 873 00:41:37,361 --> 00:41:38,595 THAT WILL BE PRESENTED LATER 874 00:41:38,595 --> 00:41:44,001 HERE AND AS WE GET INTO 875 00:41:44,001 --> 00:41:49,339 NONCOMMUNICABLE DISEASES 876 00:41:49,339 --> 00:41:55,579 INFLAMMATION IS THERE. 877 00:41:55,579 --> 00:41:58,482 I'M GOING TO FINISH WITH THE KEY 878 00:41:58,482 --> 00:41:59,116 OBJECTIVES. 879 00:41:59,116 --> 00:42:02,553 AS I SAID BEFORE WE HAVE AN 880 00:42:02,553 --> 00:42:05,455 AMBITIOUS AGENDA BUT WE HOPE TO 881 00:42:05,455 --> 00:42:08,258 ACHIEVE SEVERAL KEY AIMS. 882 00:42:08,258 --> 00:42:10,060 LEVERAGE LARGE POPULATION COHORT 883 00:42:10,060 --> 00:42:12,296 STUDIES AND EVIDENCE TO 884 00:42:12,296 --> 00:42:13,830 UNDERSTAND THE IMPACT OF 885 00:42:13,830 --> 00:42:15,832 NUTRITION AND DIET IN THE 886 00:42:15,832 --> 00:42:18,435 PREVALENCE OF RESPIRATORY 887 00:42:18,435 --> 00:42:19,303 DISEASES. 888 00:42:19,303 --> 00:42:22,606 EXAMINE THE IMPACT OF CLIMATE 889 00:42:22,606 --> 00:42:25,842 CHANGE ON FOOD SYSTEMS AND 890 00:42:25,842 --> 00:42:26,109 SECURITY. 891 00:42:26,109 --> 00:42:27,945 WE'RE GOING TO DISCUSS 892 00:42:27,945 --> 00:42:29,913 MECHANISMS FOR WHICH NUTRITION 893 00:42:29,913 --> 00:42:31,048 MIGHT INFLUENCE RESPIRATORY 894 00:42:31,048 --> 00:42:31,582 HEALTH. 895 00:42:31,582 --> 00:42:36,453 WE'RE GOING TO PRESENT PRESSURES 896 00:42:36,453 --> 00:42:39,623 TO IMPROVE THE WAY IN WHICH WE 897 00:42:39,623 --> 00:42:41,325 MEASURE NUTRITION IN THE GENERAL 898 00:42:41,325 --> 00:42:44,661 POPULATION AND WE'RE GOING TO 899 00:42:44,661 --> 00:42:48,966 DISCUSS THE EVIDENCE -- DIETARY 900 00:42:48,966 --> 00:42:50,500 EXAMINATIONS THAT CAN EXAMINE 901 00:42:50,500 --> 00:42:54,137 THE ROLES OF VARIOUS 902 00:42:54,137 --> 00:42:55,005 OPPORTUNITIES. 903 00:42:55,005 --> 00:42:57,341 WE'RE GOING TO IDENTIFY CRITICAL 904 00:42:57,341 --> 00:43:00,310 RESEARCH GAPS, CHALLENGES, 905 00:43:00,310 --> 00:43:01,011 OPPORTUNITIES AND KEY RESEARCH 906 00:43:01,011 --> 00:43:03,780 QUESTIONS THAT CAN INFORM THE 907 00:43:03,780 --> 00:43:05,916 FUTURE SCIENTIFIC RESEARCH 908 00:43:05,916 --> 00:43:08,518 AGENDA AT THE NATIONAL HEALTH 909 00:43:08,518 --> 00:43:08,785 INSTITUTE. 910 00:43:08,785 --> 00:43:09,686 THANK YOU. 911 00:43:09,686 --> 00:43:12,889 AND WITH THAT I'M GOING TO OPEN 912 00:43:12,889 --> 00:43:14,224 THE FIRST SECTION OF THIS 913 00:43:14,224 --> 00:43:16,660 WORKSHOP AND I ABSOLUTELY AM 914 00:43:16,660 --> 00:43:20,297 DELIGHTED TO INTRODUCE OUR TWO 915 00:43:20,297 --> 00:43:22,499 CO-MODERATORS. 916 00:43:22,499 --> 00:43:24,368 AND I'M VERY GRATEFUL THAT 917 00:43:24,368 --> 00:43:28,238 THEY'VE AGREED TO SERVE AND 918 00:43:28,238 --> 00:43:31,308 PARTICIPATE IN THIS WORKSHOP. 919 00:43:31,308 --> 00:43:41,718 WE HAVE CARLOS CAMARGO. 920 00:43:55,432 --> 00:43:58,268 HE IS AN INTERNATIONAL EXPERT IN 921 00:43:58,268 --> 00:44:00,137 RESPIRATORY AND ALLERGY 922 00:44:00,137 --> 00:44:02,272 EMERGENCY MEDICINE, HEALTH 923 00:44:02,272 --> 00:44:04,908 EFFECTS OF VITAMIN D AND A 924 00:44:04,908 --> 00:44:06,977 VARIETY OF OTHER PUBLIC HEALTH 925 00:44:06,977 --> 00:44:07,210 ISSUES. 926 00:44:07,210 --> 00:44:11,148 WE ALSO HAVE DR. EMILY BRIGHAM, 927 00:44:11,148 --> 00:44:13,817 AN ASSOCIATE PROFESSOR AT THE 928 00:44:13,817 --> 00:44:15,485 UNIVERSITY OF BRITISH COLUMBIA. 929 00:44:15,485 --> 00:44:20,390 SHE IS A RESEARCH SCIENTIST AS 930 00:44:20,390 --> 00:44:24,795 WELL AS A PRACTICING RESPIRATORY 931 00:44:24,795 --> 00:44:25,962 DOCTOR. 932 00:44:25,962 --> 00:44:27,964 SHE HE HAD HER PROFESSIONAL 933 00:44:27,964 --> 00:44:33,837 DEGREE AT THE JOHNS HOPKINS 934 00:44:33,837 --> 00:44:44,181 SCHOOL OF MEDICINE. 935 00:44:49,553 --> 00:44:51,822 THANK YOU. 936 00:44:51,822 --> 00:44:55,559 >> THANK YOU, VANESSA. 937 00:44:55,559 --> 00:44:57,994 AND THANK YOU ALSO TO NHLBI 938 00:44:57,994 --> 00:44:59,262 FOR PUTTING TOGETHER THIS 939 00:44:59,262 --> 00:45:00,097 WORKSHOP. 940 00:45:00,097 --> 00:45:03,300 WE'LL START WITH THE FIRST 941 00:45:03,300 --> 00:45:07,370 SESSION WHAT IS THE AIM OF THIS 942 00:45:07,370 --> 00:45:07,604 SESSION? 943 00:45:07,604 --> 00:45:09,306 THE KEY QUESTION? 944 00:45:09,306 --> 00:45:13,810 SESSION ONE IS GOING TO FOCUS ON 945 00:45:13,810 --> 00:45:19,850 THE EPIDEMILOGICAL EVIDENCE. 946 00:45:19,850 --> 00:45:23,587 AND VERY IMPORTANT IN ADULTS. 947 00:45:23,587 --> 00:45:26,356 WE'RE GOING TO FOCUS ON ADULTS. 948 00:45:26,356 --> 00:45:28,692 WE MAY BRING UPDATE A FROM 949 00:45:28,692 --> 00:45:31,828 CHILDREN BUT THE FOCUS IS ON 950 00:45:31,828 --> 00:45:32,796 ADULTS. 951 00:45:32,796 --> 00:45:35,132 ALSO EMPHASIZE VULNERABLE 952 00:45:35,132 --> 00:45:38,301 POPULATIONS. 953 00:45:38,301 --> 00:45:44,007 THE KEY QUESTION FROM NHLBI IS 954 00:45:44,007 --> 00:45:45,342 THERE ADEQUATE EVIDENCE 955 00:45:45,342 --> 00:45:48,345 SUPPORTING THE ROLE OF DIET AND 956 00:45:48,345 --> 00:45:50,013 NUTRITION WHICH RAISES THE 957 00:45:50,013 --> 00:45:51,481 QUESTION ADEQUATE FOR WHAT? 958 00:45:51,481 --> 00:45:53,583 AND AGAIN YOU'VE HEARD FROM THE 959 00:45:53,583 --> 00:45:54,317 PREVIOUS SPEAKERS. 960 00:45:54,317 --> 00:45:56,787 THE ANSWER TO THIS IS I BELIEF 961 00:45:56,787 --> 00:45:58,688 ADEQUATE TO JUSTIFY FURTHER 962 00:45:58,688 --> 00:45:59,890 RESEARCH. 963 00:45:59,890 --> 00:46:02,125 WHICH IN TURN MAY LEAD TO 964 00:46:02,125 --> 00:46:04,561 CLINICAL PRACTICE CHANGES AND 965 00:46:04,561 --> 00:46:06,329 WHICH HAPPENS ONE DAY MAY LEAD 966 00:46:06,329 --> 00:46:09,299 TO CHANGES IN HEALTH POLICY BUT 967 00:46:09,299 --> 00:46:11,168 EVERYTHING HERE IN THE WORKSHOP 968 00:46:11,168 --> 00:46:13,837 IS FOCUSING ON GAPS, RESEARCH 969 00:46:13,837 --> 00:46:15,272 QUESTIONS AND SO, THAT IS OUR 970 00:46:15,272 --> 00:46:15,806 FOCUS. 971 00:46:15,806 --> 00:46:18,475 AS STATED BY THE NHLBI THE 972 00:46:18,475 --> 00:46:21,211 OVER-ALL GOAL IS TO IDENTIFY KEY 973 00:46:21,211 --> 00:46:22,546 RESEARCH QUESTIONS THAT CAN BE 974 00:46:22,546 --> 00:46:24,548 ADDRESSED TO ADVANCE NUTRITION 975 00:46:24,548 --> 00:46:26,883 RESEARCH TO PROMOTE RESPIRATORY 976 00:46:26,883 --> 00:46:29,753 HEALTH AND DISEASE, PREVENTION 977 00:46:29,753 --> 00:46:31,421 AND MANAGEMENT IN ADULTS. 978 00:46:31,421 --> 00:46:33,824 I'M GOING TO SKIP DETAILED 979 00:46:33,824 --> 00:46:35,792 SPEAKER INTRODUCTIONS. 980 00:46:35,792 --> 00:46:38,028 WE ENCOURAGE YOU TO LOOK AT THE 981 00:46:38,028 --> 00:46:40,030 SPEAKER BIOS THAT ARE AVAILABLE 982 00:46:40,030 --> 00:46:41,431 ON THE WEBSITE. 983 00:46:41,431 --> 00:46:43,567 AND WITH THAT I'LL STOP TALKING 984 00:46:43,567 --> 00:46:46,436 AND EMILY WILL INTRODUCE THE 985 00:46:46,436 --> 00:46:48,338 FIRST OF OUR SPEAKERS. 986 00:46:48,338 --> 00:46:51,074 >> THANK YOU, DR. CAMARGO. 987 00:46:51,074 --> 00:46:53,810 I HAVE THE PLEASURE OF DOING A 988 00:46:53,810 --> 00:46:56,913 BRIEF INTRODUCTION FOR DR. JUAN 989 00:46:56,913 --> 00:47:00,884 CELEDON. 990 00:47:00,884 --> 00:47:02,786 AND TODAY HE WILL BE SPEAKING TO 991 00:47:02,786 --> 00:47:04,120 US ABOUT EVIDENCE AND THE 992 00:47:04,120 --> 00:47:05,822 RELATIONSHIP BETWEEN DIETARY 993 00:47:05,822 --> 00:47:06,957 PATTERNS AND HEALTH. 994 00:47:06,957 --> 00:47:09,526 THANK YOU, DR. CELEDON. 995 00:47:09,526 --> 00:47:10,427 >> THANK YOU. 996 00:47:10,427 --> 00:47:13,964 I WANT TO THANK THE NHLBI FOR 997 00:47:13,964 --> 00:47:20,637 THEIR KIND INVITATION. 998 00:47:20,637 --> 00:47:26,142 SO AS YOU KNOW ASTHMA IS A 999 00:47:26,142 --> 00:47:28,111 COMMON DISEASE. 1000 00:47:28,111 --> 00:47:31,214 IT AFFECTS ABOUT 260 MILLION 1001 00:47:31,214 --> 00:47:33,850 PEOPLE GLOBALLY AND IN THE U.S. 1002 00:47:33,850 --> 00:47:37,287 19 MILLION ADULTS WHICH IS WHY 1003 00:47:37,287 --> 00:47:39,990 WE'RE DISCUSSING THIS. 1004 00:47:39,990 --> 00:47:44,728 IT POSES ENORMOUS COSTS TO OUR 1005 00:47:44,728 --> 00:47:46,396 HEALTH CARE SYSTEM. 1006 00:47:46,396 --> 00:47:50,300 $81 BILLION A YEAR. 1007 00:47:50,300 --> 00:47:53,169 CHARACTERIZED BY INFLAMMATION, 1008 00:47:53,169 --> 00:47:55,272 HYPER REACTION ACTIVITY AND 1009 00:47:55,272 --> 00:47:57,407 OBSTRUCTION THAT IS OFTEN BUT 1010 00:47:57,407 --> 00:48:03,613 NOT ALWAYS REVERSIBLE. 1011 00:48:03,613 --> 00:48:06,483 THIS IS A SLIDE TO SHOW HOW THE 1012 00:48:06,483 --> 00:48:08,818 PREVALENCE OF ASTHMA INCREASED 1013 00:48:08,818 --> 00:48:13,823 FROM A PERIOD THAT WAS STARTED 1014 00:48:13,823 --> 00:48:18,194 IN THE 1960 UNTIL THE 1990s 1015 00:48:18,194 --> 00:48:21,665 LOW AND MEDIAN INCOME COUNTRIES. 1016 00:48:21,665 --> 00:48:25,735 BUT THE PURPOSE IS THAT IT IS 1017 00:48:25,735 --> 00:48:28,605 IMPOSSIBLE TO ATTRIBUTE THIS TO 1018 00:48:28,605 --> 00:48:31,775 GENETICS ALONE. 1019 00:48:31,775 --> 00:48:34,678 SO SOMETHING HAD TO CHANGE IN 1020 00:48:34,678 --> 00:48:40,116 OUR LIFESTYLE AND ENVIRONMENT. 1021 00:48:40,116 --> 00:48:42,686 AND I WOULD POSE THAT ONE OF THE 1022 00:48:42,686 --> 00:48:44,688 MOST DRAMATIC CHANGES IS THE 1023 00:48:44,688 --> 00:48:47,324 ADOPTION OF A DIET THAT OFTEN 1024 00:48:47,324 --> 00:48:49,326 INCLUDES HIGHLY PROCESSED FOODS 1025 00:48:49,326 --> 00:48:52,963 AND REDUCED CONSUMPTION OF 1026 00:48:52,963 --> 00:48:55,832 FRUITS AND VEGETABLES AND THIS 1027 00:48:55,832 --> 00:48:59,069 PAY EXPLAIN THE ASTHMA EPIDEMIC 1028 00:48:59,069 --> 00:49:01,204 IN COUNTRIES WITH SO-CALLED 1029 00:49:01,204 --> 00:49:04,941 WESTERN LIFESTYLES. 1030 00:49:04,941 --> 00:49:08,912 SO I WOULD MENTION ONE SLIDE FOR 1031 00:49:08,912 --> 00:49:12,282 THE KIDS. 1032 00:49:12,282 --> 00:49:14,284 THIS IS FROM MY COLLEAGUE IN 1033 00:49:14,284 --> 00:49:18,421 SPAIN. 1034 00:49:18,421 --> 00:49:24,995 COMPARING THE MEDITERRANEAN 1035 00:49:24,995 --> 00:49:25,762 DIET. 1036 00:49:25,762 --> 00:49:29,099 RESULTED IN 15% DECREASED ODDS 1037 00:49:29,099 --> 00:49:33,236 OF ASTHMA IN CHILDREN. 1038 00:49:33,236 --> 00:49:36,473 SO IN ADULTS WE CONDUCTED THE 1039 00:49:36,473 --> 00:49:42,712 STUDY IN THE NATIONAL HEALTH AND 1040 00:49:42,712 --> 00:49:45,382 EXAMINATION. 1041 00:49:45,382 --> 00:49:48,251 IT'S CALCULATED BY NUTRIENT 1042 00:49:48,251 --> 00:49:48,785 INTAKE. 1043 00:49:48,785 --> 00:49:52,389 IT WAS NORMALIZED. 1044 00:49:52,389 --> 00:49:55,458 TO ACCOUNT FOR TOTAL ENERGY 1045 00:49:55,458 --> 00:49:56,159 INTAKE. 1046 00:49:56,159 --> 00:50:00,497 THIS WAS A CROSS-SECTIONAL 1047 00:50:00,497 --> 00:50:10,607 STUDY. 1048 00:50:12,876 --> 00:50:21,818 WE CONDUCTED ANALYSIS AND THREE 1049 00:50:21,818 --> 00:50:25,221 OUTCOMES. 1050 00:50:25,221 --> 00:50:28,091 SO WHAT -- THIS IS THE GIST OF 1051 00:50:28,091 --> 00:50:32,996 THE PAPER. 1052 00:50:32,996 --> 00:50:34,998 WE FOUND THAT THERE WAS 1053 00:50:34,998 --> 00:50:37,000 MODIFICATION OF THE ESTIMATED 1054 00:50:37,000 --> 00:50:42,305 EFFECTS OF THE D II SCORE BY THE 1055 00:50:42,305 --> 00:50:49,879 FRACTIONAL -- OXIDE -- AIRWAY 1056 00:50:49,879 --> 00:50:52,415 INFLAMMATION. 1057 00:50:52,415 --> 00:50:53,850 SO IT WAS INTERESTING IN 1058 00:50:53,850 --> 00:50:57,587 CHILDREN THAT THE D II WAS 1059 00:50:57,587 --> 00:51:01,758 ASSOCIATED WITH -- ONLY IN 1060 00:51:01,758 --> 00:51:06,496 CHILDREN WITH A HIGH FENO WHO 1061 00:51:06,496 --> 00:51:09,732 PROBABLY HAVE -- ASTHMA. 1062 00:51:09,732 --> 00:51:13,436 WHEREAS FOR ADULTS WE OBSERVE AN 1063 00:51:13,436 --> 00:51:15,105 ASSOCIATION BETWEEN THE HIGHEST 1064 00:51:15,105 --> 00:51:20,176 -- D II IN BOTH ADULTS WITH LOW 1065 00:51:20,176 --> 00:51:25,415 AND HIGHER FENO. 1066 00:51:25,415 --> 00:51:28,118 WE ALSO FOUND THAT THE D II WAS 1067 00:51:28,118 --> 00:51:34,090 ASSOCIATED WITH REDUCED -- 1068 00:51:34,090 --> 00:51:37,060 FUNCTIONS AND ALSO FBC IN THE 1069 00:51:37,060 --> 00:51:39,596 ANALYSIS INCLUDING ALL 1070 00:51:39,596 --> 00:51:41,030 PARTICIPATING ADULTS. 1071 00:51:41,030 --> 00:51:45,768 IF YOU STRATIFY BY CONTROLS 1072 00:51:45,768 --> 00:51:48,304 VERSUS SUBJECTS WITH ASTHMA IT 1073 00:51:48,304 --> 00:51:50,640 WAS ONLY SIGNIFICANT IN CONTROLS 1074 00:51:50,640 --> 00:51:54,377 BECAUSE WE THINK THE SAMPLE SIZE 1075 00:51:54,377 --> 00:52:00,150 WAS MUCH MORE CONTROLLED. 1076 00:52:00,150 --> 00:52:03,319 WE DID NOT FIND ASSOCIATION WITH 1077 00:52:03,319 --> 00:52:06,422 ASTHMA DEFINED AS PHYSICIAN 1078 00:52:06,422 --> 00:52:09,726 DIAGNOSED ASTHMA. 1079 00:52:09,726 --> 00:52:17,634 IN EITHER CHILDREN OR ADULTS. 1080 00:52:17,634 --> 00:52:22,572 NOW I MUST MENTION BECAUSE THIS 1081 00:52:22,572 --> 00:52:25,608 IS THE CRUX OF MY RESEARCH. 1082 00:52:25,608 --> 00:52:28,278 ASTHMA IS NOT AN EQUAL 1083 00:52:28,278 --> 00:52:29,712 OPPORTUNITY DISEASE. 1084 00:52:29,712 --> 00:52:33,216 IN THIS NATION NONHISPANIC 1085 00:52:33,216 --> 00:52:39,055 BLACKS, AMERICAN INDIANS AND 1086 00:52:39,055 --> 00:52:42,158 ALASKANS HAVE A HIGHER 1087 00:52:42,158 --> 00:52:44,994 PREVALENCE OF ASTHMA. 1088 00:52:44,994 --> 00:52:48,198 A COMMON ERROR IS MADE IS TO 1089 00:52:48,198 --> 00:52:50,967 CONSIDER HISPANICS AS A 1090 00:52:50,967 --> 00:52:54,337 MONOLITHIC GROUP. 1091 00:52:54,337 --> 00:52:58,374 BUT THIS IS A FALLACY. 1092 00:52:58,374 --> 00:53:01,811 ONCE YOU DECOMPOSE HISPANICS 1093 00:53:01,811 --> 00:53:04,247 INTO SUBGROUPS A COMPLETE 1094 00:53:04,247 --> 00:53:06,015 DIFFERENT PICTURE EMERGES. 1095 00:53:06,015 --> 00:53:10,620 THIS IS DATA AND ONCE YOU DO 1096 00:53:10,620 --> 00:53:13,823 THAT AND YOU LOOK AT ADJUSTED 1097 00:53:13,823 --> 00:53:16,125 PREVALENCE OF ASTHMA PUERTO 1098 00:53:16,125 --> 00:53:18,461 RICANS HAVE FIVE TIMES MORE 1099 00:53:18,461 --> 00:53:21,331 PREVALENCE OF ASTHMA THAN 1100 00:53:21,331 --> 00:53:24,834 MEXICANS. 1101 00:53:24,834 --> 00:53:27,403 WHEREAS MEXICANS HAVE LOWER 1102 00:53:27,403 --> 00:53:35,812 BURDEN OF ASTHMA. 1103 00:53:35,812 --> 00:53:43,987 THIS ALSO IS -- MORBIDITY. 1104 00:53:43,987 --> 00:53:45,054 COMPARING PUERTO RICANS TO OTHER 1105 00:53:45,054 --> 00:53:47,156 HISPANIC OR LATINO ADULTS AND 1106 00:53:47,156 --> 00:53:50,059 THEY HIGHER HEALTH CARE USE 1107 00:53:50,059 --> 00:53:51,894 HIGHER SHOP. 1108 00:53:51,894 --> 00:54:02,405 SITUATIONS -- VISITS, USE OF 1109 00:54:02,405 --> 00:54:03,606 SYSTEMIC STEROIDS. 1110 00:54:03,606 --> 00:54:08,211 NOW WE ALSO LOOK AT THE D II 1111 00:54:08,211 --> 00:54:11,114 AMONG HISPANIC ADULTS IN SOL. 1112 00:54:11,114 --> 00:54:14,417 AGAIN WE USED ENERGY ADJUSTED D 1113 00:54:14,417 --> 00:54:15,151 II. 1114 00:54:15,151 --> 00:54:20,123 ALSO ANOTHER DIETARY INDEX -- 1115 00:54:20,123 --> 00:54:25,628 HEALTHY EATING INDEX AND HERE WE 1116 00:54:25,628 --> 00:54:30,166 INCLUDED 12,687 LATINO ADULTS 1117 00:54:30,166 --> 00:54:39,008 AGE 18-76 YEARS. 1118 00:54:39,008 --> 00:54:42,312 AND THIS IS -- THESE ARE THE 1119 00:54:42,312 --> 00:54:42,979 MAIN FINDINGS. 1120 00:54:42,979 --> 00:54:45,315 AFTER ADJUSTING FOR THE SUB 1121 00:54:45,315 --> 00:54:47,183 GROUP THE D II WAS ASSOCIATED 1122 00:54:47,183 --> 00:54:52,588 WITH A HIGHER RISK OF ASTHMA -- 1123 00:54:52,588 --> 00:54:55,358 AND FOR ALL CORE TILES ABOVE THE 1124 00:54:55,358 --> 00:54:57,260 LOWESTS ASSOCIATED WITH HIGH 1125 00:54:57,260 --> 00:55:00,096 RISK OF ASTHMA SYMPTOMS. 1126 00:55:00,096 --> 00:55:02,965 THE OTHER DIETARY INDEX 1127 00:55:02,965 --> 00:55:05,468 INDICATING HIGHER DIETARY 1128 00:55:05,468 --> 00:55:07,136 QUALITY WAS NOT ASSOCIATED WITH 1129 00:55:07,136 --> 00:55:11,941 ASTHMA SYMPTOMS. 1130 00:55:11,941 --> 00:55:15,044 WE ALSO FOUND THAT IN FACT THE D 1131 00:55:15,044 --> 00:55:22,051 II WAS ASSOCIATED WITH LOWER 1132 00:55:22,051 --> 00:55:24,987 FVB1. 1133 00:55:24,987 --> 00:55:33,830 WITH SINGULAR -- ASTHMATICS. 1134 00:55:33,830 --> 00:55:37,934 AN THE OTHER INDEX THE AHEI WAS 1135 00:55:37,934 --> 00:55:48,511 ASSOCIATED WITH HIGHER -- THIS 1136 00:55:48,911 --> 00:55:52,415 IS A SUMMARY SLIDE. 1137 00:55:52,415 --> 00:56:02,925 THE HIGHER -- WAS ASSOCIATED. 1138 00:56:08,364 --> 00:56:10,633 WE WOULD HAVE LOVED TO LOOK AT 1139 00:56:10,633 --> 00:56:14,303 THIS IN A SPECIFIC SUBGROUPS BUT 1140 00:56:14,303 --> 00:56:16,439 SAMPLE SIZE DID NOT ALLOW US TO 1141 00:56:16,439 --> 00:56:17,206 DO SO. 1142 00:56:17,206 --> 00:56:19,976 MORE RECENTLY WE LOOK AT 1143 00:56:19,976 --> 00:56:28,751 PROSPECTIVE DATA IN TWO STUDIES. 1144 00:56:28,751 --> 00:56:29,952 THESE ARE PUERTO RICAN YOUTH. 1145 00:56:29,952 --> 00:56:33,356 LOOKED AT A BASELINE WHEN THEY 1146 00:56:33,356 --> 00:56:36,025 WERE 6-14 AND THEN AS YOUNG 1147 00:56:36,025 --> 00:56:37,927 ADULTS ABOUT FIVE YEARS LATER 1148 00:56:37,927 --> 00:56:41,130 AND IN THIS STUDY AN UNHEALTHY 1149 00:56:41,130 --> 00:56:44,901 DIET DEFINED BY A SCORE THAT WE 1150 00:56:44,901 --> 00:56:49,939 PREVIOUSLY PRESENTED -- WAS 1151 00:56:49,939 --> 00:56:53,242 ASSOCIATED WITH HIGHER RISK OF 1152 00:56:53,242 --> 00:56:58,347 ASTHMA AND HIGHER RISK OF SEVERE 1153 00:56:58,347 --> 00:57:04,220 ASTHMA. 1154 00:57:04,220 --> 00:57:06,656 SO AGAIN WHAT I SHOWED YOU 1155 00:57:06,656 --> 00:57:06,889 BEFORE. 1156 00:57:06,889 --> 00:57:09,425 AN UNHEALTHY DIET WAS ASSOCIATED 1157 00:57:09,425 --> 00:57:14,096 WITH INCREASED ODDS' PERSISTING 1158 00:57:14,096 --> 00:57:17,166 ASTHMA 9-20. 1159 00:57:17,166 --> 00:57:19,469 THERE WAS NO ASSOCIATION BUT THE 1160 00:57:19,469 --> 00:57:24,273 SAMPLE SIZE WAS SMALL. 1161 00:57:24,273 --> 00:57:26,909 SO TOGETHER WITH RESULTS FROM 1162 00:57:26,909 --> 00:57:30,580 THE STUDIES OUR FINDINGS SUPPORT 1163 00:57:30,580 --> 00:57:33,115 HEALTH POLICIES PROMOTING A 1164 00:57:33,115 --> 00:57:36,953 HEALTHY DIET. 1165 00:57:36,953 --> 00:57:39,155 SO THIS IS SOMETHING THAT WILL 1166 00:57:39,155 --> 00:57:40,723 BE DISCUSSED IN DEPTH BY OUR 1167 00:57:40,723 --> 00:57:46,729 NEXT SPEAKERS. 1168 00:57:46,729 --> 00:57:49,532 THERE ARE SOME HIGH RISK 1169 00:57:49,532 --> 00:57:51,000 POPULATIONS THAT MAY BENEFIT 1170 00:57:51,000 --> 00:57:53,002 THAT MAY INCLUDE THOSE EXPOSED 1171 00:57:53,002 --> 00:57:57,340 TO HIGH LEVELS OF POLLUTANTS, 1172 00:57:57,340 --> 00:57:58,975 SMOKERS. 1173 00:57:58,975 --> 00:58:01,511 AND THEY MAY HAVE DIRECT OR IN 1174 00:58:01,511 --> 00:58:04,680 DIRECT EFFECTS. 1175 00:58:04,680 --> 00:58:09,852 THIS WAS ELUDED BY 1176 00:58:09,852 --> 00:58:10,253 DR. GARCIA-LARSEN. 1177 00:58:10,253 --> 00:58:13,923 THE EFFECTS OF ANTIOXIDANTS AND 1178 00:58:13,923 --> 00:58:24,200 INCREASED FIBER. 1179 00:58:25,902 --> 00:58:27,870 IN TERMS OF FUTURE DIRECTIONS I 1180 00:58:27,870 --> 00:58:31,140 KNOW THAT INTERVENTIONAL SITES 1181 00:58:31,140 --> 00:58:33,776 ARE GOING TO BE DISCUSSED LATER. 1182 00:58:33,776 --> 00:58:37,513 WE'RE PLANNING TO DO ANALYSIS OF 1183 00:58:37,513 --> 00:58:47,023 DIET AND ASTHMA ENDO TYPES. 1184 00:58:47,023 --> 00:58:50,560 WE'LL LOOKING AT THE 1185 00:58:50,560 --> 00:58:52,228 RELATIONSHIP AND THEN A THIRD 1186 00:58:52,228 --> 00:58:54,463 PHASE OF THE PUERTO RICAN STUDY 1187 00:58:54,463 --> 00:58:56,699 WHERE WE'RE LOOKING AT DIET AND 1188 00:58:56,699 --> 00:59:00,136 ASTHMA WHEN THE PARTICIPANTS ARE 1189 00:59:00,136 --> 00:59:01,904 21 - 29. 1190 00:59:01,904 --> 00:59:04,473 WHICH IS NHLBI FUNDED. 1191 00:59:04,473 --> 00:59:07,009 JUST TO THANK A BUNCH OF PEOPLE 1192 00:59:07,009 --> 00:59:08,711 BOTH IN OUR GROUP AND ELSEWHERE 1193 00:59:08,711 --> 00:59:11,781 AND PARTICULARLY THE NHLBI AND 1194 00:59:11,781 --> 00:59:14,984 DR. JIM KILEY WHO IS RETIRING 1195 00:59:14,984 --> 00:59:19,155 SOON AND HAS BEEN THE ONLY 1196 00:59:19,155 --> 00:59:21,057 DIRECTOR THAT I'VE KNOWN. 1197 00:59:21,057 --> 00:59:22,158 THANKS, JIM. 1198 00:59:22,158 --> 00:59:24,961 THANKS, EVERYBODY. 1199 00:59:24,961 --> 00:59:27,330 >> THANK YOU, JUAN. 1200 00:59:27,330 --> 00:59:29,231 THAT WAS EXCELLENT AND RIGHT OFF 1201 00:59:29,231 --> 00:59:30,633 SCHEDULE. 1202 00:59:30,633 --> 00:59:33,336 SO OUR NEXT SPEAKER IS 1203 00:59:33,336 --> 00:59:37,139 DR. KHOURY HANSON. 1204 00:59:37,139 --> 00:59:47,617 -- DR. CORRINE HANSON *. 1205 00:59:51,454 --> 00:59:52,254 >> ALL RIGHT. 1206 00:59:52,254 --> 00:59:53,456 NEXT SLIDE PLEASE. 1207 00:59:53,456 --> 00:59:55,524 THANK YOU, CARLOS VERY MUCH. 1208 00:59:55,524 --> 00:59:57,760 LIKE YOU MENTIONED MY TALK IS 1209 00:59:57,760 --> 01:00:01,063 GOING TO FOCUS ON FATTY ACIDS IN 1210 01:00:01,063 --> 01:00:05,901 RESPIRATORY HEALTH AND DISEASE. 1211 01:00:05,901 --> 01:00:09,305 SO AS AN OVERVIEW I HAD PLANNED 1212 01:00:09,305 --> 01:00:13,175 TO PRESENT A SUMMARY OF THE 1213 01:00:13,175 --> 01:00:14,644 EPIDEMILOGICAL EVIDENCE THAT 1214 01:00:14,644 --> 01:00:18,714 STRIKES THE IMPACT OF FATTY 1215 01:00:18,714 --> 01:00:28,157 ACIDS. 1216 01:00:28,157 --> 01:00:30,059 MOST OF THESE STUDIES THAT WILL 1217 01:00:30,059 --> 01:00:33,029 BE INCLUDED IN MY TALK TODAY 1218 01:00:33,029 --> 01:00:34,797 HAVE BEEN CONDUCTED AND 1219 01:00:34,797 --> 01:00:36,365 PUBLISHED BY THE OTHER SPEAKERS 1220 01:00:36,365 --> 01:00:38,134 THAT YOU WILL HEAR FROM AS PART 1221 01:00:38,134 --> 01:00:40,703 OF THE WORKSHOP SO I THINK IT 1222 01:00:40,703 --> 01:00:42,605 SHOWS THAT WE'VE GATHERED THE 1223 01:00:42,605 --> 01:00:44,507 GREAT MINDS OF THIS TOPIC TO 1224 01:00:44,507 --> 01:00:46,175 HAVE SOME GREAT DISCUSSION AND 1225 01:00:46,175 --> 01:00:47,209 DETERMINE THE FUTURE DIRECTION 1226 01:00:47,209 --> 01:00:48,811 OF THIS VERY IMPORTANT FIELD. 1227 01:00:48,811 --> 01:00:51,280 SO I WILL GIVE AN OVERVIEW ABOUT 1228 01:00:51,280 --> 01:00:52,948 THE CURRENT STATE OF THE SCIENCE 1229 01:00:52,948 --> 01:00:57,720 ON THIS TOPIC AND THEN TRY TO 1230 01:00:57,720 --> 01:01:01,991 SIN THEY SIZE SOME OF THE GAPS 1231 01:01:01,991 --> 01:01:04,193 *. 1232 01:01:04,193 --> 01:01:06,996 AND THE CHALLENGES. 1233 01:01:06,996 --> 01:01:08,631 ALL RIGHT. 1234 01:01:08,631 --> 01:01:11,967 LET'S START WITH POLYUNSATURATED 1235 01:01:11,967 --> 01:01:13,703 FATTY ACIDS. 1236 01:01:13,703 --> 01:01:16,272 THE ACIDS THAT MOST OF US ARE 1237 01:01:16,272 --> 01:01:18,107 FAMILIAR WITH. 1238 01:01:18,107 --> 01:01:20,910 OMEGA 3 AND OMEGA 6. 1239 01:01:20,910 --> 01:01:23,279 THEY ARE BASICALLY DEFINED AS 1240 01:01:23,279 --> 01:01:26,048 THEY ARE A FATTY ACID THAT HAS 1241 01:01:26,048 --> 01:01:29,819 TWO OR MORE CARBON TO CARBON 1242 01:01:29,819 --> 01:01:32,288 DOUBLE BONDS IN THEIR MOLECULAR 1243 01:01:32,288 --> 01:01:33,255 STRUCTURE. 1244 01:01:33,255 --> 01:01:37,259 THE CHALLENGED TO IS TO 1245 01:01:37,259 --> 01:01:38,494 DETERMINE WHETHER OR NOT THERE 1246 01:01:38,494 --> 01:01:40,796 IS ENOUGH EVIDENCE OF THE 1247 01:01:40,796 --> 01:01:45,835 RELATIONSHIP BETWEEN THESE 1248 01:01:45,835 --> 01:01:48,270 POLYUNSATURATED ACIDS AND THESE 1249 01:01:48,270 --> 01:01:49,839 DISEASE STATES IN ORDER TO 1250 01:01:49,839 --> 01:01:50,806 JUSTIFY FURTHER RESEARCH. 1251 01:01:50,806 --> 01:01:52,641 IF YOU LOOK AT THE RESEARCH THAT 1252 01:01:52,641 --> 01:01:56,679 HAS BEEN CONDUCTED IT'S FOCUSED 1253 01:01:56,679 --> 01:01:59,081 IN SEVERAL AREAS. 1254 01:01:59,081 --> 01:02:02,618 ASTHMA IS THE MOST WIDELY 1255 01:02:02,618 --> 01:02:05,020 STUDIED DISEASE. 1256 01:02:05,020 --> 01:02:07,089 COPD HAS BEEN STUDIED. 1257 01:02:07,089 --> 01:02:09,091 DURING THE COVID-19 PANDEMIC 1258 01:02:09,091 --> 01:02:11,527 THERE WAS AN EXPLOSION OF 1259 01:02:11,527 --> 01:02:13,763 RESEARCH ABOUT THE ROLE IN 1260 01:02:13,763 --> 01:02:16,098 COVID-19 AND THEN ALSO THE 1261 01:02:16,098 --> 01:02:16,766 ASSOCIATED DOWNSTREAM THINGS 1262 01:02:16,766 --> 01:02:20,636 THAT HAPPEN TO THOSE PEOPLE SUCH 1263 01:02:20,636 --> 01:02:23,139 AS COGNITIVE DECLINE AND 1264 01:02:23,139 --> 01:02:24,140 FATIGUE. 1265 01:02:24,140 --> 01:02:27,543 A SMALL AMOUNT OF EPIDEMILOGICAL 1266 01:02:27,543 --> 01:02:29,311 RESEARCH ON THE EFFECT OF LUNG 1267 01:02:29,311 --> 01:02:32,515 FUNCTION AND LUNG FUNCTION 1268 01:02:32,515 --> 01:02:33,749 DECLINE AND THERE HAVE BEEN A 1269 01:02:33,749 --> 01:02:38,487 COUPLE OF STUDIES THAT HAVE BEEN 1270 01:02:38,487 --> 01:02:44,059 LOOKED AT PULMONARY FIBROSIS. 1271 01:02:44,059 --> 01:02:47,596 ONE THING THAT IS MISSING IS 1272 01:02:47,596 --> 01:02:48,264 PREVENTION. 1273 01:02:48,264 --> 01:02:50,332 THERE IS MUCH LESS RESEARCH ON 1274 01:02:50,332 --> 01:02:53,235 THE PREVENTION OF LUNG DISEASE 1275 01:02:53,235 --> 01:02:56,071 WITH REGARD TO ANY FATTY ACIDS. 1276 01:02:56,071 --> 01:02:59,608 ONE THING THAT IS INTERESTING 1277 01:02:59,608 --> 01:03:02,344 THAT HAS COME TO LIGHT LIGHTLY 1278 01:03:02,344 --> 01:03:04,346 IS THAT A LOT OF THE ORIGINAL 1279 01:03:04,346 --> 01:03:08,117 RESEARCH TENDS TO LOOK AT A 1280 01:03:08,117 --> 01:03:09,819 DIRECT EFFECT. 1281 01:03:09,819 --> 01:03:11,387 EXPOSURE OUTCOME. 1282 01:03:11,387 --> 01:03:15,591 IS INTAKE OR STATUS OF POLLY 1283 01:03:15,591 --> 01:03:20,763 UNSATURDAY RATED FATTY ACIDS 1284 01:03:20,763 --> 01:03:22,498 ASSOCIATED? 1285 01:03:22,498 --> 01:03:24,867 THERE IS MORE EVIDENCE COMING TO 1286 01:03:24,867 --> 01:03:26,535 LIGHT OF IN DIRECT EFFECTS. 1287 01:03:26,535 --> 01:03:31,273 A COUPLE OF STUDIES THAT FATTY 1288 01:03:31,273 --> 01:03:33,709 ACIDS CAN MODIFY THE EFFECTS OF 1289 01:03:33,709 --> 01:03:36,045 OTHER EXPOSURES SPECIFICALLY AIR 1290 01:03:36,045 --> 01:03:40,783 POLLUTION. 1291 01:03:40,783 --> 01:03:45,821 SO FOCUSING FOR A MINUTE ON 1292 01:03:45,821 --> 01:03:46,488 ASTHMA. 1293 01:03:46,488 --> 01:03:48,724 LOOKING AT THE EPIDEMILOGICAL 1294 01:03:48,724 --> 01:03:50,626 EVIDENCE WITH REGARD TO ASTHMA I 1295 01:03:50,626 --> 01:03:52,628 THINK GIVES US A NICE PICTURE OF 1296 01:03:52,628 --> 01:03:54,396 SOME OF THE CHALLENGES THAT WE 1297 01:03:54,396 --> 01:03:57,132 FACE WHEN WE LOOK AT OTHER FATTY 1298 01:03:57,132 --> 01:03:59,134 ACIDS AND WHEN WE LOOK AT THE 1299 01:03:59,134 --> 01:04:00,703 RELATIONSHIP BETWEEN DIET AND 1300 01:04:00,703 --> 01:04:01,670 DISEASE IN GENERAL. 1301 01:04:01,670 --> 01:04:05,007 IT'S THE MOST COMMONLY STUDIED 1302 01:04:05,007 --> 01:04:07,109 OUTCOME AND THE RESULTS 1303 01:04:07,109 --> 01:04:08,978 HIGHLIGHT THE CHALLENGES. 1304 01:04:08,978 --> 01:04:11,180 SO AS PART OF THE WORKSHOP I 1305 01:04:11,180 --> 01:04:13,816 TOOK THE LAST FIVE YEARS AND 1306 01:04:13,816 --> 01:04:15,918 PULLED THE EPIDEMILOGICAL 1307 01:04:15,918 --> 01:04:17,853 STUDIES IN ADULTS THAT I COULD 1308 01:04:17,853 --> 01:04:19,521 FIND THAT DESCRIBE THE 1309 01:04:19,521 --> 01:04:21,757 RELATIONSHIP BETWEEN FATTY ACIDS 1310 01:04:21,757 --> 01:04:24,126 AND LUNG HEALTH OUTCOMES. 1311 01:04:24,126 --> 01:04:26,328 AND SO FROM IN ROUGHLY THE LAST 1312 01:04:26,328 --> 01:04:28,731 FIVE YEARS THERE HAVE BEEN 18 1313 01:04:28,731 --> 01:04:30,332 EPIDEMILOGICAL STUDIES STUDYING 1314 01:04:30,332 --> 01:04:38,507 THE RELATIONSHIP BETWE. 1315 01:04:38,507 --> 01:04:40,509 IT DOES INCLUDE A LITTLE BIT OF 1316 01:04:40,509 --> 01:04:42,211 CHILDHOOD THINGS THAT ARE 1317 01:04:42,211 --> 01:04:43,679 INTERESTING AND COULD PROBABLY 1318 01:04:43,679 --> 01:04:45,547 IMPACT THE DEVELOPMENT OF 1319 01:04:45,547 --> 01:04:46,882 DISEASE IN ADULTS. 1320 01:04:46,882 --> 01:04:50,019 IF YOU LOOK AT THOSE 18 STUDIES, 1321 01:04:50,019 --> 01:04:52,621 8 OF THEM REPORTED A DIRECT 1322 01:04:52,621 --> 01:04:56,158 POSITIVE ASSOCIATION BETWEEN 1323 01:04:56,158 --> 01:05:06,535 POLYUNSATURATED FATS. 1324 01:05:07,169 --> 01:05:09,872 BUT MORE THAN HALF OF THESE 1325 01:05:09,872 --> 01:05:13,509 STUDIES 9 REPORTED AN 1326 01:05:13,509 --> 01:05:16,845 ASSOCIATION BUT ONLY WHEN THEY 1327 01:05:16,845 --> 01:05:20,616 CONSIDERED CONSIDERED 1328 01:05:20,616 --> 01:05:21,050 MODIFICATION. 1329 01:05:21,050 --> 01:05:26,255 THERE WAS NO ASSOCIATION BETWEEN 1330 01:05:26,255 --> 01:05:27,990 PUFA AND ASTHMA. 1331 01:05:27,990 --> 01:05:29,992 ONLY AN ASSOCIATION WHEN THEY 1332 01:05:29,992 --> 01:05:32,127 LOOKED AT SPECIFIC POPULATIONS 1333 01:05:32,127 --> 01:05:34,563 AND THE RESULTSES VARIED BY MANY 1334 01:05:34,563 --> 01:05:35,197 FACTORS. 1335 01:05:35,197 --> 01:05:39,134 SO JUST WITHIN THESE NINE 1336 01:05:39,134 --> 01:05:42,237 STUDIES RESULTS VARIED BY 1337 01:05:42,237 --> 01:05:47,910 GENOTYPE. 1338 01:05:47,910 --> 01:05:51,180 SEX WAS A FACTOR. 1339 01:05:51,180 --> 01:05:53,182 VITAMIN D STATUS IMPACTED 1340 01:05:53,182 --> 01:05:54,750 WHETHER OR NOT PEOPLE WITH 1341 01:05:54,750 --> 01:06:02,291 ASTHMA WOULD SEE A BENEFIT FROM 1342 01:06:02,291 --> 01:06:08,330 POLPOLYUNSATURATED FATTY ACIDS. 1343 01:06:08,330 --> 01:06:08,530 BOLSONARO. 1344 01:06:23,712 --> 01:06:27,783 -- ONE STUDY HAD NO FINDINGS. 1345 01:06:27,783 --> 01:06:28,817 NO RELATIONSHIP, NO RELATIONSHIP 1346 01:06:28,817 --> 01:06:31,587 WITH ANY SORT OF STRATIFICATION 1347 01:06:31,587 --> 01:06:34,023 OR MODIFICATION AND ONE STUDY 1348 01:06:34,023 --> 01:06:35,157 REPORTED DIRECT ASSOCIATIONS AS 1349 01:06:35,157 --> 01:06:37,860 WELL AS THE MODIFICATION OF 1350 01:06:37,860 --> 01:06:39,194 OTHER ENVIRONMENTAL FACTORS 1351 01:06:39,194 --> 01:06:41,263 NAMELY AIR POLLUTION, SHOWING 1352 01:06:41,263 --> 01:06:43,766 THAT YOUR POLYUNSATURATED FATTY 1353 01:06:43,766 --> 01:06:46,402 ACIDS STATUS WILL IMPACT HOW YOU 1354 01:06:46,402 --> 01:06:49,471 RESPOND IF YOU'RE EXPOSED TO 1355 01:06:49,471 --> 01:06:51,373 HIGH OR LOW LEVELS OF AIR 1356 01:06:51,373 --> 01:06:52,975 POLLUTION. 1357 01:06:52,975 --> 01:07:03,719 IF WE MOVE ON TO MONTGOMERY -- N 1358 01:07:14,296 --> 01:07:16,598 STUDIED EXTENSIVELY AND THERE IS 1359 01:07:16,598 --> 01:07:19,134 EVIDENCE TO SUPPORT THE BENEFITS 1360 01:07:19,134 --> 01:07:21,136 OF MONOUNSATURATED FATTY ACIDS 1361 01:07:21,136 --> 01:07:23,605 ON CARDIOVASCULAR HEALTH DIRECT 1362 01:07:23,605 --> 01:07:26,341 EVIDENCE LINKING THIS TO 1363 01:07:26,341 --> 01:07:28,777 RESPIRATORY DISEASE IS STILL 1364 01:07:28,777 --> 01:07:29,812 VERY LIMITED. 1365 01:07:29,812 --> 01:07:31,647 I COULD FIND THREE STUDIES OVER 1366 01:07:31,647 --> 01:07:33,982 THE PAST FIVE YEARS THAT 1367 01:07:33,982 --> 01:07:35,984 EVALUATED ANY SORT OF 1368 01:07:35,984 --> 01:07:37,052 ASSOCIATION BETWEEN 1369 01:07:37,052 --> 01:07:39,421 MONOUNSATURATED FATTY ACIDS AND 1370 01:07:39,421 --> 01:07:41,323 ASTHMA AND THE RESULTS WERE 1371 01:07:41,323 --> 01:07:42,391 COMPLETELY MIXED. 1372 01:07:42,391 --> 01:07:45,027 ONE STUDY HAD NO FINDINGS. 1373 01:07:45,027 --> 01:07:47,296 ONE SHOWED A NEGATIVE EFFECT. 1374 01:07:47,296 --> 01:07:49,531 ONE STUDY SHOWED THERE WAS A 1375 01:07:49,531 --> 01:07:51,400 POSITIVE EFFECT ON ASTHMA 1376 01:07:51,400 --> 01:07:53,168 DEVELOPMENT OR ASTHMA OUTCOMES. 1377 01:07:53,168 --> 01:07:55,938 ONE THING THAT HAS BEEN UTILIZED 1378 01:07:55,938 --> 01:07:59,174 IN THE STUDIES OF 1379 01:07:59,174 --> 01:08:03,846 MONOUNSATURATED FATTY ACIDS WAS 1380 01:08:03,846 --> 01:08:04,780 METABALOMICS PROFILING AND THIS 1381 01:08:04,780 --> 01:08:07,082 COULD EXPAND OUR UNDERSTANDING 1382 01:08:07,082 --> 01:08:09,651 OF LIPIDS AS YOU CAN EVALUATE 1383 01:08:09,651 --> 01:08:12,521 THE ENTIRE LIPID PROFILE OF A 1384 01:08:12,521 --> 01:08:15,390 PERSON AS OPPOSED TO INTAKES OF 1385 01:08:15,390 --> 01:08:19,161 JUST ONE FATTY ACID. 1386 01:08:19,161 --> 01:08:21,063 WHEN YOU START TALKING ABOUT 1387 01:08:21,063 --> 01:08:23,198 DIET PATTERNS THAT MAYBE THE SUM 1388 01:08:23,198 --> 01:08:25,367 OF THE PARTS BECOMES MORE 1389 01:08:25,367 --> 01:08:28,670 IMPORTANT THAN FOCUSING ON ONE 1390 01:08:28,670 --> 01:08:29,838 INDIVIDUAL NUTRIENT AND LOOKING 1391 01:08:29,838 --> 01:08:32,641 AT THE BIG PICTURE. 1392 01:08:32,641 --> 01:08:36,945 SO USING THIS PROFILING WHERE 1393 01:08:36,945 --> 01:08:38,847 THIS WAS LOOKING AT THE 1394 01:08:38,847 --> 01:08:41,517 RELATIONSHIP OF MONOUNSATURATED 1395 01:08:41,517 --> 01:08:44,153 FATTY ACIDS -- THE METABOLIC 1396 01:08:44,153 --> 01:08:46,355 PROFILE IN COMPARISON TO OTHER 1397 01:08:46,355 --> 01:08:48,490 FATTY ACIDS THIS SHOWED THAT 1398 01:08:48,490 --> 01:08:51,360 HIGHER CONCENTRATIONS OF 1399 01:08:51,360 --> 01:08:53,362 MONOUNSATURATED FATTY ACIDS WERE 1400 01:08:53,362 --> 01:08:55,264 BENEFICIAL IN IMPROVING OUTCOMES 1401 01:08:55,264 --> 01:08:57,266 AND REDUCING INFLAMMATION AND 1402 01:08:57,266 --> 01:08:59,334 THE TWO POPULATIONS WHERE THIS 1403 01:08:59,334 --> 01:09:03,238 HAS BEEN STUDIED WERE COVID-19 1404 01:09:03,238 --> 01:09:11,980 AND PULMONARY HYPERTENSION. 1405 01:09:11,980 --> 01:09:13,882 SATURATED FATTY ACIDS HAVE BEEN 1406 01:09:13,882 --> 01:09:20,789 A BIT MORE STUDIED. 1407 01:09:20,789 --> 01:09:23,492 MOST IMPLICATED SATURATE FATTY 1408 01:09:23,492 --> 01:09:26,895 ACIDS TO AN INCREASED RISK OF 1409 01:09:26,895 --> 01:09:28,564 DISEASE BOTH WITH ASTHMA AND 1410 01:09:28,564 --> 01:09:29,665 LUNG CANCER. 1411 01:09:29,665 --> 01:09:31,900 BUT USING THE PROFILING OR 1412 01:09:31,900 --> 01:09:34,503 MACHINE LEARNING GIVES US MORE 1413 01:09:34,503 --> 01:09:40,943 INCITE AND MACHINE LEARNING HAS 1414 01:09:40,943 --> 01:09:45,414 BEEN USED TO DETERMINE THE 1415 01:09:45,414 --> 01:09:50,485 CONTRIBUTION. 1416 01:09:50,485 --> 01:10:00,729 SALTALAMACCHIA 1417 01:10:03,365 --> 01:10:07,202 AND IN THIS STUDY THAT LOOKED AT 1418 01:10:07,202 --> 01:10:12,507 ASTHMA THE MACHINE LEARNING 1419 01:10:12,507 --> 01:10:13,976 METHODOLOGY WAS ABLE TO 1420 01:10:13,976 --> 01:10:19,481 DELINEATE THE RISK AND 1421 01:10:19,481 --> 01:10:23,151 DECREASING WITH A -- A HIGHER 1422 01:10:23,151 --> 01:10:24,620 AMOUNTS OF THE SHORT CHAIN FATTY 1423 01:10:24,620 --> 01:10:26,922 ACIDS. 1424 01:10:26,922 --> 01:10:30,058 SO THE SHORT CHAIN FATTY ACIDS 1425 01:10:30,058 --> 01:10:32,361 THAT ARE SATURATED WE THINK OF 1426 01:10:32,361 --> 01:10:36,298 THESE AS BEING PRODUCED BY THE 1427 01:10:36,298 --> 01:10:39,067 GUT MICROBIOME. 1428 01:10:39,067 --> 01:10:41,603 WHAT IS INTERESTING IS THAT IT 1429 01:10:41,603 --> 01:10:45,040 APPEARS TO BE ONLY THE GUT 1430 01:10:45,040 --> 01:10:46,275 MICROBIOME THAT CONTRIBUTES TO 1431 01:10:46,275 --> 01:10:50,479 THE PRODUCTION OF THESE SHORT 1432 01:10:50,479 --> 01:10:54,683 CHAIN S.A.T. S.A.T. WITH -- 1433 01:11:09,197 --> 01:11:10,799 ONE STUDY SHOWED THERE WAS AN 1434 01:11:10,799 --> 01:11:14,236 INCREASE IN LUNG CANCER RISK DUE 1435 01:11:14,236 --> 01:11:17,873 TO HIGH SATURATED FATTY ACID 1436 01:11:17,873 --> 01:11:20,442 INTAKE IN SMOKERS BUT THIS WAS 1437 01:11:20,442 --> 01:11:23,345 NOT SEEN IN AFRICAN-AMERICANS. 1438 01:11:23,345 --> 01:11:26,782 SO IN SUMMARY TO ANSWER THE 1439 01:11:26,782 --> 01:11:29,184 QUESTION DO FATTY ACIDS HAVE THE 1440 01:11:29,184 --> 01:11:31,720 POTENTIAL TO PLAY A SIGNIFICANT 1441 01:11:31,720 --> 01:11:34,756 ROLE IN LUNG HEALTH? 1442 01:11:34,756 --> 01:11:36,224 EPIDEMILOGICAL EVIDENCE WOULD 1443 01:11:36,224 --> 01:11:39,795 SUPPORT THIS. 1444 01:11:39,795 --> 01:11:41,263 MOST OF THE EPIDEMILOGICAL 1445 01:11:41,263 --> 01:11:43,265 EVIDENCE IS AROUND 1446 01:11:43,265 --> 01:11:44,533 POLYUNSATURATED FATTY ACIDS WITH 1447 01:11:44,533 --> 01:11:46,868 THE EFFECTS OF OTHER FATTY ACIDS 1448 01:11:46,868 --> 01:11:49,071 BEING LESS UNDERSTOOD. 1449 01:11:49,071 --> 01:11:51,606 THEY APPEAR TO HAVE DIRECT 1450 01:11:51,606 --> 01:11:53,942 EFFECTS BUT HAVE THE ABILITY TO 1451 01:11:53,942 --> 01:11:57,479 MODIFY THE EFFECTS OF OTHER 1452 01:11:57,479 --> 01:11:57,813 EXPOSURES. 1453 01:11:57,813 --> 01:12:02,451 WE HAVE OTHER SPEAKERS WHO WILL 1454 01:12:02,451 --> 01:12:09,558 DELVE MORE INTO THIS. 1455 01:12:09,558 --> 01:12:16,398 THIS MAY ACCOUNT FOR SOME OF THE 1456 01:12:16,398 --> 01:12:19,768 DISCREPANCIES. 1457 01:12:19,768 --> 01:12:21,403 SO SOME OF THE KEY GAPS THAT WE 1458 01:12:21,403 --> 01:12:23,238 CAN IDENTIFY FROM THE 1459 01:12:23,238 --> 01:12:24,573 EPIDEMILOGICAL LITERATURE IS 1460 01:12:24,573 --> 01:12:27,442 AGAIN WITH THE OVER-ALL LIPID 1461 01:12:27,442 --> 01:12:28,443 DOME HAS BEEN IGNORED. 1462 01:12:28,443 --> 01:12:30,979 SOMETIMES WE FOCUS ON ONE CLASS 1463 01:12:30,979 --> 01:12:34,149 OF FATTY ACIDS BUT HOW DO THEY 1464 01:12:34,149 --> 01:12:39,354 ALL INTERACT AND THE COMPLEXITY 1465 01:12:39,354 --> 01:12:41,456 -- HOW THEY INTERACT WITH EACH 1466 01:12:41,456 --> 01:12:42,657 OTHER. 1467 01:12:42,657 --> 01:12:46,895 WHAT THE BIG PICTURE IS HAS BEEN 1468 01:12:46,895 --> 01:12:50,932 IGNORED. 1469 01:12:50,932 --> 01:12:54,002 THERE IS FAIRLY STRONG EVIDENCE 1470 01:12:54,002 --> 01:12:57,706 THAT GENETIC POLLY MORE OFISMS 1471 01:12:57,706 --> 01:12:59,441 WILL IMPACT YOUR RESPONSE. 1472 01:12:59,441 --> 01:13:04,513 THERE IS A NEED FOR DEEPER 1473 01:13:04,513 --> 01:13:05,714 INSIGHTS. 1474 01:13:05,714 --> 01:13:10,318 AND AGAIN THE RESPONDERS THE 1475 01:13:10,318 --> 01:13:11,787 NONRESPONDERS -- MAKE IT 1476 01:13:11,787 --> 01:13:14,356 DIFFICULT FOR US TO DRAW 1477 01:13:14,356 --> 01:13:16,358 GENERALIZABLE CONCLUSIONS AND 1478 01:13:16,358 --> 01:13:18,493 SUPPORT THE PATH OF PRECISION 1479 01:13:18,493 --> 01:13:22,264 NUTRITION. 1480 01:13:22,264 --> 01:13:24,199 >> SPEAKER, YOU HAVE ONE MINUTE 1481 01:13:24,199 --> 01:13:25,367 REMAINING 1482 01:13:25,367 --> 01:13:25,667 >> OKAY. 1483 01:13:25,667 --> 01:13:27,235 I HAVE COVERED MOST OF THE 1484 01:13:27,235 --> 01:13:29,504 OPPORTUNITIES. 1485 01:13:29,504 --> 01:13:33,708 PRECISION NUTRITION, THE 1486 01:13:33,708 --> 01:13:42,784 HETEROGENEITY RESPONSE. 1487 01:13:42,784 --> 01:13:45,787 AND SO THIS LEADS US TO SOME OF 1488 01:13:45,787 --> 01:13:48,857 OUR KEY RESEARCH QUESTIONS AGAIN 1489 01:13:48,857 --> 01:13:59,367 -- PERSONALIZED NUTRITION. 1490 01:13:59,768 --> 01:14:01,369 MECHANISTIC STUDIES WILL HELP US 1491 01:14:01,369 --> 01:14:03,472 UNDERSTAND HOW THE SPECIFIC 1492 01:14:03,472 --> 01:14:04,973 MECHANISMS HOW IT WORKS AND HOW 1493 01:14:04,973 --> 01:14:07,709 IT HAPPENS AND INTERVENTIONAL 1494 01:14:07,709 --> 01:14:09,077 TRIALS WILL BE IMPORTANT AS WE 1495 01:14:09,077 --> 01:14:11,079 UNDERSTAND THIS AND TAKE INTO 1496 01:14:11,079 --> 01:14:12,314 ACCOUNT THE VARIABILITY AND 1497 01:14:12,314 --> 01:14:14,416 RESPONSE AS WE DESIGN THESE 1498 01:14:14,416 --> 01:14:17,452 FUTURE TRIALS. 1499 01:14:17,452 --> 01:14:22,123 THANK YOU. 1500 01:14:22,123 --> 01:14:22,557 >> WONDERFUL. 1501 01:14:22,557 --> 01:14:27,596 THANK YOU SO MUCH DR. HANSEN. 1502 01:14:27,596 --> 01:14:29,130 WE'LL MOVE ON TO THE NEXT 1503 01:14:29,130 --> 01:14:30,232 SPEAKER FOR TIME. 1504 01:14:30,232 --> 01:14:34,636 I'M PLEASED TO INTRODUCE MY 1505 01:14:34,636 --> 01:14:37,038 CO-MODERATOR, DR. CAMARGO. 1506 01:14:37,038 --> 01:14:38,306 PROFESSOR OF EMERGENCY MEDICINE 1507 01:14:38,306 --> 01:14:41,943 AS WELL AS EPIDIMENIOLOGY AT 1508 01:14:41,943 --> 01:14:42,611 HARVARD. 1509 01:14:42,611 --> 01:14:44,279 TODAY HE WILL BE SPEAKING US TO 1510 01:14:44,279 --> 01:14:46,848 ABOUT THE RELATIONSHIP OF 1511 01:14:46,848 --> 01:14:57,225 DIETARY, ANTIOXIDANTS. 1512 01:15:00,462 --> 01:15:03,098 >> I DON'T HAVE ANY CONFLICTS TO 1513 01:15:03,098 --> 01:15:04,165 REPORT. 1514 01:15:04,165 --> 01:15:07,936 I'LL GIVE A DEFINITION OF 1515 01:15:07,936 --> 01:15:09,738 DIETARY ANTIOXIDANTS AND THEN 1516 01:15:09,738 --> 01:15:11,306 I'LL TALK ABOUT OUTCOMES AND 1517 01:15:11,306 --> 01:15:13,074 SOME OF THE OTHER SPEAKERS HAVE 1518 01:15:13,074 --> 01:15:14,309 STARTED TO INDICATE THAT THERE 1519 01:15:14,309 --> 01:15:17,078 ARE A LOT OF OUTCOMES IN 1520 01:15:17,078 --> 01:15:19,614 ADDITION TO A LOT OF EXPOSURES. 1521 01:15:19,614 --> 01:15:21,616 A ONE SLIDE SUMMARY OF WHAT IS 1522 01:15:21,616 --> 01:15:24,386 KNOWN ABOUT DIETARY ANTIOXIDANTS 1523 01:15:24,386 --> 01:15:27,489 AND ASTHMA AND THEN FOCUS ON THE 1524 01:15:27,489 --> 01:15:30,625 TWO REQUESTED SLIDES WHICH IS 1525 01:15:30,625 --> 01:15:31,426 CURRENT RESEARCH GAPS AND 1526 01:15:31,426 --> 01:15:36,064 QUESTIONS. 1527 01:15:36,064 --> 01:15:40,035 SO THE DEFINITION OF DIETARY 1528 01:15:40,035 --> 01:15:41,436 ANTIOXIDANTS. 1529 01:15:41,436 --> 01:15:43,471 IT'S A COMPOUND THAT INHIBITS 1530 01:15:43,471 --> 01:15:45,974 OXIDATION. 1531 01:15:45,974 --> 01:15:48,743 CHEMICAL REACTION THAT CAN 1532 01:15:48,743 --> 01:15:51,346 PRODUCE FREE RADICALS. 1533 01:15:51,346 --> 01:15:54,783 THE POINT THAT I WANT TO MAKE 1534 01:15:54,783 --> 01:15:58,453 WAS THAT THE DIETARIANT OX DANCE 1535 01:15:58,453 --> 01:16:01,356 CAN INCLUDE MANY DELIVER 1536 01:16:01,356 --> 01:16:03,758 DIFFERENT FORMS. 1537 01:16:03,758 --> 01:16:07,062 -- * FRESH FRUITS AND 1538 01:16:07,062 --> 01:16:09,931 VEGETABLES. 1539 01:16:09,931 --> 01:16:11,433 MICRONUTRIENTS. 1540 01:16:11,433 --> 01:16:13,835 VITAMINS, A, C AND E AND 1541 01:16:13,835 --> 01:16:15,437 REMEMBERING THERE ARE OTHER 1542 01:16:15,437 --> 01:16:18,773 TRIALS THAT LARGE AMOUNTS OF 1543 01:16:18,773 --> 01:16:21,042 SOME OF THESE HAVE THE POTENTIAL 1544 01:16:21,042 --> 01:16:22,811 TO CAUSE HARM. 1545 01:16:22,811 --> 01:16:27,849 THERE'S ALSO FIGHT OH NUTRIENTS. 1546 01:16:27,849 --> 01:16:31,353 THE FLAVONOIDS *. 1547 01:16:31,353 --> 01:16:37,292 SO AS I LOOK AT THIS BIG ARRAY 1548 01:16:37,292 --> 01:16:38,827 OF EXPOSURES ONE THING THAT I'LL 1549 01:16:38,827 --> 01:16:40,729 PUT OUT THERE FOR DISCUSSION IS 1550 01:16:40,729 --> 01:16:42,764 THAT IT SEEMS PERHAPS THE 1551 01:16:42,764 --> 01:16:45,400 EASIEST AND THAT IS IN QUOTES 1552 01:16:45,400 --> 01:16:48,103 AND SAFEST INTERVENTION WOULD BE 1553 01:16:48,103 --> 01:16:50,305 TO GIVE PEOPLE MORE FRESH FRUITS 1554 01:16:50,305 --> 01:16:52,340 AND VEGETABLES SO I'LL LEAVE YOU 1555 01:16:52,340 --> 01:16:53,041 WITH THAT THOUGHT. 1556 01:16:53,041 --> 01:16:55,276 ONE OF MY CONCERNS IN ALL OF 1557 01:16:55,276 --> 01:16:57,379 THIS NUTRITION RESEARCH IS THE 1558 01:16:57,379 --> 01:16:59,614 TENDENCY FOR US TO ENGAGE IN 1559 01:16:59,614 --> 01:17:03,351 THIS REDUCTIONISM WHERE WE KEEP 1560 01:17:03,351 --> 01:17:05,553 GOING SMALLER AND SMALLER AND WE 1561 01:17:05,553 --> 01:17:09,290 THINK WE'VE FOUND THE KEY. 1562 01:17:09,290 --> 01:17:11,726 DIETARY PATTERNS MAY BE CENTRAL 1563 01:17:11,726 --> 01:17:15,130 TO ANY EFFECT ON LUNG HEALTH. 1564 01:17:15,130 --> 01:17:18,466 WITH REGARD TO THE OUTCOME I'VE 1565 01:17:18,466 --> 01:17:20,035 ORGANIZED HERE JUST HOW COMPLEX 1566 01:17:20,035 --> 01:17:23,304 THIS CAN BE. 1567 01:17:23,304 --> 01:17:25,106 NHLBI ASKED US TO COMMENT ON 1568 01:17:25,106 --> 01:17:25,974 LUNG HEALTH. 1569 01:17:25,974 --> 01:17:28,276 THE CONCEPT OF POSITIVE HEALTH. 1570 01:17:28,276 --> 01:17:30,145 MORE THAN THE ABSENCE OF 1571 01:17:30,145 --> 01:17:30,712 DISEASE. 1572 01:17:30,712 --> 01:17:33,248 THIS IS REALLY WELL FUNCTIONING 1573 01:17:33,248 --> 01:17:34,816 LUNGS AND EVERYTHING INSIDE OF 1574 01:17:34,816 --> 01:17:35,684 THEM. 1575 01:17:35,684 --> 01:17:37,085 SO HOW DO YOU MEASURE THAT? 1576 01:17:37,085 --> 01:17:38,353 WHAT DOES THAT MEAN? 1577 01:17:38,353 --> 01:17:40,922 THIS IS A NEGLECTED AREA I THINK 1578 01:17:40,922 --> 01:17:42,991 IN PULMONARY RESEARCH. 1579 01:17:42,991 --> 01:17:44,793 BUT IT COULD BE CHARACTERIZED BY 1580 01:17:44,793 --> 01:17:50,832 MORE THAN 100% -- IT COULD BE 1581 01:17:50,832 --> 01:17:53,201 CHARACTERIZED BY SUPERIOR 1582 01:17:53,201 --> 01:17:54,736 EXERCISE PERFORMANCE. 1583 01:17:54,736 --> 01:17:56,304 THINKING ABOUT ATHLETES AND 1584 01:17:56,304 --> 01:17:58,206 THEIR LUNGS THAT ARE WORKING SO 1585 01:17:58,206 --> 01:17:59,407 WELL IN THEIR PRIME. 1586 01:17:59,407 --> 01:18:01,743 THAT IS VERY DIFFERENT THAN 1587 01:18:01,743 --> 01:18:02,711 DISEASES. 1588 01:18:02,711 --> 01:18:04,946 WHICH TENDS TO BE OUR FOCUS AND 1589 01:18:04,946 --> 01:18:07,982 HAS BEEN FOR A CENTURY OR MORE. 1590 01:18:07,982 --> 01:18:12,754 WHERE WE TALK ABOUT ASTHMA, 1591 01:18:12,754 --> 01:18:14,556 TUBERCULOSIS AND ALL OF THESE 1592 01:18:14,556 --> 01:18:17,292 DIFFERENT DISEASES AND NOT 1593 01:18:17,292 --> 01:18:19,294 HAVING THOSE DISEASES DOES NOT 1594 01:18:19,294 --> 01:18:21,162 MEAN POSITIVE HEALTH. 1595 01:18:21,162 --> 01:18:23,598 IT'S HELPING PEOPLE HAVE THE 1596 01:18:23,598 --> 01:18:25,667 HEALTHIEST LUNGS POSSIBLE. 1597 01:18:25,667 --> 01:18:27,435 SO JUST CHEW ON THAT FOR A 1598 01:18:27,435 --> 01:18:28,536 SECOND. 