>> GOOD MORNING.
OR I SHOULD ALSO SAY GOOD
AFTERNOON OR GOOD EVENING TO
SOME OF YOU LOCATED IN A
DIFFERENT PART OF THE GLOBE.
I'M DR. QING LU.
A PROGRAM DIRECTOR IN THE
DIVISION OF LUNG DISEASE.
WELCOME YOU TO PARTICIPATE IN
THE TWO-DAY WORKSHOP TITLED
ADVANCING NUTRITION RESEARCH TO
PROMOTE RESPIRATORY HEALTH IN A
WILL ADULTS.
I'M VERY EXCITED TO REPORT THERE
WERE MORE THAN 500 PEOPLE WHO
HAVE REGISTERED FOR THIS
WORKSHOP.
THIS WORKSHOP IS ALSO BEING LIVE
STREAMED AND THE NIH VIDEO CAST
AND RECORDED.
THE RECORDINGS WILL BE AVAILABLE
IN THE VIDEO CAST ON-LINE
REPORTS ONE WEEK FROM TODAY.
BEFORE I IN TOE INTRODUCE MY
DIVISION * DIRECTOR I WOULD LIKE
TO THANK ALL OF OUR COCHAIRS FOR
THEIR EXTRAORDINARY WORK ON THE
PLANNING OF THIS WORKSHOP.
I WOULD ALSO LIKE TO EXPRESS OUR
GRATITUDE TO ALL MODERATORS AND
SPEAKERS FOR YOUR INSIGHTS AND
CONTRIBUTIONS TO THIS IMPORTANT
EVENT.
I WANT TO THANK OUR AUDIENCE
PARTICULARLY THOSE WHO HAVE
OVERCOME CHALLENGING TIME ZONE
DIFFERENCES.
I WOULD LIKE TO ALSO LIKE TO
THANK THE SUPPORT TEAM FOR THEIR
ASSISTANCE.
LAST BUT NOT LEAST I WOULD LIKE
TO THANK OUR DIVISION LEADERSHIP
AND OUR PLANNING COMMUNITY
MEMBERS FOR THEIR SUPPORT.
THE GOAL OF THIS WORKSHOP IS TO
BRING TOGETHER
MULTI-DISCIPLINARY RESEARCHERS
INCLUDING NUTRITION AND DIETARY
SCIENCE EXPERTS AND THE DATA
SCIENTISTS TO DISCUSS THE
CURRENT STATE OF SCIENCE
REGARDING NUTRITION AND THE DIET
IN RESPIRATORY HEALTH AND
DISEASE AND IDENTIFY GAPS AND
CHALLENGES AND OPPORTUNITIES.
THANK YOU FOR YOUR
PARTICIPATION.
WE LOOK FORWARD TO A SUCCESSFUL
WORKSHOP AND YOUR ACTIONABLE
RECOMMENDATIONS.
NOW LET US WELCOME THE DIRECTOR
DIRECTOR.
>> THANK YOU VERY MUCH AND IT'S
REALLY A PLEASURE TO HAVE AN
OPPORTUNITY TO SAY A FEW WORDS
TO KICK OFF THIS WORKSHOP.
IT'S REALLY WONDERFUL TO SEE SO
MANY PARTICIPANTS THAT HAVE
SIGNED UP FOR THIS IMPORTANT
WORKSHOP.
THAT DEMONSTRATES THE LEVEL OF
INTEREST AND THE ENTHUSIASM AND
THE IMPORTANCE OF THE TOPIC THAT
IS BEING ADDRESSED.
AND IT'S WONDERFUL TO HAVE IT
DONE IN A VIRTUAL FORMAT.
WE WOULD LOVE TO BE ABLE TO SEE
YOU ALL FACE TO FACE TO SEE MANY
THAT WE'VE WORKED WITH IN THE
PAST BUT THAT IS NOT POSSIBLE
AND I THINK THE HYBRID OR THE
VIRTUAL PLATFORM GIVES US AN
OPPORTUNITY TO REALLY ENGAGE A
VERY WIDE RANGE OF INDIVIDUALS,
STAKEHOLDERS, EXPERTS WHO CAN
CONTRIBUTE TO OUR UNDERSTANDING
OF WHERE WE ARE WITH ADVANCING
NUTRITION RESEARCH TO PROMOTE
RESPIRATORY HEALTH.
SO, ITS GREAT TO SEE YOU AND
HAPPY TO SEE SUCH A DIVERSE AND
INCLUSIVE PANEL.
THAT'S ONE OF THE THINGS THAT
WE'RE PROUD OF THAT WE TRY TO
MAKE SURE THAT WE HEAR FROM ALL
VOICES AND THAT WE LISTEN TO ALL
SECTORS OF THE COMMUNITY AS WE
TO THESE WORKSHOPS AND WE THINK
ABOUT WHERE WE'LL TAKE THEM
NEXT.
7 YOU HEARD A LITTLE BIT FR QING
ALREADY.
I ALSO WANT TO MAKE SURE I DO
RECOGNIZE DR. JUN MA AND
DR. VANESSA GARCIA-LARSEN WHO
HAVE WORKED CLOSELY WITH QING
TOO.
TO HAVE A SUPER AGENDA TO BRING
FORWARD OUR CURRENT STATE OF
KNOWLEDGE AND WHERE WE'RE GOING
WITH THIS AREA.
I'LL JUST -- I DON'T WANT TO
TAKE TOO MUCH TIME -- BUT I
DON'T THINK THERE IS ANY NEED TO
HIGHLIGHT TO THIS GROUP THE
IMPORTANCE AND THE BURDEN OF
CHRONIC LUNG DISEASE WORLDWIDE
AND I THINK THAT IS HAS BEEN
EMPHASIZED BY THE WIDE RANGE OF
PARTICIPANTS.
THIS IS NOT JUST A LOCAL
PROBLEM.
AND I HOPE THAT EVERYBODY
RECOGNIZES THAT THIS IS AN AREA
THAT WE DIDN'T JUST YESTERDAY
DECIDE UH-HO WHAT IS GOING ON
WITH NUTRITION IN A VARIETY OF
DIFFERENT AREAS OF NUTRITION AS
IT RELATES TO THE LUNG.
I THINK WE'VE HAD A HISTORY OF
SUPPORTING RESEARCH IN THIS
AREA.
BUT NOW WE WANT TO REALLY FOCUS
A BIT MORE ON HOW NUTRITION AND
DIET IMPACTS RESPIRATORY HEALTH
AND THE PREVALENCE OF CHRONIC
LUNG DISEASES PARTICULARLY IN
VULNERABLE POPULATIONS INCLUDING
THOSE THAT ARE SOCIO
ECONOMICALLY DISADVANTAGED.
A LITTLE BIT MORE OF AN EMPHASIS
ON LUNG HEALTH.
A LITTLE LESS SO ON LOOKING AT
NUTRITION AS IT RELATES TO
DISEASE BECAUSE WE HAVE LOOKED
AT THAT IN THE PAST.
SO AS YOU HEARD THE PURPOSE IS
TO BRING TOGETHER THIS
MULTI-DISCIPLINARY GROUP.
WE HAVE NUTRITIONIST, DIETARY
SCIENCE EXPERTS.
PEOPLE FROM PULMONARY AND DATA
SCIENCE AND WE WANT TO ENGAGE A
VERY BROAD COMMUNITY.
NOT JUST THOSE THAT WE TALK TO
ALL THE TIME BUT THOSE THAT WE
OFTEN DON'T TALK TO MUCH SO WE
CAN BRING YOU TOGETHER BECAUSE
THIS WILL POTENTIALLY SPARK NEW
IDEAS AND COLLABORATIONS AND NEW
WAYS TO PROMOTE THIS AREA.
IT'S BRINGING IN THE NEW
EXPERTISE THAT WILL LIKELY BRING
US NEW ADVANCES RELATED TO
RESPIRATORY HEALTH AND THE ROLE
OF NUTRITION AND DIET IN THAT.
SO WE WANT TO LOOK AT CRITICAL
KNOWLEDGE GAPS.
KEY CHALLENGES.
BARRIERS AND OPPORTUNITIES.
I HAVE TO SAY THAT IN GENERAL
IT'S VERY TEMPTING TO DO TWO
THINGS.
ONE IS TO TELL NIH HOW TO DO ITS
BUSINESS.
USE THIS MECHANISM OR THAT
MECHANISM.
DO A WORKSHOP HERE.
THAT IS OKAY.
SPEND SOME TIME ON THAT BUT NOT
MUCH BECAUSE THAT IS WHAT WE DO.
WHAT WE'RE HERE TO DO SO WE'LL
FIGURE THAT OUT.
BUT WHAT WE NEED IS THE
SCIENTIFIC CONTENT AND ONCE WE
HAVE THAT THEN WE'RE ABLE TO
REALLY DECIDE HOW TO BEST
ADVANCE THAT SCIENCE.
THE SECOND THING THAT YOU LIKE
TO DO IS GIVE US A LAUNDRY LIST.
SOMETIMES 10, 20-50 IDEAS.
THAT IS ALL IMPORTANT AND USEFUL
BUT I WOULD HAVE TO SAY AS YOU
SUMMARIZE THE WORKSHOP AT THE
END OF THE DAY TO THINK ABOUT
WHAT WOULD BE THE COUPLE ONE TO
TWO THINGS THAT IF YOU DO THOSE
THINGS YOU WOULD REALLY ADVANCE
THE FIELD.
YOU MAY REVOLUTIONIZE THE WAY WE
LOOK AT IT.
WE MAY REALLY OPEN THE DOOR TO
SPUR ON NEW RESEARCH.
SO, ITS REALLY GOOD THAT YOU
TALK ABOUT IT IN A VERY
BROADWAY.
TRY NOT TO GET TOO DEEP INTO THE
RABBIT HOLES AND BRING IT BACK
AT THE END SO THAT THERE IS AN
OPPORTUNITY FOR US TO REALLY
UTILIZE THE OUTPUT FROM THIS
WORKSHOP.
THE ONE THING THAT WE CAN TELL
YOU AND I KNOW THAT THE COCHAIRS
WILL DO THEIR BEST TO PUBLISH
THIS WORKSHOP.
WE REALLY TRY HARD TO GET IT
INTO A JOURNAL SO THAT EVERYONE
CAN BENEFIT FROM THE OUTPUT OF
YOUR DISCUSSIONS.
WE WILL HAVE EXECUTIVE SUMMARIES
ON THE WEBSITE.
NUMBER ONE OUTPUT WILL
DEFINITELY BE SOME TYPE OF
PUBLICATION AND THEN WE'LL SEE
WHERE WE CAN GO.
IT'S DEPENDENT ON A LOT OF
THINGS BUT WE'LL LOOK AT THIS
CAREFULLY.
WE WOULD NOT DO THIS WORKSHOP IF
WE DIDN'T THINK THERE WERE SOME
GAPS.
AND WE'RE GOING TO TRY TO FILL
THOSE GAPS.
HOW TO ADVANCE NUTRITION, DIET
RESEARCH AND PROMOTE RESPIRATORY
HEALTH.
SO AGAIN I WANT TO THANK YOU FOR
PARTICIPATING.
TAKING TIME OUT OF YOUR VERY
BUSY SCHEDULES AND ALSO OUR
COCHAIRS JUN AND VANESSA.
AND FROM ALL OF OUR STAFF IN THE
LUNG DIVISION.
THANK YOU AGAIN FOR
PARTICIPATING AND I KNOW ALL OF
US WILL BENEFIT GREATLY.
I'LL STOP THERE.
I'M HAPPY TO TAKE QUESTIONS.
I'LL TURN IT BACK OVER TO YOU
QING.
>> THANK YOU, DR. KILEY.
DR. ALAN DAVIS.
YOU'RE MUTED.
I THINK I CANNOT HEAR YOU.
I'M GOING TO CONTINUE YOU.
YOU MAY PUT YOUR QUESTION IN THE
CHAT.
SO NOW I WOULD LIKE TO WELCOME,
INTRODUCE OUR WORKSHOP COCHAIRS.
DR. JUN MA.
A DISTINGUISHED PROFESSOR OF
MEDICINE DIRECTOR OF THE -- --
PROGRAM.
AND -- IN THE DEPARTMENT OF
MEDICINE AT THE UNIVERSITY OF
ILLINOIS CHICAGO.
DR. MA IS SPECIALIZED IN
RANDOMIZED CLINICAL TRIAL AND
TRANSLATIONAL BEHAVIORAL
MEDICINE.
SHE HAS LED 16 EFFICACY --
TRIALS IN BEHAVIORAL.
WHO HAVE MULTIPLE CHRONICLE
CONDITIONS SUCH AS OBESITY AND
ASTHMA.
SHE HAS HAD NUMEROUS LEADERSHIP
POSITION.
YOU CAN SEE THE FULL DETAILS IN
HER BIOIN THE BOOKLET.
DR. VANESSA GARCIA-LARSEN.
SHE ALSO IS ASSOCIATE PROFESSOR
IN THE NATIONAL HOUSE -- JOHN
HOP SKINS.
SHE WAS TRAINED * IN NUTRITION.
HER EVIDENCE BASED RESEARCH
SHOWING THAT -- DIET DURING
PREGNANCY IS LINKED TO
ALLERGIES, RESPIRATOR OTHER
DISEASE HAS INFORMED
INTERNATIONAL -- GUIDELINES.
YOU CAN ALSO SEE DETAILS OF HER
BIOIN THE BOOKLET.
I WELCOME YOU.
PLEASE TAKE IT AWAY.
>> THANK YOU, DR. LU.
HELLO, EVERYONE.
PLEASE ALLOW ME TO ADD MY
WELCOME TO YOU ALL FOR
PARTICIPATING IN THIS VERY
IMPORTANT AND TIMELY WORKSHOP.
I WANT TO FIRST THANK DR. KILEY
AND DR. LU FOR YOUR KIND AND
INSPIRING WORDS.
I WANT TO THANK YOU THE OTHER
MEMBERS OF THE PLANNING
COMMITTEE FOR YOUR LEADERSHIP
AND INSIGHT TO FURTHER ELEVATE
THE IMPORTANCE OF NUTRITIONAL
RESEARCH IN RESPIRATORY HEALTH
AND DISEASE AND TO SHINE A
SPOTLIGHT ON THIS CRITICAL TOPIC
BY SUPPORTING THIS WORKSHOP.
I FEEL VERY PRIVILEGED -- AND I
ESPECIALLY AM GRATEFUL FOR
HAVING DONE SO IN PARTNERSHIP
WITH MY COCHAIR.