1599 01:18:28,536 --> 01:18:32,273 THE OTHER CONCEPT WHICH DID COME 1600 01:18:32,273 --> 01:18:35,477 UP EARLIER IS JUST A REAL 1601 01:18:35,477 --> 01:18:37,245 CRITICAL IDEA IS THAT WHAT 1602 01:18:37,245 --> 01:18:40,915 CAUSES NEW DISEASE IS THE FOCUS 1603 01:18:40,915 --> 01:18:44,452 OF PRIMARY PREVENTION MAY OR MAY 1604 01:18:44,452 --> 01:18:47,322 NOT RELATE TO WHAT AFFECTS 1605 01:18:47,322 --> 01:18:48,990 SEVERITY AND CONTROL AMONG THOSE 1606 01:18:48,990 --> 01:18:51,326 WHO HAVE THE DISEASE WHICH WE 1607 01:18:51,326 --> 01:18:53,661 CAN CALL SECONDARY PREVENTION 1608 01:18:53,661 --> 01:18:56,264 AND THERE TENDS TO BE IN THIS 1609 01:18:56,264 --> 01:18:59,701 FIELD AND I THINK IN MANY AREAS 1610 01:18:59,701 --> 01:19:02,170 AN IDEA WELL HERE IS A NUTRIENT 1611 01:19:02,170 --> 01:19:03,838 AND IT EFFECTS SOMETHING ABOUT 1612 01:19:03,838 --> 01:19:04,405 THE LUNG. 1613 01:19:04,405 --> 01:19:05,974 IS IT GOOD OR BAD? 1614 01:19:05,974 --> 01:19:08,610 IT'S SO MUCH MORE COMPLICATED. 1615 01:19:08,610 --> 01:19:11,179 YOU JUST HEARD ALL OF THE 1616 01:19:11,179 --> 01:19:12,814 POSSIBLE FATTY ACIDS AND THE 1617 01:19:12,814 --> 01:19:16,184 SAME IS TRUE FOR ANTIOXIDANTS. 1618 01:19:16,184 --> 01:19:17,886 WHAT IS THE OUTCOME? 1619 01:19:17,886 --> 01:19:20,421 EVEN IF YOU CAN AGREE ON THE 1620 01:19:20,421 --> 01:19:22,390 EXPOSURE WHAT IS THE OUTCOME. 1621 01:19:22,390 --> 01:19:26,661 IS IT LUNG HEALTH OR IS IT 1622 01:19:26,661 --> 01:19:26,895 DISEASE? 1623 01:19:26,895 --> 01:19:32,901 WHICH DID -- DISEASE AND WHEN. 1624 01:19:32,901 --> 01:19:35,303 SO WHY ANTIOXIDANTS? 1625 01:19:35,303 --> 01:19:37,872 THIS SLIDE SUMMARIZES A VERY 1626 01:19:37,872 --> 01:19:39,574 COMPLEX STORY. 1627 01:19:39,574 --> 01:19:41,309 BUT BASICALLY IF YOU'RE EXPOSED 1628 01:19:41,309 --> 01:19:45,046 TO A VARIETY OF FACTORS SUCH AS 1629 01:19:45,046 --> 01:19:49,784 SMOKING AND AIR POLLUTION YOU 1630 01:19:49,784 --> 01:19:52,520 TEND TO TILT THE OXIDATIVE 1631 01:19:52,520 --> 01:19:55,523 STRESS AND IT HAS AN ARRAY OF 1632 01:19:55,523 --> 01:19:57,659 EFFECTS ON DIFFERENT SYSTEMS 1633 01:19:57,659 --> 01:20:01,496 INCLUDING INFLAMMATION INCLUDING 1634 01:20:01,496 --> 01:20:04,799 ALL KINDS OF DOWNSTREAM 1635 01:20:04,799 --> 01:20:08,536 UNHEALTHY OUTCOMES. 1636 01:20:08,536 --> 01:20:11,206 SO BRIEFLY OXIDATIVE STRESS WE 1637 01:20:11,206 --> 01:20:16,044 DO KNOW COULD CAUSE LUNG DAMAGE 1638 01:20:16,044 --> 01:20:18,813 AND INITIATING INFLAMMATORY 1639 01:20:18,813 --> 01:20:20,582 RESPONSES. 1640 01:20:20,582 --> 01:20:23,551 BUT YOU CAN SEE THAT THE CONCEPT 1641 01:20:23,551 --> 01:20:30,692 OOF ANTIOXIDANT IS MIXED IN WITH 1642 01:20:30,692 --> 01:20:34,429 INFLAMMATION SO THE HIGH IDEA -- 1643 01:20:34,429 --> 01:20:36,231 THESE SUBSTANCES ARE AFFECTING 1644 01:20:36,231 --> 01:20:37,932 LOTS OF PATHWAYS AT THE SAME 1645 01:20:37,932 --> 01:20:38,333 TIME. 1646 01:20:38,333 --> 01:20:41,302 AND AGAIN I'M VERY CONCERNED 1647 01:20:41,302 --> 01:20:44,205 ABOUT THE TENDENCY TO REDUCE, 1648 01:20:44,205 --> 01:20:45,640 REDUCE, REDUCE INTO ONE 1649 01:20:45,640 --> 01:20:48,276 MOLECULE. 1650 01:20:48,276 --> 01:20:50,545 SO WHAT DO WE KNOW ABOUT ASTHMA? 1651 01:20:50,545 --> 01:20:52,547 THIS HAS BEEN A RESEARCH FOCUS 1652 01:20:52,547 --> 01:20:54,782 FOR ABOUT 30 PLUS YEARS. 1653 01:20:54,782 --> 01:20:57,218 AND OBSERVATIONAL STUDIES HAVE 1654 01:20:57,218 --> 01:21:00,521 IN MY OPINION PROVIDED MIXED 1655 01:21:00,521 --> 01:21:01,222 RESULTS. 1656 01:21:01,222 --> 01:21:03,491 THERE ABOUT AS MANY POSITIVE 1657 01:21:03,491 --> 01:21:05,693 STUDIES AS NULL STUDIES BUT I'VE 1658 01:21:05,693 --> 01:21:07,395 NEVER SEEN AN INDICATION THAT 1659 01:21:07,395 --> 01:21:12,033 MORE DIETARY ANTIOXIDANTS CAUSES 1660 01:21:12,033 --> 01:21:12,700 MORE HARM. 1661 01:21:12,700 --> 01:21:17,438 THERE ARE SOME DATA SHOWING 1662 01:21:17,438 --> 01:21:18,339 POTENTIAL BENEFIT WHEN MOTHERS 1663 01:21:18,339 --> 01:21:20,575 WHO ARE PREGNANT TAKE IT IN 1664 01:21:20,575 --> 01:21:22,343 TERMS OF THE RISK OF THEIR 1665 01:21:22,343 --> 01:21:24,345 CHILDREN GETTING ASTHMA BUT 1666 01:21:24,345 --> 01:21:27,148 AGAIN OUR FOCUSING ADULTS AND IN 1667 01:21:27,148 --> 01:21:31,753 MY OWN EXPERIENCE -- WE 1668 01:21:31,753 --> 01:21:34,222 CONSISTENTLY DID NOT SEE MUCH 1669 01:21:34,222 --> 01:21:35,990 RELATION BETWEEN DIETARY INTAKE 1670 01:21:35,990 --> 01:21:39,894 AND RISK OF ADULT ON SET ASTHMA. 1671 01:21:39,894 --> 01:21:43,331 THAT IS NOT TRUE FOR COPD WHICH 1672 01:21:43,331 --> 01:21:44,632 WE'LL GET TO SHORTLY. 1673 01:21:44,632 --> 01:21:47,168 WHERE I THINK THE DIETARY 1674 01:21:47,168 --> 01:21:49,804 ANTIOXIDANTS HAVE A ROLE IS A 1675 01:21:49,804 --> 01:21:52,140 THEME YOU'VE ALREADY HEARD. 1676 01:21:52,140 --> 01:21:54,575 POTENTIAL BENEFIT FOR ASTHMA 1677 01:21:54,575 --> 01:21:57,612 SEVERITY CONTROL AMONG PEOPLE 1678 01:21:57,612 --> 01:22:01,816 WITH HIGH OXIDANTS LOAD AMONG 1679 01:22:01,816 --> 01:22:02,750 SMOKERS. 1680 01:22:02,750 --> 01:22:04,953 OR HIGH LEVELS OF AIR POLLUTION. 1681 01:22:04,953 --> 01:22:10,792 ONE THAT I DO WANT TO HIGHLIGHT 1682 01:22:10,792 --> 01:22:15,096 IS ONE BY CINDY MCVOY WHERE SHE 1683 01:22:15,096 --> 01:22:18,199 AND HER TEAM GAVE VITAMIN C TO 1684 01:22:18,199 --> 01:22:20,535 PREGNANT SMOKERS DURING 1685 01:22:20,535 --> 01:22:21,803 PREGNANCY AND THEN LOOKED AT 1686 01:22:21,803 --> 01:22:23,571 WHAT HAPPENED TO THE OFFSPRING 1687 01:22:23,571 --> 01:22:28,876 AND IT SHOWED THAT INFANTS WHO 1688 01:22:28,876 --> 01:22:35,049 WERE BORN HAD BETTER P FTs AND 1689 01:22:35,049 --> 01:22:36,451 THAT IS SOME OF THE STRONGEST 1690 01:22:36,451 --> 01:22:38,886 EVIDENCE THAT I'M AWARE OF THAT 1691 01:22:38,886 --> 01:22:44,158 DIET CAN MATTER. 1692 01:22:44,158 --> 01:22:47,462 IN TERMS OF COPD THE RESEARCH 1693 01:22:47,462 --> 01:22:49,263 FOCUSES A LITTLE LESS BUT STILL 1694 01:22:49,263 --> 01:22:50,999 ABOUT TWO DECADES. 1695 01:22:50,999 --> 01:22:53,835 BOTH OF THESE TOPICS HAVE SEEMED 1696 01:22:53,835 --> 01:22:56,070 TO BE SECONDARY FOR MANY YEARS. 1697 01:22:56,070 --> 01:22:58,272 PEOPLE HAVE BEEN STUDYING IT BUT 1698 01:22:58,272 --> 01:23:01,509 NOT A MAJOR FOCUS CERTAINLY NOT 1699 01:23:01,509 --> 01:23:02,944 WITH WHAT YOU SEE WITH 1700 01:23:02,944 --> 01:23:08,916 CARDIOVASCULAR AND CANCER. 1701 01:23:08,916 --> 01:23:11,519 NO CLEAR HARM. 1702 01:23:11,519 --> 01:23:14,722 BUT NOT ONLY POTENTIAL BENEFIT 1703 01:23:14,722 --> 01:23:19,994 BUT ALSO POTENTIAL BENEFIT FOR 1704 01:23:19,994 --> 01:23:25,800 SEVESEE SEVERITY. 1705 01:23:25,800 --> 01:23:35,209 THERE ARE A FEW RCTs AND COPD. 1706 01:23:35,209 --> 01:23:38,646 ONE WAS A STUDY -- AFTER THREE 1707 01:23:38,646 --> 01:23:41,849 YEARS OF INCREASED FRUITS AND 1708 01:23:41,849 --> 01:23:46,587 VEGETABLES THEY FOUND IMPROVED 1709 01:23:46,587 --> 01:23:47,555 SPREMOTERY. 1710 01:23:47,555 --> 01:23:56,631 * NOW THE MESSAGE -- I THINK IS 1711 01:23:56,631 --> 01:23:57,465 LIKELY IF THERE IS SOMETHING 1712 01:23:57,465 --> 01:23:59,801 GOING ON YOU NEED TO GIVE IT 1713 01:23:59,801 --> 01:24:01,469 SEVERAL YEARS TO AFFECT THE 1714 01:24:01,469 --> 01:24:05,206 OUTCOMES. 1715 01:24:05,206 --> 01:24:07,041 SO WHAT ARE THE RESEARCH GAPS? 1716 01:24:07,041 --> 01:24:08,709 I WOULD SAY THERE ARE MANY 1717 01:24:08,709 --> 01:24:10,645 POSSIBLE EXPOSURES HERE. 1718 01:24:10,645 --> 01:24:12,013 MANY POSSIBLE OUTCOMES AND 1719 01:24:12,013 --> 01:24:14,649 THEREFORE MANY GAPS. 1720 01:24:14,649 --> 01:24:17,819 IF I WERE TO FOCUS ON WHAT SEEMS 1721 01:24:17,819 --> 01:24:20,488 MOST PROMISING AS WE GO FROM 1722 01:24:20,488 --> 01:24:22,924 COHORT TO NEXT RESEARCH I WOULD 1723 01:24:22,924 --> 01:24:28,162 PUT HERE USING THE PICO DESIGN. 1724 01:24:28,162 --> 01:24:29,630 ADULT SMOKERS WITH THE 1725 01:24:29,630 --> 01:24:32,600 INTERVENTION OF LOTS OF FRESH 1726 01:24:32,600 --> 01:24:34,802 FRUITS AND VEGETABLES AND THE 1727 01:24:34,802 --> 01:24:37,038 COMPARISON WOULD BE NOT GETTING 1728 01:24:37,038 --> 01:24:38,239 THAT. 1729 01:24:38,239 --> 01:24:42,944 90% EAT LESS THAN FIVE SERVINGS. 1730 01:24:42,944 --> 01:24:45,847 SO EVEN IF PEOPLE START EATING 1731 01:24:45,847 --> 01:24:48,282 FRUITS AND VEGETABLES IF YOU 1732 01:24:48,282 --> 01:24:51,252 DON'T FACILITATE IT THEY WILL 1733 01:24:51,252 --> 01:24:55,623 COME OFF OF IT SOON. 1734 01:24:55,623 --> 01:24:57,225 WHAT IS THE OUTCOME? 1735 01:24:57,225 --> 01:24:59,127 IF YOU FOCUS ON THESE 1736 01:24:59,127 --> 01:25:01,629 POPULATIONS AND INTERESTS 1737 01:25:01,629 --> 01:25:05,500 CONVENIENCES IT COULD BE A 1738 01:25:05,500 --> 01:25:07,502 CHANGE -- THERE IS EVIDENCE TO 1739 01:25:07,502 --> 01:25:09,604 SUPPORT THAT KIND OF A TRIAL FOR 1740 01:25:09,604 --> 01:25:11,606 ANY OF THOSE OUTCOMES. 1741 01:25:11,606 --> 01:25:16,043 IN TERMS OF MECHANISMS IS THE 1742 01:25:16,043 --> 01:25:19,914 ROLE OF OMICS. 1743 01:25:19,914 --> 01:25:25,820 AND WHAT IS THEIR ROLE? 1744 01:25:25,820 --> 01:25:27,822 SO I'LL CLOSE WITH KEY RESEARCH 1745 01:25:27,822 --> 01:25:31,959 QUESTIONS. 1746 01:25:31,959 --> 01:25:36,497 ARE SPECIFIC REGIMENS ASSOCIATED 1747 01:25:36,497 --> 01:25:38,166 WITH IMPROVED LUNG HEALTH? 1748 01:25:38,166 --> 01:25:40,835 AGAIN THE POSITIVE SIDE OF 1749 01:25:40,835 --> 01:25:41,335 HEALTH. 1750 01:25:41,335 --> 01:25:43,404 NOT TALKING ABOUT YOU JUST DON'T 1751 01:25:43,404 --> 01:25:46,274 HAVE DISEASE BUT YOU'RE SOMEHOW 1752 01:25:46,274 --> 01:25:47,241 BETTER. 1753 01:25:47,241 --> 01:25:49,310 YOUR LUNGS WORK BETTER. 1754 01:25:49,310 --> 01:25:53,214 WHAT IS THE OUTCOME AND THEN THE 1755 01:25:53,214 --> 01:25:54,482 CONVENTIONAL APPROACH. 1756 01:25:54,482 --> 01:25:58,452 LUNG DISEASE OR LOWER DISEASE 1757 01:25:58,452 --> 01:26:04,225 SEVERITY OR IMPROVED CONTROL. 1758 01:26:04,225 --> 01:26:06,694 I THREW OUT COPD. 1759 01:26:06,694 --> 01:26:08,229 WHAT ARE THE MECHANISMS. 1760 01:26:08,229 --> 01:26:12,200 THE OMICS HAS A LOT TO OFFER AND 1761 01:26:12,200 --> 01:26:13,234 ULTIMATELY THE BIG RESEARCH 1762 01:26:13,234 --> 01:26:17,738 QUESTION IS DO RANDOMIZED 1763 01:26:17,738 --> 01:26:28,716 CONTROLLED TRIALS SUPPORT SUPP? 1764 01:26:30,585 --> 01:26:40,695 THANK YOU. 1765 01:26:41,829 --> 01:26:43,731 >> THANK YOU SO MUCH FOR THAT 1766 01:26:43,731 --> 01:26:50,705 EXCELLENT SUMMARY. 1767 01:26:50,705 --> 01:26:52,240 MORE TO COME IN DISCUSSION. 1768 01:26:52,240 --> 01:26:56,310 I'M PLEASED TO INTRODUCE OUR 1769 01:26:56,310 --> 01:27:01,282 FINAL SPEAKER FOR SESSION ONE, 1770 01:27:01,282 --> 01:27:11,726 DR. VANESSA GARCIA-LARSEN. 1771 01:27:15,763 --> 01:27:22,436 >> THANK YOU VERY MUCH. 1772 01:27:22,436 --> 01:27:25,406 I HAVE NO CONFLICTS OF INTEREST. 1773 01:27:25,406 --> 01:27:29,110 THANK YOU. 1774 01:27:29,110 --> 01:27:39,620 SO DIETARY FLAVONOIDS AND LUNG 1775 01:27:42,390 --> 01:27:44,225 FUNCTION -- HAS BEEN AN INTEREST 1776 01:27:44,225 --> 01:27:44,992 TO ME. 1777 01:27:44,992 --> 01:27:46,327 THERE ARE PLENTY OF 1778 01:27:46,327 --> 01:27:52,600 OPPORTUNITIES TO SEE HOW 1779 01:27:52,600 --> 01:27:55,369 FLAVONOIDS COULD PREVENT CHRONIC 1780 01:27:55,369 --> 01:27:58,205 RESPIRATORY DISEASES. 1781 01:27:58,205 --> 01:28:04,045 THE FLAVONOIDS ARE A TYPE OF 1782 01:28:04,045 --> 01:28:11,952 POLLY PHENOLS. 1783 01:28:11,952 --> 01:28:13,354 THERE HAVE BEEN SEVERAL STUDIES 1784 01:28:13,354 --> 01:28:17,258 NOT THAT MANY BUT SEVERAL THAT 1785 01:28:17,258 --> 01:28:18,793 HAVE EXAMINED IF THEY ARE 1786 01:28:18,793 --> 01:28:21,228 ASSOCIATED WITH IMPROVED LUNG 1787 01:28:21,228 --> 01:28:22,897 FUNCTION AND I'M GOING TO 1788 01:28:22,897 --> 01:28:24,031 EXPLORE WHAT THE EVIDENCE TELLS 1789 01:28:24,031 --> 01:28:29,870 US SO FAR. 1790 01:28:29,870 --> 01:28:32,373 EVIDENCE HAS BEEN QUITE 1791 01:28:32,373 --> 01:28:33,874 CATEGORICAL IN TERMS OF 1792 01:28:33,874 --> 01:28:37,078 SUGGESTING VARIOUS SUB CLASSES 1793 01:28:37,078 --> 01:28:39,980 CAN PROTECT LUNG TISSUE. 1794 01:28:39,980 --> 01:28:43,751 OVERCOME EXPERIMENTAL -- COPD 1795 01:28:43,751 --> 01:28:48,289 AND ALSO ATTENUATE INFLAMMATION 1796 01:28:48,289 --> 01:28:54,695 -- A VERY INTERESTING SUB CLASS 1797 01:28:54,695 --> 01:29:03,537 OF FLAVONOIDS. 1798 01:29:03,537 --> 01:29:05,406 -- THEY CAN BE FOUND IN LUNG 1799 01:29:05,406 --> 01:29:07,208 TISSUE AND THIS IS QUITE 1800 01:29:07,208 --> 01:29:08,442 INTERESTING BECAUSE I BELIEVE 1801 01:29:08,442 --> 01:29:11,846 THERE MIGHT BE UP A STRUCTURAL 1802 01:29:11,846 --> 01:29:16,984 FUNCTIONAL ROLE. 1803 01:29:16,984 --> 01:29:21,188 WHAT DO WE KNOW SO FAR? 1804 01:29:21,188 --> 01:29:22,223 EXPERIMENTAL EVIDENCE SUPPORTS 1805 01:29:22,223 --> 01:29:26,560 THE POSSIBILITY OF SEVERAL 1806 01:29:26,560 --> 01:29:30,931 CLASSES OF FLAVONOIDS MIGHT HAVE 1807 01:29:30,931 --> 01:29:34,702 AAN A EFFECT AND THERE HAS BEENA 1808 01:29:34,702 --> 01:29:36,337 NUMBER OF SCIENTISTS LOOKING 1809 01:29:36,337 --> 01:29:39,006 INTO THE POSSIBILITY THAT 1810 01:29:39,006 --> 01:29:41,275 SPECIFIC COMPOUNDS MIGHT BE 1811 01:29:41,275 --> 01:29:43,778 INVOLVED IN IMPROVING RESPONSES 1812 01:29:43,778 --> 01:29:46,747 TO COVID-19. 1813 01:29:46,747 --> 01:29:48,616 EPIDEMILOGICAL EVIDENCE COMES 1814 01:29:48,616 --> 01:29:50,518 FROM HIGH RESOURCE SETTINGS 1815 01:29:50,518 --> 01:29:58,826 INCLUDING HIGH INCOME COUNTRIES. 1816 01:29:58,826 --> 01:30:02,696 THERE ARE SOME STUDIES -- FROM 1817 01:30:02,696 --> 01:30:07,768 NORWAY AND UK AND THE U.S. 1818 01:30:07,768 --> 01:30:10,738 BUT ONE OF THE BIGGEST PROBLEMS 1819 01:30:10,738 --> 01:30:17,344 WITH DIETARY FLAVONOIDS WE DON'T 1820 01:30:17,344 --> 01:30:20,748 KNOW HOW ACCURATELY WE'RE 1821 01:30:20,748 --> 01:30:23,717 MEASURING THEM. 1822 01:30:23,717 --> 01:30:27,555 AND WE'RE NOT CERTAIN ABOUT 1823 01:30:27,555 --> 01:30:29,590 WHETHER -- WHAT WAS CONSUMED IS 1824 01:30:29,590 --> 01:30:31,792 WHAT IS ABSORBED AND WHETHER 1825 01:30:31,792 --> 01:30:34,128 THEY ARE METABOLICALLY 1826 01:30:34,128 --> 01:30:37,865 FUNCTIONAL. 1827 01:30:37,865 --> 01:30:40,334 SO THERE ARE LOADS OF CHALLENGES 1828 01:30:40,334 --> 01:30:43,170 AROUND THAT. 1829 01:30:43,170 --> 01:30:46,607 I MENTIONED BEFORE IN MY 1830 01:30:46,607 --> 01:30:52,046 PREVIOUS TALK THE STUDY FROM THE 1831 01:30:52,046 --> 01:30:55,583 EARLY -- 2000s IN THE 1832 01:30:55,583 --> 01:30:58,052 NETHERLANDS. 1833 01:30:58,052 --> 01:31:08,963 SOME SUB CLASSES OF FLAVONO FLAS 1834 01:31:14,735 --> 01:31:20,140 -- EATING MORE WAS ASSOCIATED 1835 01:31:20,140 --> 01:31:24,445 WITH HAVING -- BETTER -- 1836 01:31:24,445 --> 01:31:34,989 COMPARED TO THOSE WHO ATE LESS. 1837 01:31:40,261 --> 01:31:43,597 I'VE PREPARED THIS SUMMARY. 1838 01:31:43,597 --> 01:31:45,466 THEY ARE NOT RELATED. 1839 01:31:45,466 --> 01:31:49,203 THEY USE DIFFERENT METHODS BUT 1840 01:31:49,203 --> 01:31:53,073 STANDARDIZED METHODS TO 1841 01:31:53,073 --> 01:31:55,042 ASCERTAIN LUNG FUNCTION. 1842 01:31:55,042 --> 01:32:01,982 THE FIRST -- LONGITUDINAL -- 1843 01:32:01,982 --> 01:32:03,350 WHICH FOLLOWED ADULTS OVER THE 1844 01:32:03,350 --> 01:32:08,656 AGE OF 65 OVER 15 YEARS AND THE 1845 01:32:08,656 --> 01:32:16,997 EUROPEAN MULTINATIONAL STUDY -- 1846 01:32:16,997 --> 01:32:22,269 -- JUST OVER 800 PARTICIPANTS. 1847 01:32:22,269 --> 01:32:27,174 INCLUDED TWO COHORTS -- AND OVER 1848 01:32:27,174 --> 01:32:37,351 400 PARTICIPANTS -- THE VETERAN 1849 01:32:37,351 --> 01:32:39,820 STUDIES -- FOLLOWED UP FOR 15 1850 01:32:39,820 --> 01:32:42,489 YEARS. 1851 01:32:42,489 --> 01:32:45,192 AND WHAT WE HAVE HERE IS THE 1852 01:32:45,192 --> 01:32:49,496 RESULTS WHEN THEY -- THEY BOTH 1853 01:32:49,496 --> 01:32:53,834 EXAMINED DIETARY INTAKE OF 1854 01:32:53,834 --> 01:32:55,536 FLAVONOIDS. 1855 01:32:55,536 --> 01:32:57,805 AND LUNG FUNCTION DATA WAS 1856 01:32:57,805 --> 01:33:08,349 STANDSTANDARDIZED. 1857 01:33:13,721 --> 01:33:14,521 I'M SUMMARIZING HERE. 1858 01:33:14,521 --> 01:33:17,424 THE VETERAN STUDY SHOWED THAT 1859 01:33:17,424 --> 01:33:21,729 THOSE -- THE MEAN ANNUAL 1860 01:33:21,729 --> 01:33:23,897 DECLINE, INDIVIDUALS WHO HAD THE 1861 01:33:23,897 --> 01:33:26,433 HIGHEST INTAKE -- WAS HIGHER 1862 01:33:26,433 --> 01:33:29,737 THAN THOSE IN THE LOWEST -- 1863 01:33:29,737 --> 01:33:38,946 TYPE. 1864 01:33:38,946 --> 01:33:41,949 AND THE RESULTS WERE CONFIRMED 1865 01:33:41,949 --> 01:33:52,326 IN THE VETERAN STUDY. 1866 01:33:52,559 --> 01:33:56,497 THEY INCLUDED OTHER DIETARY AND 1867 01:33:56,497 --> 01:34:00,934 NUTRITIONAL -- AS WELL. 1868 01:34:00,934 --> 01:34:03,504 NOW AS I SAID BEFORE ONE OF THE 1869 01:34:03,504 --> 01:34:06,707 CHALLENGES WHEN WE LOOK INTO 1870 01:34:06,707 --> 01:34:09,043 DIETARY DATA IS THE FACT THAT WE 1871 01:34:09,043 --> 01:34:13,013 NEED TO ACCOUNTS FOR HOW 1872 01:34:13,013 --> 01:34:14,982 RELIABLE THE MEASUREMENTS ARE 1873 01:34:14,982 --> 01:34:18,819 GOING TO BE. 1874 01:34:18,819 --> 01:34:23,290 WE COLLECTED -- WE DESIGNED THE 1875 01:34:23,290 --> 01:34:24,792 QUESTION THAT WAS ADMINISTERED 1876 01:34:24,792 --> 01:34:28,095 TO PARTICIPANTS ACROSS 10 1877 01:34:28,095 --> 01:34:30,664 COUNTRIES IN EUROPE AND WE 1878 01:34:30,664 --> 01:34:34,201 VALIDATED IT TO SEE IF IT WAS 1879 01:34:34,201 --> 01:34:37,604 HARMONIZED ENOUGH SO THAT WE 1880 01:34:37,604 --> 01:34:39,740 COULD EXAMINE LUNG FUNCTION AND 1881 01:34:39,740 --> 01:34:42,509 A NUMBER OF RESPIRATORY OUTCOMES 1882 01:34:42,509 --> 01:34:45,345 USING A STANDARDIZED APPROACH. 1883 01:34:45,345 --> 01:34:48,549 BUT WE WANTED TO SEE IF IT WAS 1884 01:34:48,549 --> 01:34:49,850 RELIABLE ENOUGH. 1885 01:34:49,850 --> 01:34:52,586 AND THEN SEE IF WE COULD 1886 01:34:52,586 --> 01:34:55,589 REPLICATE OR CONFIRM SOME OF THE 1887 01:34:55,589 --> 01:34:58,225 OBSERVATIONS. 1888 01:34:58,225 --> 01:35:02,963 AND WE DID AN EXERCISE TO 1889 01:35:02,963 --> 01:35:08,569 IDENTIFY MARKETS OF METABOLITES 1890 01:35:08,569 --> 01:35:11,872 AND WE OBSERVED THAT THE DIETARY 1891 01:35:11,872 --> 01:35:14,308 QUESTIONNAIRE WAS RELIABLE 1892 01:35:14,308 --> 01:35:17,411 ENOUGH TO CAPTURE THE 1893 01:35:17,411 --> 01:35:20,280 CONSUMPTION OF SEVERAL IMPORTANT 1894 01:35:20,280 --> 01:35:23,917 FLAVONOIDS AND THIS GAVE US SOME 1895 01:35:23,917 --> 01:35:29,089 REASSURE ANC THAT THE FAQ HAD TO 1896 01:35:29,089 --> 01:35:32,493 CAPTURE THE INITIAL INTAKE OF 1897 01:35:32,493 --> 01:35:38,398 FLAVONOIDS. 1898 01:35:38,398 --> 01:35:46,573 THIS TELLS US THAT WE HAVE -- 1899 01:35:46,573 --> 01:35:49,676 [ INDISCERNIBLE ] 1900 01:35:49,676 --> 01:35:53,847 AND SO WE EXAMINED VARIATIONS OF 1901 01:35:53,847 --> 01:35:56,416 DIETARY FLAVONOID INTAKE ACROSS 1902 01:35:56,416 --> 01:35:58,519 EUROPE AND WE WANTED TO SEE HOW 1903 01:35:58,519 --> 01:36:02,222 DIFFERENT OR SIMILAR THEY WERE. 1904 01:36:02,222 --> 01:36:06,326 THE SECOND SLIDE SHOWS THE TOTAL 1905 01:36:06,326 --> 01:36:08,095 NAV NOTICED TAKE ACROSS 1906 01:36:08,095 --> 01:36:09,563 COUNTRIES. 1907 01:36:09,563 --> 01:36:12,266 BETWEEN 200mg PER DAY TO 1908 01:36:12,266 --> 01:36:22,109 JUST OVER 400mg PER DAY. 1909 01:36:22,109 --> 01:36:25,245 WE TENDED TO SEE A SIMILAR TREND 1910 01:36:25,245 --> 01:36:27,347 AND THIS IS JUST TO ILLUSTRATE 1911 01:36:27,347 --> 01:36:29,249 ONE OF THE STUB CLASSES BUT WE 1912 01:36:29,249 --> 01:36:31,685 TENDED TO SEE THE SAME TREND IN 1913 01:36:31,685 --> 01:36:35,289 TERMS OF TOTAL CONSUMPTION AND 1914 01:36:35,289 --> 01:36:37,958 SEVERAL SUB CLASSES. 1915 01:36:37,958 --> 01:36:39,726 EASTERN EUROPEAN COUNTRIES 1916 01:36:39,726 --> 01:36:42,162 TENDED TO HAVE THE HIGHEST. 1917 01:36:42,162 --> 01:36:44,364 NORDIC COUNTRIES TENDED TO HAVE 1918 01:36:44,364 --> 01:36:48,335 THE LOWEST. 1919 01:36:48,335 --> 01:36:51,972 SO WE EXAMINED WHETHER THE 1920 01:36:51,972 --> 01:36:57,845 DIETARY INTAKE OF A SPECIFIC 1921 01:36:57,845 --> 01:36:59,880 DIETARY FLAVONOIDS WERE 1922 01:36:59,880 --> 01:37:01,448 ASSOCIATED WITH LUNG INTAKE. 1923 01:37:01,448 --> 01:37:04,751 WHICH INCLUDED TENUREIAN 1924 01:37:04,751 --> 01:37:06,653 COUNTRIES AND AFTER CARRYING OUT 1925 01:37:06,653 --> 01:37:09,857 SEVERAL ADJUSTMENTS FOR 1926 01:37:09,857 --> 01:37:13,427 POTENTIAL -- COME FOUNDMENTS -- 1927 01:37:13,427 --> 01:37:16,864 * INDIVIDUALS WHO WERE IN THE 1928 01:37:16,864 --> 01:37:19,233 HIGHEST -- HAD BETTER LUNG 1929 01:37:19,233 --> 01:37:22,736 FUNCTION AND WE ALSO OBSERVED -- 1930 01:37:22,736 --> 01:37:25,505 INDIVIDUALS WHO HAVE THE HIGHEST 1931 01:37:25,505 --> 01:37:29,710 INTAKE ALSO HAD LOWER -- OF 1932 01:37:29,710 --> 01:37:39,920 RESTRICTION. 1933 01:37:40,153 --> 01:37:47,094 SO THIS IS MULTINATIONAL SERVICE 1934 01:37:47,094 --> 01:37:50,097 IN EUROPE AND ALSO FROM COHORTS 1935 01:37:50,097 --> 01:37:51,265 IN EUROPE. 1936 01:37:51,265 --> 01:37:54,268 BUT WHAT HAPPENS IN LOWER AND 1937 01:37:54,268 --> 01:37:55,669 MIDDLE INCOME COUNTRIES. 1938 01:37:55,669 --> 01:37:57,437 THERE IS BASICALLY NO RESEARCH 1939 01:37:57,437 --> 01:38:02,109 AND THE BURDEN OF OBSTRUCTIVE 1940 01:38:02,109 --> 01:38:04,745 LUNG DISEASE HAS OFFERED THE 1941 01:38:04,745 --> 01:38:09,082 FIRST OPPORTUNITY TO EXAMINE THE 1942 01:38:09,082 --> 01:38:19,326 RELATIONSHIP. 1943 01:38:22,262 --> 01:38:24,097 BUT THAT REQUIRED US TO CARRY 1944 01:38:24,097 --> 01:38:27,067 OUT ADDITIONAL ADAPTATION 1945 01:38:27,067 --> 01:38:29,403 PROCESSES AND VALIDATION TO 1946 01:38:29,403 --> 01:38:32,372 ENSURE THAT THE QUESTION AND THE 1947 01:38:32,372 --> 01:38:37,678 INSTRUMENTS WE WERE USING WERE 1948 01:38:37,678 --> 01:38:41,848 STILL APPLICABLE. 1949 01:38:41,848 --> 01:38:42,582 *. 1950 01:38:42,582 --> 01:38:47,287 TO MAKE IT RELIABLE IN SOME OF 1951 01:38:47,287 --> 01:38:54,594 THE CENTERS. 1952 01:38:54,594 --> 01:38:57,898 SO HERE WHAT WE'VE DONE WE'VE 1953 01:38:57,898 --> 01:39:02,569 EXAMINED ONE OF THE WELL-KNOWN 1954 01:39:02,569 --> 01:39:06,473 DIET INDEXES. 1955 01:39:06,473 --> 01:39:14,715 WE ANNUALIZED -- WHO HAD DIETARY 1956 01:39:14,715 --> 01:39:17,017 DATA. BELOW 4,000 PARTICIPANTS 1957 01:39:17,017 --> 01:39:20,153 FROM FIVE COUNTRIES AND WE 1958 01:39:20,153 --> 01:39:22,589 EXAMINED THE ASSOCIATION BETWEEN 1959 01:39:22,589 --> 01:39:25,592 DIET QUALITY AND LUNG FUNCTION 1960 01:39:25,592 --> 01:39:28,128 AND HERE YOU CAN SEE THE 1961 01:39:28,128 --> 01:39:30,430 ASSOCIATION OBSERVED FOR THIS 1962 01:39:30,430 --> 01:39:32,065 QUALITY INDEX. 1963 01:39:32,065 --> 01:39:34,401 DR. IS A TREND THAT SUGGEST THAT 1964 01:39:34,401 --> 01:39:37,404 HAVING A HIGHER OR BETTER DIET 1965 01:39:37,404 --> 01:39:38,972 QUALITY INDEX WAS ASSOCIATED 1966 01:39:38,972 --> 01:39:42,709 WITH BETTER LUNG FUNCTION. 1967 01:39:42,709 --> 01:39:46,580 WE DO ADJUST FOR SEVERAL 1968 01:39:46,580 --> 01:39:48,615 IMPORTANT SOCIOECONOMIC 1969 01:39:48,615 --> 01:39:52,552 CONFOUNDERS BUT ALSO DIETARY AND 1970 01:39:52,552 --> 01:39:54,821 NUTRITIONAL CONFOUNDERS AS WELL. 1971 01:39:54,821 --> 01:39:59,893 FOR FLAVONOIDS THEY ARE WIDELY 1972 01:39:59,893 --> 01:40:01,128 DISTRIBUTED IN PLANT BASED 1973 01:40:01,128 --> 01:40:09,102 FOODS. 1974 01:40:09,102 --> 01:40:12,606 BUT WE ALSO WOULD THE ADDITIONAL 1975 01:40:12,606 --> 01:40:14,674 CHALLENGE OF HAVING TO SEE WHAT 1976 01:40:14,674 --> 01:40:18,612 WE WERE USING TO MEASURE 1977 01:40:18,612 --> 01:40:21,848 FLAVONOIDS IS AT QUIET IN TERMS 1978 01:40:21,848 --> 01:40:23,817 OF THE FOOD TABLES. 1979 01:40:23,817 --> 01:40:25,852 AND THIS IS SOME WORK THAT WAS 1980 01:40:25,852 --> 01:40:36,363 LED BY DR. -- DURING HIS PhD. 1981 01:40:37,164 --> 01:40:41,735 THEY HAVE DATA ON NAV NOTICED 1982 01:40:41,735 --> 01:40:45,906 CONTENT AND WE * FOUND THEY WERE 1983 01:40:45,906 --> 01:40:56,116 COMPARABLE. 1984 01:41:03,457 --> 01:41:04,958 >> SPEAKER, YOU HAVE TWO MINUTES 1985 01:41:04,958 --> 01:41:05,492 REMAINING. 1986 01:41:05,492 --> 01:41:09,329 >> THANK YOU. 1987 01:41:09,329 --> 01:41:13,433 THIS CAPTURES, ILLUSTRATES THE 1988 01:41:13,433 --> 01:41:21,641 MULTI-VARIABLE A ASSOCIATIONS. 1989 01:41:21,641 --> 01:41:24,744 AND AS YOU CAN SEE HERE -- THE 1990 01:41:24,744 --> 01:41:26,947 TREND TENDS TO BE SLIGHTLY 1991 01:41:26,947 --> 01:41:27,380 DIFFERENT. 1992 01:41:27,380 --> 01:41:31,818 IF YOU LOOK AT THE FIRST -- A 1993 01:41:31,818 --> 01:41:38,291 HIGHER -- AS THE INTAKE OF TOTAL 1994 01:41:38,291 --> 01:41:41,027 FLAVONOIDS. 1995 01:41:41,027 --> 01:41:51,404 BUT THEN IT PLATEAUS. 1996 01:41:58,879 --> 01:42:01,681 SO WHAT DOES THE CURRENT 1997 01:42:01,681 --> 01:42:02,516 EVIDENCE SUGGEST? 1998 01:42:02,516 --> 01:42:05,819 THAT DIETARY FLAVONOIDS ARE 1999 01:42:05,819 --> 01:42:07,487 ASSOCIATED WITH HIGHER LUNG 2000 01:42:07,487 --> 01:42:09,823 FUNCTION AND POSSIBLY WITH LOWER 2001 01:42:09,823 --> 01:42:13,793 PREVALENCE AND RISK OF CO PD 2002 01:42:13,793 --> 01:42:17,831 RISK OUTCOMES. 2003 01:42:17,831 --> 01:42:20,734 THE MAIN SCIENTIFIC GAPS IN 2004 01:42:20,734 --> 01:42:21,801 KNOWLEDGE. 2005 01:42:21,801 --> 01:42:23,904 THE NEED TO HARMONIZE THE 2006 01:42:23,904 --> 01:42:24,938 EVIDENCE. 2007 01:42:24,938 --> 01:42:28,942 AND ADVANCE THE KNOWLEDGE. 2008 01:42:28,942 --> 01:42:31,945 SO WE UNDERSTAND HOW POWERFUL OR 2009 01:42:31,945 --> 01:42:33,046 ACTIVE THEY ARE. 2010 01:42:33,046 --> 01:42:36,449 THE NEED TO HARMONIZE 2011 01:42:36,449 --> 01:42:38,118 RESPIRATORY OUTCOMES IF WE WANT 2012 01:42:38,118 --> 01:42:41,555 TO MAKE INTERNATIONAL DATA COME 2013 01:42:41,555 --> 01:42:47,294 PRACTICABLE. 2014 01:42:47,294 --> 01:42:55,969 AND ADDRESS THE DIFFERENCES. 2015 01:42:55,969 --> 01:43:03,710 THIS ARE MY RESEARCH QUESTIONS? 2016 01:43:03,710 --> 01:43:09,216 HOW DO SOCIAL DETERMINANTS AND 2017 01:43:09,216 --> 01:43:19,859 OTHER LIFESTYLE RELATED FACTOR 2018 01:43:19,859 --> 01:43:20,427 FIGURE IN. 2019 01:43:20,427 --> 01:43:21,761 AND WHICH POPULATION GROUPS 2020 01:43:21,761 --> 01:43:24,397 WOULD BE MOST LIKELY TO BENEFIT 2021 01:43:24,397 --> 01:43:25,999 FROM INTERVENTION AND STUDIES? 2022 01:43:25,999 --> 01:43:29,302 THANK YOU. 2023 01:43:29,302 --> 01:43:31,204 THIS IS JUST AN ACKNOWLEDGEMENT 2024 01:43:31,204 --> 01:43:33,840 TO THE MANY RESEARCH FELLOWS AND 2025 01:43:33,840 --> 01:43:35,408 COLLEAGUES WHO HAVE BEEN 2026 01:43:35,408 --> 01:43:37,077 SUPPORTING THE MULTINATIONAL 2027 01:43:37,077 --> 01:43:47,220 STUDIES. 2028 01:43:49,089 --> 01:43:53,293 >> THANK YOU SO MUCH, 2029 01:43:53,293 --> 01:43:54,761 DR. GARCIA-LARSEN FOR THAT 2030 01:43:54,761 --> 01:43:57,497 AMAZING PRESENTATION. 2031 01:43:57,497 --> 01:44:00,900 WE ARE AT THIS POINT 2032 01:44:00,900 --> 01:44:02,135 TRANSITIONING INTO OUR PANEL 2033 01:44:02,135 --> 01:44:03,803 DISCUSSION WHICH I THINK WE'RE 2034 01:44:03,803 --> 01:44:05,272 ALL VERY EXCITED ABOUT AND 2035 01:44:05,272 --> 01:44:06,940 LOOKING FORWARD TO THIS 2036 01:44:06,940 --> 01:44:08,174 OPPORTUNITY TO IDENTIFY 2037 01:44:08,174 --> 01:44:09,743 PRIORITIES AND NEXT STEPS ACROSS 2038 01:44:09,743 --> 01:44:11,311 THE SPEAKERS THAT ARE PRESENT 2039 01:44:11,311 --> 01:44:12,779 HERE TODAY AND EXPERTS IN THE 2040 01:44:12,779 --> 01:44:14,514 FIELD. 2041 01:44:14,514 --> 01:44:19,352 BEFORE GOING INTO A VERY BRIEF 2042 01:44:19,352 --> 01:44:20,920 OVER-ALL HIGHLIGHT -- THEY'VE 2043 01:44:20,920 --> 01:44:22,822 PROVIDED US WITH SOME SUMMARY 2044 01:44:22,822 --> 01:44:23,790 SLIDES. 2045 01:44:23,790 --> 01:44:26,326 BUT I WANT TO GO BACK AND 2046 01:44:26,326 --> 01:44:27,460 HIGHLIGHT THE INITIAL QUESTION 2047 01:44:27,460 --> 01:44:29,996 THAT WE'RE ASKED TO ADDRESS AND 2048 01:44:29,996 --> 01:44:31,898 THAT'S THERE ADEQUATE 2049 01:44:31,898 --> 01:44:32,699 EPIDEMILOGICAL EVIDENCE 2050 01:44:32,699 --> 01:44:35,135 SUPPORTING THE RULE OF DIET AND 2051 01:44:35,135 --> 01:44:36,903 NUTRITION IN RESPIRATORY HEALTH 2052 01:44:36,903 --> 01:44:41,007 AND DISEASES AND WE'VE 2053 01:44:41,007 --> 01:44:44,010 INTERPRETED THIS ADEQUATE TO 2054 01:44:44,010 --> 01:44:53,653 JUSTIFY FURTHER RESEARCH. 2055 01:44:53,653 --> 01:45:00,894 DR. CAMARGO -- WILL BE PAYING 2056 01:45:00,894 --> 01:45:05,598 ATTENTION TO THE Q&A SECTION. 2057 01:45:05,598 --> 01:45:06,833 WE HAVE A NUMBER OF QUESTIONS 2058 01:45:06,833 --> 01:45:09,135 THAT WE'VE PREDEVELOPED TO HELP 2059 01:45:09,135 --> 01:45:10,236 GUIDE THIS CONVERSATION. 2060 01:45:10,236 --> 01:45:13,106 IT WILL BE VERY DIFFICULT TO GET 2061 01:45:13,106 --> 01:45:14,674 TO EVERY SINGLE QUESTION THAT IS 2062 01:45:14,674 --> 01:45:17,777 ASKED IN THE Q&A SO APOLOGIES IN 2063 01:45:17,777 --> 01:45:18,311 ADVANCE. 2064 01:45:18,311 --> 01:45:19,646 THAT DOES NOT SPEAK TO THE 2065 01:45:19,646 --> 01:45:22,949 IMPORTANCE OF YOUR QUESTION BUT 2066 01:45:22,949 --> 01:45:26,386 A FACT TO THE MULTIPLE STREAMS 2067 01:45:26,386 --> 01:45:28,154 OF INFORMATION THAT ARE COMING 2068 01:45:28,154 --> 01:45:33,793 IN. 2069 01:45:33,793 --> 01:45:35,562 >> BRING UP THE SUMMARY SLIDES. 2070 01:45:35,562 --> 01:45:45,905 THAT WOULD BE GREAT. 2071 01:45:47,307 --> 01:45:48,875 >> PANEL DISCUSSION ONE SLIDES 2072 01:45:48,875 --> 01:45:57,384 IF THAT HELPS. 2073 01:45:57,384 --> 01:46:00,520 >> WHAT I WAS GOING TO DO AFTER 2074 01:46:00,520 --> 01:46:03,390 THAT IS WHILE PULLING THAT UP -- 2075 01:46:03,390 --> 01:46:05,925 OUR PLAN WAS TO HIGHLIGHT SOME 2076 01:46:05,925 --> 01:46:08,228 OF THE DISCUSSIONS HAPPENING. 2077 01:46:08,228 --> 01:46:10,964 IT WOULD BE IMPOSSIBLE NOT TO 2078 01:46:10,964 --> 01:46:13,767 TOUCH ON SOME OF THESE AND I'VE 2079 01:46:13,767 --> 01:46:16,970 TOUCHED ON SOME OF THESE DURING 2080 01:46:16,970 --> 01:46:19,038 THE PRESENTATIONS. 2081 01:46:19,038 --> 01:46:20,874 BUT THOSE LATER DISCUSSIONS 2082 01:46:20,874 --> 01:46:23,276 INCLUDE THE IMPACT OF CLIMATE 2083 01:46:23,276 --> 01:46:25,645 CHANGE ON FOOD SYSTEMS AND 2084 01:46:25,645 --> 01:46:27,814 SECURITY. 2085 01:46:27,814 --> 01:46:31,251 MECHANISMS -- EMERGING PRECISION 2086 01:46:31,251 --> 01:46:36,523 MEASURES OF DIET AND DIETARY 2087 01:46:36,523 --> 01:46:36,856 INTERVENTIONS. 2088 01:46:36,856 --> 01:46:38,725 WE'LL TOUCH ON SOME OF THOSE BUT 2089 01:46:38,725 --> 01:46:41,528 WE'LL TRY TO STAY FOCUSED ON THE 2090 01:46:41,528 --> 01:46:44,230 EPIDEMILOGICAL EVIDENCE. 2091 01:46:44,230 --> 01:46:46,733 >> WE CAN SHARE THE SLIDES HERE. 2092 01:46:46,733 --> 01:46:48,435 >> THANK YOU SO MUCH. 2093 01:46:48,435 --> 01:46:49,769 >> ALL RIGHT. 2094 01:46:49,769 --> 01:46:51,438 SO THIS IS AGAIN NONE OF THE 2095 01:46:51,438 --> 01:46:54,007 SPEAKERS OR MODERATORS HAVE ANY 2096 01:46:54,007 --> 01:46:57,610 RELEVANT CONFLICTS. 2097 01:46:57,610 --> 01:47:00,713 AND EMILY, WHY DON'T YOU 2098 01:47:00,713 --> 01:47:03,216 SUMMARIZE -- THIS FIRST SLIDE. 2099 01:47:03,216 --> 01:47:05,652 >> AND WE'RE GOING TO BE JUMPING 2100 01:47:05,652 --> 01:47:07,787 IN TRYING TO KEEP THE FLOW OF 2101 01:47:07,787 --> 01:47:10,190 THE CONVERSATION. 2102 01:47:10,190 --> 01:47:13,460 SO WE HEARD FROM DR. CELEDON. 2103 01:47:13,460 --> 01:47:15,462 I WON'T READ ALL OF THESE BUT A 2104 01:47:15,462 --> 01:47:17,797 BIG TAKE AWAY FROM HIS LECTURE 2105 01:47:17,797 --> 01:47:20,867 AND TALK WAS THAT NO SINGLE 2106 01:47:20,867 --> 01:47:24,838 NUTRIENT OR VITAMIN COULD BE 2107 01:47:24,838 --> 01:47:30,009 RECOMMENDED TO -- TREAT -- 2108 01:47:30,009 --> 01:47:40,353 ASTHMA AT THIS TIME. 2109 01:47:45,525 --> 01:47:46,926 DR. HANSON SPOKE TO US OF THE 2110 01:47:46,926 --> 01:47:49,162 DATA AS IT STANDS WITH FATTY 2111 01:47:49,162 --> 01:47:49,562 ACIDS. 2112 01:47:49,562 --> 01:47:54,434 7 EPIDEMILOGICAL STUDIES OF 2113 01:47:54,434 --> 01:47:56,536 POLYUNSATURATED FATTY ACIDS HAVE 2114 01:47:56,536 --> 01:47:59,439 SHOWN PROMISE BUT HAVE MIXED 2115 01:47:59,439 --> 01:48:01,641 RESULTS. 2116 01:48:01,641 --> 01:48:04,110 AND SPECIFICALLY MONOUNSATURATED 2117 01:48:04,110 --> 01:48:06,179 FATTY ACIDS ARE LESS UNDERSTOOD. 2118 01:48:06,179 --> 01:48:13,953 TAREK FATAH HAVE LESS EFFECT. 2119 01:48:13,953 --> 01:48:18,758 AND HETEROGENEITY MAKES IT 2120 01:48:18,758 --> 01:48:20,894 DIFFICULT TO DRAW CONCLUSIONS. 2121 01:48:20,894 --> 01:48:30,970 * 2122 01:49:17,183 --> 01:49:18,284 >> THANK YOU. 2123 01:49:18,284 --> 01:49:22,021 >> AND JUST TO RETURN US TO 2124 01:49:22,021 --> 01:49:25,825 FOCUS US ON THE KEY QUESTION. 2125 01:49:25,825 --> 01:49:27,193 IS THERE SUFFICIENT 2126 01:49:27,193 --> 01:49:28,027 EPIDEMILOGICAL EVIDENCE 2127 01:49:28,027 --> 01:49:30,330 SUPPORTING THE ROLLING OF DIET 2128 01:49:30,330 --> 01:49:32,231 AND NUTRITION IN RESPIRATORY 2129 01:49:32,231 --> 01:49:33,766 HEALTH AND DISEASES. 2130 01:49:33,766 --> 01:49:35,768 SUFFICIENT TO INITIATE, CONTINUE 2131 01:49:35,768 --> 01:49:38,605 MORE RESEARCH IN THIS AREA? 2132 01:49:38,605 --> 01:49:40,173 MORE RESEARCH BEING 2133 01:49:40,173 --> 01:49:43,843 EPIDEMILOGICAL BUT ALSO 2134 01:49:43,843 --> 01:49:45,178 INCREASINGLY I WOULD HOPE 2135 01:49:45,178 --> 01:49:46,846 INTERNATIONAL CONVENIENCAL BUT 2136 01:49:46,846 --> 01:49:49,616 WHAT DO WE INTERVENE WITH * AND 2137 01:49:49,616 --> 01:49:52,151 HOW AND WHEN. 2138 01:49:52,151 --> 01:49:52,819 AND WHO. 2139 01:49:52,819 --> 01:49:53,953 THOSE ARE SOME OF THE ISSUES 2140 01:49:53,953 --> 01:49:57,991 THAT WE NEED TO GRAPPLE WITH. 2141 01:49:57,991 --> 01:50:00,660 EMILY -- SHE IS GOING -- I'M 2142 01:50:00,660 --> 01:50:02,662 GOING TO BE IN THE BACKGROUND 2143 01:50:02,662 --> 01:50:05,198 SENDING HER QUESTIONS. 2144 01:50:05,198 --> 01:50:07,634 IT WOULD BE HELPFUL IF THE TECH 2145 01:50:07,634 --> 01:50:09,636 TEAM COULD BRING UP THE 2146 01:50:09,636 --> 01:50:11,404 PANELISTS ON TO THE SCREEN. 2147 01:50:11,404 --> 01:50:15,475 SO THAT WE CAN SEE THE FOUR 2148 01:50:15,475 --> 01:50:18,244 PANELISTS AND MODERATORS AT ONCE 2149 01:50:18,244 --> 01:50:20,246 AND I WOULD ASK THAT THEY ALSO 2150 01:50:20,246 --> 01:50:21,447 REMOVE THE SLIDES SO WE HAVE 2151 01:50:21,447 --> 01:50:23,149 MORE ATTENTION ON THE PEOPLE WHO 2152 01:50:23,149 --> 01:50:24,817 ARE SPEAKING RATHER THAN THE 2153 01:50:24,817 --> 01:50:29,288 GIANT SLIDE. 2154 01:50:29,288 --> 01:50:30,390 PERFECT. 2155 01:50:30,390 --> 01:50:32,158 MAYBE IF YOU COULD MAKE ALL OF 2156 01:50:32,158 --> 01:50:35,194 THE SPEAKERS EQUAL ON THE SCREEN 2157 01:50:35,194 --> 01:50:43,536 THAT WOULD BE HELPFUL. 2158 01:50:43,536 --> 01:50:44,771 ALL RIGHT. 2159 01:50:44,771 --> 01:50:47,807 EMILY, TAKE IT AWAY. 2160 01:50:47,807 --> 01:50:49,409 >> WONDERFUL AND ALSO ASK THE 2161 01:50:49,409 --> 01:50:51,444 TECH TEAM IF YOU COULD GIVE US A 2162 01:50:51,444 --> 01:50:59,552 FIVE MINUTE WARNING AS WELL. 2163 01:50:59,552 --> 01:51:00,153 AND TO GROUND THIS TALK GOING 2164 01:51:00,153 --> 01:51:00,820 BACK TO WHAT DR. KIREY MENTIONED 2165 01:51:00,820 --> 01:51:03,756 WE HAVE A LOT OF QUESTIONS. 2166 01:51:03,756 --> 01:51:06,092 WE'RE SEEKING TO PRIORITIZE IN 2167 01:51:06,092 --> 01:51:09,095 ORDER TO REVOLUTIONIZE THIS 2168 01:51:09,095 --> 01:51:12,065 PROGRESS IN NUTRITION AS IT 2169 01:51:12,065 --> 01:51:13,700 RELATES TO LUNG HEALTH. 2170 01:51:13,700 --> 01:51:16,636 I WANTED TO START -- DO WE AGREE 2171 01:51:16,636 --> 01:51:19,038 ON THE IDEA THAT MORE RESEARCH 2172 01:51:19,038 --> 01:51:21,207 IS POTENTIALLY NEEDED VERSUS 2173 01:51:21,207 --> 01:51:21,941 NOT. 2174 01:51:21,941 --> 01:51:23,910 DO WE HAVE ADEQUATE INFORMATION 2175 01:51:23,910 --> 01:51:25,111 TO JUSTIFY MORE RESEARCH. 2176 01:51:25,111 --> 01:51:26,879 ALL OF THE SPEAKERS SPOKE TO 2177 01:51:26,879 --> 01:51:29,849 THIS. 2178 01:51:29,849 --> 01:51:32,518 SO INSTEAD I WANT TO POSE TO THE 2179 01:51:32,518 --> 01:51:34,654 PANEL AS TO WHETHER THERE ARE 2180 01:51:34,654 --> 01:51:36,556 ANY ASPECTS OF THIS QUESTION 2181 01:51:36,556 --> 01:51:39,892 THAT ARE SOLIDLY ANSWERED WITH 2182 01:51:39,892 --> 01:51:40,760 EPIDEMILOGICAL RESEARCH. 2183 01:51:40,760 --> 01:51:44,163 AND PERHAPS WE CAN START WITH 2184 01:51:44,163 --> 01:51:47,333 DR. GARCIA-LARSEN WHO MADE A 2185 01:51:47,333 --> 01:51:51,370 VERY GOOD CASE OF FLAVONOIDS AND 2186 01:51:51,370 --> 01:51:54,407 LUNG FUNCTION. 2187 01:51:54,407 --> 01:51:57,043 >> I GUESS YOU HAVE TO TAKE IT 2188 01:51:57,043 --> 01:52:00,279 WITH A PINCH OF SALT BECAUSE I'M 2189 01:52:00,279 --> 01:52:03,483 HIGHLY BIASED. 2190 01:52:03,483 --> 01:52:06,486 IT'S A COMPLEX PICTURE BECAUSE 2191 01:52:06,486 --> 01:52:10,256 WE WHEN WE REFER TO FLAVONOIDS 2192 01:52:10,256 --> 01:52:11,691 WE'RE TALKING ABOUT SEVERAL 2193 01:52:11,691 --> 01:52:12,358 MULTIPLE. 2194 01:52:12,358 --> 01:52:14,660 OVER 8,000 COMPOUNDS WHEN WE 2195 01:52:14,660 --> 01:52:18,965 THINK OF POLLY PHENOLS AND 2196 01:52:18,965 --> 01:52:21,367 FLAVONOIDS THE MAIN GROUP. 2197 01:52:21,367 --> 01:52:22,502 HOWEVER I THINK THAT SOME OF 2198 01:52:22,502 --> 01:52:26,372 THEM MIGHT HAVE A MORE WELL 2199 01:52:26,372 --> 01:52:29,342 ESTABLISHED STRUCTURAL 2200 01:52:29,342 --> 01:52:31,744 FUNCTIONAL OR ROLE IN VARIOUS 2201 01:52:31,744 --> 01:52:31,944 WAYS. 2202 01:52:31,944 --> 01:52:34,147 THIS IS WHAT WE UNDERSTAND FROM 2203 01:52:34,147 --> 01:52:35,348 EXPERIMENTAL EVIDENCE. 2204 01:52:35,348 --> 01:52:38,651 BUT GENERALLY SPEAKING ALL 2205 01:52:38,651 --> 01:52:43,723 FLAVONOIDS HAVE VERY POWERFUL 2206 01:52:43,723 --> 01:52:45,858 ANTIOXIDANTS AND 2207 01:52:45,858 --> 01:52:46,959 ANTI-IMFLAMMATORY PROPERTIES. 2208 01:52:46,959 --> 01:52:50,530 BECAUSE THEY ARE SO WIDELY 2209 01:52:50,530 --> 01:52:52,231 DISTRIBUTED IN PLANT BASED FOODS 2210 01:52:52,231 --> 01:52:54,000 THERE IS AN OPPORTUNITY TO 2211 01:52:54,000 --> 01:52:57,537 EXAMINE LET'S EAT MORE FRUITS 2212 01:52:57,537 --> 01:52:59,238 AND VEGETABLES AND THAT MIGHT BE 2213 01:52:59,238 --> 01:53:01,274 A GOOD STARTING POINT BUT IF WE 2214 01:53:01,274 --> 01:53:03,476 WANT TO UNDERSTAND THE ROLE OF 2215 01:53:03,476 --> 01:53:10,883 DIET AND LUNG DISEASE -- IF DIET 2216 01:53:10,883 --> 01:53:13,119 CAN EFFECT CHANGE -- WE NEED TO 2217 01:53:13,119 --> 01:53:16,122 UNDERSTAND A BIT BETTER WHAT 2218 01:53:16,122 --> 01:53:19,192 FLAVONOIDS DO. 2219 01:53:19,192 --> 01:53:21,828 THE RESULTS SEEM TO SUGGEST THAT 2220 01:53:21,828 --> 01:53:25,064 IT'S GOING IN THAT DIRECTION. 2221 01:53:25,064 --> 01:53:27,633 DIETARY FLAVONOIDS ARE 2222 01:53:27,633 --> 01:53:32,338 BENEFICIAL. 2223 01:53:32,338 --> 01:53:35,208 SO IF THERE IS AN EFFECT IT 2224 01:53:35,208 --> 01:53:37,677 MIGHT NOT JUST BE BECAUSE WE'RE 2225 01:53:37,677 --> 01:53:40,112 JUST EATING MORE BUT SOMETHING 2226 01:53:40,112 --> 01:53:45,284 THAT MIGHT MAKE THEM SUITABLE TO 2227 01:53:45,284 --> 01:53:46,619 PRESERVE LUNG FUNCTION. 2228 01:53:46,619 --> 01:53:49,488 I THINK COHORT STUDIES CAN HELP 2229 01:53:49,488 --> 01:53:50,790 A HUGE DEAL. 2230 01:53:50,790 --> 01:53:52,925 LUNG FUNCTION CHANGES HAPPIES 2231 01:53:52,925 --> 01:53:55,561 OVER A LONG PERIOD OF TIME AND 2232 01:53:55,561 --> 01:53:58,764 THEREFORE INTERVENTION STUDIES 2233 01:53:58,764 --> 01:54:01,901 MIGHT NOT BE THE BEST ROUTE. 2234 01:54:01,901 --> 01:54:06,505 BUT IF WE ENRICH COHORT STUDIES 2235 01:54:06,505 --> 01:54:09,909 WITH BETTER PRECISION TOOLS WE 2236 01:54:09,909 --> 01:54:13,613 MIGHT HAVE MORE MEASURES. 2237 01:54:13,613 --> 01:54:15,514 THAT COULD BE A REALLY GOOD STEP 2238 01:54:15,514 --> 01:54:19,752 FORWARD. 2239 01:54:19,752 --> 01:54:23,022 >> THANK YOU, DR. GARCIA-LARSEN. 2240 01:54:23,022 --> 01:54:24,690 SUCH A GREAT POINT ABOUT 2241 01:54:24,690 --> 01:54:27,360 INTERVENTION STUDIES AND THEIR 2242 01:54:27,360 --> 01:54:28,394 POTENTIAL TO ANSWER CERTAIN 2243 01:54:28,394 --> 01:54:30,563 QUESTIONS. 2244 01:54:30,563 --> 01:54:33,332 PARTICULARLY LONG-TERM FUNCTION 2245 01:54:33,332 --> 01:54:34,867 AND OUTCOMES. 2246 01:54:34,867 --> 01:54:36,235 DO ANY OF THE OTHER SPEAKERS 2247 01:54:36,235 --> 01:54:38,671 WANT TO SPEAK TO ANY AREAS WHERE 2248 01:54:38,671 --> 01:54:41,007 THEY FEEL THAT WE HAVE SOLID 2249 01:54:41,007 --> 01:54:41,874 ANSWERS. 2250 01:54:41,874 --> 01:54:43,709 UNDERSTANDING THESE MAY BE VERY 2251 01:54:43,709 --> 01:54:47,947 SPECIFIC AREAS. 2252 01:54:47,947 --> 01:54:50,850 PERHAPS DR. CAMARGO WITH REGARD 2253 01:54:50,850 --> 01:54:52,551 TO FRUITS AND VEGETABLES 2254 01:54:52,551 --> 01:54:54,687 >> I WOULD NOT SAY WE HAVE SOLID 2255 01:54:54,687 --> 01:54:55,554 ANSWERS TO MUCH. 2256 01:54:55,554 --> 01:54:57,890 I DON'T WANT TO BE NEGATIVE BUT 2257 01:54:57,890 --> 01:54:59,892 CERTAINLY INTERESTING SIGNALS. 2258 01:54:59,892 --> 01:55:03,329 BUT IT'S BEEN 20-30 YEARS OF 2259 01:55:03,329 --> 01:55:04,897 RESEARCH AND PART OF THE PROBLEM 2260 01:55:04,897 --> 01:55:07,333 IS WE'RE JUST TOO SCATTERED SO 2261 01:55:07,333 --> 01:55:13,239 THIS WORKSHOP IF WE COULD AGREE 2262 01:55:13,239 --> 01:55:16,575 ON EXPOSURE AND OUTCOME -- THAT 2263 01:55:16,575 --> 01:55:18,577 WOULD BE OR AT LEAST A FEW OF 2264 01:55:18,577 --> 01:55:19,679 THEM BUT NOT EVERYTHING. 2265 01:55:19,679 --> 01:55:23,082 YOU TRY TO DO EVERYTHING YOU END 2266 01:55:23,082 --> 01:55:24,517 UP WITH VERY LITTLE. 2267 01:55:24,517 --> 01:55:26,852 SO MY ANSWER TO YOUR QUESTION IS 2268 01:55:26,852 --> 01:55:30,389 I DON'T THINK WE HAVE ANYTHING 2269 01:55:30,389 --> 01:55:31,324 ESTABLISHED EXCEPT THERE IS 2270 01:55:31,324 --> 01:55:32,725 PROMISE HERE. 2271 01:55:32,725 --> 01:55:36,529 PROMISE NOT YET A ACHIEVED. 2272 01:55:36,529 --> 01:55:39,398 >> I WOULD JUST ADD I UNDERSTAND 2273 01:55:39,398 --> 01:55:42,802 THE -- WORKSHOP IS ON ADULTS BUT 2274 01:55:42,802 --> 01:55:46,238 LET'S NOT FORGET THAT LUNG 2275 01:55:46,238 --> 01:55:48,140 FUNCTION AND ASTHMA IN 2276 01:55:48,140 --> 01:55:49,475 PARTICULAR IS DETERMINED EARLY 2277 01:55:49,475 --> 01:55:51,844 IN LIFE SO DEPENDING ON WHICH 2278 01:55:51,844 --> 01:55:58,985 STUDY YOU LOOK AT IS 70%-80% IS 2279 01:55:58,985 --> 01:56:01,487 STARTED IN THE EARLY YEARS. 2280 01:56:01,487 --> 01:56:05,124 IT'S IMPOSSIBLE TO IGNORE THE 2281 01:56:05,124 --> 01:56:09,161 DATA. 2282 01:56:09,161 --> 01:56:10,830 COHORT STUDIES COULD BE VERY 2283 01:56:10,830 --> 01:56:11,330 IMPORTANT. 2284 01:56:11,330 --> 01:56:14,200 THE DATA IN KIDS WHEN YOU'RE 2285 01:56:14,200 --> 01:56:17,069 LOOKING AT AGGREGATE IT'S QUITE 2286 01:56:17,069 --> 01:56:18,871 REASONABLE IN TERMS OF THE 2287 01:56:18,871 --> 01:56:20,506 OVER-ALL IMPACT. 2288 01:56:20,506 --> 01:56:26,212 DIETARY PATTERNS AND I THINK 2289 01:56:26,212 --> 01:56:28,714 DR. CAMARGO ELUDED TO THAT. 2290 01:56:28,714 --> 01:56:32,451 >> I KNOW YOU'LL AGREE WITH ME 2291 01:56:32,451 --> 01:56:38,290 JUAN, I THINK PREGNANT ADVISING- 2292 01:56:38,290 --> 01:56:43,462 INDIVIDUALS IS WHERE IT STARTS. 2293 01:56:43,462 --> 01:56:47,233 THAT REALLY ARGUES THAT AT LEAST 2294 01:56:47,233 --> 01:56:49,335 VITAMIN C IN THAT SETTING 2295 01:56:49,335 --> 01:56:50,436 MATTERS. 2296 01:56:50,436 --> 01:56:53,339 SO PERHAPS THERE SHOULD BE MUCH 2297 01:56:53,339 --> 01:56:55,975 MORE EMPHASIS ON PREGNANCY AND 2298 01:56:55,975 --> 01:56:57,743 CHILDHOOD WITH AN UNDERSTANDING 2299 01:56:57,743 --> 01:57:00,079 THAT IT ULTIMATELY RELATES TO 2300 01:57:00,079 --> 01:57:00,913 ADULTS. 2301 01:57:00,913 --> 01:57:03,282 BUT IF YOU START WITH ADULTS YOU 2302 01:57:03,282 --> 01:57:06,752 MAY OR MAY NOT BE TOO LATE. 2303 01:57:06,752 --> 01:57:08,854 >> DR. LU PUT IN THE CHAT THERE 2304 01:57:08,854 --> 01:57:11,757 IS ANOTHER WORKSHOP THAT FOCUSES 2305 01:57:11,757 --> 01:57:15,694 ON PREGNANCY AND EARLY 2306 01:57:15,694 --> 01:57:16,162 CHILDHOOD. 2307 01:57:16,162 --> 01:57:17,596 THAT IS WONDERFUL. 2308 01:57:17,596 --> 01:57:19,999 THANK YOU. 2309 01:57:19,999 --> 01:57:24,937 I DO WONDER IF JUST TO TAKE A 2310 01:57:24,937 --> 01:57:27,573 SEMI STRUCTURED APPROACH TO 2311 01:57:27,573 --> 01:57:28,374 THIS. 2312 01:57:28,374 --> 01:57:32,344 IF MAYBE WE CAN START WITH 2313 01:57:32,344 --> 01:57:34,480 COMING UP WITH STATEMENTS ON 2314 01:57:34,480 --> 01:57:37,216 SOME OF THE KEY DIETARY 2315 01:57:37,216 --> 01:57:40,953 EXPOSURES THAT WARRANT 2316 01:57:40,953 --> 01:57:42,421 PRIORITIZATION FOR FURTHER 2317 01:57:42,421 --> 01:57:44,190 EPIDEMILOGICAL RESEARCH. 2318 01:57:44,190 --> 01:57:45,624 UNDERSTANDING THAT IT WILL BE 2319 01:57:45,624 --> 01:57:48,160 CONTENT SPECIFIC AND WE SHOULD 2320 01:57:48,160 --> 01:57:51,263 ALSO TALK ABOUT VULNERABLE AND 2321 01:57:51,263 --> 01:57:58,370 SUSCEPTIBLE POPULATIONS. 2322 01:57:58,370 --> 01:58:00,039 BUT THINKING ABOUT KEY EXPOSURES 2323 01:58:00,039 --> 01:58:01,774 THAT DESERVE FURTHER RESEARCH AT 2324 01:58:01,774 --> 01:58:04,743 THIS TIME. 2325 01:58:04,743 --> 01:58:06,412 DR. HANSON I WONDER IF YOU WANT 2326 01:58:06,412 --> 01:58:09,415 TO START. 2327 01:58:09,415 --> 01:58:10,182 >> SURE, EMILY. 2328 01:58:10,182 --> 01:58:12,451 THAT IS A REALLY GOOD QUESTION. 2329 01:58:12,451 --> 01:58:14,487 I FELT LIKE I HAD A CLEARER 2330 01:58:14,487 --> 01:58:16,155 ANSWER TO YOUR PREVIOUS QUESTION 2331 01:58:16,155 --> 01:58:17,923 THAN I DO TO THIS ONE. 2332 01:58:17,923 --> 01:58:21,427 SO I GUESS MY TOPIC BEING FATTY 2333 01:58:21,427 --> 01:58:25,431 ACIDS I DO THINK THAT THAT -- 2334 01:58:25,431 --> 01:58:27,466 THIS IS A DIFFICULT TOPIC THAT 2335 01:58:27,466 --> 01:58:29,869 WE ALL STRUGGLE WITH VERY MUCH 2336 01:58:29,869 --> 01:58:32,438 BECAUSE WE SHOULD I THINK ALL 2337 01:58:32,438 --> 01:58:36,842 KEEP IN MIND THAT IT'S 2338 01:58:36,842 --> 01:58:37,910 CONSIDERED DIFFICULT. 