I VERY MUCH LOOK FORWARD TO THE
PRESENTATIONS FROM SOME OF OUR
BEST SCIENTISTS AND CLINICIANS
IN THE FIELD AND INTELLECTUALLY
STIMULATING DISCUSSIONS OVER THE
NEXT TWO DAYS.
I TURN IT OVER TO YOU VANESSA.
>> THANK YOU.
THANK YOU SO MUCH, DR. MA AND I
WOULD ALSO LIKE TO EXTEND MY
THANKS FOR THE OPPORTUNITY TO
HAVE THIS WORKSHOP AND TO
DISCUSS THE RESEARCH PRIORITIES
FOR RESPIRATORY HEALTH.
I'M DELIGHTED TO SEE YOU ALL
HERE AND LOOK FORWARD TO THE
INTERACTIONS WE'RE GOING TO HAVE
OVER THE NEXT TWO DAYS.
OUR FIRST SPEAKER IS PROFESSOR
PETER BURNEY.
CAN WE PUT UP THE FIRST SLIDE OF
THE PRESENTATION.
THANK YOU.
SO PROFESSOR PETER BURNEY IS A
WORLD EXPERT IN RESPIRATORY
EPIDIMENIOLOGY.
HE -- -- AND THIS WAS FOLLOWED
BY SPECIALIST TRAINING IN
PUBLIC HEALTH IN ST. THOMAS'
HOSPITAL.
HE WAS A PROFESSOR AT THE SCHOOL
OF HIGH KEEP AND PUBLIC HEALTH
AT JOHNS HOPKINS UNIVERSITY AND
HE WAS ALSO PROFESSOR OF PUBLIC
HEALTH MEDICINE -- PRIMARY CARE
AND PUBLIC HEALTH SCIENCES AT
KING COLLEGE LONDON UNTIL 2006
WHEN HE MOVED.
HE WAS PRINCIPLE INVESTIGATOR OF
THE WIDELY RECOGNIZED EUROPEAN -
EUROPEAN RESPIRATORY HEALTH.
FROM 2006 HE WAS PRINCIPLE
INVESTIGATOR -- THE BOLD STUDY.
THIS IS THE LARGEST
INTERNATIONAL STUDY BASED ON THE
PREVALENCE AND RISK FACTORS.
THANK YOU, DR. BURNEY FOR
JOINING US TODAY.
>> OKAY.
VANESSA, THANK YOU VERY MUCH FOR
THE INVITATION TO COME TO THIS
VERY EXCITING PROGRAM OF WORK.
WHICH I THINK WE'RE ALL GOING TO
LEARN A GREAT DEAL FROM.
IF I COULD HAVE THE FIRST SLIDE.
YES AND THE NEXT.
I'VE GOT A VERY LARGE TOPIC AS
YOU CAN SEE SO I THINK WE'LL
PRESS ON.
SO I'LL START WITH ASTHMA.
ASTHMA IS PROBABLY OF ALL OF THE
CONDITIONS I'M GOING TO TALK
ABOUT THE MOST RESEARCHED.
IT STILL DOESN'T HAVE A VERY
PRECISE DEFINITION.
THE GENERAL DEFINITION GIVEN
HERES ONE THAT IS USUALLY --
SATISFIES MOST PEOPLE BUT WHEN
IT COMES TO DEFINING WHAT ASTHMA
IS AND FINDING A TEST FOR
WHETHER SOMEONE HAS ASTHMA THERE
IS A LOT OF DISAGREEMENT.
THERE ARE A LOT OF DIFFERENT
TEST AVAILABLE AND THEY COME UP
WITH SLIGHTLY DIFFERENT ANSWERS.
NEXT SLIDE.
SO SEVERAL DECADES AGO NOW DAVID
-- RECOGNIZED THAT PEOPLE WHO
CAME FROM VERY LARGE FAMILIES
WERE MUCH LESS LIKELY TO HAVE
HAYFEVER AND THIS SLIDE SHOWS
THE SAME.
A STUDY IN YOUNG ADULTS.
AND YOU'LL SEE EXACTLY THE SAME
THING.
THE RED BARS REPRESENT
DECREASING EVENTS OF HAYFEVER AS
YOU GET TO LARGER SIZES.
IF YOU PUT IN POSITIVE SKIN
TESTS FOR ALLERGENS YOU WOULD
GET THE SAME KIND OF BAR CHART
BUT NOTICE WHEN YOU LOOK AT THE
GREEN BARS THOSE OR FOR
SHORTNESS OF BREATH AND THAT IS
A PRETTY GOOD QUESTION.
IF YOU'RE GOING TO DIAGNOSIS MAY
THAT COMES PRETTY CLOSE TO WHAT
PEOPLE THINK OF AS ASTHMA.
AND THERE YOU SEE THE TREND IS
IN THE OPPOSITE DIRECTION AND
YOU CAN SEE THAT IN LOTS OF
OTHER PLACES AND IT'S IMPORTANT
BECAUSE WHEN YOU GO TO
LOW-INCOME COUNTRIES THEY HAVE
MUCH LESS A TOPIC WHEEZE AND
HYPER RESPONSIVENESS.
THAT IS LESS OF A PROBLEM BUT IT
BECOMES INCREASINGLY A PROBLEM
AS PEOPLE MOVE INTO THE CITIES.
SO THAT IS AN ISSUE FOR LOOKING
AT THE GENERAL DISTRIBUTION OF
DISEASE.
SO IF YOU WANT TO KNOW ABOUT THE
DISTRIBUTION OF ASTHMA IN THE
WORLD THE GLOBAL ASTHMA NETWORK
IS PROBABLY THE MOST UP-TO-DATE
PLACE TO LOOK FOR THIS.
AND YOU'LL SEE IN THIS MAP THAT
ASTHMA IN ADULTS ALSO REALLY
PRETTY UNCOMMON IN ACROSS ASIA
AND IN SU SUB AFRICA.
THERE ARE SOME HOTSPOTS IN NORTH
AMERICA BUT THIS IS THE ANSWER
TO A QUESTION.
HAVE YOU EVER HAD ASTHMA?
AND YOU CAN TAKE FROM THAT WHAT
YOU LIKE.
IT'S A START BUT IT'S PROBABLY
NOT A VERY DETAILED
UNDERSTANDING OF WHAT IS MEANT
BY THE DISTRIBUTION OF ASTHMA
WHICH BRINGS ME TO THE NEXT
SLIDE TO THE NEXT CONDITION
WHICH IS CHRONIC BRONCHITIS.
NOW THIS IS KNOWN AS THE ENGLISH
DISEASE AND THOUGHT TO BE VERY
IMPORTANT.
SO IT'S ACTUALLY WITHIN FOR A
VERY LONG TIME -- * IN TERMS OF
A QUESTIONNAIRE AND THAT WAS THE
BRITISH MEDICAL RESEARCH COUNCIL
QUESTION THAT WAS DEVELOPED IN
THE 1960s.
IT'S BEEN CARRIED OVER INTO THE
QUESTIONNAIRE -- LOTS OF OTHER
INTERNATIONAL SURVEYS HAVE USED
THE SAME FORMULA.
IT IS NOT HOWEVER THOUGHT TO BE
SO IMPORTANT.
NEXT SLIDE.
AND THAT IS BECAUSE OF STUDIES
DONE BY CHARLES FLETCHER AND
RICHARD PETER WHO REALLY SHOWED
THAT CHRONIC -- DOES NOT LEAD ON
TO OBSTRUCTION AND THAT IF YOU
WANT TO KNOW WHAT IS GOING TO
HAPPEN TO SOMEONE IN THE NEXT 20
YEARS YOU REALLY WANT TO KNOW
WHAT THEIR LUNG FUNCTION IS.
MOOSE AS SECRETION ADDS * VERY
LITTLE TO THAT.
BUT THE ONE WARNING WE RATHER
IGNORE THE CONDITION AND YOU SEE
FROM THIS SLIDE WHICH IS TAKEN
FROM THE LONDON STUDY LOOKING AT
THE CHANGE IN QUALITY OF LIFE,
PHYSICAL HEALTH SCALE OF THE
SHORT FORM 12 QUESTIONNAIRE AND
YOU'LL SEE THAT IT'S ACTUALLY
MORE INFLUENTIAL IN TERMS OF
QUALITY OF LIFE.
AND IT'S MORE OR LESS -- TO AN
ADDITIONAL 30 YEARS OF LIFE.
WE DON'T MEASURE IT IN THE SAME
WAY AND MAYBE WE SHOULD PAY A
LITTLE BIT MORE ATTENTION TO IT
IN THE FUTURE.
WHICH BRINGS ME ON TO COPD AND
CHRONIC AIRFLOW OBSTRUCTION.
AGAIN A DIAGNOSIS MADE BY A
DOCTOR.
THERE HAVE BEEN LOTS OF PEOPLE
WHO HAVE WRITTEN ESSAYS TRYING
TO DEFINE IT.
IT'S UNDEFINED.
BUT WHAT WE DO HAVE IS CHRONIC
AIRFLOW OBSTRUCTION AND THAT IS
MORE OR LESS ESTABLISHED NOW
THAT WE USE THE FEV ONE FVC
RATIO.
SO, THAT IS PRETTY CLEAR.
NOW THE -- THE FIRST THING THAT
WE KNOW ABOUT THIS IS THAT IT'S
STRONGLY ASSOCIATED WITH SMOKING
AND HERE YOU'LL SEE FOR WOMEN
AND FOR MEN THAT THE RESPONSE
INCREASES IN RELATIVE RISK AS
THE YEARS OF LIFE INCREASE.
SO THE DISTRIBUTION OF THE
DISEASE IS VERY WIDE.
SO IT GOES FROM LESS THAN 5% IN
COLUMBIA AND MEXICO TO VERY HIGH
LEVELS OVER 15% IN CAPETOWN.
BUT MORE IMPORTANT THAN THAT IS
THE RED LINE WHICH SHOWS THE
PERCENT UNDER DIAGNOSIS.
SO IF YOU ASK PEOPLE DO THEY
HAVE COPD THEY ALMOST ALL SAY
NO.
THE HONORABLE EXCEPTION IS IN
KENTUCKY IN THE USA WHERE 50% OF
PEOPLE RECOGNIZED THAT THEY HAVE
COPD.
EVERYWHERE ELSE IT'S ON AVERAGE
LESS THAN 20%.
WHICH BRINGS US TO THE NEXT
PUZZLE WITH CHRONIC AIRFLOW
DISEASE.
THE MORTALITY RATES DON'T RELATE
TO SMOKING.
ON THE LEFT YOU'VE GOT THE
MORTALITY RATE ON THE Y AXIS AND
THE PREVALENCE OF SIG RUT
CONSUMPTION ON THE X AXIS AND
THERE IS NO RELATIONSHIP BETWEEN
THE TWO.
IN FACT ACTUALLY THERE IS A
NEGATIVE ASSOCIATION WHICH IS A
BIT WORRYING.
ON THE RIGHT-HAND SIDE YOU'LL
SEE SOMETHING RATHER SIMILAR.
THESE ARE THE MORTALITY RATES
FROM THE COAD ACROSS THE CENTURY
THE 20th CENTURY FROM
12901-1991.
THE RATES ARE REALLY HIGH AT THE
BEGINNING OF THE CENTURY AND
THIS IS ON A LARGE SCALE.
THEM YOU GET A REALLY STEEP
DECLINE BETWEEN BEFORE YOU GET
AN UP TICK AGAIN AND A SECOND
PEEK IN AROUND 1960-1970 AND
THEN THE DECLINE STARTS AGAIN.
THAT IS NOT AT ALL WHAT SEE WITH
SMOKING.
THAT DIDN'T GET STARTED UNTIL
AFTER THE FIRST WORLD WAR IN
ENGLAND.
SO THAT IS A PUZZLE.
NEXT SLIDE.
SO I'LL GET ON TO SOMETHING WE
CALL SMALL LUNG SYNDROME WHICH
YOU CAN DEFINE AS A LOW TOTAL
LUNG CAPACITY.
THAT IS GENERALLY -- LOWER
LEVELS THAN NORMAL BECAUSE THAT
IS THE INFORMATION THAT WE
MOSTLY HAVE FROM SURVEYS.
RESTRICTION IS MUCH MORE
STRONGLY ASSOCIATED WITH
MORTALITY.
A MUCH BETTER PREDICTOR THAN A
LA-- LOW FB1.
IT'S ALSO MAYBE RELEVANT TO THE
MEETING IT'S ALSO ASSOCIATED
WITH -- AND WITH CARDIOVASCULAR
DISEASE WHICH AIRWAY OBSTRUCTION
IS NOT IN SPITE OF SOME PARTS OF
THE COUNTRY.
IN THESE TWO PICTURES YOU SEE
SOMETHING A LITTLE BIT DIFFERENT
FROM WHAT I SHARED THE LAST TIME
WHEN I SHOWED RESULTS FROM COAD
AGAINST SMOKING.
THAT SHOWED NO REAL ASSOCIATION.
HERE ON THE LEFT-HAND SIDE
YOU'VE GOT THE SAME GRAPH REALLY
WITH MORTALITY BY COUNTRY ON THE
Y AXIS BUT THIS TIME THE GROSS
NATIONAL INCOME PER CAPITA ALONG
THE X AXIS AND YOU CAN SEE THAT
THERE IS A HUGE INCREASE AS THE
GROSS NATIONAL INCOME PER CAPITA
FALLS BELOW $15,000 A YEAR.
AND ON THE RIGHT-HAND SIDE YOU
SEE A SIMILAR PICTURE BUT THIS
TIME IT'S LOOKING AT THE
PREVALENCE OF A LOW -- AGAIN
BELOW THE LIMITS OF NORMAL AND
YOU SEE THE PICTURE IS ALMOST
IDENTICAL.
SUGGESTING THAT IT'S THIS THAT
IS CAUSING WHATEVER CALLS THE
EPIDEMIC IS VOAD.
-- COAD.
*.
RESEARCH QUESTIONS -- I'VE TAKEN
DR. KILEY'S ADVICE.
SO WHAT COMPONENTS OF URBAN LIFE
INCREASE THE RISK OF LUNG
DISEASE.
I THINK THAT IS IMPORTANT AS
PEOPLE MOVE FROM RURAL AREAS TO
URBAN AREAS.
THEY GET A LOT OF ADVANTAGES.
BUT THEY DO GET ANOTHER
DISADVANTAGE WHICH IS THE LUNG
DISEASE INCREASES IN RISK.