2339 01:58:37,910 --> 01:58:44,083 YOU EAT A DIET THAT CONTAINS A 2340 01:58:44,083 --> 01:58:47,620 WIDE VARIETY AND WE NEED TO 2341 01:58:47,620 --> 01:58:52,892 LEARN AUCTION -- CAUTIONARY 2342 01:58:52,892 --> 01:58:53,893 TALES. 2343 01:58:53,893 --> 01:58:57,062 CANCER RESEARCH WHERE PEOPLE 2344 01:58:57,062 --> 01:58:58,063 DECIDE VITAMIN E FOR EXAMPLE IS 2345 01:58:58,063 --> 01:59:01,300 OUR FOCUS AND WE SEE STRONG 2346 01:59:01,300 --> 01:59:03,068 SIGNALS IN THE EPIDEMILOGICAL 2347 01:59:03,068 --> 01:59:05,838 LITERATURE REGARDING VITAMIN E 2348 01:59:05,838 --> 01:59:07,940 THEREFORE WE'RE GOING TO MOVE 2349 01:59:07,940 --> 01:59:10,176 FORWARD WITH A TRIAL TO SEE IF 2350 01:59:10,176 --> 01:59:13,145 IT PREVENTS CANCER AND BAD 2351 01:59:13,145 --> 01:59:14,680 THINGS HAPPEN. 2352 01:59:14,680 --> 01:59:15,881 WHETHER THAT BE BECAUSE OF THE 2353 01:59:15,881 --> 01:59:17,816 DESIGN OR THE POPULATION OR THE 2354 01:59:17,816 --> 01:59:19,785 LACK OF CONSIDERATION OF THE 2355 01:59:19,785 --> 01:59:21,820 SYNERGISTIC IMPACTS THAT 2356 01:59:21,820 --> 01:59:22,955 NUTRIENTS HAVE. 2357 01:59:22,955 --> 01:59:25,357 SO, ITS REALLY HARD TO SAY. 2358 01:59:25,357 --> 01:59:27,359 IS THERE ONE THAT WE SHOULD 2359 01:59:27,359 --> 01:59:28,694 TEASE OUT AND SAY THIS IS THE 2360 01:59:28,694 --> 01:59:32,097 ONE THAT WE SHOULD STUDY BECAUSE 2361 01:59:32,097 --> 01:59:35,067 IT CAN STAND ALONE WITH NOT 2362 01:59:35,067 --> 01:59:36,936 IMPACTING OTHER ONES. 2363 01:59:36,936 --> 01:59:39,471 I FEEL LIKE I'M DANCING AROUND 2364 01:59:39,471 --> 01:59:40,673 YOUR QUESTION A LITTLE BIT. 2365 01:59:40,673 --> 01:59:41,941 SOME OF THE THINGS THAT WILL 2366 01:59:41,941 --> 01:59:44,443 GIVE US MORE INCITE WILL BE SOME 2367 01:59:44,443 --> 01:59:48,781 OF THE NEW * TECHNOLOGIES -- 2368 01:59:48,781 --> 01:59:50,883 BECAUSE THIS MAY HELP US 2369 01:59:50,883 --> 01:59:53,452 UNDERSTAND THE RELATIONSHIP THAT 2370 01:59:53,452 --> 01:59:56,689 THESE HAVE TO EACH OTHER. 2371 01:59:56,689 --> 01:59:59,592 SO IF I FEEL STRONGLY AND MOVE 2372 01:59:59,592 --> 02:00:00,292 FORWARD. 2373 02:00:00,292 --> 02:00:01,694 IT WOULD HELP ME TO UNDERSTAND 2374 02:00:01,694 --> 02:00:06,899 WHAT IMPACT THAT HAS ON THE REST 2375 02:00:06,899 --> 02:00:09,401 OF THE SUBJECT LIP DOME. 2376 02:00:09,401 --> 02:00:13,038 IF I * SUPPLEMENT DOES THAT 2377 02:00:13,038 --> 02:00:18,043 REDUCE OMEGA 9s? 2378 02:00:18,043 --> 02:00:20,145 AND SO THEREFORE HAVE I CREATED 2379 02:00:20,145 --> 02:00:21,480 ANOTHER SITUATION WHERE THE 2380 02:00:21,480 --> 02:00:22,948 EFFECT I SEE IS DUE TO THE 2381 02:00:22,948 --> 02:00:25,050 CHANGE IN THE SECONDARY FATTY 2382 02:00:25,050 --> 02:00:25,451 ACID? 2383 02:00:25,451 --> 02:00:29,188 SO, THAT IS GOING TO GIVE US 2384 02:00:29,188 --> 02:00:32,992 SOME INSIGHTS. 2385 02:00:32,992 --> 02:00:34,326 BETTER UNDERSTANDING OF THE 2386 02:00:34,326 --> 02:00:36,195 MECHANISM OF HOW THESE THINGS 2387 02:00:36,195 --> 02:00:38,297 WORK ALSO MIGHT HELP US. 2388 02:00:38,297 --> 02:00:40,065 WE WILL HAVE SPEAKERS TALKING 2389 02:00:40,065 --> 02:00:41,333 ABOUT THIS MORE. 2390 02:00:41,333 --> 02:00:43,135 BUT I THINK WE DO UNDERSTAND 2391 02:00:43,135 --> 02:00:45,271 THAT CERTAIN FATTY ACIDS HAVE 2392 02:00:45,271 --> 02:00:47,139 SPECIFIC MECHANISMS SO IF WE 2393 02:00:47,139 --> 02:00:48,707 UNDERSTAND THAT AND WE WANT TO 2394 02:00:48,707 --> 02:00:51,243 DESIGN TRIALS TO ENHANCE THAT 2395 02:00:51,243 --> 02:00:53,679 SPECIFIC MECHANISM THAT MAY BE 2396 02:00:53,679 --> 02:00:55,914 ANOTHER WAY TO MOVE FORWARD WITH 2397 02:00:55,914 --> 02:00:58,784 DECIDING WHAT SORT OF SPECIFIC 2398 02:00:58,784 --> 02:01:00,252 NUTRIENTS WE CAN STUDY IN 2399 02:01:00,252 --> 02:01:01,453 ISOLATION. 2400 02:01:01,453 --> 02:01:03,889 DOES THAT EVEN COME CLOSE TO 2401 02:01:03,889 --> 02:01:05,324 ADDRESSING WHAT YOU WERE ASKING? 2402 02:01:05,324 --> 02:01:05,724 >> YES. 2403 02:01:05,724 --> 02:01:08,761 I THINK SO AND YOU ELUDED TO THE 2404 02:01:08,761 --> 02:01:10,195 FACT THAT YOU WANTED TO ANSWER 2405 02:01:10,195 --> 02:01:12,831 THE PREVIOUS QUESTION AS WELL. 2406 02:01:12,831 --> 02:01:14,400 >> YOU ASKED A YES OR NO 2407 02:01:14,400 --> 02:01:15,401 QUESTION. 2408 02:01:15,401 --> 02:01:17,069 YOUR QUESTION WAS DO WE HAVE 2409 02:01:17,069 --> 02:01:20,372 ENOUGH EVIDENCE AT THIS POINT IN 2410 02:01:20,372 --> 02:01:21,440 TIME? 2411 02:01:21,440 --> 02:01:22,875 SOLID EVIDENCE. 2412 02:01:22,875 --> 02:01:24,510 AND I THOUGHT NO. 2413 02:01:24,510 --> 02:01:26,912 IS THE ANSWER TO THAT AND ALL OF 2414 02:01:26,912 --> 02:01:28,747 THE SPEAKERS LAID OUT GREAT 2415 02:01:28,747 --> 02:01:30,949 AREAS WHERE WE NEED MORE 2416 02:01:30,949 --> 02:01:31,517 INFORMATION. 2417 02:01:31,517 --> 02:01:34,053 AND THERE IS STILL LOTS OF TO 2418 02:01:34,053 --> 02:01:35,054 LEARN. 2419 02:01:35,054 --> 02:01:40,092 THE MORE EA -- STUDIES THAT ARE 2420 02:01:40,092 --> 02:01:41,894 LEARNED THE MORE QUESTIONS IT 2421 02:01:41,894 --> 02:01:47,366 REVEALS. 2422 02:01:47,366 --> 02:01:51,103 >> THANK YOU. 2423 02:01:51,103 --> 02:01:52,204 DR. GARCIA-LARSEN. 2424 02:01:52,204 --> 02:01:54,807 I SEE YOUR HAND UP. 2425 02:01:54,807 --> 02:01:55,474 >> THANK YOU. 2426 02:01:55,474 --> 02:01:59,345 I THINK THAT IN TERMS OF WHICH 2427 02:01:59,345 --> 02:02:03,482 DIETARY EXPOSURES WE CAN FOCUS 2428 02:02:03,482 --> 02:02:06,318 -- FOR FLAVONOIDS THERE ARE NOT 2429 02:02:06,318 --> 02:02:08,721 THAT MANY STUDIES. 2430 02:02:08,721 --> 02:02:10,589 PROBABLY 10 STUDIES WORLDWIDE 2431 02:02:10,589 --> 02:02:14,493 LOOKING AT POPULATION BASED 2432 02:02:14,493 --> 02:02:21,600 STUDIES. 2433 02:02:21,600 --> 02:02:23,402 GENERALLY SPEAKING TOTAL 2434 02:02:23,402 --> 02:02:25,871 FLAVONOIDS ARE NOT SEEN TO BE 2435 02:02:25,871 --> 02:02:27,439 ASSOCIATED WITH THE RESPIRATORY 2436 02:02:27,439 --> 02:02:31,910 OUTCOMES BUT WE DO SEE A 2437 02:02:31,910 --> 02:02:33,679 CONSTANT TREND TO -- SUB 2438 02:02:33,679 --> 02:02:35,414 CLASSES. 2439 02:02:35,414 --> 02:02:37,850 BUT IN ORDER TO IDENTIFY THOSE 2440 02:02:37,850 --> 02:02:40,419 SUB CLASSES WE NEED TO HAVE 2441 02:02:40,419 --> 02:02:42,554 TOTAL FLAVONOIDS AS WELL. 2442 02:02:42,554 --> 02:02:45,424 IT CAN BE HYPOTHESIS DRIVEN AS 2443 02:02:45,424 --> 02:02:46,225 WELL. 2444 02:02:46,225 --> 02:02:51,363 THERE MIGHT BE ROOM THERE. 2445 02:02:51,363 --> 02:02:53,465 AND THAT IS ALL I WANTED TO SAY. 2446 02:02:53,465 --> 02:02:55,768 THANKS. 2447 02:02:55,768 --> 02:02:58,837 >> I SEE DR. BURNEY'S HAND UP AS 2448 02:02:58,837 --> 02:02:59,438 WELL. 2449 02:02:59,438 --> 02:03:04,376 I MAY LET DR. CELEDON GO FIRST. 2450 02:03:04,376 --> 02:03:06,378 WE'VE BEEN DISCUSSING THE 2451 02:03:06,378 --> 02:03:09,848 COMPLEXITY AND THEN TO 2452 02:03:09,848 --> 02:03:11,450 DR. BURNEY 2453 02:03:11,450 --> 02:03:13,218 >> VERY BRIEF. 2454 02:03:13,218 --> 02:03:17,055 -- THE DATA HAS BEEN USED GIVEN 2455 02:03:17,055 --> 02:03:18,390 FINANCIAL CONSTRAINTS AND 2456 02:03:18,390 --> 02:03:19,158 LIMITED FUNDING. 2457 02:03:19,158 --> 02:03:22,161 YOU CANNOT FUND THESE EXPENSIVE 2458 02:03:22,161 --> 02:03:23,695 STUDIES. 2459 02:03:23,695 --> 02:03:25,898 CONCENTRATED ON HIGH RISK 2460 02:03:25,898 --> 02:03:28,867 POPULATIONS. 2461 02:03:28,867 --> 02:03:30,536 SEVERE DEFICIENCIES OR RACIAL OR 2462 02:03:30,536 --> 02:03:32,771 ETHNIC GROUP. 2463 02:03:32,771 --> 02:03:35,441 7 THESE PUERTO RICANS HAD THE 2464 02:03:35,441 --> 02:03:39,445 FIRST McDonald's OUT OF THE 2465 02:03:39,445 --> 02:03:41,346 CONTINENTAL U.S. AND WE HAVE 2466 02:03:41,346 --> 02:03:41,847 SIGNALS THERE. 2467 02:03:41,847 --> 02:03:44,082 OR POPULATIONS THAT ARE EXPOSED 2468 02:03:44,082 --> 02:03:46,151 TO OXIDATIVE STRESS. 2469 02:03:46,151 --> 02:03:47,252 PREGNANT SMOKERS. 2470 02:03:47,252 --> 02:03:50,122 WE HAVE SOME INTERESTING DATA ON 2471 02:03:50,122 --> 02:03:52,791 PERSONS EXPOSED TO HIGH LEVELS 2472 02:03:52,791 --> 02:03:55,794 OF PARTICULATE MATTER. 2473 02:03:55,794 --> 02:03:57,830 BUT THAT MAY ALLOW YOU TO PICK 2474 02:03:57,830 --> 02:04:00,399 UP SIGNALS WITH A SMALLER SAMPLE 2475 02:04:00,399 --> 02:04:03,435 SIZE. 2476 02:04:03,435 --> 02:04:04,536 >> WONDERFUL. 2477 02:04:04,536 --> 02:04:07,639 DR. BURNEY. 2478 02:04:07,639 --> 02:04:08,173 >> YES. 2479 02:04:08,173 --> 02:04:11,977 THANK YOU. 2480 02:04:11,977 --> 02:04:14,346 TO A MORE GENERAL POINT, THAT IS 2481 02:04:14,346 --> 02:04:18,183 ONE OF THE PROBLEMS THAT WE HAVE 2482 02:04:18,183 --> 02:04:20,652 IS THAT EVERY SINGLE STUDY THAT 2483 02:04:20,652 --> 02:04:22,221 IS DONE STARTS OFF WITH A 2484 02:04:22,221 --> 02:04:25,290 DIFFERENT WAY OF COLLECTING DATA 2485 02:04:25,290 --> 02:04:28,293 AND I THINK TO HARMONIZE DATA 2486 02:04:28,293 --> 02:04:30,195 COLLECTION WOULD BE A BIG STEP 2487 02:04:30,195 --> 02:04:30,863 FORWARD. 2488 02:04:30,863 --> 02:04:32,564 SO FOR INSTANCE THE 2489 02:04:32,564 --> 02:04:34,666 QUESTIONNAIRE THAT VANESSA 2490 02:04:34,666 --> 02:04:39,104 DEVELOPED SEEMS TO BE A VERY 2491 02:04:39,104 --> 02:04:40,906 GOOD QUESTIONNAIRE IN THAT IT'S 2492 02:04:40,906 --> 02:04:44,443 VERY FLEXIBLE AND YET IT HAS A 2493 02:04:44,443 --> 02:04:47,346 RIGID CORE AND SOMETHING LIKE 2494 02:04:47,346 --> 02:04:49,848 THAT WOULD BE VERY HELPFUL. 2495 02:04:49,848 --> 02:04:53,919 THE OTHER POINT IS PROMPTED BY 2496 02:04:53,919 --> 02:05:00,492 SOMETHING THAT WAS SAID -- IT'S 2497 02:05:00,492 --> 02:05:03,061 A FREQUENT THING THAT 2498 02:05:03,061 --> 02:05:04,963 NUTRITIONAL EPIDEMIOLOGIST SAY 2499 02:05:04,963 --> 02:05:07,733 IS THAT YOU DON'T EAT FOODS IN 2500 02:05:07,733 --> 02:05:08,000 ISOLATION. 2501 02:05:08,000 --> 02:05:10,269 YOU EAT THEM AS A PATTERN OF 2502 02:05:10,269 --> 02:05:10,969 FOODS. 2503 02:05:10,969 --> 02:05:14,873 THAT CAN LEAD TO A LONG WAY DOWN 2504 02:05:14,873 --> 02:05:18,844 A WRONG PATHWAY AND THAT IS 2505 02:05:18,844 --> 02:05:21,547 BECAUSE THE FOOD THAT YOU EAT IS 2506 02:05:21,547 --> 02:05:24,149 MORE THAN ANYTHING -- 2507 02:05:24,149 --> 02:05:27,119 [ INDISCERNIBLE ] 2508 02:05:27,119 --> 02:05:29,988 -- HIGHLY CONFOUNDED BY ALMOST 2509 02:05:29,988 --> 02:05:33,191 ANY OTHER THING THAT YOU CAN 2510 02:05:33,191 --> 02:05:35,093 MENTION IN THE PERSON'S SOCIAL 2511 02:05:35,093 --> 02:05:36,495 ENVIRONMENT. 2512 02:05:36,495 --> 02:05:39,298 SO I THINK THAT ANOTHER I TAKE 2513 02:05:39,298 --> 02:05:42,067 THE POINT AND IT'S A WELL MADE 2514 02:05:42,067 --> 02:05:44,069 POINT BUT I THINK IT ALSO HAS A 2515 02:05:44,069 --> 02:05:46,939 LITTLE BIT OF A PROBLEM ATTACHED 2516 02:05:46,939 --> 02:05:49,341 TO AT THIS TIME. 2517 02:05:49,341 --> 02:05:51,577 >> THAT'S AN INTERESTING POINT 2518 02:05:51,577 --> 02:05:52,010 DR. BURNEY. 2519 02:05:52,010 --> 02:05:53,312 THANK YOU FOR RAISING THAT. 2520 02:05:53,312 --> 02:05:56,882 AS WE'RE DISCUSSING THE IDEA OF 2521 02:05:56,882 --> 02:05:58,517 DIETARY PATTERNS AND THE 2522 02:05:58,517 --> 02:06:00,919 COMPLEXITY OF DIET AS AND 2523 02:06:00,919 --> 02:06:02,554 EXPOSER IN THE CONTEXT OF THE 2524 02:06:02,554 --> 02:06:04,456 COMPLEXITY OF LIFE AS AN 2525 02:06:04,456 --> 02:06:06,592 EXPOSURE AND WHAT GOES ALONG 2526 02:06:06,592 --> 02:06:09,394 WITH SOME OF OUR DIETARY CHOICES 2527 02:06:09,394 --> 02:06:14,866 AND THE AVAILABILITY OF FOODS. 2528 02:06:14,866 --> 02:06:19,271 AS WE MOVE FORWARD IN 2529 02:06:19,271 --> 02:06:21,840 EPIDEMILOGICAL RESEARCH I WONDER 2530 02:06:21,840 --> 02:06:24,710 IF THERE ARE ANY COMMON 2531 02:06:24,710 --> 02:06:25,777 RECOMMENDATIONS WE CAN COME 2532 02:06:25,777 --> 02:06:28,113 FORTHWITH TRYING TO LOOK AT BOTH 2533 02:06:28,113 --> 02:06:31,483 WITHIN THE SAME STUDIES? 2534 02:06:31,483 --> 02:06:33,819 WHERE THERE IS POSSIBILITY TO DO 2535 02:06:33,819 --> 02:06:37,990 SO. 2536 02:06:37,990 --> 02:06:41,193 DR. GARCIA-LARSEN IN TERMS OF 2537 02:06:41,193 --> 02:06:43,829 YOUR -- APPROACH TO 2538 02:06:43,829 --> 02:06:46,865 HARMONIZATION OF DATA WOULD YOU 2539 02:06:46,865 --> 02:06:48,133 -- DO YOU HAVE ANY 2540 02:06:48,133 --> 02:06:49,401 RECOMMENDATIONS ABOUT DATA 2541 02:06:49,401 --> 02:06:50,969 COLLECTION AND REALLY ANALYSIS 2542 02:06:50,969 --> 02:06:53,872 OF THAT DATA PERHAPS LOOKING IN 2543 02:06:53,872 --> 02:06:56,341 PARALLEL AT BOTH NUTRIENTS AND 2544 02:06:56,341 --> 02:06:58,343 DIETARY PATTERNS TO ACCOUNT FOR 2545 02:06:58,343 --> 02:07:01,346 THAT COMPLEXITY? 2546 02:07:01,346 --> 02:07:02,347 >> PERHAPS AND THANK YOU 2547 02:07:02,347 --> 02:07:03,815 PROFESSOR BURNEY FOR YOUR 2548 02:07:03,815 --> 02:07:08,053 COMMENTS AS WELL. 2549 02:07:08,053 --> 02:07:09,821 SO THE CERTAIN TOOLS AND 2550 02:07:09,821 --> 02:07:11,857 INSTRUMENTS THAT ARE WIDELY 2551 02:07:11,857 --> 02:07:12,124 AVAILABLE. 2552 02:07:12,124 --> 02:07:16,695 8 AND FOR EXAMPLE THE U.S.D.A 2553 02:07:16,695 --> 02:07:21,433 HAS A WONDERFUL TABLE TO 2554 02:07:21,433 --> 02:07:24,770 ESTIMATE A WIDE RANGE OF POLLY 2555 02:07:24,770 --> 02:07:27,973 PHENOLS AND FLAVONOIDS AND 2556 02:07:27,973 --> 02:07:31,043 NUTRIENT CONTENT IN GENERAL. 2557 02:07:31,043 --> 02:07:33,045 HARMONIZING AND HAVING 2558 02:07:33,045 --> 02:07:34,513 COMPARABLE -- FOR US TO 2559 02:07:34,513 --> 02:07:37,149 UNDERSTAND. 2560 02:07:37,149 --> 02:07:38,717 IDENTIFY CRITICAL NUTRIENTS THAT 2561 02:07:38,717 --> 02:07:45,557 COULD BE -- WHEN MEASURED COULD 2562 02:07:45,557 --> 02:07:47,225 BE MADE COMPARABLE. 2563 02:07:47,225 --> 02:07:50,529 THAT IS WHY I WANTED TO SHARE 2564 02:07:50,529 --> 02:07:55,167 THAT TABLE -- TWO VERY DIFFERENT 2565 02:07:55,167 --> 02:07:57,302 STUDIES -- BOTH OUTCOMES AND 2566 02:07:57,302 --> 02:07:59,971 EXPOSURES WERE MEASURED USING 2567 02:07:59,971 --> 02:08:03,942 VERY SIMILAR -- OBJECTIVE TOOLS 2568 02:08:03,942 --> 02:08:05,377 FOR LUNG FUNCTION AND TO 2569 02:08:05,377 --> 02:08:08,914 DETERMINE THE CONTENT. 2570 02:08:08,914 --> 02:08:10,816 AND THAT IS THE FIRST STEPS TO 2571 02:08:10,816 --> 02:08:13,418 MAKE THINGS COMPARABLE. 2572 02:08:13,418 --> 02:08:16,755 WE DO NEED MORE RESOURCES TO 2573 02:08:16,755 --> 02:08:18,957 MEASURE FUNCTION IN COPD. 2574 02:08:18,957 --> 02:08:22,327 IT IS VERY COMPLEX TO DEFINE. 2575 02:08:22,327 --> 02:08:24,129 SO CLEARLY IT'S MUCH MORE 2576 02:08:24,129 --> 02:08:28,100 COMPLEX THAT MEASURING OTHER 2577 02:08:28,100 --> 02:08:32,070 OUTCOMES FOR OTHER 2578 02:08:32,070 --> 02:08:39,311 NONCOMMUNICABLE DISEASES. 2579 02:08:39,311 --> 02:08:42,380 AND FOR DIET THERE ARE SEVERAL 2580 02:08:42,380 --> 02:08:44,750 VERY NICE INTERNATIONAL 2581 02:08:44,750 --> 02:08:45,450 QUESTIONNAIRES. 2582 02:08:45,450 --> 02:08:46,952 SOME ARE LONGER. 2583 02:08:46,952 --> 02:08:48,520 SOME ARE SHORTER. 2584 02:08:48,520 --> 02:08:52,791 WE DEVELOPED -- GALEN AND IT HAS 2585 02:08:52,791 --> 02:08:55,660 A STANDARD APPROACH TO DERIVING 2586 02:08:55,660 --> 02:08:55,894 CONTENT. 2587 02:08:55,894 --> 02:08:57,329 FREE TO ACCESS. 2588 02:08:57,329 --> 02:08:58,463 ANYONE WHO IS INTERESTED CAN 2589 02:08:58,463 --> 02:09:00,098 ACCESS IT. 2590 02:09:00,098 --> 02:09:01,767 BUT OF COURSE IT REQUIRES TIME. 2591 02:09:01,767 --> 02:09:03,902 IT'S NOT A SHORT QUESTIONNAIRE 2592 02:09:03,902 --> 02:09:07,205 BUT IT'S FLEXIBLE IN TERMS OF 2593 02:09:07,205 --> 02:09:10,075 ADAPTATIONS. 2594 02:09:10,075 --> 02:09:12,778 IF WE IMPROVE THE OBSERVATIONAL 2595 02:09:12,778 --> 02:09:15,847 TOOLS AVAILABLE. 2596 02:09:15,847 --> 02:09:19,851 IT'S DIFFICULT TO DO HIGH 2597 02:09:19,851 --> 02:09:21,953 PRECISION MEDICINE IT'S FAR MORE 2598 02:09:21,953 --> 02:09:30,729 EXPENSIVE. 2599 02:09:30,729 --> 02:09:35,901 SO - I AGREE ON A FEW COMMON 2600 02:09:35,901 --> 02:09:37,803 TOOLS. 2601 02:09:37,803 --> 02:09:39,905 NUTRITIONAL EXPOSURES WOULD BE A 2602 02:09:39,905 --> 02:09:45,544 GOOD FIRST STEP IN MY VIEW. 2603 02:09:45,544 --> 02:09:46,845 >> THANK YOU. 2604 02:09:46,845 --> 02:09:49,314 AND IN LINE WITH THAT THERE IS A 2605 02:09:49,314 --> 02:09:53,819 SPECIFIC QUESTION IN THE Q&A FOR 2606 02:09:53,819 --> 02:09:55,120 DR. CELEDON ABOUT DIETARY 2607 02:09:55,120 --> 02:09:55,954 SCORES. 2608 02:09:55,954 --> 02:09:57,489 THE QUESTION WAS SPECIFICALLY 2609 02:09:57,489 --> 02:10:00,725 ABOUT D II AND ITS 2610 02:10:00,725 --> 02:10:02,627 APPROPRIATENESS FOR USE WITHIN 2611 02:10:02,627 --> 02:10:04,462 CHILDREN AND ALSO SOME QUESTIONS 2612 02:10:04,462 --> 02:10:07,966 COME THROUGH REGARDING THE HEI 2613 02:10:07,966 --> 02:10:16,508 AND THE AHEI. 2614 02:10:16,508 --> 02:10:20,478 COULD YOU COMMENT? 2615 02:10:20,478 --> 02:10:22,047 >> -- BOTH IN CHILDREN AND 2616 02:10:22,047 --> 02:10:24,783 ADULTS -- AND THE RESULTS APPEAR 2617 02:10:24,783 --> 02:10:27,752 TO BE RELATIVELY CONSISTENT. 2618 02:10:27,752 --> 02:10:29,754 AGAIN WHEN YOU ACCOUNT FOR 2619 02:10:29,754 --> 02:10:32,858 SAMPLE SIZE THE ONLY STUDY WHICH 2620 02:10:32,858 --> 02:10:36,161 WE USED AEHI WAS SALT BECAUSE 2621 02:10:36,161 --> 02:10:38,296 THEY DID HAVE IT. 2622 02:10:38,296 --> 02:10:40,632 AND ORIGINALLY IT WAS INTENDED 2623 02:10:40,632 --> 02:10:43,034 FOR STUDIES OF CANCER. 2624 02:10:43,034 --> 02:10:45,136 AND WE FOUND SIGNALS FOR LUNG 2625 02:10:45,136 --> 02:10:47,405 FUNCTION BUT NOT FOR ASTHMA 2626 02:10:47,405 --> 02:10:49,374 WHICH IS KIND OF INTERESTING. 2627 02:10:49,374 --> 02:10:52,410 THE OTHER QUESTION IN THE CHAT 2628 02:10:52,410 --> 02:10:58,783 WAS THIS STUDY WAS CROSS SEXUAL. 2629 02:10:58,783 --> 02:11:01,086 -- SECTIONAL. 2630 02:11:01,086 --> 02:11:06,591 WE DID HAVE LONGITUDINAL BUT IT 2631 02:11:06,591 --> 02:11:10,095 WAS A SIMPLER SCORE. 2632 02:11:10,095 --> 02:11:14,866 * DO ANY OTHER SPEAKERS WANT TO 2633 02:11:14,866 --> 02:11:16,868 COMMENT ON DIETARY SCORES 2634 02:11:16,868 --> 02:11:19,537 SPECIFICALLY? 2635 02:11:19,537 --> 02:11:23,541 >> I'LL JUST ADD THAT A CLASSIC 2636 02:11:23,541 --> 02:11:27,946 DIETARY PATTERNS IS THE 2637 02:11:27,946 --> 02:11:29,180 MEDITERRANEAN DIET. 2638 02:11:29,180 --> 02:11:31,650 AND ONE OF THE CONCERNS RAISED 2639 02:11:31,650 --> 02:11:33,218 ABOUT THESE STUDIES IS HOW DO 2640 02:11:33,218 --> 02:11:40,558 YOU GET PEOPLE TO FOLLOW A DIET. 2641 02:11:40,558 --> 02:11:42,160 THE CARDIOLOGIST HAVE BEEN DOING 2642 02:11:42,160 --> 02:11:43,929 IT SPECIFICALLY WITH THE 2643 02:11:43,929 --> 02:11:44,930 MEDITERRANEAN DIET. 2644 02:11:44,930 --> 02:11:46,698 IT WOULD BE EASIER TO GIVE 2645 02:11:46,698 --> 02:11:48,767 PEOPLE A PILL. 2646 02:11:48,767 --> 02:11:50,335 MAYBE A PILL THEY COULD TAKE 2647 02:11:50,335 --> 02:11:51,202 ONCE A MONTH. 2648 02:11:51,202 --> 02:11:55,707 THAT IS NOT JUST GOING TO 2649 02:11:55,707 --> 02:11:56,308 HAPPEN. 2650 02:11:56,308 --> 02:11:59,177 I'D ENCOURAGE US TO NOT BE TOO 2651 02:11:59,177 --> 02:12:01,846 NEGATIVE ABOUT THE DIETARY 2652 02:12:01,846 --> 02:12:03,548 INTERVENTIONS BECAUSE WE DO HAVE 2653 02:12:03,548 --> 02:12:05,116 COLLEAGUES THAT ARE DOING THIS 2654 02:12:05,116 --> 02:12:12,657 KIND OF WORK SUCCESSFULLY. 2655 02:12:12,657 --> 02:12:14,659 >> I WANT TO TRANSITION TO 2656 02:12:14,659 --> 02:12:16,294 PRIORITY POPULATIONS. 2657 02:12:16,294 --> 02:12:19,331 AND BY THAT I MEAN THOSE WHO ARE 2658 02:12:19,331 --> 02:12:21,399 EITHER KNOWN TO BE SUSCEPTIBLE 2659 02:12:21,399 --> 02:12:25,804 OR VULNERABLE. 2660 02:12:25,804 --> 02:12:28,406 DR. HANSON I MAY ASK YOU FIRST 2661 02:12:28,406 --> 02:12:32,711 BECAUSE YOU DISCUSSED A FAIR BIT 2662 02:12:32,711 --> 02:12:34,279 OF EFFECT MODIFICATION BUT ALSO 2663 02:12:34,279 --> 02:12:37,482 LOOKING AT SUBSETS OF 2664 02:12:37,482 --> 02:12:37,782 POPULATIONS. 2665 02:12:37,782 --> 02:12:40,485 CAN YOU COMMENT ON WHERE YOU SEE 2666 02:12:40,485 --> 02:12:44,122 IMPORTANT FUTURE DIRECTION? 2667 02:12:44,122 --> 02:12:46,858 >> ONE IS GENETIC. 2668 02:12:46,858 --> 02:12:49,561 THERE DO SEEM TO BE GENETIC 2669 02:12:49,561 --> 02:12:53,398 DIFFERENCES IN PEOPLE'S ABILITY 2670 02:12:53,398 --> 02:12:55,633 TO METABOLIZE FATTY ACIDS. 2671 02:12:55,633 --> 02:12:58,136 THAT WOULD BE ONE FUTURE FOCUS 2672 02:12:58,136 --> 02:13:00,905 OF RESEARCH AS FAR AS LIPIDS GO. 2673 02:13:00,905 --> 02:13:03,341 YOU SEE DIFFERENCES BY SEX AND 2674 02:13:03,341 --> 02:13:05,977 BY THE HEALTH OF THE MOTHER. 2675 02:13:05,977 --> 02:13:08,847 WHETHER OR NOT THE MOTHER HAD 2676 02:13:08,847 --> 02:13:12,217 ASTHMA AND SMOKING POPULATIONS. 2677 02:13:12,217 --> 02:13:15,453 I THINK THAT WOULD BE IMPORTANT 2678 02:13:15,453 --> 02:13:17,122 FOR LIPIDS. 2679 02:13:17,122 --> 02:13:20,625 SOME OF THE ACTIONS OF LIPIDS 2680 02:13:20,625 --> 02:13:22,460 INVOLVE THE RESOLUTION OF 2681 02:13:22,460 --> 02:13:22,894 INFLAMMATION. 2682 02:13:22,894 --> 02:13:28,066 SO POPULATIONS AT HIGH RISK OF 2683 02:13:28,066 --> 02:13:30,602 INFLAMMATION WOULD BE MAYBE A 2684 02:13:30,602 --> 02:13:33,471 VERY GOOD POPULATION TO TARGET 2685 02:13:33,471 --> 02:13:39,911 FOR INTERVENTIONS. 2686 02:13:39,911 --> 02:13:43,148 >> DR. CELEDON YOU HAD MENTIONED 2687 02:13:43,148 --> 02:13:46,418 ETHNIC AND RACIAL -- 2688 02:13:46,418 --> 02:13:47,252 DISPARITIES. 2689 02:13:47,252 --> 02:13:50,321 >> SURE. 2690 02:13:50,321 --> 02:13:51,856 TWO THINGS. 2691 02:13:51,856 --> 02:13:54,292 ONE IS AGREE SMOKERS IS AN 2692 02:13:54,292 --> 02:13:55,060 IMPORTANT POPULATION. 2693 02:13:55,060 --> 02:13:56,694 THE OTHER ONE IS PEOPLE LIVING 2694 02:13:56,694 --> 02:13:58,396 IN AREAS THAT ARE HIGHLY 2695 02:13:58,396 --> 02:13:59,831 POLLUTED. 2696 02:13:59,831 --> 02:14:05,770 AND I REMEMBER WORK THAT 2697 02:14:05,770 --> 02:14:10,975 DR. CAMARGO DID IN MONGOLIA -- 2698 02:14:10,975 --> 02:14:13,511 LOW VITAMIN D LEVELS. 2699 02:14:13,511 --> 02:14:16,281 WE HAD A PAPER THAT WAS 2700 02:14:16,281 --> 02:14:19,050 FAVORABLY REVIEWED DOING A 2701 02:14:19,050 --> 02:14:20,285 SECONDARY ANALYSIS OF OUR 2702 02:14:20,285 --> 02:14:23,021 VITAMIN D TRIAL. 2703 02:14:23,021 --> 02:14:28,960 WHAT WE'RE FINDING IS A SIGNAL 2704 02:14:28,960 --> 02:14:31,529 -- PARTICULATE MATTER MIGHT 2705 02:14:31,529 --> 02:14:34,799 MINUTE D MIGHT, PROTECTIVE. 2706 02:14:34,799 --> 02:14:35,800 PREGNANT SMOKERS. 2707 02:14:35,800 --> 02:14:38,436 THAT IS A HIGH RISK POPULATION 2708 02:14:38,436 --> 02:14:40,371 AND IN OUR STUDIES IN PUERTO 2709 02:14:40,371 --> 02:14:42,373 RICO NOW WE'RE STARTING TO LOOK 2710 02:14:42,373 --> 02:14:45,543 AT ENDO TYPES. 2711 02:14:45,543 --> 02:14:47,979 THE DIFFICULTY WITH THE 2712 02:14:47,979 --> 02:14:49,147 BIOMARKERS ON THE OUTCOME SIDE 2713 02:14:49,147 --> 02:14:51,683 BUT WE'RE HAVING ENCOURAGING 2714 02:14:51,683 --> 02:14:52,383 RESULTS. 2715 02:14:52,383 --> 02:14:54,919 WE ALSO HAVE DATA COMING UP IN 2716 02:14:54,919 --> 02:14:57,822 ADULTS AND DIET IS ONE OF THE 2717 02:14:57,822 --> 02:15:00,692 STRONGEST RISK FACTORS THAT WE 2718 02:15:00,692 --> 02:15:00,892 FIND. 2719 02:15:00,892 --> 02:15:03,394 IT APPEARS TO EFFECT OF THE TWO 2720 02:15:03,394 --> 02:15:05,230 ENDO TYPES. 2721 02:15:05,230 --> 02:15:06,965 IT'S PRELIMINARY. 2722 02:15:06,965 --> 02:15:09,000 7 BUT STUDYING THESE POPULATIONS 2723 02:15:09,000 --> 02:15:11,369 WITH HIGH BURDEN OF ASTHMA LIKE 2724 02:15:11,369 --> 02:15:13,838 PUERTO RICO HIGHLY EXPOSED TO 2725 02:15:13,838 --> 02:15:23,381 POLLUTANTS MAY BE A WAY TO GO. 2726 02:15:23,381 --> 02:15:24,716 >> DR. GARCIA-LARSEN YOU 2727 02:15:24,716 --> 02:15:26,384 EMPHASIZED RESEARCH NEEDS IN 2728 02:15:26,384 --> 02:15:28,620 LOW-INCOME COUNTRIES 2729 02:15:28,620 --> 02:15:31,523 CAN YOU ELABORATE MORE? 2730 02:15:31,523 --> 02:15:31,990 >> THANK YOU. 2731 02:15:31,990 --> 02:15:33,658 THAT IS A REALLY EXCITING 2732 02:15:33,658 --> 02:15:35,426 QUESTION. 2733 02:15:35,426 --> 02:15:39,097 AND ONE THAT HAPPENS I COULD 2734 02:15:39,097 --> 02:15:40,765 HOPE IN THE FUTURE GET FUNDING 2735 02:15:40,765 --> 02:15:44,536 SUPPORT BECAUSE WE REALLY DO 2736 02:15:44,536 --> 02:15:49,107 NEED EVIDENCE. 2737 02:15:49,107 --> 02:15:55,146 WE NEED TO -- HOW IMPORTANT 2738 02:15:55,146 --> 02:15:57,382 POVERTY IS IN TERMS OF ITS 2739 02:15:57,382 --> 02:16:00,151 INTERACTION WITH NUTRITION. 2740 02:16:00,151 --> 02:16:01,819 AND THERE IS A WHOLE SET OF 2741 02:16:01,819 --> 02:16:06,191 FACTORS THAT BEHAVE DIFFERENTLY. 2742 02:16:06,191 --> 02:16:10,028 POVERTY IS DEFINED DIFFERENTLY. 2743 02:16:10,028 --> 02:16:12,397 WHAT WE CAN SEE -- IN THE 2744 02:16:12,397 --> 02:16:14,499 SETTINGS IS DIFFERENT FROM 2745 02:16:14,499 --> 02:16:21,940 LOW-INCOME COUNTRIES. 2746 02:16:21,940 --> 02:16:25,510 AND SO I BELIEVE THERE IS A HUGE 2747 02:16:25,510 --> 02:16:28,546 NEED TO COLLECT OBJECTIVE DATA. 2748 02:16:28,546 --> 02:16:31,749 TO FIRST OF ALL UNDERSTAND MUCH 2749 02:16:31,749 --> 02:16:35,086 BETTER WHAT THE DISTRIBUTION OF 2750 02:16:35,086 --> 02:16:37,422 THIS IS AND HOW IT RELATES TO 2751 02:16:37,422 --> 02:16:39,624 RISK FACTORS. 2752 02:16:39,624 --> 02:16:43,027 IF THERE IS A CAUSAL 2753 02:16:43,027 --> 02:16:53,004 RELATIONSHIP -- IF WE DO BELIEVE 2754 02:16:53,004 --> 02:16:55,773 THAT NUTRITION HAS A CAUSAL ROLE 2755 02:16:55,773 --> 02:16:58,343 IN CHRONIC RESPIRATORY DISEASES 2756 02:16:58,343 --> 02:17:02,313 WE NEED TO UNDERSTAND HOW WHAT 2757 02:17:02,313 --> 02:17:04,115 HAPPENS IN LOW AND MIDDLE INCOME 2758 02:17:04,115 --> 02:17:04,682 COUNTRIES. 2759 02:17:04,682 --> 02:17:07,986 WE NEED TO UNDERSTAND DIETARY 2760 02:17:07,986 --> 02:17:09,854 PATTERNS. 2761 02:17:09,854 --> 02:17:12,991 WE COULD HAVE BASIC STANDARDIZED 2762 02:17:12,991 --> 02:17:14,025 INFORMATION ABOUT CERTAIN FOODS 2763 02:17:14,025 --> 02:17:15,793 AND COMPARE THAT AND SEE WHAT 2764 02:17:15,793 --> 02:17:17,262 HAPPENS. 2765 02:17:17,262 --> 02:17:20,098 IDEALLY WE SHOULD BE ABLE TO 2766 02:17:20,098 --> 02:17:20,999 COMPARE FINDINGS FROM HIGH 2767 02:17:20,999 --> 02:17:22,700 INCOME AND LOW-INCOME COUNTRIES 2768 02:17:22,700 --> 02:17:24,802 AND SEE USING THE SAME TOOLS 2769 02:17:24,802 --> 02:17:27,872 WHAT THE FINDINGS INDICATE. 2770 02:17:27,872 --> 02:17:30,341 AND YOU DID SAY SOMETHING VERY 2771 02:17:30,341 --> 02:17:32,343 IMPORTANT -- ABOUT INTERVENTION 2772 02:17:32,343 --> 02:17:33,978 STUDIES. 2773 02:17:33,978 --> 02:17:36,114 I DO THINK THEY ARE EXTREMELY 2774 02:17:36,114 --> 02:17:37,548 IMPORTANT. 2775 02:17:37,548 --> 02:17:39,651 THE CURRENT EVIDENCE HAS FOCUSED 2776 02:17:39,651 --> 02:17:41,319 ON SMALL TRIALS BECAUSE FOOD 2777 02:17:41,319 --> 02:17:42,687 INTERESTS CONVENIENCE IS VERY 2778 02:17:42,687 --> 02:17:44,822 DIFFICULT TO DO. 2779 02:17:44,822 --> 02:17:48,359 THE ATTRITION BIAS IS MASSIVE. 2780 02:17:48,359 --> 02:17:51,162 IT'S A DIFFICULT TO KEEP PEOPLE 2781 02:17:51,162 --> 02:17:54,666 ENGAGED IN SPECIFIC TYPE OF DIET 2782 02:17:54,666 --> 02:17:55,433 FOR TOO LONG. 2783 02:17:55,433 --> 02:17:56,434 IT'S HARD. 2784 02:17:56,434 --> 02:17:59,337 BUT WE DO SEE SOME PROMISING 2785 02:17:59,337 --> 02:18:02,073 RESULTS IN TERMS OF CHANGES IN 2786 02:18:02,073 --> 02:18:03,374 BIOMARKERS OF INFLAMMATION AND 2787 02:18:03,374 --> 02:18:05,810 THAT IS A VERY IMPORTANT PIECE 2788 02:18:05,810 --> 02:18:11,516 OF EVIDENCE I THINK IF WE CAN 2789 02:18:11,516 --> 02:18:17,355 ACTUALLY -- MULTIPLY OXIDATIVE 2790 02:18:17,355 --> 02:18:20,858 STRESS WE'RE GETTING FURTHER. 2791 02:18:20,858 --> 02:18:24,028 WE NEED TO HAVE SOLID 2792 02:18:24,028 --> 02:18:25,163 EPIDEMILOGICAL EVIDENCE. 2793 02:18:25,163 --> 02:18:26,931 WE NEED MORE STUDIES TO 2794 02:18:26,931 --> 02:18:28,533 UNDERSTAND WHAT ARE THE CRITICAL 2795 02:18:28,533 --> 02:18:30,868 PROBLEMS IN TERMS OF CHRONIC 2796 02:18:30,868 --> 02:18:32,170 DISEASE DISABILITY. 2797 02:18:32,170 --> 02:18:34,205 WHAT ARE THE DETERMINANTS OF 2798 02:18:34,205 --> 02:18:36,607 POOR LUNG FUNCTIONING ADULTS. 2799 02:18:36,607 --> 02:18:38,576 IT MIGHT BE COMPLETELY 2800 02:18:38,576 --> 02:18:42,213 DIFFERENT. 2801 02:18:42,213 --> 02:18:45,983 A COHORT STUDY IN NEPAL WHERE 2802 02:18:45,983 --> 02:18:48,953 PEOPLE HAVE DISEASE IN THEIR 2803 02:18:48,953 --> 02:18:51,589 EARLY 30s. 2804 02:18:51,589 --> 02:18:54,792 AND CLEARLY THERE IS A MATERNAL 2805 02:18:54,792 --> 02:18:56,928 NUTRITION TO BLAME FOR IT IN 2806 02:18:56,928 --> 02:18:57,528 PART. 2807 02:18:57,528 --> 02:19:01,199 SO I THINK WELL DESIGNED -- 2808 02:19:01,199 --> 02:19:03,868 COHORT STUDIES COMBINED WITH 2809 02:19:03,868 --> 02:19:05,002 GOOD PRECISION TOOLS TO BETTER 2810 02:19:05,002 --> 02:19:07,772 ASSESS OUTCOMES AND NUTRITIONAL 2811 02:19:07,772 --> 02:19:11,209 EXPOSURES AND OTHER RISK FACTORS 2812 02:19:11,209 --> 02:19:14,545 IS CRITICAL. 2813 02:19:14,545 --> 02:19:16,414 >> THANK YOU. 2814 02:19:16,414 --> 02:19:18,416 WE'VE HAD A SPECIFIC QUESTION 2815 02:19:18,416 --> 02:19:21,185 BUT I MAY CIRCLE BACK FOR TO YOU 2816 02:19:21,185 --> 02:19:26,023 CATCH YOUR BREATH AND VOICE. 2817 02:19:26,023 --> 02:19:27,258 DR. CAMARGO, ARE THERE ANY 2818 02:19:27,258 --> 02:19:28,159 POPULATIONS THAT YOU HAVE WANT 2819 02:19:28,159 --> 02:19:31,796 TO HIGHLIGHT AS HIGH PRIORITY 2820 02:19:31,796 --> 02:19:35,900 FOR INVESTIGATION OR ONGOING 2821 02:19:35,900 --> 02:19:36,501 WORK 2822 02:19:36,501 --> 02:19:37,034 >> YES. 2823 02:19:37,034 --> 02:19:39,504 IT DEPENDS ON THE OUTCOME THAT 2824 02:19:39,504 --> 02:19:41,372 YOU'RE INTERESTED IN. 2825 02:19:41,372 --> 02:19:43,941 IF IT'S POSITIVE LUNG HEALTH YOU 2826 02:19:43,941 --> 02:19:44,709 CANNOT STUDY PEOPLE WITH 2827 02:19:44,709 --> 02:19:45,243 DISEASE. 2828 02:19:45,243 --> 02:19:47,445 IF YOU'RE TRYING TO PREVENT THE 2829 02:19:47,445 --> 02:19:48,913 DISEASE YOU NEED PEOPLE WITHOUT 2830 02:19:48,913 --> 02:19:51,249 THE DISEASE BUT WHO ARE AT 2831 02:19:51,249 --> 02:19:53,451 HIGHER RISK OF GETTING IT. 2832 02:19:53,451 --> 02:19:56,854 AND IF YOU'RE FOCUSING ON 2833 02:19:56,854 --> 02:19:58,423 DISEASE MODIFICATION YOU NEED 2834 02:19:58,423 --> 02:20:00,958 PEOPLE WITH THE DISEASE. 2835 02:20:00,958 --> 02:20:03,294 THESE ARE DIFFERENT CONCEPTS AND 2836 02:20:03,294 --> 02:20:05,963 THE ONLY THING THAT UNITES THEM 2837 02:20:05,963 --> 02:20:08,132 IS SOMEHOW WE'RE LOOKING AT 2838 02:20:08,132 --> 02:20:08,566 LUNGS. 2839 02:20:08,566 --> 02:20:11,002 WE SHOULD NOT BE SURPRISED IF AT 2840 02:20:11,002 --> 02:20:14,539 THE END OF THE EXPERIENCE WE'RE 2841 02:20:14,539 --> 02:20:15,306 CONFUSED. 2842 02:20:15,306 --> 02:20:18,376 IT COULD BE HELPFUL FOR ONE BUT 2843 02:20:18,376 --> 02:20:19,477 NOT THE OTHER TWO. 2844 02:20:19,477 --> 02:20:22,013 IF WE'RE LUCKY IT'S GOOD FOR ALL 2845 02:20:22,013 --> 02:20:23,981 OF THEM BUT THAT IS A LOT TO 2846 02:20:23,981 --> 02:20:24,549 ASK. 2847 02:20:24,549 --> 02:20:27,185 >> AND I AGREE AND YOU'VE 2848 02:20:27,185 --> 02:20:29,620 TRANSITIONED SO NICE KNEE INTO 2849 02:20:29,620 --> 02:20:32,790 OUTCOMES. 2850 02:20:32,790 --> 02:20:34,926 AND I THINK RATHER THAN ASKING 2851 02:20:34,926 --> 02:20:37,829 WHERE OUR PRIORITY OUTCOMES CAN 2852 02:20:37,829 --> 02:20:40,798 AND SHOULD BE GIVEN THE ABILITY 2853 02:20:40,798 --> 02:20:46,070 TO LOOK AT SO MANY OUTCOMES 2854 02:20:46,070 --> 02:20:50,708 WHERE DO WE THINK EPIDEMIOLOGY 2855 02:20:50,708 --> 02:20:56,314 HAS SPECIFIC STRENGTHS TO ANSWER 2856 02:20:56,314 --> 02:20:58,483 QUESTIONS. 2857 02:20:58,483 --> 02:21:01,886 I WONDER DR. GARCIA-LARSEN YOU 2858 02:21:01,886 --> 02:21:04,922 HAD BEGUN TO SPEAK TO THIS SO I 2859 02:21:04,922 --> 02:21:07,492 HESITATE TO ASK YOU TO SPEAK SO 2860 02:21:07,492 --> 02:21:09,193 SOON BUT DO YOU MIND STARTING TO 2861 02:21:09,193 --> 02:21:10,728 COMMENT ON THIS? 2862 02:21:10,728 --> 02:21:11,929 >> NOT AT ALL. 2863 02:21:11,929 --> 02:21:12,363 THANKS. 2864 02:21:12,363 --> 02:21:17,134 I THINK THAT WELL I'M LOOKING AT 2865 02:21:17,134 --> 02:21:19,136 THE QUESTION FROM MICHELE FREE 2866 02:21:19,136 --> 02:21:26,611 MAN HERE AND -- CAN OFFER HUGE 2867 02:21:26,611 --> 02:21:28,613 INSIGHTS FOR CHRONIC RESPIRATORY 2868 02:21:28,613 --> 02:21:29,247 DISEASES. 2869 02:21:29,247 --> 02:21:31,749 THERE ARE THINGS THAT WE CANNOT 2870 02:21:31,749 --> 02:21:32,416 MEASURE. 2871 02:21:32,416 --> 02:21:37,588 WE KNOW THAT LOW BIRTH WEIGHT IS 2872 02:21:37,588 --> 02:21:40,157 A RISK FACTOR FOR POOR LUNG 2873 02:21:40,157 --> 02:21:41,392 FUNCTION SO WE NEED TO 2874 02:21:41,392 --> 02:21:43,628 UNDERSTAND MORE ABOUT WHAT 2875 02:21:43,628 --> 02:21:47,398 INFLUENCES POOR LUNG FUNCTION. 2876 02:21:47,398 --> 02:21:51,435 GROWTH OR SUFFICIENT LUNG 2877 02:21:51,435 --> 02:21:55,172 FUNCTION GROWTH. 2878 02:21:55,172 --> 02:21:57,909 EXAMINE WHAT HAPPENS DURING 2879 02:21:57,909 --> 02:21:59,911 PREGNANCY AND CHILDHOOD AND 2880 02:21:59,911 --> 02:22:03,314 ADULTHOOD. 2881 02:22:03,314 --> 02:22:05,216 WE KNOW THAT FOR INSTANCE FOOD 2882 02:22:05,216 --> 02:22:06,584 ALLERGIES SET IN THE FIRST YEAR 2883 02:22:06,584 --> 02:22:07,351 OF LIFE. 2884 02:22:07,351 --> 02:22:11,756 THAT ASTHMA IS NOT REALLY ASTHMA 2885 02:22:11,756 --> 02:22:15,226 IF CHILDREN HAVE WHEEZING BEFORE 2886 02:22:15,226 --> 02:22:16,260 AGE 3. 2887 02:22:16,260 --> 02:22:18,329 ASTHMA IS USUALLY DIAGNOSED 2888 02:22:18,329 --> 02:22:21,332 BETWEEN THE AGES OF 4-6 AND WE 2889 02:22:21,332 --> 02:22:24,635 KNOW THE NORMAL TRAJECTORY OF 2890 02:22:24,635 --> 02:22:25,836 LUNG FUNCTION. 2891 02:22:25,836 --> 02:22:27,872 WE CAN COMPANY GOOD COHORT 2892 02:22:27,872 --> 02:22:31,809 STUDIES LOOKING AT SUSCEPTIBLE 2893 02:22:31,809 --> 02:22:32,476 VULNERABLE POPULATIONS. 2894 02:22:32,476 --> 02:22:36,213 HOW THIS INTERACTS WITH VARIOUS 2895 02:22:36,213 --> 02:22:40,051 DOMAINS OF POVERTY. 2896 02:22:40,051 --> 02:22:43,454 AND IT INFLUENCES BODY MASS 2897 02:22:43,454 --> 02:22:45,122 INDEX. 2898 02:22:45,122 --> 02:22:46,123 EDUCATION OPPORTUNITIES ETC. AND 2899 02:22:46,123 --> 02:22:51,095 ALL OF THAT IN TURN AFFECTS OUR 2900 02:22:51,095 --> 02:22:52,597 NUTRITIONAL CHOICESES. 2901 02:22:52,597 --> 02:22:56,567 AND FOOD ACCESS. 2902 02:22:56,567 --> 02:22:59,370 COHORT STUDIES CAN HELP TO 2903 02:22:59,370 --> 02:23:01,539 FURTHER ELUCIDATE HOW THESE 2904 02:23:01,539 --> 02:23:04,342 FACTORS INTERACT AND HOW THEY 2905 02:23:04,342 --> 02:23:06,043 TOGETHER MAY OR MAY NOT 2906 02:23:06,043 --> 02:23:08,079 INFLUENCE LUNG HEALTH LATER ON. 2907 02:23:08,079 --> 02:23:12,516 WE CAN ALSO SEE FOR RESPIRATORY 2908 02:23:12,516 --> 02:23:14,719 -- RESILIENCE IF THE LUNGS CAN 2909 02:23:14,719 --> 02:23:17,822 RECOVER FROM EARLIER GADGETS. 2910 02:23:17,822 --> 02:23:19,924 AND INTERVENTION STUDIES CAN 2911 02:23:19,924 --> 02:23:24,328 ALSO ANSWER EXTREMELY IMPORTANT 2912 02:23:24,328 --> 02:23:25,463 MECHANISTIC QUESTIONS AND 2913 02:23:25,463 --> 02:23:28,265 ADDRESS WHICH NUTRIENTS CAN BE 2914 02:23:28,265 --> 02:23:30,301 MORE POWERFUL IN TERMS OF HAVING 2915 02:23:30,301 --> 02:23:34,805 THE GREATEST CAPACITY TO REDUCE 2916 02:23:34,805 --> 02:23:37,742 ACUTE INFLAMMATION. 2917 02:23:37,742 --> 02:23:39,744 IN LOW AND MIDDLE INCOME 2918 02:23:39,744 --> 02:23:41,646 COUNTRIES WE NEED TO HAVE 2919 02:23:41,646 --> 02:23:44,849 ADEQUATE TOOLS TO MEASURE 2920 02:23:44,849 --> 02:23:46,851 POVERTY, BODY WEIGHT DEVELOPMENT 2921 02:23:46,851 --> 02:23:51,455 IN CHILDREN AND BODY MASS INDEX, 2922 02:23:51,455 --> 02:23:51,989 OBESITY. 2923 02:23:51,989 --> 02:23:55,626 FOOD SECURITY, FOOD INSECURITY. 2924 02:23:55,626 --> 02:23:59,930 ETC. AND THAT CAN BE VERY WE'LL 2925 02:23:59,930 --> 02:24:02,466 ADDRESSED WITH REPRESENTATIVE 2926 02:24:02,466 --> 02:24:05,002 POPULATIONS IN DIFFERENT 2927 02:24:05,002 --> 02:24:07,605 SETTINGS AND I DON'T THINK THE 2928 02:24:07,605 --> 02:24:11,042 COPD OR THE CAUSES THAT LEAD TO 2929 02:24:11,042 --> 02:24:13,144 POOR LUNG FUNCTION ARE RESTRICT 2930 02:24:13,144 --> 02:24:15,112 TO ONE SPECIFIC COUNTRY. 2931 02:24:15,112 --> 02:24:17,248 THERE ARE COMMON FACTORS THAT WE 2932 02:24:17,248 --> 02:24:19,116 KNOW THAT AFFECT DISEASE. 2933 02:24:19,116 --> 02:24:25,389 I THINK THAT WE MUST -- 2934 02:24:25,389 --> 02:24:25,990 NONCOMMUNICABLE DISEASES WHERE 2935 02:24:25,990 --> 02:24:28,826 WE SEE A PATTERN. 2936 02:24:28,826 --> 02:24:30,928 AND TO UNDERSTAND WHICH ONES IN 2937 02:24:30,928 --> 02:24:31,629 PARTICULAR AND HOW IMPORTANT 2938 02:24:31,629 --> 02:24:33,597 THEY ARE. 2939 02:24:33,597 --> 02:24:37,001 I THINK WE NEED COHORT STUDIES. 2940 02:24:37,001 --> 02:24:40,071 AND REPLICATE -- TO SEE IF THE 2941 02:24:40,071 --> 02:24:41,372 ASSOCIATION IS OUT THERE. 2942 02:24:41,372 --> 02:24:44,408 THE DATA IS OUT THERE. 2943 02:24:44,408 --> 02:24:46,911 IT'S HELPFUL. 2944 02:24:46,911 --> 02:24:50,815 IN DEMONSTRATING THAT THERE IS A 2945 02:24:50,815 --> 02:24:52,950 CLEAR ASSOCIATION THERE AND 2946 02:24:52,950 --> 02:24:54,885 THERE IS A SIGNAL. 2947 02:24:54,885 --> 02:24:57,121 WE DID HAVE SIGNS HERE THAT 2948 02:24:57,121 --> 02:25:01,792 SOMETHING IS HAPPENING. 2949 02:25:01,792 --> 02:25:02,159 >> EXCELLENT. 2950 02:25:02,159 --> 02:25:04,762 THANK YOU. 2951 02:25:04,762 --> 02:25:07,665 DR. HANSON, I WONDER WHERE YOU 2952 02:25:07,665 --> 02:25:10,868 SEE THE STRENGTHS OF 2953 02:25:10,868 --> 02:25:13,304 EPIDEMIOLOGY AND ADVANCING THE 2954 02:25:13,304 --> 02:25:15,206 KNOWLEDGE OF LIPIDS IN LUNG 2955 02:25:15,206 --> 02:25:16,307 HEALTH 2956 02:25:16,307 --> 02:25:17,875 >> I'M NOT SURE I HAVE MUCH TO 2957 02:25:17,875 --> 02:25:18,409 ADD. 2958 02:25:18,409 --> 02:25:21,378 THAT WAS A WONDERFUL RESPONSE TO 2959 02:25:21,378 --> 02:25:22,046 THAT QUESTION. 2960 02:25:22,046 --> 02:25:24,381 I WOULD IDENTIFY MANY OF THE 2961 02:25:24,381 --> 02:25:25,382 SAME STRENGTHS. 2962 02:25:25,382 --> 02:25:27,284 ONE OF THEM BEING TIME THAT 2963 02:25:27,284 --> 02:25:29,887 YOU'RE ABLE TO FOLLOW. 2964 02:25:29,887 --> 02:25:33,157 OVER THE TRAJECTORY OF LUNG 2965 02:25:33,157 --> 02:25:34,592 FUNCTION. 2966 02:25:34,592 --> 02:25:38,929 TO DR. CAMARGO'S POINT AGAIN 2967 02:25:38,929 --> 02:25:40,064 CAPTURING -- WHICH OF THE 2968 02:25:40,064 --> 02:25:42,366 OUTCOMES YOU'RE INTERESTED IN. 2969 02:25:42,366 --> 02:25:46,137 SO I'M NOT SURE I HAVE ANYTHING 2970 02:25:46,137 --> 02:25:49,974 SUBSTANTIAL TO ADD TO THAT. 2971 02:25:49,974 --> 02:25:55,479 >> IF I MAY BRIEFLY SO I AGREE 2972 02:25:55,479 --> 02:25:57,281 WITH EVERYTHING 2973 02:25:57,281 --> 02:25:58,649 DR. GARCIA-LARSEN SAID. 2974 02:25:58,649 --> 02:26:00,417 THAT WAS EXCELLENT. 2975 02:26:00,417 --> 02:26:02,953 HUMANS ARE NOT MICE. 2976 02:26:02,953 --> 02:26:06,557 TRIALS ARE VERY EXPENSIVE. 2977 02:26:06,557 --> 02:26:11,061 SO THE COHORT STUDIES -- IS TO 2978 02:26:11,061 --> 02:26:11,962 REMEMBER THE RELATIONSHIP 2979 02:26:11,962 --> 02:26:14,532 BETWEEN DIET AND LUNG HEALTH ARE 2980 02:26:14,532 --> 02:26:15,733 VERY COMPLEX. 2981 02:26:15,733 --> 02:26:20,070 SO OBESITY IS A MEASURING 2982 02:26:20,070 --> 02:26:23,174 FACTOR, FOR ASTHMA -- YOU HAVE 2983 02:26:23,174 --> 02:26:25,810 INTERACTIONS WITH POO 2984 02:26:25,810 --> 02:26:26,110 POLLUTANTS. 2985 02:26:26,110 --> 02:26:26,343 SMOKING. 2986 02:26:26,343 --> 02:26:32,082 * SO IN THAT REGARD COHORT 2987 02:26:32,082 --> 02:26:33,751 STUDIES ARE VERY POWERFUL. 2988 02:26:33,751 --> 02:26:35,653 WE HAVE THESE TOOLS TO ASSESS 2989 02:26:35,653 --> 02:26:37,855 DIET AND ONCE YOU START TO 2990 02:26:37,855 --> 02:26:40,925 TRANSLATE THESE TOOLS INTO 2991 02:26:40,925 --> 02:26:41,625 DIFFERENT LANGUAGES YOU HAVE TO 2992 02:26:41,625 --> 02:26:43,060 BE VERY CAREFUL. 2993 02:26:43,060 --> 02:26:47,331 SO I WILL SPEAK TO SPANISH. 2994 02:26:47,331 --> 02:26:50,801 THERE ARE NUMEROUS DIALECTS. 2995 02:26:50,801 --> 02:26:53,838 PUERTO RICO -- TRANSLATING INTO 2996 02:26:53,838 --> 02:26:55,272 PUERTO RICO OR MEXICO. 2997 02:26:55,272 --> 02:26:57,508 YOU HAVE TO BE COGNIZANT OF 2998 02:26:57,508 --> 02:27:00,978 THESE DIFFERENCES. 2999 02:27:00,978 --> 02:27:02,246 >> THAT IS A GREAT POINT. 3000 02:27:02,246 --> 02:27:05,416 7 THANK YOU. 3001 02:27:05,416 --> 02:27:06,584 DR. BURNEY, YOU HAVE YOUR HAND 3002 02:27:06,584 --> 02:27:08,052 RAISED. 3003 02:27:08,052 --> 02:27:11,255 >> JUST A SMALL POINT. 3004 02:27:11,255 --> 02:27:20,664 -- EVERYBODY IS BEING A BIT 3005 02:27:20,664 --> 02:27:22,132 PESSIMISTIC ABOUT THE VIABILITY 3006 02:27:22,132 --> 02:27:24,568 OF TRIALS BUT THERE IS A VERY 3007 02:27:24,568 --> 02:27:28,873 LARGE NUMBER OF TRIALS THAT ARE 3008 02:27:28,873 --> 02:27:31,742 BEING DONE FOR OTHER REASONS. 3009 02:27:31,742 --> 02:27:35,746 CARDIOVASCULAR TRIALS BECAUSE 3010 02:27:35,746 --> 02:27:37,815 CARDIOVASCULAR HAVE MORE MONEY. 3011 02:27:37,815 --> 02:27:40,150 ACTUALLY USING THOSE AND ADDING 3012 02:27:40,150 --> 02:27:42,820 A RESPIRATORY OUTCOME IS A VERY 3013 02:27:42,820 --> 02:27:45,289 CHEAP WAY OF DOING A VERY 3014 02:27:45,289 --> 02:27:47,391 EXPENSIVE STUDY SO IT MIGHT BE 3015 02:27:47,391 --> 02:27:50,261 WORTH LOOKING AT ALL OF YOUR 3016 02:27:50,261 --> 02:27:52,830 TRIALS AT THE NIH AND SEEING 3017 02:27:52,830 --> 02:27:56,901 WHETHER -- IF AN ADDITIONAL 3018 02:27:56,901 --> 02:28:00,404 OUTCOME COULD BE ADDED. 3019 02:28:00,404 --> 02:28:05,743 MIGHT BE -- VERY INFORMATIVE. 3020 02:28:05,743 --> 02:28:07,478 >> I LOVE THAT SUGGESTION. 3021 02:28:07,478 --> 02:28:08,512 THAT IS FANTASTIC. 3022 02:28:08,512 --> 02:28:10,481 AND I THINK THAT IS WHERE WE 3023 02:28:10,481 --> 02:28:12,316 FIND SOME OF THE MOST 3024 02:28:12,316 --> 02:28:14,451 INTERESTING DISCOVERIES IS THE 3025 02:28:14,451 --> 02:28:16,654 ADD ONS TO ALMOST ESTABLISHED 3026 02:28:16,654 --> 02:28:17,855 STUDIES MOVING FORWARD. 3027 02:28:17,855 --> 02:28:18,822 THANK YOU FOR THAT. 3028 02:28:18,822 --> 02:28:21,492 I DO WANT TO NOTE THAT THOUGH 3029 02:28:21,492 --> 02:28:23,494 OUR SPEAKERS DID NOT ADDRESS 3030 02:28:23,494 --> 02:28:26,830 THIS DIRECTLY WE DID DISCUSS 3031 02:28:26,830 --> 02:28:30,801 PULMONARY INFECTIONS AND 3032 02:28:30,801 --> 02:28:35,239 PULMONARY TUBERCULOSIS HAS BEEN 3033 02:28:35,239 --> 02:28:39,209 RAISED AS A MORBID DISEASE TIED 3034 02:28:39,209 --> 02:28:40,544 CLOSELY TO NUTRITION. 3035 02:28:40,544 --> 02:28:43,347 WE MAY NOT BE ABLE TO GO NIGHT 3036 02:28:43,347 --> 02:28:46,450 GIVEN TIME FOR THIS DISCUSSION 3037 02:28:46,450 --> 02:28:48,218 BUT SOMETHING THAT BEARS 3038 02:28:48,218 --> 02:28:51,889 MENTIONING AND RAISING DURING 3039 02:28:51,889 --> 02:28:53,324 OTHER SECTIONS. 3040 02:28:53,324 --> 02:28:56,393 BUT I DO WONDER WHETHER ANY OF 3041 02:28:56,393 --> 02:28:59,596 THE SPEAKERS HERE HAVE THE -- 3042 02:28:59,596 --> 02:29:01,966 FEEL THAT THEY CAN SPEAK TO THIS 3043 02:29:01,966 --> 02:29:04,068 TOPIC IN RELATION TO THE 3044 02:29:04,068 --> 02:29:05,402 EXPOSURES THEY'VE MENTIONED. 3045 02:29:05,402 --> 02:29:13,577 7 AND IF NOT THAT MIGHT 3046 02:29:13,577 --> 02:29:15,045 HIGHLIGHT ANOTHER GAP AND 3047 02:29:15,045 --> 02:29:16,580 RESEARCH DIRECTION. 3048 02:29:16,580 --> 02:29:19,616 SOMETHING THAT I'M SO GLAD THAT 3049 02:29:19,616 --> 02:29:21,185 OUR AUDIENCE HAS BROUGHT 3050 02:29:21,185 --> 02:29:25,322 FORWARD. 3051 02:29:25,322 --> 02:29:26,790 DR. CAMARGO, I WANT TO GIVE YOU 3052 02:29:26,790 --> 02:29:27,891 THE OPPORTUNITY. 3053 02:29:27,891 --> 02:29:30,427 YOU SEEM LIKE YOU MIGHT HAVE 3054 02:29:30,427 --> 02:29:31,628 SOME CLOSING REMARKS. 3055 02:29:31,628 --> 02:29:33,097 >> I WOULD POINT OUT AGAIN THAT 3056 02:29:33,097 --> 02:29:35,432 MANY EXPOSURES MANY OUTCOMES 3057 02:29:35,432 --> 02:29:37,835 LET'S DECIDE WHAT WE THINK IS 3058 02:29:37,835 --> 02:29:39,403 MOST PROMISING AND CHASE IT. 3059 02:29:39,403 --> 02:29:40,904 WE CANNOT DO ALL OF THEM AT THE 3060 02:29:40,904 --> 02:29:41,972 SAME TIME. 3061 02:29:41,972 --> 02:29:45,075 THERE IS A DESIRE TO MAKE REAL 3062 02:29:45,075 --> 02:29:47,511 WORLD INTERVENTIONS LIKE DIETS 3063 02:29:47,511 --> 02:29:49,380 AND FOODS. 3064 02:29:49,380 --> 02:29:51,415 BUT AT THE SAME TIME A LOT OF 3065 02:29:51,415 --> 02:29:52,850 INTEREST IN SPECIFIC PILLS THAT 3066 02:29:52,850 --> 02:29:54,885 MIGHT BE A LOT EASIER TO 3067 02:29:54,885 --> 02:29:55,486 IMPLEMENT. 3068 02:29:55,486 --> 02:29:57,855 SO WE DON'T HAVE TO NECESSARILY 3069 02:29:57,855 --> 02:29:59,189 CHOOSE BETWEEN THESE TWO 3070 02:29:59,189 --> 02:30:00,424 EXTREMES. 3071 02:30:00,424 --> 02:30:01,692 WE COULD PURSUE BOTH. 3072 02:30:01,692 --> 02:30:07,264 LOOK AT A MEDITERRANEAN DIET AND 3073 02:30:07,264 --> 02:30:09,366 ASK OURSELVES WHAT IS THE MOST 3074 02:30:09,366 --> 02:30:10,601 PROMISING PILL. 3075 02:30:10,601 --> 02:30:17,441 MAYBE A FLAVONOID PILL. 3076 02:30:17,441 --> 02:30:19,877 MAYBE ANNAL CYST TEEN PILL. 3077 02:30:19,877 --> 02:30:21,645 *. 3078 02:30:21,645 --> 02:30:23,447 WE NEED CLARITY ABOUT THE 3079 02:30:23,447 --> 02:30:25,449 PLAYING FIELD. 3080 02:30:25,449 --> 02:30:27,684 WHAT ARE WE ACTUALLY STUDYING 3081 02:30:27,684 --> 02:30:29,753 AND WHO AND WHEN ETC. AND WHAT 3082 02:30:29,753 --> 02:30:31,388 IS THE MOST PROMISING AND IF YOU 3083 02:30:31,388 --> 02:30:34,024 THINK ABOUT THE WAY PEOPLE 3084 02:30:34,024 --> 02:30:36,493 DEVELOP MEDICATIONS THAT IS WHAT 3085 02:30:36,493 --> 02:30:38,495 GOES INTO EVERY SINGLE 3086 02:30:38,495 --> 02:30:39,930 MEDICATION DEVELOPMENT PROGRAM. 3087 02:30:39,930 --> 02:30:42,699 IT'S NOT JUST LIKE LET'S LOOK AT 3088 02:30:42,699 --> 02:30:43,600 EVERYTHING. 3089 02:30:43,600 --> 02:30:46,070 AT SOME POINT YOU NEED TO MOVE 3090 02:30:46,070 --> 02:30:47,871 ON AND THAT IS WHERE WE'RE AT 3091 02:30:47,871 --> 02:30:48,772 NOW. 3092 02:30:48,772 --> 02:30:51,442 WE'VE GOT TO START CHOOSING AND 3093 02:30:51,442 --> 02:30:53,310 I HOPE THAT IS WHAT COMES OUT OF 3094 02:30:53,310 --> 02:30:54,378 THIS WORKSHOP. 3095 02:30:54,378 --> 02:30:55,779 >> THANK YOU SO MUCH. 3096 02:30:55,779 --> 02:30:57,548 THANK YOU TO ALL OF THE 3097 02:30:57,548 --> 02:30:59,550 SPEAKERS, THE ORGANIZERS. 3098 02:30:59,550 --> 02:31:01,885 THE NIH FOR HOSTING US FOR THIS 3099 02:31:01,885 --> 02:31:02,186 DISCUSSION. 3100 02:31:02,186 --> 02:31:04,388 I THINK WE HAVE A LOT OF WORK TO 3101 02:31:04,388 --> 02:31:06,590 DO AND LOOK FORWARD TO ONGOING 3102 02:31:06,590 --> 02:31:08,492 DISCUSSIONS. 3103 02:31:08,492 --> 02:31:11,995 I BELIEVE AT THIS TIME WE ARE 3104 02:31:11,995 --> 02:31:13,597 CONCLUDING SESSION ONE AND THERE 3105 02:31:13,597 --> 02:31:16,467 WILL BE A BREAK UNTIL 1:00 3106 02:31:16,467 --> 02:31:18,569 EASTERN STANDARD TIME WHERE WE 3107 02:31:18,569 --> 02:31:22,039 WILL RESUME 3108 02:31:22,039 --> 02:31:24,808 >> I WILL SEE YOU AT 1:00. 3109 02:31:24,808 --> 02:31:27,651 >> THANK YOU, EVERYONE. 3110 02:31:27,651 --> 02:31:30,287 WELCOME BACK, EVERYONE. 3111 02:31:30,287 --> 02:31:32,189 WE'RE GOING TO START WITH THE 3112 02:31:32,189 --> 02:31:38,662 AFTERNOON SESSION NOW AND WE'RE 3113 02:31:38,662 --> 02:31:41,431 GOING TO START WITH SECTION TWO 3114 02:31:41,431 --> 02:31:44,501 WHERE WE'RE GOING TO EXAMINE THE 3115 02:31:44,501 --> 02:31:46,303 IMPACT OF CLIMATE CHANGE ON FOOD 3116 02:31:46,303 --> 02:31:49,373 SYSTEMS AND SECURITY AND THE 3117 02:31:49,373 --> 02:31:50,841 IMPLICATIONS IN RESPIRATORY 3118 02:31:50,841 --> 02:31:53,343 HEALTH AND DISEASE. 3119 02:31:53,343 --> 02:31:55,779 THE OBJECTIVE IS TO DISCUSS THE 3120 02:31:55,779 --> 02:31:57,981 IMPACT THAT CLIMATE CHANGE MIGHT 3121 02:31:57,981 --> 02:32:00,984 HAVE ON FOOD SYSTEMS AND ALSO 3122 02:32:00,984 --> 02:32:02,452 FOOD SECURITY AND DIET QUALITY 3123 02:32:02,452 --> 02:32:09,393 OF NUTRIENTS AND -- SUBSEQUENT 3124 02:32:09,393 --> 02:32:11,295 TO RESPIRATORY HEALTH. 3125 02:32:11,295 --> 02:32:17,034 AND I'M DELIGHTED TO WELCOME MY 3126 02:32:17,034 --> 02:32:18,569 CO-MODERATOR DR. PAULINE 3127 02:32:18,569 --> 02:32:21,071 SCHEELBEEK. 3128 02:32:21,071 --> 02:32:24,207 SHE IS AN ASSOCIATE PROFESSOR IN 3129 02:32:24,207 --> 02:32:26,977 CLINICAL HEALTH AT THE LONG DON 3130 02:32:26,977 --> 02:32:29,880 SCHOOL OF LONDON. 3131 02:32:29,880 --> 02:32:37,120 SHE SERVES AS THE DIRECTOR AND 3132 02:32:37,120 --> 02:32:41,091 IS THE PROGRAM DIRECTOR OF THE 3133 02:32:41,091 --> 02:32:44,828 MSC AND PLANETARY HEALTH AT LONG 3134 02:32:44,828 --> 02:32:46,396 DON SCHOOL. 3135 02:32:46,396 --> 02:32:50,567 SHE IS FOCUSED ON FINDING 3136 02:32:50,567 --> 02:32:53,804 HEALTHY, SUSTAINABLE AND 3137 02:32:53,804 --> 02:32:56,373 REALISTIC SOLUTIONS. 3138 02:32:56,373 --> 02:32:59,710 HER CURRENT RESEARCH STUDIES ARE 3139 02:32:59,710 --> 02:33:03,347 FOCUSED ON MODELING FUTURE FOOD 3140 02:33:03,347 --> 02:33:08,852 SYSTEMS FOR THE UK, SOUTH 3141 02:33:08,852 --> 02:33:14,992 AFRICA, AND COLUMBIA. 3142 02:33:14,992 --> 02:33:16,526 SO WELCOME, PAULINE. 3143 02:33:16,526 --> 02:33:18,695 THANK YOU FOR BEING HERE WITH US 3144 02:33:18,695 --> 02:33:20,964 >> THANK YOU SO MUCH FOR 3145 02:33:20,964 --> 02:33:22,032 INVITING ME. 3146 02:33:22,032 --> 02:33:24,368 >> WITH THAT WE CAN OPEN THE 3147 02:33:24,368 --> 02:33:27,237 FLOOR TO OUR FIRST SPEAKER. 3148 02:33:27,237 --> 02:33:30,240 IT'S AN ABSOLUTE PLEASURE TO 3149 02:33:30,240 --> 02:33:31,208 INTRODUCE HER. 3150 02:33:31,208 --> 02:33:34,344 WE'RE VERY LUCKY TO HAVE HER 3151 02:33:34,344 --> 02:33:36,647 PARTICIPATING IN THIS WORKSHOP. 3152 02:33:36,647 --> 02:33:38,649 PROFESSOR MAUREEN LICHTVELD. 3153 02:33:38,649 --> 02:33:42,653 THE DEAN OF 9 SCHOOL OF PUBLIC 3154 02:33:42,653 --> 02:33:44,321 HEALTH. 3155 02:33:44,321 --> 02:33:45,789 AND PROFESSOR FOR ENVIRONMENTAL 3156 02:33:45,789 --> 02:33:47,924 AND OCCUPATIONAL HEALTH AT THE 3157 02:33:47,924 --> 02:33:49,893 UNIVERSITY OF PITTSBURGH. 3158 02:33:49,893 --> 02:33:52,095 SHE HAS OVER 35 YEARS OF 3159 02:33:52,095 --> 02:33:53,230 EXPERIENCE IN ENVIRONMENTAL 3160 02:33:53,230 --> 02:33:55,999 HEALTH AND HER RESEARCH HAS 3161 02:33:55,999 --> 02:33:58,468 FOCUSED MOSTLY ENVIRONMENTALLY 3162 02:33:58,468 --> 02:34:05,275 INDUCED DISEASES, HEALTH 3163 02:34:05,275 --> 02:34:06,843 DISPARITIES, CLIMATE AND HEALTH, 3164 02:34:06,843 --> 02:34:09,312 ENVIRONMENTAL HEALTH POLICY, 3165 02:34:09,312 --> 02:34:11,248 DISEASE PREPAREDNESS. 3166 02:34:11,248 --> 02:34:13,050 PUBLIC HEALTH SYSTEMS AND 3167 02:34:13,050 --> 02:34:14,184 COMMUNITY RESILIENCE. 3168 02:34:14,184 --> 02:34:16,386 HER EXPERTISE IN CLIMATE AND 3169 02:34:16,386 --> 02:34:18,522 HEALTH IS LOCALLY AND NATIONALLY 3170 02:34:18,522 --> 02:34:21,091 AND GLOBALLY RECOGNIZED AND SHE 3171 02:34:21,091 --> 02:34:26,997 HAS BEEN THE RECIPIENT OF 3172 02:34:26,997 --> 02:34:37,274 NUMEROUS HONORS. 3173 02:34:39,976 --> 02:34:40,944 >> PLEASED TO BE HERE. 3174 02:34:40,944 --> 02:34:43,980 THAT. THANK YOU FOR BEING HERE. 3175 02:34:43,980 --> 02:34:47,417 >> SO WE CAN MOVE THE SLIDES 3176 02:34:47,417 --> 02:34:49,486 FORWARD NOW. 3177 02:34:49,486 --> 02:34:56,860 DO WE HAVE -- -- I BEG YOUR 3178 02:34:56,860 --> 02:34:58,929 PARDON, PROFESSOR LICHTVELD. 3179 02:34:58,929 --> 02:35:09,239 I THINK -- -. 3180 02:35:11,274 --> 02:35:13,610 PAULINE, WE'RE READY FOR YOU. 3181 02:35:13,610 --> 02:35:14,044 >> EXCELLENT. 3182 02:35:14,044 --> 02:35:15,779 THANK YOU VERY MUCH. 3183 02:35:15,779 --> 02:35:17,481 AND THANKS SO MUCH FOR INVITING 3184 02:35:17,481 --> 02:35:17,981 ME. 3185 02:35:17,981 --> 02:35:19,616 IT WAS REALLY INTERESTING TO 3186 02:35:19,616 --> 02:35:23,053 HEAR THE PRESENTATION AND THE 3187 02:35:23,053 --> 02:35:25,122 DISCUSSION THIS MORNING. 3188 02:35:25,122 --> 02:35:29,292 I'M GOING TO SHARE A SLIGHTLY 3189 02:35:29,292 --> 02:35:30,627 DIFFERENT LIGHT ON THE 3190 02:35:30,627 --> 02:35:32,963 DISCUSSION AT THE LONDON SCHOOL 3191 02:35:32,963 --> 02:35:35,866 OF MEDICINE WE DO A LOT OF 3192 02:35:35,866 --> 02:35:38,068 RESEARCH AFTER ROUND THE 3193 02:35:38,068 --> 02:35:39,069 INTERACTION OF CLIMATE CHANGE 3194 02:35:39,069 --> 02:35:41,505 AND HEALTH AND I'M ORIGINALLY -- 3195 02:35:41,505 --> 02:35:43,507 AN EPIDEMIOLOGIST BY TRAINING 3196 02:35:43,507 --> 02:35:46,376 BUT I'VE BEEN VERY INTERESTED IN 3197 02:35:46,376 --> 02:35:51,014 HUMAN NUTRITION AND WORK IN A 3198 02:35:51,014 --> 02:35:54,484 NUTRITION GROUP. 3199 02:35:54,484 --> 02:35:59,222 BEFORE -- LOOKING AT HOW CLIMATE 3200 02:35:59,222 --> 02:36:02,659 CHANGE HAS AN IMPACT ON THE FOOD 3201 02:36:02,659 --> 02:36:04,394 AND THE AVAILABILITY OF FOOD BUT 3202 02:36:04,394 --> 02:36:07,030 ALSO WHAT HUMANS CAN DO TO 3203 02:36:07,030 --> 02:36:08,064 ALLEVIATE SOME OF THE PRESSURE 3204 02:36:08,064 --> 02:36:09,466 ON THE FOOD SYSTEM. 3205 02:36:09,466 --> 02:36:13,003 SO I'LL GIVE YOU A BIT OF A 3206 02:36:13,003 --> 02:36:15,205 WHISTLE STOP TOUR HOW CLIMATE 3207 02:36:15,205 --> 02:36:17,207 CHANGE HAS AN IMPACT AND ALSO 3208 02:36:17,207 --> 02:36:20,510 THAT THIS LINK IS BI-DIRECTIONAL 3209 02:36:20,510 --> 02:36:25,248 AND THE SOLUTIONS THAT WE AT THE 3210 02:36:25,248 --> 02:36:28,652 SCHOOL ARE WORKING ON AT THE 3211 02:36:28,652 --> 02:36:32,923 MOMENT. 3212 02:36:32,923 --> 02:36:35,659 SO WHEN WE SPEAK ABOUT FOOD 3213 02:36:35,659 --> 02:36:37,794 SYSTEMS THAT IS SLIDELY WIDER 3214 02:36:37,794 --> 02:36:39,663 THAN JUST HUMAN CONSUMPTION. 3215 02:36:39,663 --> 02:36:41,431 EVERYTHING FROM FARM TO 3216 02:36:41,431 --> 02:36:43,433 PROCESSING AND PACKAGING AND 3217 02:36:43,433 --> 02:36:47,170 WHOLESALING AND RETAILING TO 3218 02:36:47,170 --> 02:36:49,172 COOKING IN THE HOUSE, CONSUMING 3219 02:36:49,172 --> 02:36:49,940 AND WASTE. 3220 02:36:49,940 --> 02:36:52,042 YOU CAN IMAGINE THAT CLIMATE 3221 02:36:52,042 --> 02:36:54,144 CHANGE CAN HAVE AN IMPACT ON ALL 3222 02:36:54,144 --> 02:36:57,280 OF THESE PROCESSES BUT WE FOCUS 3223 02:36:57,280 --> 02:36:58,815 ON CLIMATE CHANGE IMPACT MORE ON 3224 02:36:58,815 --> 02:37:00,917 THE FARM SIDE IMPACTS WHICH I 3225 02:37:00,917 --> 02:37:02,619 WILL DO NOW AS WELL. 3226 02:37:02,619 --> 02:37:05,722 SO HOW DOES CLIMATE CHANGE MAKE 3227 02:37:05,722 --> 02:37:07,524 IT MORE DIFFICULT TO PRODUCE 3228 02:37:07,524 --> 02:37:09,025 FOOD. 3229 02:37:09,025 --> 02:37:10,827 WHEN WE TALK ABOUT MITIGATION 3230 02:37:10,827 --> 02:37:13,230 HOW CAN WE STOP CLIMATE CHANGE 3231 02:37:13,230 --> 02:37:14,798 FROM HAPPENING OR CAN WE REVERSE 3232 02:37:14,798 --> 02:37:17,000 SOME OF THE IMPACTS THAT WE 3233 02:37:17,000 --> 02:37:19,069 OFTEN LOOK AT THE CONSUMER. 3234 02:37:19,069 --> 02:37:21,304 WHAT SORT OF DIFFERENCES CAN 3235 02:37:21,304 --> 02:37:24,374 THEY MAKE IN THEIR DIETS SO THAT 3236 02:37:24,374 --> 02:37:27,210 THEIR DIETARY FOOTPRINT IS 3237 02:37:27,210 --> 02:37:28,111 LOWER. 3238 02:37:28,111 --> 02:37:29,846 AND SO THAT I WILL DO IN THIS 3239 02:37:29,846 --> 02:37:31,014 PRESENTATION AS WELL. 3240 02:37:31,014 --> 02:37:33,016 BUT IT DOESN'T MEAN THAT THERE 3241 02:37:33,016 --> 02:37:35,218 ARE NOT ANY OTHER WAYS. 3242 02:37:35,218 --> 02:37:39,522 YOU CAN FOR EXAMPLE THINK ABOUT 3243 02:37:39,522 --> 02:37:44,194 COOL CHAIN ALONG THE WAY OR EVEN 3244 02:37:44,194 --> 02:37:45,462 FUEL FOR COOKING. 3245 02:37:45,462 --> 02:37:48,565 SO THERE IS ANOTHER WAY CLIMATE 3246 02:37:48,565 --> 02:37:52,435 HAS AN IMPACT ON FOOD BUT 3247 02:37:52,435 --> 02:37:54,504 PREDOMINATELY WHAT WE'RE DEALING 3248 02:37:54,504 --> 02:37:56,573 WITH ARE ON THE FARM. 3249 02:37:56,573 --> 02:38:06,149 THIS IS -- AN OVERVIEW OF HOW 3250 02:38:06,149 --> 02:38:11,821 THE IMPACTS OF CLIMATE CHANGE. 3251 02:38:11,821 --> 02:38:13,390 THERE IS SOME DIRECT EFFECT. 3252 02:38:13,390 --> 02:38:15,158 YOU CAN IMAGINE THAT HEAT COULD 3253 02:38:15,158 --> 02:38:20,230 HAVE AN IMPACT ON AGRICULTURAL 3254 02:38:20,230 --> 02:38:21,965 WORKERS. 3255 02:38:21,965 --> 02:38:26,202 THEY MIGHT SUFFER MORE FROM HEAT 3256 02:38:26,202 --> 02:38:29,873 STRESS OR STROKES AND ALSO IN 3257 02:38:29,873 --> 02:38:31,675 DIRECT EFFECT ETC. 3258 02:38:31,675 --> 02:38:34,444 CLIMB CHANGE CAN LOWER CROP 3259 02:38:34,444 --> 02:38:36,146 YIELDS AND QUALITY AND CAN 3260 02:38:36,146 --> 02:38:41,418 AFFECT LIVESTOCK AND * INTRODUCE 3261 02:38:41,418 --> 02:38:45,355 DIFFERENT PESTS AND POLLINATORS. 3262 02:38:45,355 --> 02:38:47,123 THE HABITATS CHANGE. 3263 02:38:47,123 --> 02:38:50,427 SOIL FERTILITY FOR EXAMPLE AND 3264 02:38:50,427 --> 02:38:55,598 THAT ALSO DISRUPTS THE SUPPLY 3265 02:38:55,598 --> 02:38:56,599 CHAIN. 3266 02:38:56,599 --> 02:39:00,403 AND EXTERNAL FACTORS. 3267 02:39:00,403 --> 02:39:01,738 ALSO TO OTHER SECTORS. 3268 02:39:01,738 --> 02:39:05,075 SUCH AS FUEL AND RESOURCE 3269 02:39:05,075 --> 02:39:08,044 SHORTAGES OR CONFLICT THAT MIGHT 3270 02:39:08,044 --> 02:39:11,915 HAVE BEEN PARTIALLY OR FULLY 3271 02:39:11,915 --> 02:39:13,216 CAUSED BY CLIMATE CHANGE. 3272 02:39:13,216 --> 02:39:16,886 SO ALL OF THESE THINGS TOGETHER 3273 02:39:16,886 --> 02:39:19,689 DISRUPTS THE SUPPLY CHAIN, 3274 02:39:19,689 --> 02:39:21,992 CAUSES LESS FOOD TO BE PRODUCED 3275 02:39:21,992 --> 02:39:24,427 OF A LOWER QUALITY AND THAT 3276 02:39:24,427 --> 02:39:29,532 AFFECTS DOMESTIC SUPPLY BUT ALSO 3277 02:39:29,532 --> 02:39:32,736 IMPORTED FOODS AND THE GLOBAL 3278 02:39:32,736 --> 02:39:34,170 FOOD TRADE MARKET. 3279 02:39:34,170 --> 02:39:38,475 AND DEPENDING ON FOOD PRICES AND 3280 02:39:38,475 --> 02:39:40,343 AVAILABILITY AND THE LOCAL 3281 02:39:40,343 --> 02:39:41,811 ENVIRONMENT THAT COULD HAVE AN 3282 02:39:41,811 --> 02:39:43,880 IMPACT ON HOUSEHOLDS. 3283 02:39:43,880 --> 02:39:46,082 77 AND WITHIN THE HOUSEHOLDS ON 3284 02:39:46,082 --> 02:39:48,485 WHO IS EATING WHAT? 3285 02:39:48,485 --> 02:39:49,853 HOW HEALTHY THOSE FOODS ARE AND 3286 02:39:49,853 --> 02:39:52,922 HOW THAT AFFECTS THE NUTRITIONAL 3287 02:39:52,922 --> 02:39:54,257 STATUS FOR EACH OF THE 3288 02:39:54,257 --> 02:39:56,726 INDIVIDUALS IN THE HOUSE HOLD. 3289 02:39:56,726 --> 02:39:59,162 7 SO THESE ARE SOME OF THE MAPS 3290 02:39:59,162 --> 02:40:01,798 THAT YOU MIGHT HAVE SEEN. 3291 02:40:01,798 --> 02:40:05,869 SO THIS IS A PROJECTION OF 3292 02:40:05,869 --> 02:40:10,140 CHANGES IN MAZE. 3293 02:40:10,140 --> 02:40:13,109 SO, ITS A PERCENTAGE CHANGE SO 3294 02:40:13,109 --> 02:40:19,082 THE RED ONES MEANS BY 2070 IS 3295 02:40:19,082 --> 02:40:21,851 THE YIELD WILL BE LOWER. 3296 02:40:21,851 --> 02:40:23,086 IN SOME PARTS OF THE WORLD 3297 02:40:23,086 --> 02:40:26,723 BECAUSE OF HIGHER CO2 3298 02:40:26,723 --> 02:40:28,091 FERTILIZATION YOU GET BETTER 3299 02:40:28,091 --> 02:40:28,324 YIELDS. 3300 02:40:28,324 --> 02:40:31,828 BUT ALSO A LOT OF REDS IN 3301 02:40:31,828 --> 02:40:36,032 COUNTRIES THAT WE KNOW ARE 3302 02:40:36,032 --> 02:40:37,901 STRUGGLING ALREADY WITH 3303 02:40:37,901 --> 02:40:40,370 SUFFICIENT AVAILABILITY OF 3304 02:40:40,370 --> 02:40:43,139 STAPLE CROPS OR FOOD IN GENERAL 3305 02:40:43,139 --> 02:40:45,508 FOR THEIR POPULATION. 3306 02:40:45,508 --> 02:40:49,279 AND IT'S NOT ONLY THE YIELDS 3307 02:40:49,279 --> 02:40:53,917 THAT WE'RE TALKING ABOUT BUT 3308 02:40:53,917 --> 02:40:55,485 CLIMATE CHANGE AND AGAIN THE 3309 02:40:55,485 --> 02:40:59,556 EXAMPLE OF CO2 FERTILIZATION -- 3310 02:40:59,556 --> 02:41:02,358 CAN HAVE AN IMPACT ON THE 3311 02:41:02,358 --> 02:41:03,560 NUTRITIONAL QUALITY OF CROPS AND 3312 02:41:03,560 --> 02:41:08,198 THIS WAS A STUDY DONE BY SOME 3313 02:41:08,198 --> 02:41:09,899 COLLEAGUES AT HARVARD WHO LOOKED 3314 02:41:09,899 --> 02:41:17,574 AT THE REDUCED QUANTITY -- OR 3315 02:41:17,574 --> 02:41:22,345 COMPOSITION OF IRON, ZINC AND 3316 02:41:22,345 --> 02:41:24,514 PROTEIN. 3317 02:41:24,514 --> 02:41:28,885 AND SO YOU SEE AGAIN THAT IT 3318 02:41:28,885 --> 02:41:31,921 DOESN'T HAPPEN TOO MUCH IN 3319 02:41:31,921 --> 02:41:33,823 EUROPE AND NORTHERN AMERICA AND 3320 02:41:33,823 --> 02:41:36,693 AUSTRALIA BUT THERE ARE VERY 3321 02:41:36,693 --> 02:41:39,462 DARK BITS WITH VERY HIGH SCORE 3322 02:41:39,462 --> 02:41:44,334 MEANING A LOT OF IRON, ZINC AND 3323 02:41:44,334 --> 02:41:46,002 PROTEIN FROM COUNTRIES THAT WE 3324 02:41:46,002 --> 02:41:48,972 KNOW ARE SUFFERING IN 3325 02:41:48,972 --> 02:41:55,545 MICRONUTRIENTS. 3326 02:41:55,545 --> 02:41:57,547 IF THESE ARE DIETS THAT ARE 3327 02:41:57,547 --> 02:42:00,717 ALREADY SHORT IN SOME OF THE 3328 02:42:00,717 --> 02:42:03,052 MICRONUTRIENTS THEN A FURTHER 3329 02:42:03,052 --> 02:42:04,687 DROP COULD BE QUITE 3330 02:42:04,687 --> 02:42:09,392 CATASTROPHIC. 3331 02:42:09,392 --> 02:42:12,962 AND WE TALKED ABOUT CROPS BUT OF 3332 02:42:12,962 --> 02:42:14,464 COURSE LIVESTOCK CAN BE 3333 02:42:14,464 --> 02:42:14,931 AFFECTED. 3334 02:42:14,931 --> 02:42:18,134 NOT ONLY THE FEED BUT ALSO 3335 02:42:18,134 --> 02:42:20,069 LIVESTOCK BY HEAT FOR EXAMPLE. 3336 02:42:20,069 --> 02:42:22,071 AND SO, THAT IS ALSO SOMETHING 3337 02:42:22,071 --> 02:42:26,843 THAT IS CERTAINLY WILL AFFECT 3338 02:42:26,843 --> 02:42:28,745 LIVESTOCK BOTH IN TERMS OF MILK 3339 02:42:28,745 --> 02:42:30,680 AND MEAT IN THE FUTURE. 3340 02:42:30,680 --> 02:42:32,448 CURRENTLY ALREADY BUT MORE SO IN 3341 02:42:32,448 --> 02:42:34,684 THE FUTURE. 3342 02:42:34,684 --> 02:42:38,087 AND THEN THERE ARE SOME OTHER 3343 02:42:38,087 --> 02:42:39,556 PATHWAYS THAT WE'RE LESS 3344 02:42:39,556 --> 02:42:40,857 FAMILIAR WITH. 3345 02:42:40,857 --> 02:42:42,959 HERE I'VE PUT AN EXAMPLE OF A 3346 02:42:42,959 --> 02:42:44,861 STUDY THAT WE WORKED ON A NUMBER 3347 02:42:44,861 --> 02:42:49,933 OF YEARS AGO IN BANGLADESH WHERE 3348 02:42:49,933 --> 02:42:52,268 CLIMATE CHANGE HAS AN A EFFECT 3349 02:42:52,268 --> 02:42:57,073 ON SALINE TEE OF WATER *. 3350 02:42:57,073 --> 02:43:00,143 MORE STORMS -- TROPICAL CYCLONES 3351 02:43:00,143 --> 02:43:03,846 AND THE WATER WAS VERY SALTY. 3352 02:43:03,846 --> 02:43:05,715 NOT ONLY THE DRINKING WATER. 3353 02:43:05,715 --> 02:43:08,484 YOU SEE THE GIRLS ARE HOLDING -- 3354 02:43:08,484 --> 02:43:11,621 WHICH LED TO QUITE A HIGH LEVEL 3355 02:43:11,621 --> 02:43:14,090 OF -- HYPERTENSION IN THE 3356 02:43:14,090 --> 02:43:16,859 POPULATION BUT ALSO SOME CROPS 3357 02:43:16,859 --> 02:43:20,263 DON'T DO VERY WELL IN MUCH MORE 3358 02:43:20,263 --> 02:43:23,032 SALTY WATER AND THAT WATER WAS 3359 02:43:23,032 --> 02:43:25,101 ALSO BLACK ISSUE WATER. 3360 02:43:25,101 --> 02:43:27,870 THAT WATER WAS ALSO USED TO 3361 02:43:27,870 --> 02:43:38,381 IRRIGATION SOME OF THE CROPS. 3362 02:43:40,750 --> 02:43:43,353 BUT ALSO OTHER PATHWAYS SUCH AS 3363 02:43:43,353 --> 02:43:44,287 POLLINATORS. 3364 02:43:44,287 --> 02:43:46,556 BECAUSE OF CLIMATE CHANGE WE SEE 3365 02:43:46,556 --> 02:43:50,860 A DECLINE IN POLLINATORS AND YOU 3366 02:43:50,860 --> 02:43:54,063 SEE A MAP TWOS PUBLISHED IN THE 3367 02:43:54,063 --> 02:43:56,499 LANCET -- WHICH SHOWS YOU THE 3368 02:43:56,499 --> 02:43:58,401 ADDITIONAL HEALTH BURDENS FROM 3369 02:43:58,401 --> 02:43:59,936 POLLINATION REMOVAL. 3370 02:43:59,936 --> 02:44:01,604 THAT WOULD BE THE CASE OF ALL OF 3371 02:44:01,604 --> 02:44:03,806 THE POLLINATORS WOULD BE GONE. 3372 02:44:03,806 --> 02:44:07,243 WOULD NO LONGER EXHIBIT IN THAT 3373 02:44:07,243 --> 02:44:10,113 PARTICULAR AREA AND WHAT IS 3374 02:44:10,113 --> 02:44:13,116 INTERESTING IS THIS IS MOSTLY 3375 02:44:13,116 --> 02:44:16,319 IMPACTING ON THE GLOBAL FRUIT 3376 02:44:16,319 --> 02:44:18,221 SUPPLIES THAT ARE POLLINATED BY 3377 02:44:18,221 --> 02:44:21,491 FOR EXAMPLE BEES SO GLOBAL FRUIT 3378 02:44:21,491 --> 02:44:24,527 SUPPLIES COULD FALL BY 23%. 3379 02:44:24,527 --> 02:44:29,932 WHICH IS ESTIMATED IN THIS PAPER 3380 02:44:29,932 --> 02:44:32,001 AND VEGETABLES BY 16%. 3381 02:44:32,001 --> 02:44:34,771 SO THESE ADDITIONAL HEALTH 3382 02:44:34,771 --> 02:44:36,005 BURDENS ARE THE DIRECT RESULT OF 3383 02:44:36,005 --> 02:44:44,414 THESE HEALTHY FOODS LES MOONVES- 3384 02:44:44,414 --> 02:44:46,115 AVAILABLE OR AT A MUCH HIGHER 3385 02:44:46,115 --> 02:44:50,019 PRICE. 3386 02:44:50,019 --> 02:44:51,854 AND ANOTHER PATHWAY THAT IS 3387 02:44:51,854 --> 02:44:55,191 PERHAPS LESS KNOWN IS HOW 3388 02:44:55,191 --> 02:44:57,827 CLIMATE CHANGE IS ALSO AFFECTING 3389 02:44:57,827 --> 02:45:00,096 THE QUALITY OF WATER. 3390 02:45:00,096 --> 02:45:04,801 AVENUE THERE WITH THE FISHERIES. 3391 02:45:04,801 --> 02:45:07,136 THIS HAS A HUGE IMPACT ON 3392 02:45:07,136 --> 02:45:09,005 POPULATIONS THAT ARE FOR A LARGE 3393 02:45:09,005 --> 02:45:12,342 PART DEPENDENT ON FISH FOR 3394 02:45:12,342 --> 02:45:13,443 CONSUMPTION BUT SOMETIMES ALSO 3395 02:45:13,443 --> 02:45:16,979 IN TERMS OF FISHERIES AND THEIR 3396 02:45:16,979 --> 02:45:19,415 INCOME AND SO HERE AGAIN YOU SEE 3397 02:45:19,415 --> 02:45:21,751 THAT IN SOME PARTS OF THE WORLD 3398 02:45:21,751 --> 02:45:24,020 THE WATERS ARE MORE AFFECTED 3399 02:45:24,020 --> 02:45:27,623 THAN IN OTHERS BUT IT'S SLIGHTLY 3400 02:45:27,623 --> 02:45:30,827 LESS WELL-KNOWN IMPACT OF 3401 02:45:30,827 --> 02:45:36,833 CLIMATE CHANGE ON NUTRITION. 3402 02:45:36,833 --> 02:45:38,401 UNFORTUNATELY WE SEE IF WE LOOK 3403 02:45:38,401 --> 02:45:41,003 AT NUTRITIONAL PROBLEMS FOR 3404 02:45:41,003 --> 02:45:44,107 EXAMPLE THIS IS A MAP SHARE OF 3405 02:45:44,107 --> 02:45:47,443 CHILDREN UNDER 5 WHO ARE STUNTED 3406 02:45:47,443 --> 02:45:57,887 -- AND UP FORTUNATELY THE 3407 02:45:59,689 --> 02:46:02,625 COUNTRIES THAT WE SEE ARE MOSTLY 3408 02:46:02,625 --> 02:46:04,560 HIT BY CLIMATE CHANGE ARE THOSE 3409 02:46:04,560 --> 02:46:06,996 WHERE THE HIGHEST PREVALENCE OF 3410 02:46:06,996 --> 02:46:10,066 FOOD INSECURITY IS ALREADY 3411 02:46:10,066 --> 02:46:11,834 CURRENTLY IN PLACE. 3412 02:46:11,834 --> 02:46:14,937 AND SIMILARLY YOU SEE THAT IT 3413 02:46:14,937 --> 02:46:18,141 OVERLAPS WITH MICRO NUTRIENT 3414 02:46:18,141 --> 02:46:23,946 DEFICIENCY IN THE WORLD. 3415 02:46:23,946 --> 02:46:28,584 SO, IT'S NOT ONLY EXACTLY 3416 02:46:28,584 --> 02:46:30,653 CLIMATE CHANGE IS AN IMPACT 3417 02:46:30,653 --> 02:46:33,723 WHERE WE SEE THESE 3418 02:46:33,723 --> 02:46:34,090 VULNERABILITIES. 3419 02:46:34,090 --> 02:46:36,826 WE SEE THAT CREATES A 3420 02:46:36,826 --> 02:46:37,827 VULNERABILITY EVERYWHERE AND 3421 02:46:37,827 --> 02:46:39,395 EVEN IN THE UK. 3422 02:46:39,395 --> 02:46:41,697 THIS WAS A REPORT THAT WE WORKED 3423 02:46:41,697 --> 02:46:44,267 ON THE HEALTH ASPECTS OF CLIMATE 3424 02:46:44,267 --> 02:46:45,067 CHANGE. 3425 02:46:45,067 --> 02:46:47,503 WHAT PERCENTAGE OF HEALTHIER AND 3426 02:46:47,503 --> 02:46:50,273 UNHEALTHIER FOODS ARE IMPORTED 3427 02:46:50,273 --> 02:46:52,108 TO THE UK FOR EXAMPLE AND YOU 3428 02:46:52,108 --> 02:46:58,981 SEE FRUITS AND LEGUMES AND NUTS 3429 02:46:58,981 --> 02:47:01,083 AND SEEDS, THEY ARE COMING FROM 3430 02:47:01,083 --> 02:47:02,885 MORE CLIMATE VULNERABLE AREAS 3431 02:47:02,885 --> 02:47:08,891 THAN THE UK ITSELF OR EUROPE. 3432 02:47:08,891 --> 02:47:12,195 SO YOU SEE THAT AT THE MOMENT 3433 02:47:12,195 --> 02:47:15,198 PERHAPS THERE ARE NO DISRUPTIONS 3434 02:47:15,198 --> 02:47:17,967 EVEN THOUGH WE SEE IN THE UK IN 3435 02:47:17,967 --> 02:47:20,403 THE SUPERMARKETS WHEN THERE HAS 3436 02:47:20,403 --> 02:47:24,273 BEEN A HEATWAVE OR A STORM AND 3437 02:47:24,273 --> 02:47:26,342 ALL OF A SUDDEN THERE ARE 3438 02:47:26,342 --> 02:47:27,877 CERTAIN PRODUCTS THAT YOU CANNOT 3439 02:47:27,877 --> 02:47:30,847 FIND ANY MORE OR AT A HIGHER 3440 02:47:30,847 --> 02:47:34,851 PRICE BECAUSE WE'VE BECOME MORE 3441 02:47:34,851 --> 02:47:37,186 DEPENDENT ON CLIMATE VULNERABLE 3442 02:47:37,186 --> 02:47:39,021 AREAS FOR OUR IMPORTS. 3443 02:47:39,021 --> 02:47:42,792 THE LIKELIHOOD THAT THESE 3444 02:47:42,792 --> 02:47:44,460 SUPPLIES WILL BE DISRUPTED WILL 3445 02:47:44,460 --> 02:47:46,229 BE HIGHER. 3446 02:47:46,229 --> 02:47:48,097 THEY WILL HAPPEN MORE 3447 02:47:48,097 --> 02:47:48,431 FREQUENTLY. 3448 02:47:48,431 --> 02:47:51,934 WHICH IS FOR QUITE A NUMBER OF 3449 02:47:51,934 --> 02:47:53,002 HOUSEHOLDS NOT A PROBLEM. 3450 02:47:53,002 --> 02:47:56,105 BUT AGAIN FOR THE POORER 3451 02:47:56,105 --> 02:48:00,710 HOUSEHOLDS CONSUMPTION IS 3452 02:48:00,710 --> 02:48:02,478 ALREADY VERY LOW AND THAT DOES 3453 02:48:02,478 --> 02:48:04,714 NOT HELP WITH TRYING TO GET THEM 3454 02:48:04,714 --> 02:48:09,585 TO EAT MORE HEALTHY FOODS. 3455 02:48:09,585 --> 02:48:11,053 >> YOU HAVE TWO MINUTES 3456 02:48:11,053 --> 02:48:12,722 REMAINING. 3457 02:48:12,722 --> 02:48:16,359 >> AND PERHAPS IMPORTANT TO 3458 02:48:16,359 --> 02:48:22,431 MENTION -- THAT THE IMPACTS OF 3459 02:48:22,431 --> 02:48:24,233 CLIMATE CHANGE -- ARE NOT 3460 02:48:24,233 --> 02:48:25,935 EVERYWHERE THE SAME. 3461 02:48:25,935 --> 02:48:28,104 SO CERTAIN AREAS WHERE PEOPLE 3462 02:48:28,104 --> 02:48:30,840 CAN DO A LOT ABOUT CLIMATE 3463 02:48:30,840 --> 02:48:32,308 CHANGE FOR EXAMPLE BY GROWING 3464 02:48:32,308 --> 02:48:33,609 FOODS INSIDE. 3465 02:48:33,609 --> 02:48:35,878 PROTECTING TREES OR OTHER PLANTS 3466 02:48:35,878 --> 02:48:38,314 FROM HEAT OR COLD ETC. 3467 02:48:38,314 --> 02:48:40,316 WHEREAS IN OTHER PLACES THIS IS 3468 02:48:40,316 --> 02:48:43,185 NOT THE CASE. 3469 02:48:43,185 --> 02:48:44,987 SO CAN YOU GO TO THE NEXT SLIDE, 3470 02:48:44,987 --> 02:48:47,690 PLEASE. 3471 02:48:47,690 --> 02:48:50,593 AND UNFORTUNATELY THE SYSTEM 3472 02:48:50,593 --> 02:48:51,694 KEEPS ITSELF IN PLACE. 3473 02:48:51,694 --> 02:48:53,729 THEY ARE NOT ONLY IMPACTED BY 3474 02:48:53,729 --> 02:48:55,464 CLIMATE CHANGE BUT THEY ARE ALSO 3475 02:48:55,464 --> 02:48:58,768 ONE OF THE BIG CAUSES OF CLIMATE 3476 02:48:58,768 --> 02:48:59,869 CHANGE. 3477 02:48:59,869 --> 02:49:01,404 GREENHOUSE GASES COMING FROM 3478 02:49:01,404 --> 02:49:02,305 FOODS. 3479 02:49:02,305 --> 02:49:05,174 A LARGE PORTION OF LAND USE BY 3480 02:49:05,174 --> 02:49:07,810 AGRICULTURE ALSO. 3481 02:49:07,810 --> 02:49:09,011 WATER. 3482 02:49:09,011 --> 02:49:16,385 AND 94% OF ALL MAMMALS -- ARE 3483 02:49:16,385 --> 02:49:18,554 USED -- OUR LIVESTOCK. 3484 02:49:18,554 --> 02:49:20,856 IF YOU CAN GO TO THE NEXT SLIDE 3485 02:49:20,856 --> 02:49:24,026 -- I'LL SKIP THE NEXT SLIDE IN 3486 02:49:24,026 --> 02:49:25,094 THE INTEREST OF TIME. 3487 02:49:25,094 --> 02:49:27,296 THERE ARE OBVIOUSLY A LOT OF 3488 02:49:27,296 --> 02:49:28,030 SOLUTIONS. 3489 02:49:28,030 --> 02:49:31,100 SO YOU MIGHT BE FAMILIAR WITH 3490 02:49:31,100 --> 02:49:33,269 THE CLIMATE SENATOR AGRICULTURE 3491 02:49:33,269 --> 02:49:37,239 WHERE PEOPLE LOOK * LOOK AT 3492 02:49:37,239 --> 02:49:39,108 SUSTAINABLE MANAGEMENT. 3493 02:49:39,108 --> 02:49:41,777 AND CROPS THAT DO MUCH BETTER 3494 02:49:41,777 --> 02:49:44,313 UNDER THESE MORE STRESSED 3495 02:49:44,313 --> 02:49:44,747 CIRCUMSTANCES. 3496 02:49:44,747 --> 02:49:47,683 FOR EXAMPLE DROUGHT AND HEAT. 3497 02:49:47,683 --> 02:49:58,227 AND HERE YOU SEE -- A FEW OF THE 3498 02:50:00,696 --> 02:50:04,300 EXAMPLES OF SUCH CROPS IN SOUTH 3499 02:50:04,300 --> 02:50:07,770 AFRICA OFTEN THESE ARE MUCH MORE 3500 02:50:07,770 --> 02:50:09,839 WATER EFFICIENT AND ALSO OFTEN 3501 02:50:09,839 --> 02:50:12,074 CONTAIN LOTS OF THE 3502 02:50:12,074 --> 02:50:14,110 MICRONUTRIENTS THAT ARE MISSING 3503 02:50:14,110 --> 02:50:17,947 SUCH AS VITAMIN A, ZINC, IRON 3504 02:50:17,947 --> 02:50:21,851 ETC. 3505 02:50:21,851 --> 02:50:24,020 I'LL SKIP THIS ONE AS WELL IN 3506 02:50:24,020 --> 02:50:29,125 THE INTEREST OF TIME. 3507 02:50:29,125 --> 02:50:31,994 AND SO WE ARE QUITE FAMILIAR 3508 02:50:31,994 --> 02:50:37,566 WITH HOW THE -- SOLUTIONS ON THE 3509 02:50:37,566 --> 02:50:38,701 CONSUMER SIDE. 3510 02:50:38,701 --> 02:50:41,737 LOTS OF FRUITS AND VEGETABLES. 3511 02:50:41,737 --> 02:50:47,276 STILL WITH ANIMAL SOURCED FOOD 3512 02:50:47,276 --> 02:50:49,045 BUT SMALLER QUANTITIES. 3513 02:50:49,045 --> 02:50:53,349 HERE ON THE RIGHT-HAND SIDE THE 3514 02:50:53,349 --> 02:50:57,653 DOTTED LINE IS THE 100% 3515 02:50:57,653 --> 02:51:00,122 RECOMMENDED AMOUNT OF EACH FOOD 3516 02:51:00,122 --> 02:51:06,295 AS RECOMMEN RECOMMENDED BY THE T 3517 02:51:06,295 --> 02:51:08,798 COMMISSION. 3518 02:51:08,798 --> 02:51:11,467 TO SHOW THE WORLD WHAT THE WORLD 3519 02:51:11,467 --> 02:51:13,803 COULD EAT IF WE WERE TO STAY 3520 02:51:13,803 --> 02:51:17,073 WITHIN THE PARRIS AGREEMENTS. 3521 02:51:17,073 --> 02:51:21,410 AND WHILE THIS IS ALSO SEEN AS A 3522 02:51:21,410 --> 02:51:23,379 DIET THAT MEANS WE NAMED TO 3523 02:51:23,379 --> 02:51:25,081 REDUCE MEAT AND DAIRY AND 3524 02:51:25,081 --> 02:51:28,117 EVERYONE NEEDS TO BECOME VEGAN. 3525 02:51:28,117 --> 02:51:28,984 IT'S NOT LIKE THAT. 3526 02:51:28,984 --> 02:51:31,520 IN DIFFERENT PARTS IN THE WORLD 3527 02:51:31,520 --> 02:51:34,190 IT WOULD MEENEN INCREASE IN 3528 02:51:34,190 --> 02:51:37,393 POULTRY AND DAIRY AND FISH AND 3529 02:51:37,393 --> 02:51:38,327 RED MEAT. 3530 02:51:38,327 --> 02:51:40,262 ALL OF THOSE PARTS OF THE WORLD 3531 02:51:40,262 --> 02:51:43,199 WHERE THE CURRENT BAR IS LOWER. 3532 02:51:43,199 --> 02:51:45,634 BUT IN OTHER PARTS OF THE WORLD 3533 02:51:45,634 --> 02:51:49,371 SUCH AS EUROPE AND NORTH AMERICA 3534 02:51:49,371 --> 02:51:51,474 AND AUSTRALIA FOR EXAMPLE THAT 3535 02:51:51,474 --> 02:51:53,175 WOULD MEAN QUITE A SUBSTANTIAL 3536 02:51:53,175 --> 02:51:55,344 REDUCTION. 3537 02:51:55,344 --> 02:51:58,013 SO TO END WITH IF YOU CAN GO TO 3538 02:51:58,013 --> 02:52:00,116 THE NEXT SLIDE. 3539 02:52:00,116 --> 02:52:02,384 THERE IS QUITE A NUMBER OF 3540 02:52:02,384 --> 02:52:04,687 TECHNOLOGICAL SOLUTIONS AS WELL. 3541 02:52:04,687 --> 02:52:07,123 YOU MIGHT BE FAMILIAR WITH 3542 02:52:07,123 --> 02:52:08,224 REGENERATIVE AGRICULTURE WHICH I 3543 02:52:08,224 --> 02:52:09,892 THINK IN THE U.S. IS QUITE UP 3544 02:52:09,892 --> 02:52:12,294 AND COMING. 3545 02:52:12,294 --> 02:52:15,865 OTHER WAYS OF MAKING PLANT BASED 3546 02:52:15,865 --> 02:52:16,632 FOODS. 3547 02:52:16,632 --> 02:52:18,868 YOU SEE A FEW EXAMPLES ON THE 3548 02:52:18,868 --> 02:52:21,403 RIGHT AND IF YOU GO TO THE NEXT 3549 02:52:21,403 --> 02:52:28,477 SLIDE -- ALSO MANY TECHNOLOGICAL 3550 02:52:28,477 --> 02:52:31,647 POSSIBILITIES SUCH AS 3551 02:52:31,647 --> 02:52:32,982 BIOTECHNOLOGY, POSITION 3552 02:52:32,982 --> 02:52:35,551 AGRICULTURE AND MORE PRECISE 3553 02:52:35,551 --> 02:52:38,888 DATA ANALYTIC SO YOU CAN EMBED 3554 02:52:38,888 --> 02:52:40,456 THAT INTO THE AGRICULTURAL 3555 02:52:40,456 --> 02:52:41,423 SYSTEM. 3556 02:52:41,423 --> 02:52:44,460 I THINK I'LL LEAVE IT -- I HAD 3557 02:52:44,460 --> 02:52:46,796 TWO SLIDES BUT I WOULD SAY IT'S 3558 02:52:46,796 --> 02:52:49,899 VERY IMPORTANT TO EMBED ALL OF 3559 02:52:49,899 --> 02:52:52,234 THIS INTO NUTRITION POLICIES AND 3560 02:52:52,234 --> 02:52:55,004 TO MAKE SURE IT ALIGNS AND IT IS 3561 02:52:55,004 --> 02:52:56,472 SUPER IMPORTANT TO INCLUDE THE 3562 02:52:56,472 --> 02:52:59,108 PUBLIC IN THIS AS WELL BECAUSE 3563 02:52:59,108 --> 02:53:01,677 THEY ALL EAT THE FOODS THAT 3564 02:53:01,677 --> 02:53:05,147 WE'RE STUDYING ABOUT. 3565 02:53:05,147 --> 02:53:06,615 MAYBE IF YOU CAN SKIP TO THE 3566 02:53:06,615 --> 02:53:09,118 LAST SLIDE TO THANK MY 3567 02:53:09,118 --> 02:53:12,822 COWORKERS. 3568 02:53:12,822 --> 02:53:18,027 THANK YOU SO MUCH. 3569 02:53:18,027 --> 02:53:23,833 >> THANK YOU SO MUCH. 3570 02:53:23,833 --> 02:53:25,734 WE KNOW CLIMATE CHANGE IS SUCH A 3571 02:53:25,734 --> 02:53:28,070 COMPLEX ISSUE TO ADDRESS AND WE 3572 02:53:28,070 --> 02:53:30,506 KNOW THAT THE INTERACTION WITH 3573 02:53:30,506 --> 02:53:32,408 FOODS AND FOOD SYSTEMS IN 3574 02:53:32,408 --> 02:53:35,945 GENERAL IS FASCINATING AND NOW 3575 02:53:35,945 --> 02:53:38,948 PROFESSOR LICHTVELD, THANK YOU 3576 02:53:38,948 --> 02:53:40,382 AND WE CAN MOVE TO THE NEXT 3577 02:53:40,382 --> 02:53:40,583 SLIDE 3578 02:53:40,583 --> 02:53:42,585 >> THANK YOU AND WE CAN START MY 3579 02:53:42,585 --> 02:53:43,018 SLIDES. 3580 02:53:43,018 --> 02:53:44,119 THANK YOU. 3581 02:53:44,119 --> 02:53:51,560 AND AS WE STARTLED SAY TO DR. 3582 02:53:51,560 --> 02:53:53,262 DR. SCHEELBEEK YOUR NAME IS VERY 3583 02:53:53,262 --> 02:53:53,696 DUTCH. 3584 02:53:53,696 --> 02:53:56,832 I'M PLEASED TO FOLLOW HER TO 3585 02:53:56,832 --> 02:54:00,135 FOCUS ON THE IMPACT OF CLIMATE 3586 02:54:00,135 --> 02:54:05,708 CHANGE ON RESPIRATORY SYSTEMS. 3587 02:54:05,708 --> 02:54:08,711 HOW CLIMATE CHANGE IMPACTS THE 3588 02:54:08,711 --> 02:54:09,245 FOOD SYMPTOM. 3589 02:54:09,245 --> 02:54:11,814 WHAT I WANTED TO POINT OUT IS 3590 02:54:11,814 --> 02:54:14,416 THAT IT'S A SYSTEM. 3591 02:54:14,416 --> 02:54:18,387 AND SO IT REQUIRES A 3592 02:54:18,387 --> 02:54:20,322 TRANSDISCIPLINARY 3593 02:54:20,322 --> 02:54:21,523 MULTI-SECTORIAL APPROACH. 3594 02:54:21,523 --> 02:54:23,926 WE'RE NOT GOING TO SOLVE THIS AS 3595 02:54:23,926 --> 02:54:24,827 INDIVIDUAL DISCIPLINES. 3596 02:54:24,827 --> 02:54:29,031 SO YOU'VE HEARD THE PANEL WAS 3597 02:54:29,031 --> 02:54:31,433 VERY INFORMATIVE TO THAT BUT 3598 02:54:31,433 --> 02:54:34,303 HERE YOU SEE OF ALL OF THE 3599 02:54:34,303 --> 02:54:36,538 THREATS THAT WE'RE FACING, 3600 02:54:36,538 --> 02:54:39,742 CLIMATE AND THE IMPACT ON HUMAN 3601 02:54:39,742 --> 02:54:41,610 HEALTH REQUIRES A SYSTEMS 3602 02:54:41,610 --> 02:54:43,412 APPROACH BECAUSE WE'RE GETTING 3603 02:54:43,412 --> 02:54:45,214 BOTH IMPACT ON QUALITY AND 3604 02:54:45,214 --> 02:54:47,750 SAFETY OF THE FOOD BUT ALSO THE 3605 02:54:47,750 --> 02:54:50,753 IMPACT ON SECURITY AND 3606 02:54:50,753 --> 02:54:52,955 VOLATILITY OF FOOD PRICES THAT 3607 02:54:52,955 --> 02:54:56,458 LEAD TO HUNGER AND MALNUTRITION. 3608 02:54:56,458 --> 02:54:58,794 AND SO WHEN WE LOOK AT THE 3609 02:54:58,794 --> 02:55:03,065 IMPACT OF CLIMATE CHANGE ON THE 3610 02:55:03,065 --> 02:55:04,934 FOOD SECURITY AND NUTRITION WE 3611 02:55:04,934 --> 02:55:10,439 CANNOT DO IT JUST BY OURSELVES. 3612 02:55:10,439 --> 02:55:14,743 AND I'M COMING FROM A COMMUNITY 3613 02:55:14,743 --> 02:55:16,879 PERSPECTIVE AS AN ENVIRONMENTAL 3614 02:55:16,879 --> 02:55:18,113 EPIDEMIOLOGIST. 3615 02:55:18,113 --> 02:55:21,050 BUT PARTICULARLY HERE WE BEGIN 3616 02:55:21,050 --> 02:55:23,852 TO APPRECIATE THE COMPLEXITY AND 3617 02:55:23,852 --> 02:55:26,388 THE INTERCONNECTEDNESS OF THE 3618 02:55:26,388 --> 02:55:28,624 PIECES SO IF YOU CONSIDER THIS A 3619 02:55:28,624 --> 02:55:32,728 PIE NOT A PIZZA PIE THEN THE -- 3620 02:55:32,728 --> 02:55:35,564 REGARDLESS OF HOW WHICH PART OF 3621 02:55:35,564 --> 02:55:38,867 THE PIZZA AND WHICH PART OF THE 3622 02:55:38,867 --> 02:55:41,971 PIE -- WHICH SLICE YOU TAKE AND 3623 02:55:41,971 --> 02:55:44,740 WHICH DRIVER YOU SELECT 3624 02:55:44,740 --> 02:55:47,076 ULTIMATELY IT IMPACTS IN MANY 3625 02:55:47,076 --> 02:55:48,944 CASES DIRECTLY RESPIRATORY 3626 02:55:48,944 --> 02:55:51,513 HEALTH OR IN DIRECTLY 3627 02:55:51,513 --> 02:55:52,247 RESPIRATORY HEALTH. 3628 02:55:52,247 --> 02:55:54,683 SO YOU COULD GO ALONG THE PIE 3629 02:55:54,683 --> 02:55:58,253 AND YOU COULD SEE THAT FROM AIR 3630 02:55:58,253 --> 02:55:59,788 POLLUTION THAT IS A DIRECT 3631 02:55:59,788 --> 02:56:00,456 IMPACT. 3632 02:56:00,456 --> 02:56:02,992 NOT ONLY ON RESPIRATORY HEALTH 3633 02:56:02,992 --> 02:56:05,527 BUT ALSO ON CARDIOVASCULAR 3634 02:56:05,527 --> 02:56:05,761 DISEASE. 3635 02:56:05,761 --> 02:56:08,530 AND INCREASING -- BUT SO IS 3636 02:56:08,530 --> 02:56:10,833 WATER AND THE FOOD SUPPLY 3637 02:56:10,833 --> 02:56:11,567 SYSTEM. 3638 02:56:11,567 --> 02:56:14,069 THE NOTION IS THAT WE CANNOT DO 3639 02:56:14,069 --> 02:56:19,775 IT BY OURSELVES. 3640 02:56:19,775 --> 02:56:24,713 WHEN I WAS ASKED TO SHARE THE 3641 02:56:24,713 --> 02:56:26,949 REPORT OR WHAT KEEPS ME UP AT 3642 02:56:26,949 --> 02:56:29,918 NIGHT WHEN WE HIT $8 BILLION -- 3643 02:56:29,918 --> 02:56:34,456 I WISH WE HAD THAT -- 8 BILLION 3644 02:56:34,456 --> 02:56:35,724 PEOPLE IN THE WORLD THERE ARE 3645 02:56:35,724 --> 02:56:37,659 FOUR ISSUES. 3646 02:56:37,659 --> 02:56:40,029 IT IS CLIMATE CHANGE AND WITHIN 3647 02:56:40,029 --> 02:56:42,431 CLIMATE CHANGE INFECTIOUS 3648 02:56:42,431 --> 02:56:45,567 DISEASE, EXTREME HEAT, FOOD AND 3649 02:56:45,567 --> 02:56:47,136 WATER SECURITY AND POOR AIR 3650 02:56:47,136 --> 02:56:47,536 QUALITY. 3651 02:56:47,536 --> 02:56:52,841 YOU CAN LINK ALL OF THESE FOUR 3652 02:56:52,841 --> 02:56:54,977 TO A CUMULATIVE EFFECT ON THE 3653 02:56:54,977 --> 02:56:55,811 RESPIRATORY SYSTEM. 3654 02:56:55,811 --> 02:57:01,016 AND SO IF WE UNRAVEL WHAT THE 3655 02:57:01,016 --> 02:57:02,584 IMPACT IS ON CLIMATE ON HUMAN 3656 02:57:02,584 --> 02:57:04,920 HEALTH IS THERE ARE TWO MAJOR 3657 02:57:04,920 --> 02:57:06,755 SYSTEMS THAT ARE IMPACTED. 3658 02:57:06,755 --> 02:57:09,725 AGAIN THAT SYSTEMS APPROACH. 3659 02:57:09,725 --> 02:57:12,394 THE DISRUPTION OF THE ECOSYSTEM 3660 02:57:12,394 --> 02:57:16,932 WHERE WHEN ULTIMATELY WE'RE 3661 02:57:16,932 --> 02:57:24,473 FACED WITH INCREASED ALLERGIES 3662 02:57:24,473 --> 02:57:26,875 AND FOODBORNE DISEASES. 3663 02:57:26,875 --> 02:57:28,877 IN ADDITION TO MALNUTRITION I 3664 02:57:28,877 --> 02:57:31,246 WANT TO FOCUS ON WORKFORCE 3665 02:57:31,246 --> 02:57:32,081 CAPACITY. 3666 02:57:32,081 --> 02:57:35,551 WE DO NOT HAVE ENOUGH PEOPLE WHO 3667 02:57:35,551 --> 02:57:38,720 ARE TRAINED IN UNRAVELING THE 3668 02:57:38,720 --> 02:57:41,557 IMPACT OF CLIENT ON HEALTH. 3669 02:57:41,557 --> 02:57:43,258 IN PUBLIC HEALTH WE'RE MAKING 3670 02:57:43,258 --> 02:57:44,359 PROGRESS. 3671 02:57:44,359 --> 02:57:46,862 IN MEDICINE TINY BIT. 3672 02:57:46,862 --> 02:57:49,098 WHERE CLIMATE IS NOT BEING 3673 02:57:49,098 --> 02:57:51,100 TAUGHT AS AN ESSENTIAL COMPONENT 3674 02:57:51,100 --> 02:57:54,069 OF WHAT WE NEED THOUGH KNOW AS 3675 02:57:54,069 --> 02:57:55,537 PRACTICING CLINICIANS AND 3676 02:57:55,537 --> 02:57:57,106 PARTICULARLY HERE YOU'VE HEARD 3677 02:57:57,106 --> 02:58:00,642 ABOUT CONFLICT AND THE FORCED 3678 02:58:00,642 --> 02:58:01,076 MIGRATION. 3679 02:58:01,076 --> 02:58:04,079 I WANT TO FOCUS ON THE IMPACT OF 3680 02:58:04,079 --> 02:58:07,916 MENTAL HEALTH. 3681 02:58:07,916 --> 02:58:12,988 AND I WANT TO TALK ABOUT -- 3682 02:58:12,988 --> 02:58:14,656 POPULATIONS AND I COULD NOT 3683 02:58:14,656 --> 02:58:16,492 AGREE MORE. 3684 02:58:16,492 --> 02:58:20,395 I HAVE A STUDY OF 1200 MOM AND 3685 02:58:20,395 --> 02:58:21,396 CHILDREN'S DIET. 3686 02:58:21,396 --> 02:58:24,933 I COULD NOT AGREE MORE ON 3687 02:58:24,933 --> 02:58:26,602 PREGNANT WOMEN AS THE KEY 3688 02:58:26,602 --> 02:58:28,770 POPULATION TO FOCUS ON. 3689 02:58:28,770 --> 02:58:30,439 I WANT TO FOCUS ON THE PEOPLE 3690 02:58:30,439 --> 02:58:32,474 WHO ARE MOST IMPACTED AND WHO 3691 02:58:32,474 --> 02:58:34,676 ARE MOST VULNERABLE WHO PROVIDE 3692 02:58:34,676 --> 02:58:37,546 MUCH OF THE FOOD THAT IS ON OUR 3693 02:58:37,546 --> 02:58:40,249 TABLES AND THAT IS IMMIGRANTS, 3694 02:58:40,249 --> 02:58:42,050 MINUTE GRANT WORKERS AND 3695 02:58:42,050 --> 02:58:44,853 AGRICULTURAL WORKERS. 3696 02:58:44,853 --> 02:58:47,222 SO IF YOU LOOK AT EACH OF THE 3697 02:58:47,222 --> 02:58:49,358 CLIMATE DRIVERS AND THE IMPACT 3698 02:58:49,358 --> 02:58:52,194 ON RESPIRATORY HEALTH WHETHER 3699 02:58:52,194 --> 02:58:56,098 YOU TAKE HEAT, WILDFIRES, 3700 02:58:56,098 --> 02:58:59,935 POLLEN, EXTREME VIRUSES 3701 02:58:59,935 --> 02:59:02,070 ULTIMATELY THEY ALL IMPACT THE 3702 02:59:02,070 --> 02:59:04,506 RESPIRATORY HEALTH SYSTEM. 3703 02:59:04,506 --> 02:59:08,243 SOME EVIDENCE IS MORE 3704 02:59:08,243 --> 02:59:10,012 PRONOUNCED. 3705 02:59:10,012 --> 02:59:11,580 THAN OTHER PIECES OF EVIDENCE SO 3706 02:59:11,580 --> 02:59:13,549 WE HAVE WORK TO DO. 3707 02:59:13,549 --> 02:59:15,350 SO I'LL COME BACK TO THE KIND OF 3708 02:59:15,350 --> 02:59:17,819 RESEARCH THAT I WOULD BE 3709 02:59:17,819 --> 02:59:20,989 PROPOSING. 3710 02:59:20,989 --> 02:59:23,492 NOW LET'S LOOK AT OUR NEIGHBORS. 3711 02:59:23,492 --> 02:59:26,395 OUR NEIGHBORS IN THE STATES THAT 3712 02:59:26,395 --> 02:59:28,263 WE LIVE AND CONSIDER WHERE THE 3713 02:59:28,263 --> 02:59:30,232 AIR POLLUTION IS COMING FROM. 3714 02:59:30,232 --> 02:59:33,502 IF WE THOUGHT THAT WE COULD HAVE 3715 02:59:33,502 --> 02:59:36,638 -- SET UP TO KEEP THE AIR 3716 02:59:36,638 --> 02:59:39,975 POLLUTION AWAY WE CANNOT. 3717 02:59:39,975 --> 02:59:41,677 SO FIND THE STATE WHERE YOU LIVE 3718 02:59:41,677 --> 02:59:43,912 IN AND SEE HOW MUCH OF THAT 3719 02:59:43,912 --> 02:59:46,014 POLLUTION IS COMING FROM WITHIN 3720 02:59:46,014 --> 02:59:48,584 YOUR STATE BECAUSE OF 3721 02:59:48,584 --> 02:59:51,353 PRACTICEs WITHIN YOUR STATE 3722 02:59:51,353 --> 02:59:55,057 VERSUS OUTSIDE OF YOUR STATE. 3723 02:59:55,057 --> 02:59:57,392 IF YOU'RE BLUE IN COLOR THEN 3724 02:59:57,392 --> 02:59:59,161 IT'S COMING FROM WITHIN. 3725 02:59:59,161 --> 03:00:03,131 IF IT'S ORANGE IT'S COMING FROM 3726 03:00:03,131 --> 03:00:05,200 SOMEWHERE ELSE. 3727 03:00:05,200 --> 03:00:11,473 IT'S A REALIZATION OF A A-HA 3728 03:00:11,473 --> 03:00:14,876 MOMENT. 3729 03:00:14,876 --> 03:00:16,979 SO EACH OF US HAVE A 3730 03:00:16,979 --> 03:00:23,885 RESPONSIBILITY TO TAKE. 3731 03:00:23,885 --> 03:00:25,988 SO IN THE FIRST PANEL YOU HEARD 3732 03:00:25,988 --> 03:00:28,757 ABOUT THE EXPOSURE AND WHAT 3733 03:00:28,757 --> 03:00:30,626 EXPOSURES WE SHOULD CONSIDER. 3734 03:00:30,626 --> 03:00:33,395 HERE I'M HEARING JUST AND THIS 3735 03:00:33,395 --> 03:00:36,798 LOOKS LIKE A COMPLICATED SLIDE 3736 03:00:36,798 --> 03:00:39,368 BUT JUST AN EXAMPLE OF WHAT AN 3737 03:00:39,368 --> 03:00:41,203 EXPOSER PATHWAY WOULD LOOK LIKE. 3738 03:00:41,203 --> 03:00:44,973 SO AGAIN TAKING THE CLIMATE 3739 03:00:44,973 --> 03:00:48,277 DRIVERS AND HERE WE CAN LOOK AT 3740 03:00:48,277 --> 03:00:50,078 CHANGE IN TEMPERATURES BUT ALSO 3741 03:00:50,078 --> 03:00:52,247 CHANGE IN PRECIPITATION. 3742 03:00:52,247 --> 03:00:55,250 WHETHER IT'S MORE OR LESS 3743 03:00:55,250 --> 03:00:57,019 PRECIPITATION HAS DIRECT IMPACT 3744 03:00:57,019 --> 03:00:59,388 ON ULTIMATELY WHAT THE FOOD 3745 03:00:59,388 --> 03:01:02,257 SYSTEM IS BUT ALSO IF YOU LOOK 3746 03:01:02,257 --> 03:01:04,259 AT THE ENVIRONMENTAL CONDITIONS 3747 03:01:04,259 --> 03:01:07,396 RELATED TO THESE DRIVERS WHETHER 3748 03:01:07,396 --> 03:01:09,064 IT'S LONGER SPRING, MORE 3749 03:01:09,064 --> 03:01:12,167 FLOODING. 3750 03:01:12,167 --> 03:01:15,003 WHETHER IT'S PROLONGED EXPOSURE 3751 03:01:15,003 --> 03:01:15,537 TO HEAT. 3752 03:01:15,537 --> 03:01:17,205 WE HAVE A SERIES OF HEALTH 3753 03:01:17,205 --> 03:01:20,509 OUTCOMES AND ASTHMA, ALLERGIES 3754 03:01:20,509 --> 03:01:23,078 AND RESPIRATORY ILLNESSES ARE 3755 03:01:23,078 --> 03:01:23,979 RIGHT IN THERE. 3756 03:01:23,979 --> 03:01:27,049 I'M GOING TO SKIP QUICKLY 3757 03:01:27,049 --> 03:01:28,417 THROUGH THESE SLIDES BECAUSE I 3758 03:01:28,417 --> 03:01:31,753 WANT TO EMPHASIZE -- WHAT IS -- 3759 03:01:31,753 --> 03:01:33,989 YOU KNOW THE CASES IN LUNG 3760 03:01:33,989 --> 03:01:36,124 CANCERS. 3761 03:01:36,124 --> 03:01:39,695 ALSO THE DIFFERENCES IN BY SEX 3762 03:01:39,695 --> 03:01:45,600 IN TERMS OF LUNG CANCER. 3763 03:01:45,600 --> 03:01:49,237 ASTHMA AND ASTHMA BASED ON RACE 3764 03:01:49,237 --> 03:01:51,540 AND ETHNIC DIFFERENCES. 3765 03:01:51,540 --> 03:01:56,445 NEXT PLEASE. 3766 03:01:56,445 --> 03:01:58,213 COPD. 3767 03:01:58,213 --> 03:02:04,386 MEN AND WOMEN. 3768 03:02:04,386 --> 03:02:06,455 AND THEN OF COURSE ACROSS MANY 3769 03:02:06,455 --> 03:02:09,057 OF THE OTHER AREAS AND ACROSS 3770 03:02:09,057 --> 03:02:09,891 TIME. 3771 03:02:09,891 --> 03:02:12,494 ONE OF THE REASONS I PUT UP THIS 3772 03:02:12,494 --> 03:02:15,497 SLIDE IS TO REMIND US THAT WE'RE 3773 03:02:15,497 --> 03:02:17,265 ALWAYS RUNNING BEHIND WITH DATA. 3774 03:02:17,265 --> 03:02:20,802 SO THERE IS A LOT OF 3775 03:02:20,802 --> 03:02:22,904 CONVERSATION -- THIS MAKES IT 3776 03:02:22,904 --> 03:02:24,773 DIFFICULT FOR US TO GET ON TO 3777 03:02:24,773 --> 03:02:29,044 THE FRONT LINE. 3778 03:02:29,044 --> 03:02:31,613 WHAT I WANT TO FOCUS ON IS 3779 03:02:31,613 --> 03:02:33,949 BEGINNING FOR US TO REALIZE WHAT 3780 03:02:33,949 --> 03:02:36,651 THAT CUMULATIVE RISK FACTOR 3781 03:02:36,651 --> 03:02:37,319 LOOKS LIKE. 3782 03:02:37,319 --> 03:02:41,189 IT IS AN INCREASED BURDEN 3783 03:02:41,189 --> 03:02:42,524 AFFECTING PARTICULARLY 3784 03:02:42,524 --> 03:02:45,193 COMMUNITIES WHO ARE ALREADY 3785 03:02:45,193 --> 03:02:49,030 IMPACTED BY INEQUITIES. 3786 03:02:49,030 --> 03:02:52,234 THEIR INABILITY TO COUNTER THESE 3787 03:02:52,234 --> 03:02:54,703 RISK, THE EVERY DAY RISK BUT 3788 03:02:54,703 --> 03:02:57,906 PARTICULARLY THE RISK FROM 3789 03:02:57,906 --> 03:03:00,008 CLIMATE IS INTENSE AND SEVERE 3790 03:03:00,008 --> 03:03:03,245 AND IT IS THAT FOCUS THAT WE'RE 3791 03:03:03,245 --> 03:03:04,079 MISSING. 3792 03:03:04,079 --> 03:03:06,448 IT IS THE FOCUS ON COMMUNITIES 3793 03:03:06,448 --> 03:03:10,786 OF COLORS AND OTHER MARGINALIZED 3794 03:03:10,786 --> 03:03:12,954 GROUPS AND IT IS TAKING A CLOSER 3795 03:03:12,954 --> 03:03:15,424 LOOK AT THE ROLE OF EQUITY AND 3796 03:03:15,424 --> 03:03:16,958 LOOKING AT THESE PROBLEMS 3797 03:03:16,958 --> 03:03:18,794 THROUGH THE LENS OF EQUITY. 