WHY DO LOW-INCOME COUNTRIES HAVE
LOW LEVELS OF ATOPY AND SMALL
LUNG SIZE?
AND WHAT LINKS SMALL LUNGS WITH
CARDIOMETABOLIC CO-MORBIDITIES.
AND WITH THAT I'LL STOP.
AND TAKE ANY QUESTIONS.
>> THANK YOU SO MUCH PROFESSOR
BURNEY.
I THINK WE CAN INVITE --
COLLEAGUES TO PUT QUESTIONS IN
THE CHAT BOX AND THERE WILL BE A
DISCUSSION IN A LITTLE WHILE.
THANK YOU.
NEXT SLIDE, PLEASE.
THANK YOU.
SO I'M GOING TO FOLLOW-UP NOW
WITH PROVIDING YOU WITH ANOTHER
VIEW OF NUTRITION RESEARCH AND
RESPIRATORY HEALTH AND DISEASE
AND THE OVER-ALL GOALS WE EXPECT
TO ACHIEVE IN THE NEXT TWO DAYS.
NEXT PLEASE.
AND NEXT.
NEXT.
THANK YOU.
THE TWO OVER-ALL GOALS THAT WE
HAVE SET OUT FOR THIS WORKSHOP
ARE FIRST OF ALL TO ADVANCE
NUTRITION RESEARCH TO PROMOTE
RESPIRATORY HEALTH AND TO AID IN
THE PREVENTION AND MANAGEMENT OF
DISEASES IN ADULTS WITH CHRONIC
RESPIRATORY CONDITIONS AND ALSO
TO DISCUSS THE CURRENT STATE OF
SCIENCE REGARDING NUTRITION AND
DIET AND RESPIRATORY HEALTH AND
DISEASES AND TO IDENTIFY
CRITICAL RESEARCH GAPS,
CHALLENGES AND OPPORTUNITIES.
NOW NUTRITION IS A LIFESTYLE
RELATED FACTOR AND HAS THE
POTENTIAL TO INFLUENCE A NUMBER
OF NONCOMMUNICABLE DISEASES.
I'M USING LUNG FUNCTION AND IF
WE CAN PRESERVE LUNG FUNCTION
THROUGH HEALTHY DIETS AND
HEALTHY LIFESTYLES I THINK WE'RE
GOING TO EFFECTIVELY MULTIPLY
THE -- BUT WE DON'T EAT FOODS IN
ISOLATION AND WHAT WE EAT IS
HEAVILY INFLUENCED BY OUR
ENVIRONMENT AND A NUMBER OF
SOCIOECONOMIC FACTORS AS WELL.
SO IT'S A COMPLEX PICTURE.
WE HAVE A VERY AMBITIOUS AGENDA
THAT IS GOING TO TRY TO HELP.
NOW THERE ARE A NUMBER OF RISK
FACTORS THAT HAVE BEEN WELL
ESTABLISHED FOR THE RISK OF
CHRONIC RESPIRATORY DISEASES.
I'M USING THE EXAMPLE OF COPD
BECAUSE IT IS THE THIRD CAUSE OF
DEATH WORLDWIDE.
TOBACCO IS ACKNOWLEDGED AS AN
IMPORTANT RISK FACTOR BUT ALSO
EXPOSURE TO FUMES OR CHEMICALS.
INDOOR AIR POLLUTION.
LIFE EVENTS ARE INVOLVED IN THE
RISK PARTICULARLY -- AND
FREQUENT OR SEVERE INFECTIONS
DURING CHILDHOOD AND ALSO TO A
SMALLER EXTENT GENETIC
CONDITIONS.
BUT WE DON'T SEE NUTRITION AS
LISTED AS ONE OF THE TRADITIONAL
RISK FACTORS AND I THINK THAT IS
WHY THIS WORKSHOP IS SO
IMPORTANT.
AND I'M GOING TO PRESENT THREE
SCENARIOS WHERE WE USUALLY CAN
SEE DIFFERENT CLASSES OF RISK
FACTORS FOR POOR LUNG FUNCTION
AND EVENTUALLY COPD.
THE FIRST ONE IS FAILURE TO FULL
LUNG GROWTH WHICH HAPPENS IN
ADULTS AS INDICATED IN THE
YELLOW LINE WITH THE RED ARROW
AND THE MAIN RISK FACTORS ARE
LOW BIRTH RATE, EARLY
INFECTIONS, RESPIRATORY
INFECTIONS AND SECONDHAND
TOBACCO SMOKE AND THERE IS A
GROWING BODY -- THAT SHOWS --
TIED TO NUTRITIONALLY POOR WITH
OBTAINING LOWER LUNG FUNCTION.
THE SECOND SCENARIO REFERS TO
THE RAPID DECLINE IN LUNG
FUNCTION.
THEY HAVE A DECLINE AND WHAT HAS
BEEN DEMONSTRATED ARE ACTIVE
SMOKING BUT ALSO SECONDHAND
SMOKING TO, TAM TUBERCULOSIS * D
EVIDENCE THAT IN FLENSES.
*.
THE WORST CASE SCENARIO WE REFER
TO INDIVIDUALS WHO HAVE BOTH
PROBLEMS.
THEY CAN ACHIEVE THE MAXIMUM
LEVEL OF LUNG FUNCTION AND THEY
HAVE A DECLINE AND HERE WE SEE A
COMBINATION OF RISK FACTORS.
ALSO POLLUTION AND SOCIAL
DETERMINANTS OF HEALTH INCLUDING
POVERTY AND GENDER DISPARITIES.
AND OF COURSE NUTRITION HAS A
LOT TO DO WITH THOSE TWO.
NOW THE GOOD THING ABOUT COPD IS
THAT IT'S PREVENTABLE AND THIS
HAS BEEN RECOGNIZED BY THE WORLD
HEALTH ORGANIZATION AND ALSO BY
SEVERAL INTERNATIONAL SCIENTIFIC
RESPIRATORY SOCIETIES AND
THEREFORE THERE IS A HUGE
OPPORTUNITY HERE FOR TO IDENTIFY
WAYS IN WHICH -- SUCH AS
NUTRITION CAN AFFECT CHANGE AND
MODIFY CHANGE.
NOW WE HAVE -- LOADS OF EXPERTS
IN THIS ROOM.
I DON'T SEE MY SLIDES.
NO.
ANTOINE, THANK YOU.
SO THE DIFFERENT WAYS IN WHICH
WE CAN EXAMINE THE ASSOCIATION.
THIS IS A TRADITIONAL OR CLASSIC
DEPICTION OF THE WAY IN WHICH
UNHEALTHY FOODS AND MORE HEALTHY
FOODS MIGHT INFLUENCE LUNG
HEALTH.
WE KNOW CERTAIN DIETARY PATTERNS
AND FOOD CAN BE UNHEALTHY
BECAUSE THEY CONTAIN HIGH ENERGY
DEPS FOODS.
PROCESSED MEATS AND LOW IN
ANTIOXIDANTS.
ON THE OTHER HAND DIETS THAT ARE
RICH IN FRUITS, VEGETABLES AND
FIBER AND ALSO REACHING
ANTIOXIDANTS HAVE THE POTENTIAL
TO PROTECT THE LUNGS FROM A
NUMBER OF ENVIRONMENT AM INSULTS
AND OF COURSE THE MOST
TRADITIONALLY RECOGNIZED
MECHANISMS ARE INFLAMMATION,
OXIDATED STRESS AND DEPRESSION.
AND THERE ARE SEVERAL OTHERS
THAT NUTRITION CAN INFLUENCE
THOSE.
THERE ARE ALSO MINIMAL
PROPERTIES OF NUTRIENTS IN
RELATION TO LUNG HEALTH.
MINERALS, AND VITAMINS ALL OF
WHICH ARE GOING TO BE COVERED
HAVE BEEN DEMONSTRATED TO HAVE A
NUMBER OF PROPERTIES THAT CAN
PROTECT THE AIRWAYS FROM
OXIDATIVE STRESS AND A NUMBER OF
OTHER INSULTS THAT CAN AFFECT
LUNG HEALTH.
THERE IS ALSO RECENT INTEREST IN
UNDERSTANDING A BIT MORE THE
AXIS AND HOW THE GUT MICROBIOME
CAN INFLUENCE.
NOW WHAT DO WE KNOW ABOUT THE
EPIDEMILOGICAL RESEARCH?
IT'S RESTRICT TO HIGH INCOME
COUNTRIES.
THERE IS ONE STUDY FROM THE
EARLY 2000s THAT WAS THE FIRST
STUDY THAT SUBJECT THAT DIETARY
FLAVONOIDS MIGHT BE RELATED.
WE DO KNOW FROM LONGITUDINAL
SURVEYS THAT IT MIGHT BE
ASSOCIATED WITH THE SLOWER
DECLINE OF LUNG FUNCTION.
THERE IS VERY LITTLE EVIDENCE --
-- PARTICULARLY FROM
DISADVANTAGED POPULATIONS.
COPD IS NOT AN EASY OUTCOME TO
DEFINE SO WE HAVE SEVERAL
CHALLENGES THERE AND OF COURSE
WHEN WE TALK ABOUT THIS WE HAVE
THE HUGE CHALLENGE OF HOW DO WE
MEASURE IT.
SO HERE I'VE SELECTED THREE
EXAMPLES FROM OBSERVATIONAL
STUDIES IN THE U.S. THAT ARE
REPRESENTATIVE OF THE GENERAL
POPULATION OF ADULTS IN THIS
COUNTRY AND ALL OF THESE STUDIES
HAVE EXAMINED WAYS IN WHICH DIET
MIGHT BE ASSOCIATED.
AND WHAT WE KNOW SO FAR FROM THE
NATIONAL HEALTH AND NUTRITION
EXAMINATION SURVEY AND THE
STUDIES THAT HAVING A BEEN DIET
QUALITY AND HIGHER INTAKE IN
FLAVONOIDS IS ASSOCIATED WITH
BETTER LUNG FUNCTION.
AND ON THE OTHER HAND PROCESSED
FOOD IS ASSOCIATED WITH LOWER
LUNG FUNCTION.
SPECIFIC DIETARY PATTERNS ARE
ALSO ASSOCIATED WITH VARYING --
OF COPD.
NOW THE DIFFICULTIES ASSESSING
DIETARY INTAKE AND THIS IS A
HUGE CHALLENGE IF WE WANT TO
PROGRESS THE SCIENTIFIC AGENDA
ON THE RESEARCH DEDICATED TO
NUTRITION AND RESPIRATORY
DISEASES.
WE NEED TO ADDRESS THE ISSUE OF
INTERNATIONAL COMPRABILITY.
WE ARE ABLE TO GRADE THE
EVIDENCE -- WE NEED TO ADDRESS A
NUMBER OF BIASES RELATED TO THE
COLLECTION OF DATA. DIET IS
MULTI-CULTURAL AND SOMETIMES WE
SEE HUGE VARIATIONS.
AND WE NEED TO ACCOUNT FOR
CULTURE SPECIFICITY.
THE OLD FASHIONED METHODS REMAIN
RELIABLE BUT WE NEED TO IMPROVE
THE WAY IN WHICH WE MEASURE THE
DIET AND INCREASE THE PRECIS
PRECISIONS.
SO ALL IN ALL THE EVIDENCE
SUGGEST THAT WHAT WE EAT MIGHT
BE ASSOCIATED WITH ASTHMA, LUNG
FUNCTION AND COPD.
THE EVIDENCE COMES PRESENT FROM
HIGH INCOME COUNTRIES.
WE HAVE SOME PROMISING RESULTS
FROM SMALL INTERVENTION STUDIES
THAT WILL BE PRESENTED LATER
HERE AND AS WE GET INTO
NONCOMMUNICABLE DISEASES
INFLAMMATION IS THERE.
I'M GOING TO FINISH WITH THE KEY
OBJECTIVES.
AS I SAID BEFORE WE HAVE AN
AMBITIOUS AGENDA BUT WE HOPE TO
ACHIEVE SEVERAL KEY AIMS.
LEVERAGE LARGE POPULATION COHORT
STUDIES AND EVIDENCE TO
UNDERSTAND THE IMPACT OF
NUTRITION AND DIET IN THE
PREVALENCE OF RESPIRATORY
DISEASES.
EXAMINE THE IMPACT OF CLIMATE
CHANGE ON FOOD SYSTEMS AND
SECURITY.
WE'RE GOING TO DISCUSS
MECHANISMS FOR WHICH NUTRITION
MIGHT INFLUENCE RESPIRATORY
HEALTH.
WE'RE GOING TO PRESENT PRESSURES
TO IMPROVE THE WAY IN WHICH WE
MEASURE NUTRITION IN THE GENERAL
POPULATION AND WE'RE GOING TO
DISCUSS THE EVIDENCE -- DIETARY
EXAMINATIONS THAT CAN EXAMINE
THE ROLES OF VARIOUS
OPPORTUNITIES.
WE'RE GOING TO IDENTIFY CRITICAL
RESEARCH GAPS, CHALLENGES,
OPPORTUNITIES AND KEY RESEARCH
QUESTIONS THAT CAN INFORM THE
FUTURE SCIENTIFIC RESEARCH
AGENDA AT THE NATIONAL HEALTH
INSTITUTE.
THANK YOU.
AND WITH THAT I'M GOING TO OPEN
THE FIRST SECTION OF THIS
WORKSHOP AND I ABSOLUTELY AM
DELIGHTED TO INTRODUCE OUR TWO
CO-MODERATORS.
AND I'M VERY GRATEFUL THAT
THEY'VE AGREED TO SERVE AND
PARTICIPATE IN THIS WORKSHOP.
WE HAVE CARLOS CAMARGO.
HE IS AN INTERNATIONAL EXPERT IN
RESPIRATORY AND ALLERGY
EMERGENCY MEDICINE, HEALTH
EFFECTS OF VITAMIN D AND A
VARIETY OF OTHER PUBLIC HEALTH
ISSUES.
WE ALSO HAVE DR. EMILY BRIGHAM,
AN ASSOCIATE PROFESSOR AT THE
UNIVERSITY OF BRITISH COLUMBIA.
SHE IS A RESEARCH SCIENTIST AS
WELL AS A PRACTICING RESPIRATORY
DOCTOR.
SHE HE HAD HER PROFESSIONAL
DEGREE AT THE JOHNS HOPKINS
SCHOOL OF MEDICINE.
THANK YOU.
>> THANK YOU, VANESSA.