3798 03:03:18,794 --> 03:03:21,329 BECAUSE EQUITY DOESN'T ONLY CUT 3799 03:03:21,329 --> 03:03:25,300 ACROSS THE ENTIRE RESEARCH 3800 03:03:25,300 --> 03:03:27,769 CONTINUUM BUT ALSO IS IMPORTANT 3801 03:03:27,769 --> 03:03:34,543 WHEN WE LOOK AT THE INTERCON 3802 03:03:34,543 --> 03:03:38,547 INTERCONNECTEDNESS OF HEALTH. 3803 03:03:38,547 --> 03:03:41,850 SO WHEN YOU LOOK AT INEQUITIES 3804 03:03:41,850 --> 03:03:44,219 THERE ARE THREE DIMENSIONS THAT 3805 03:03:44,219 --> 03:03:46,288 I AM TAKING YOU NOW TO THE 3806 03:03:46,288 --> 03:03:48,890 COMMUNITY FOCUS WHERE I LIVE 3807 03:03:48,890 --> 03:03:50,392 FROM A PUBLIC HEALTH 3808 03:03:50,392 --> 03:03:53,695 PERSPECTIVE. 3809 03:03:53,695 --> 03:03:56,097 IN TERMS OF -- EQUITY OF WHAT 3810 03:03:56,097 --> 03:03:59,034 AND I'LL COME BACK TO WHAT IS 3811 03:03:59,034 --> 03:04:01,603 UNDER THE WHAT? 3812 03:04:01,603 --> 03:04:03,939 EQUITY BETWEEN ALL WHETHER IT'S 3813 03:04:03,939 --> 03:04:07,976 CLASS, OCCUPATION, GENDER AND 3814 03:04:07,976 --> 03:04:08,877 GEOGRAPHY. 3815 03:04:08,877 --> 03:04:15,550 AND INTRA AND INTERGENERATIONAL. 3816 03:04:15,550 --> 03:04:17,552 PREGNANCY AND LOOKING DOWN AND 3817 03:04:17,552 --> 03:04:21,556 UP THE GENERATION BECOMES SUCH A 3818 03:04:21,556 --> 03:04:25,727 SPECIAL FORMIDABLE POPULATION. 3819 03:04:25,727 --> 03:04:30,031 LAST YEAR WE WERE ASKED TO FOCUS 3820 03:04:30,031 --> 03:04:31,366 ON CLIMATE AND RESPIRATORY 3821 03:04:31,366 --> 03:04:34,302 HEALTH FROM AN EXPOSURE 3822 03:04:34,302 --> 03:04:35,971 VULNERABILITY AND RISK 3823 03:04:35,971 --> 03:04:36,438 PERSPECTIVE. 3824 03:04:36,438 --> 03:04:38,940 IF YOU LOOK AT THE EXPOSURE 3825 03:04:38,940 --> 03:04:44,112 CAUSED BY THE DRIVERS OF CLIMATE 3826 03:04:44,112 --> 03:04:48,216 CHANGE THEN THE RISK IS THAT 3827 03:04:48,216 --> 03:04:53,922 DIAGRAM AMONG THE EXPOSURES, THE 3828 03:04:53,922 --> 03:04:55,824 SENSITIVITY NOT ONLY AT THE 3829 03:04:55,824 --> 03:04:57,692 INDIVIDUAL LEVEL WE ALL KNOW 3830 03:04:57,692 --> 03:04:59,461 WHAT PRECISION MEDICINE DOES FOR 3831 03:04:59,461 --> 03:05:00,028 US. 3832 03:05:00,028 --> 03:05:03,598 THIS IS PRECISION PUBLIC HEALTH. 3833 03:05:03,598 --> 03:05:05,066 RAZOR SHARP FOCUS ON THE 3834 03:05:05,066 --> 03:05:08,069 COMMUNITY THAT IS MOST AFFECTED 3835 03:05:08,069 --> 03:05:11,573 AND THE COMMUNITIES -- CAPACITY. 3836 03:05:11,573 --> 03:05:14,442 WITHIN THE VULNERABILITY IT IS 3837 03:05:14,442 --> 03:05:16,778 THE RISK OF WHERE THESE THREE 3838 03:05:16,778 --> 03:05:18,446 AREAS COME TOGETHER THAT WE 3839 03:05:18,446 --> 03:05:23,718 SHOULD BE FOCUSING ON. 3840 03:05:23,718 --> 03:05:25,954 SO IF YOU ASK ME WHAT KIND OF 3841 03:05:25,954 --> 03:05:28,590 RESEARCH NEEDS TO BE DONE -- 3842 03:05:28,590 --> 03:05:30,191 REGARDLESS OF WHAT TYPE OF 3843 03:05:30,191 --> 03:05:33,395 RESEARCH ACROSS THE RESEARCH 3844 03:05:33,395 --> 03:05:34,629 CONTINUUM IT IS IMPORTANT THAT 3845 03:05:34,629 --> 03:05:39,034 WE FOCUS ON AND I KNOW NHLBI 3846 03:05:39,034 --> 03:05:42,237 AND OTHER INSTITUTES FOCUS ON 3847 03:05:42,237 --> 03:05:43,738 IMPLEMENTATION SCIENCE AS A 3848 03:05:43,738 --> 03:05:46,174 STRATEGY TO GET TO INTERVENTIONS 3849 03:05:46,174 --> 03:05:50,478 BUT IMPLEMENTATION SCIENCE 3850 03:05:50,478 --> 03:05:52,347 REQUIRES THAT BEGIN WITH 3851 03:05:52,347 --> 03:05:53,915 IDENTIFYING WHO THE STAKEHOLDERS 3852 03:05:53,915 --> 03:05:54,349 ARE. 3853 03:05:54,349 --> 03:05:56,451 THAT WE FOCUS ON THE COMMUNITIES 3854 03:05:56,451 --> 03:06:00,055 THAT ARE AT RISK AND THAT THEY 3855 03:06:00,055 --> 03:06:01,756 COLLABORATE WITH US THROUGHOUT 3856 03:06:01,756 --> 03:06:05,327 THE DEVELOPMENT AND 3857 03:06:05,327 --> 03:06:08,063 IMPLEMENTATION AND EVALUATION 3858 03:06:08,063 --> 03:06:09,197 BEGINNING WITH IDENTIFYING 3859 03:06:09,197 --> 03:06:11,433 COMMON GOALS NOT WHAT WE THINK 3860 03:06:11,433 --> 03:06:13,401 IS IMPORTANT TO KNOW BUT WHAT 3861 03:06:13,401 --> 03:06:17,272 THEY THINK IS IMPORTANT FOR US 3862 03:06:17,272 --> 03:06:19,007 TO INTERVENE TOGETHER WITH THEM. 3863 03:06:19,007 --> 03:06:25,814 SO CO-CREATION, CO-ANALYSIS, DID 3864 03:06:25,814 --> 03:06:27,549 OUR RESEARCH MAKE A DIFFERENCE? 3865 03:06:27,549 --> 03:06:29,884 DID OUR INTERVENTION MAKE A 3866 03:06:29,884 --> 03:06:32,554 DIFFERENCE AND BACK TO WHAT WE 3867 03:06:32,554 --> 03:06:34,656 DO TO SEE WHAT IS THE NEXT STEP 3868 03:06:34,656 --> 03:06:39,928 AND HOW DO WE CREATE ULTIMATELY 3869 03:06:39,928 --> 03:06:43,865 A MOTION OF RESILIENCE. 3870 03:06:43,865 --> 03:06:47,969 AND SO WHEN WE LOOK AT WHAT IS 3871 03:06:47,969 --> 03:06:50,005 THE CAPACITY OF COMMUNITIES TO 3872 03:06:50,005 --> 03:06:50,639 RESPOND? 3873 03:06:50,639 --> 03:06:53,274 WE SELDOM FOCUS ON WHAT THE 3874 03:06:53,274 --> 03:06:55,010 ASSETS ARE. 3875 03:06:55,010 --> 03:06:56,678 WE'RE QUICK TO TALK ABOUT WHAT 3876 03:06:56,678 --> 03:06:58,680 THE GAPS ARE. 3877 03:06:58,680 --> 03:07:00,915 BUT HERE ARE THE ASSETS AND 3878 03:07:00,915 --> 03:07:03,752 WHERE WE FIND THE GAPS. 3879 03:07:03,752 --> 03:07:04,786 WHETHER IT'S IN THE NATURAL 3880 03:07:04,786 --> 03:07:06,221 ENVIRONMENT. 3881 03:07:06,221 --> 03:07:08,757 WHAT IS THE HEALTH OF THE 3882 03:07:08,757 --> 03:07:11,726 ENVIRONMENT AROUND THEM AND WE 3883 03:07:11,726 --> 03:07:14,396 FOCUS MORE AND MORE ON THE 3884 03:07:14,396 --> 03:07:14,629 HEALTH. 3885 03:07:14,629 --> 03:07:16,097 THE HEALTH OF ENVIRONMENT AND 3886 03:07:16,097 --> 03:07:20,268 PEOPLE AND ANIMALS AND PLANTS 3887 03:07:20,268 --> 03:07:23,304 AND HOW THOSE COME TOGETHER. 3888 03:07:23,304 --> 03:07:25,040 WHAT IS THE HEALTH AND THE GAPS 3889 03:07:25,040 --> 03:07:29,444 ON THE INFRASTRUCTURE? 3890 03:07:29,444 --> 03:07:32,313 PARTICULARLY THE PUBLIC HEALTH 3891 03:07:32,313 --> 03:07:33,248 INFRASTRUCTURE. 3892 03:07:33,248 --> 03:07:35,517 WHAT IS THE CAPACITY TO DELIVER 3893 03:07:35,517 --> 03:07:37,185 THE INTERVENTION IN LOWER AND 3894 03:07:37,185 --> 03:07:38,520 MIDDLE INCOME COUNTRIES. 3895 03:07:38,520 --> 03:07:40,722 I COME FROM A COUNTRY IN SOUTH 3896 03:07:40,722 --> 03:07:42,724 AMERICA. 3897 03:07:42,724 --> 03:07:45,260 AND THERE THE CAPACITY TO 3898 03:07:45,260 --> 03:07:48,163 DELIVER SERVICES IN THE AMAZON 3899 03:07:48,163 --> 03:07:49,497 RAINFOREST WHERE I USED TO 3900 03:07:49,497 --> 03:07:52,033 PRACTICE AS A YOUNG PHYSICIANS 3901 03:07:52,033 --> 03:07:53,668 NOT EASY. 3902 03:07:53,668 --> 03:07:57,405 WHEN WE SEE THAT BECAUSE OF 3903 03:07:57,405 --> 03:08:00,608 CLIMATE CHANGES AND INCREASED 3904 03:08:00,608 --> 03:08:03,945 FLOODING TAKES PEOPLE AWAY FROM 3905 03:08:03,945 --> 03:08:06,614 GROWING THEIR FRUITS AND 3906 03:08:06,614 --> 03:08:08,383 VEGETABLES ON THE RICH RIVER 3907 03:08:08,383 --> 03:08:11,052 BANK SOIL MOVING UPSTREAM WHERE 3908 03:08:11,052 --> 03:08:15,757 THE SOIL IS LESS HEALTHY THAN 3909 03:08:15,757 --> 03:08:19,828 REVERTING TO USING PESTICIDES. 3910 03:08:19,828 --> 03:08:24,466 WE HAVE 50% ANEMIA OF PREGNANT 3911 03:08:24,466 --> 03:08:26,000 WOMEN. 3912 03:08:26,000 --> 03:08:27,302 SO WHAT IS THE FINANCIAL 3913 03:08:27,302 --> 03:08:29,904 CAPACITY. 3914 03:08:29,904 --> 03:08:33,341 AND I'M GLAD THAT MY COLLEAGUE 3915 03:08:33,341 --> 03:08:34,676 JUAN TALKED ABOUT THE IMPORTANCE 3916 03:08:34,676 --> 03:08:38,079 OF CULTURE. 3917 03:08:38,079 --> 03:08:40,949 THERE ARE COMMUNITIES WHERE I 3918 03:08:40,949 --> 03:08:43,384 COME FROM WHERE VEGETABLES ARE 3919 03:08:43,384 --> 03:08:47,088 TOO EXPENSIVE TO AFFORD. 3920 03:08:47,088 --> 03:08:50,358 SO WHAT IS THE -- 3921 03:08:50,358 --> 03:08:51,760 >> YOU HAVE ONE MINUTE 3922 03:08:51,760 --> 03:08:53,194 REMAINING. 3923 03:08:53,194 --> 03:08:56,931 >> WHAT IS THE FOCUS THAT WE 3924 03:08:56,931 --> 03:09:00,935 HAVE ON EATING FISH EATING 3925 03:09:00,935 --> 03:09:03,705 PROTEINS VERSUS CONTAMINATED 3926 03:09:03,705 --> 03:09:04,272 FISH. 3927 03:09:04,272 --> 03:09:06,808 PEOPLE ARE FORCED TO EAT 3928 03:09:06,808 --> 03:09:07,742 CONTAMINATED FISH BECAUSE THAT 3929 03:09:07,742 --> 03:09:10,378 IS THE ONLY SOURCE OF PROTEIN. 3930 03:09:10,378 --> 03:09:13,348 ULTIMATELY WHAT IS THE POLITICAL 3931 03:09:13,348 --> 03:09:13,982 OR GOVERNMENT STRUCTURE. 3932 03:09:13,982 --> 03:09:15,550 WHEN YOU THINK ABOUT 3933 03:09:15,550 --> 03:09:17,218 INTERVENTIONS AND YOU THINK 3934 03:09:17,218 --> 03:09:18,853 ABOUT THE IMPACT OF CLIMATE ON 3935 03:09:18,853 --> 03:09:20,388 THE RESPIRATORY HEALTH WE NEED 3936 03:09:20,388 --> 03:09:22,190 TO THINK ABOUT WHAT IS OUR 3937 03:09:22,190 --> 03:09:24,292 COMMUNITY FOCUS AND HOW DO WE DO 3938 03:09:24,292 --> 03:09:26,528 THIS TOGETHER SO LET ME LEAVE 3939 03:09:26,528 --> 03:09:33,201 YOU WITH INVITING YOU TO COME -- 3940 03:09:33,201 --> 03:09:36,671 AND ENJOY THE RICH FOOD OF MY 3941 03:09:36,671 --> 03:09:38,940 COUNTRY AND I WOULD BE PLEASED 3942 03:09:38,940 --> 03:09:40,141 TO ANSWER QUESTIONS LATER. 3943 03:09:40,141 --> 03:09:41,943 THANK YOU. 3944 03:09:41,943 --> 03:09:44,813 >> THANK YOU SO MUCH PROFESSOR 3945 03:09:44,813 --> 03:09:46,614 LICHTVELD FOR THAT VERY 3946 03:09:46,614 --> 03:09:52,687 INTERESTING INTRODUCTION TO THE 3947 03:09:52,687 --> 03:09:54,589 TOPIC. 3948 03:09:54,589 --> 03:09:56,891 WE HAVE APPROXIMATELY 10 MINUTES 3949 03:09:56,891 --> 03:09:59,594 NOW TO OPEN THE DISCUSSION. 3950 03:09:59,594 --> 03:10:10,104 7 WE HAVE SUMMARIZED THE MAIN 3951 03:10:12,740 --> 03:10:15,443 POINTS THAT WE FELT WERE 3952 03:10:15,443 --> 03:10:17,879 CRITICAL TO THE PRESENTATIONS 3953 03:10:17,879 --> 03:10:21,482 YOU GAVE. 3954 03:10:21,482 --> 03:10:22,517 DR. SCHEELBEEK ADDRESSED THE 3955 03:10:22,517 --> 03:10:26,688 ISSUE OF CLIMATE CHANGE 3956 03:10:26,688 --> 03:10:28,923 IMPACTING LIFE DOMAINS AND 3957 03:10:28,923 --> 03:10:30,458 RESOURCES. 3958 03:10:30,458 --> 03:10:32,160 GLOBALIZATION CREATES 3959 03:10:32,160 --> 03:10:34,596 VULNERABILITY EVERYWHERE AND 3960 03:10:34,596 --> 03:10:38,233 SEVERAL CLIMATE CHANGE FRIENDLY 3961 03:10:38,233 --> 03:10:43,171 ADAPTATIONS CAN SUPPORT FOOD 3962 03:10:43,171 --> 03:10:53,414 AVAILABILITY. 3963 03:11:23,912 --> 03:11:28,449 -- SO THE KEY TO THE DISCUSSION 3964 03:11:28,449 --> 03:11:38,993 -- WHAT IS THE IMPACT OF CLIMATE 3965 03:11:40,361 --> 03:11:44,599 CHANGE ON FOOD SYSTEMS, FOOD 3966 03:11:44,599 --> 03:11:47,702 SECURITY, DIET QUALITY AND 3967 03:11:47,702 --> 03:11:49,337 NUTRIENTS. 3968 03:11:49,337 --> 03:11:51,472 PERHAPS I CAN START WITH 3969 03:11:51,472 --> 03:11:55,109 PROFESSOR LICHTVELD WHO NICELY 3970 03:11:55,109 --> 03:11:56,778 SUMMARIZED THE SITUATION. 3971 03:11:56,778 --> 03:11:58,846 AND IN THAT PART OF SOUTH 3972 03:11:58,846 --> 03:11:59,080 AMERICA. 3973 03:11:59,080 --> 03:12:02,150 HOW DO YOU SEE THE IMPACT OF 3974 03:12:02,150 --> 03:12:02,750 CLIMATE CHANGE AFFECTING 3975 03:12:02,750 --> 03:12:07,088 RESPIRATORY HEALTH AND WHAT DO 3976 03:12:07,088 --> 03:12:10,258 YOU PROPOSE IN TERMS OF 3977 03:12:10,258 --> 03:12:11,526 ADVANCING THE RESEARCH. 3978 03:12:11,526 --> 03:12:14,128 >> I MENTIONED EARLIER THAT THE 3979 03:12:14,128 --> 03:12:17,365 FOCUS ON PREGNANT WOMEN IS -- 3980 03:12:17,365 --> 03:12:19,334 WILL GIVE US THE GREATEST YIELD 3981 03:12:19,334 --> 03:12:22,370 OF WHERE WE WANT TO GO BECAUSE 3982 03:12:22,370 --> 03:12:25,373 IF YOU HAVE THE DEFICIENCIES 3983 03:12:25,373 --> 03:12:29,477 DURING PREGNANCY WE'RE SEEING 3984 03:12:29,477 --> 03:12:36,384 SMALLER GESTATION -- AND 3985 03:12:36,384 --> 03:12:39,120 DECREASED APKAR SCORES. 3986 03:12:39,120 --> 03:12:48,029 7 TWO, BY INTEGRATING -- A 3987 03:12:48,029 --> 03:12:49,464 MULTI-SECTORIAL AND 3988 03:12:49,464 --> 03:12:50,732 TRANSDISCIPLINARY APPROACH WE 3989 03:12:50,732 --> 03:12:54,402 CAN WORK WITH NUTRITIONIST AND 3990 03:12:54,402 --> 03:12:58,673 ALSO CULTURAL LEADERS AND 3991 03:12:58,673 --> 03:13:00,508 WHETHER SCIENTISTS. 3992 03:13:00,508 --> 03:13:03,044 PEOPLE WHO ADDRESS SOIL. 3993 03:13:03,044 --> 03:13:04,512 ENVIRONMENTAL HEALTH SCIENTISTS 3994 03:13:04,512 --> 03:13:08,116 AND LIKE WHAT I DO ENVIRONMENTAL 3995 03:13:08,116 --> 03:13:10,118 EPIDEMIOLOGIST. 3996 03:13:10,118 --> 03:13:16,491 THIRDLY IT IS NOT -- ANOTHER -- 3997 03:13:16,491 --> 03:13:18,526 WE WOULD WANT TO FOCUS ON A 3998 03:13:18,526 --> 03:13:20,228 SINGLE ASPECT. 3999 03:13:20,228 --> 03:13:22,764 A SINGLE HEALTH OUTCOME. 4000 03:13:22,764 --> 03:13:24,198 HERE IT IS IMPOSSIBLE. 4001 03:13:24,198 --> 03:13:29,570 HERE WE NEED TO TAKE THAT 4002 03:13:29,570 --> 03:13:31,606 TRANSDISCIPLINARY APPROACH AND 4003 03:13:31,606 --> 03:13:35,043 SEE HOW A MILL YA IMPACTS 4004 03:13:35,043 --> 03:13:36,844 LEARNING AND HOW LEARNING 4005 03:13:36,844 --> 03:13:39,514 IMPACTS TO JOBS THAT ULTIMATELY 4006 03:13:39,514 --> 03:13:41,215 LEADS TO POVERTY AND 4007 03:13:41,215 --> 03:13:43,184 MALNUTRITION. 4008 03:13:43,184 --> 03:13:46,621 SO BY USING THAT PRECISION 4009 03:13:46,621 --> 03:13:50,391 PUBLIC HEALTH APPROACH THAT IS 4010 03:13:50,391 --> 03:13:52,593 LOOKING THROUGH THE LENS OF 4011 03:13:52,593 --> 03:13:55,396 THOSE WHO ARE MOST VULNERABLE 4012 03:13:55,396 --> 03:13:57,065 NOT ONLY AT THE INDIVIDUAL LEVEL 4013 03:13:57,065 --> 03:13:59,834 BUT HOW THE COMMUNITY COMPONENTS 4014 03:13:59,834 --> 03:14:02,170 AND THE ASPECTS OF COMMUNITY 4015 03:14:02,170 --> 03:14:04,105 RESILIENCE ULTIMATELY IMPACTS 4016 03:14:04,105 --> 03:14:06,074 WHAT IS GOING ON WITH THE 4017 03:14:06,074 --> 03:14:06,941 INDIVIDUAL IN THE COMMUNITY. 4018 03:14:06,941 --> 03:14:08,643 I THINK THAT IS THE APPROACH 4019 03:14:08,643 --> 03:14:10,411 THAT WILL GIVE US THE GREATEST 4020 03:14:10,411 --> 03:14:11,913 YIELD. 4021 03:14:11,913 --> 03:14:15,817 >> THANK YOU VERY MUCH. 4022 03:14:15,817 --> 03:14:17,819 TO DR. SCHEELBEEK. 4023 03:14:17,819 --> 03:14:21,456 YOU PRESENTED A VERY NICE 4024 03:14:21,456 --> 03:14:24,125 OUTLINE OF THE AFFECTS OF 4025 03:14:24,125 --> 03:14:25,993 CLIMATE CHANGE AND HOW IT MIGHT 4026 03:14:25,993 --> 03:14:28,296 AFFECT FOOD PRODUCTION. 4027 03:14:28,296 --> 03:14:30,531 DO YOU HAVE ANY SUGGESTIONS 4028 03:14:30,531 --> 03:14:31,666 ABOUT KEY RESEARCH QUESTIONS 4029 03:14:31,666 --> 03:14:35,203 THAT WE COULD THINK OF TO 4030 03:14:35,203 --> 03:14:39,073 ADVANCE THE SCIENTIFIC -- AGENDA 4031 03:14:39,073 --> 03:14:41,175 AND HOW THIS IS LINKED TO 4032 03:14:41,175 --> 03:14:42,844 RESPIRATORY DISEASES IN THE 4033 03:14:42,844 --> 03:14:44,712 FUTURE? 4034 03:14:44,712 --> 03:14:46,614 >> FIRST IT IS IMPORTANT BECAUSE 4035 03:14:46,614 --> 03:14:49,517 I DON'T THINK THE DIFFERENT 4036 03:14:49,517 --> 03:14:51,586 AGENDAS OF FOR EXAMPLE PLANETARY 4037 03:14:51,586 --> 03:14:56,557 HEALTH SCIENTISTS, AGRICULTURE 4038 03:14:56,557 --> 03:14:58,292 SCIENTIST AND RESPIRATORY 4039 03:14:58,292 --> 03:15:02,864 RESEARCHERS IS VERY MUCH LINKED. 4040 03:15:02,864 --> 03:15:05,299 AND I WOULD BE SURPRISED IF 4041 03:15:05,299 --> 03:15:09,270 PEOPLE THAT LOOK AT MORE 4042 03:15:09,270 --> 03:15:12,273 RESILIENCE IN FOOD PRODUCTION 4043 03:15:12,273 --> 03:15:14,275 AND CONSUMPTION KNOW A LOT ABOUT 4044 03:15:14,275 --> 03:15:17,378 WHAT FOODS ARE PARTICULARLY 4045 03:15:17,378 --> 03:15:20,915 IMPORTANT IN TERMS OF PREVENTION 4046 03:15:20,915 --> 03:15:23,985 RESPIRATORY ILLNESS AND I THINK 4047 03:15:23,985 --> 03:15:25,453 FINDING THESE CO-BENEFITS 4048 03:15:25,453 --> 03:15:27,555 BECAUSE I'M SURE THERE WILL BE 4049 03:15:27,555 --> 03:15:27,989 MANY. 4050 03:15:27,989 --> 03:15:29,757 WE SEE LOTS OF COACH BENEFITS 4051 03:15:29,757 --> 03:15:33,394 WHEN IT COMES TO FOODS THAT ARE 4052 03:15:33,394 --> 03:15:36,731 HEALTHY FOR PEOPLE AND ALSO 4053 03:15:36,731 --> 03:15:38,633 CAUSE LESS OF AN IMPACT ON THE 4054 03:15:38,633 --> 03:15:40,034 ENVIRONMENT TO PRODUCE. 4055 03:15:40,034 --> 03:15:44,505 I'M SURE THERE ARE MORE OF THESE 4056 03:15:44,505 --> 03:15:45,873 WIN-WINS WHERE THEY WOULD ALSO 4057 03:15:45,873 --> 03:15:48,543 CONTRIBUTE TO A DIET THAT WOULD 4058 03:15:48,543 --> 03:15:52,113 PREVENT MORE RESPIRATORY ILLNESS 4059 03:15:52,113 --> 03:15:53,414 OR CARDIOVASCULAR DISEASE IN 4060 03:15:53,414 --> 03:15:53,848 GENERAL. 4061 03:15:53,848 --> 03:15:58,119 AND SO NOT SO MUCH A RESEARCH 4062 03:15:58,119 --> 03:16:01,422 QUESTION PER SAY BUT ALIGNING 4063 03:16:01,422 --> 03:16:03,424 THESE AGENDAS AND HAVING PEOPLE 4064 03:16:03,424 --> 03:16:05,426 IN DIFFERENT RESEARCH FIELDS 4065 03:16:05,426 --> 03:16:07,395 TALK TO EACH OTHER. 4066 03:16:07,395 --> 03:16:09,530 AND I MIGHT BE BIASED BECAUSE 4067 03:16:09,530 --> 03:16:12,066 THIS IS THE AREA THAT I WORK IN. 4068 03:16:12,066 --> 03:16:13,801 BUT CLIMATE CHANGE IS GOING TO 4069 03:16:13,801 --> 03:16:17,071 BE SO IMPACTFUL IN EVERY HEALTH 4070 03:16:17,071 --> 03:16:19,607 DOMAIN SO HAVING THAT CLIMATE 4071 03:16:19,607 --> 03:16:21,642 ANGLE AS PART OF THE DISCUSSION 4072 03:16:21,642 --> 03:16:24,312 EVERYWHERE WOULD REALLY HELP. 4073 03:16:24,312 --> 03:16:25,513 >> THANK YOU. 4074 03:16:25,513 --> 03:16:27,248 THAT IS REALLY HELPFUL. 4075 03:16:27,248 --> 03:16:31,485 WE HAVE A QUESTION IN THE CHAT 4076 03:16:31,485 --> 03:16:34,155 AND WE HAVE ONLY THREE MINUTES 4077 03:16:34,155 --> 03:16:35,990 BEFORE THE NEXT SESSION. 4078 03:16:35,990 --> 03:16:39,060 WHICH MODELS DO YOU THINK ARE 4079 03:16:39,060 --> 03:16:42,063 BEST PLACED TO PREDICT THE 4080 03:16:42,063 --> 03:16:44,532 PREVALENCE OF UNDER WEIGHT 4081 03:16:44,532 --> 03:16:51,239 INDIVIDUALS WORLDWIDE? 4082 03:16:51,239 --> 03:16:55,343 >> SO FROM -- THERE ARE SEVERAL 4083 03:16:55,343 --> 03:16:56,077 MODELS. 4084 03:16:56,077 --> 03:16:58,546 FROM A CLINICAL MODEL AND HEALTH 4085 03:16:58,546 --> 03:17:01,015 CARE SERVICES MODEL WHAT WE'VE 4086 03:17:01,015 --> 03:17:06,621 DONE IN MANY COUNTRIES IS NOT 4087 03:17:06,621 --> 03:17:09,190 DEPEND ON PHYSICIANS TO PROVIDE 4088 03:17:09,190 --> 03:17:11,292 CARE BUT TO PROVIDE TO CREATE, 4089 03:17:11,292 --> 03:17:13,427 WE HAVE A SERIES OF WHAT YOU 4090 03:17:13,427 --> 03:17:15,096 CALL COMMUNITY HEALTH CARE 4091 03:17:15,096 --> 03:17:19,267 WORKERS WHO WOULD THEN AND ARE 4092 03:17:19,267 --> 03:17:20,268 DIRECTLY CONNECTED. 4093 03:17:20,268 --> 03:17:22,937 IF YOU CONNECT A COMMUNITY 4094 03:17:22,937 --> 03:17:26,774 HEALTH WORKER WITH A PREGNANT 4095 03:17:26,774 --> 03:17:28,309 WOMAN WE HAVE INCREASED 4096 03:17:28,309 --> 03:17:30,778 CONNECTION BUT THAT MODEL HAS 4097 03:17:30,778 --> 03:17:34,615 SHOWN THAT WE HAVE TWO-THIRDS 4098 03:17:34,615 --> 03:17:36,484 FEWER ADVERSE BIRTH OUTCOMES. 4099 03:17:36,484 --> 03:17:38,886 SO PROMISING. 4100 03:17:38,886 --> 03:17:40,087 VERY LOW COST. 4101 03:17:40,087 --> 03:17:42,123 THAT IS ONE MODEL. 4102 03:17:42,123 --> 03:17:46,327 THE SECOND IS THAT WE INTEGRATE 4103 03:17:46,327 --> 03:17:49,797 IN PRENATAL SCREENING. 4104 03:17:49,797 --> 03:17:52,667 ALSO QUESTIONS ABOUT EXPOSURES. 4105 03:17:52,667 --> 03:17:53,868 ENVIRONMENTAL EXPOSURES. 4106 03:17:53,868 --> 03:17:56,070 AND THIRDLY AND THIS AS WHAT I'M 4107 03:17:56,070 --> 03:17:56,737 DOING NOW. 4108 03:17:56,737 --> 03:17:58,639 WE HAVE BEGIN TO TEACH 4109 03:17:58,639 --> 03:18:00,541 PHYSICIANS HOW TO TAKE A CLIMATE 4110 03:18:00,541 --> 03:18:01,742 AND HEALTH HISTORY. 4111 03:18:01,742 --> 03:18:04,645 SO THAT WE CAN INTERVENE AS 4112 03:18:04,645 --> 03:18:05,646 EARLY AS POSSIBLE. 4113 03:18:05,646 --> 03:18:07,782 THREE MODELS. 4114 03:18:07,782 --> 03:18:08,549 >> THANK YOU. 4115 03:18:08,549 --> 03:18:13,421 THAT IS EXTREMELY INSIGHTFUL AND 4116 03:18:13,421 --> 03:18:15,856 THANK YOU AGAIN FOR YOUR TIME IN 4117 03:18:15,856 --> 03:18:16,824 THIS SESSION. 4118 03:18:16,824 --> 03:18:19,126 I THINK WE'RE JUST ON TIME NOW. 4119 03:18:19,126 --> 03:18:25,700 I'M GOING TO HAND THE FLOOR %VR 4120 03:18:25,700 --> 03:18:30,938 TO-- MY COLLEAGUE FOR SESSION 4121 03:18:30,938 --> 03:18:31,872 THREE. 4122 03:18:31,872 --> 03:18:34,709 >> NOW WE'LL PROCEED TO NEXT 4123 03:18:34,709 --> 03:18:37,044 SESSION WHICH WILL FOCUS ON 4124 03:18:37,044 --> 03:18:40,114 MECHANISMS AND NUTRITION AND 4125 03:18:40,114 --> 03:18:43,017 DIETARY IMPACT RESPIRATORY 4126 03:18:43,017 --> 03:18:46,020 HEALTH AND DISEASES AND IT'S MY 4127 03:18:46,020 --> 03:18:54,562 GREAT PLEASURE TO INTRODUCE 4128 03:18:54,562 --> 03:18:56,130 DR. MATTHEW POYNTER. 4129 03:18:56,130 --> 03:18:58,099 HE IS A PROFESSOR OF MEDICINE AT 4130 03:18:58,099 --> 03:18:59,867 THE UNIVERSITY OF VERMONT. 4131 03:18:59,867 --> 03:19:03,170 HIS RESEARCH USES PRECLINICAL 4132 03:19:03,170 --> 03:19:06,941 CELL CULTURE AND ANIMAL MODELING 4133 03:19:06,941 --> 03:19:08,743 EQUIPPED WITH THE TRANSLATIONAL 4134 03:19:08,743 --> 03:19:10,845 AND CLINICAL APPROACHES TO 4135 03:19:10,845 --> 03:19:13,614 EXAMINE THE IMPACT OF THE 4136 03:19:13,614 --> 03:19:16,684 IMMUNE, ENDOCRINE AND NUTRITION 4137 03:19:16,684 --> 03:19:23,290 AND LIFESTYLE FACTORS ON ASTHMA, 4138 03:19:23,290 --> 03:19:28,229 AND DIABETES. 4139 03:19:28,229 --> 03:19:32,133 AND I TURN IT OVER TO YOU 4140 03:19:32,133 --> 03:19:32,600 DR. POYNTER. 4141 03:19:32,600 --> 03:19:35,369 >> THANK YOU FOR THE 4142 03:19:35,369 --> 03:19:36,404 INTRODUCTION AND THANK YOU TO 4143 03:19:36,404 --> 03:19:38,839 THE AUDIENCE MEMBERS AND 4144 03:19:38,839 --> 03:19:42,076 PARTICIPANTS FOR STILL BEING ON 4145 03:19:42,076 --> 03:19:47,314 THIS SESSION. 4146 03:19:47,314 --> 03:19:49,049 I APPRECIATE THAT THE 4147 03:19:49,049 --> 03:19:50,418 CONFERENCE ORGANIZERS HAVE 4148 03:19:50,418 --> 03:19:56,690 PRESENTED A PROGRAM THAT IS 4149 03:19:56,690 --> 03:20:05,132 MULTI-LEVEL IN APPROACH. 4150 03:20:05,132 --> 03:20:07,902 OUR OBJECTIVE IS TO EXPLORE 4151 03:20:07,902 --> 03:20:09,703 MECHANISMS UNDERLING NUTRITIONAL 4152 03:20:09,703 --> 03:20:12,373 AND DIETARY IMPACTS BOTH ON 4153 03:20:12,373 --> 03:20:14,141 NORMAL LUNG FUNCTION, LUNG 4154 03:20:14,141 --> 03:20:15,910 FUNCTION DECLINE AND IN LUNG 4155 03:20:15,910 --> 03:20:16,477 DISEASE. 4156 03:20:16,477 --> 03:20:20,548 WE INTEND TO EXAM UP NUTRITIONAL 4157 03:20:20,548 --> 03:20:23,884 METABOLIC PROGRAMMING, 4158 03:20:23,884 --> 03:20:29,056 INFLAMMATION, OXIDATIVE STRESS, 4159 03:20:29,056 --> 03:20:33,093 GUT MICROBIOME. 4160 03:20:33,093 --> 03:20:38,833 I WILL BE PROVIDING THE FIRST OF 4161 03:20:38,833 --> 03:20:44,004 THESE. 4162 03:20:44,004 --> 03:20:50,177 MY TALK IS ENTITLED METABOLIC 4163 03:20:50,177 --> 03:20:51,178 PROGRAMMING. 4164 03:20:51,178 --> 03:20:54,748 AND I HAVE NO CONFLICTS TO 4165 03:20:54,748 --> 03:20:56,517 DECLARE. 4166 03:20:56,517 --> 03:20:59,587 MY TALK ALSO TAKES A MULTI-SCALE 4167 03:20:59,587 --> 03:20:59,854 APPROACH. 4168 03:20:59,854 --> 03:21:01,722 WE'VE HEARD ABOUT SOCIETAL AND 4169 03:21:01,722 --> 03:21:03,591 GLOBAL IMPACTS. 4170 03:21:03,591 --> 03:21:06,894 WE'RE GOING TO MOVE INTO ORGAN 4171 03:21:06,894 --> 03:21:09,396 AND CELL. 4172 03:21:09,396 --> 03:21:11,866 AND THE CHOICE IS DELIVERED -- 4173 03:21:11,866 --> 03:21:13,601 THERE IS POWER IN CONTROLLING 4174 03:21:13,601 --> 03:21:14,201 ENERGY. 4175 03:21:14,201 --> 03:21:16,170 THE ILLUSTRATION DEPICTS THAT 4176 03:21:16,170 --> 03:21:18,806 THE DROPS OF WATER ARE REALLY 4177 03:21:18,806 --> 03:21:22,877 WHAT COMPRISE THE WAVE. 4178 03:21:22,877 --> 03:21:23,944 ENERGETICS AT EVERY SCALE. 4179 03:21:23,944 --> 03:21:26,680 OUR BODIES AND CELLS RELY ON 4180 03:21:26,680 --> 03:21:29,450 NUTRIENTS NOT ONLY AS FUEL BUT 4181 03:21:29,450 --> 03:21:32,152 THEY ALSO SENSE THESE NUTRIENTS 4182 03:21:32,152 --> 03:21:34,922 AND THEIR METABOLITES TO AFFECT 4183 03:21:34,922 --> 03:21:36,023 DIFFERENT ACTIVITIES. 4184 03:21:36,023 --> 03:21:39,326 WE CONSIDER THAT CARBOHYDRATES 4185 03:21:39,326 --> 03:21:42,630 ARE THE MAJOR CELLULAR FUEL. 4186 03:21:42,630 --> 03:21:45,299 AND WE USE THAT BECAUSE IT 4187 03:21:45,299 --> 03:21:48,068 GENERATES ATP -- EASILY. 4188 03:21:48,068 --> 03:21:51,038 THE BRAIN AS AN EXAMPLE RELIES 4189 03:21:51,038 --> 03:21:57,077 ON GLUCOSE FOR ITS ENERGY. 4190 03:21:57,077 --> 03:21:59,713 ON THE OTHER HAND THERE ARE MANY 4191 03:21:59,713 --> 03:22:03,050 TUMORS THAT ALSO CONSUME SUGAR 4192 03:22:03,050 --> 03:22:06,053 SUCH AS GLUCOSE AND THIS FUELS 4193 03:22:06,053 --> 03:22:07,221 THEIR GROWTH. 4194 03:22:07,221 --> 03:22:10,357 WE NOW KNOW THAT PROCESSED 4195 03:22:10,357 --> 03:22:13,561 SIMPLE CARBOHYDRATE LADEN AND 4196 03:22:13,561 --> 03:22:15,362 EASILY AVAILABLE FOODS HAVE 4197 03:22:15,362 --> 03:22:17,464 FUELED THE OBESITY ESPECIALLY 4198 03:22:17,464 --> 03:22:19,667 DEMOCRATIC AND THAT HAS 4199 03:22:19,667 --> 03:22:20,935 NEGATIVELY AFFECTED RESPIRATORY 4200 03:22:20,935 --> 03:22:25,372 HEALTH. 4201 03:22:25,372 --> 03:22:27,708 NUTRITION GUIDELINES HAVE 4202 03:22:27,708 --> 03:22:30,311 FOCUSED ON HOW MUCH DO WE EAT? 4203 03:22:30,311 --> 03:22:31,912 CONSIDERING TOTAL CALORIES. 4204 03:22:31,912 --> 03:22:34,315 WHAT DO WE EAT? 4205 03:22:34,315 --> 03:22:37,217 FATS, CARBOHYDRATES? 4206 03:22:37,217 --> 03:22:40,821 WESTERN OR MEDITERRANEAN DIET. 4207 03:22:40,821 --> 03:22:44,658 UNREFINED FRESH FOODS. 4208 03:22:44,658 --> 03:22:47,361 HOW MUCH POLYUNSATURATED FATTY 4209 03:22:47,361 --> 03:22:49,530 ACIDS AND HOW MUCH FIBER CONTENT 4210 03:22:49,530 --> 03:22:53,233 ARE PART OF OUR DIETS. 4211 03:22:53,233 --> 03:23:03,510 WHEN DO WE EAT? 4212 03:23:07,748 --> 03:23:10,351 ALSO THE IMPORTANCE OF LANGUAGE. 4213 03:23:10,351 --> 03:23:13,320 THINKING ABOUT THE TERM DIET 4214 03:23:13,320 --> 03:23:16,657 MORE AS A NOUN RATHER THAN A 4215 03:23:16,657 --> 03:23:18,058 VERB. 4216 03:23:18,058 --> 03:23:20,160 I'M TELLING PEOPLE TO THINK 4217 03:23:20,160 --> 03:23:21,528 ABOUT THE DIET THAT THEY 4218 03:23:21,528 --> 03:23:24,164 CONSUME. 4219 03:23:24,164 --> 03:23:25,866 MY PRESENTATION COMES FROM MY 4220 03:23:25,866 --> 03:23:29,169 OWN PERSPECTIVE IN WHICH OUR LAB 4221 03:23:29,169 --> 03:23:29,837 STUDIES OBESITY. 4222 03:23:29,837 --> 03:23:33,040 A RISK FACTOR CONTRIBUTING TO 4223 03:23:33,040 --> 03:23:33,674 ASTHMA. 4224 03:23:33,674 --> 03:23:41,548 DEFINED AS HAVING ACCESS -- 4225 03:23:41,548 --> 03:23:46,253 LACTATE PRODUCTION, CHRONIC 4226 03:23:46,253 --> 03:23:47,755 SYSTEMATIC LOW GRADE 4227 03:23:47,755 --> 03:23:50,824 INFLAMMATION. 4228 03:23:50,824 --> 03:23:52,793 THEY HAVE WORSE SYMPTOMS IN 4229 03:23:52,793 --> 03:23:55,229 ASTHMA CONTROL DESPITE BEING ON 4230 03:23:55,229 --> 03:23:56,430 INCREASED STANDARD TREATMENT. 4231 03:23:56,430 --> 03:23:59,066 THESE ARE SEVERE ASTHMATICS. 4232 03:23:59,066 --> 03:24:01,268 WE ALSO KNOW THAT STUDIES HAVE 4233 03:24:01,268 --> 03:24:05,239 SHOWN THAT 5% OR MORE WEIGHT 4234 03:24:05,239 --> 03:24:07,141 LOSSES LISETTES ASTHMA 4235 03:24:07,141 --> 03:24:08,575 PROTECTION. 4236 03:24:08,575 --> 03:24:11,278 THERE ARE IMPROVEMENTS. 4237 03:24:11,278 --> 03:24:14,415 AS A RESULT OF LOSING GREATER 4238 03:24:14,415 --> 03:24:16,583 THAN 5% OF THE BODY WEIGHT. 4239 03:24:16,583 --> 03:24:20,688 THOSE WHO DO ABOUT 50% OF THEM 4240 03:24:20,688 --> 03:24:22,389 DISCONTINUE MEDICATIONS 4241 03:24:22,389 --> 03:24:22,656 ENTIRELY. 4242 03:24:22,656 --> 03:24:25,726 THERE IS A LOT OF WAYS TO ELICIT 4243 03:24:25,726 --> 03:24:28,362 WEIGHT LOSS TO IMPROVE ASTHMA. 4244 03:24:28,362 --> 03:24:33,100 WE'VE USED BARIATRIC SURGERY TO 4245 03:24:33,100 --> 03:24:37,171 ELICIT THIS TYPE OF BENEFIT AND 4246 03:24:37,171 --> 03:24:40,374 I CONSIDER IT TO BE A METABOLIC 4247 03:24:40,374 --> 03:24:41,642 CRISIS. 4248 03:24:41,642 --> 03:24:43,477 THE REASON FOR THIS IS BECAUSE 4249 03:24:43,477 --> 03:24:46,013 AS A CONSEQUENCE OF BARIATRIC 4250 03:24:46,013 --> 03:24:48,115 SURGERY THE BODY DOES NOT 4251 03:24:48,115 --> 03:24:50,584 SYNTHESIZE THE SAME AMOUNT OF 4252 03:24:50,584 --> 03:24:54,188 HUNGER PRODUCING HORMONES. 4253 03:24:54,188 --> 03:24:59,626 IT PROMOTES FULLNESS AND ABSORBS 4254 03:24:59,626 --> 03:25:05,099 IS COMPROMISED. 4255 03:25:05,099 --> 03:25:09,503 AND SO METABOLISM CHANGES DURING 4256 03:25:09,503 --> 03:25:12,873 ENERGETIC CRISIS. 4257 03:25:12,873 --> 03:25:15,175 REPROGRAMMING IS ELICITED. 4258 03:25:15,175 --> 03:25:23,751 THIS IT SHOWS THAT DURING FASTIG 4259 03:25:23,751 --> 03:25:27,254 WHICH OCCURS IN THREE PHASES 4260 03:25:27,254 --> 03:25:29,490 OVER TIME YOU CAN SEE THAT THE 4261 03:25:29,490 --> 03:25:32,025 RELATIVE LEVELS OF GLUCOSE 4262 03:25:32,025 --> 03:25:34,762 DECLINE. 4263 03:25:34,762 --> 03:25:37,531 PROTEIN AND U REMARKS ERA GOES 4264 03:25:37,531 --> 03:25:39,800 DOWN. 4265 03:25:39,800 --> 03:25:48,442 METABOLIC RATE INCREASES. 4266 03:25:48,442 --> 03:25:51,545 THERE IS A MOLECULE ILLUSTRATED 4267 03:25:51,545 --> 03:25:54,214 IN RED THAT ELEVATES QUITE 4268 03:25:54,214 --> 03:25:56,617 QUICKLY AND QUITE SUBSTANTIALLY. 4269 03:25:56,617 --> 03:25:59,953 IN FACT DURING STARVATION OR 4270 03:25:59,953 --> 03:26:02,956 FASTING THIS IS THE MOST HIGHLY 4271 03:26:02,956 --> 03:26:04,625 INDUCED METABOLITE PRESENT 4272 03:26:04,625 --> 03:26:06,026 WITHIN OUR CIRCULATION. 4273 03:26:06,026 --> 03:26:08,762 ON THE LEFT IS AN ILLUSTRATION 4274 03:26:08,762 --> 03:26:10,330 OF WHAT HAPPENS DURING FASTING 4275 03:26:10,330 --> 03:26:12,566 BUT ON THE RIGHT THIS IS A BOOK 4276 03:26:12,566 --> 03:26:15,002 CALLED THE LORE OF RUNNING WHICH 4277 03:26:15,002 --> 03:26:17,437 TALKS ABOUT THE SAME BIOCHEMICAL 4278 03:26:17,437 --> 03:26:21,275 PROCESSES OCCURRING IN ULTRA 4279 03:26:21,275 --> 03:26:24,278 ATHLETES, ENDURANCE RUNNERS AND 4280 03:26:24,278 --> 03:26:25,846 PEOPLE PRACTICING AND DOING 4281 03:26:25,846 --> 03:26:26,914 MARATHONS. 4282 03:26:26,914 --> 03:26:28,248 BUT THEY DON'T ONLY HAPPEN 4283 03:26:28,248 --> 03:26:30,984 DURING FASTING AND EXERCISE. 4284 03:26:30,984 --> 03:26:33,754 THEY ALSO HAPPEN DURING FEVER 4285 03:26:33,754 --> 03:26:44,264 AND INFLAMMATION AND DISEASES. 4286 03:26:49,036 --> 03:26:52,506 THIS COMES ABOUT DURING WHAT IS 4287 03:26:52,506 --> 03:26:53,774 CALLED KETOSIS. 4288 03:26:53,774 --> 03:26:56,977 7 WHAT I CONSIDER TO BE A 4289 03:26:56,977 --> 03:27:04,017 THERAPEUTIC KETOSIS. SO 4290 03:27:04,017 --> 03:27:06,553 THERAPEUTIC IS A FORM OF 4291 03:27:06,553 --> 03:27:09,223 METABOLIC REPROGRAMMING THAT CAN 4292 03:27:09,223 --> 03:27:10,490 BENEFIT RESPIRATORY HEALTH. 4293 03:27:10,490 --> 03:27:12,826 IT CAN COME ABOUT DURING FASTING 4294 03:27:12,826 --> 03:27:16,496 OR DURING CRITICAL ILLNESS AS A 4295 03:27:16,496 --> 03:27:19,233 RESULT -- FATTY ACIDS THAT 4296 03:27:19,233 --> 03:27:22,002 TRAVEL TO THE LIVER AND ARE 4297 03:27:22,002 --> 03:27:24,171 CONVERTED INTO THE KETONE 4298 03:27:24,171 --> 03:27:25,939 BODIES. 4299 03:27:25,939 --> 03:27:29,042 THE KETONE BODIES CAN THEN CROSS 4300 03:27:29,042 --> 03:27:30,477 THE BLOOD BRAIN BARRIER AND 4301 03:27:30,477 --> 03:27:32,913 SERVE IS A AN ALTERNATIVE SOURCE 4302 03:27:32,913 --> 03:27:36,783 OF FUEL BUT ALSO FUEL THE HEART, 4303 03:27:36,783 --> 03:27:39,553 SKELETAL MUSCLES AND HAVE AN 4304 03:27:39,553 --> 03:27:45,692 IMPACT WITHIN THE LUNG ITSELF. 4305 03:27:45,692 --> 03:27:50,964 AND IN THE UPPER RIGHT IS A 4306 03:27:50,964 --> 03:27:54,868 DIAGRAM -- THIS IS CONSTITUTING 4307 03:27:54,868 --> 03:27:56,069 APPROXIMATELY 80% OF THE 4308 03:27:56,069 --> 03:27:59,139 CIRCULATING KETONES. 4309 03:27:59,139 --> 03:28:02,943 WE HAVE SHOWN THAT IN 4310 03:28:02,943 --> 03:28:06,446 INDIVIDUALS UNDERGOING BARIATRIC 4311 03:28:06,446 --> 03:28:09,116 SURGERY WE CAN SEE THAT BMI 4312 03:28:09,116 --> 03:28:12,219 WHETHER INDIVIDUALS ARE OBESE, 4313 03:28:12,219 --> 03:28:15,956 HAVE OBESE ASTHMA THEIR BMI 4314 03:28:15,956 --> 03:28:18,392 DECREASES AND YOU SEE A 4315 03:28:18,392 --> 03:28:20,861 SUBSTANTIAL DECREASE IN THEIR 4316 03:28:20,861 --> 03:28:22,095 BMI. 4317 03:28:22,095 --> 03:28:23,530 THIS CONTINUES TO IMPROVE OVER 4318 03:28:23,530 --> 03:28:25,966 THE COURSE OF SIX MONTHS TO A 4319 03:28:25,966 --> 03:28:26,166 YEAR. 4320 03:28:26,166 --> 03:28:28,402 A LONG THIS TIME COURSE 4321 03:28:28,402 --> 03:28:29,870 ESPECIALLY VERY EARLY AND WHEN 4322 03:28:29,870 --> 03:28:31,738 WE'VE LOOKED AT TWO WEEKS YOU 4323 03:28:31,738 --> 03:28:34,107 CAN SEE THERE IS A TRANSIENT 4324 03:28:34,107 --> 03:28:35,676 INCREASE IN THE CIRCULATION OF 4325 03:28:35,676 --> 03:28:39,212 THESE INDIVIDUALS. 4326 03:28:39,212 --> 03:28:42,215 NOW OTHER PUBLICATIONS HAVE 4327 03:28:42,215 --> 03:28:44,685 SHOWN THAT THERE IS A TRANSIENT 4328 03:28:44,685 --> 03:28:48,889 AND SUBSTANTIAL INCREASE IN THE 4329 03:28:48,889 --> 03:28:51,925 LEVELS THAT FASTING ELEVATES 4330 03:28:51,925 --> 03:28:55,362 THIS AND EVEN TREATMENT WITH A 4331 03:28:55,362 --> 03:28:57,798 RECEPTOR AGONIST -- WHICH CAUSES 4332 03:28:57,798 --> 03:29:01,234 WEIGHT LOSS AND IMPROVEMENTS IN 4333 03:29:01,234 --> 03:29:11,745 ASTHMA ALSO HAS THE INCREASE. 4334 03:29:13,580 --> 03:29:13,847 HYDROXYCHLOROQUINE 4335 03:29:33,500 --> 03:29:35,435 INTEREST MITT EVENT FASTING CAN 4336 03:29:35,435 --> 03:29:41,108 BE A * MEANS TO -- 4337 03:29:44,177 --> 03:29:49,383 AND ONE CAN PROVIDE DIETARY 4338 03:29:49,383 --> 03:29:54,054 SUPPLEMENTS -- OR A KETONE 4339 03:29:54,054 --> 03:29:59,659 ESTHER THAT CONTAINS -- -- TO 4340 03:29:59,659 --> 03:30:02,996 AUGMENT CIRCULATING KETONE BODY 4341 03:30:02,996 --> 03:30:04,398 CONCENTRATIONS. 4342 03:30:04,398 --> 03:30:08,168 IN OUR PRECLINICAL STUDIES WE'VE 4343 03:30:08,168 --> 03:30:11,271 SHOWN THAT AS ILLUSTRATED IN 4344 03:30:11,271 --> 03:30:14,474 PANEL "A" A NUMBER OF OBESE OR 4345 03:30:14,474 --> 03:30:18,245 ALLERGIC ASTHMA MOUSE MODELS WE 4346 03:30:18,245 --> 03:30:24,384 CAN ELEVATE HYDROXYBUTYRATE AND 4347 03:30:24,384 --> 03:30:29,022 AS A CONSEQUENCE REDUCE -- 4348 03:30:29,022 --> 03:30:31,124 RESPONSIVENESS. 4349 03:30:31,124 --> 03:30:35,762 AND SO WHAT WE SEE IS THAT BY 4350 03:30:35,762 --> 03:30:40,934 EVOKING THERAPEUTIC AND RAISING 4351 03:30:40,934 --> 03:30:47,307 HYDROXYBUTYRATE LEVELS REDUCES 4352 03:30:47,307 --> 03:30:48,975 RESPONSIVENESS AND AIRWAY 4353 03:30:48,975 --> 03:30:49,743 INFLAMMATION. 4354 03:30:49,743 --> 03:30:52,112 OUR GROUP IS NOT THE ONLY ONE TO 4355 03:30:52,112 --> 03:30:54,347 HAVE PUBLISHED THIS. 4356 03:30:54,347 --> 03:30:58,418 THIS CAN ALSO DECREASE AIRWAY 4357 03:30:58,418 --> 03:30:59,419 INFLAMMATION THROUGH THE 4358 03:30:59,419 --> 03:31:06,426 REGULATION OF MASS CELLS. 4359 03:31:06,426 --> 03:31:09,629 SO KETONE BODIES -- I BELIEVE 4360 03:31:09,629 --> 03:31:11,965 HAVE AN IMPACT ON RESPIRATORY 4361 03:31:11,965 --> 03:31:13,233 HEALTH. 4362 03:31:13,233 --> 03:31:15,402 RECENT REVIEW SUGGESTED A NUMBER 4363 03:31:15,402 --> 03:31:18,271 OF OTHER ORGAN SYSTEMS AND 4364 03:31:18,271 --> 03:31:20,607 CELLULAR MECHANISMS WHEREBY 4365 03:31:20,607 --> 03:31:24,077 KETONE BODIES CAN ELICIT 4366 03:31:24,077 --> 03:31:26,079 BENEFIT. 4367 03:31:26,079 --> 03:31:28,515 WE KNOW THAT KETONE BODIES WORK 4368 03:31:28,515 --> 03:31:30,217 THROUGH A NUMBER OF DIFFERENT 4369 03:31:30,217 --> 03:31:30,717 PATHWAYS. 4370 03:31:30,717 --> 03:31:35,155 THEY CAN DECREASE PRO 4371 03:31:35,155 --> 03:31:38,024 INFLAMMATORY GENE -- THERAPY. 4372 03:31:38,024 --> 03:31:42,395 THEY CAN CAUSE HIS STONE -- 4373 03:31:42,395 --> 03:31:44,464 MODIFICATION THROUGH A PROCESS. 4374 03:31:44,464 --> 03:31:48,902 THEY CAN ACTIVATE CELL SURFACE 4375 03:31:48,902 --> 03:31:49,436 RECEPTORS. 4376 03:31:49,436 --> 03:31:55,942 AND THEY CAN ALSO CHANGE -- -- 4377 03:31:55,942 --> 03:31:56,576 ACTIVITY. 4378 03:31:56,576 --> 03:31:58,011 THEY'VE GOT A NUMBER OF 4379 03:31:58,011 --> 03:31:59,779 DIFFERENT MECHANISMS AND 4380 03:31:59,779 --> 03:32:02,215 PATHWAYS WHERE THEY MAY INTERACT 4381 03:32:02,215 --> 03:32:07,554 WITH THE RESPIRATORY SYSTEM. 4382 03:32:07,554 --> 03:32:10,557 >> YOU HAVE -- MINUTES REMAINING 4383 03:32:10,557 --> 03:32:12,459 >> WE'VE DEMONSTRATED THAT LUNG 4384 03:32:12,459 --> 03:32:14,928 FUNCTION IS BENEFICIALLY 4385 03:32:14,928 --> 03:32:20,901 AFFECTED THROUGH THIS DES TO US. 4386 03:32:20,901 --> 03:32:22,435 -- KETOSIS. 4387 03:32:22,435 --> 03:32:24,037 7 *. 4388 03:32:24,037 --> 03:32:27,174 AND EVEN LOOKING AT THE SUB 4389 03:32:27,174 --> 03:32:30,844 CELLULAR LEVEL WE CAN SEE THAT 4390 03:32:30,844 --> 03:32:33,580 MITOCHONDRIAL ARE AFFECTED. 4391 03:32:33,580 --> 03:32:37,117 THIS IS DONE IN AN INVITRO 4392 03:32:37,117 --> 03:32:40,787 CULTURE SETTING USING 4393 03:32:40,787 --> 03:32:44,824 TRANSFORMED CELLS INVITRO. 4394 03:32:44,824 --> 03:32:47,360 THIS IS HAVING AN IMPACT. 4395 03:32:47,360 --> 03:32:49,196 AND I WANT TO LEAVE YOU WITH A 4396 03:32:49,196 --> 03:32:54,267 PIECE OF DATA -- SHOWING THAT AN 4397 03:32:54,267 --> 03:33:00,006 INDIVIDUAL WHO CONSUMES -- THIS 4398 03:33:00,006 --> 03:33:03,009 KETONE ESTHER YOU CAN SEE THAT 4399 03:33:03,009 --> 03:33:11,251 IN GREEN THE LEVELS -- AND 4400 03:33:11,251 --> 03:33:14,788 AIRWAY RESISTANCE IS RELIEVED 4401 03:33:14,788 --> 03:33:24,965 WHICH SHOWS AN ACUTE EFFECT. 4402 03:33:24,965 --> 03:33:27,734 AND I'M GOING TO JUMP TO THE ONE 4403 03:33:27,734 --> 03:33:28,935 AFTER. 4404 03:33:28,935 --> 03:33:31,171 SO THIS MIGHT SEEM LIKE THIS IS 4405 03:33:31,171 --> 03:33:32,906 A NOVEL MECHANISM. 4406 03:33:32,906 --> 03:33:35,742 BUT IN FACT THIS IS NEARLY 100 4407 03:33:35,742 --> 03:33:36,443 YEARS OLD. 4408 03:33:36,443 --> 03:33:39,646 THERE ARE TWO PAPES ILLUSTRATED 4409 03:33:39,646 --> 03:33:42,983 THAT A KETOGENIC DIET WAS 4410 03:33:42,983 --> 03:33:44,417 ATTEMPTED IN CHILDREN TO 4411 03:33:44,417 --> 03:33:47,187 CHEETAHS MAY AND IT HAD MIXED 4412 03:33:47,187 --> 03:33:47,621 RESULTS. 4413 03:33:47,621 --> 03:33:52,592 WE WERE AT A TIME WHEN WE DIDN'T 4414 03:33:52,592 --> 03:33:57,831 UNDERSTAND ENDO TYPING. 4415 03:33:57,831 --> 03:34:01,268 THERE IS A TYPE OF ASTHMA THAT 4416 03:34:01,268 --> 03:34:04,571 IS BEING TARGETED USING 4417 03:34:04,571 --> 03:34:08,308 NUTRITIONAL -- KETOSIS. 4418 03:34:08,308 --> 03:34:10,610 AND SOME OF THE DATA HAVE BEEN 4419 03:34:10,610 --> 03:34:13,546 PRESENTED IN ABSTRACT FORM AT 4420 03:34:13,546 --> 03:34:16,216 ATS IN 2013 AND THEY LOOK VERY 4421 03:34:16,216 --> 03:34:18,151 PROMISING. 4422 03:34:18,151 --> 03:34:21,621 SO THERE IS A NUMBER OF RESEARCH 4423 03:34:21,621 --> 03:34:23,490 GAPS FOR RESPIRATORY HEALTH. 4424 03:34:23,490 --> 03:34:26,660 I'D LIKE TO KNOW WHETHER KETONE 4425 03:34:26,660 --> 03:34:29,062 BODIES ARE NECESSARY. 4426 03:34:29,062 --> 03:34:31,264 WHETHER ELEVATED LEVELS CAN BE 4427 03:34:31,264 --> 03:34:32,632 SUSTAINED AND CONTINUED TO 4428 03:34:32,632 --> 03:34:34,434 PROVIDE BENEFIT AND CAUSE NO 4429 03:34:34,434 --> 03:34:34,634 HARM. 4430 03:34:34,634 --> 03:34:37,404 WE NEED TO UNDERSTAND IN WHICH 4431 03:34:37,404 --> 03:34:41,074 PARENTS THIS IS TO BE AVOIDED 4432 03:34:41,074 --> 03:34:43,276 SUCH AS DIBS OR INDIVIDUALS THAT 4433 03:34:43,276 --> 03:34:49,516 ARE LACTATING. 4434 03:34:49,516 --> 03:34:50,050 *. 4435 03:34:50,050 --> 03:34:51,518 I'D LIKE TO UNDERSTAND THE 4436 03:34:51,518 --> 03:34:53,286 COURSE OF KETONE BODIES. 4437 03:34:53,286 --> 03:34:55,622 THEIR TARGETS AND MECHANISMS OF 4438 03:34:55,622 --> 03:34:57,057 ACTION AND I THINK REALLY 4439 03:34:57,057 --> 03:34:58,058 IMPORTANT TO CONSIDER THE 4440 03:34:58,058 --> 03:34:59,959 IMPORTANCE OF POWER 4441 03:34:59,959 --> 03:35:01,061 TRANSFORMATION AND WE'RE 4442 03:35:01,061 --> 03:35:04,097 BEGINNING TO RELY ON MULTIPLE 4443 03:35:04,097 --> 03:35:07,701 SOURCES OF ENERGY AND I THINK 4444 03:35:07,701 --> 03:35:10,470 METABOLIC FLEXIBILITY -- ON THE 4445 03:35:10,470 --> 03:35:17,577 CELLULAR LEVEL MAY BE IMPORTANT. 4446 03:35:17,577 --> 03:35:18,712 SO THE OPPORTUNITIES AND KEY 4447 03:35:18,712 --> 03:35:19,813 RESEARCH QUESTIONS. 4448 03:35:19,813 --> 03:35:24,117 WE WONDER WHETHER THERAPEUTIC 4449 03:35:24,117 --> 03:35:26,453 KETOSIS COULD BE APPLIED TO A 4450 03:35:26,453 --> 03:35:28,154 MULTIPLE OF RESPIRATORY 4451 03:35:28,154 --> 03:35:28,755 CONDITIONS. 4452 03:35:28,755 --> 03:35:32,258 WHAT ABOUT COPD. 4453 03:35:32,258 --> 03:35:36,062 PULMONARY HYPERTENSION. 4454 03:35:36,062 --> 03:35:36,930 ETC. 4455 03:35:36,930 --> 03:35:39,265 THERE WAS A PAPER THAT CAME OUT 4456 03:35:39,265 --> 03:35:43,636 -- REDUCES COVID-19 DEATHS. 4457 03:35:43,636 --> 03:35:45,205 WHAT ARE THE MECHANISMS 4458 03:35:45,205 --> 03:35:48,041 UNDERLYING THAT? 4459 03:35:48,041 --> 03:35:51,711 CAN WE HAVE A NUTRITIONAL 4460 03:35:51,711 --> 03:35:53,480 RECOMMENDATION OR THROUGH 4461 03:35:53,480 --> 03:35:56,916 SUPPLEMENTATION THAT CAN A 4462 03:35:56,916 --> 03:35:59,552 PROVIDE A AN ATTRACTIVE MEANS. 4463 03:35:59,552 --> 03:36:06,426 DO WE NEED IT TO BE LONG-TERM? 4464 03:36:06,426 --> 03:36:09,329 AFTER ADDITIONAL TYPES OR SCALES 4465 03:36:09,329 --> 03:36:10,997 OF METABOLIC PROGRAMMING THAT 4466 03:36:10,997 --> 03:36:14,200 ARE ALTERNATIVES. 4467 03:36:14,200 --> 03:36:18,471 AND I BRING UP THE -- FACES OF 4468 03:36:18,471 --> 03:36:20,039 THERAPEUTIC KETOSIS. 4469 03:36:20,039 --> 03:36:23,309 THERE IS NO FREE RUN. 4470 03:36:23,309 --> 03:36:25,812 POTENTIAL CAVEATS. 4471 03:36:25,812 --> 03:36:28,214 YOU CANNOT JUST EAT FAT. 4472 03:36:28,214 --> 03:36:30,550 THERE ARE SATURATED FATS THAT 4473 03:36:30,550 --> 03:36:36,055 ARE VERY BAD FOR CARDIOVASCULAR 4474 03:36:36,055 --> 03:36:40,860 HEALTH. 4475 03:36:40,860 --> 03:36:51,337 -- AND -- PART OF THE CHRONIC 4476 03:36:51,337 --> 03:36:56,543 CONDITION IS PART OF AN OVER 4477 03:36:56,543 --> 03:37:01,548 EXUBERANT INFLAMMATORY SYSTEM. 4478 03:37:01,548 --> 03:37:03,550 AND I WOULD LIKE TO THANK THE 4479 03:37:03,550 --> 03:37:04,918 OPPORTUNITY TO SPEAK TO THIS 4480 03:37:04,918 --> 03:37:15,028 WORK. 4481 03:37:20,733 --> 03:37:22,469 AND WITH THAT WE'RE GOING TO 4482 03:37:22,469 --> 03:37:26,206 MOVE ON TO OUR NEXT SPEAKER. 4483 03:37:26,206 --> 03:37:34,013 DR. KYMBERLY GOWDY AT THE OHIO 4484 03:37:34,013 --> 03:37:39,552 STATE UNIVERSITY. 4485 03:37:39,552 --> 03:37:40,653 >> THANK YOU VERY MUCH TO THE 4486 03:37:40,653 --> 03:37:43,323 ORGANIZERS FOR ALLOWING ME TO 4487 03:37:43,323 --> 03:37:45,225 SPEAK IN THIS VERY EXCITING 4488 03:37:45,225 --> 03:37:45,825 WORKSHOP. 4489 03:37:45,825 --> 03:37:47,427 I'M GOING TO TELL THE AUDIENCE 4490 03:37:47,427 --> 03:37:49,462 ABOUT ONE OF THE PROJECTS WE'VE 4491 03:37:49,462 --> 03:37:52,232 GOT IN MY LAB TO GET YOU TO 4492 03:37:52,232 --> 03:37:56,069 APPRECIATE HOW DIET MIGHT CHANGE 4493 03:37:56,069 --> 03:38:04,110 THE LIPID HOME OF THE LUNGS. 4494 03:38:04,110 --> 03:38:06,479 MY LAB IS VERY INTERESTED IN 4495 03:38:06,479 --> 03:38:08,615 UNDERSTANDING THE MECHANISMS 4496 03:38:08,615 --> 03:38:10,717 BEHIND HOW AIR POLLUTION CAN 4497 03:38:10,717 --> 03:38:12,619 CONTRIBUTE TO CHRONIC LUNG 4498 03:38:12,619 --> 03:38:13,386 DISEASES. 4499 03:38:13,386 --> 03:38:16,256 THIS WAS NICELY HIGHLIGHTED BY 4500 03:38:16,256 --> 03:38:17,257 THE CLIMATE CHANGE SESSION 4501 03:38:17,257 --> 03:38:20,894 BEFORE THIS. 4502 03:38:20,894 --> 03:38:23,329 I DO WANT YOU TO APPRECIATE THAT 4503 03:38:23,329 --> 03:38:24,998 ON THIS GRAPH WHICH IS FROM THE 4504 03:38:24,998 --> 03:38:27,100 STATE OF GLOBAL AIR IF YOU LOOK 4505 03:38:27,100 --> 03:38:33,840 AT WHAT PEOPLE ARE DYING FROM -- 4506 03:38:33,840 --> 03:38:38,144 ON THE AXIS -- THE LEFT AXIS OF 4507 03:38:38,144 --> 03:38:39,112 THE BAR GRAPH. 4508 03:38:39,112 --> 03:38:42,315 YOU CAN SEE WHAT -- ARE 4509 03:38:42,315 --> 03:38:43,650 INFLUENCING WHAT PEOPLE ARE 4510 03:38:43,650 --> 03:38:44,317 DYING FROM. 4511 03:38:44,317 --> 03:38:46,953 WHEN WE LOOK AT THOSE GREEN BARS 4512 03:38:46,953 --> 03:38:50,323 IN THE TOP 10 BASICALLY HAS A 4513 03:38:50,323 --> 03:38:52,625 LOT TO DO WITH THE AIR QUALITY 4514 03:38:52,625 --> 03:38:56,429 THAT WE'RE BREATHING IN. 4515 03:38:56,429 --> 03:38:59,933 AMBIENT PARTICULATE MATTER. 4516 03:38:59,933 --> 03:39:02,468 OZONE IS KNOWN TO INFLUENCE 4517 03:39:02,468 --> 03:39:04,137 MORTALITY RATES FROM CHRONIC 4518 03:39:04,137 --> 03:39:08,708 LUNG DISEASE. 4519 03:39:08,708 --> 03:39:10,543 AND SO HOW THIS HAPPENS. 4520 03:39:10,543 --> 03:39:13,212 I WILL SAY THAT WE STILL HAVE A 4521 03:39:13,212 --> 03:39:15,348 LOT TO LEARN BUT WE CAN SAY IN 4522 03:39:15,348 --> 03:39:18,051 PART AIR POLLUTION IS KNOWN TO 4523 03:39:18,051 --> 03:39:19,719 INDUCE PULMONARY INFLAMMATION. 4524 03:39:19,719 --> 03:39:22,255 THIS IS A SIMPLE SCHEMATIC OF 4525 03:39:22,255 --> 03:39:25,058 WHAT WE DO KNOW HAPPENS WHEN YOU 4526 03:39:25,058 --> 03:39:31,497 INHALE THESE. 