AND THANK YOU ALSO TO NHLBI
FOR PUTTING TOGETHER THIS
WORKSHOP.
WE'LL START WITH THE FIRST
SESSION WHAT IS THE AIM OF THIS
SESSION?
THE KEY QUESTION?
SESSION ONE IS GOING TO FOCUS ON
THE EPIDEMILOGICAL EVIDENCE.
AND VERY IMPORTANT IN ADULTS.
WE'RE GOING TO FOCUS ON ADULTS.
WE MAY BRING UPDATE A FROM
CHILDREN BUT THE FOCUS IS ON
ADULTS.
ALSO EMPHASIZE VULNERABLE
POPULATIONS.
THE KEY QUESTION FROM NHLBI IS
THERE ADEQUATE EVIDENCE
SUPPORTING THE ROLE OF DIET AND
NUTRITION WHICH RAISES THE
QUESTION ADEQUATE FOR WHAT?
AND AGAIN YOU'VE HEARD FROM THE
PREVIOUS SPEAKERS.
THE ANSWER TO THIS IS I BELIEF
ADEQUATE TO JUSTIFY FURTHER
RESEARCH.
WHICH IN TURN MAY LEAD TO
CLINICAL PRACTICE CHANGES AND
WHICH HAPPENS ONE DAY MAY LEAD
TO CHANGES IN HEALTH POLICY BUT
EVERYTHING HERE IN THE WORKSHOP
IS FOCUSING ON GAPS, RESEARCH
QUESTIONS AND SO, THAT IS OUR
FOCUS.
AS STATED BY THE NHLBI THE
OVER-ALL GOAL IS TO IDENTIFY KEY
RESEARCH QUESTIONS THAT CAN BE
ADDRESSED TO ADVANCE NUTRITION
RESEARCH TO PROMOTE RESPIRATORY
HEALTH AND DISEASE, PREVENTION
AND MANAGEMENT IN ADULTS.
I'M GOING TO SKIP DETAILED
SPEAKER INTRODUCTIONS.
WE ENCOURAGE YOU TO LOOK AT THE
SPEAKER BIOS THAT ARE AVAILABLE
ON THE WEBSITE.
AND WITH THAT I'LL STOP TALKING
AND EMILY WILL INTRODUCE THE
FIRST OF OUR SPEAKERS.
>> THANK YOU, DR. CAMARGO.
I HAVE THE PLEASURE OF DOING A
BRIEF INTRODUCTION FOR DR. JUAN
CELEDON.
AND TODAY HE WILL BE SPEAKING TO
US ABOUT EVIDENCE AND THE
RELATIONSHIP BETWEEN DIETARY
PATTERNS AND HEALTH.
THANK YOU, DR. CELEDON.
>> THANK YOU.
I WANT TO THANK THE NHLBI FOR
THEIR KIND INVITATION.
SO AS YOU KNOW ASTHMA IS A
COMMON DISEASE.
IT AFFECTS ABOUT 260 MILLION
PEOPLE GLOBALLY AND IN THE U.S.
19 MILLION ADULTS WHICH IS WHY
WE'RE DISCUSSING THIS.
IT POSES ENORMOUS COSTS TO OUR
HEALTH CARE SYSTEM.
$81 BILLION A YEAR.
CHARACTERIZED BY INFLAMMATION,
HYPER REACTION ACTIVITY AND
OBSTRUCTION THAT IS OFTEN BUT
NOT ALWAYS REVERSIBLE.
THIS IS A SLIDE TO SHOW HOW THE
PREVALENCE OF ASTHMA INCREASED
FROM A PERIOD THAT WAS STARTED
IN THE 1960 UNTIL THE 1990s
LOW AND MEDIAN INCOME COUNTRIES.
BUT THE PURPOSE IS THAT IT IS
IMPOSSIBLE TO ATTRIBUTE THIS TO
GENETICS ALONE.
SO SOMETHING HAD TO CHANGE IN
OUR LIFESTYLE AND ENVIRONMENT.
AND I WOULD POSE THAT ONE OF THE
MOST DRAMATIC CHANGES IS THE
ADOPTION OF A DIET THAT OFTEN
INCLUDES HIGHLY PROCESSED FOODS
AND REDUCED CONSUMPTION OF
FRUITS AND VEGETABLES AND THIS
PAY EXPLAIN THE ASTHMA EPIDEMIC
IN COUNTRIES WITH SO-CALLED
WESTERN LIFESTYLES.
SO I WOULD MENTION ONE SLIDE FOR
THE KIDS.
THIS IS FROM MY COLLEAGUE IN
SPAIN.
COMPARING THE MEDITERRANEAN
DIET.
RESULTED IN 15% DECREASED ODDS
OF ASTHMA IN CHILDREN.
SO IN ADULTS WE CONDUCTED THE
STUDY IN THE NATIONAL HEALTH AND
EXAMINATION.
IT'S CALCULATED BY NUTRIENT
INTAKE.
IT WAS NORMALIZED.
TO ACCOUNT FOR TOTAL ENERGY
INTAKE.
THIS WAS A CROSS-SECTIONAL
STUDY.
WE CONDUCTED ANALYSIS AND THREE
OUTCOMES.
SO WHAT -- THIS IS THE GIST OF
THE PAPER.
WE FOUND THAT THERE WAS
MODIFICATION OF THE ESTIMATED
EFFECTS OF THE D II SCORE BY THE
FRACTIONAL -- OXIDE -- AIRWAY
INFLAMMATION.
SO IT WAS INTERESTING IN
CHILDREN THAT THE D II WAS
ASSOCIATED WITH -- ONLY IN
CHILDREN WITH A HIGH FENO WHO
PROBABLY HAVE -- ASTHMA.
WHEREAS FOR ADULTS WE OBSERVE AN
ASSOCIATION BETWEEN THE HIGHEST
-- D II IN BOTH ADULTS WITH LOW
AND HIGHER FENO.
WE ALSO FOUND THAT THE D II WAS
ASSOCIATED WITH REDUCED --
FUNCTIONS AND ALSO FBC IN THE
ANALYSIS INCLUDING ALL
PARTICIPATING ADULTS.
IF YOU STRATIFY BY CONTROLS
VERSUS SUBJECTS WITH ASTHMA IT
WAS ONLY SIGNIFICANT IN CONTROLS
BECAUSE WE THINK THE SAMPLE SIZE
WAS MUCH MORE CONTROLLED.
WE DID NOT FIND ASSOCIATION WITH
ASTHMA DEFINED AS PHYSICIAN
DIAGNOSED ASTHMA.
IN EITHER CHILDREN OR ADULTS.
NOW I MUST MENTION BECAUSE THIS
IS THE CRUX OF MY RESEARCH.
ASTHMA IS NOT AN EQUAL
OPPORTUNITY DISEASE.
IN THIS NATION NONHISPANIC
BLACKS, AMERICAN INDIANS AND
ALASKANS HAVE A HIGHER
PREVALENCE OF ASTHMA.
A COMMON ERROR IS MADE IS TO
CONSIDER HISPANICS AS A
MONOLITHIC GROUP.
BUT THIS IS A FALLACY.
ONCE YOU DECOMPOSE HISPANICS
INTO SUBGROUPS A COMPLETE
DIFFERENT PICTURE EMERGES.
THIS IS DATA AND ONCE YOU DO
THAT AND YOU LOOK AT ADJUSTED
PREVALENCE OF ASTHMA PUERTO
RICANS HAVE FIVE TIMES MORE
PREVALENCE OF ASTHMA THAN
MEXICANS.
WHEREAS MEXICANS HAVE LOWER
BURDEN OF ASTHMA.
THIS ALSO IS -- MORBIDITY.
COMPARING PUERTO RICANS TO OTHER
HISPANIC OR LATINO ADULTS AND
THEY HIGHER HEALTH CARE USE
HIGHER SHOP.
SITUATIONS -- VISITS, USE OF
SYSTEMIC STEROIDS.
NOW WE ALSO LOOK AT THE D II
AMONG HISPANIC ADULTS IN SOL.
AGAIN WE USED ENERGY ADJUSTED D
II.
ALSO ANOTHER DIETARY INDEX --
HEALTHY EATING INDEX AND HERE WE
INCLUDED 12,687 LATINO ADULTS
AGE 18-76 YEARS.
AND THIS IS -- THESE ARE THE
MAIN FINDINGS.
AFTER ADJUSTING FOR THE SUB
GROUP THE D II WAS ASSOCIATED
WITH A HIGHER RISK OF ASTHMA --
AND FOR ALL CORE TILES ABOVE THE
LOWESTS ASSOCIATED WITH HIGH
RISK OF ASTHMA SYMPTOMS.
THE OTHER DIETARY INDEX
INDICATING HIGHER DIETARY
QUALITY WAS NOT ASSOCIATED WITH
ASTHMA SYMPTOMS.
WE ALSO FOUND THAT IN FACT THE D
II WAS ASSOCIATED WITH LOWER
FVB1.
WITH SINGULAR -- ASTHMATICS.
AN THE OTHER INDEX THE AHEI WAS
ASSOCIATED WITH HIGHER -- THIS
IS A SUMMARY SLIDE.
THE HIGHER -- WAS ASSOCIATED.
WE WOULD HAVE LOVED TO LOOK AT
THIS IN A SPECIFIC SUBGROUPS BUT
SAMPLE SIZE DID NOT ALLOW US TO
DO SO.
MORE RECENTLY WE LOOK AT
PROSPECTIVE DATA IN TWO STUDIES.
THESE ARE PUERTO RICAN YOUTH.
LOOKED AT A BASELINE WHEN THEY
WERE 6-14 AND THEN AS YOUNG
ADULTS ABOUT FIVE YEARS LATER
AND IN THIS STUDY AN UNHEALTHY
DIET DEFINED BY A SCORE THAT WE
PREVIOUSLY PRESENTED -- WAS
ASSOCIATED WITH HIGHER RISK OF
ASTHMA AND HIGHER RISK OF SEVERE
ASTHMA.
SO AGAIN WHAT I SHOWED YOU
BEFORE.
AN UNHEALTHY DIET WAS ASSOCIATED
WITH INCREASED ODDS' PERSISTING
ASTHMA 9-20.
THERE WAS NO ASSOCIATION BUT THE
SAMPLE SIZE WAS SMALL.
SO TOGETHER WITH RESULTS FROM
THE STUDIES OUR FINDINGS SUPPORT
HEALTH POLICIES PROMOTING A
HEALTHY DIET.
SO THIS IS SOMETHING THAT WILL
BE DISCUSSED IN DEPTH BY OUR
NEXT SPEAKERS.
THERE ARE SOME HIGH RISK
POPULATIONS THAT MAY BENEFIT
THAT MAY INCLUDE THOSE EXPOSED
TO HIGH LEVELS OF POLLUTANTS,
SMOKERS.
AND THEY MAY HAVE DIRECT OR IN
DIRECT EFFECTS.
THIS WAS ELUDED BY
DR. GARCIA-LARSEN.
THE EFFECTS OF ANTIOXIDANTS AND
INCREASED FIBER.
IN TERMS OF FUTURE DIRECTIONS I
KNOW THAT INTERVENTIONAL SITES
ARE GOING TO BE DISCUSSED LATER.
WE'RE PLANNING TO DO ANALYSIS OF
DIET AND ASTHMA ENDO TYPES.
WE'LL LOOKING AT THE
RELATIONSHIP AND THEN A THIRD
PHASE OF THE PUERTO RICAN STUDY
WHERE WE'RE LOOKING AT DIET AND
ASTHMA WHEN THE PARTICIPANTS ARE
21 - 29.
WHICH IS NHLBI FUNDED.
JUST TO THANK A BUNCH OF PEOPLE
BOTH IN OUR GROUP AND ELSEWHERE
AND PARTICULARLY THE NHLBI AND
DR. JIM KILEY WHO IS RETIRING
SOON AND HAS BEEN THE ONLY
DIRECTOR THAT I'VE KNOWN.
THANKS, JIM.
THANKS, EVERYBODY.
>> THANK YOU, JUAN.
THAT WAS EXCELLENT AND RIGHT OFF
SCHEDULE.
SO OUR NEXT SPEAKER IS
DR. KHOURY HANSON.
-- DR. CORRINE HANSON *.
>> ALL RIGHT.
NEXT SLIDE PLEASE.
THANK YOU, CARLOS VERY MUCH.
LIKE YOU MENTIONED MY TALK IS
GOING TO FOCUS ON FATTY ACIDS IN
RESPIRATORY HEALTH AND DISEASE.
SO AS AN OVERVIEW I HAD PLANNED
TO PRESENT A SUMMARY OF THE
EPIDEMILOGICAL EVIDENCE THAT
STRIKES THE IMPACT OF FATTY
ACIDS.
MOST OF THESE STUDIES THAT WILL
BE INCLUDED IN MY TALK TODAY
HAVE BEEN CONDUCTED AND
PUBLISHED BY THE OTHER SPEAKERS
THAT YOU WILL HEAR FROM AS PART
OF THE WORKSHOP SO I THINK IT
SHOWS THAT WE'VE GATHERED THE
GREAT MINDS OF THIS TOPIC TO
HAVE SOME GREAT DISCUSSION AND
DETERMINE THE FUTURE DIRECTION
OF THIS VERY IMPORTANT FIELD.
SO I WILL GIVE AN OVERVIEW ABOUT
THE CURRENT STATE OF THE SCIENCE
ON THIS TOPIC AND THEN TRY TO
SIN THEY SIZE SOME OF THE GAPS
*.
AND THE CHALLENGES.
ALL RIGHT.
LET'S START WITH POLYUNSATURATED
FATTY ACIDS.
THE ACIDS THAT MOST OF US ARE
FAMILIAR WITH.
OMEGA 3 AND OMEGA 6.
THEY ARE BASICALLY DEFINED AS
THEY ARE A FATTY ACID THAT HAS
TWO OR MORE CARBON TO CARBON
DOUBLE BONDS IN THEIR MOLECULAR
STRUCTURE.
THE CHALLENGED TO IS TO
DETERMINE WHETHER OR NOT THERE
IS ENOUGH EVIDENCE OF THE
RELATIONSHIP BETWEEN THESE
POLYUNSATURATED ACIDS AND THESE
DISEASE STATES IN ORDER TO
JUSTIFY FURTHER RESEARCH.
IF YOU LOOK AT THE RESEARCH THAT
HAS BEEN CONDUCTED IT'S FOCUSED
IN SEVERAL AREAS.
ASTHMA IS THE MOST WIDELY
STUDIED DISEASE.
COPD HAS BEEN STUDIED.
DURING THE COVID-19 PANDEMIC
THERE WAS AN EXPLOSION OF
RESEARCH ABOUT THE ROLE IN
COVID-19 AND THEN ALSO THE
ASSOCIATED DOWNSTREAM THINGS
THAT HAPPEN TO THOSE PEOPLE SUCH
AS COGNITIVE DECLINE AND
FATIGUE.
A SMALL AMOUNT OF EPIDEMILOGICAL
RESEARCH ON THE EFFECT OF LUNG
FUNCTION AND LUNG FUNCTION
DECLINE AND THERE HAVE BEEN A
COUPLE OF STUDIES THAT HAVE BEEN
LOOKED AT PULMONARY FIBROSIS.
ONE THING THAT IS MISSING IS
PREVENTION.
THERE IS MUCH LESS RESEARCH ON
THE PREVENTION OF LUNG DISEASE
WITH REGARD TO ANY FATTY ACIDS.
ONE THING THAT IS INTERESTING
THAT HAS COME TO LIGHT LIGHTLY
IS THAT A LOT OF THE ORIGINAL
RESEARCH TENDS TO LOOK AT A
DIRECT EFFECT.
EXPOSURE OUTCOME.
IS INTAKE OR STATUS OF POLLY
UNSATURDAY RATED FATTY ACIDS
ASSOCIATED?
THERE IS MORE EVIDENCE COMING TO
LIGHT OF IN DIRECT EFFECTS.
A COUPLE OF STUDIES THAT FATTY
ACIDS CAN MODIFY THE EFFECTS OF
OTHER EXPOSURES SPECIFICALLY AIR
POLLUTION.
SO FOCUSING FOR A MINUTE ON
ASTHMA.
LOOKING AT THE EPIDEMILOGICAL
EVIDENCE WITH REGARD TO ASTHMA I
THINK GIVES US A NICE PICTURE OF
SOME OF THE CHALLENGES THAT WE
FACE WHEN WE LOOK AT OTHER FATTY
ACIDS AND WHEN WE LOOK AT THE
RELATIONSHIP BETWEEN DIET AND
DISEASE IN GENERAL.
IT'S THE MOST COMMONLY STUDIED
OUTCOME AND THE RESULTS
HIGHLIGHT THE CHALLENGES.
SO AS PART OF THE WORKSHOP I
TOOK THE LAST FIVE YEARS AND
PULLED THE EPIDEMILOGICAL
STUDIES IN ADULTS THAT I COULD
FIND THAT DESCRIBE THE
RELATIONSHIP BETWEEN FATTY ACIDS
AND LUNG HEALTH OUTCOMES.
AND SO FROM IN ROUGHLY THE LAST
FIVE YEARS THERE HAVE BEEN 18
EPIDEMILOGICAL STUDIES STUDYING
THE RELATIONSHIP BETWE.
IT DOES INCLUDE A LITTLE BIT OF
CHILDHOOD THINGS THAT ARE
INTERESTING AND COULD PROBABLY
IMPACT THE DEVELOPMENT OF
DISEASE IN ADULTS.
IF YOU LOOK AT THOSE 18 STUDIES,
8 OF THEM REPORTED A DIRECT
POSITIVE ASSOCIATION BETWEEN
POLYUNSATURATED FATS.
BUT MORE THAN HALF OF THESE
STUDIES 9 REPORTED AN
ASSOCIATION BUT ONLY WHEN THEY
CONSIDERED CONSIDERED
MODIFICATION.
THERE WAS NO ASSOCIATION BETWEEN
PUFA AND ASTHMA.
ONLY AN ASSOCIATION WHEN THEY
LOOKED AT SPECIFIC POPULATIONS
AND THE RESULTSES VARIED BY MANY
FACTORS.
SO JUST WITHIN THESE NINE
STUDIES RESULTS VARIED BY
GENOTYPE.
SEX WAS A FACTOR.
VITAMIN D STATUS IMPACTED
WHETHER OR NOT PEOPLE WITH
ASTHMA WOULD SEE A BENEFIT FROM
POLPOLYUNSATURATED FATTY ACIDS.
BOLSONARO.
-- ONE STUDY HAD NO FINDINGS.
NO RELATIONSHIP, NO RELATIONSHIP
WITH ANY SORT OF STRATIFICATION
OR MODIFICATION AND ONE STUDY
REPORTED DIRECT ASSOCIATIONS AS
WELL AS THE MODIFICATION OF
OTHER ENVIRONMENTAL FACTORS
NAMELY AIR POLLUTION, SHOWING
THAT YOUR POLYUNSATURATED FATTY
ACIDS STATUS WILL IMPACT HOW YOU
RESPOND IF YOU'RE EXPOSED TO
HIGH OR LOW LEVELS OF AIR
POLLUTION.
IF WE MOVE ON TO MONTGOMERY -- N
STUDIED EXTENSIVELY AND THERE IS
EVIDENCE TO SUPPORT THE BENEFITS
OF MONOUNSATURATED FATTY ACIDS
ON CARDIOVASCULAR HEALTH DIRECT
EVIDENCE LINKING THIS TO
RESPIRATORY DISEASE IS STILL
VERY LIMITED.
I COULD FIND THREE STUDIES OVER
THE PAST FIVE YEARS THAT
EVALUATED ANY SORT OF
ASSOCIATION BETWEEN
MONOUNSATURATED FATTY ACIDS AND
ASTHMA AND THE RESULTS WERE
COMPLETELY MIXED.
ONE STUDY HAD NO FINDINGS.
ONE SHOWED A NEGATIVE EFFECT.
ONE STUDY SHOWED THERE WAS A
POSITIVE EFFECT ON ASTHMA
DEVELOPMENT OR ASTHMA OUTCOMES.
ONE THING THAT HAS BEEN UTILIZED
IN THE STUDIES OF
MONOUNSATURATED FATTY ACIDS WAS
METABALOMICS PROFILING AND THIS
COULD EXPAND OUR UNDERSTANDING
OF LIPIDS AS YOU CAN EVALUATE
THE ENTIRE LIPID PROFILE OF A
PERSON AS OPPOSED TO INTAKES OF
JUST ONE FATTY ACID.
WHEN YOU START TALKING ABOUT
DIET PATTERNS THAT MAYBE THE SUM
OF THE PARTS BECOMES MORE
IMPORTANT THAN FOCUSING ON ONE
INDIVIDUAL NUTRIENT AND LOOKING
AT THE BIG PICTURE.
SO USING THIS PROFILING WHERE
THIS WAS LOOKING AT THE
RELATIONSHIP OF MONOUNSATURATED
FATTY ACIDS -- THE METABOLIC
PROFILE IN COMPARISON TO OTHER
FATTY ACIDS THIS SHOWED THAT
HIGHER CONCENTRATIONS OF
MONOUNSATURATED FATTY ACIDS WERE
BENEFICIAL IN IMPROVING OUTCOMES
AND REDUCING INFLAMMATION AND
THE TWO POPULATIONS WHERE THIS
HAS BEEN STUDIED WERE COVID-19
AND PULMONARY HYPERTENSION.
SATURATED FATTY ACIDS HAVE BEEN
A BIT MORE STUDIED.
MOST IMPLICATED SATURATE FATTY
ACIDS TO AN INCREASED RISK OF
DISEASE BOTH WITH ASTHMA AND
LUNG CANCER.
BUT USING THE PROFILING OR
MACHINE LEARNING GIVES US MORE
INCITE AND MACHINE LEARNING HAS
BEEN USED TO DETERMINE THE
CONTRIBUTION.
SALTALAMACCHIA
AND IN THIS STUDY THAT LOOKED AT
ASTHMA THE MACHINE LEARNING
METHODOLOGY WAS ABLE TO
DELINEATE THE RISK AND
DECREASING WITH A -- A HIGHER
AMOUNTS OF THE SHORT CHAIN FATTY
ACIDS.
SO THE SHORT CHAIN FATTY ACIDS
THAT ARE SATURATED WE THINK OF
THESE AS BEING PRODUCED BY THE
GUT MICROBIOME.
WHAT IS INTERESTING IS THAT IT
APPEARS TO BE ONLY THE GUT
MICROBIOME THAT CONTRIBUTES TO
THE PRODUCTION OF THESE SHORT
CHAIN S.A.T. S.A.T. WITH --
ONE STUDY SHOWED THERE WAS AN
INCREASE IN LUNG CANCER RISK DUE
TO HIGH SATURATED FATTY ACID
INTAKE IN SMOKERS BUT THIS WAS
NOT SEEN IN AFRICAN-AMERICANS.
SO IN SUMMARY TO ANSWER THE
QUESTION DO FATTY ACIDS HAVE THE
POTENTIAL TO PLAY A SIGNIFICANT
ROLE IN LUNG HEALTH?
EPIDEMILOGICAL EVIDENCE WOULD
SUPPORT THIS.
MOST OF THE EPIDEMILOGICAL
EVIDENCE IS AROUND
POLYUNSATURATED FATTY ACIDS WITH
THE EFFECTS OF OTHER FATTY ACIDS
BEING LESS UNDERSTOOD.
THEY APPEAR TO HAVE DIRECT
EFFECTS BUT HAVE THE ABILITY TO
MODIFY THE EFFECTS OF OTHER
EXPOSURES.
WE HAVE OTHER SPEAKERS WHO WILL
DELVE MORE INTO THIS.
THIS MAY ACCOUNT FOR SOME OF THE
DISCREPANCIES.
SO SOME OF THE KEY GAPS THAT WE
CAN IDENTIFY FROM THE
EPIDEMILOGICAL LITERATURE IS
AGAIN WITH THE OVER-ALL LIPID
DOME HAS BEEN IGNORED.
SOMETIMES WE FOCUS ON ONE CLASS
OF FATTY ACIDS BUT HOW DO THEY
ALL INTERACT AND THE COMPLEXITY
-- HOW THEY INTERACT WITH EACH
OTHER.
WHAT THE BIG PICTURE IS HAS BEEN
IGNORED.
THERE IS FAIRLY STRONG EVIDENCE
THAT GENETIC POLLY MORE OFISMS
WILL IMPACT YOUR RESPONSE.
THERE IS A NEED FOR DEEPER
INSIGHTS.
AND AGAIN THE RESPONDERS THE
NONRESPONDERS -- MAKE IT
DIFFICULT FOR US TO DRAW
GENERALIZABLE CONCLUSIONS AND
SUPPORT THE PATH OF PRECISION
NUTRITION.
>> SPEAKER, YOU HAVE ONE MINUTE
REMAINING
>> OKAY.
I HAVE COVERED MOST OF THE
OPPORTUNITIES.
PRECISION NUTRITION, THE
HETEROGENEITY RESPONSE.
AND SO THIS LEADS US TO SOME OF
OUR KEY RESEARCH QUESTIONS AGAIN
-- PERSONALIZED NUTRITION.
MECHANISTIC STUDIES WILL HELP US
UNDERSTAND HOW THE SPECIFIC
MECHANISMS HOW IT WORKS AND HOW
IT HAPPENS AND INTERVENTIONAL
TRIALS WILL BE IMPORTANT AS WE
UNDERSTAND THIS AND TAKE INTO
ACCOUNT THE VARIABILITY AND
RESPONSE AS WE DESIGN THESE
FUTURE TRIALS.
THANK YOU.
>> WONDERFUL.
THANK YOU SO MUCH DR. HANSEN.
WE'LL MOVE ON TO THE NEXT
SPEAKER FOR TIME.
I'M PLEASED TO INTRODUCE MY
CO-MODERATOR, DR. CAMARGO.
PROFESSOR OF EMERGENCY MEDICINE
AS WELL AS EPIDIMENIOLOGY AT
HARVARD.
TODAY HE WILL BE SPEAKING US TO
ABOUT THE RELATIONSHIP OF
DIETARY, ANTIOXIDANTS.
>> I DON'T HAVE ANY CONFLICTS TO
REPORT.
I'LL GIVE A DEFINITION OF
DIETARY ANTIOXIDANTS AND THEN
I'LL TALK ABOUT OUTCOMES AND
SOME OF THE OTHER SPEAKERS HAVE
STARTED TO INDICATE THAT THERE
ARE A LOT OF OUTCOMES IN
ADDITION TO A LOT OF EXPOSURES.
A ONE SLIDE SUMMARY OF WHAT IS
KNOWN ABOUT DIETARY ANTIOXIDANTS
AND ASTHMA AND THEN FOCUS ON THE
TWO REQUESTED SLIDES WHICH IS
CURRENT RESEARCH GAPS AND
QUESTIONS.
SO THE DEFINITION OF DIETARY
ANTIOXIDANTS.
IT'S A COMPOUND THAT INHIBITS
OXIDATION.
CHEMICAL REACTION THAT CAN
PRODUCE FREE RADICALS.
THE POINT THAT I WANT TO MAKE
WAS THAT THE DIETARIANT OX DANCE
CAN INCLUDE MANY DELIVER
DIFFERENT FORMS.
-- * FRESH FRUITS AND
VEGETABLES.
MICRONUTRIENTS.
VITAMINS, A, C AND E AND
REMEMBERING THERE ARE OTHER
TRIALS THAT LARGE AMOUNTS OF
SOME OF THESE HAVE THE POTENTIAL
TO CAUSE HARM.
THERE'S ALSO FIGHT OH NUTRIENTS.
THE FLAVONOIDS *.
SO AS I LOOK AT THIS BIG ARRAY
OF EXPOSURES ONE THING THAT I'LL
PUT OUT THERE FOR DISCUSSION IS
THAT IT SEEMS PERHAPS THE
EASIEST AND THAT IS IN QUOTES
AND SAFEST INTERVENTION WOULD BE
TO GIVE PEOPLE MORE FRESH FRUITS
AND VEGETABLES SO I'LL LEAVE YOU
WITH THAT THOUGHT.
ONE OF MY CONCERNS IN ALL OF
THIS NUTRITION RESEARCH IS THE
TENDENCY FOR US TO ENGAGE IN
THIS REDUCTIONISM WHERE WE KEEP
GOING SMALLER AND SMALLER AND WE
THINK WE'VE FOUND THE KEY.
DIETARY PATTERNS MAY BE CENTRAL
TO ANY EFFECT ON LUNG HEALTH.
WITH REGARD TO THE OUTCOME I'VE
ORGANIZED HERE JUST HOW COMPLEX
THIS CAN BE.
NHLBI ASKED US TO COMMENT ON
LUNG HEALTH.