4527 03:39:31,497 --> 03:39:33,967 BASICALLY THESE POLLUTANTS CAN 4528 03:39:33,967 --> 03:39:38,371 CARRY IN -- PATHOGEN ASSOCIATED 4529 03:39:38,371 --> 03:39:40,306 MOLECULAR PATTERNS OR THEY CAN 4530 03:39:40,306 --> 03:39:42,809 REACT WITH THE LUNG LINING 4531 03:39:42,809 --> 03:39:44,444 FLUID. 4532 03:39:44,444 --> 03:39:49,148 AND THESE -- THEY SET OFF AN 4533 03:39:49,148 --> 03:39:50,516 INFLAMMATORY CASCADE IN THE 4534 03:39:50,516 --> 03:39:52,118 LUNGS. 4535 03:39:52,118 --> 03:39:56,956 WHICH THEN ALLOW THEM TO SECRETE 4536 03:39:56,956 --> 03:40:01,728 CITE KINDS MAKING IT MORE RICO 4537 03:40:01,728 --> 03:40:01,928 *. 4538 03:40:01,928 --> 03:40:05,164 SO WE'VE BEEN ABLE TO SHOW THIS 4539 03:40:05,164 --> 03:40:06,966 NOT ONLY IN A LOT OF PATIENT 4540 03:40:06,966 --> 03:40:09,736 STUDIES BUT ALSO IN LABORATORY 4541 03:40:09,736 --> 03:40:12,939 STUDIES THAT AIR POLLUTION DOZEN 4542 03:40:12,939 --> 03:40:14,874 INTRODUCE AN INFLAMMATORY 4543 03:40:14,874 --> 03:40:15,842 RESPONSE. 4544 03:40:15,842 --> 03:40:18,444 AND SO WE AS WELL AS OTHERS HAVE 4545 03:40:18,444 --> 03:40:21,948 BEEN ABLE TO RECAPITULATE THIS 4546 03:40:21,948 --> 03:40:24,150 RESPONSE TO AIR POLLUTION 4547 03:40:24,150 --> 03:40:27,053 SPECIFICALLY OZONE IN RODENT 4548 03:40:27,053 --> 03:40:28,755 MODELS IN A LABORATORY SETTING. 4549 03:40:28,755 --> 03:40:31,858 THIS WAS A PAPER THAT MY GROUP 4550 03:40:31,858 --> 03:40:33,226 PUBLISHED WHERE WE WERE ABLE TO 4551 03:40:33,226 --> 03:40:39,799 SHOW THAT 24 HOURS POST AN ACUTE 4552 03:40:39,799 --> 03:40:43,670 AMBIENT INCREASE IN OZONE -- HAD 4553 03:40:43,670 --> 03:40:47,740 AN INCREASE IN MACROPHAGIAS IN 4554 03:40:47,740 --> 03:40:48,708 THE LUNG. 4555 03:40:48,708 --> 03:40:51,477 THIS WAS ALSO AUGMENTED 4556 03:40:51,477 --> 03:40:54,013 FOLLOWING EXPOSURE. 4557 03:40:54,013 --> 03:40:56,082 THIS RECAPITULATES WHAT WE SEE 4558 03:40:56,082 --> 03:41:02,889 IN HUMANS. 4559 03:41:02,889 --> 03:41:05,558 AND SO AROUND THE TIME THAT WE 4560 03:41:05,558 --> 03:41:08,294 GOT INTERESTED IN LIPID 4561 03:41:08,294 --> 03:41:10,063 METABOLISM AND INFLAMMATION AND 4562 03:41:10,063 --> 03:41:12,065 AIR POLLUTION THERE WERE SOME 4563 03:41:12,065 --> 03:41:14,534 NICE STUDIES COMING OUT LOOKING 4564 03:41:14,534 --> 03:41:17,303 AT DIET AND THE EFFECT THAT DIET 4565 03:41:17,303 --> 03:41:20,073 MIGHT HAVE ON THE HEALTH EFFECTS 4566 03:41:20,073 --> 03:41:24,077 OF AIR POLLUTION. 4567 03:41:24,077 --> 03:41:27,346 ONE IS BY DR. BRIGHAM. 4568 03:41:27,346 --> 03:41:29,916 AND THEY WERE ABLE TO SHOW THAT 4569 03:41:29,916 --> 03:41:32,452 WHEN CHILDREN CONSUMED A DIET 4570 03:41:32,452 --> 03:41:37,623 THAT WAS HIGH IN -- ON POOR AIR 4571 03:41:37,623 --> 03:41:38,624 QUALITY DAYS THOSE CHILDREN 4572 03:41:38,624 --> 03:41:41,494 ACTUALLY HAD A SIGNIFICANT 4573 03:41:41,494 --> 03:41:47,433 DECREASE IN THEIR FVE1. 4574 03:41:47,433 --> 03:41:50,603 PEOPLE THAT ADHERED TO A 4575 03:41:50,603 --> 03:41:52,205 MEDITERRANEAN DIET HAD LESS 4576 03:41:52,205 --> 03:41:54,407 CARDIOVASCULAR OR PULMONARY 4577 03:41:54,407 --> 03:41:57,410 EFFECTS ON BAD AIR POLLUTION 4578 03:41:57,410 --> 03:42:06,385 DAYS. 4579 03:42:06,385 --> 03:42:09,155 THEY MIGHT BE ONE OF THE WAYS 4580 03:42:09,155 --> 03:42:12,058 WHERE WE MIGHT BE ABLE TO 4581 03:42:12,058 --> 03:42:13,893 INTERVENE. 4582 03:42:13,893 --> 03:42:19,499 AND AS WE HEARD BEFORE WE ARE -- 4583 03:42:19,499 --> 03:42:29,909 POOR CONSUMERS OF PUFA. 4584 03:42:33,880 --> 03:42:36,716 BUT AGAIN THE DATA AS TO WHAT 4585 03:42:36,716 --> 03:42:38,684 THE MECHANISMS IS STILL AT 4586 03:42:38,684 --> 03:42:43,256 LARGE. 4587 03:42:43,256 --> 03:42:45,391 SO ONE OF THE INTERESTING 4588 03:42:45,391 --> 03:42:48,327 CAVEATS ABOUT STUDYING PUFA 4589 03:42:48,327 --> 03:42:51,097 INTAKE AND AIR POLLUTION, IS AIR 4590 03:42:51,097 --> 03:42:54,066 POLLUTION IS KNOWN TO ALTER 4591 03:42:54,066 --> 03:42:55,168 LIPID METABOLISM. 4592 03:42:55,168 --> 03:42:57,937 YOU SEE POST EXPOSURE IN RODENT 4593 03:42:57,937 --> 03:43:06,345 MODELS AS WELL AS HUMANS. 4594 03:43:06,345 --> 03:43:10,850 EVEN THE ENZYMES THAT ARE KNOWN 4595 03:43:10,850 --> 03:43:12,518 TO METABOLIZE THESE MEDIATORS 4596 03:43:12,518 --> 03:43:14,520 CAN HAVE ALTERED EXPRESSION AS 4597 03:43:14,520 --> 03:43:16,622 WELL AS ACTIVITY IN THE LUNG 4598 03:43:16,622 --> 03:43:19,192 FOLLOWING AIR POLLUTION EXPOSURE 4599 03:43:19,192 --> 03:43:24,664 AND THIS NICE STUDY IN 2016 WHEN 4600 03:43:24,664 --> 03:43:28,534 THEY HAD A HUMAN VOLUNTEERS THAT 4601 03:43:28,534 --> 03:43:30,336 WERE EXPOSED TO OZONE THEY WERE 4602 03:43:30,336 --> 03:43:32,772 ABLE TO SEE THERE WAS A 4603 03:43:32,772 --> 03:43:33,673 SIGNIFICANT INCREASE IN 4604 03:43:33,673 --> 03:43:39,045 CIRCULATING AS WELL AS 4605 03:43:39,045 --> 03:43:46,152 POLYUNSATURATED FATTY ACIDS. 4606 03:43:46,152 --> 03:43:48,487 IT WAS COUPLED WITH A DECREASE 4607 03:43:48,487 --> 03:43:53,326 IN THE PRODUCTION OF THE M3 4608 03:43:53,326 --> 03:43:55,995 DERIVED LIPID MEDIATORS IN THE 4609 03:43:55,995 --> 03:43:58,965 LUNG. 4610 03:43:58,965 --> 03:44:03,636 HIGHLIGHTING AN IMBALANCE. 4611 03:44:03,636 --> 03:44:12,078 SO THIS IS TO THE QUESTION -- IF 4612 03:44:12,078 --> 03:44:13,079 DIETARY N3PUFAs DECREASE 4613 03:44:13,079 --> 03:44:17,483 HEALTH EFFECTS IS THIS DUE TO A 4614 03:44:17,483 --> 03:44:20,887 DIFFERENTIAL -- LIPID 4615 03:44:20,887 --> 03:44:22,822 METABOLISM. 4616 03:44:22,822 --> 03:44:27,126 TO TEST THIS -- WE WERE FOCUSED 4617 03:44:27,126 --> 03:44:28,227 ON OZONE. 4618 03:44:28,227 --> 03:44:32,198 IF YOU'RE NOT FAMILIAR OZONE IS 4619 03:44:32,198 --> 03:44:34,700 A CRITERIA AIR POLLUTE 4620 03:44:34,700 --> 03:44:35,134 APARTMENT. 4621 03:44:35,134 --> 03:44:37,870 IT IS GOING TO INCREASE WITH 4622 03:44:37,870 --> 03:44:43,009 CLIMATE CHANGE. 4623 03:44:43,009 --> 03:44:46,979 STUDIES HAVE SHOWN THAT IT 4624 03:44:46,979 --> 03:44:48,080 INCREASES CARDIOVASCULAR 4625 03:44:48,080 --> 03:44:50,950 MORTALITY. 4626 03:44:50,950 --> 03:44:53,719 YOU CAN SEE THAT SUSCEPTIBLE 4627 03:44:53,719 --> 03:44:55,821 POPULATIONS SUCH AS ELDERLY AND 4628 03:44:55,821 --> 03:44:57,490 CHILDREN HAVE DECREASED LUNG 4629 03:44:57,490 --> 03:44:59,558 FUNCTION. 4630 03:44:59,558 --> 03:45:01,994 INCREASED EMERGENCY ROOM VISITS. 4631 03:45:01,994 --> 03:45:04,530 AND SOME OF THE NEWER DATA WITH 4632 03:45:04,530 --> 03:45:05,998 OZONE IS SHOWN THAT YOU'RE 4633 03:45:05,998 --> 03:45:08,434 SEEING AN INCREASE IN INCIDENTS 4634 03:45:08,434 --> 03:45:11,938 OF SEVERITY IN CHRONIC LUNG 4635 03:45:11,938 --> 03:45:12,405 DISEASES. 4636 03:45:12,405 --> 03:45:16,375 NOW WE'RE STARTING TO SEE THIS 4637 03:45:16,375 --> 03:45:18,110 WITH IPF. 4638 03:45:18,110 --> 03:45:20,446 THIS IS AN IMPORTANT POLLUTANT 4639 03:45:20,446 --> 03:45:23,316 THAT WE NEED TO BE COGNIZANT OF 4640 03:45:23,316 --> 03:45:26,819 WITH RESPIRATORY DISEASES. 4641 03:45:26,819 --> 03:45:29,722 AND SO TO MODEL THIS WE'RE USING 4642 03:45:29,722 --> 03:45:32,191 A RODENT MODEL. 4643 03:45:32,191 --> 03:45:35,127 FEEDING THEM A NORMAL CHOW DIET 4644 03:45:35,127 --> 03:45:38,030 OR AN EPA SUPPLEMENTED DIET. 4645 03:45:38,030 --> 03:45:39,832 WE START FEEDING THIS RIGHT 4646 03:45:39,832 --> 03:45:43,135 AFTER WEANING SO IT'S SUPPOSED 4647 03:45:43,135 --> 03:45:46,138 TO RECAPITULATE GROWING UP 4648 03:45:46,138 --> 03:45:49,308 EATING A DIET RICH IN THIS RICH 4649 03:45:49,308 --> 03:45:50,409 EPA. 4650 03:45:50,409 --> 03:45:53,746 THIS HAS ABOUT 2% KILL CALORIES 4651 03:45:53,746 --> 03:45:57,383 OF EPA AND IT'S A HIGH QUALITY 4652 03:45:57,383 --> 03:45:57,883 EPA. 4653 03:45:57,883 --> 03:46:00,353 THIS GETS THAT WAY FROM THE 4654 03:46:00,353 --> 03:46:02,655 CONTAMINANTS. 4655 03:46:02,655 --> 03:46:05,858 THE 2% CALORIE SHOULD MODEL 4656 03:46:05,858 --> 03:46:15,701 ABOUT A 2-GRAM -- CALORIE. 4657 03:46:15,701 --> 03:46:19,038 AND THEN WE'RE GOING TO EXPOSE 4658 03:46:19,038 --> 03:46:22,108 -- THEM TO FILTERED AIR FOR 4659 03:46:22,108 --> 03:46:25,277 THREE HOURS. 4660 03:46:25,277 --> 03:46:26,212 RECAPITULATING WHAT YOU WOULD 4661 03:46:26,212 --> 03:46:32,251 SEE ON AN OZONE ACTION DAY. 4662 03:46:32,251 --> 03:46:34,253 WE'RE GOING TO LOOK IN THE LUNG 4663 03:46:34,253 --> 03:46:36,489 -- FOR MARKERS OF INFLAMMATION 4664 03:46:36,489 --> 03:46:42,328 AS WELL AS WE DID TARGETED LIPID 4665 03:46:42,328 --> 03:46:43,529 MIX ON THE LUNG TISSUE. 4666 03:46:43,529 --> 03:46:47,133 AND SO THIS IS DATA THAT WAS 4667 03:46:47,133 --> 03:46:49,368 GENERATED BY A VERY TALENTED 4668 03:46:49,368 --> 03:46:52,772 GRADUATE STUDENT IN MY LAB. 4669 03:46:52,772 --> 03:46:57,443 HANNAH LOVINS. 4670 03:46:57,443 --> 03:47:01,280 IS THAT IN FACT EPA IN THE DIET 4671 03:47:01,280 --> 03:47:03,949 DOES SEEM TO BLOCK THE RESPONSE 4672 03:47:03,949 --> 03:47:06,285 TO OZONE AND THAT IS PICKED IN 4673 03:47:06,285 --> 03:47:07,486 THE GRAPH ON THE LEFT. 4674 03:47:07,486 --> 03:47:09,822 HOWEVER WHEN WE LOOKED AT 4675 03:47:09,822 --> 03:47:13,459 MARKERS -- WE DID NOT SEE THAT 4676 03:47:13,459 --> 03:47:15,428 THIS WAS ABLE TO PROTECT THAT 4677 03:47:15,428 --> 03:47:17,329 WHICH I FIND VERY INTERESTING 4678 03:47:17,329 --> 03:47:20,132 BECAUSE MAYBE THIS INDICATES A 4679 03:47:20,132 --> 03:47:22,768 SPECIFICITY OF HOW THIS FATTY 4680 03:47:22,768 --> 03:47:24,537 ACID IN THE DIET MIGHT BE 4681 03:47:24,537 --> 03:47:27,807 CAUSING SOME OF ITS EFFECTS AND 4682 03:47:27,807 --> 03:47:31,110 SO THEN -- WE LOADED THE DIET 4683 03:47:31,110 --> 03:47:34,146 WITH EPA. 4684 03:47:34,146 --> 03:47:37,716 WHAT ARE THE LIPID MEDIATORS 4685 03:47:37,716 --> 03:47:44,957 BEING METABOLIZED IN THE LUNGS? 4686 03:47:44,957 --> 03:47:49,962 AND IT CAN BE ME TAPLIZED -- OR 4687 03:47:49,962 --> 03:47:58,804 EVEN -- INTO DIFFERENT HEAPS. 4688 03:47:58,804 --> 03:48:04,176 OR THE DIHETES. 4689 03:48:04,176 --> 03:48:08,080 JUST DO KNOW THAT A LOT OF THESE 4690 03:48:08,080 --> 03:48:10,049 ARE ANTIINFLAMMATORY IN NATURE 4691 03:48:10,049 --> 03:48:14,320 AS WELL AS HAVE SOME RULES IN 4692 03:48:14,320 --> 03:48:15,721 GLUCOSE HOMEOSTASIS. 4693 03:48:15,721 --> 03:48:18,591 7 NOT ALL WERE UP IN THE LUNG 4694 03:48:18,591 --> 03:48:21,861 WITH EMPA IN THE DIET. 4695 03:48:21,861 --> 03:48:26,465 IF YOU LOOK AT THE BLUE BARS -- 4696 03:48:26,465 --> 03:48:29,502 -- THEY HAD AN INCREASE IN THE 4697 03:48:29,502 --> 03:48:33,939 AMOUNT OF -- HEPS. 4698 03:48:33,939 --> 03:48:39,211 SO THESE ARE SPECIFICALLY EPA 4699 03:48:39,211 --> 03:48:43,315 MEDIATORS -- INDICATING THAT 4700 03:48:43,315 --> 03:48:45,417 MAYBE THE ENZYME ACTIVITY 4701 03:48:45,417 --> 03:48:47,953 ACTUALLY WAS PLAYING A ROLE IN 4702 03:48:47,953 --> 03:48:53,125 THE EPA -- METABOLISM IN THE 4703 03:48:53,125 --> 03:48:53,325 LUNG. 4704 03:48:53,325 --> 03:48:56,462 WE DID NOT SEE THE OZONE CHANGED 4705 03:48:56,462 --> 03:48:58,564 -- THE PRODUCTION OF THESE LUNGS 4706 03:48:58,564 --> 03:49:01,200 BUT I DO THINK THIS IS 4707 03:49:01,200 --> 03:49:02,434 INTERESTING DATA THAT SHOWS THAT 4708 03:49:02,434 --> 03:49:06,639 THE LUNG TISSUE IS MALLEABLE TO 4709 03:49:06,639 --> 03:49:07,506 DIETARY FATTY ACIDS. 4710 03:49:07,506 --> 03:49:11,877 7 AND SO THEN WE ASKED THE 4711 03:49:11,877 --> 03:49:14,580 QUESTION -- WHAT IS THIS DOING 4712 03:49:14,580 --> 03:49:20,052 TO SOME OF THE LIPID MEDIATORS 4713 03:49:20,052 --> 03:49:23,756 -- AND THE DATA WE GOT BACK WAS 4714 03:49:23,756 --> 03:49:25,191 VERY INTERESTING. 4715 03:49:25,191 --> 03:49:26,825 OZONE IN THE CONTROLLED DIET YOU 4716 03:49:26,825 --> 03:49:28,527 ARE SEEING THAT THEY HAVE AN 4717 03:49:28,527 --> 03:49:31,697 INCREASE IN THE PRO INFLAMMATORY 4718 03:49:31,697 --> 03:49:35,267 MEDIATORS BUT IT WAS BLUNTED 4719 03:49:35,267 --> 03:49:44,977 WITH EPA IN THE DIET. 4720 03:49:44,977 --> 03:49:46,412 WE'RE GETTING MORE OF THE ONES 4721 03:49:46,412 --> 03:49:48,380 THAT ARE DOWNSTREAM OF EPA THAT 4722 03:49:48,380 --> 03:49:52,551 IS IN A DIET WHEN THE MICE ARE 4723 03:49:52,551 --> 03:49:56,088 FED AN EPA SUPPLEMENTED DIET. 4724 03:49:56,088 --> 03:49:58,757 IS THIS DUE TO THE FACT THAT EPA 4725 03:49:58,757 --> 03:50:03,128 IS PUSHING SOME OF THE PUFAs 4726 03:50:03,128 --> 03:50:04,496 OUT OF THE LUNG? 4727 03:50:04,496 --> 03:50:08,901 WE DID -- A TEST IN LUNG TISSUE 4728 03:50:08,901 --> 03:50:11,804 AND WHAT WE SAW WAS SIMILAR TO 4729 03:50:11,804 --> 03:50:16,075 THE HEAT DATA THAT I SHOWED YOU 4730 03:50:16,075 --> 03:50:16,542 EARLIER. 4731 03:50:16,542 --> 03:50:19,845 IT DOES SEEM TO RESULT IN MORE 4732 03:50:19,845 --> 03:50:21,947 EPA IN THE LUNG TISSUE WHICH IS 4733 03:50:21,947 --> 03:50:23,749 GREAT. 4734 03:50:23,749 --> 03:50:27,686 EPA CAN BE METABOLIZED. 4735 03:50:27,686 --> 03:50:30,456 WE'RE SEEING MORE DHA IN THE 4736 03:50:30,456 --> 03:50:35,394 LUNG BUT WHEN WE LOOK AT -- -- 4737 03:50:35,394 --> 03:50:38,731 THERE SEEMS TO BE A DISPLACEMENT 4738 03:50:38,731 --> 03:50:41,400 WITH EPA IN THE DIET INDICATING 4739 03:50:41,400 --> 03:50:44,703 THAT WHEN YOU EAT THESE FATTY 4740 03:50:44,703 --> 03:50:47,006 ACIDS PRESUMABLY WHAT MIGHT BE 4741 03:50:47,006 --> 03:50:51,110 HAPPENING IS THAT THE EPA MIGHT 4742 03:50:51,110 --> 03:50:54,947 BE PUSHING THESE OUT OF THE 4743 03:50:54,947 --> 03:50:56,682 MEMBRANES. 4744 03:50:56,682 --> 03:50:59,251 THE FUEL THAT IS THERE FOR THESE 4745 03:50:59,251 --> 03:51:01,453 ENZYMES TO PRODUCE IS PROBABLY 4746 03:51:01,453 --> 03:51:03,088 MORE INDICATIVE OF WHAT WAS IN 4747 03:51:03,088 --> 03:51:08,093 THE DIET. 4748 03:51:08,093 --> 03:51:09,895 >> SPEAKER, YOU HAVE TWO MINUTES 4749 03:51:09,895 --> 03:51:10,796 REMAINING. 4750 03:51:10,796 --> 03:51:13,032 >> I'D LIKE TO SUMMARIZE WHAT 4751 03:51:13,032 --> 03:51:13,966 I'VE SHOWN YOU. 4752 03:51:13,966 --> 03:51:16,302 I WANTED TO SHOW YOU MORE OF A 4753 03:51:16,302 --> 03:51:18,737 STORY THAT WE'RE WORKING ON TO 4754 03:51:18,737 --> 03:51:21,073 HIGHLIGHT HOW DIET CAN INFLUENCE 4755 03:51:21,073 --> 03:51:23,275 THE LIPID CONTENT IN THE LUNG. 4756 03:51:23,275 --> 03:51:26,312 WE HAVE DATA THAT DHA DOES THE 4757 03:51:26,312 --> 03:51:28,213 SAME THING. 4758 03:51:28,213 --> 03:51:32,184 WE SEE THAT WE GET MORE DHA ROXY 4759 03:51:32,184 --> 03:51:38,590 LINE INS IN THE * LUNG. 4760 03:51:38,590 --> 03:51:41,393 IT DOES SEEM TO MEDICATE SOME OF 4761 03:51:41,393 --> 03:51:43,829 THE INFLAMMATORY RESPONSES. 4762 03:51:43,829 --> 03:51:45,931 AND WE THINK THIS MIGHT BE A 4763 03:51:45,931 --> 03:51:50,336 RESULT OF SOME OF THESE -- BEING 4764 03:51:50,336 --> 03:51:52,738 DECREASED IN THE LUNG. 4765 03:51:52,738 --> 03:51:53,939 BUT JUST THINKING FORWARD OF 4766 03:51:53,939 --> 03:51:56,175 WHERE THE FIELD COULD GO -- 4767 03:51:56,175 --> 03:51:57,509 BECAUSE I THINK THAT IS ONE OF 4768 03:51:57,509 --> 03:51:59,078 THE THINGS THIS WORKSHOP IS 4769 03:51:59,078 --> 03:52:02,681 TRYING TO GET AT. 4770 03:52:02,681 --> 03:52:04,116 OUR LUNGS ARE NEVER THOUGHT OF 4771 03:52:04,116 --> 03:52:06,752 AS A TARGET OF DIET. 4772 03:52:06,752 --> 03:52:10,723 WE'VE THOUGHT OF THEM AS A 4773 03:52:10,723 --> 03:52:15,094 BYSTANDER UNTIL RECENTLY. 4774 03:52:15,094 --> 03:52:17,196 I'M VERY CURIOUS TO SEE HOW WHAT 4775 03:52:17,196 --> 03:52:19,365 WE EAT IS GETTING TO THE LUNGS. 4776 03:52:19,365 --> 03:52:21,300 WHAT ARE THE TRANSPORTERS AS 4777 03:52:21,300 --> 03:52:23,769 WELL AS WE'VE BEEN FOCUSING ON 4778 03:52:23,769 --> 03:52:26,605 THE FATTY ACIDS TO ENRICH THE 4779 03:52:26,605 --> 03:52:37,049 DIET AND WATER SOLUBLE -- THESE 4780 03:52:37,049 --> 03:52:38,684 ARE OVER-ALL QUESTIONS THAT 4781 03:52:38,684 --> 03:52:40,285 STILL NEED TO BE ANSWERED AND I 4782 03:52:40,285 --> 03:52:43,455 WILL SAY THAT WE'RE IN THE 4783 03:52:43,455 --> 03:52:46,458 PROCESS OF RECAPITULATING THIS 4784 03:52:46,458 --> 03:52:55,667 IN HUMANS. 4785 03:52:55,667 --> 03:52:58,771 WITH THAT I'D LIKE TO THANK MY 4786 03:52:58,771 --> 03:53:01,106 GROUP ESPECIALLY HANNAH WHO DID 4787 03:53:01,106 --> 03:53:04,076 THE MAJORITY OF THE RESEARCH I 4788 03:53:04,076 --> 03:53:04,643 SHOWED. 4789 03:53:04,643 --> 03:53:06,645 WE'RE VERY FORTUNATE TO HAVE 4790 03:53:06,645 --> 03:53:13,519 SOME NUTRITIONAL COLLABORATORS. 4791 03:53:13,519 --> 03:53:22,327 THANK YOU. 4792 03:53:22,327 --> 03:53:24,129 >> WE CAN NOW MOVE TO THE NEXT 4793 03:53:24,129 --> 03:53:29,601 SPEAKER. 4794 03:53:29,601 --> 03:53:36,608 DR. TARA NORDGREN FROM COL. 4795 03:53:36,608 --> 03:53:37,376 STATE UNIVERSITY. 4796 03:53:37,376 --> 03:53:38,911 SHE WILL BE SPEAKING ON 4797 03:53:38,911 --> 03:53:42,047 INFLAMMATION AND THE IMMUNE CELL 4798 03:53:42,047 --> 03:53:43,749 DYSFUNCTION UNDERLYING 4799 03:53:43,749 --> 03:53:45,851 NUTRITIONAL AND DIETARY IMPACTS 4800 03:53:45,851 --> 03:53:47,753 ON RESPIRATORY HEALTH AND 4801 03:53:47,753 --> 03:53:49,588 DISEASES. 4802 03:53:49,588 --> 03:53:51,290 >> SO THANK YOU SO MUCH TO THE 4803 03:53:51,290 --> 03:53:52,724 ORGANIZERS FOR LETTING ME TO 4804 03:53:52,724 --> 03:53:54,493 COME HERE AND TALK ABOUT THIS 4805 03:53:54,493 --> 03:53:57,963 TOPIC. 4806 03:53:57,963 --> 03:53:59,998 I DON'T HAVE ANY CONFLICTS OF 4807 03:53:59,998 --> 03:54:02,734 INTEREST TO DISCLOSE. 4808 03:54:02,734 --> 03:54:06,171 NEEDLESS TO SAY THE CONCEPT OF 4809 03:54:06,171 --> 03:54:13,579 HOW NUTRITION AND DIET IMPACTING 4810 03:54:13,579 --> 03:54:15,514 CELL AND INFLAMMATION IS A BROAD 4811 03:54:15,514 --> 03:54:15,914 TOPIC. 4812 03:54:15,914 --> 03:54:21,220 SO I WANT TO FOCUS IN ON A FEW 4813 03:54:21,220 --> 03:54:22,187 NUTRIENTS. 4814 03:54:22,187 --> 03:54:26,925 AS REGULATORS -- AS AN EXAMPLE. 4815 03:54:26,925 --> 03:54:30,562 AND THAT WORK IN UNIQUE LEEWAYS 4816 03:54:30,562 --> 03:54:34,867 TO SHOW HOW NUTRITION AND DIET 4817 03:54:34,867 --> 03:54:42,741 MAY IMPACT IMMUNITY. 4818 03:54:42,741 --> 03:54:53,318 * HOW THEY LEAD TO DYSFUNCTION. 4819 03:54:54,520 --> 03:54:56,622 I THINK THAT THE PREVIOUS 4820 03:54:56,622 --> 03:54:59,291 SPEAKERS HAVE SET ME UP WELL TO 4821 03:54:59,291 --> 03:55:01,860 SAY AN INDIVIDUAL'S DIET HAS THE 4822 03:55:01,860 --> 03:55:05,063 CAPACITY TO EXACERBATE OR 4823 03:55:05,063 --> 03:55:15,407 MITIGATE RESPONSES. 4824 03:55:15,741 --> 03:55:18,977 THEY CAN HAVE DIFFERENCES IN 4825 03:55:18,977 --> 03:55:20,012 INFLAMMATION, REPAIR CAPACITY 4826 03:55:20,012 --> 03:55:26,151 AND MUCH MORE. 4827 03:55:26,151 --> 03:55:28,820 SO, ITS IMPORTANT TO NOTE THAT 4828 03:55:28,820 --> 03:55:32,024 MALNUTRITION AND WHEN I SAY 4829 03:55:32,024 --> 03:55:34,893 MALNUTRITION -- PROTEIN CALORIE 4830 03:55:34,893 --> 03:55:36,962 INTAKE. 4831 03:55:36,962 --> 03:55:39,531 IT'S BEEN WELL ESTABLISHED THAT 4832 03:55:39,531 --> 03:55:41,633 MALNUTRITION WHICH CAN BE OVER 4833 03:55:41,633 --> 03:55:43,969 OR UNDER NUTRITION CAN 4834 03:55:43,969 --> 03:55:53,845 NEGATIVELY IMPACT IMMUNITY. 4835 03:55:53,845 --> 03:55:55,614 AND I ALSO WANT TO POINT OUT 4836 03:55:55,614 --> 03:55:58,083 THAT THERE IS CROSS TALK BETWEEN 4837 03:55:58,083 --> 03:56:00,185 NUTRITION AND INFLAMMATION AND 4838 03:56:00,185 --> 03:56:01,053 IMMUNITY. 4839 03:56:01,053 --> 03:56:03,956 I'M GOING TO FOCUS ON HOW 4840 03:56:03,956 --> 03:56:07,559 NUTRITION IMPACTS THIS. 4841 03:56:07,559 --> 03:56:09,328 INFLAMMATION CAN ALSO LEAD TO 4842 03:56:09,328 --> 03:56:10,429 MALNUTRITION. 4843 03:56:10,429 --> 03:56:12,664 IN GENERAL THE TAKE HOME MESSAGE 4844 03:56:12,664 --> 03:56:23,208 IS THERE IS SUBSTANTIAL DATA -- 4845 03:56:24,543 --> 03:56:27,379 AND SOME OF THIS IS ALSO SHOWN 4846 03:56:27,379 --> 03:56:30,248 IN VULNERABLE POPULATIONS AS 4847 03:56:30,248 --> 03:56:33,218 OTHERS HAVE MENTIONED SO FAR 4848 03:56:33,218 --> 03:56:34,019 TODAY. 4849 03:56:34,019 --> 03:56:36,455 INDIVIDUALS OVER 50 YEARS OF AGE 4850 03:56:36,455 --> 03:56:39,458 AT LEAST 35% HAVE DEFICIENCIES 4851 03:56:39,458 --> 03:56:42,160 IN SOME KIND OF MICRO NUTRIENT 4852 03:56:42,160 --> 03:56:44,062 AND SUPPLEMENTING THEM HAVE 4853 03:56:44,062 --> 03:56:46,064 SHOWN TO IMPROVE IMMUNE 4854 03:56:46,064 --> 03:56:49,568 RESPONSES. 4855 03:56:49,568 --> 03:56:52,971 SO I DO WANT TO GO THROUGH FIVE 4856 03:56:52,971 --> 03:56:55,340 CLASSES OF NUTRIENTS AND GIVE 4857 03:56:55,340 --> 03:56:57,142 YOU EXAMPLE MECHANISMS OF HOW 4858 03:56:57,142 --> 03:57:00,445 THEY PROMOTE IMMUNE FUNCTION OR 4859 03:57:00,445 --> 03:57:02,381 DYSFUNCTION. 4860 03:57:02,381 --> 03:57:06,985 AND SO ANTIOXIDANT COMPOUNDS WE 4861 03:57:06,985 --> 03:57:08,420 BRIEFLY MENTIONED TODAY. 4862 03:57:08,420 --> 03:57:11,757 THEY ARE WELL-KNOWN TO SCAVENGE 4863 03:57:11,757 --> 03:57:16,795 FREE RADICALS AND REDUCE THEM. 4864 03:57:16,795 --> 03:57:19,031 AND REGULATE IMMUNITY IN OTHER 4865 03:57:19,031 --> 03:57:22,634 WAYS SUCH AS WORKING AS 4866 03:57:22,634 --> 03:57:26,071 CO-FACTORS IN AND ALSO METAL 4867 03:57:26,071 --> 03:57:26,705 COLLATION. 4868 03:57:26,705 --> 03:57:32,544 * CHELATION. 4869 03:57:32,544 --> 03:57:35,280 IT CAN BE REALLY IMPORTANT AS 4870 03:57:35,280 --> 03:57:38,283 VITAMIN C DEFICIENCY CAN 4871 03:57:38,283 --> 03:57:40,252 CONTRIBUTE TO AREA INFLAMMATION 4872 03:57:40,252 --> 03:57:42,921 AND RISK FOR THINGS LIKE -- 4873 03:57:42,921 --> 03:57:44,923 INFECTION. 4874 03:57:44,923 --> 03:57:47,893 AND SOME IMPORTANT AND 4875 03:57:47,893 --> 03:57:54,966 REGULATING -- AND ALSO PROMOTING 4876 03:57:54,966 --> 03:57:58,170 ANTI-- IT ENHANCES THEIR 4877 03:57:58,170 --> 03:57:59,137 CAPACITY. 4878 03:57:59,137 --> 03:58:02,441 AND IT'S ALSO THOUGHT THAT IN 4879 03:58:02,441 --> 03:58:05,577 CELLS THAT HAVE OXIDATIVE BIRTH 4880 03:58:05,577 --> 03:58:07,212 STIMULATED THEY ACCUMULATE HIGH 4881 03:58:07,212 --> 03:58:09,981 LEVELS OF VITAMIN C AND THAT IS 4882 03:58:09,981 --> 03:58:11,349 THOUGHT TO BE PROTECTIVE AS WELL 4883 03:58:11,349 --> 03:58:21,827 AS SUPPORTING LIMB GO SIGHT 4884 03:58:26,198 --> 03:58:26,665 PRODUCTION. 4885 03:58:26,665 --> 03:58:31,002 *. 4886 03:58:31,002 --> 03:58:33,405 IT'S REALLY IMPLEMENTING. 4887 03:58:33,405 --> 03:58:36,074 ZINC IS HIGHLY REGULATED IN THE 4888 03:58:36,074 --> 03:58:36,274 BODY. 4889 03:58:36,274 --> 03:58:38,577 DOZENS OF PROTEINS THAT ARE 4890 03:58:38,577 --> 03:58:40,679 EXPRESSED IN TISSUE. 4891 03:58:40,679 --> 03:58:44,182 AND ALLOW IT TO DO A GREAT JOB. 4892 03:58:44,182 --> 03:58:46,585 IN TERMS OF REGULATING 4893 03:58:46,585 --> 03:58:48,854 SIGNALING, GENE ACTIVATION. 4894 03:58:48,854 --> 03:58:52,090 AND ZINC IS REQUIRED FOR ALL 4895 03:58:52,090 --> 03:58:56,061 ENZYME PROCESSES AND UP TO 10% 4896 03:58:56,061 --> 03:59:00,098 -- MIGHT BIND IN ZINC. 4897 03:59:00,098 --> 03:59:01,600 ZINC PLAYS A REALLY IMPORTANT 4898 03:59:01,600 --> 03:59:06,338 ROLE. 4899 03:59:06,338 --> 03:59:08,206 AND ALL OF THIS LEADS DIRECTLY 4900 03:59:08,206 --> 03:59:10,408 TO THE ABILITY OF IMMUNE CELLS 4901 03:59:10,408 --> 03:59:11,910 TO FUNCTION PROPERLY. 4902 03:59:11,910 --> 03:59:15,781 SO CERTAINLY DEFICIENCY IS 4903 03:59:15,781 --> 03:59:19,851 ASSOCIATED WITH ALTERED RATIOS 4904 03:59:19,851 --> 03:59:22,254 -- AND ACTIVITIES. 4905 03:59:22,254 --> 03:59:25,891 AND SO WE'VE SHOWN THAT ON THE 4906 03:59:25,891 --> 03:59:28,560 OTHER SIDE ZINC SUPPLEMENTATION 4907 03:59:28,560 --> 03:59:31,997 HAS BEEN SHOWN TO -- IN ELDERLY 4908 03:59:31,997 --> 03:59:35,233 POPULATIONS. 4909 03:59:35,233 --> 03:59:38,537 7 IT CAN LEAD TO INCREASED 4910 03:59:38,537 --> 03:59:41,406 INFLAMMATORY OUTCOMES BASED ON 4911 03:59:41,406 --> 03:59:43,008 VARIOUS ANIMAL MODELS OF 4912 03:59:43,008 --> 03:59:43,308 EXPOSESSER. 4913 03:59:43,308 --> 03:59:51,049 7 SO TALKING ABOUT VITAMIN D. 4914 03:59:51,049 --> 03:59:53,251 VITAMIN D IN ADDITION TO OTHER 4915 03:59:53,251 --> 03:59:55,487 KNOWN ROLES HAS BEEN RECOGNIZED 4916 03:59:55,487 --> 04:00:02,260 AS AN IMPORTANT MODULATOR. 4917 04:00:02,260 --> 04:00:05,997 VITAMIN D BINDS TO A RECEPTOR -- 4918 04:00:05,997 --> 04:00:10,502 AND THAT IS HOW IT MEDIATES ITS 4919 04:00:10,502 --> 04:00:14,206 EFFECTS. 4920 04:00:14,206 --> 04:00:16,007 MACROPHAGES -- CAN STIMULATE 4921 04:00:16,007 --> 04:00:17,676 EXPRESSION. 4922 04:00:17,676 --> 04:00:20,645 ALSO FOUND TO PROMOTE -- 4923 04:00:20,645 --> 04:00:29,221 INTEGRITY AND TO PROMOTE T CELL 4924 04:00:29,221 --> 04:00:31,756 -- MIGRATION. 4925 04:00:31,756 --> 04:00:42,701 AND WITH VITAMIN D SUN POLICE--O 4926 04:00:51,943 --> 04:00:53,845 BRIEFLY MENTIONED EARLIER. 4927 04:00:53,845 --> 04:00:57,816 FIBER CERTAINLY IS FOUND IN MANY 4928 04:00:57,816 --> 04:01:01,353 DIFFERENT WHOLE FOODS, FRUITS 4929 04:01:01,353 --> 04:01:02,854 AND VEGETABLES AND GRAINS. 4930 04:01:02,854 --> 04:01:05,490 WE TALK ABOUT IT AS BEING A 4931 04:01:05,490 --> 04:01:07,459 PREBIOTIC. 4932 04:01:07,459 --> 04:01:10,228 BUT I WON'T BE LABOR THIS 4933 04:01:10,228 --> 04:01:12,364 BECAUSE THERE IS TALK AFTER THIS 4934 04:01:12,364 --> 04:01:14,332 THAT WILL GO INTO THIS IN MORE 4935 04:01:14,332 --> 04:01:15,700 DETAIL. 4936 04:01:15,700 --> 04:01:22,841 THE GUT CAN FERMENT -- FIBER AND 4937 04:01:22,841 --> 04:01:25,644 THESE ARE KNOWN TO ACTIVATE 4938 04:01:25,644 --> 04:01:28,079 SIGNALING PATHWAYS -- THAT 4939 04:01:28,079 --> 04:01:31,349 REDUCE INFLAMMATORY RESPONSES. 4940 04:01:31,349 --> 04:01:33,351 THROUGH THESE MECHANISMS IT 4941 04:01:33,351 --> 04:01:36,488 PLAYS A ROLE IN SYSTEMATIC 4942 04:01:36,488 --> 04:01:39,124 INFLAMMATION BUT ALSO WITHIN THE 4943 04:01:39,124 --> 04:01:41,459 LUNG AND SUCH AS WHAT HAS BEEN 4944 04:01:41,459 --> 04:01:43,995 SHOWN THAT LOW FIBER DIETS DO 4945 04:01:43,995 --> 04:01:48,066 HAVE THIS ELEVATED RISK FOR 4946 04:01:48,066 --> 04:01:53,838 AIRFLOW OBSTRUCTION, INCREASED 4947 04:01:53,838 --> 04:01:57,542 RISK WITH PULMONARY DISEASES AS 4948 04:01:57,542 --> 04:01:57,742 WELL. 4949 04:01:57,742 --> 04:01:59,978 THIS CAN PREVENT IMMUNE 4950 04:01:59,978 --> 04:02:01,680 RESPONSES FROM EXCESSIVE 4951 04:02:01,680 --> 04:02:03,014 PROTEINS AND THINGS CROSSING 4952 04:02:03,014 --> 04:02:13,258 THAT BARRIER. 4953 04:02:13,591 --> 04:02:15,593 AND THEN DIETARY FAT. 4954 04:02:15,593 --> 04:02:20,298 WE JUST HEARD ABOUT DIETARY FAT. 4955 04:02:20,298 --> 04:02:21,132 INCLUDE POLYUNSATURATED FATTY 4956 04:02:21,132 --> 04:02:23,301 ACIDS. 4957 04:02:23,301 --> 04:02:26,838 THEY HAVE STRONG LINK TO IMMUNE 4958 04:02:26,838 --> 04:02:30,642 RESPONSE REGULATION. 4959 04:02:30,642 --> 04:02:37,349 THEY CAN HAVE IMPACTS GENE 4960 04:02:37,349 --> 04:02:39,451 EXPRESSION THROUGH RESEM SCEPTER 4961 04:02:39,451 --> 04:02:43,054 BINDING AS WELL. 4962 04:02:43,054 --> 04:02:45,123 * RECEPTOR AS WELL. 4963 04:02:49,127 --> 04:02:52,364 WHILE OMEGA 3 POLYUNSATURATED 4964 04:02:52,364 --> 04:02:53,631 FATTY ACIDS HAVE BEEN CONSIDERED 4965 04:02:53,631 --> 04:03:00,105 TO CREATE THESE -- AFFECTS SUCH 4966 04:03:00,105 --> 04:03:04,009 AS THE RESOLVING AND PROTECTANTS 4967 04:03:04,009 --> 04:03:11,016 AND THE LIKE. 4968 04:03:11,016 --> 04:03:13,118 AND SO WHAT ABOUT THE OTHER 4969 04:03:13,118 --> 04:03:14,586 DIETARY FATS? 4970 04:03:14,586 --> 04:03:17,022 WE HAVE ALSO TALKED ABOUT 4971 04:03:17,022 --> 04:03:19,557 SATURATED FATS. 4972 04:03:19,557 --> 04:03:23,028 LONGER CHAIN SATURATED FATS. 4973 04:03:23,028 --> 04:03:25,830 THE HIGH FAT MEALS INCLUDE THOSE 4974 04:03:25,830 --> 04:03:29,567 WITH HIGH SATURATED FATS ARE 4975 04:03:29,567 --> 04:03:30,702 ASSOCIATED WITH INFLAMMATORY 4976 04:03:30,702 --> 04:03:33,304 STATES. 4977 04:03:33,304 --> 04:03:36,841 THERE IS AN ASSOCIATION BETWEEN 4978 04:03:36,841 --> 04:03:43,748 THIS AND TLR4. 4979 04:03:43,748 --> 04:03:46,951 AND IT USED TO BE THOUGHT THAT 4980 04:03:46,951 --> 04:03:49,421 SATURATED FATS DIRECTLY SERVE AS 4981 04:03:49,421 --> 04:03:54,025 -- IT'S LESS CLEAR NOW IF SOME 4982 04:03:54,025 --> 04:03:57,028 SATURATED FATS DO THAT BUT THEY 4983 04:03:57,028 --> 04:04:00,799 WORK IN DIRECTLY OR IN A 4984 04:04:00,799 --> 04:04:02,867 SYNERGISTIC FASHION. 4985 04:04:02,867 --> 04:04:07,072 THEY CAN INDUCE ER STRESS. 4986 04:04:07,072 --> 04:04:08,973 AND THIS LEADS TO THIS 4987 04:04:08,973 --> 04:04:09,974 INFLAMMATORY ENVIRONMENT AND 4988 04:04:09,974 --> 04:04:13,411 THEY CAN ALSO ACTIVATE THESE 4989 04:04:13,411 --> 04:04:18,249 PROTEINS THAT SENSE SATURATED 4990 04:04:18,249 --> 04:04:19,818 FAT ACCUMULATION. 4991 04:04:19,818 --> 04:04:23,555 SO IN A STUDY ASSESSING DID I 4992 04:04:23,555 --> 04:04:28,626 TERRY FATS IN ASTHMATICS -- -- * 4993 04:04:28,626 --> 04:04:30,295 ONCE AGAIN GOING BACK TO THOSE 4994 04:04:30,295 --> 04:04:32,130 OTHER FACTORS THAT WE NEED TO 4995 04:04:32,130 --> 04:04:34,866 CONSIDER THAT MIGHT BE IMPACTING 4996 04:04:34,866 --> 04:04:41,406 OUTCOMES IN THESE STUDIES. 4997 04:04:41,406 --> 04:04:43,641 SO SOME REMAINING RESEARCH GAPS 4998 04:04:43,641 --> 04:04:45,076 AND CHALLENGES. 4999 04:04:45,076 --> 04:04:47,178 I THINK WE'VE HEARD THIS A 5000 04:04:47,178 --> 04:04:48,480 NUMBER OF TIMES TODAY. 5001 04:04:48,480 --> 04:04:53,118 7 BUT MANY STUDIES INVESTIGATING 5002 04:04:53,118 --> 04:04:56,821 THE MECHANISTIC IMPACTS -- RELY 5003 04:04:56,821 --> 04:05:04,095 ON DIETARY SUN -- SUN POLICE MEN 5004 04:05:04,095 --> 04:05:09,501 TAKES. 5005 04:05:09,501 --> 04:05:11,970 SUN POLICE MEN TAKES. 5006 04:05:11,970 --> 04:05:12,137 STAROSTA 5007 04:05:26,985 --> 04:05:32,457 -- THERE ARE SNIPS ASSOCIATED -- 5008 04:05:32,457 --> 04:05:35,160 BUT THESE ARE SOMEWHAT RARELY 5009 04:05:35,160 --> 04:05:37,695 CONSIDERED IN SUPPLEMENTATION 5010 04:05:37,695 --> 04:05:40,331 TRIALS. 5011 04:05:40,331 --> 04:05:45,370 SO THESE ARE JUST ONE EXAMPLE OF 5012 04:05:45,370 --> 04:05:48,473 GENES SNIPS THAT SEEM TO BE 5013 04:05:48,473 --> 04:05:50,041 REALLY IMPORTANT WHEN THINKING 5014 04:05:50,041 --> 04:05:51,276 ABOUT WHETHER OR NOT A 5015 04:05:51,276 --> 04:05:52,577 SUPPLEMENT IS GOING TO BE AS 5016 04:05:52,577 --> 04:05:54,579 EFFECTIVE AS WE WOULD LIKE IT TO 5017 04:05:54,579 --> 04:05:55,046 BE. 5018 04:05:55,046 --> 04:05:58,149 SO THERE IS A CRITICAL NEED FOR 5019 04:05:58,149 --> 04:06:01,486 PRIORITIZE RESEARCH STUDIES. 5020 04:06:01,486 --> 04:06:03,621 AND THERE ARE GAPS IN 5021 04:06:03,621 --> 04:06:05,089 PRECLINICAL TO CLINICAL 5022 04:06:05,089 --> 04:06:05,757 TRANSLATION. 5023 04:06:05,757 --> 04:06:07,625 THIS IS DUE TO INCONSISTENT 5024 04:06:07,625 --> 04:06:10,128 OUTCOMES AT EACH RESEARCH LEVEL 5025 04:06:10,128 --> 04:06:11,296 THAT PREVENT NUTRITION RESEARCH 5026 04:06:11,296 --> 04:06:13,831 TO MOVE FORWARD TO CLINICAL 5027 04:06:13,831 --> 04:06:15,767 PRACTICE. 5028 04:06:15,767 --> 04:06:26,344 SU-- SUN HEMENTS ARE NOT FDA 5029 04:06:26,744 --> 04:06:34,118 REGULATED. 5030 04:06:34,118 --> 04:06:38,189 AND SO, I'VE SHARED SOME OF THE 5031 04:06:38,189 --> 04:06:42,060 BETTER RECOGNIZED COMPOUNDS AND 5032 04:06:42,060 --> 04:06:42,927 THEIR EFFECTS. 5033 04:06:42,927 --> 04:06:44,929 THERE ARE MANY OTHER NUTRIENTS 5034 04:06:44,929 --> 04:06:48,967 THAT WE KNOW MUCH LESS ABOUT BUT 5035 04:06:48,967 --> 04:06:50,101 EVEN IN THE CASE OF THE 5036 04:06:50,101 --> 04:06:51,502 NUTRIENTS I DISCUSSED TODAY. 5037 04:06:51,502 --> 04:06:53,605 THERE ARE A COUPLE OF PLACES 5038 04:06:53,605 --> 04:06:54,939 WHERE WE DON'T FULLY UNDERSTAND 5039 04:06:54,939 --> 04:06:57,275 WHAT IS GOING ON AND MANY 5040 04:06:57,275 --> 04:07:00,445 STUDIES ARE LACKING ESPECIALLY 5041 04:07:00,445 --> 04:07:02,113 WITHIN SPECIFIC SETTINGS OR 5042 04:07:02,113 --> 04:07:04,716 WITHIN RELATIVELY RECENT 5043 04:07:04,716 --> 04:07:06,217 CHARACTERIZED IMMUNE CELLS AND 5044 04:07:06,217 --> 04:07:08,553 PROCESSES. 5045 04:07:08,553 --> 04:07:09,687 EXAMPLES WOULD BE WHAT IS 5046 04:07:09,687 --> 04:07:13,691 HAPPENING TO TRAINED IMMUNITY. 5047 04:07:13,691 --> 04:07:17,328 OTHER CLASSICALLY CATEGORIZED 5048 04:07:17,328 --> 04:07:19,497 STRUCTURAL CELLS. 5049 04:07:19,497 --> 04:07:22,500 ESPECIALLY THIELIAL CELLS -- 5050 04:07:22,500 --> 04:07:24,469 THEY HAVE IMPORTANT IMMUNE 5051 04:07:24,469 --> 04:07:27,105 MODULATING CAPACITIES. 5052 04:07:27,105 --> 04:07:29,540 * AND WITHIN SPECIFIC LUNG 5053 04:07:29,540 --> 04:07:31,643 CHALLENGES AND DISEASES IS 5054 04:07:31,643 --> 04:07:34,979 CERTAINLY NEEDED. 5055 04:07:34,979 --> 04:07:37,015 MANY STUDIES KIND OF LOOK AT 5056 04:07:37,015 --> 04:07:41,986 THINGS AS ONLY PRO VERSUS 5057 04:07:41,986 --> 04:07:42,620 ANTIINFLAMMATORY EFFECTS. 5058 04:07:42,620 --> 04:07:44,188 WITH MUCH MORE LIMITED 5059 04:07:44,188 --> 04:07:46,524 INVESTIGATION ON OTHER FACTORS 5060 04:07:46,524 --> 04:07:52,063 THAT COULD BE -- OTHERWISE 5061 04:07:52,063 --> 04:07:55,333 IMMUNE MOD OOOH, LA TORI. 5062 04:07:55,333 --> 04:07:57,435 -- MOD OOOH, LA TORI. 5063 04:07:57,435 --> 04:07:58,970 *. 5064 04:08:01,939 --> 04:08:03,675 IS HOW AND THE SETTING OF 5065 04:08:03,675 --> 04:08:08,079 INFECTIOUS DISEASE HOW PATHOGEN 5066 04:08:08,079 --> 04:08:12,950 HOST INTERACTIONS OCCUR. 5067 04:08:12,950 --> 04:08:14,986 THOSE STUDIES ARE REALLY WANTED 5068 04:08:14,986 --> 04:08:17,088 AND WE'VE JUST STARTED TO TOUCH 5069 04:08:17,088 --> 04:08:20,425 THE SURFACE OF HOW A HOST DIET 5070 04:08:20,425 --> 04:08:22,093 MAY EFFECT PATHOGEN HEALTH 5071 04:08:22,093 --> 04:08:24,429 THROUGH SHARING OF NUTRIENTS AND 5072 04:08:24,429 --> 04:08:25,763 RESOURCES. 5073 04:08:25,763 --> 04:08:34,138 THANK YOU FOR YOUR TIME. 5074 04:08:34,138 --> 04:08:35,373 >> THANK YOU FOR A FANTASTIC 5075 04:08:35,373 --> 04:08:35,807 TALK. 5076 04:08:35,807 --> 04:08:40,078 WE'RE GOING TO MOVE ON TO 5077 04:08:40,078 --> 04:08:50,488 DR. ARUN PRAKASH BUDDE. 5078 04:08:55,927 --> 04:08:56,994 >> THANKS SO MUCH. 5079 04:08:56,994 --> 04:08:59,664 I HAVE NO CONFLICTS OR 5080 04:08:59,664 --> 04:09:00,098 DISCLOSURES. 5081 04:09:00,098 --> 04:09:02,533 I WOULD LIKE TO THANK THE 5082 04:09:02,533 --> 04:09:04,001 ORGANIZERS FORGIVING ME THE 5083 04:09:04,001 --> 04:09:06,304 OPPORTUNITY TO SPEAK AT THIS 5084 04:09:06,304 --> 04:09:06,537 SESSION. 5085 04:09:06,537 --> 04:09:10,508 I'M NOT A NUTRITIONAL OR DIETARY 5086 04:09:10,508 --> 04:09:15,513 EXPERT NOR AM A DATA SCIENTIST. 5087 04:09:15,513 --> 04:09:18,282 I'M A PRACTICING 5088 04:09:18,282 --> 04:09:28,593 ANESTHESIOLOGIST. 5089 04:09:37,368 --> 04:09:39,971 BUT MORE RELEVANT TO THIS TOPIC 5090 04:09:39,971 --> 04:09:43,941 WE ALSO FOCUS ON THE GUT 5091 04:09:43,941 --> 04:09:50,181 MICROBIOME AND METABOLITES. 5092 04:09:50,181 --> 04:09:54,485 AND ALSO THE ROLE OF DIET IN 5093 04:09:54,485 --> 04:10:02,160 REGULATING THE GUT LUNG AXIS. 5094 04:10:02,160 --> 04:10:06,364 -- SOME OF WHICH ARE MOST 5095 04:10:06,364 --> 04:10:10,635 RELEVANT TO THIS TALK -- THE 5096 04:10:10,635 --> 04:10:12,870 DIET WHICH CAN BE CONTROLLED IN 5097 04:10:12,870 --> 04:10:13,638 SOME SENSE. 5098 04:10:13,638 --> 04:10:16,541 HEALTHY VERSUS UNHEALTHY DIETS 5099 04:10:16,541 --> 04:10:22,814 AND HOST FACTORS, GENETICS, 5100 04:10:22,814 --> 04:10:25,416 DELIVERY MECHANISM. 5101 04:10:25,416 --> 04:10:28,719 INFECTIONS, LIFESTYLES AND 5102 04:10:28,719 --> 04:10:33,691 STRESS AND CIRCADIAN RHYTHM. 5103 04:10:33,691 --> 04:10:35,993 AND ALSO THE MEDICATIONS AND THE 5104 04:10:35,993 --> 04:10:38,329 HEALTH CARE THAT WE PROVIDE TO 5105 04:10:38,329 --> 04:10:38,729 INDIVIDUALS. 5106 04:10:38,729 --> 04:10:42,266 ALL OF THIS CAN AFFECT THE 5107 04:10:42,266 --> 04:10:42,567 MICROBIOME. 5108 04:10:42,567 --> 04:10:45,937 AND WHAT IS STUDIED IS THE 5109 04:10:45,937 --> 04:10:47,672 BACTERIAL MICROBIOME BUT THERE 5110 04:10:47,672 --> 04:10:52,009 IS ALSO A VIRAL MICROBIOME AND 5111 04:10:52,009 --> 04:10:54,679 FUNGAL -- BIOME THAT IS NOT AS 5112 04:10:54,679 --> 04:10:56,981 WELL STUDIED BUT DOESN'T MEAN 5113 04:10:56,981 --> 04:11:00,384 THAT IT IS NOT IMPORTANT. 5114 04:11:00,384 --> 04:11:02,119 SO ALL OF THESE DIFFERENT 5115 04:11:02,119 --> 04:11:04,989 FACTORS CAN AFFECT THE GUT 5116 04:11:04,989 --> 04:11:08,759 MICROBIOME AND ALSO WHAT THEY 5117 04:11:08,759 --> 04:11:09,827 PRODUCE. 5118 04:11:09,827 --> 04:11:12,263 AND THAT IS WHAT WE CALL THE ME 5119 04:11:12,263 --> 04:11:22,440 TAB LOAM. 5120 04:11:24,141 --> 04:11:30,581 AND THIS REFERS TO HOW THE GUT 5121 04:11:30,581 --> 04:11:34,318 MICROBIOME -- TO THE LUNG. 5122 04:11:34,318 --> 04:11:37,722 77 MORE DIRECTLY ON THE 5123 04:11:37,722 --> 04:11:39,624 METABOLITES A LIST OF SOME OF 5124 04:11:39,624 --> 04:11:41,726 THE KEY METABOLITES THAT HAVE 5125 04:11:41,726 --> 04:11:43,494 BEEN MOST STUDIED IN HOW THE 5126 04:11:43,494 --> 04:11:46,063 MICROBIOME INFLUENCES THE LUNG 5127 04:11:46,063 --> 04:11:48,065 BIOLOGY AND I'VE LISTED THEM 5128 04:11:48,065 --> 04:11:55,540 OVER HERE. 5129 04:11:55,540 --> 04:11:57,909 AND OTHERS AS WELL AS COMPONENTS 5130 04:11:57,909 --> 04:12:02,413 FROM THE BACTERIA SUCH AS -- LPS 5131 04:12:02,413 --> 04:12:05,650 AND OTHER COMPONENTS THAT CAN 5132 04:12:05,650 --> 04:12:09,620 INFLUENCE LUNG FUNCTION AND LUNG 5133 04:12:09,620 --> 04:12:09,887 IMMUNITY. 5134 04:12:09,887 --> 04:12:12,456 THEY CAN TAKE PLACE DIRECTLY. 5135 04:12:12,456 --> 04:12:14,458 TRANSMIT TO THE LUNG AND AFFECT 5136 04:12:14,458 --> 04:12:17,128 LUNG RESPONSES AND LUNG FUNCTION 5137 04:12:17,128 --> 04:12:22,033 OR GO IN DIRECTLY THROUGH THE 5138 04:12:22,033 --> 04:12:25,503 BONE MARROW. 5139 04:12:25,503 --> 04:12:28,239 AND THESE DIFFERENT COMPOUNDS 5140 04:12:28,239 --> 04:12:30,608 CAN ACT AS -- SINCE THIS IS A 5141 04:12:30,608 --> 04:12:32,376 TALK ABOUT MECHANISM ON 5142 04:12:32,376 --> 04:12:34,979 DIFFERENT RECEPTORS CLASSES AS 5143 04:12:34,979 --> 04:12:35,179 WELL. 5144 04:12:35,179 --> 04:12:36,981 I'VE HIGHLIGHTED A COUPLE OF 5145 04:12:36,981 --> 04:12:39,083 THEM AS WELL. 5146 04:12:39,083 --> 04:12:41,285 AND THESE VARIOUS DIFFERENT 5147 04:12:41,285 --> 04:12:45,723 COMPOUNDS CAN ACT ON SIGNALING 5148 04:12:45,723 --> 04:12:52,363 AS WELL. 5149 04:12:52,363 --> 04:12:55,800 SO THE METABOLITES AND THIS IS 5150 04:12:55,800 --> 04:12:58,235 TO LAYOUT AS I SEE IT THE 5151 04:12:58,235 --> 04:13:00,638 CURRENT SCIENCE IN THE FIELD. 5152 04:13:00,638 --> 04:13:10,114 ASSOCIATED WITH LUNG IMMUNITY -- 5153 04:13:10,114 --> 04:13:13,985 -- AND THESE CAN CAUSE DIRECT 5154 04:13:13,985 --> 04:13:16,420 EFFECTS ON LUNG IMMUNITY AND 5155 04:13:16,420 --> 04:13:19,190 HAVE BEEN SHOWN IN PRELYNN CALL 5156 04:13:19,190 --> 04:13:22,827 MODELS THAT THEY ARE * EITHER 5157 04:13:22,827 --> 04:13:25,496 ADDED INTO THE DIET OR 5158 04:13:25,496 --> 04:13:27,031 INTRODUCED TO THE SYSTEM AND YOU 5159 04:13:27,031 --> 04:13:29,133 SEE DIFFERENT EFFECTS AND THIS 5160 04:13:29,133 --> 04:13:32,136 -- THE DIET CAN AFFECT THE LEVEL 5161 04:13:32,136 --> 04:13:34,672 EITHER THROUGH THE GUT 5162 04:13:34,672 --> 04:13:37,541 MICROBIOME WHICH EITHER PRODUCES 5163 04:13:37,541 --> 04:13:40,645 OR MODIFIES THESE COMPONENTS 5164 04:13:40,645 --> 04:13:43,681 SUCH AS FIBER. 5165 04:13:43,681 --> 04:13:45,783 AND ALSO SOME METABOLITES 5166 04:13:45,783 --> 04:13:50,154 THROUGH THE DIET CAN BE MODIFIED 5167 04:13:50,154 --> 04:13:59,463 THROUGH THE MICROBIOME. 5168 04:13:59,463 --> 04:14:01,032 AND OF COURSE AS YOU'VE HEARD 5169 04:14:01,032 --> 04:14:03,267 FROM MANY TALKS PRIOR TO THIS 5170 04:14:03,267 --> 04:14:06,570 ONE THEY ARE ALSO METABOLITES 5171 04:14:06,570 --> 04:14:08,139 THAT CAN AGAINST INDEPENDENT OF 5172 04:14:08,139 --> 04:14:09,807 THE GUT MICROBIOME. 5173 04:14:09,807 --> 04:14:12,243 THESE CAN MITIGATE OR WORSEN 5174 04:14:12,243 --> 04:14:15,579 LUNG DISEASES BOTH IN THE ON SET 5175 04:14:15,579 --> 04:14:18,749 AND PROGRESSION. 5176 04:14:18,749 --> 04:14:21,619 AND HERE IS SOME OF THE LUNG 5177 04:14:21,619 --> 04:14:23,387 DISEASES THAT HAVE BEEN SHOWN TO 5178 04:14:23,387 --> 04:14:26,257 BE ASSOCIATED EITHER THROUGH IN 5179 04:14:26,257 --> 04:14:28,693 PRECLINICAL STUDIES OR ACTUAL 5180 04:14:28,693 --> 04:14:31,996 CLINICAL STUDIES WITH THE GUT 5181 04:14:31,996 --> 04:14:34,298 LUNG AXIS. 5182 04:14:34,298 --> 04:14:38,736 INCLUDING ASTHMA AND COPD 5183 04:14:38,736 --> 04:14:39,837 COVID-19. 5184 04:14:39,837 --> 04:14:41,706 BUT ALSO OTHERS THAT HAVE NOT 5185 04:14:41,706 --> 04:14:44,141 BEEN MENTIONED SUCH AS LUNG 5186 04:14:44,141 --> 04:14:45,209 CANCER. 5187 04:14:45,209 --> 04:14:50,081 STERILE INJURY. 5188 04:14:50,081 --> 04:14:54,652 BACTERIAL AND VIRAL INFECTIONS. 5189 04:14:54,652 --> 04:14:55,219 CYSTIC FIBROSIS. 5190 04:14:55,219 --> 04:14:56,854 AND PULMONARY HYPERTENSION. 5191 04:14:56,854 --> 04:14:59,724 YOU CAN SEE THE DIFFERENT 5192 04:14:59,724 --> 04:15:04,228 METABOLITES AND ALSO THE GUT 5193 04:15:04,228 --> 04:15:06,430 BACTERIAL SPECIES WHERE THE 5194 04:15:06,430 --> 04:15:08,032 BACTERIA HAS BEEN ASSOCIATED 5195 04:15:08,032 --> 04:15:09,900 WITH THE INDIVIDUAL METABOLITES 5196 04:15:09,900 --> 04:15:16,841 HAVE NOT BEEN FULLY DISSECTED 5197 04:15:16,841 --> 04:15:19,443 OUT. 5198 04:15:19,443 --> 04:15:23,647 YOU SEE THE SHORT CHAIN FATTY 5199 04:15:23,647 --> 04:15:26,517 ACIDS ARE ONE OF THE MORE 5200 04:15:26,517 --> 04:15:28,853 STUDIES AND I INCLUDE RICO GUT 5201 04:15:28,853 --> 04:15:33,157 HERE WHERE UNKNOWN COMPOUNDS 5202 04:15:33,157 --> 04:15:39,196 INCLUDING LPS THAT CAN AFFECT 5203 04:15:39,196 --> 04:15:43,000 LUNG DISEASES. 5204 04:15:43,000 --> 04:15:46,003 SO AS I SEE THE CURRENT RESEARCH 5205 04:15:46,003 --> 04:15:48,439 GAPS -- THAT WE DON'T HAVE A 5206 04:15:48,439 --> 04:15:54,278 GOOD SENSE OF THE COMPREHENSIVE 5207 04:15:54,278 --> 04:15:54,912 METABOLOME. 5208 04:15:54,912 --> 04:15:59,216 AND THERE ARE SOME NEW 5209 04:15:59,216 --> 04:16:01,185 APPROACHES TO TRY TO ADDRESS 5210 04:16:01,185 --> 04:16:01,819 THIS. 5211 04:16:01,819 --> 04:16:05,689 AND I'LL INCLUDE A PAPER 5212 04:16:05,689 --> 04:16:08,559 REFERENCE ABOUT A METABOLOME 5213 04:16:08,559 --> 04:16:11,128 PIPELINE THAT CAN TRY TO 5214 04:16:11,128 --> 04:16:13,664 UNDERSTAND THESE EMERGING. 5215 04:16:13,664 --> 04:16:16,200 WE HAVE ALSO DON'T HAVE A GOOD 5216 04:16:16,200 --> 04:16:20,504 SEASONS SENSE OF MODIFIED VERSUS 5217 04:16:20,504 --> 04:16:23,040 UNMODIFIED AND THAT AFFECTS THE 5218 04:16:23,040 --> 04:16:25,910 LUNG RESPONSES AND LUNG 5219 04:16:25,910 --> 04:16:30,247 IMMUNITY. 5220 04:16:30,247 --> 04:16:33,150 AND FROM OUR LAB STANDPOINT WE 5221 04:16:33,150 --> 04:16:34,718 THINK IT'S IMPORTANT THAT WE 5222 04:16:34,718 --> 04:16:37,788 DON'T UNDERSTAND WHAT IS THE 5223 04:16:37,788 --> 04:16:40,457 RESTING METABOLIC IMMUNE STATE 5224 04:16:40,457 --> 04:16:44,395 FOR HEALTHY LUNGS. 5225 04:16:44,395 --> 04:16:47,064 AND IN TERMS OF INJURY AND 5226 04:16:47,064 --> 04:16:49,834 DISEASE WHAT ARE THE EFFECTS ON 5227 04:16:49,834 --> 04:16:52,369 ACUTE INJURY RESPONSES VERSUS 5228 04:16:52,369 --> 04:16:55,039 CHRONIC INJURY RESPONSES OF 5229 04:16:55,039 --> 04:16:56,240 THESE METABOLITES. 5230 04:16:56,240 --> 04:16:57,908 IT'S IMPORTANT TO CONSIDER THE 5231 04:16:57,908 --> 04:17:01,212 BALANCE OF INFLAMMATION CONTROL 5232 04:17:01,212 --> 04:17:02,112 VERSUS HOST DEFENSE AGAINST 5233 04:17:02,112 --> 04:17:03,781 INFECTION AND GETTING THE 5234 04:17:03,781 --> 04:17:05,482 BALANCE JUST RIGHT IS OBVIOUSLY 5235 04:17:05,482 --> 04:17:07,651 VERY IMPORTANT. 5236 04:17:07,651 --> 04:17:10,621 FOR LUNG HEALTH AND IN DISEASE 5237 04:17:10,621 --> 04:17:14,158 AND HOW THE DIET CAN IMPACT THAT 5238 04:17:14,158 --> 04:17:20,698 IS A BIG RESEARCH GAP AS WELL. 5239 04:17:20,698 --> 04:17:23,000 SO I WOULD LIKE TO FOCUS ON 5240 04:17:23,000 --> 04:17:26,303 SHORT CHAIN FATTY ACIDS. 5241 04:17:26,303 --> 04:17:28,105 THEY ARE IMPORTANT PRODUCTS THAT 5242 04:17:28,105 --> 04:17:31,041 COME OUT OF FIBER FERMENTATION. 5243 04:17:31,041 --> 04:17:34,144 AND A COUPLE OF DIFFERENT 5244 04:17:34,144 --> 04:17:35,145 MECHANISMS WHERE THEY MIGHT 5245 04:17:35,145 --> 04:17:35,679 WORK. 5246 04:17:35,679 --> 04:17:38,582 THESE ARE THREE OF THE MAIN ONES 5247 04:17:38,582 --> 04:17:41,418 BEING STUDIED RIGHT NOW. 5248 04:17:41,418 --> 04:17:45,155 YOU CAN SEE THE THREE MAIN SHORT 5249 04:17:45,155 --> 04:17:50,661 CHAIN FATTY ACIDS. 5250 04:17:50,661 --> 04:17:53,097 AND THESE CAN ACT THROUGH A 5251 04:17:53,097 --> 04:17:55,666 COUPLE OF DIFFERENT MECHANISMS 5252 04:17:55,666 --> 04:17:57,768 INCLUDING AT THE TOP SIGNALING 5253 04:17:57,768 --> 04:18:00,771 THROUGH RECEPTORS -- THEY CAN 5254 04:18:00,771 --> 04:18:03,941 ALSO ACT ON THE RIGHT SIDE 5255 04:18:03,941 --> 04:18:07,311 THROUGH METABOLISM. 5256 04:18:07,311 --> 04:18:10,114 SERVE AS FUEL SOURCES AND AFFECT 5257 04:18:10,114 --> 04:18:14,285 THE CELL'S CHOICE OF WHICH 5258 04:18:14,285 --> 04:18:17,421 METABOLIC PATHWAYS THEY MAY PLOY 5259 04:18:17,421 --> 04:18:21,558 AND ESPECIALLY GEMIC CONTROLS. 5260 04:18:21,558 --> 04:18:32,036 -- ESPECIALLY BEGINIC *. 5261 04:18:33,304 --> 04:18:37,274 AND THEY -- INTERACT WITH 5262 04:18:37,274 --> 04:18:38,542 VARIOUS OTHERS AS WELL. 5263 04:18:38,542 --> 04:18:43,647 I MENTIONED THE METABOLISM. 5264 04:18:43,647 --> 04:18:49,253 THE PRESENCE CAN EFFECT THE 5265 04:18:49,253 --> 04:18:52,623 BALANCE -- IN TERMS OF SIGNALING 5266 04:18:52,623 --> 04:18:54,725 DOWNSTREAM OF THE RECEPTORS 5267 04:18:54,725 --> 04:18:57,594 THERE COULD BE PPR GAMMA 5268 04:18:57,594 --> 04:19:08,138 ACTIVATION AND -- -- AND THEN -- 5269 04:19:11,175 --> 04:19:18,849 IMPACT TC DIFFERENTIATION. 5270 04:19:18,849 --> 04:19:21,318 AND THESE EFFECTS ARE OCCURRING 5271 04:19:21,318 --> 04:19:26,190 IN ALL THREE OF THE LOCATIONS OR 5272 04:19:26,190 --> 04:19:30,427 TWO OR MORE. 5273 04:19:30,427 --> 04:19:33,063 THROUGH THE BONE MARROW AND THEN 5274 04:19:33,063 --> 04:19:34,965 ALSO IN THE LUNG AS IS THE FOCUS 5275 04:19:34,965 --> 04:19:37,901 OF THIS WORKSHOP. 5276 04:19:37,901 --> 04:19:40,471 7 AND THE RESULTS INDICATE THAT 5277 04:19:40,471 --> 04:19:42,673 THESE DIFFERENT MECHANISMS ARE 5278 04:19:42,673 --> 04:19:45,709 NOT ALSO OCCURRING IN ISOLATION. 5279 04:19:45,709 --> 04:19:48,712 THE METABOLISM EFFECTS CAN 5280 04:19:48,712 --> 04:19:53,017 AFFECT THE EPPIE GENETIC CELL AS 5281 04:19:53,017 --> 04:19:58,555 WELL. 5282 04:19:58,555 --> 04:20:00,657 SO THE CHALLENGES AND 5283 04:20:00,657 --> 04:20:01,125 OPPORTUNITIES. 5284 04:20:01,125 --> 04:20:07,264 AS I SEE THEM -- COUNTY POSITIVE 5285 04:20:07,264 --> 04:20:08,966 EFFECTS BE GENERALIZED TO ALL 5286 04:20:08,966 --> 04:20:09,266 INDIVIDUALS? 5287 04:20:09,266 --> 04:20:11,101 I THINK THE ANSWER IS NO. 5288 04:20:11,101 --> 04:20:13,837 THAT IS THE FIRST LINE -- 5289 04:20:13,837 --> 04:20:15,539 APPROACH AS HAS BEEN MENTIONED 5290 04:20:15,539 --> 04:20:17,775 BY OTHER SPEAKERS AS WELL. 5291 04:20:17,775 --> 04:20:23,914 ANRESPIRATORY HEALTH IS DIFFICU. 5292 04:20:23,914 --> 04:20:26,383 IN HEALTH AND DISEASE AS YOU'VE 5293 04:20:26,383 --> 04:20:28,685 HEARD IN OTHER SESSIONS IS 5294 04:20:28,685 --> 04:20:30,120 IMPORTANT TO DISTINGUISH. 5295 04:20:30,120 --> 04:20:33,023 YOU'VE HEARD ABOUT THE USE OF 5296 04:20:33,023 --> 04:20:36,860 PULMONARY TESTS AND WE OFTEN USE 5297 04:20:36,860 --> 04:20:38,429 OXYGEN SATURATION WHICH IS NOT A 5298 04:20:38,429 --> 04:20:41,165 GOOD MEASURE OF LUNG HEALTH. 5299 04:20:41,165 --> 04:20:43,367 THERE ARE SOME CHALLENGES IN 5300 04:20:43,367 --> 04:20:45,035 TERMS OF HOW TO MEASURE 5301 04:20:45,035 --> 04:20:46,537 RESPIRATORY HEALTH. 5302 04:20:46,537 --> 04:20:49,406 TRYING TO DEVELOP NEW DEVICES 5303 04:20:49,406 --> 04:20:51,842 THAT CAN SOLVE THIS PROBLEM. 5304 04:20:51,842 --> 04:20:55,179 THERE ARE NO GOOD BIO MARKERS 5305 04:20:55,179 --> 04:21:02,653 FOR LUNG INJURY. 5306 04:21:02,653 --> 04:21:04,455 THERE ARE NEW APPROACHES COMING 5307 04:21:04,455 --> 04:21:07,324 OUT FOR EXPIRED BREATH 5308 04:21:07,324 --> 04:21:09,059 MEASUREMENTS AND THAT IS GOING 5309 04:21:09,059 --> 04:21:10,928 TO BE AN INTERESTING AND 5310 04:21:10,928 --> 04:21:12,863 IMPORTANT WAY TO MOVE FORWARD. 5311 04:21:12,863 --> 04:21:15,432 AND ESPECIALLY IF WE CAN DEVELOP 5312 04:21:15,432 --> 04:21:18,402 ONES THAT CAN GIVE US AN 5313 04:21:18,402 --> 04:21:20,737 ASSESSMENT OF THE IMMUNE AND 5314 04:21:20,737 --> 04:21:22,239 METABOLIC ACTIVITY HEALTH OF THE 5315 04:21:22,239 --> 04:21:23,874 LUNG. 5316 04:21:23,874 --> 04:21:27,611 USING PRECLINICAL MODELS WE CAN 5317 04:21:27,611 --> 04:21:29,713 SAMPLE LUNG TISSUE TO TRACK 5318 04:21:29,713 --> 04:21:31,348 THESE METABOLITES AS THEY MOVE 5319 04:21:31,348 --> 04:21:34,485 FROM THE GUT TO THE LUNG. 5320 04:21:34,485 --> 04:21:37,154 AND THEN AN OPPORTUNITY TO COME 5321 04:21:37,154 --> 04:21:41,358 UP WITH A WAY TO CREATE A 5322 04:21:41,358 --> 04:21:43,160 PERSONALIZED LUNG STRESS TEST TO 5323 04:21:43,160 --> 04:21:44,394 UNDERSTAND HOW AN INDIVIDUAL 5324 04:21:44,394 --> 04:21:47,397 MIGHT RESPOND TO AN INJURY OR 5325 04:21:47,397 --> 04:21:52,870 INFECTION. 5326 04:21:52,870 --> 04:21:54,571 SOME KEY RESEARCH QUESTIONS: 5327 04:21:54,571 --> 04:21:57,808 HOW QUICKLY CAN THE DIET CHANGE 5328 04:21:57,808 --> 04:22:00,310 LUNG IMMUNITY. 5329 04:22:00,310 --> 04:22:04,314 WE KNOW FROM PRECLINICAL MODELS 5330 04:22:04,314 --> 04:22:06,650 AND RODENT STUDIES THAT EVEN A 5331 04:22:06,650 --> 04:22:09,620 WEEK OR TWO WEEKS OF A DIETARY 5332 04:22:09,620 --> 04:22:11,655 CHANGE CAN CHANGE HOW LUNGS 5333 04:22:11,655 --> 04:22:15,993 RESPOND TO INJURY AND INFECTION. 5334 04:22:15,993 --> 04:22:18,495 QUESTIONS REMAIN AS FAR AS HOW 5335 04:22:18,495 --> 04:22:21,965 LONG THESE CHANGES LAST? 5336 04:22:21,965 --> 04:22:23,400 THE STABILITY OF THIS SYSTEM. 5337 04:22:23,400 --> 04:22:25,102 AND ALSO DOES THE DURATION OF 5338 04:22:25,102 --> 04:22:28,505 THE DIET CHANGE AND AFFECT THE 5339 04:22:28,505 --> 04:22:28,772 STABILITY. 5340 04:22:28,772 --> 04:22:31,308 HOW LONG YOU'RE ON A PARTICULAR 5341 04:22:31,308 --> 04:22:36,713 DIET DOES IT AFFECT HOW HOW LONG 5342 04:22:36,713 --> 04:22:38,782 IT LAST. 5343 04:22:38,782 --> 04:22:41,451 WE HAVE CERTAIN DIETS FOR OTHER 5344 04:22:41,451 --> 04:22:42,219 ORGAN HEALTH. 5345 04:22:42,219 --> 04:22:43,887 I THINK THAT IS AN IMPORTANT 5346 04:22:43,887 --> 04:22:49,459 PLACE TO ALSO FOCUS OUR WORK. 5347 04:22:49,459 --> 04:22:52,896 AND ARE THERE DIETS CAN IMPACT 5348 04:22:52,896 --> 04:22:56,800 LONGS LUNG DISEASE SUCH AS 5349 04:22:56,800 --> 04:22:59,102 PREBIOTICS AND THEN CAN THE 5350 04:22:59,102 --> 04:23:02,773 DIETARY SUPPLEMENTS BE GIVEN IN 5351 04:23:02,773 --> 04:23:03,040 ISOLATION. 5352 04:23:03,040 --> 04:23:04,875 FOR EXAMPLE THE SHORT CHAIN 5353 04:23:04,875 --> 04:23:06,376 FATTY ACIDS. 5354 04:23:06,376 --> 04:23:09,780 COULD THEY BE USED TO ALTER THE 5355 04:23:09,780 --> 04:23:11,381 INFLAMMATORY STATE OF THE LUNG 5356 04:23:11,381 --> 04:23:15,485 UNDER PARTICULAR CONDITIONS. 5357 04:23:15,485 --> 04:23:16,954 >> SPEAKER, YOU HAVE A MINUTE 5358 04:23:16,954 --> 04:23:17,888 REMAINING. 5359 04:23:17,888 --> 04:23:19,122 >> SO YES. 5360 04:23:19,122 --> 04:23:21,191 IMMEDIATE AND LONG-TERM RESEARCH 5361 04:23:21,191 --> 04:23:22,726 DIRECTIONS ON THIS TOPIC. 5362 04:23:22,726 --> 04:23:28,966 HOW DOES THE DIET AND MICROBIOME 5363 04:23:28,966 --> 04:23:31,134 ESTABLISH THE TONE. 5364 04:23:31,134 --> 04:23:39,009 7 MEASURE THE TONE NONINVASIVELY 5365 04:23:39,009 --> 04:23:42,746 WOULD BE A GREAT WAY TO TRACK 5366 04:23:42,746 --> 04:23:44,248 THIS IF POSSIBLE. 5367 04:23:44,248 --> 04:23:47,651 AND TO UNDERSTAND WHETHER THE 5368 04:23:47,651 --> 04:23:50,220 COMPOSITION COULD HELP SUB 5369 04:23:50,220 --> 04:23:52,522 CATEGORIZE -- AND WHETHER THAT 5370 04:23:52,522 --> 04:23:54,658 CAN EXPLAIN THEIR LUNG INJURY 5371 04:23:54,658 --> 04:23:58,128 AND MAYBE EVEN TARGET THERAPY. 5372 04:23:58,128 --> 04:23:59,796 AND UNDERSTANDING IF DIETS CAN 5373 04:23:59,796 --> 04:24:04,401 IMPROVE VARIOUS LUNG DISEASES. 5374 04:24:04,401 --> 04:24:07,938 THE IDEA OF FECAL MICROBIOME 5375 04:24:07,938 --> 04:24:10,607 TRANSPLANTS WHETHER THOSE CAN 5376 04:24:10,607 --> 04:24:13,277 STABLY CHANGE THE MICROBIOME AND 5377 04:24:13,277 --> 04:24:21,551 HOST IMMUNITY. 5378 04:24:21,551 --> 04:24:27,791 I HOPE I'VE CONVINCED YOU THE 5379 04:24:27,791 --> 04:24:28,959 IMPORTANCE. 5380 04:24:28,959 --> 04:24:31,328 I'LL LEAVE YOU WITH SOME AGE OLD 5381 04:24:31,328 --> 04:24:33,163 QUOTES FROM WISE PEOPLE. 5382 04:24:33,163 --> 04:24:38,902 WHO MANY CENTURIES SAID LET FOOD 5383 04:24:38,902 --> 04:24:42,839 BE THY FOOD AND FOOD BE THY 5384 04:24:42,839 --> 04:24:45,475 MEDICINE. 5385 04:24:45,475 --> 04:24:55,786 FROM HIPPOCRATES. 5386 04:25:04,061 --> 04:25:06,229 AND THEN TWO OTHERS THAT MAY 5387 04:25:06,229 --> 04:25:08,365 HAVE BEEN UNKNOWINGLY REFERRED 5388 04:25:08,365 --> 04:25:11,535 TO THE MICROBIOME. 5389 04:25:11,535 --> 04:25:13,770 NATURAL FORCES WITHIN US ARE THE 5390 04:25:13,770 --> 04:25:16,506 TRUE HEALERS OF DISEASE AND 5391 04:25:16,506 --> 04:25:19,810 LOUIE PASTURE SAID THE ROLE OF 5392 04:25:19,810 --> 04:25:23,447 IN FINISH NATELY SMALL IN NATURE 5393 04:25:23,447 --> 04:25:28,085 IS INFINITELY LARGE. 5394 04:25:28,085 --> 04:25:28,285 *. 5395 04:25:28,285 --> 04:25:30,087 ACKNOWLEDGING OTHER LABS WORKING 5396 04:25:30,087 --> 04:25:32,989 ON THE GUT LUNG AXIS AND OTHER 5397 04:25:32,989 --> 04:25:36,093 PLACES AROUND THE WORLD THAT ARE 5398 04:25:36,093 --> 04:25:38,061 UNCOVERING IMPORTANT ASPECTS OF 5399 04:25:38,061 --> 04:25:40,364 THIS NETWORK. 5400 04:25:40,364 --> 04:25:42,799 AND I'D LIKE TO ACKNOWLEDGE 5401 04:25:42,799 --> 04:25:46,036 MEMBERS OF MY OWN GROUP -- AND 5402 04:25:46,036 --> 04:25:47,838 SOME OF THE RECENT MEMBERS WHO 5403 04:25:47,838 --> 04:25:50,474 ARE DOING WORK T. HAVEN'T HAD A 5404 04:25:50,474 --> 04:25:51,375 CHANCE TO TALK ABOUT THE WORK 5405 04:25:51,375 --> 04:25:53,910 THAT WE'RE DOING IN THE LAB 5406 04:25:53,910 --> 04:25:55,779 DIRECTLY BUT THEY ARE THE FOLKS 5407 04:25:55,779 --> 04:25:58,382 THAT ARE WORKING HARD ON THIS 5408 04:25:58,382 --> 04:25:59,683 TOPIC. 5409 04:25:59,683 --> 04:26:01,818 AND KNOWLEDGE MY FUNDING SOURCES 5410 04:26:01,818 --> 04:26:02,619 AS WELL. 5411 04:26:02,619 --> 04:26:04,121 THANK YOU. 5412 04:26:04,121 --> 04:26:07,023 >> THANK YOU DR. PRAKASH BUDDE 5413 04:26:07,023 --> 04:26:09,893 FOR THAT OUTSTANDING 5414 04:26:09,893 --> 04:26:11,228 PRESENTATION AND NOW WE MOVE TO 5415 04:26:11,228 --> 04:26:15,232 THE LAST TALK AND IT'S MY 5416 04:26:15,232 --> 04:26:19,336 PLEASURE TO INTRODUCE DR. MARIE 5417 04:26:19,336 --> 04:26:29,479 PIERRE. 5418 04:26:35,519 --> 04:26:37,053 >> THANK YOU SO MUCH. 5419 04:26:37,053 --> 04:26:40,824 I WOULD LIKE TO THANK THE 5420 04:26:40,824 --> 04:26:42,192 ORGANIZERS FOR INVITING ME TO 5421 04:26:42,192 --> 04:26:44,060 SPEAK ON THIS TOPIC. 5422 04:26:44,060 --> 04:26:46,163 I HAVE NO CONFLICTS OF INTEREST 5423 04:26:46,163 --> 04:26:47,464 TO DISCLOSE. 5424 04:26:47,464 --> 04:26:49,232 I WOULD LIKE TO FOCUS ON SLEEP 5425 04:26:49,232 --> 04:26:53,270 AND THE IMPACT. 5426 04:26:53,270 --> 04:26:58,008 FOCUSING ON BREATHING DISORDERS 5427 04:26:58,008 --> 04:26:59,776 SUCH AS SLEEP APNEA. 5428 04:26:59,776 --> 04:27:02,546 SOME MECHANISMS AND OTHER HEALTH 5429 04:27:02,546 --> 04:27:05,782 OUTCOMES RELATED TO DIET AND 5430 04:27:05,782 --> 04:27:09,953 OBSTRUCTIVE SLEEP APNEA THROUGH 5431 04:27:09,953 --> 04:27:12,489 CLINICAL INTERVENTION STUDIES. 5432 04:27:12,489 --> 04:27:14,624 IT'S NOW PRETTY WELL ESTABLISHED 5433 04:27:14,624 --> 04:27:17,160 THAT SLEEP QUALITY AND SLEEP 5434 04:27:17,160 --> 04:27:19,496 DURATION HAVE A DRAMATIC IMPACT 5435 04:27:19,496 --> 04:27:23,533 ON DIETARY QUALITY. 5436 04:27:23,533 --> 04:27:25,735 WHERE INDIVIDUALS WHO HAVE POOR 5437 04:27:25,735 --> 04:27:28,605 QUALITY SLEEP TEND TO CONSUME AN 5438 04:27:28,605 --> 04:27:33,477 UNHEALTHY DIET RESULTING THAT 5439 04:27:33,477 --> 04:27:37,214 CAN LEAD TO A VICIOUS CYCLE. 5440 04:27:37,214 --> 04:27:39,015 WHERE DIET QUALITY CAN INFLUENCE 5441 04:27:39,015 --> 04:27:40,083 SLEEP QUALITY. 5442 04:27:40,083 --> 04:27:47,023 AND WE'VE PROPOSED THIS VICIOUS 5443 04:27:47,023 --> 04:27:50,227 CYCLE -- POOR SLEEP QUALITY 5444 04:27:50,227 --> 04:27:55,599 LEADS TO POOR DIET QUALITY. 5445 04:27:55,599 --> 04:27:58,034 HOW CAN WE LEVERAGE DIET TO 5446 04:27:58,034 --> 04:27:59,002 IMPROVE SLEEP QUALITY. 5447 04:27:59,002 --> 04:28:01,538 A HEALTHY DIET PROVIDES THE 5448 04:28:01,538 --> 04:28:04,307 FOUNDATION FOR HEALTHY SLEEP AND 5449 04:28:04,307 --> 04:28:14,751 HEALTHY CIRCADIAN RHYTHMS. 5450 04:28:18,922 --> 04:28:21,157 OUR GROUP AND OTHERS HAVE SHOWN 5451 04:28:21,157 --> 04:28:22,959 THAT INDIVIDUALS WHO CONSUME A 5452 04:28:22,959 --> 04:28:27,230 HEALTHY DIETARY PATTERN -- THE 5453 04:28:27,230 --> 04:28:30,400 MEDITERRANEAN DIET, THE 5454 04:28:30,400 --> 04:28:33,503 HYPERTENSION DIET OR MIND DIET 5455 04:28:33,503 --> 04:28:38,542 LEADS TO BETTER SLEEPY QUALITY. 5456 04:28:38,542 --> 04:28:42,479 MOSTLY THROUGH VARIOUS NUTRIENTS 5457 04:28:42,479 --> 04:28:44,214 WITHIN THESE PLANT BASED FOODS 5458 04:28:44,214 --> 04:28:45,916 THAT ARE CONTAINED. 5459 04:28:45,916 --> 04:28:52,622 SUCH AS MELATONIN -- AND THEN 5460 04:28:52,622 --> 04:28:55,825 ALSO THE DIETARY FIBER THAT 5461 04:28:55,825 --> 04:28:57,394 INFLUENCES THE GUT MICROBIOME AS 5462 04:28:57,394 --> 04:28:59,896 WE'VE HEARD IN PREVIOUS TALKS. 5463 04:28:59,896 --> 04:29:02,666 THE GUT MICROBIOME LEADS TO A 5464 04:29:02,666 --> 04:29:06,303 DIET IN FIBER AND SHORT CHAIN 5465 04:29:06,303 --> 04:29:09,606 FATTY ACID PRODUCTION WHICH 5466 04:29:09,606 --> 04:29:13,944 REDUCES INFLAMMATION BUT ALSO UP 5467 04:29:13,944 --> 04:29:20,550 RATES CIRCADIAN CLOCKS. 5468 04:29:20,550 --> 04:29:23,653 CONVERSELY CONSUMPTION OF ULTRA 5469 04:29:23,653 --> 04:29:26,022 PROCESSED FOODS AND UNHEALTHY 5470 04:29:26,022 --> 04:29:28,224 DIETARY PATTERNS CAN HAVE AN 5471 04:29:28,224 --> 04:29:29,659 ADVERSE EFFECT ON SLEEP QUALITY 5472 04:29:29,659 --> 04:29:32,228 AND INCREASE THE RISK OF 5473 04:29:32,228 --> 04:29:35,031 INSOMNIA. 5474 04:29:35,031 --> 04:29:39,035 SO SIMILARLY TO SLEEP QUALITY, 5475 04:29:39,035 --> 04:29:42,973 SLEEP DURATION AND RISK OF 5476 04:29:42,973 --> 04:29:49,379 INSOMNIA THERE IS A PATTERN OF 5477 04:29:49,379 --> 04:29:50,046 DIETARY QUALITY INFLUENCING 5478 04:29:50,046 --> 04:29:51,915 SLEEP APNEA. 5479 04:29:51,915 --> 04:29:55,685 HERE I'M SHOWING ASSOCIATIONS 5480 04:29:55,685 --> 04:29:57,988 FROM EPIDEMILOGICAL STUDIES 5481 04:29:57,988 --> 04:30:00,423 SHOWING INDIVIDUALS WITH SLEEP 5482 04:30:00,423 --> 04:30:07,063 APNEA CONSUME HIGHER INTAKES OF 5483 04:30:07,063 --> 04:30:15,238 RED MEETS AND ALSO UNHEALTHY 5484 04:30:15,238 --> 04:30:17,273 PATTERNS AND THIS HAS BEEN SHOWN 5485 04:30:17,273 --> 04:30:25,448 TO BE REMEDIATED -- -- SLOW WAVE 5486 04:30:25,448 --> 04:30:25,649 SLEEP. 5487 04:30:25,649 --> 04:30:27,817 THESE EPIDEMILOGICAL STUDIES 5488 04:30:27,817 --> 04:30:29,152 SHOW THAT INDIVIDUALS WHO 5489 04:30:29,152 --> 04:30:32,355 CONSUME A LOWER INFLAMMATORY 5490 04:30:32,355 --> 04:30:34,891 DIET AND ARE MORE ADHERENT TO 5491 04:30:34,891 --> 04:30:39,896 THE DIETARY GUIDELINES -- THESE 5492 04:30:39,896 --> 04:30:42,265 DIETS PROVIDING MORE FRUITS AND 5493 04:30:42,265 --> 04:30:43,700 VEGETABLES AND WHOLE GRAINS HAVE 5494 04:30:43,700 --> 04:30:54,210 A REDUCED RISK OF SLEEP APNEA. 5495 04:30:55,512 --> 04:30:57,847 THE POPULATION BASED STUDIES 5496 04:30:57,847 --> 04:30:59,182 PROVIDE INFORMATION ON 5497 04:30:59,182 --> 04:31:01,518 ASSOCIATIONS BETWEEN DIET AND 5498 04:31:01,518 --> 04:31:04,354 RISK OF SLEEP APNEA BUT ALSO 5499 04:31:04,354 --> 04:31:07,457 CAUSAL EVIDENCE FROM CLINICAL 5500 04:31:07,457 --> 04:31:08,391 INTERVENTION STUDIES. 5501 04:31:08,391 --> 04:31:09,993 FOUR SPECIFIC STUDIES THAT HAVE 5502 04:31:09,993 --> 04:31:13,630 BEEN DONE TO TEST THE IMPACT OF 5503 04:31:13,630 --> 04:31:22,405 DIET ON SLEEP APNEA. 5504 04:31:22,405 --> 04:31:25,442 THE LARGEST STUDY THAT HAS BEEN 5505 04:31:25,442 --> 04:31:31,614 CONDUCTED TO DATE -- RANDOMIZED 5506 04:31:31,614 --> 04:31:36,519 187 PARTICIPANTS -- TREATED WITH 5507 04:31:36,519 --> 04:31:39,155 C PAP. 5508 04:31:39,155 --> 04:31:42,459 AND TWO GROUPS WERE COUNSELED 5509 04:31:42,459 --> 04:31:44,694 TOWARD A WEIGHT LOSS 5510 04:31:44,694 --> 04:31:45,795 INTERVENTION WITH THE 5511 04:31:45,795 --> 04:31:52,001 MEDITERRANEAN DIET. 5512 04:31:52,001 --> 04:31:54,571 THE AUTHORS FOUND THAT A 5513 04:31:54,571 --> 04:31:57,540 LIFESTYLE INTERVENTION ON TOP OF 5514 04:31:57,540 --> 04:32:02,278 CPAP REDUCED THE APNEA -- EVEN 5515 04:32:02,278 --> 04:32:05,348 AFTER ADJUSTING FOR CHANGE IN 5516 04:32:05,348 --> 04:32:07,016 BODY WEIGHT SHOWING INDEPENDENT 5517 04:32:07,016 --> 04:32:11,688 EFFECT OF LIFESTYLE BEHAVIORS ON 5518 04:32:11,688 --> 04:32:18,294 THE SEVERITY. 5519 04:32:18,294 --> 04:32:20,830 ANOTHER STUDY EVALUATED A 5520 04:32:20,830 --> 04:32:23,199 MEDITERRANEAN DIET VERSUS A 5521 04:32:23,199 --> 04:32:27,470 LOW-FAT DIET AND RANDOMIZED 40 5522 04:32:27,470 --> 04:32:28,371 INDIVIDUALS. 5523 04:32:28,371 --> 04:32:31,808 ALL OF WHO WERE TREATED WITH 5524 04:32:31,808 --> 04:32:34,110 CPAP AND ADVICED TO WALK AT 5525 04:32:34,110 --> 04:32:34,978 LEAST 30 MINUTES PER DAY. 5526 04:32:34,978 --> 04:32:38,815 IN THIS STUDY THE PARTICIPANTS 5527 04:32:38,815 --> 04:32:40,416 RANDOMIZED TO THE MEDITERRANEAN 5528 04:32:40,416 --> 04:32:44,721 DIET GROUP, EXERCISED MORE AND 5529 04:32:44,721 --> 04:32:51,394 HAD GREATER REDUCTION IN THE 5530 04:32:51,394 --> 04:32:59,903 WAIST. 5531 04:32:59,903 --> 04:33:02,005 IT'S UNCLEAR IF THE EFFECT IS 5532 04:33:02,005 --> 04:33:07,644 INDEPENDENT IN CHANGES OF BODY 5533 04:33:07,644 --> 04:33:09,345 COMPOSITION AND OTHER LIFESTYLE 5534 04:33:09,345 --> 04:33:13,917 CHANGES. 5535 04:33:13,917 --> 04:33:16,586 ANOTHER STUDY EVALUATED HEALTHY 5536 04:33:16,586 --> 04:33:19,556 EATING AND PHYSICAL ACTIVITY 5537 04:33:19,556 --> 04:33:21,858 ADVICE. 5538 04:33:21,858 --> 04:33:28,798 SEVERITY --BOTH GROUPS TREATED 5539 04:33:28,798 --> 04:33:30,433 WITH CPAP. 5540 04:33:30,433 --> 04:33:33,570 ONE GROUP RECEIVING ADVICE. 5541 04:33:33,570 --> 04:33:37,106 ANOTHER GROUP RECEIVING MEDICINE 5542 04:33:37,106 --> 04:33:39,976 INTERVENTION THAT FOCUSED ON 5543 04:33:39,976 --> 04:33:42,879 KEEPING REGULAR FOOD HABITS AND 5544 04:33:42,879 --> 04:33:44,380 PHYSICAL ACTIVITY. 5545 04:33:44,380 --> 04:33:46,516 THIS WAS A PERSONALIZED INTEREST 5546 04:33:46,516 --> 04:33:47,784 CONVENIENCES IN THIS GROUP. 5547 04:33:47,784 --> 04:33:51,988 WE FOUND THAT MORE PARTICIPANTS 5548 04:33:51,988 --> 04:33:53,456 IMPROVED VERSUS THE CONTROLLED 5549 04:33:53,456 --> 04:33:55,892 GROUP AND THE ODDS OF 5550 04:33:55,892 --> 04:33:58,428 IMPROVEMENT WAS 4.5 FOR THE 5551 04:33:58,428 --> 04:33:59,929 INTERVENTION GROUP. 5552 04:33:59,929 --> 04:34:02,065 AGAIN HERE IT'S UNCLEAR WHAT 5553 04:34:02,065 --> 04:34:05,802 ASPECT OF THE BEHAVIORAL SLEEP 5554 04:34:05,802 --> 04:34:07,470 MEDICINE INTERVENTION LED TO THE 5555 04:34:07,470 --> 04:34:11,307 IMPROVEMENT IN OSA SEVERITY DUE 5556 04:34:11,307 --> 04:34:14,177 TO THE MULTI-DIMENSIONAL 5557 04:34:14,177 --> 04:34:16,746 ACTIVITY OF THIS INTERVENTION. 5558 04:34:16,746 --> 04:34:19,949 AND THIS LAST STUDY I'D LIKE TO 5559 04:34:19,949 --> 04:34:26,956 HIGHLIGHT EXAMINE THE PALEO 5560 04:34:26,956 --> 04:34:35,832 DIET. 5561 04:34:35,832 --> 04:34:40,203 ONLY TWO WAS TREATED WITH CPAP. 5562 04:34:40,203 --> 04:34:46,209 WOMEN WERE RANDOMIZED. 5563 04:34:46,209 --> 04:34:48,211 AND THEY FOLLOWED GROUP SESSIONS 5564 04:34:48,211 --> 04:34:50,213 WITH A DIETICIAN FOR THE FIRST 5565 04:34:50,213 --> 04:34:52,448 SIX MONTHS WITH A TWO-YEAR 5566 04:34:52,448 --> 04:34:53,416 FOLLOW-UP PERIOD. 5567 04:34:53,416 --> 04:34:55,852 THE WEIGHT LOSS WAS GREATER IN 5568 04:34:55,852 --> 04:34:58,955 THE PAL OHIO DIET GROUP AND THIS 5569 04:34:58,955 --> 04:35:03,026 WAS RELATED * TO THE CHANGE IN 5570 04:35:03,026 --> 04:35:04,761 THE INDEX. 5571 04:35:04,761 --> 04:35:06,863 BUT IN THE FOLLOW-UP PERIOD 5572 04:35:06,863 --> 04:35:08,765 THERE WAS NO DIFFERENCE BETWEEN 5573 04:35:08,765 --> 04:35:09,632 THE TWO GROUPS. 5574 04:35:09,632 --> 04:35:12,835 THE INVESTIGATORS FOUND THAT THE 5575 04:35:12,835 --> 04:35:16,839 REDUCTION IN AHI WAS MOSTLY 5576 04:35:16,839 --> 04:35:20,710 OBSERVED IN THOSE THAT LOST 5577 04:35:20,710 --> 04:35:23,246 8 KILOGRAMS OF BODY WEIGHT 5578 04:35:23,246 --> 04:35:27,717 REGARDLESS OF THE DIET. 5579 04:35:27,717 --> 04:35:30,586 AND SO AGAIN WE DON'T KNOW IF 5580 04:35:30,586 --> 04:35:31,921 THERE IS AN INDEPENDENT EFFECT 5581 04:35:31,921 --> 04:35:35,591 OF DIET ON ON STRUCK THE I HAVE 5582 04:35:35,591 --> 04:35:38,594 SLEEP APPEAR KNEE SEVERITY. 5583 04:35:38,594 --> 04:35:45,034 7 *. 5584 04:35:45,034 --> 04:35:47,937 THIS IS A FIGURE THAT WAS 5585 04:35:47,937 --> 04:35:51,240 PUBLISHED -- IN THE JOURNAL OF 5586 04:35:51,240 --> 04:35:53,042 CLINICAL SLEEP MEDICINE SHOWING 5587 04:35:53,042 --> 04:35:55,812 AN IMPACT OF HEALTHY LIFESTYLE 5588 04:35:55,812 --> 04:35:58,181 THROUGH HEALTHY DIET. 5589 04:35:58,181 --> 04:35:59,182 HAVING REGULAR PHYSICAL 5590 04:35:59,182 --> 04:36:00,817 ACTIVITY. 5591 04:36:00,817 --> 04:36:03,886 LOW ALCOHOL CONSUMPTION AND 5592 04:36:03,886 --> 04:36:04,187 NONSMOKING. 5593 04:36:04,187 --> 04:36:07,857 SO MOSTLY HAVING 5594 04:36:07,857 --> 04:36:11,160 ANTIINFLAMMATORY DIET OR OVER 5595 04:36:11,160 --> 04:36:12,628 HIGH DIETARY QUALITIEDING TO 5596 04:36:12,628 --> 04:36:15,798 REDUCED RISK OF CHRONIC DISEASE. 5597 04:36:15,798 --> 04:36:18,434 ALSO THROUGH REDUCTIONS IN 5598 04:36:18,434 --> 04:36:21,037 CHRONIC INFLAMMATION, INCREASED 5599 04:36:21,037 --> 04:36:23,139 MUSCLE MASS AND MUSCLE TONE 5600 04:36:23,139 --> 04:36:28,211 INCLUDING MUSCLES THAT KEEP THE 5601 04:36:28,211 --> 04:36:34,117 AIRWAY -- -- THAT CAN ALL LEAD 5602 04:36:34,117 --> 04:36:36,452 TO A REDUCTION IN SLEEP APNEA 5603 04:36:36,452 --> 04:36:37,754 RISK. 5604 04:36:37,754 --> 04:36:42,458 THESE AUTHORS FURTHER REPORTED 5605 04:36:42,458 --> 04:36:46,396 THAT INFLAMMATION IS RESPONSIBLE 5606 04:36:46,396 --> 04:36:48,031 FOR REMEDIATING. 5607 04:36:48,031 --> 04:36:50,166 IF YOU LOOK AT THE TWO TRIANGLES 5608 04:36:50,166 --> 04:36:53,770 IN THE MIDDLE -- THIS TENDS TO 5609 04:36:53,770 --> 04:36:55,872 MEDIATE ABOUT 25% OF THE 5610 04:36:55,872 --> 04:36:57,573 ASSOCIATION BETWEEN A HEALTHY 5611 04:36:57,573 --> 04:37:01,310 DIET AND SLEEP APNEA RISK AND TO 5612 04:37:01,310 --> 04:37:11,020 THE FAR RIGHT -- BMI MEDIATES -- 5613 04:37:11,020 --> 04:37:16,392 -- -- SO BEYOND OSA SEVERITY 5614 04:37:16,392 --> 04:37:18,261 OTHER HEALTH OUTCOMES ARE 5615 04:37:18,261 --> 04:37:20,063 IMPROVED BY CONSUMPTION OF A 5616 04:37:20,063 --> 04:37:23,566 HEALTHY DIET. 5617 04:37:23,566 --> 04:37:25,902 PARTICIPANTS WHO CONSUMED A 5618 04:37:25,902 --> 04:37:27,804 GREATER WHOLE FOOD PLANT BASED 5619 04:37:27,804 --> 04:37:35,778 DIET HAVE REDUCED SLEEPINESS. 5620 04:37:35,778 --> 04:37:39,949 PATIENTS WERE RANDOMIZED WITH 5621 04:37:39,949 --> 04:37:43,486 THE MEDITERRANEAN DIET HAVE 5622 04:37:43,486 --> 04:37:44,720 REDUCED INFLAMMATION AND 5623 04:37:44,720 --> 04:37:45,922 OXIDATIVE STRESS. 5624 04:37:45,922 --> 04:37:48,491 FOLLOWING A HEALTHY DIET WITHIN 5625 04:37:48,491 --> 04:37:52,161 THE CONTEXT OF OSA A TIN OOOH, 5626 04:37:52,161 --> 04:37:56,099 IT'S THE RISK OF DEPRESSION AND 5627 04:37:56,099 --> 04:37:59,001 ALL CAUSE MORTALITIES WITHIN 5628 04:37:59,001 --> 04:37:59,569 THESE INDIVIDUALS. 5629 04:37:59,569 --> 04:38:03,005 SO TO SUMMARIZE EPIDEMILOGICAL 5630 04:38:03,005 --> 04:38:04,707 STUDIES SUPPORT AN ASSOCIATION 5631 04:38:04,707 --> 04:38:06,442 BETWEEN HEALTHY DIETARY 5632 04:38:06,442 --> 04:38:09,112 PATTERNS. 5633 04:38:09,112 --> 04:38:10,780 CLINICAL INTERVENTION STUDIES 5634 04:38:10,780 --> 04:38:12,748 FURTHER ADDRESS CAUSALITY 5635 04:38:12,748 --> 04:38:18,988 SUGGESTING AN IMPACT OF DIETED. 5636 04:38:18,988 --> 04:38:21,157 AND LONG-TERM LIFESTYLE 5637 04:38:21,157 --> 04:38:24,460 MANAGEMENT OF OSA INCLUDING DIET 5638 04:38:24,460 --> 04:38:25,695 AND PHYSICAL ACTIVITY 5639 04:38:25,695 --> 04:38:27,163 RECOMMENDATIONS CAN IMPROVE 5640 04:38:27,163 --> 04:38:28,798 OTHER HEALTH PARAMETERS AND 5641 04:38:28,798 --> 04:38:31,501 SHOULD BE CONSIDERED IN A 5642 04:38:31,501 --> 04:38:32,401 CLINICAL MANAGEMENT OF THESE 5643 04:38:32,401 --> 04:38:38,074 BRAIN DISORDERS DURING SLEEP. 5644 04:38:38,074 --> 04:38:41,277 I WOULD ALSO LIKE TO END BY 5645 04:38:41,277 --> 04:38:44,147 ADDRESSING SOME -- HIGHLIGHTING 5646 04:38:44,147 --> 04:38:46,883 SOME RESEARCH GAPS. 5647 04:38:46,883 --> 04:38:50,653 WE NEED MORE CAUSAL EVIDENCE FOR 5648 04:38:50,653 --> 04:38:52,421 MECHANISTIC CLINICAL STUDIES AND 5649 04:38:52,421 --> 04:38:54,524 BASIC SCIENCE STUDIES TO ADDRESS 5650 04:38:54,524 --> 04:38:57,727 THE ROLE OF DIET ON SLEEP APNEA 5651 04:38:57,727 --> 04:39:01,063 USING ANIMAL MODELS -- 5652 04:39:01,063 --> 04:39:02,632 CONDUCTING STUDIES IN PATIENTS 5653 04:39:02,632 --> 04:39:05,134 WITH OSA. 5654 04:39:05,134 --> 04:39:07,803 BUT ALSO EVALUATING THE SEPARATE 5655 04:39:07,803 --> 04:39:10,673 IMPACT OF DIETARY QUALITY FROM 5656 04:39:10,673 --> 04:39:13,809 DIETARY QUANTITY. 5657 04:39:13,809 --> 04:39:15,611 SO DETERMINING WHETHER A DIETARY 5658 04:39:15,611 --> 04:39:18,481 PATTERN INFLUENCE OSA SEVERITY 5659 04:39:18,481 --> 04:39:20,349 INDEPENDENT OF CHANGE IN BODY 5660 04:39:20,349 --> 04:39:20,783 WEIGHT. 5661 04:39:20,783 --> 04:39:22,418 AND ALL OF THE SPEAKERS AGREE 5662 04:39:22,418 --> 04:39:25,988 THAT WE NEED TO BE EVALUATING 5663 04:39:25,988 --> 04:39:28,324 WHOLE FOODS AND WHOLE DIETARY 5664 04:39:28,324 --> 04:39:33,029 PATTERNS AS OPPOSED TO DIETARY 5665 04:39:33,029 --> 04:39:34,730 SUPPLEMENTS. 5666 04:39:34,730 --> 04:39:38,501 I ALSO WOULD LIKE TO HIGHLIGHT 5667 04:39:38,501 --> 04:39:44,874 ANOTHER AVENUE OF RESEARCH -- 5668 04:39:44,874 --> 04:39:48,277 CHRONO NUTRITION. 5669 04:39:48,277 --> 04:39:52,682 * MODERATING OR MODULATING 5670 04:39:52,682 --> 04:39:55,518 EVENING DIETARY INTAKE. 5671 04:39:55,518 --> 04:39:59,155 DETERMINING WHETHER IT HAS AN 5672 04:39:59,155 --> 04:40:01,757 IMPACT ON BREATHING DURING YOUR 5673 04:40:01,757 --> 04:40:04,427 SLEEP. 5674 04:40:04,427 --> 04:40:06,862 AND WITH THAT I WOULD LIKE TO 5675 04:40:06,862 --> 04:40:09,065 THANK YOU AND THE MEMBERS OF MY 5676 04:40:09,065 --> 04:40:11,400 LAB AND FUNDING AGENCIES FOR 5677 04:40:11,400 --> 04:40:12,902 SUPPORTING MY WORK. 5678 04:40:12,902 --> 04:40:15,538 >> THANK YOU FOR A WONDERFUL 5679 04:40:15,538 --> 04:40:16,539 TALK. 5680 04:40:16,539 --> 04:40:18,307 ACTUALLY STIMULATING WHEN YOU 5681 04:40:18,307 --> 04:40:20,176 TALK ABOUT SLEEPINESS. 5682 04:40:20,176 --> 04:40:22,011 THAT IS VERY HIGH PRAYS. 5683 04:40:22,011 --> 04:40:23,913 WE CAN MOVE INTO OUR PANEL 5684 04:40:23,913 --> 04:40:24,981 DISCUSSION. 5685 04:40:24,981 --> 04:40:27,416 SO IN THIS SESSION NUMBER THREE 5686 04:40:27,416 --> 04:40:29,819 WE'VE HEARD FROM FIVE SPEAKERS. 5687 04:40:29,819 --> 04:40:33,689 WHO HAVE TALKED ABOUT DISTINCT 5688 04:40:33,689 --> 04:40:36,359 ASPECTS THAT ARE RELATED TO 5689 04:40:36,359 --> 04:40:37,693 INTERACTIONS BETWEEN NUTRIENTS 5690 04:40:37,693 --> 04:40:41,130 AND EFFECTS ON THE RESPIRATORY 5691 04:40:41,130 --> 04:40:41,831 SYSTEM. 5692 04:40:41,831 --> 04:40:52,375 I SPOKE ABOUT THERAPEUTIC -- -- 5693 04:40:55,344 --> 04:40:56,946 AND SOME OF THE BENEFITS AND 5694 04:40:56,946 --> 04:40:59,815 MAYBE SOME OF THE POTENTIAL 5695 04:40:59,815 --> 04:41:01,484 CAVEATS ASSOCIATED WITH THEIR 5696 04:41:01,484 --> 04:41:03,019 USE. 5697 04:41:03,019 --> 04:41:06,689 DR. GOWDY TALKED ABOUT DHA AND 5698 04:41:06,689 --> 04:41:09,859 EPA BEING USED TO CREATE 5699 04:41:09,859 --> 04:41:12,161 PULMONARY -- LIPID LEVELS THAT 5700 04:41:12,161 --> 04:41:13,529 ARE PROTECTIVE IN A NUMBER OF 5701 04:41:13,529 --> 04:41:15,164 STATES. 5702 04:41:15,164 --> 04:41:18,034 MITIGATING OZONE INDUCED LUNG 5703 04:41:18,034 --> 04:41:19,969 INJURY. 5704 04:41:19,969 --> 04:41:23,005 BUT NOT ALTERING MARKERS OF LUNG 5705 04:41:23,005 --> 04:41:24,507 INJURY. 5706 04:41:24,507 --> 04:41:30,313 ALTERATIONS OF -- ACID AS A 5707 04:41:30,313 --> 04:41:31,180 COMPONENT. 5708 04:41:31,180 --> 04:41:32,181 SHE TALKED ABOUT THE IMPORTANCE 5709 04:41:32,181 --> 04:41:35,217 OF ALTERING THE PULMONARY 5710 04:41:35,217 --> 04:41:36,152 LIPIDOME. 5711 04:41:36,152 --> 04:41:39,955 AND THE POTENTIALS FOR USING 5712 04:41:39,955 --> 04:41:43,259 OMEGA 3 FATTY ACIDS AS A WAY TO 5713 04:41:43,259 --> 04:41:46,295 DO SO. 5714 04:41:46,295 --> 04:41:48,097 DR. NORDEGREN SPOKE ABOUT IMMUNE 5715 04:41:48,097 --> 04:41:48,764 FUNCTION. 5716 04:41:48,764 --> 04:41:52,101 THE IMPORTANCE OF CONSIDERING 5717 04:41:52,101 --> 04:41:56,972 MULTIPLE NUTRIENTS. 5718 04:41:56,972 --> 04:41:58,874 SOME WAYS THAT WE MIGHT BE ABLE 5719 04:41:58,874 --> 04:42:01,410 TO CHANGE OUR STUDY DESIGN IN 5720 04:42:01,410 --> 04:42:04,814 ORDER TO CONSIDER ASPECTS OF 5721 04:42:04,814 --> 04:42:07,116 ABSORBS OR METABOLISM. 5722 04:42:07,116 --> 04:42:09,218 THINKING ABOUT THE INDIVIDUAL 5723 04:42:09,218 --> 04:42:10,886 SUSCEPTIBILITIES THAT AT A 5724 04:42:10,886 --> 04:42:14,557 POPULATION LEVEL -- MAY AFFECT 5725 04:42:14,557 --> 04:42:17,193 THE EFFICACY OF THE DIFFERENT 5726 04:42:17,193 --> 04:42:18,761 NUTRIENTS AS A CONSEQUENCE OF 5727 04:42:18,761 --> 04:42:21,530 THEIR DIFFERENTIAL METABOLISM 5728 04:42:21,530 --> 04:42:23,966 AND PROVIDING AN OPPORTUNITY FOR 5729 04:42:23,966 --> 04:42:27,169 PRECISION BASED NUTRITIONAL 5730 04:42:27,169 --> 04:42:28,871 APPROACHES THAT COULD BE 5731 04:42:28,871 --> 04:42:29,705 INCORPORATED INTO FUTURE 5732 04:42:29,705 --> 04:42:31,240 RESEARCH STUDIES. 5733 04:42:31,240 --> 04:42:33,442 DR. PRAKASH BUDDE TALKED ABOUT 5734 04:42:33,442 --> 04:42:37,213 THE GUT LUNG AXIS AND SHORT 5735 04:42:37,213 --> 04:42:39,982 CHAIN FATTY ACIDS. 5736 04:42:39,982 --> 04:42:49,558 THEY CAN AFFORD PROTECTION. 5737 04:42:49,558 --> 04:42:57,533 AND DR. MARIE PIERRE -- 5738 04:42:57,533 --> 04:43:00,736 DIFFERENT STRATEGIES -- WITH 5739 04:43:00,736 --> 04:43:02,705 SLEEP APNEA. 5740 04:43:02,705 --> 04:43:05,341 COULD THERE BE A DIET. 5741 04:43:05,341 --> 04:43:07,309 LIKE WE HAVE A DASH DIET FOR 5742 04:43:07,309 --> 04:43:10,045 OTHER APPLICATIONS. 5743 04:43:10,045 --> 04:43:12,114 MEDITERRANEAN DIET APPEARS TO BE 5744 04:43:12,114 --> 04:43:17,286 PROTECTIVE. 5745 04:43:17,286 --> 04:43:19,855 AND I THOUGHT IT WAS INTERESTING 5746 04:43:19,855 --> 04:43:21,657 THAT SHE INCORPORATED OTHER 5747 04:43:21,657 --> 04:43:23,793 ASPECTS OF A HEALTHY LIFESTYLE 5748 04:43:23,793 --> 04:43:26,162 HAVE GREATER IMPACTS OVER-ALL. 5749 04:43:26,162 --> 04:43:28,964 ONE THING THAT I GOT OUT OF THE 5750 04:43:28,964 --> 04:43:30,433 FIVE TALKS THIS AFTERNOON AND 5751 04:43:30,433 --> 04:43:32,835 CONSIDERING MY OWN WORKING HOW 5752 04:43:32,835 --> 04:43:34,637 ESSENTIAL IT IS TO BE ABLE TO 5753 04:43:34,637 --> 04:43:38,474 INTEGRATE IN A 5754 04:43:38,474 --> 04:43:39,241 MULTI-DISCIPLINARY FASHION WITH 5755 04:43:39,241 --> 04:43:42,545 OTHER PEOPLE IN DIFFERENT 5756 04:43:42,545 --> 04:43:45,948 DISCIPLINES TO DO OUR WORK. 5757 04:43:45,948 --> 04:43:49,118 IN ORDER TO GENERATE THE DATA. 5758 04:43:49,118 --> 04:43:50,786 I'M SURE THAT OTHER PEOPLE HAVE 5759 04:43:50,786 --> 04:43:52,354 THE NEED AND THE OPPORTUNITY TO 5760 04:43:52,354 --> 04:43:54,123 WORK WITH OTHER INDIVIDUALS THAT 5761 04:43:54,123 --> 04:43:55,925 REALLY COMPLIMENT THEIR RESEARCH 5762 04:43:55,925 --> 04:43:57,693 PRODUCTIVITY AND I WONDER 5763 04:43:57,693 --> 04:43:59,128 WHETHER ONE OF THE THINGS THAT 5764 04:43:59,128 --> 04:44:01,931 THE NHLBI SHOULD CONSIDER IS 5765 04:44:01,931 --> 04:44:04,033 INTERACTING WITH OTHER 5766 04:44:04,033 --> 04:44:07,102 INSTITUTES IN ORDER TO SOLICIT 5767 04:44:07,102 --> 04:44:09,004 COMPETITIVE APPLICATION THAT'S 5768 04:44:09,004 --> 04:44:11,273 ADDRESS MULTIPLE ORGAN SYSTEMS. 5769 04:44:11,273 --> 04:44:14,810 I CAN THINK OF THE RESPIRATORY 5770 04:44:14,810 --> 04:44:16,812 THE ENDOCRINE AND PERHAPS OTHERS 5771 04:44:16,812 --> 04:44:19,915 THAT ARE IMPORTANT TO MOVE THIS 5772 04:44:19,915 --> 04:44:21,684 FIELD FORWARD. 5773 04:44:21,684 --> 04:44:24,019 I'LL SEND THAT OUT THERE TO 5774 04:44:24,019 --> 04:44:25,688 PANELIST TO DISCUSS INTEGRATING 5775 04:44:25,688 --> 04:44:28,123 OTHER DISCIPLINES AND OTHER 5776 04:44:28,123 --> 04:44:31,026 ORGAN SYSTEMS INTO THIS WORK 5777 04:44:31,026 --> 04:44:31,927 >> I'LL START. 5778 04:44:31,927 --> 04:44:35,564 I WILL SAY THAT WE WORK HAND IN 5779 04:44:35,564 --> 04:44:38,534 HAND WITH LIPID BIOCHEMIST AS 5780 04:44:38,534 --> 04:44:41,303 WELL AS NUTRITIONIST. 5781 04:44:41,303 --> 04:44:43,205 I WOULD BE LOST WITHOUT THEM SO 5782 04:44:43,205 --> 04:44:45,941 I FEEL LIKE THEIR EXPERTISE IS 5783 04:44:45,941 --> 04:44:46,575 INVALUABLE. 5784 04:44:46,575 --> 04:44:50,246 THE OFFICE OF DIETARY SUN 5785 04:44:50,246 --> 04:44:53,883 HEMEANT DOES HAVE THE 5786 04:44:53,883 --> 04:44:55,484 ADMINISTRATIVE SUN POLICEMENTS 5787 04:44:55,484 --> 04:44:57,720 WITH A GRANT 5788 04:44:57,720 --> 04:45:07,763 8 5789 04:45:17,473 --> 04:45:20,342 AND MAYBE I'LL CONTINUE. 5790 04:45:20,342 --> 04:45:31,420 YOU MENTIONE MENTION OH MI -- O- 5791 04:45:33,589 --> 04:45:35,724 DIFFERENT METABOLITES ON LUNG 5792 04:45:35,724 --> 04:45:36,125 HEALTH. 5793 04:45:36,125 --> 04:45:38,494 ESPECIALLY ONCE WE'RE ABLE TO 5794 04:45:38,494 --> 04:45:40,362 GENERATE IN THE PRECLINICAL 5795 04:45:40,362 --> 04:45:42,731 MODELS LARGE AMOUNTS OF DATA 5796 04:45:42,731 --> 04:45:44,500 COMING OUT OF THE LUNG AND THE 5797 04:45:44,500 --> 04:45:46,602 MICROBIOME AND MAKING SENSE OF 5798 04:45:46,602 --> 04:45:48,304 IT ALL TOGETHER IS VERY 5799 04:45:48,304 --> 04:45:51,607 CHALLENGING AND GETTING THAT 5800 04:45:51,607 --> 04:45:53,275 SUPPORT IS GOING TO BE VERY 5801 04:45:53,275 --> 04:45:56,378 IMPORTANT. 5802 04:45:56,378 --> 04:45:56,912 >> RIGHT. 5803 04:45:56,912 --> 04:45:57,479 THANK YOU. 5804 04:45:57,479 --> 04:46:01,984 APPRECIATE THAT. 5805 04:46:01,984 --> 04:46:05,354 RELATED COMMENTS TO THAT TOPIC. 5806 04:46:05,354 --> 04:46:08,891 >> I WILL JUST SAY THAT I 5807 04:46:08,891 --> 04:46:10,192 WHOLEHEARTEDLY AGREE. 5808 04:46:10,192 --> 04:46:13,963 SOMETIMES I FEEL LIKE 5809 04:46:13,963 --> 04:46:15,664 JACK-OF-ALL-TRADES. 5810 04:46:15,664 --> 04:46:17,967 EXPERT ON NONE. 5811 04:46:17,967 --> 04:46:22,471 I RELY HEAVILY ON MY COLLEAGUES 5812 04:46:22,471 --> 04:46:26,408 AND WORKING ON -- A QUESTION IN 5813 04:46:26,408 --> 04:46:28,310 SECLUSION THAT WE'RE NEVER GOING 5814 04:46:28,310 --> 04:46:31,180 TO SEE THE WHOLE BREATH OF THE 5815 04:46:31,180 --> 04:46:32,548 POTENTIAL OUTCOMES OF WHAT WE'RE 5816 04:46:32,548 --> 04:46:35,884 SEEING. 5817 04:46:35,884 --> 04:46:39,388 >> SINCE I'VE GOT YOU ON TARA 5818 04:46:39,388 --> 04:46:42,057 WOULD YOU BE WILLING TO TALK 5819 04:46:42,057 --> 04:46:47,997 MORE ABOUT POTENTIAL PRECISION 5820 04:46:47,997 --> 04:46:48,297 APPROACHES. 5821 04:46:48,297 --> 04:46:51,266 -- I DON'T KNOW IF 5822 04:46:51,266 --> 04:46:53,769 IMPLEMENTATION IS THE RIGHT 5823 04:46:53,769 --> 04:46:56,271 QUESTION TO ASK. 5824 04:46:56,271 --> 04:47:03,879 GENERATING COHORTS THAT ALLOW 5825 04:47:03,879 --> 04:47:05,581 US. 5826 04:47:05,581 --> 04:47:07,216 ENDO TYPING OF ASTHMA. 5827 04:47:07,216 --> 04:47:09,652 TAKING LARGE COHORTS AND 5828 04:47:09,652 --> 04:47:10,919 CONSTRAIN THEM SO WE CAN BETTER 5829 04:47:10,919 --> 04:47:13,255 UNDERSTAND WHERE WE MIGHT SEE 5830 04:47:13,255 --> 04:47:17,626 EFFICACY. 5831 04:47:17,626 --> 04:47:18,961 >> CERTAINLY I'LL START. 5832 04:47:18,961 --> 04:47:21,497 I THINK AND IT'S BEEN TALKED 5833 04:47:21,497 --> 04:47:22,731 ABOUT A LITTLE BIT THUS FAR IN 5834 04:47:22,731 --> 04:47:25,200 THE WORKSHOP THAT THINKING ABOUT 5835 04:47:25,200 --> 04:47:27,202 VULNERABLE POPULATIONS WHERE WE 5836 04:47:27,202 --> 04:47:29,204 KNOW THERE ARE CERTAIN FACTORS 5837 04:47:29,204 --> 04:47:31,940 THAT DO PREDISPOSE CERTAIN 5838 04:47:31,940 --> 04:47:35,477 POPULATIONS DO HAVE THESE POLLY 5839 04:47:35,477 --> 04:47:38,580 MORISMS THAT ARE ATTAR 5840 04:47:38,580 --> 04:47:41,216 REPRESENTATION. 5841 04:47:41,216 --> 04:47:44,119 SO * I COME FROM THE FATTY ACID 5842 04:47:44,119 --> 04:47:46,321 WORLD SO WE THINK ABOUT FOR 5843 04:47:46,321 --> 04:47:49,024 THOSE WHO MAY NOT HAVE AS GREAT 5844 04:47:49,024 --> 04:47:52,094 OF AN ABILITY TO METABOLIZE 5845 04:47:52,094 --> 04:47:57,766 FATTY ACIDS INTO THESE HELPFUL 5846 04:47:57,766 --> 04:48:00,202 LIPIDS SHOULD WE BE THINKING 5847 04:48:00,202 --> 04:48:05,274 ABOUT A DIETARY OR -- 5848 04:48:05,274 --> 04:48:09,311 SUPPLEMENTATION APPROACH. 5849 04:48:09,311 --> 04:48:14,683 OR PROVIDING THE ACTUAL . 5850 04:48:14,683 --> 04:48:17,653 I DO ABSOLUTELY THINK THAT 5851 04:48:17,653 --> 04:48:19,521 BYPASSERRING OUT WHERE THE 5852 04:48:19,521 --> 04:48:22,491 VULNERABILITY LIES IN TERMS OF 5853 04:48:22,491 --> 04:48:24,827 EFFICACY -- WE CAN GET A MORE 5854 04:48:24,827 --> 04:48:26,595 CLEAR UNDERSTANDING OF WHO IS 5855 04:48:26,595 --> 04:48:31,066 GOING TO BENEFIT FROM WHAT. 5856 04:48:31,066 --> 04:48:32,634 >> ADDRESSING THE ENDO TYPING 5857 04:48:32,634 --> 04:48:35,604 PART. 5858 04:48:35,604 --> 04:48:41,643 I-- WE STARTED TO ENDO TYPE INTO 5859 04:48:41,643 --> 04:48:43,679 DIFFERENT CATEGORIES LIKE SUB 5860 04:48:43,679 --> 04:48:45,914 TIGHTS THAT BEHAVE DIFFERENTLY 5861 04:48:45,914 --> 04:48:47,583 AND I WOULD BE SURPRISED IF 5862 04:48:47,583 --> 04:48:51,353 THERE WAS NOT A GUT LUNG AXIS TO 5863 04:48:51,353 --> 04:48:54,389 THAT TOO. 5864 04:48:54,389 --> 04:48:55,491 METABOLITES ARE ALSO 5865 04:48:55,491 --> 04:48:59,695 CONTRIBUTING TO SEPARATE OUT 5866 04:48:59,695 --> 04:49:02,231 PATHOPHYSIOLOGY OF WHAT WE THINK 5867 04:49:02,231 --> 04:49:06,435 OF UNIFIED DISEASES BUT ARE MANY 5868 04:49:06,435 --> 04:49:07,102 DIFFERENT SUBCATEGORIES. 5869 04:49:07,102 --> 04:49:09,037 IN TERMS OF THE MICROBIOME THERE 5870 04:49:09,037 --> 04:49:12,841 HAS BEEN WORK IN THE CRITICAL 5871 04:49:12,841 --> 04:49:17,813 CARE FIELD ABOUT DIFFERENT 5872 04:49:17,813 --> 04:49:19,381 COMPOSITIONS THAT ARE -- THAT 5873 04:49:19,381 --> 04:49:22,951 TRACK WITH SURVIVAL OR NOT 5874 04:49:22,951 --> 04:49:25,154 SURVIVAL IN CRITICAL CARE 5875 04:49:25,154 --> 04:49:27,389 CONDITIONS BUT NOT YET WITH 5876 04:49:27,389 --> 04:49:29,591 SPECIFIC LUNG DISEASES OTHER 5877 04:49:29,591 --> 04:49:31,927 THAN CONNECTED TO THESE 5878 04:49:31,927 --> 04:49:33,362 INDIVIDUAL METABOLITES THAT 5879 04:49:33,362 --> 04:49:34,863 MIGHT BE CONNECTED TO THEM. 5880 04:49:34,863 --> 04:49:36,999 I THINK THERE IS A LOT OF SCOPE 5881 04:49:36,999 --> 04:49:41,837 FOR THAT IN THE FUTURE. 5882 04:49:41,837 --> 04:49:44,540 >> DOES ANYONE CARE TO COMMENT 5883 04:49:44,540 --> 04:49:46,208 ON THE NOTION OF UPSETTING A 5884 04:49:46,208 --> 04:49:47,843 BALANCE. 5885 04:49:47,843 --> 04:49:50,078 WE'VE TALKED ABOUT MALNUTRITION. 5886 04:49:50,078 --> 04:49:52,014 UNDER AND OVER NUTRITION. 5887 04:49:52,014 --> 04:49:54,149 WE'VE TALKED ABOUT 5888 04:49:54,149 --> 04:49:56,485 ANTIINFLAMMATORY EFFECTS OF 5889 04:49:56,485 --> 04:49:58,287 DIETARY CONSTITUENTS. 5890 04:49:58,287 --> 04:50:00,589 THE IMMUNE SYSTEMS PLACED TO 5891 04:50:00,589 --> 04:50:02,825 BLAME FOR A LOT OF DISEASES 5892 04:50:02,825 --> 04:50:06,028 WHERE IT'S DOING ITS JOB THAT IS 5893 04:50:06,028 --> 04:50:06,795 NECESSARY UNDER OTHER 5894 04:50:06,795 --> 04:50:07,563 CONDITIONS. 5895 04:50:07,563 --> 04:50:10,332 AND SO I CAN THINK OF MY OWN 5896 04:50:10,332 --> 04:50:12,901 WORK PROFOUNDLY IMPAIRING THE 5897 04:50:12,901 --> 04:50:15,671 ABILITY TO GENERATE PROTECTIVE 5898 04:50:15,671 --> 04:50:20,275 IMMUNE RESPONSES IF WIELD HELD 5899 04:50:20,275 --> 04:50:21,143 INAPPROPRIATELY. 5900 04:50:21,143 --> 04:50:23,512 HAVE WE EXPERIENCED TIPPING THE 5901 04:50:23,512 --> 04:50:25,614 BALANCE TOO MUCH WHERE WE SEE 5902 04:50:25,614 --> 04:50:27,649 COMPROMISE INSTEAD OF BENEFIT 5903 04:50:27,649 --> 04:50:28,784 >> ABSOLUTELY. 5904 04:50:28,784 --> 04:50:33,088 >> I CAN SPEAK FROM OUR OWN WORK 5905 04:50:33,088 --> 04:50:35,324 WHERE WHEN WE GIVE HEAVY FIBER 5906 04:50:35,324 --> 04:50:38,627 DIETS TO MICE WE CAN BLUNT THE 5907 04:50:38,627 --> 04:50:40,829 STERILE IN PLANATION BUT IN 5908 04:50:40,829 --> 04:50:45,234 ONGOING WORK IT MIGHT WORSEN IN 5909 04:50:45,234 --> 04:50:49,805 INFECTION AND PNEUMONIA MODELS. 5910 04:50:49,805 --> 04:50:51,740 AGGRESSIVELY GOING AFTER ONE 5911 04:50:51,740 --> 04:50:57,412 SINGLE ASPECT MAY UNBALANCE IT. 5912 04:50:57,412 --> 04:50:59,014 >> I'LL AMEND TO THAT. 5913 04:50:59,014 --> 04:51:02,217 WE HAD STARTED OFF DOING SOME 5914 04:51:02,217 --> 04:51:05,654 FISH OIL AND COCONUT OIL 5915 04:51:05,654 --> 04:51:07,189 SUPPLEMENTED DIETS AND WHAT WE 5916 04:51:07,189 --> 04:51:13,262 WERE STARTING TO SEES A LOT OF 5917 04:51:13,262 --> 04:51:15,998 MACROPHAGES -- I DO FEEL LIKE 5918 04:51:15,998 --> 04:51:18,533 THERE IS A TIPPING POINT AS WELL 5919 04:51:18,533 --> 04:51:20,736 AS I DO THINK OUR BODIES ARE 5920 04:51:20,736 --> 04:51:21,637 SMART. 5921 04:51:21,637 --> 04:51:25,240 YOU OVER LOAD ON ONE THING IT'S 5922 04:51:25,240 --> 04:51:28,677 GOT TO KICK SOMETHING ELSE OUT. 5923 04:51:28,677 --> 04:51:31,313 AND THAT MIGHT HAVE ADVERSE 5924 04:51:31,313 --> 04:51:32,414 EFFECTS. 5925 04:51:32,414 --> 04:51:34,549 DR. NORDEGREN YOU MENTIONED LIKE 5926 04:51:34,549 --> 04:51:36,318 THE HOST DEFENSE ASPECT AND I 5927 04:51:36,318 --> 04:51:38,553 THOUGHT THAT WAS A KEY THING TO 5928 04:51:38,553 --> 04:51:40,322 THINK ABOUT. 5929 04:51:40,322 --> 04:51:42,024 ANTIINFLAMMATORY IS GREAT IN THE 5930 04:51:42,024 --> 04:51:45,327 CONTEXT OF COPD OR ASTHMA BUT IN 5931 04:51:45,327 --> 04:51:48,430 THE CONTEXT OF INFECTION IT 5932 04:51:48,430 --> 04:51:50,666 COULD GO THE OPPOSITE WAY SO THE 5933 04:51:50,666 --> 04:51:53,769 CONTEXT OF WHAT THE CHALLENGE IS 5934 04:51:53,769 --> 04:51:56,204 ALSO VERY IMPORTANT. 5935 04:51:56,204 --> 04:51:58,307 >> OF COURSE I ABSOLUTELY AGREE. 5936 04:51:58,307 --> 04:52:02,277 WHEN I GIVE A SEMINAR MY VERY 5937 04:52:02,277 --> 04:52:04,379 FIRST SLIDE IS ALWAYS A REMINDER 5938 04:52:04,379 --> 04:52:06,148 THAT INFLAMMATION IS A GOOD 5939 04:52:06,148 --> 04:52:06,682 THING. 5940 04:52:06,682 --> 04:52:08,383 BECAUSE IT'S IMPORTANT TO TAKE 5941 04:52:08,383 --> 04:52:10,652 CARE OF INJURY. 5942 04:52:10,652 --> 04:52:12,087 TAKING CARE OF PATHOGENIC 5943 04:52:12,087 --> 04:52:13,989 INSULT. 5944 04:52:13,989 --> 04:52:15,190 EVERYTHING IN BALANCE AND WE 5945 04:52:15,190 --> 04:52:17,192 KNEELED THE RIGHT QUANTITIES IN 5946 04:52:17,192 --> 04:52:18,994 ORDER TO WORK EFFECTIVELY AND 5947 04:52:18,994 --> 04:52:21,596 THINKING ABOUT WHAT I WAS SAYING 5948 04:52:21,596 --> 04:52:25,133 IN TERMS OF THINKING ABOUT THE 5949 04:52:25,133 --> 04:52:30,405 HOST PATHOGEN INTERFACE. 5950 04:52:30,405 --> 04:52:35,844 PATHOGENS UTILIZE HOST NUTRIENTS 5951 04:52:35,844 --> 04:52:37,679 TO INFECT AND I THINK IT'S 5952 04:52:37,679 --> 04:52:39,448 SOMETHING THAT WE DON'T OFTEN 5953 04:52:39,448 --> 04:52:41,350 THINK B. THERE ARE OTHER STUDIES 5954 04:52:41,350 --> 04:52:44,653 LOOKING AT THINGS LIKE THINKING 5955 04:52:44,653 --> 04:52:46,088 OF GREEN TEA AS SOMETHING THAT 5956 04:52:46,088 --> 04:52:48,223 IS VERY HEALTHY BUT WHEN YOU 5957 04:52:48,223 --> 04:52:51,093 GIVE HIGH DOSES THERE CAN BE 5958 04:52:51,093 --> 04:52:53,295 NEGATIVE THINGS. 5959 04:52:53,295 --> 04:52:56,264 SO THE ADAGE OF ALL THINGS IN 5960 04:52:56,264 --> 04:52:57,833 BALANCE ALL THINGS IN MODERATION 5961 04:52:57,833 --> 04:52:59,267 IS REALLY IMPORTANT TO THINK 5962 04:52:59,267 --> 04:53:00,268 ABOUT HERE. 5963 04:53:00,268 --> 04:53:02,804 EVEN WHEN YOU THINK ABOUT THE 5964 04:53:02,804 --> 04:53:06,708 RECEPTOR SIGNALING MECHANISM. 5965 04:53:06,708 --> 04:53:12,247 THESE ROXY LIP INS THEY HAVE -- 5966 04:53:12,247 --> 04:53:14,583 HIGH LEVELS CAN HAVE OFF TARGET 5967 04:53:14,583 --> 04:53:16,485 BINDING THAT CAN LEAD TO 5968 04:53:16,485 --> 04:53:18,720 NEGATIVE IMPACTS THAT WE DON'T 5969 04:53:18,720 --> 04:53:23,625 WANT TO HAPPEN. 5970 04:53:23,625 --> 04:53:26,294 >> THERE IS A QUESTION IN THE 5971 04:53:26,294 --> 04:53:31,767 CHAT FROM DR. -- BRIGHAM. 5972 04:53:31,767 --> 04:53:35,670 YOUR OPINION ON EMERGING 5973 04:53:35,670 --> 04:53:41,109 BIOMARKERS -- IN THE LONG HAUL. 5974 04:53:41,109 --> 04:53:43,979 >> I'M INTRIGUED BY SOME OF THE 5975 04:53:43,979 --> 04:53:46,415 DATA THAT I'VE SEEN. 5976 04:53:46,415 --> 04:53:49,217 THERE HAS BEEN SOME STUDIES OUT 5977 04:53:49,217 --> 04:53:51,353 OF ROCHESTER WHERE THEY'VE 5978 04:53:51,353 --> 04:53:55,957 LOOKED AT FATTY ACIDS AND I FEEL 5979 04:53:55,957 --> 04:53:58,860 LIKE THAT IS A NONINVASIVE 5980 04:53:58,860 --> 04:54:01,296 MEASUREMENT THAT WE KNOW HAS 5981 04:54:01,296 --> 04:54:03,665 SOME KIND OF TIE WITH LUNG 5982 04:54:03,665 --> 04:54:05,901 HEALTH THAT WE MIGHT BE ABLE TO 5983 04:54:05,901 --> 04:54:10,505 GET SOME MORE DIET DERIVED 5984 04:54:10,505 --> 04:54:11,907 INFORMATION OUT OF. 5985 04:54:11,907 --> 04:54:12,340 >> ABSOLUTELY. 5986 04:54:12,340 --> 04:54:14,876 THERE ARE SOME COMPANIES 5987 04:54:14,876 --> 04:54:16,111 MARKETING SOME OF THESE THINGS 5988 04:54:16,111 --> 04:54:17,646 DIRECTLY TO THE PUBLIC. 