THE CONCEPT OF POSITIVE HEALTH.
MORE THAN THE ABSENCE OF
DISEASE.
THIS IS REALLY WELL FUNCTIONING
LUNGS AND EVERYTHING INSIDE OF
THEM.
SO HOW DO YOU MEASURE THAT?
WHAT DOES THAT MEAN?
THIS IS A NEGLECTED AREA I THINK
IN PULMONARY RESEARCH.
BUT IT COULD BE CHARACTERIZED BY
MORE THAN 100% -- IT COULD BE
CHARACTERIZED BY SUPERIOR
EXERCISE PERFORMANCE.
THINKING ABOUT ATHLETES AND
THEIR LUNGS THAT ARE WORKING SO
WELL IN THEIR PRIME.
THAT IS VERY DIFFERENT THAN
DISEASES.
WHICH TENDS TO BE OUR FOCUS AND
HAS BEEN FOR A CENTURY OR MORE.
WHERE WE TALK ABOUT ASTHMA,
TUBERCULOSIS AND ALL OF THESE
DIFFERENT DISEASES AND NOT
HAVING THOSE DISEASES DOES NOT
MEAN POSITIVE HEALTH.
IT'S HELPING PEOPLE HAVE THE
HEALTHIEST LUNGS POSSIBLE.
SO JUST CHEW ON THAT FOR A
SECOND.
THE OTHER CONCEPT WHICH DID COME
UP EARLIER IS JUST A REAL
CRITICAL IDEA IS THAT WHAT
CAUSES NEW DISEASE IS THE FOCUS
OF PRIMARY PREVENTION MAY OR MAY
NOT RELATE TO WHAT AFFECTS
SEVERITY AND CONTROL AMONG THOSE
WHO HAVE THE DISEASE WHICH WE
CAN CALL SECONDARY PREVENTION
AND THERE TENDS TO BE IN THIS
FIELD AND I THINK IN MANY AREAS
AN IDEA WELL HERE IS A NUTRIENT
AND IT EFFECTS SOMETHING ABOUT
THE LUNG.
IS IT GOOD OR BAD?
IT'S SO MUCH MORE COMPLICATED.
YOU JUST HEARD ALL OF THE
POSSIBLE FATTY ACIDS AND THE
SAME IS TRUE FOR ANTIOXIDANTS.
WHAT IS THE OUTCOME?
EVEN IF YOU CAN AGREE ON THE
EXPOSURE WHAT IS THE OUTCOME.
IS IT LUNG HEALTH OR IS IT
DISEASE?
WHICH DID -- DISEASE AND WHEN.
SO WHY ANTIOXIDANTS?
THIS SLIDE SUMMARIZES A VERY
COMPLEX STORY.
BUT BASICALLY IF YOU'RE EXPOSED
TO A VARIETY OF FACTORS SUCH AS
SMOKING AND AIR POLLUTION YOU
TEND TO TILT THE OXIDATIVE
STRESS AND IT HAS AN ARRAY OF
EFFECTS ON DIFFERENT SYSTEMS
INCLUDING INFLAMMATION INCLUDING
ALL KINDS OF DOWNSTREAM
UNHEALTHY OUTCOMES.
SO BRIEFLY OXIDATIVE STRESS WE
DO KNOW COULD CAUSE LUNG DAMAGE
AND INITIATING INFLAMMATORY
RESPONSES.
BUT YOU CAN SEE THAT THE CONCEPT
OOF ANTIOXIDANT IS MIXED IN WITH
INFLAMMATION SO THE HIGH IDEA --
THESE SUBSTANCES ARE AFFECTING
LOTS OF PATHWAYS AT THE SAME
TIME.
AND AGAIN I'M VERY CONCERNED
ABOUT THE TENDENCY TO REDUCE,
REDUCE, REDUCE INTO ONE
MOLECULE.
SO WHAT DO WE KNOW ABOUT ASTHMA?
THIS HAS BEEN A RESEARCH FOCUS
FOR ABOUT 30 PLUS YEARS.
AND OBSERVATIONAL STUDIES HAVE
IN MY OPINION PROVIDED MIXED
RESULTS.
THERE ABOUT AS MANY POSITIVE
STUDIES AS NULL STUDIES BUT I'VE
NEVER SEEN AN INDICATION THAT
MORE DIETARY ANTIOXIDANTS CAUSES
MORE HARM.
THERE ARE SOME DATA SHOWING
POTENTIAL BENEFIT WHEN MOTHERS
WHO ARE PREGNANT TAKE IT IN
TERMS OF THE RISK OF THEIR
CHILDREN GETTING ASTHMA BUT
AGAIN OUR FOCUSING ADULTS AND IN
MY OWN EXPERIENCE -- WE
CONSISTENTLY DID NOT SEE MUCH
RELATION BETWEEN DIETARY INTAKE
AND RISK OF ADULT ON SET ASTHMA.
THAT IS NOT TRUE FOR COPD WHICH
WE'LL GET TO SHORTLY.
WHERE I THINK THE DIETARY
ANTIOXIDANTS HAVE A ROLE IS A
THEME YOU'VE ALREADY HEARD.
POTENTIAL BENEFIT FOR ASTHMA
SEVERITY CONTROL AMONG PEOPLE
WITH HIGH OXIDANTS LOAD AMONG
SMOKERS.
OR HIGH LEVELS OF AIR POLLUTION.
ONE THAT I DO WANT TO HIGHLIGHT
IS ONE BY CINDY MCVOY WHERE SHE
AND HER TEAM GAVE VITAMIN C TO
PREGNANT SMOKERS DURING
PREGNANCY AND THEN LOOKED AT
WHAT HAPPENED TO THE OFFSPRING
AND IT SHOWED THAT INFANTS WHO
WERE BORN HAD BETTER P FTs AND
THAT IS SOME OF THE STRONGEST
EVIDENCE THAT I'M AWARE OF THAT
DIET CAN MATTER.
IN TERMS OF COPD THE RESEARCH
FOCUSES A LITTLE LESS BUT STILL
ABOUT TWO DECADES.
BOTH OF THESE TOPICS HAVE SEEMED
TO BE SECONDARY FOR MANY YEARS.
PEOPLE HAVE BEEN STUDYING IT BUT
NOT A MAJOR FOCUS CERTAINLY NOT
WITH WHAT YOU SEE WITH
CARDIOVASCULAR AND CANCER.
NO CLEAR HARM.
BUT NOT ONLY POTENTIAL BENEFIT
BUT ALSO POTENTIAL BENEFIT FOR
SEVESEE SEVERITY.
THERE ARE A FEW RCTs AND COPD.
ONE WAS A STUDY -- AFTER THREE
YEARS OF INCREASED FRUITS AND
VEGETABLES THEY FOUND IMPROVED
SPREMOTERY.
* NOW THE MESSAGE -- I THINK IS
LIKELY IF THERE IS SOMETHING
GOING ON YOU NEED TO GIVE IT
SEVERAL YEARS TO AFFECT THE
OUTCOMES.
SO WHAT ARE THE RESEARCH GAPS?
I WOULD SAY THERE ARE MANY
POSSIBLE EXPOSURES HERE.
MANY POSSIBLE OUTCOMES AND
THEREFORE MANY GAPS.
IF I WERE TO FOCUS ON WHAT SEEMS
MOST PROMISING AS WE GO FROM
COHORT TO NEXT RESEARCH I WOULD
PUT HERE USING THE PICO DESIGN.
ADULT SMOKERS WITH THE
INTERVENTION OF LOTS OF FRESH
FRUITS AND VEGETABLES AND THE
COMPARISON WOULD BE NOT GETTING
THAT.
90% EAT LESS THAN FIVE SERVINGS.
SO EVEN IF PEOPLE START EATING
FRUITS AND VEGETABLES IF YOU
DON'T FACILITATE IT THEY WILL
COME OFF OF IT SOON.
WHAT IS THE OUTCOME?
IF YOU FOCUS ON THESE
POPULATIONS AND INTERESTS
CONVENIENCES IT COULD BE A
CHANGE -- THERE IS EVIDENCE TO
SUPPORT THAT KIND OF A TRIAL FOR
ANY OF THOSE OUTCOMES.
IN TERMS OF MECHANISMS IS THE
ROLE OF OMICS.
AND WHAT IS THEIR ROLE?
SO I'LL CLOSE WITH KEY RESEARCH
QUESTIONS.
ARE SPECIFIC REGIMENS ASSOCIATED
WITH IMPROVED LUNG HEALTH?
AGAIN THE POSITIVE SIDE OF
HEALTH.
NOT TALKING ABOUT YOU JUST DON'T
HAVE DISEASE BUT YOU'RE SOMEHOW
BETTER.
YOUR LUNGS WORK BETTER.
WHAT IS THE OUTCOME AND THEN THE
CONVENTIONAL APPROACH.
LUNG DISEASE OR LOWER DISEASE
SEVERITY OR IMPROVED CONTROL.
I THREW OUT COPD.
WHAT ARE THE MECHANISMS.
THE OMICS HAS A LOT TO OFFER AND
ULTIMATELY THE BIG RESEARCH
QUESTION IS DO RANDOMIZED
CONTROLLED TRIALS SUPPORT SUPP?
THANK YOU.
>> THANK YOU SO MUCH FOR THAT
EXCELLENT SUMMARY.
MORE TO COME IN DISCUSSION.
I'M PLEASED TO INTRODUCE OUR
FINAL SPEAKER FOR SESSION ONE,
DR. VANESSA GARCIA-LARSEN.
>> THANK YOU VERY MUCH.
I HAVE NO CONFLICTS OF INTEREST.
THANK YOU.
SO DIETARY FLAVONOIDS AND LUNG
FUNCTION -- HAS BEEN AN INTEREST
TO ME.
THERE ARE PLENTY OF
OPPORTUNITIES TO SEE HOW
FLAVONOIDS COULD PREVENT CHRONIC
RESPIRATORY DISEASES.
THE FLAVONOIDS ARE A TYPE OF
POLLY PHENOLS.
THERE HAVE BEEN SEVERAL STUDIES
NOT THAT MANY BUT SEVERAL THAT
HAVE EXAMINED IF THEY ARE
ASSOCIATED WITH IMPROVED LUNG
FUNCTION AND I'M GOING TO
EXPLORE WHAT THE EVIDENCE TELLS
US SO FAR.
EVIDENCE HAS BEEN QUITE
CATEGORICAL IN TERMS OF
SUGGESTING VARIOUS SUB CLASSES
CAN PROTECT LUNG TISSUE.
OVERCOME EXPERIMENTAL -- COPD
AND ALSO ATTENUATE INFLAMMATION
-- A VERY INTERESTING SUB CLASS
OF FLAVONOIDS.
-- THEY CAN BE FOUND IN LUNG
TISSUE AND THIS IS QUITE
INTERESTING BECAUSE I BELIEVE
THERE MIGHT BE UP A STRUCTURAL
FUNCTIONAL ROLE.
WHAT DO WE KNOW SO FAR?
EXPERIMENTAL EVIDENCE SUPPORTS
THE POSSIBILITY OF SEVERAL
CLASSES OF FLAVONOIDS MIGHT HAVE
AAN A EFFECT AND THERE HAS BEENA
NUMBER OF SCIENTISTS LOOKING
INTO THE POSSIBILITY THAT
SPECIFIC COMPOUNDS MIGHT BE
INVOLVED IN IMPROVING RESPONSES
TO COVID-19.
EPIDEMILOGICAL EVIDENCE COMES
FROM HIGH RESOURCE SETTINGS
INCLUDING HIGH INCOME COUNTRIES.
THERE ARE SOME STUDIES -- FROM
NORWAY AND UK AND THE U.S.
BUT ONE OF THE BIGGEST PROBLEMS
WITH DIETARY FLAVONOIDS WE DON'T
KNOW HOW ACCURATELY WE'RE
MEASURING THEM.
AND WE'RE NOT CERTAIN ABOUT
WHETHER -- WHAT WAS CONSUMED IS
WHAT IS ABSORBED AND WHETHER
THEY ARE METABOLICALLY
FUNCTIONAL.
SO THERE ARE LOADS OF CHALLENGES
AROUND THAT.
I MENTIONED BEFORE IN MY
PREVIOUS TALK THE STUDY FROM THE
EARLY -- 2000s IN THE
NETHERLANDS.
SOME SUB CLASSES OF FLAVONO FLAS
-- EATING MORE WAS ASSOCIATED
WITH HAVING -- BETTER --
COMPARED TO THOSE WHO ATE LESS.
I'VE PREPARED THIS SUMMARY.
THEY ARE NOT RELATED.
THEY USE DIFFERENT METHODS BUT
STANDARDIZED METHODS TO
ASCERTAIN LUNG FUNCTION.
THE FIRST -- LONGITUDINAL --
WHICH FOLLOWED ADULTS OVER THE
AGE OF 65 OVER 15 YEARS AND THE
EUROPEAN MULTINATIONAL STUDY --
-- JUST OVER 800 PARTICIPANTS.
INCLUDED TWO COHORTS -- AND OVER
400 PARTICIPANTS -- THE VETERAN
STUDIES -- FOLLOWED UP FOR 15
YEARS.
AND WHAT WE HAVE HERE IS THE
RESULTS WHEN THEY -- THEY BOTH
EXAMINED DIETARY INTAKE OF
FLAVONOIDS.
AND LUNG FUNCTION DATA WAS
STANDSTANDARDIZED.
I'M SUMMARIZING HERE.
THE VETERAN STUDY SHOWED THAT
THOSE -- THE MEAN ANNUAL
DECLINE, INDIVIDUALS WHO HAD THE
HIGHEST INTAKE -- WAS HIGHER
THAN THOSE IN THE LOWEST --
TYPE.
AND THE RESULTS WERE CONFIRMED
IN THE VETERAN STUDY.
THEY INCLUDED OTHER DIETARY AND
NUTRITIONAL -- AS WELL.
NOW AS I SAID BEFORE ONE OF THE
CHALLENGES WHEN WE LOOK INTO
DIETARY DATA IS THE FACT THAT WE
NEED TO ACCOUNTS FOR HOW
RELIABLE THE MEASUREMENTS ARE
GOING TO BE.
WE COLLECTED -- WE DESIGNED THE
QUESTION THAT WAS ADMINISTERED
TO PARTICIPANTS ACROSS 10
COUNTRIES IN EUROPE AND WE
VALIDATED IT TO SEE IF IT WAS
HARMONIZED ENOUGH SO THAT WE
COULD EXAMINE LUNG FUNCTION AND
A NUMBER OF RESPIRATORY OUTCOMES
USING A STANDARDIZED APPROACH.
BUT WE WANTED TO SEE IF IT WAS
RELIABLE ENOUGH.
AND THEN SEE IF WE COULD
REPLICATE OR CONFIRM SOME OF THE
OBSERVATIONS.
AND WE DID AN EXERCISE TO
IDENTIFY MARKETS OF METABOLITES
AND WE OBSERVED THAT THE DIETARY
QUESTIONNAIRE WAS RELIABLE
ENOUGH TO CAPTURE THE
CONSUMPTION OF SEVERAL IMPORTANT
FLAVONOIDS AND THIS GAVE US SOME
REASSURE ANC THAT THE FAQ HAD TO
CAPTURE THE INITIAL INTAKE OF
FLAVONOIDS.
THIS TELLS US THAT WE HAVE --
[ INDISCERNIBLE ]
AND SO WE EXAMINED VARIATIONS OF
DIETARY FLAVONOID INTAKE ACROSS
EUROPE AND WE WANTED TO SEE HOW
DIFFERENT OR SIMILAR THEY WERE.
THE SECOND SLIDE SHOWS THE TOTAL
NAV NOTICED TAKE ACROSS
COUNTRIES.
BETWEEN 200mg PER DAY TO
JUST OVER 400mg PER DAY.
WE TENDED TO SEE A SIMILAR TREND
AND THIS IS JUST TO ILLUSTRATE
ONE OF THE STUB CLASSES BUT WE
TENDED TO SEE THE SAME TREND IN
TERMS OF TOTAL CONSUMPTION AND
SEVERAL SUB CLASSES.
EASTERN EUROPEAN COUNTRIES
TENDED TO HAVE THE HIGHEST.
NORDIC COUNTRIES TENDED TO HAVE
THE LOWEST.
SO WE EXAMINED WHETHER THE
DIETARY INTAKE OF A SPECIFIC
DIETARY FLAVONOIDS WERE
ASSOCIATED WITH LUNG INTAKE.
WHICH INCLUDED TENUREIAN
COUNTRIES AND AFTER CARRYING OUT
SEVERAL ADJUSTMENTS FOR
POTENTIAL -- COME FOUNDMENTS --
* INDIVIDUALS WHO WERE IN THE
HIGHEST -- HAD BETTER LUNG
FUNCTION AND WE ALSO OBSERVED --
INDIVIDUALS WHO HAVE THE HIGHEST
INTAKE ALSO HAD LOWER -- OF
RESTRICTION.
SO THIS IS MULTINATIONAL SERVICE
IN EUROPE AND ALSO FROM COHORTS
IN EUROPE.
BUT WHAT HAPPENS IN LOWER AND
MIDDLE INCOME COUNTRIES.
THERE IS BASICALLY NO RESEARCH
AND THE BURDEN OF OBSTRUCTIVE
LUNG DISEASE HAS OFFERED THE
FIRST OPPORTUNITY TO EXAMINE THE
RELATIONSHIP.
BUT THAT REQUIRED US TO CARRY
OUT ADDITIONAL ADAPTATION
PROCESSES AND VALIDATION TO
ENSURE THAT THE QUESTION AND THE
INSTRUMENTS WE WERE USING WERE
STILL APPLICABLE.
*.
TO MAKE IT RELIABLE IN SOME OF
THE CENTERS.
SO HERE WHAT WE'VE DONE WE'VE
EXAMINED ONE OF THE WELL-KNOWN
DIET INDEXES.
WE ANNUALIZED -- WHO HAD DIETARY
DATA. BELOW 4,000 PARTICIPANTS
FROM FIVE COUNTRIES AND WE
EXAMINED THE ASSOCIATION BETWEEN
DIET QUALITY AND LUNG FUNCTION
AND HERE YOU CAN SEE THE
ASSOCIATION OBSERVED FOR THIS
QUALITY INDEX.
DR. IS A TREND THAT SUGGEST THAT
HAVING A HIGHER OR BETTER DIET
QUALITY INDEX WAS ASSOCIATED
WITH BETTER LUNG FUNCTION.
WE DO ADJUST FOR SEVERAL
IMPORTANT SOCIOECONOMIC
CONFOUNDERS BUT ALSO DIETARY AND
NUTRITIONAL CONFOUNDERS AS WELL.
FOR FLAVONOIDS THEY ARE WIDELY
DISTRIBUTED IN PLANT BASED
FOODS.
BUT WE ALSO WOULD THE ADDITIONAL
CHALLENGE OF HAVING TO SEE WHAT
WE WERE USING TO MEASURE
FLAVONOIDS IS AT QUIET IN TERMS
OF THE FOOD TABLES.
AND THIS IS SOME WORK THAT WAS
LED BY DR. -- DURING HIS PhD.
THEY HAVE DATA ON NAV NOTICED
CONTENT AND WE * FOUND THEY WERE
COMPARABLE.
>> SPEAKER, YOU HAVE TWO MINUTES
REMAINING.
>> THANK YOU.
THIS CAPTURES, ILLUSTRATES THE
MULTI-VARIABLE A ASSOCIATIONS.
AND AS YOU CAN SEE HERE -- THE
TREND TENDS TO BE SLIGHTLY
DIFFERENT.
IF YOU LOOK AT THE FIRST -- A
HIGHER -- AS THE INTAKE OF TOTAL
FLAVONOIDS.
BUT THEN IT PLATEAUS.
SO WHAT DOES THE CURRENT
EVIDENCE SUGGEST?
THAT DIETARY FLAVONOIDS ARE
ASSOCIATED WITH HIGHER LUNG
FUNCTION AND POSSIBLY WITH LOWER
PREVALENCE AND RISK OF CO PD
RISK OUTCOMES.
THE MAIN SCIENTIFIC GAPS IN
KNOWLEDGE.
THE NEED TO HARMONIZE THE
EVIDENCE.
AND ADVANCE THE KNOWLEDGE.
SO WE UNDERSTAND HOW POWERFUL OR
ACTIVE THEY ARE.
THE NEED TO HARMONIZE
RESPIRATORY OUTCOMES IF WE WANT
TO MAKE INTERNATIONAL DATA COME
PRACTICABLE.
AND ADDRESS THE DIFFERENCES.
THIS ARE MY RESEARCH QUESTIONS?
HOW DO SOCIAL DETERMINANTS AND
OTHER LIFESTYLE RELATED FACTOR
FIGURE IN.
AND WHICH POPULATION GROUPS
WOULD BE MOST LIKELY TO BENEFIT
FROM INTERVENTION AND STUDIES?
THANK YOU.
THIS IS JUST AN ACKNOWLEDGEMENT
TO THE MANY RESEARCH FELLOWS AND
COLLEAGUES WHO HAVE BEEN
SUPPORTING THE MULTINATIONAL
STUDIES.
>> THANK YOU SO MUCH,
DR. GARCIA-LARSEN FOR THAT
AMAZING PRESENTATION.
WE ARE AT THIS POINT
TRANSITIONING INTO OUR PANEL
DISCUSSION WHICH I THINK WE'RE
ALL VERY EXCITED ABOUT AND
LOOKING FORWARD TO THIS
OPPORTUNITY TO IDENTIFY
PRIORITIES AND NEXT STEPS ACROSS
THE SPEAKERS THAT ARE PRESENT
HERE TODAY AND EXPERTS IN THE
FIELD.
BEFORE GOING INTO A VERY BRIEF
OVER-ALL HIGHLIGHT -- THEY'VE
PROVIDED US WITH SOME SUMMARY
SLIDES.
BUT I WANT TO GO BACK AND
HIGHLIGHT THE INITIAL QUESTION
THAT WE'RE ASKED TO ADDRESS AND
THAT'S THERE ADEQUATE
EPIDEMILOGICAL EVIDENCE
SUPPORTING THE RULE OF DIET AND
NUTRITION IN RESPIRATORY HEALTH
AND DISEASES AND WE'VE
INTERPRETED THIS ADEQUATE TO
JUSTIFY FURTHER RESEARCH.
DR. CAMARGO -- WILL BE PAYING
ATTENTION TO THE Q&A SECTION.
WE HAVE A NUMBER OF QUESTIONS
THAT WE'VE PREDEVELOPED TO HELP
GUIDE THIS CONVERSATION.
IT WILL BE VERY DIFFICULT TO GET
TO EVERY SINGLE QUESTION THAT IS
ASKED IN THE Q&A SO APOLOGIES IN
ADVANCE.
THAT DOES NOT SPEAK TO THE
IMPORTANCE OF YOUR QUESTION BUT
A FACT TO THE MULTIPLE STREAMS
OF INFORMATION THAT ARE COMING
IN.
>> BRING UP THE SUMMARY SLIDES.
THAT WOULD BE GREAT.
>> PANEL DISCUSSION ONE SLIDES
IF THAT HELPS.
>> WHAT I WAS GOING TO DO AFTER
THAT IS WHILE PULLING THAT UP --
OUR PLAN WAS TO HIGHLIGHT SOME
OF THE DISCUSSIONS HAPPENING.
IT WOULD BE IMPOSSIBLE NOT TO
TOUCH ON SOME OF THESE AND I'VE
TOUCHED ON SOME OF THESE DURING
THE PRESENTATIONS.
BUT THOSE LATER DISCUSSIONS
INCLUDE THE IMPACT OF CLIMATE
CHANGE ON FOOD SYSTEMS AND
SECURITY.
MECHANISMS -- EMERGING PRECISION
MEASURES OF DIET AND DIETARY
INTERVENTIONS.
WE'LL TOUCH ON SOME OF THOSE BUT
WE'LL TRY TO STAY FOCUSED ON THE
EPIDEMILOGICAL EVIDENCE.
>> WE CAN SHARE THE SLIDES HERE.
>> THANK YOU SO MUCH.
>> ALL RIGHT.
SO THIS IS AGAIN NONE OF THE
SPEAKERS OR MODERATORS HAVE ANY
RELEVANT CONFLICTS.
AND EMILY, WHY DON'T YOU
SUMMARIZE -- THIS FIRST SLIDE.
>> AND WE'RE GOING TO BE JUMPING
IN TRYING TO KEEP THE FLOW OF
THE CONVERSATION.
SO WE HEARD FROM DR. CELEDON.
I WON'T READ ALL OF THESE BUT A
BIG TAKE AWAY FROM HIS LECTURE
AND TALK WAS THAT NO SINGLE
NUTRIENT OR VITAMIN COULD BE
RECOMMENDED TO -- TREAT --
ASTHMA AT THIS TIME.
DR. HANSON SPOKE TO US OF THE
DATA AS IT STANDS WITH FATTY
ACIDS.
7 EPIDEMILOGICAL STUDIES OF
POLYUNSATURATED FATTY ACIDS HAVE
SHOWN PROMISE BUT HAVE MIXED
RESULTS.
AND SPECIFICALLY MONOUNSATURATED
FATTY ACIDS ARE LESS UNDERSTOOD.
TAREK FATAH HAVE LESS EFFECT.
AND HETEROGENEITY MAKES IT
DIFFICULT TO DRAW CONCLUSIONS.
*
>> THANK YOU.
>> AND JUST TO RETURN US TO
FOCUS US ON THE KEY QUESTION.
IS THERE SUFFICIENT
EPIDEMILOGICAL EVIDENCE
SUPPORTING THE ROLLING OF DIET
AND NUTRITION IN RESPIRATORY
HEALTH AND DISEASES.
SUFFICIENT TO INITIATE, CONTINUE
MORE RESEARCH IN THIS AREA?
MORE RESEARCH BEING
EPIDEMILOGICAL BUT ALSO
INCREASINGLY I WOULD HOPE
INTERNATIONAL CONVENIENCAL BUT
WHAT DO WE INTERVENE WITH * AND
HOW AND WHEN.
AND WHO.
THOSE ARE SOME OF THE ISSUES
THAT WE NEED TO GRAPPLE WITH.
EMILY -- SHE IS GOING -- I'M
GOING TO BE IN THE BACKGROUND
SENDING HER QUESTIONS.
IT WOULD BE HELPFUL IF THE TECH
TEAM COULD BRING UP THE
PANELISTS ON TO THE SCREEN.
SO THAT WE CAN SEE THE FOUR
PANELISTS AND MODERATORS AT ONCE
AND I WOULD ASK THAT THEY ALSO
REMOVE THE SLIDES SO WE HAVE
MORE ATTENTION ON THE PEOPLE WHO
ARE SPEAKING RATHER THAN THE
GIANT SLIDE.
PERFECT.
MAYBE IF YOU COULD MAKE ALL OF
THE SPEAKERS EQUAL ON THE SCREEN
THAT WOULD BE HELPFUL.
ALL RIGHT.
EMILY, TAKE IT AWAY.
>> WONDERFUL AND ALSO ASK THE
TECH TEAM IF YOU COULD GIVE US A
FIVE MINUTE WARNING AS WELL.
AND TO GROUND THIS TALK GOING
BACK TO WHAT DR. KIREY MENTIONED
WE HAVE A LOT OF QUESTIONS.
WE'RE SEEKING TO PRIORITIZE IN
ORDER TO REVOLUTIONIZE THIS
PROGRESS IN NUTRITION AS IT
RELATES TO LUNG HEALTH.
I WANTED TO START -- DO WE AGREE
ON THE IDEA THAT MORE RESEARCH
IS POTENTIALLY NEEDED VERSUS
NOT.
DO WE HAVE ADEQUATE INFORMATION
TO JUSTIFY MORE RESEARCH.
ALL OF THE SPEAKERS SPOKE TO
THIS.
SO INSTEAD I WANT TO POSE TO THE
PANEL AS TO WHETHER THERE ARE
ANY ASPECTS OF THIS QUESTION
THAT ARE SOLIDLY ANSWERED WITH
EPIDEMILOGICAL RESEARCH.
AND PERHAPS WE CAN START WITH
DR. GARCIA-LARSEN WHO MADE A
VERY GOOD CASE OF FLAVONOIDS AND
LUNG FUNCTION.
>> I GUESS YOU HAVE TO TAKE IT
WITH A PINCH OF SALT BECAUSE I'M
HIGHLY BIASED.
IT'S A COMPLEX PICTURE BECAUSE
WE WHEN WE REFER TO FLAVONOIDS
WE'RE TALKING ABOUT SEVERAL
MULTIPLE.
OVER 8,000 COMPOUNDS WHEN WE
THINK OF POLLY PHENOLS AND
FLAVONOIDS THE MAIN GROUP.