5989 04:54:17,646 --> 04:54:19,448 BUT THERE ALSO PEOPLE THAT ARE 5990 04:54:19,448 --> 04:54:21,483 STUDYING AT A RESEARCH LEVEL AND 5991 04:54:21,483 --> 04:54:26,054 I WOULD LOVE THAT THERE IS MORE 5992 04:54:26,054 --> 04:54:27,956 NONINVASIVE WAYS TO TRACK WHAT 5993 04:54:27,956 --> 04:54:38,366 IS GOING ON IN THE LUNG. 5994 04:54:40,535 --> 04:54:42,037 >> YOU SAID SOMETHING THAT 5995 04:54:42,037 --> 04:54:42,637 INTEREST ME. 5996 04:54:42,637 --> 04:54:44,039 THERE ARE COMPANIES THAT ARE 5997 04:54:44,039 --> 04:54:46,908 MARKETING TO PATIENTS OR 5998 04:54:46,908 --> 04:54:47,209 POPULATIONS. 5999 04:54:47,209 --> 04:54:49,044 I WONDER HOW MANY FOLKS HAVE 6000 04:54:49,044 --> 04:54:50,512 TAKEN ADVANTAGE OF THAT IN THEIR 6001 04:54:50,512 --> 04:54:52,047 OWN RESEARCH. 6002 04:54:52,047 --> 04:54:54,015 WE USE COMPOUNDS THAT ARE 6003 04:54:54,015 --> 04:54:57,486 MARKETED FOR WAYS THAT AS A 6004 04:54:57,486 --> 04:55:00,021 SCIENTIST I DON'T FEEL 6005 04:55:00,021 --> 04:55:00,789 COMFORTABLE ABOUT. 6006 04:55:00,789 --> 04:55:03,225 BUT THEY ARE THE SAME COMPOUNDS 6007 04:55:03,225 --> 04:55:06,161 YOU CAN BUY FROM SIGMA OR 6008 04:55:06,161 --> 04:55:06,795 SOMEWHERE ELSE. 6009 04:55:06,795 --> 04:55:10,232 A LOT OF PEOPLE THAT ARE BUYING 6010 04:55:10,232 --> 04:55:14,603 THOSE COMPOUNDS LIKE AT GNC. 6011 04:55:14,603 --> 04:55:17,005 I WONDER IF THOSE POPULATIONS 6012 04:55:17,005 --> 04:55:22,244 CAN BE A RESOURCE TO UNDERSTAND 6013 04:55:22,244 --> 04:55:24,880 OR IF THAT'S A WASTE OF TIME. 6014 04:55:24,880 --> 04:55:27,282 >> I DID LISTEN TO A TALK WHERE 6015 04:55:27,282 --> 04:55:30,552 THEY WERE -- THE DETAILS ESCAPE 6016 04:55:30,552 --> 04:55:31,086 ME. 6017 04:55:31,086 --> 04:55:32,787 THEY WERE STUDYING A COMPOUND 6018 04:55:32,787 --> 04:55:35,157 AND IT WAS USED IN PEOPLE WHO 6019 04:55:35,157 --> 04:55:37,993 ARE INTERESTED IN MUSCLE MASS 6020 04:55:37,993 --> 04:55:39,628 AND WEIGHT LIFTING. 6021 04:55:39,628 --> 04:55:41,763 THEY USED THAT INFORMATION TO 6022 04:55:41,763 --> 04:55:44,099 ACTUALLY GET MORE UNDERSTANDING 6023 04:55:44,099 --> 04:55:46,067 OF THE EFFECTS OF THOSE 6024 04:55:46,067 --> 04:55:47,736 COMPOUNDS. 6025 04:55:47,736 --> 04:55:49,738 THAT IS DEFINITELY A VERY 6026 04:55:49,738 --> 04:55:59,080 INTERESTING WAY TO GO. 6027 04:55:59,080 --> 04:56:01,683 >> ANY THOUGHTS ABOUT EXTENDING 6028 04:56:01,683 --> 04:56:03,485 PRECLINICAL MODELS BEYOND WHERE 6029 04:56:03,485 --> 04:56:05,687 WE ARE AT RIGHT NOW? 6030 04:56:05,687 --> 04:56:07,255 MOUSE WORK. 6031 04:56:07,255 --> 04:56:14,196 SOME SPOKE ABOUT HUMAN STUDIES. 6032 04:56:14,196 --> 04:56:19,601 DURING COVID -- ANY OTHER 6033 04:56:19,601 --> 04:56:20,502 ALTERNATIVES THAT NEED TO BE 6034 04:56:20,502 --> 04:56:21,636 CONSIDERED WITH MODEL 6035 04:56:21,636 --> 04:56:23,138 DEVELOPMENT? 6036 04:56:23,138 --> 04:56:24,739 AND WE CAN GO IN THE OTHER 6037 04:56:24,739 --> 04:56:25,207 DIRECTION. 6038 04:56:25,207 --> 04:56:26,808 THINK ABOUT SOMETHING THAT IS A 6039 04:56:26,808 --> 04:56:29,878 LITTLE LESS REFINED THAN AN 6040 04:56:29,878 --> 04:56:31,279 INTACT ANIMAL. 6041 04:56:31,279 --> 04:56:35,016 CHIP CULTURES OR MULTI-ORGAN 6042 04:56:35,016 --> 04:56:38,687 APPROACHES WHERE YOU CAN MODEL 6043 04:56:38,687 --> 04:56:44,159 -- POLLY CARBONATE A GUT LUNG 6044 04:56:44,159 --> 04:56:48,296 AXIS OR LIVER LUNG AXIS 6045 04:56:48,296 --> 04:56:50,799 >> AT LEAST WE'VE GOT A 6046 04:56:50,799 --> 04:56:53,268 COLLABORATOR THAT IS DOING SOME 6047 04:56:53,268 --> 04:56:55,704 -- MEMBRANES. 6048 04:56:55,704 --> 04:56:59,874 YOU CAN SEE HOW THE MEMBRANE 6049 04:56:59,874 --> 04:57:01,610 ASSEMBLES BASED ON WHAT IS IN 6050 04:57:01,610 --> 04:57:02,544 THE MIXTURE. 6051 04:57:02,544 --> 04:57:06,648 WE'VE BEEN ABLE TO RECAPITULATE 6052 04:57:06,648 --> 04:57:10,318 -- SO I THINK SOME OF THOSE NOT 6053 04:57:10,318 --> 04:57:14,089 LOWER MODELS BUT DO HAVE UTILITY 6054 04:57:14,089 --> 04:57:16,725 AND CAN BE VERY PREDICTIVE OF 6055 04:57:16,725 --> 04:57:18,326 WHAT SOME OF THE PRECLINICAL 6056 04:57:18,326 --> 04:57:24,232 MODELS MIGHT SHOW. 6057 04:57:24,232 --> 04:57:27,035 >> KEEPING WITH THE PRECLINICAL 6058 04:57:27,035 --> 04:57:32,407 IN VIVO MODELS -- TO A MORE 6059 04:57:32,407 --> 04:57:38,513 REFLECT WHAT IS BEING ABSORBED 6060 04:57:38,513 --> 04:57:41,650 IN THE GUT. 6061 04:57:41,650 --> 04:57:43,418 THAT HAS BEEN AN INTERESTING 6062 04:57:43,418 --> 04:57:47,722 PLACE TO BE LOOKING AT -- THE 6063 04:57:47,722 --> 04:57:49,057 DIFFERENT METABOLITES THAT ARE 6064 04:57:49,057 --> 04:57:50,225 GETTING THROUGH. 6065 04:57:50,225 --> 04:57:52,727 BECAUSE I THINK I FORGOT WHO 6066 04:57:52,727 --> 04:57:54,929 MENTIONED -- -- AS WELL BECAUSE 6067 04:57:54,929 --> 04:57:57,499 IT DOES NOT GET OUT INTO 6068 04:57:57,499 --> 04:57:59,501 CIRCULATION AS WELL BECAUSE IT 6069 04:57:59,501 --> 04:58:00,902 GETS ABSORBED. 6070 04:58:00,902 --> 04:58:06,541 BUT ASSAY DOES AND I THINK 6071 04:58:06,541 --> 04:58:07,776 SAMPLING THESE DIFFERENT SOURCES 6072 04:58:07,776 --> 04:58:10,312 IS GOING TO BE AN IMPORTANT WAY 6073 04:58:10,312 --> 04:58:12,380 TO UNDERSTAND WHAT GETS WHERE. 6074 04:58:12,380 --> 04:58:16,051 AND ALSO THEN SEEING LIKE WHAT 6075 04:58:16,051 --> 04:58:17,719 THE EXHALE IN THE BREATH 6076 04:58:17,719 --> 04:58:25,260 REFLECTS WHAT IS GOING ON. 6077 04:58:25,260 --> 04:58:27,362 I'M CURIOUS MORE ABOUT THE 6078 04:58:27,362 --> 04:58:28,563 PERSONALIZED APPROACH. 6079 04:58:28,563 --> 04:58:31,132 BECAUSE I CAN IMAGINE IN THE 6080 04:58:31,132 --> 04:58:32,600 NEAR FUTURE PATIENTS WHO ARE 6081 04:58:32,600 --> 04:58:34,703 GETTING DIFFERENT KINDS OF 6082 04:58:34,703 --> 04:58:36,671 SURGERIES INCLUDING LUNG SURGERY 6083 04:58:36,671 --> 04:58:39,174 -- WE MIGHT GIVE THEM DIFFERENT 6084 04:58:39,174 --> 04:58:42,477 DIETS THAT MIGHT HELP SUPPORT 6085 04:58:42,477 --> 04:58:47,649 THEIR LUNG HEALTH PRIOR TO -- 6086 04:58:47,649 --> 04:58:48,650 THE SURGERY. 6087 04:58:48,650 --> 04:58:53,054 BUT HOW DO WE HAVE PERSONALIZED? 6088 04:58:53,054 --> 04:58:56,191 WHAT ARE WE USING AS THE READ 6089 04:58:56,191 --> 04:58:56,591 OUT? 6090 04:58:56,591 --> 04:58:58,593 WE CAN TRY DIFFERENT THINGS BUT 6091 04:58:58,593 --> 04:59:03,098 WHAT IS -- OUR -- WHETHER THE 6092 04:59:03,098 --> 04:59:07,702 LUNGS OR BETTER ARE NOT. 6093 04:59:07,702 --> 04:59:12,440 PFDs -- I'M JUST CURIOUS IF 6094 04:59:12,440 --> 04:59:14,876 PEOPLE HAVE THOUGHT MORE ABOUT 6095 04:59:14,876 --> 04:59:17,011 PERSONALIZED DIETS FOR LUNG 6096 04:59:17,011 --> 04:59:24,085 HEALTH WHAT THEIR THOUGHTS ARE. 6097 04:59:24,085 --> 04:59:27,422 >> I WOULD SAY WE'RE NOT DOING 6098 04:59:27,422 --> 04:59:29,224 SO MUCH OF THE PERSONALIZED WITH 6099 04:59:29,224 --> 04:59:32,093 DIET BUT AT LEAST SOME OF THE 6100 04:59:32,093 --> 04:59:33,561 SNIPS ASSOCIATED WITH RESPECT 6101 04:59:33,561 --> 04:59:36,030 LIPID METABOLISM AND TRYING TO 6102 04:59:36,030 --> 04:59:38,233 LOOK AT SEVERITY OF LUNG 6103 04:59:38,233 --> 04:59:38,767 DISEASE. 6104 04:59:38,767 --> 04:59:42,203 SO I IMAGINE THAT COULD BE 6105 04:59:42,203 --> 04:59:46,040 EXTRAPOLATED TO DIET. 6106 04:59:46,040 --> 04:59:49,911 A LOT OF THESE SNIPS ARE RARE. 6107 04:59:49,911 --> 04:59:51,780 BUT I THINK IT POINTS TO THE 6108 04:59:51,780 --> 04:59:54,249 FACT THAT WE ALL HAVE THE 6109 04:59:54,249 --> 04:59:56,451 POTENTIAL TO METABOLIZE THINGS 6110 04:59:56,451 --> 04:59:58,319 DIFFERENTLY. 6111 04:59:58,319 --> 05:00:01,122 >> AND TO ADD TO THAT POINT -- 6112 05:00:01,122 --> 05:00:04,159 WHAT YOU HAD MENTIONED ABOUT HOW 6113 05:00:04,159 --> 05:00:07,028 DIFFERENT ENVIRONMENTAL FACTORS 6114 05:00:07,028 --> 05:00:09,164 CAN ALSO FURTHER IMPACT OUR 6115 05:00:09,164 --> 05:00:14,302 ABILITY TO METABOLIZE. 6116 05:00:14,302 --> 05:00:16,971 MAYBE IT'S THE OTHER 6117 05:00:16,971 --> 05:00:18,640 CO-EXPOSURES AND TO ADD THIS 6118 05:00:18,640 --> 05:00:20,742 ADDITIONAL LEVEL OF COMPLEXITY I 6119 05:00:20,742 --> 05:00:22,343 KNOW THIS IS NOT HELPING AT ALL 6120 05:00:22,343 --> 05:00:26,314 BUT THIS MORNING IN THE FIRST 6121 05:00:26,314 --> 05:00:30,285 SESSION TALKING ABOUT WE DON'T 6122 05:00:30,285 --> 05:00:31,953 KNOW HOW LONG SOME OF THESE 6123 05:00:31,953 --> 05:00:33,054 THINGS TAKE. 6124 05:00:33,054 --> 05:00:36,157 SO CHOOSING THESE OUTCOMES AND 6125 05:00:36,157 --> 05:00:37,725 DURATION OF DIETS AND THINGS 6126 05:00:37,725 --> 05:00:40,094 LIKE THAT IS GOING TO BE VERY 6127 05:00:40,094 --> 05:00:40,895 TRICKY. 6128 05:00:40,895 --> 05:00:43,565 AND WE DO NEED TO BE VERY 6129 05:00:43,565 --> 05:00:45,567 CAREFUL TO POWER I GUESS IN A 6130 05:00:45,567 --> 05:00:47,669 WAY POWER OUR STUDIES TO BE ABLE 6131 05:00:47,669 --> 05:00:50,638 TO DETECT THESE DIFFERENCES SO 6132 05:00:50,638 --> 05:00:54,609 THAT WE AREN'T BLOCKED BY 6133 05:00:54,609 --> 05:00:57,579 SEEMINGLY NULL EFFECTS BECAUSE 6134 05:00:57,579 --> 05:00:59,113 DOSES ARE NOT RIGHT. 6135 05:00:59,113 --> 05:01:01,449 TIMING IS NOT RIGHT SO IN THE 6136 05:01:01,449 --> 05:01:03,885 CONTEXT OF CHANGING DIET I DON'T 6137 05:01:03,885 --> 05:01:06,321 THINK WE HAVE ENOUGH DATA TO 6138 05:01:06,321 --> 05:01:08,890 KNOW OR TO ANSWER YOUR QUESTION. 6139 05:01:08,890 --> 05:01:12,026 >> I'D LIKE TO ADD TO THAT TARA. 6140 05:01:12,026 --> 05:01:15,330 IT'S IMPORTANT TO KNOW IF OUR 6141 05:01:15,330 --> 05:01:17,298 PARTICIPANTS ARE * ADHERING TO 6142 05:01:17,298 --> 05:01:20,969 THE DIET THAT WE'RE PRESCRIBING. 6143 05:01:20,969 --> 05:01:22,637 THERE HAVE BEEN NO CONTROLLED 6144 05:01:22,637 --> 05:01:25,206 FEEDING EXPERIMENTS THAT 6145 05:01:25,206 --> 05:01:28,076 ACTUALLY GIVE INDIVIDUALS FOODS 6146 05:01:28,076 --> 05:01:30,778 OF FIXED AMOUNTS TO ENSURE THAT 6147 05:01:30,778 --> 05:01:32,180 THEY DON'T CHANGE IN WEIGHT. 6148 05:01:32,180 --> 05:01:35,617 TO ENSURE THEY ARE EATING THE 6149 05:01:35,617 --> 05:01:38,653 DIETARY PROFILE SPECIFICALLY. 6150 05:01:38,653 --> 05:01:41,122 THERE IS ALSO RANDOMIZED 6151 05:01:41,122 --> 05:01:42,457 CROSSOVER DESIGN WHERE 6152 05:01:42,457 --> 05:01:43,925 INDIVIDUALS SERVE AS THEIR OWN 6153 05:01:43,925 --> 05:01:47,128 CONTROL SO WE COULD EVALUATE THE 6154 05:01:47,128 --> 05:01:50,298 IMPACT OF ONE DIET VERSUS 6155 05:01:50,298 --> 05:01:51,232 ANOTHER DIET. 6156 05:01:51,232 --> 05:01:55,937 SO I THINK ADHERENCE IS KEY. 6157 05:01:55,937 --> 05:01:56,571 DURATIONS KEY. 6158 05:01:56,571 --> 05:01:58,907 BUT IF WE'RE DOING CONTROLLED 6159 05:01:58,907 --> 05:02:01,242 DIETS WE CANNOT DO THESE 6160 05:02:01,242 --> 05:02:02,310 FOREVER. 6161 05:02:02,310 --> 05:02:03,811 BUT IN THE CONTEXT OF A 6162 05:02:03,811 --> 05:02:05,346 CONTROLLED DIET YOU'RE MORE 6163 05:02:05,346 --> 05:02:07,248 CERTAIN OF WHAT YOU'RE GETTING 6164 05:02:07,248 --> 05:02:08,816 IN TERMS OF THE CHANGE IN 6165 05:02:08,816 --> 05:02:11,352 DIETARY PROFILE AND THAT MAY 6166 05:02:11,352 --> 05:02:16,057 LEAD TO MORE ROBUST EFFECT SIZES 6167 05:02:16,057 --> 05:02:26,234 IN THE END. 6168 05:02:26,234 --> 05:02:34,676 >> DR. MA -- -- DO WE HAVE 6169 05:02:34,676 --> 05:02:36,244 SOMETHING THAT PEOPLE MIGHT WANT 6170 05:02:36,244 --> 05:02:37,845 TO STAY ON LONG-TERM 6171 05:02:37,845 --> 05:02:39,814 >> THAT IS A GREAT QUESTION. 6172 05:02:39,814 --> 05:02:44,586 NOT NECESSARILY IN PULMONARY -- 6173 05:02:44,586 --> 05:02:45,019 DISEASE. 6174 05:02:45,019 --> 05:02:48,890 BUT AS WE HEARD OUR COLLEAGUES 6175 05:02:48,890 --> 05:02:51,092 IN OTHER CLINICAL AREAS IN TERMS 6176 05:02:51,092 --> 05:02:52,994 OF CARDIOVASCULAR DISEASE 6177 05:02:52,994 --> 05:02:54,796 PREVENTION AND CONTROL AND 6178 05:02:54,796 --> 05:02:56,564 METABOLIC DISEASE AREA AS WELL 6179 05:02:56,564 --> 05:02:59,200 THEY'VE DONE THE WORK TO LOOK AT 6180 05:02:59,200 --> 05:03:02,003 IMPACT OF DIFFERENT DIETARY 6181 05:03:02,003 --> 05:03:04,772 PATTERNS SUCH AS STASH AND IN 6182 05:03:04,772 --> 05:03:09,611 TERMS OF DASH AND HYPERTENSION 6183 05:03:09,611 --> 05:03:10,979 PREVENTION AND CONTROL OF COURSE 6184 05:03:10,979 --> 05:03:17,051 -- THERE ARE EFFICACY TRIALS 6185 05:03:17,051 --> 05:03:19,153 DEMONSTRATING -- AND ALSO 6186 05:03:19,153 --> 05:03:23,124 LONG-TERM STUDIES THAT ALSO 6187 05:03:23,124 --> 05:03:26,761 DEMONSTRATED THE SUSTAINED 6188 05:03:26,761 --> 05:03:29,931 EFFECTS. 6189 05:03:29,931 --> 05:03:37,005 I THINK -- THE POINTS THAT -- 6190 05:03:37,005 --> 05:03:39,440 WERE MADE -- THE LONG-TERM 6191 05:03:39,440 --> 05:03:41,542 EFFECTS -- THAT IS VERY MUCH 6192 05:03:41,542 --> 05:03:44,512 WELL TAKEN AND WE NEED TO -- 6193 05:03:44,512 --> 05:03:47,582 FULLY LOOK AT THOSE RESEARCH 6194 05:03:47,582 --> 05:03:50,218 QUESTIONS SPECIFICALLY IN THE 6195 05:03:50,218 --> 05:03:54,322 CONTEXT OF THE LONG HAUL AND THE 6196 05:03:54,322 --> 05:03:54,756 DISEASE. 6197 05:03:54,756 --> 05:03:57,959 I WANT TO TAKE THE CONVERSATION 6198 05:03:57,959 --> 05:04:03,231 TO REALLY ASK THE PANEL, THROUGH 6199 05:04:03,231 --> 05:04:06,668 YOUR PRESENTATIONS YOU TOUCHED 6200 05:04:06,668 --> 05:04:09,671 ON SEVERAL IMPORTANT MECHANISTIC 6201 05:04:09,671 --> 05:04:10,438 PATHWAYS. 6202 05:04:10,438 --> 05:04:12,540 YOU TALKED ABOUT THE IMPORTANCE 6203 05:04:12,540 --> 05:04:14,842 OF ENERGY CONTROL. 6204 05:04:14,842 --> 05:04:17,712 AND IN PARTICULAR IN TERMS OF 6205 05:04:17,712 --> 05:04:20,114 THERAPEUTIC KETOSIS AND SEVERAL 6206 05:04:20,114 --> 05:04:22,150 SPEAKERS FROM DIFFERENT ASPECTS 6207 05:04:22,150 --> 05:04:24,686 TALKED ABOUT INFLAMMATION 6208 05:04:24,686 --> 05:04:27,155 CONTROL AND THEN YOU TALKED 6209 05:04:27,155 --> 05:04:32,393 ABOUT CIRCADIAN CONTROL AND OSA 6210 05:04:32,393 --> 05:04:35,163 AS A SPECIFIC CONDITION. 6211 05:04:35,163 --> 05:04:36,864 IF YOU HAVE OPPORTUNITY TO THINK 6212 05:04:36,864 --> 05:04:38,533 ABOUT RESEARCH FRAMEWORK WHERE 6213 05:04:38,533 --> 05:04:41,736 YOU COULD TAKE AN INTEGRATIVE 6214 05:04:41,736 --> 05:04:43,838 APPROACH TO THINK ABOUT THESE 6215 05:04:43,838 --> 05:04:47,475 DIFFERENT MECHANISTIC PATHWAYS 6216 05:04:47,475 --> 05:04:49,477 SPECIFICALLY IN THE CONTEXT OF 6217 05:04:49,477 --> 05:04:53,014 THIS WORKSHOP IN RELATION TO 6218 05:04:53,014 --> 05:04:56,651 RESPIRATORY HEART AND DISEASE -- 6219 05:04:56,651 --> 05:05:03,257 HOW YOU MIGHT CONCEPTUALIZE -- 6220 05:05:03,257 --> 05:05:07,895 FOCUSING ON MECHANISTIC 6221 05:05:07,895 --> 05:05:09,764 INVESTIGATIONS TO MAKE A REAL 6222 05:05:09,764 --> 05:05:14,302 IMPACT IN ADVANCING THE RESEARCH 6223 05:05:14,302 --> 05:05:17,905 ON NUTRITION ON LONG HALL 6224 05:05:17,905 --> 05:05:19,140 PREVENTION. 6225 05:05:19,140 --> 05:05:21,042 >> I CAN THINK OF MULTIPLE 6226 05:05:21,042 --> 05:05:21,676 RESEARCH QUESTIONS. 6227 05:05:21,676 --> 05:05:24,679 THERE IS A QUESTION OF DIET 6228 05:05:24,679 --> 05:05:25,880 QUALITY. 6229 05:05:25,880 --> 05:05:29,617 AND THEN DIET QUANTITY AND THEN 6230 05:05:29,617 --> 05:05:30,618 DIETARY TIMING. 6231 05:05:30,618 --> 05:05:34,055 SO WE CAN ADDRESS ALL OF THESE 6232 05:05:34,055 --> 05:05:36,924 QUESTIONS WITH CONTROLLED 6233 05:05:36,924 --> 05:05:38,926 EXPERIMENTS SO -- PROVIDING A 6234 05:05:38,926 --> 05:05:43,798 CONTROLLED DIET WHERE WITH A 6235 05:05:43,798 --> 05:05:45,233 COMPARISON DIET WHERE BOTH DIETS 6236 05:05:45,233 --> 05:05:47,802 ARE PROVIDED IN WEIGHT 6237 05:05:47,802 --> 05:05:49,270 MAINTENANCE QUANTITIES SO YOU 6238 05:05:49,270 --> 05:05:52,373 TAKE OUT THE IMPACT OR CHANGE IN 6239 05:05:52,373 --> 05:05:54,475 BODY COMPOSITION WHERE BOTH 6240 05:05:54,475 --> 05:05:57,011 DIETS ARE PROVIDED WITHIN THE 6241 05:05:57,011 --> 05:05:58,946 SAME TIMING SO YOU TAKE THAT OUT 6242 05:05:58,946 --> 05:06:01,082 OF THE EQUATION AS WELL. 6243 05:06:01,082 --> 05:06:03,518 SO YOU CAN REALLY ZONE IN ON 6244 05:06:03,518 --> 05:06:05,953 DIET QUALITY AND IS THAT VERY 6245 05:06:05,953 --> 05:06:06,888 IMPORTANT. 6246 05:06:06,888 --> 05:06:08,823 THEN OTHER ISSUES YOU CAN LOOK 6247 05:06:08,823 --> 05:06:09,257 AT. 6248 05:06:09,257 --> 05:06:11,859 WITHIN THE CONTEXT OF A SINGLE 6249 05:06:11,859 --> 05:06:13,761 DIET IS IT IMPORTANT WHEN FOODS 6250 05:06:13,761 --> 05:06:17,064 ARE BEING CONSUMED AND THEN 6251 05:06:17,064 --> 05:06:19,901 SHIFT THE TIMING OF DIETARY 6252 05:06:19,901 --> 05:06:20,201 CONSUMPTION. 6253 05:06:20,201 --> 05:06:22,904 YOU CAN FIX A DIET AND CHANGE 6254 05:06:22,904 --> 05:06:24,305 QUANTITIES. 6255 05:06:24,305 --> 05:06:26,440 IS IT THE WEIGHT LOSS THAT IS 6256 05:06:26,440 --> 05:06:30,144 MOST RELEVANT. 6257 05:06:30,144 --> 05:06:32,280 ARE WE GOING TO HAVE AN 6258 05:06:32,280 --> 05:06:33,614 INDEPENDENT EFFECT ON OUR 6259 05:06:33,614 --> 05:06:43,324 OUTCOMES. 6260 05:06:43,324 --> 05:06:45,626 >> IT WOULD BE REALLY NICE IF WE 6261 05:06:45,626 --> 05:06:49,597 HAD SOME NONINVASIVE EASILY 6262 05:06:49,597 --> 05:06:52,033 ACCOMPLISHABLE ASSESSMENT OF 6263 05:06:52,033 --> 05:06:53,935 MULTIPLE END POINTS THAT ARE 6264 05:06:53,935 --> 05:06:54,602 COMPLIMENTARY. 6265 05:06:54,602 --> 05:06:58,005 SO WHEN WE'VE GOT SOMEONE 6266 05:06:58,005 --> 05:07:03,211 LOOKING AT A CARDIOVASCULAR END 6267 05:07:03,211 --> 05:07:05,746 POINT AND ONE AT A PULMONARY END 6268 05:07:05,746 --> 05:07:07,415 POINT. 6269 05:07:07,415 --> 05:07:11,385 MULTIPLE END POINTS FROM A 6270 05:07:11,385 --> 05:07:13,721 SUBJECT SO WE DON'T HAVE TO 6271 05:07:13,721 --> 05:07:17,825 REPEAT THE SAME EXPERIMENTS. 6272 05:07:17,825 --> 05:07:17,959 8 6273 05:07:17,959 --> 05:07:20,194 >> TO MAKE SURE WE KNOW BASELINE 6274 05:07:20,194 --> 05:07:22,263 LEVELS. 6275 05:07:22,263 --> 05:07:24,799 ESPECIALLY WHEN IT COMES TO 6276 05:07:24,799 --> 05:07:25,800 INFLAMMATION. 6277 05:07:25,800 --> 05:07:27,268 UNDERSTANDING WHAT THEIR CHANGE 6278 05:07:27,268 --> 05:07:31,205 IS MIGHT BE IMPORTANT. 6279 05:07:31,205 --> 05:07:33,507 >> TWO QUESTIONS IN THE CHAT. 6280 05:07:33,507 --> 05:07:40,848 ONE WAS ABOUT THE USE OF -- ANY 6281 05:07:40,848 --> 05:07:42,116 THOUGHTS FROM ANY OF THE 6282 05:07:42,116 --> 05:07:52,293 PANELISTS? 6283 05:08:00,468 --> 05:08:03,771 >> ANOTHER QUESTION -- IN THE 6284 05:08:03,771 --> 05:08:06,774 COMBINES OF DIETARY CHANGES 6285 05:08:06,774 --> 05:08:09,110 AFFECTING PULMONARY INFLAMMATION 6286 05:08:09,110 --> 05:08:12,813 IN DISEASES LIKE ASTHMA 6287 05:08:12,813 --> 05:08:15,016 >> THERE IS EVIDENCE THAT THE 6288 05:08:15,016 --> 05:08:18,152 AGONIST AUGMENT KETONE BODY 6289 05:08:18,152 --> 05:08:20,121 CONCENTRATIONS AND THOSE CAN 6290 05:08:20,121 --> 05:08:23,090 DECREASE PRO INFLAMMATORY EVENT. 6291 05:08:23,090 --> 05:08:30,298 AND EVEN -- SEE QUAIL COVID-19. 6292 05:08:30,298 --> 05:08:32,833 THERE IS A HUGE POPULATION OF 6293 05:08:32,833 --> 05:08:33,734 INDIVIDUALS ON THESE. 6294 05:08:33,734 --> 05:08:35,436 NOW WHAT IS NORMAL? 6295 05:08:35,436 --> 05:08:37,772 WE NEED TO CONSIDER OBESITY AS 6296 05:08:37,772 --> 05:08:39,740 THE NORMAL GOING INTO TRIALS. 6297 05:08:39,740 --> 05:08:42,777 WE NEED TO CONSIDER WHAT ARE THE 6298 05:08:42,777 --> 05:08:43,678 MEDICATIONS THAT OTHER 6299 05:08:43,678 --> 05:08:45,479 INDIVIDUALS ARE ON AS WELL. 6300 05:08:45,479 --> 05:08:50,651 SO THAT PROVIDES BOTH AN 6301 05:08:50,651 --> 05:08:52,453 OBLIGATION AND OPPORTUNITY TO 6302 05:08:52,453 --> 05:08:53,654 INCORPORATE THAT. 6303 05:08:53,654 --> 05:08:55,122 WE'RE GOING TO BE ASKING 6304 05:08:55,122 --> 05:08:56,691 OURSELVES CAN WE TREAT A 6305 05:08:56,691 --> 05:08:57,591 PARTICULAR CONDITION WHERE 6306 05:08:57,591 --> 05:09:00,328 INDIVIDUALS ARE ALREADY ON -- 6307 05:09:00,328 --> 05:09:01,228 MEDICATIONS FOR THEM. 6308 05:09:01,228 --> 05:09:05,366 WHETHER IN THE CASE OF ASTHMA. 6309 05:09:05,366 --> 05:09:09,303 WHAT IMPACT DOES DIET HAVE ON 6310 05:09:09,303 --> 05:09:12,173 THE USE OF THOSE MEDICATIONS. 6311 05:09:12,173 --> 05:09:15,576 THE BARIATRIC SURGERY HAS A 6312 05:09:15,576 --> 05:09:21,749 BENEFICIAL IMPACT ON THE 6313 05:09:21,749 --> 05:09:31,258 REDUCTION OF USING THOSE. 6314 05:09:31,258 --> 05:09:33,794 BUT I THINK THAT THE COMMINGLING 6315 05:09:33,794 --> 05:09:36,330 OF MECHANISMS BY THE 6316 05:09:36,330 --> 05:09:38,366 THERAPEUTICS THAT PEOPLE ARE 6317 05:09:38,366 --> 05:09:39,934 ALREADY ON IS AN IMPORTANT 6318 05:09:39,934 --> 05:09:40,868 CONSIDERATION. 6319 05:09:40,868 --> 05:09:43,070 >> ALSO LOOK AT INCIDENT OF 6320 05:09:43,070 --> 05:09:44,638 THESE DIFFERENT CONDITIONS IN 6321 05:09:44,638 --> 05:09:46,874 THOSE POPULATIONS ONCE THEY GET 6322 05:09:46,874 --> 05:09:47,508 LARGE ENOUGH. 6323 05:09:47,508 --> 05:09:51,712 PEOPLE ARE TAKING -- IN THE 6324 05:09:51,712 --> 05:09:54,682 INSTANCE OF ASTHMA AND COPD AND 6325 05:09:54,682 --> 05:09:58,552 IF YOU HAVE A LARGE ENOUGH 6326 05:09:58,552 --> 05:09:59,220 SAMPLE SIZE 6327 05:09:59,220 --> 05:10:01,822 >> INFLUENCED BY WEIGHT STATUS. 6328 05:10:01,822 --> 05:10:06,327 SO THESE -- AGONIST LEADING TO 6329 05:10:06,327 --> 05:10:09,196 WEIGHT LOSS WOULD HAVE A 6330 05:10:09,196 --> 05:10:11,332 BENEFICIAL EFFECT ON OSA 6331 05:10:11,332 --> 05:10:12,500 SEVERITY. 6332 05:10:12,500 --> 05:10:15,403 >> I DO THINK THAT IT WOULD BE 6333 05:10:15,403 --> 05:10:19,507 INTERESTING TO CONSIDER THESE 6334 05:10:19,507 --> 05:10:20,608 GOP1s. 6335 05:10:20,608 --> 05:10:24,879 IN CO-MORBIDITIES THAT MAY NOT 6336 05:10:24,879 --> 05:10:29,850 BE LUNG RELATED. 6337 05:10:29,850 --> 05:10:35,423 SO I FEEL LIKE YOU HAVE THIS YEN 6338 05:10:35,423 --> 05:10:41,629 AND -- YANG EFFECT. 6339 05:10:41,629 --> 05:10:44,198 THIS GIVES US AN IDEA THAT THERE 6340 05:10:44,198 --> 05:10:46,400 MIGHT BE SOME MORE GOING ON -- 6341 05:10:46,400 --> 05:10:48,736 THAT MIGHT HAVE SOME OFF TARGET 6342 05:10:48,736 --> 05:10:50,438 MECHANISMS THAT WE'RE NOT AWARE 6343 05:10:50,438 --> 05:10:51,405 OF. 6344 05:10:51,405 --> 05:10:54,708 >> I WAS WONDERING IF THERE IS 6345 05:10:54,708 --> 05:10:56,343 AN INDIVIDUAL IN SLEEP QUALITY 6346 05:10:56,343 --> 05:10:59,680 AND FOLKS THAT DON'T HAVE OSA? 6347 05:10:59,680 --> 05:11:03,584 >> I'M NOT AWARE OF ANY STUDIES. 6348 05:11:03,584 --> 05:11:05,886 >> LOW DOSE ASPIRIN. 6349 05:11:05,886 --> 05:11:10,191 IS THERE SUCH A BENEFIT OF A LOW 6350 05:11:10,191 --> 05:11:16,397 DOSE -- AGONIST. 6351 05:11:16,397 --> 05:11:17,965 >> -- SIDE EFFECTS. 6352 05:11:17,965 --> 05:11:21,268 SOME OF THOSE MAY ADVERSELY 6353 05:11:21,268 --> 05:11:22,403 IMPACT SLEEP IF YOU THINK ABOUT 6354 05:11:22,403 --> 05:11:23,737 IT. 6355 05:11:23,737 --> 05:11:25,840 LONG-TERM -- ONCE THOSE SUBSIDE 6356 05:11:25,840 --> 05:11:28,542 WOULD BE INTERESTING TO KNOW HOW 6357 05:11:28,542 --> 05:11:29,844 THAT INFLUENCES SLEEP. 6358 05:11:29,844 --> 05:11:30,711 SURE. 6359 05:11:30,711 --> 05:11:32,613 >> I WAS WONDERFUL WHAT THE 6360 05:11:32,613 --> 05:11:42,823 G-- WONDERINGWHAT THE GROUP THIE 6361 05:11:42,823 --> 05:11:45,926 COULD GET A BETTER SENSE OF WHAT 6362 05:11:45,926 --> 05:11:47,061 INDIVIDUAL PATIENTS OR 6363 05:11:47,061 --> 05:11:48,829 INDIVIDUALS ARE ACTUALLY EATING 6364 05:11:48,829 --> 05:11:51,499 USING EVERYONE HAS GOT A 6365 05:11:51,499 --> 05:11:53,267 SMARTPHONE IN THEIR POCKET. 6366 05:11:53,267 --> 05:11:56,137 MAYBE TAKING A PHOTO OF EVERY 6367 05:11:56,137 --> 05:11:59,473 MEAL THAT THEY EAT AND THEN 6368 05:11:59,473 --> 05:12:02,543 USING SOME KIND -- YOU CAN TAKE 6369 05:12:02,543 --> 05:12:06,514 A PICTURE OF SOMETHING AND 6370 05:12:06,514 --> 05:12:08,415 ESTIMATE HOW MUCH THERE IS OF 6371 05:12:08,415 --> 05:12:10,751 WHATEVER DIETARY COMPONENT 6372 05:12:10,751 --> 05:12:11,986 YOU'RE INTERESTED IN AND USE 6373 05:12:11,986 --> 05:12:14,755 THAT AS A WAY TO GET A BETTER 6374 05:12:14,755 --> 05:12:16,657 SENSE OF WHAT IS GOING INTO THE 6375 05:12:16,657 --> 05:12:26,800 SYSTEM. 6376 05:12:27,201 --> 05:12:29,003 >> I CAN SAY I KNOW THERE ARE 6377 05:12:29,003 --> 05:12:32,139 FOLKS WORKING ON THESE KIND OF 6378 05:12:32,139 --> 05:12:32,640 APPS. 6379 05:12:32,640 --> 05:12:34,008 THERE ARE STRATEGIES FOR TRYING 6380 05:12:34,008 --> 05:12:37,411 TO ESTIMATE TOTAL QUANTITIES. 6381 05:12:37,411 --> 05:12:42,883 WHERE THE ABILITY TO BE -- 6382 05:12:42,883 --> 05:12:44,485 ESPECIALLY ACCURATE FALLS DOWN 6383 05:12:44,485 --> 05:12:47,254 IS REALLY UNDERSTANDING -- JUST 6384 05:12:47,254 --> 05:12:50,257 AS AN EXAMPLE IF SOMEBODY IS 6385 05:12:50,257 --> 05:12:52,893 EATING MASHED POTATOES IS IT 6386 05:12:52,893 --> 05:12:55,129 MADE WITH CREAM OR -- 6387 05:12:55,129 --> 05:12:58,299 UNDERSTANDING THE TRUE DIETARY. 6388 05:12:58,299 --> 05:12:59,934 THOSE ARE SOME OF THE 6389 05:12:59,934 --> 05:13:00,234 LIMITATIONS. 6390 05:13:00,234 --> 05:13:02,570 WITH THE PICTURE APP BASED 6391 05:13:02,570 --> 05:13:04,471 APPROACHES BUT I THINK IT COULD 6392 05:13:04,471 --> 05:13:08,075 BE SO POWERFUL. 6393 05:13:08,075 --> 05:13:10,611 THAT COULD REALLY HELP WITH SOME 6394 05:13:10,611 --> 05:13:12,313 OF THESE QUESTIONS. 6395 05:13:12,313 --> 05:13:13,847 >> GIVE US INFORMATION ON 6396 05:13:13,847 --> 05:13:16,283 TIMING. 6397 05:13:16,283 --> 05:13:17,184 >> YEAH: 6398 05:13:17,184 --> 05:13:19,386 >> THEY STILL REQUIRE MUCH USER 6399 05:13:19,386 --> 05:13:20,254 INPUT. 6400 05:13:20,254 --> 05:13:23,190 WHO KNOWS HOW MUCH BUTTER OR 6401 05:13:23,190 --> 05:13:26,060 SALT WERE IN THE MASHED POTATOES 6402 05:13:26,060 --> 05:13:27,628 SO GETTING INPUT FROM THE USER 6403 05:13:27,628 --> 05:13:30,431 IS STILL NEEDED AT THIS POINT. 6404 05:13:30,431 --> 05:13:36,237 >> IF I MAY CHIME IN -- WE DO 6405 05:13:36,237 --> 05:13:42,076 HAVE AN APP THAT IS USED IN 20 6406 05:13:42,076 --> 05:13:45,512 DIFFERENT TRIALS CALLED MY 6407 05:13:45,512 --> 05:13:46,280 CIRCADIAN CLOCK. 6408 05:13:46,280 --> 05:13:52,453 IF YOU LOOK AT INSTAGRAM 6409 05:13:52,453 --> 05:13:54,388 PICTURES WE HAVE UNDERESTIMATE 6410 05:13:54,388 --> 05:13:57,224 HOW PEOPLE ARE ADDICTED TO 6411 05:13:57,224 --> 05:14:00,294 TAKING PICTURES OF WHAT THEY 6412 05:14:00,294 --> 05:14:00,894 EAT. 6413 05:14:00,894 --> 05:14:05,633 YOU CAN GET METADATA. 6414 05:14:05,633 --> 05:14:09,737 THE CHALLENGE IS -- SOME CAN GET 6415 05:14:09,737 --> 05:14:13,774 LOST IN HOW MUCH SUGAR OR SALT. 6416 05:14:13,774 --> 05:14:16,210 WHETHER ROCK SALT OR SEA TAUGHT. 6417 05:14:16,210 --> 05:14:23,417 IF YOU K -- SALT. 6418 05:14:23,417 --> 05:14:26,720 MASHED POTATO OR BROCCOLI. 6419 05:14:26,720 --> 05:14:30,958 THAT WOULD HAVE A HUGE IMPACT. 6420 05:14:30,958 --> 05:14:32,793 I GUESS WE ALSO HAVE TO FIGURE 6421 05:14:32,793 --> 05:14:39,300 OUT -- IF WE HAVE THE SEVEN DAYS 6422 05:14:39,300 --> 05:14:42,536 OF DATA THAT IS WAY MUCH BETTER 6423 05:14:42,536 --> 05:14:52,946 BECAUSE YOU GET FINER DETAIL -- 6424 05:14:52,946 --> 05:14:57,384 -- ACTUALLY TOMORROW AFTERNOON 6425 05:14:57,384 --> 05:15:00,954 I'LL SHARE SOME OF OUR -- 6426 05:15:00,954 --> 05:15:04,425 PUBLISHED DATA USING THIS APP. 6427 05:15:04,425 --> 05:15:08,729 WE HAVE COLLECTED SEVERAL 6428 05:15:08,729 --> 05:15:14,101 MILLIONS OF THE PICTURES. 6429 05:15:14,101 --> 05:15:17,838 HOPEFULLY I CAN SHARE SOME OF 6430 05:15:17,838 --> 05:15:21,442 THE STRENGTHS AND WEAKNESSES. 6431 05:15:21,442 --> 05:15:23,344 RIGHT NOW YOU CAN PUT ANY FOOD 6432 05:15:23,344 --> 05:15:26,513 PICTURE. 6433 05:15:26,513 --> 05:15:31,919 AND THEY EXTRACT -- VERY CLOSE 6434 05:15:31,919 --> 05:15:35,222 TO WHAT A DIETICIAN WOULD 6435 05:15:35,222 --> 05:15:36,423 EXTRACT. 6436 05:15:36,423 --> 05:15:38,425 THESE PICTURES ARE IMPROVING AND 6437 05:15:38,425 --> 05:15:42,429 IF WE GET PEOPLE HOOKED TO AN 6438 05:15:42,429 --> 05:15:44,431 APP THEY ARE READY TO SHARE A 6439 05:15:44,431 --> 05:15:49,303 LOT OF INFORMATION. 6440 05:15:49,303 --> 05:15:50,637 >> I THINK THAT IS A GREAT 6441 05:15:50,637 --> 05:15:51,438 POINT. 6442 05:15:51,438 --> 05:15:54,842 THIS WORK ALLOWS US TO GET THAT 6443 05:15:54,842 --> 05:15:57,811 LONGITUDINAL DATA. 6444 05:15:57,811 --> 05:16:00,681 AND WITH YOU KNOW -- SO MUCH 6445 05:16:00,681 --> 05:16:04,551 MORE BEING ON-LINE AND THESE 6446 05:16:04,551 --> 05:16:07,421 DAYS I THINK THAT IT REALLY IS 6447 05:16:07,421 --> 05:16:09,590 POTENTIALLY A POWERFUL TOOL. 6448 05:16:09,590 --> 05:16:11,592 WE SHOULD NOT GET COMPLETELY 6449 05:16:11,592 --> 05:16:14,395 CAUGHT UP IN THE WEEDS OF WHAT 6450 05:16:14,395 --> 05:16:16,397 THE OBSTACLES ARE BUT IT HAS A 6451 05:16:16,397 --> 05:16:18,532 LOT OF POTENTIAL 6452 05:16:18,532 --> 05:16:20,334 >> AND EVEN PROVIDING FOOD 6453 05:16:20,334 --> 05:16:23,203 INFORMATION -- YOU CAN TRACK 6454 05:16:23,203 --> 05:16:25,305 ACTUALLY WHEN YOU EXERCISE WHEN 6455 05:16:25,305 --> 05:16:28,842 YOU WENT TO BED WHEN YOU WOKE UP 6456 05:16:28,842 --> 05:16:31,412 -- WHEN YOU DRANK BEVERAGE 6457 05:16:31,412 --> 05:16:32,546 ANNUALS SO YOU CAN HAVE 6458 05:16:32,546 --> 05:16:37,284 INFORMATION ON ALL OF THESE 6459 05:16:37,284 --> 05:16:43,190 BEHAVIORS AT ONCE CAN GIVE YOU 6460 05:16:43,190 --> 05:16:48,529 INSIGHT. 6461 05:16:48,529 --> 05:16:51,064 >> CLEARLY I THINK THERE ARE 6462 05:16:51,064 --> 05:16:52,499 CONSISTENT THEMES THAT ARE 6463 05:16:52,499 --> 05:16:54,067 COMING THROUGH DIFFERENT TALKS 6464 05:16:54,067 --> 05:16:55,035 WE'VE HAD TODAY. 6465 05:16:55,035 --> 05:16:57,438 I THINK OF TWO WORDS. 6466 05:16:57,438 --> 05:17:00,541 7 COMPLEXITY AND PET GET NEAR 6467 05:17:00,541 --> 05:17:03,076 TEE. 6468 05:17:03,076 --> 05:17:13,420 -- PET GET NEAR TEE. 6469 05:17:13,954 --> 05:17:13,954 -- 6470 05:17:16,156 --> 05:17:22,329 HETEROGENEITY. 6471 05:17:22,329 --> 05:17:29,837 YOU TALKED ABOUT HOW -- 6472 05:17:29,837 --> 05:17:32,439 [ INDISCERNIBLE ] 6473 05:17:32,439 --> 05:17:33,240 MECHANISMs WHERE WE HAVE SOME 6474 05:17:33,240 --> 05:17:35,542 EVIDENCE. 6475 05:17:35,542 --> 05:17:37,644 YOU SEE THEY MIGHT, 6476 05:17:37,644 --> 05:17:42,816 CROSSCUTTING. 6477 05:17:42,816 --> 05:17:45,052 BE CONSISTENT MECHANISMS 6478 05:17:45,052 --> 05:17:48,155 UNDERLYING DIFFERENT NUTRIENTS 6479 05:17:48,155 --> 05:17:50,591 WHERE MAYBE THEY ARE A CANDIDATE 6480 05:17:50,591 --> 05:17:53,927 TO METABOLIZE IF WE CAN CREATE A 6481 05:17:53,927 --> 05:17:57,598 PANEL THAT MIGHT BE A POTENTIAL 6482 05:17:57,598 --> 05:18:03,103 INDICATOR OF DIET QUALITY FROM A 6483 05:18:03,103 --> 05:18:05,739 METABOLIC SPECIAL EXPECTATIVE. 6484 05:18:05,739 --> 05:18:09,743 -- PERSPECTIVE. 6485 05:18:09,743 --> 05:18:12,045 >> MAYBE I CAN START. 6486 05:18:12,045 --> 05:18:14,615 THERE IS DEFINITELY AN IDEA OF 6487 05:18:14,615 --> 05:18:17,985 THE COMPOSITION IN TERMS OF THE 6488 05:18:17,985 --> 05:18:18,819 BACTERIAS INTERESTING BUT MAY 6489 05:18:18,819 --> 05:18:20,687 NOT BE AS IMPORTANT AS WHAT THEY 6490 05:18:20,687 --> 05:18:22,556 ARE DOING. 6491 05:18:22,556 --> 05:18:24,558 SO CAN HAVE METABOLIC OUTPUT 6492 05:18:24,558 --> 05:18:29,730 THAT CAN COME FROM -- DIFFERENT 6493 05:18:29,730 --> 05:18:30,731 MEMBERS OF THE MICROBIOME 6494 05:18:30,731 --> 05:18:32,499 COMMUNITY. 6495 05:18:32,499 --> 05:18:34,902 SO EACH -- IT MAY BE MORE 6496 05:18:34,902 --> 05:18:36,403 IMPORTANT WHAT THEY ARE MAKING 6497 05:18:36,403 --> 05:18:39,907 AND WHAT THE BODY IS ABSORBING 6498 05:18:39,907 --> 05:18:42,442 THAN WHO'S ACTUALLY PRESENT. 6499 05:18:42,442 --> 05:18:43,110 BUT YEAH. 6500 05:18:43,110 --> 05:18:45,646 I THINK THAT IS ONE WAY OF 6501 05:18:45,646 --> 05:18:49,516 TRYING TO UNDERSTAND -- WHAT IS 6502 05:18:49,516 --> 05:18:57,424 IMPORTANT IN THE GUT LUNG AXIS. 6503 05:18:57,424 --> 05:19:01,662 >> I THINK I WOULD JUST SAY THAT 6504 05:19:01,662 --> 05:19:05,165 I HAVE A REALLY HARD TIME 6505 05:19:05,165 --> 05:19:07,067 PINPOINTING ONE THING OR A PANEL 6506 05:19:07,067 --> 05:19:08,802 OF THINGS. 6507 05:19:08,802 --> 05:19:10,704 WE'VE TRIED AND ONCE AGAIN LIKE 6508 05:19:10,704 --> 05:19:12,940 CERTAINLY VERY USEFUL MEASURES 6509 05:19:12,940 --> 05:19:18,011 OR INDEXES OF SYSTEMIC 6510 05:19:18,011 --> 05:19:20,747 INFLAMMATION AND FROM A LARGER 6511 05:19:20,747 --> 05:19:21,982 STANDPOINT THOSE CAN BE VERY 6512 05:19:21,982 --> 05:19:22,916 USEFUL. 6513 05:19:22,916 --> 05:19:25,419 BUT I ALSO THINK THAT WE NEED TO 6514 05:19:25,419 --> 05:19:27,988 BE CAREFUL ABOUT HOW WE 6515 05:19:27,988 --> 05:19:30,090 INTERPRET ANY DATASET THAT IS 6516 05:19:30,090 --> 05:19:32,326 LOOKING AT ONE CLASS OF 6517 05:19:32,326 --> 05:19:33,860 MEDIATORS. 6518 05:19:33,860 --> 05:19:35,195 OR SOMETHING LIKE THAT. 6519 05:19:35,195 --> 05:19:37,965 7 THE EXAMPLE THAT I'LL USE ONCE 6520 05:19:37,965 --> 05:19:42,736 AGAIN -- IS THESE OMEGA THREE 6521 05:19:42,736 --> 05:19:45,672 ROXY LIP INS. 6522 05:19:45,672 --> 05:19:48,442 WE ITO MAKING 53s AND THEN WE 6523 05:19:48,442 --> 05:19:51,912 HAVE A BETTER CAPACITY TO CREATE 6524 05:19:51,912 --> 05:19:54,081 THESE AND THEY ARE GOOD AND 6525 05:19:54,081 --> 05:19:56,083 PROTECTIVE AND WE'LL HAVE 6526 05:19:56,083 --> 05:19:57,517 REDUCED INFLAMMATION. 6527 05:19:57,517 --> 05:20:01,188 BUT THESE ARE ORIGINAL PRODUCED 6528 05:20:01,188 --> 05:20:03,357 IN SUBSTANTIAL LEVELS WHEN THERE 6529 05:20:03,357 --> 05:20:08,762 IS AN INFLAMMATORY INSULT. 6530 05:20:08,762 --> 05:20:11,865 SO THEIR ABILITY TO GO UPS 6531 05:20:11,865 --> 05:20:12,966 CRITICALLY IMPORTANT. 6532 05:20:12,966 --> 05:20:15,068 SO WE MIGHT SEE THEM AND 6533 05:20:15,068 --> 05:20:18,071 IDENTIFY THEM AS A MARKER OF 6534 05:20:18,071 --> 05:20:19,640 INFLAMMATION AND THEY WOULD GET 6535 05:20:19,640 --> 05:20:21,341 A BAD RAP. 6536 05:20:21,341 --> 05:20:23,577 WE NEED TO BE REALLY CAREFUL AND 6537 05:20:23,577 --> 05:20:25,812 I DON'T KNOW THAT I FEEL 6538 05:20:25,812 --> 05:20:28,015 COMFORTABLE SAYING THERE IS ONE 6539 05:20:28,015 --> 05:20:30,450 PANEL TO SAY THIS IS HEALTH 6540 05:20:30,450 --> 05:20:32,252 VERSUS THIS IS DISEASE. 6541 05:20:32,252 --> 05:20:36,223 >> MAYBE CONNECTED ALSO TO WHAT 6542 05:20:36,223 --> 05:20:37,891 MATTHEW WAS SAYING BEFORE WHICH 6543 05:20:37,891 --> 05:20:39,760 IS ABOUT ENERGY. 6544 05:20:39,760 --> 05:20:42,429 I STARTED THINKING MORE ABOUT 6545 05:20:42,429 --> 05:20:44,331 WHAT IS THE ENERGY STATE OF THE 6546 05:20:44,331 --> 05:20:47,200 LUNG MAYBE MORE THAN INDIVIDUAL 6547 05:20:47,200 --> 05:20:47,501 METABOLITES. 6548 05:20:47,501 --> 05:20:49,569 IF WE CAN GET A SENSE OF HOW THE 6549 05:20:49,569 --> 05:20:53,140 LUNG IS USING INPUTS TO GENERATE 6550 05:20:53,140 --> 05:20:54,808 ENERGY THAT COULD TELL US MORE 6551 05:20:54,808 --> 05:20:57,344 ABOUT HOW IT MIGHT -- HOW 6552 05:20:57,344 --> 05:20:59,880 HEALTHY IT MIGHT BE OR HOW IT 6553 05:20:59,880 --> 05:21:03,617 MIGHT RESPOND TO INJURY OR 6554 05:21:03,617 --> 05:21:04,418 INFECTION FOR EXAMPLE. 6555 05:21:04,418 --> 05:21:07,821 AND SO I THINK -- THAT COULD BE 6556 05:21:07,821 --> 05:21:11,024 ANOTHER APPROACH RATHER THAN 6557 05:21:11,024 --> 05:21:12,859 FOCUSING ON SPECIFIC 6558 05:21:12,859 --> 05:21:13,527 METABOLITES. 6559 05:21:13,527 --> 05:21:16,196 THE COMBINES OF THEM IS WHAT 6560 05:21:16,196 --> 05:21:19,299 MATTERS AND GETTING AND 6561 05:21:19,299 --> 05:21:26,740 UNDERSTANDING THE COMBINATION -- 6562 05:21:26,740 --> 05:21:28,875 IT IS DIFFICULT. 6563 05:21:28,875 --> 05:21:30,877 WHAT IT IS DOING TO THE LUNG AND 6564 05:21:30,877 --> 05:21:34,748 SECONDARY TO THAT THE LUNG IS 6565 05:21:34,748 --> 05:21:37,417 NOT GENERALLY ONE HOMOGENEOUS 6566 05:21:37,417 --> 05:21:38,385 ACTIVITY. 6567 05:21:38,385 --> 05:21:40,387 IT'S SUBSEGMENTS THAT DO 6568 05:21:40,387 --> 05:21:44,091 DIFFERENT THINGS SO THAT ADDS TO 6569 05:21:44,091 --> 05:21:45,892 THE INCREDIBLE COMPLEXITY. 6570 05:21:45,892 --> 05:21:48,361 SO MUCH TO BE UNDERSTOOD AND 6571 05:21:48,361 --> 05:21:50,397 DISCOVERED HERE. 6572 05:21:50,397 --> 05:21:53,467 >> I THINK YOUR POINT TAKEN TO 6573 05:21:53,467 --> 05:21:55,135 THESE MICRO ENVIRONMENT TO THE 6574 05:21:55,135 --> 05:21:58,004 LUNG THAT WE'RE DISREGARDING AT 6575 05:21:58,004 --> 05:21:59,306 THIS MOMENT. 6576 05:21:59,306 --> 05:22:01,208 I'M NOT SURE THAT THAT HAS BEEN 6577 05:22:01,208 --> 05:22:02,075 DISCUSSED HERE. 6578 05:22:02,075 --> 05:22:03,310 SO THANK YOU FOR BRINGING THAT 6579 05:22:03,310 --> 05:22:07,414 UP. 6580 05:22:07,414 --> 05:22:09,216 >> JUST TO BE COGNIZANT OF THE 6581 05:22:09,216 --> 05:22:09,783 TIME. 6582 05:22:09,783 --> 05:22:12,119 AS WE'RE APPROACHING THE END OF 6583 05:22:12,119 --> 05:22:14,254 THIS FIRST DAY OF THIS TWO-DAY 6584 05:22:14,254 --> 05:22:17,257 WORKSHOP I WANT TO GIVE THE 6585 05:22:17,257 --> 05:22:19,459 PANELIST AN OPPORTUNITY FOR EACH 6586 05:22:19,459 --> 05:22:23,230 OF YOU TO COMMENT ON WHAT SEE AS 6587 05:22:23,230 --> 05:22:25,866 THE MOST CRITICAL RESEARCH GAP 6588 05:22:25,866 --> 05:22:30,704 AS FAR AS LOOKING AT DIFFERENT 6589 05:22:30,704 --> 05:22:33,039 MECHANISTIC PATHWAYS TO ADVANCE 6590 05:22:33,039 --> 05:22:36,476 THE SCIENCE ON NUTRITION AND 6591 05:22:36,476 --> 05:22:40,080 RESPIRATORY HEALTH AND DISEASE. 6592 05:22:40,080 --> 05:22:42,783 I'LL START WITH MATT. 6593 05:22:42,783 --> 05:22:44,584 >> RELATED TO MY OWN WORK IT HAS 6594 05:22:44,584 --> 05:22:47,888 TO DO WITH ASSESSING THE 6595 05:22:47,888 --> 05:22:49,022 POTENTIAL BENEFIT TO THE 6596 05:22:49,022 --> 05:22:52,159 POTENTIAL DETRIMENT OF TRYING TO 6597 05:22:52,159 --> 05:22:54,161 MANIPULATE DIETS AND IT'S EASY 6598 05:22:54,161 --> 05:22:57,030 TO DO IN A MOUSE MODEL AND 6599 05:22:57,030 --> 05:23:00,367 MEASURE THEM MONTHS LATER. 6600 05:23:00,367 --> 05:23:03,336 MICE ARE USED TO BE ON VERY 6601 05:23:03,336 --> 05:23:05,138 INFLEXIBLE DIETS AND MAYBE THE 6602 05:23:05,138 --> 05:23:06,873 FLEXIBILITY IS IMPORTANT. 6603 05:23:06,873 --> 05:23:10,377 CERTAINLY IT IS FOR OUR OWN 6604 05:23:10,377 --> 05:23:12,345 HAPPINESS AND HEALTHINESS. 6605 05:23:12,345 --> 05:23:15,315 I WONDER ABOUT THE DURABILITY 6606 05:23:15,315 --> 05:23:17,417 AND SAFETY AND COUPLED WITH 6607 05:23:17,417 --> 05:23:23,657 EFFICACY. 6608 05:23:23,657 --> 05:23:25,659 >> I COMPLETELY AGREE WITH YOU 6609 05:23:25,659 --> 05:23:26,426 MATT. 6610 05:23:26,426 --> 05:23:27,961 THAT'S AN EXCELLENT POINT. 6611 05:23:27,961 --> 05:23:30,330 THE ONLY THING THAT I WOULD ADD 6612 05:23:30,330 --> 05:23:33,834 IS HOW LONG THE LONG -- 6613 05:23:33,834 --> 05:23:36,303 ADAPTABLE TO THESE DIETS. 6614 05:23:36,303 --> 05:23:40,073 THE MICROBIOME, RIGHT? 6615 05:23:40,073 --> 05:23:41,741 MICROBIOMES SOMEWHAT 6616 05:23:41,741 --> 05:23:42,309 IRREVERSIBLE. 6617 05:23:42,309 --> 05:23:45,045 SO IF YOU CHANGE YOUR DIET DOES 6618 05:23:45,045 --> 05:23:47,380 THE LUNG CHANGE WITH IT AND THEN 6619 05:23:47,380 --> 05:23:49,950 NOT CHANGE BACK OR DOES IT EBBS 6620 05:23:49,950 --> 05:23:52,185 AND FLOWS BASED ON WHAT 6621 05:23:52,185 --> 05:23:53,553 NUTRIENTS YOU'RE TAKING IN. 6622 05:23:53,553 --> 05:23:57,157 7 6623 05:23:57,157 --> 05:24:00,260 >> I THINK FOR ME ONE THING THAT 6624 05:24:00,260 --> 05:24:02,796 IS REALLY CRITICAL IS WHEN WE'RE 6625 05:24:02,796 --> 05:24:04,698 THINKING ABOUT PRECLINICAL TO 6626 05:24:04,698 --> 05:24:06,733 CLINICAL TRANSLATION AND 6627 05:24:06,733 --> 05:24:07,834 THINKING ABOUT THE 6628 05:24:07,834 --> 05:24:09,169 STANDARDIZATION OF WHAT WE HAVE 6629 05:24:09,169 --> 05:24:12,072 AND WHAT WE'RE USING FOR THESE 6630 05:24:12,072 --> 05:24:14,608 STUDIES UNDERSTANDING THAT THERE 6631 05:24:14,608 --> 05:24:17,777 IS A LACK OF STANDARDIZATION AND 6632 05:24:17,777 --> 05:24:21,014 REGULATION FOR SO MANY 6633 05:24:21,014 --> 05:24:21,448 SUPPLEMENTS. 6634 05:24:21,448 --> 05:24:23,884 THAT IS LEADING TO THESE ADVERSE 6635 05:24:23,884 --> 05:24:24,317 EFFECTS. 6636 05:24:24,317 --> 05:24:27,387 I HATE TO THINK THERE IS SO MUCH 6637 05:24:27,387 --> 05:24:28,922 RESEARCH OUT THERE THAT COULD 6638 05:24:28,922 --> 05:24:34,661 HAVE BEEN MOVED FURTHER ALONG TO 6639 05:24:34,661 --> 05:24:37,130 HELP US UNDERSTAND DIET IMPACTS 6640 05:24:37,130 --> 05:24:40,634 ON HEALTH THAT HAVE BEEN 6641 05:24:40,634 --> 05:24:42,769 THWARTED BY OUR INABILITY TO 6642 05:24:42,769 --> 05:24:45,105 PROVIDE A SUPPLEMENTAL GUIDELINE 6643 05:24:45,105 --> 05:24:47,307 THAT CAN BE USED EFFECTIVELY IN 6644 05:24:47,307 --> 05:24:52,479 THESE TRIALS. 6645 05:24:52,479 --> 05:24:55,682 >> FOR ME I THINK HUMAN DIETARY 6646 05:24:55,682 --> 05:24:57,450 INTERVENTION STUDIES ARE KEY 6647 05:24:57,450 --> 05:24:58,919 ESPECIALLY WHEN WE'RE TALKING 6648 05:24:58,919 --> 05:25:01,755 ABOUT SLEEP. 6649 05:25:01,755 --> 05:25:04,057 OUR GROUP HAS SHOWN THAT IN THE 6650 05:25:04,057 --> 05:25:07,961 CONTEXT OF SLEEP RESTRICTION -- 6651 05:25:07,961 --> 05:25:09,829 OXIDATIVE STRESS AND 6652 05:25:09,829 --> 05:25:11,398 INFLAMMATION THAT IS NOT OFFSET 6653 05:25:11,398 --> 05:25:18,438 BY THE INCREASE IN RESPONSES. 6654 05:25:18,438 --> 05:25:20,907 SLEEP RESTRICTION UP REGULATES 6655 05:25:20,907 --> 05:25:22,575 RESPONSES SO IT'S VERY IMPORTANT 6656 05:25:22,575 --> 05:25:26,379 TO DO THESE STUDIES IN HUMANS. 6657 05:25:26,379 --> 05:25:30,150 7 FORECAST OR FIVE OR SIX WEEK 6658 05:25:30,150 --> 05:25:33,486 DIETARY INTERVENTIONS ARE PRETTY 6659 05:25:33,486 --> 05:25:35,588 WELL TOLERATED AND THEN TAKING 6660 05:25:35,588 --> 05:25:38,391 OUT INTO THE CLINIC TO SEE HOW 6661 05:25:38,391 --> 05:25:40,794 THAT CAN TRANSLATE INTO 6662 05:25:40,794 --> 05:25:43,630 SUSTAINED BEHAVIOR LONG-TERM. 6663 05:25:43,630 --> 05:25:45,398 >> FOR ME IT'S A THINK ON THE 6664 05:25:45,398 --> 05:25:47,534 OTHER SIDE OF IT ABOUT THE LUNG 6665 05:25:47,534 --> 05:25:49,636 AND REITERATING WHAT I SAID 6666 05:25:49,636 --> 05:25:52,405 BEFORE ABOUT HOW IN HEALTH IN MY 6667 05:25:52,405 --> 05:25:56,276 MIND WE DON'T HAVE GOOD WAYS OF 6668 05:25:56,276 --> 05:25:57,811 MEASURING LUNG HEALTH THAT ARE 6669 05:25:57,811 --> 05:25:59,679 SENSITIVE ENOUGH. 6670 05:25:59,679 --> 05:26:02,449 OXYGEN SATURATION IS NOT AND 6671 05:26:02,449 --> 05:26:04,250 EACH INDIVIDUAL CONDITION LIKE 6672 05:26:04,250 --> 05:26:05,819 ASTHMA WE HAVE SPECIFIC ONES 6673 05:26:05,819 --> 05:26:11,191 LIKE THE FE B-1 AND SO ON. 6674 05:26:11,191 --> 05:26:12,659 IT MAY BE THE CHALLENGE OF THE 6675 05:26:12,659 --> 05:26:14,260 SYSTEM THAT WE CHOSE TO STUDY 6676 05:26:14,260 --> 05:26:18,398 THAT THE LUNG IS SO RESILIENT 6677 05:26:18,398 --> 05:26:22,102 AND ALSO HAS HETEROGENEITY. 6678 05:26:22,102 --> 05:26:24,537 IT'S HARD TO STUDY IN A SIMPLE 6679 05:26:24,537 --> 05:26:29,409 INJURY MARKER WAY OR THE X-RAYS 6680 05:26:29,409 --> 05:26:30,944 ARE ALSO NOT GREAT. 6681 05:26:30,944 --> 05:26:33,513 YOU CANNOT DO THOSE ON EVERYBODY 6682 05:26:33,513 --> 05:26:36,049 ON A REGULAR BASES. 6683 05:26:36,049 --> 05:26:38,084 BUT THAT IS FOR ME ONE OF THE 6684 05:26:38,084 --> 05:26:39,619 BIG GAPS. 6685 05:26:39,619 --> 05:26:42,489 HOW DO YOU TRACK LUNG INJURY IN 6686 05:26:42,489 --> 05:26:45,592 A NONINVASIVE WAY AND IF WE 6687 05:26:45,592 --> 05:26:48,028 COULD DO THAT YOU COULD IMAGINE 6688 05:26:48,028 --> 05:26:50,463 SUDDENLY YOUR DIET STUDIES AND 6689 05:26:50,463 --> 05:26:52,999 INTERVENTIONS COULD REALLY -- 6690 05:26:52,999 --> 05:26:55,902 YOU COULD GET MUCH MORE GRANULAR 6691 05:26:55,902 --> 05:26:57,370 INFORMATION ABOUT WHETHER IT'S 6692 05:26:57,370 --> 05:26:59,873 MAKING A DIFFERENCE OR NOT. 6693 05:26:59,873 --> 05:27:01,641 >> THANK YOU ALL ONCE AGAIN FOR 6694 05:27:01,641 --> 05:27:05,178 YOUR OUTSTANDING PRESENTATIONS 6695 05:27:05,178 --> 05:27:08,448 AND INSIGHTFUL REMARKS. 6696 05:27:08,448 --> 05:27:13,720 AT THIS POINT -- DR. LU, WOULD 6697 05:27:13,720 --> 05:27:16,089 YOU LIKE TO CLOSE OUTFITTER DAY 6698 05:27:16,089 --> 05:27:16,456 >> YEAH. 6699 05:27:16,456 --> 05:27:20,026 IT WAS A GREAT MEETING TODAY. 6700 05:27:20,026 --> 05:27:21,928 I LEARNED A LOT. 6701 05:27:21,928 --> 05:27:22,262 DEFINITELY. 6702 05:27:22,262 --> 05:27:25,465 I WANT TO THANK ALL OF OUR 6703 05:27:25,465 --> 05:27:27,901 COCHAIRS, THE MODERATORS AND 6704 05:27:27,901 --> 05:27:30,336 SPEAKERS FOR YOUR WONDERFUL 6705 05:27:30,336 --> 05:27:30,804 TALK. 6706 05:27:30,804 --> 05:27:33,339 I THINK THE WORKSHOP WAS WELL 6707 05:27:33,339 --> 05:27:34,908 ORGANIZED AND THANK YOU TO THE 6708 05:27:34,908 --> 05:27:40,380 CHAIRS AND THE MODERATORS. 6709 05:27:40,380 --> 05:27:42,649 I LOOK FORWARD TO THE SECOND DAY 6710 05:27:42,649 --> 05:27:42,916 TOMORROW. 6711 05:27:42,916 --> 05:27:43,550 THANK YOU. 6712 05:27:43,550 --> 05:27:51,758 WE CAN CLOSE THE WORKSHOP. 6713 05:27:51,758 --> 05:27:53,960 TOMORROW WOULD BE THE ZOOM OPEN 6714 05:27:53,960 --> 05:27:59,232 AGAIN AT 9:30. 6715 05:27:59,232 --> 05:28:01,935 AND DISCUSSION WILL START AT 10:00. 6716 05:28:01,935 --> 05:28:11,935 >> RECORDING STOPPED.