HOWEVER I THINK THAT SOME OF
THEM MIGHT HAVE A MORE WELL
ESTABLISHED STRUCTURAL
FUNCTIONAL OR ROLE IN VARIOUS
WAYS.
THIS IS WHAT WE UNDERSTAND FROM
EXPERIMENTAL EVIDENCE.
BUT GENERALLY SPEAKING ALL
FLAVONOIDS HAVE VERY POWERFUL
ANTIOXIDANTS AND
ANTI-IMFLAMMATORY PROPERTIES.
BECAUSE THEY ARE SO WIDELY
DISTRIBUTED IN PLANT BASED FOODS
THERE IS AN OPPORTUNITY TO
EXAMINE LET'S EAT MORE FRUITS
AND VEGETABLES AND THAT MIGHT BE
A GOOD STARTING POINT BUT IF WE
WANT TO UNDERSTAND THE ROLE OF
DIET AND LUNG DISEASE -- IF DIET
CAN EFFECT CHANGE -- WE NEED TO
UNDERSTAND A BIT BETTER WHAT
FLAVONOIDS DO.
THE RESULTS SEEM TO SUGGEST THAT
IT'S GOING IN THAT DIRECTION.
DIETARY FLAVONOIDS ARE
BENEFICIAL.
SO IF THERE IS AN EFFECT IT
MIGHT NOT JUST BE BECAUSE WE'RE
JUST EATING MORE BUT SOMETHING
THAT MIGHT MAKE THEM SUITABLE TO
PRESERVE LUNG FUNCTION.
I THINK COHORT STUDIES CAN HELP
A HUGE DEAL.
LUNG FUNCTION CHANGES HAPPIES
OVER A LONG PERIOD OF TIME AND
THEREFORE INTERVENTION STUDIES
MIGHT NOT BE THE BEST ROUTE.
BUT IF WE ENRICH COHORT STUDIES
WITH BETTER PRECISION TOOLS WE
MIGHT HAVE MORE MEASURES.
THAT COULD BE A REALLY GOOD STEP
FORWARD.
>> THANK YOU, DR. GARCIA-LARSEN.
SUCH A GREAT POINT ABOUT
INTERVENTION STUDIES AND THEIR
POTENTIAL TO ANSWER CERTAIN
QUESTIONS.
PARTICULARLY LONG-TERM FUNCTION
AND OUTCOMES.
DO ANY OF THE OTHER SPEAKERS
WANT TO SPEAK TO ANY AREAS WHERE
THEY FEEL THAT WE HAVE SOLID
ANSWERS.
UNDERSTANDING THESE MAY BE VERY
SPECIFIC AREAS.
PERHAPS DR. CAMARGO WITH REGARD
TO FRUITS AND VEGETABLES
>> I WOULD NOT SAY WE HAVE SOLID
ANSWERS TO MUCH.
I DON'T WANT TO BE NEGATIVE BUT
CERTAINLY INTERESTING SIGNALS.
BUT IT'S BEEN 20-30 YEARS OF
RESEARCH AND PART OF THE PROBLEM
IS WE'RE JUST TOO SCATTERED SO
THIS WORKSHOP IF WE COULD AGREE
ON EXPOSURE AND OUTCOME -- THAT
WOULD BE OR AT LEAST A FEW OF
THEM BUT NOT EVERYTHING.
YOU TRY TO DO EVERYTHING YOU END
UP WITH VERY LITTLE.
SO MY ANSWER TO YOUR QUESTION IS
I DON'T THINK WE HAVE ANYTHING
ESTABLISHED EXCEPT THERE IS
PROMISE HERE.
PROMISE NOT YET A ACHIEVED.
>> I WOULD JUST ADD I UNDERSTAND
THE -- WORKSHOP IS ON ADULTS BUT
LET'S NOT FORGET THAT LUNG
FUNCTION AND ASTHMA IN
PARTICULAR IS DETERMINED EARLY
IN LIFE SO DEPENDING ON WHICH
STUDY YOU LOOK AT IS 70%-80% IS
STARTED IN THE EARLY YEARS.
IT'S IMPOSSIBLE TO IGNORE THE
DATA.
COHORT STUDIES COULD BE VERY
IMPORTANT.
THE DATA IN KIDS WHEN YOU'RE
LOOKING AT AGGREGATE IT'S QUITE
REASONABLE IN TERMS OF THE
OVER-ALL IMPACT.
DIETARY PATTERNS AND I THINK
DR. CAMARGO ELUDED TO THAT.
>> I KNOW YOU'LL AGREE WITH ME
JUAN, I THINK PREGNANT ADVISING-
INDIVIDUALS IS WHERE IT STARTS.
THAT REALLY ARGUES THAT AT LEAST
VITAMIN C IN THAT SETTING
MATTERS.
SO PERHAPS THERE SHOULD BE MUCH
MORE EMPHASIS ON PREGNANCY AND
CHILDHOOD WITH AN UNDERSTANDING
THAT IT ULTIMATELY RELATES TO
ADULTS.
BUT IF YOU START WITH ADULTS YOU
MAY OR MAY NOT BE TOO LATE.
>> DR. LU PUT IN THE CHAT THERE
IS ANOTHER WORKSHOP THAT FOCUSES
ON PREGNANCY AND EARLY
CHILDHOOD.
THAT IS WONDERFUL.
THANK YOU.
I DO WONDER IF JUST TO TAKE A
SEMI STRUCTURED APPROACH TO
THIS.
IF MAYBE WE CAN START WITH
COMING UP WITH STATEMENTS ON
SOME OF THE KEY DIETARY
EXPOSURES THAT WARRANT
PRIORITIZATION FOR FURTHER
EPIDEMILOGICAL RESEARCH.
UNDERSTANDING THAT IT WILL BE
CONTENT SPECIFIC AND WE SHOULD
ALSO TALK ABOUT VULNERABLE AND
SUSCEPTIBLE POPULATIONS.
BUT THINKING ABOUT KEY EXPOSURES
THAT DESERVE FURTHER RESEARCH AT
THIS TIME.
DR. HANSON I WONDER IF YOU WANT
TO START.
>> SURE, EMILY.
THAT IS A REALLY GOOD QUESTION.
I FELT LIKE I HAD A CLEARER
ANSWER TO YOUR PREVIOUS QUESTION
THAN I DO TO THIS ONE.
SO I GUESS MY TOPIC BEING FATTY
ACIDS I DO THINK THAT THAT --
THIS IS A DIFFICULT TOPIC THAT
WE ALL STRUGGLE WITH VERY MUCH
BECAUSE WE SHOULD I THINK ALL
KEEP IN MIND THAT IT'S
CONSIDERED DIFFICULT.
YOU EAT A DIET THAT CONTAINS A
WIDE VARIETY AND WE NEED TO
LEARN AUCTION -- CAUTIONARY
TALES.
CANCER RESEARCH WHERE PEOPLE
DECIDE VITAMIN E FOR EXAMPLE IS
OUR FOCUS AND WE SEE STRONG
SIGNALS IN THE EPIDEMILOGICAL
LITERATURE REGARDING VITAMIN E
THEREFORE WE'RE GOING TO MOVE
FORWARD WITH A TRIAL TO SEE IF
IT PREVENTS CANCER AND BAD
THINGS HAPPEN.
WHETHER THAT BE BECAUSE OF THE
DESIGN OR THE POPULATION OR THE
LACK OF CONSIDERATION OF THE
SYNERGISTIC IMPACTS THAT
NUTRIENTS HAVE.
SO, ITS REALLY HARD TO SAY.
IS THERE ONE THAT WE SHOULD
TEASE OUT AND SAY THIS IS THE
ONE THAT WE SHOULD STUDY BECAUSE
IT CAN STAND ALONE WITH NOT
IMPACTING OTHER ONES.
I FEEL LIKE I'M DANCING AROUND
YOUR QUESTION A LITTLE BIT.
SOME OF THE THINGS THAT WILL
GIVE US MORE INCITE WILL BE SOME
OF THE NEW * TECHNOLOGIES --
BECAUSE THIS MAY HELP US
UNDERSTAND THE RELATIONSHIP THAT
THESE HAVE TO EACH OTHER.
SO IF I FEEL STRONGLY AND MOVE
FORWARD.
IT WOULD HELP ME TO UNDERSTAND
WHAT IMPACT THAT HAS ON THE REST
OF THE SUBJECT LIP DOME.
IF I * SUPPLEMENT DOES THAT
REDUCE OMEGA 9s?
AND SO THEREFORE HAVE I CREATED
ANOTHER SITUATION WHERE THE
EFFECT I SEE IS DUE TO THE
CHANGE IN THE SECONDARY FATTY
ACID?
SO, THAT IS GOING TO GIVE US
SOME INSIGHTS.
BETTER UNDERSTANDING OF THE
MECHANISM OF HOW THESE THINGS
WORK ALSO MIGHT HELP US.
WE WILL HAVE SPEAKERS TALKING
ABOUT THIS MORE.
BUT I THINK WE DO UNDERSTAND
THAT CERTAIN FATTY ACIDS HAVE
SPECIFIC MECHANISMS SO IF WE
UNDERSTAND THAT AND WE WANT TO
DESIGN TRIALS TO ENHANCE THAT
SPECIFIC MECHANISM THAT MAY BE
ANOTHER WAY TO MOVE FORWARD WITH
DECIDING WHAT SORT OF SPECIFIC
NUTRIENTS WE CAN STUDY IN
ISOLATION.
DOES THAT EVEN COME CLOSE TO
ADDRESSING WHAT YOU WERE ASKING?
>> YES.
I THINK SO AND YOU ELUDED TO THE
FACT THAT YOU WANTED TO ANSWER
THE PREVIOUS QUESTION AS WELL.
>> YOU ASKED A YES OR NO
QUESTION.
YOUR QUESTION WAS DO WE HAVE
ENOUGH EVIDENCE AT THIS POINT IN
TIME?
SOLID EVIDENCE.
AND I THOUGHT NO.
IS THE ANSWER TO THAT AND ALL OF
THE SPEAKERS LAID OUT GREAT
AREAS WHERE WE NEED MORE
INFORMATION.
AND THERE IS STILL LOTS OF TO
LEARN.
THE MORE EA -- STUDIES THAT ARE
LEARNED THE MORE QUESTIONS IT
REVEALS.
>> THANK YOU.
DR. GARCIA-LARSEN.
I SEE YOUR HAND UP.
>> THANK YOU.
I THINK THAT IN TERMS OF WHICH
DIETARY EXPOSURES WE CAN FOCUS
-- FOR FLAVONOIDS THERE ARE NOT
THAT MANY STUDIES.
PROBABLY 10 STUDIES WORLDWIDE
LOOKING AT POPULATION BASED
STUDIES.
GENERALLY SPEAKING TOTAL
FLAVONOIDS ARE NOT SEEN TO BE
ASSOCIATED WITH THE RESPIRATORY
OUTCOMES BUT WE DO SEE A
CONSTANT TREND TO -- SUB
CLASSES.
BUT IN ORDER TO IDENTIFY THOSE
SUB CLASSES WE NEED TO HAVE
TOTAL FLAVONOIDS AS WELL.
IT CAN BE HYPOTHESIS DRIVEN AS
WELL.
THERE MIGHT BE ROOM THERE.
AND THAT IS ALL I WANTED TO SAY.
THANKS.
>> I SEE DR. BURNEY'S HAND UP AS
WELL.
I MAY LET DR. CELEDON GO FIRST.
WE'VE BEEN DISCUSSING THE
COMPLEXITY AND THEN TO
DR. BURNEY
>> VERY BRIEF.
-- THE DATA HAS BEEN USED GIVEN
FINANCIAL CONSTRAINTS AND
LIMITED FUNDING.
YOU CANNOT FUND THESE EXPENSIVE
STUDIES.
CONCENTRATED ON HIGH RISK
POPULATIONS.
SEVERE DEFICIENCIES OR RACIAL OR
ETHNIC GROUP.
7 THESE PUERTO RICANS HAD THE
FIRST McDonald's OUT OF THE
CONTINENTAL U.S. AND WE HAVE
SIGNALS THERE.
OR POPULATIONS THAT ARE EXPOSED
TO OXIDATIVE STRESS.
PREGNANT SMOKERS.
WE HAVE SOME INTERESTING DATA ON
PERSONS EXPOSED TO HIGH LEVELS
OF PARTICULATE MATTER.
BUT THAT MAY ALLOW YOU TO PICK
UP SIGNALS WITH A SMALLER SAMPLE
SIZE.
>> WONDERFUL.
DR. BURNEY.
>> YES.
THANK YOU.
TO A MORE GENERAL POINT, THAT IS
ONE OF THE PROBLEMS THAT WE HAVE
IS THAT EVERY SINGLE STUDY THAT
IS DONE STARTS OFF WITH A
DIFFERENT WAY OF COLLECTING DATA
AND I THINK TO HARMONIZE DATA
COLLECTION WOULD BE A BIG STEP
FORWARD.
SO FOR INSTANCE THE
QUESTIONNAIRE THAT VANESSA
DEVELOPED SEEMS TO BE A VERY
GOOD QUESTIONNAIRE IN THAT IT'S
VERY FLEXIBLE AND YET IT HAS A
RIGID CORE AND SOMETHING LIKE
THAT WOULD BE VERY HELPFUL.
THE OTHER POINT IS PROMPTED BY
SOMETHING THAT WAS SAID -- IT'S
A FREQUENT THING THAT
NUTRITIONAL EPIDEMIOLOGIST SAY
IS THAT YOU DON'T EAT FOODS IN
ISOLATION.
YOU EAT THEM AS A PATTERN OF
FOODS.
THAT CAN LEAD TO A LONG WAY DOWN
A WRONG PATHWAY AND THAT IS
BECAUSE THE FOOD THAT YOU EAT IS
MORE THAN ANYTHING --
[ INDISCERNIBLE ]
-- HIGHLY CONFOUNDED BY ALMOST
ANY OTHER THING THAT YOU CAN
MENTION IN THE PERSON'S SOCIAL
ENVIRONMENT.
SO I THINK THAT ANOTHER I TAKE
THE POINT AND IT'S A WELL MADE
POINT BUT I THINK IT ALSO HAS A
LITTLE BIT OF A PROBLEM ATTACHED
TO AT THIS TIME.
>> THAT'S AN INTERESTING POINT
DR. BURNEY.
THANK YOU FOR RAISING THAT.
AS WE'RE DISCUSSING THE IDEA OF
DIETARY PATTERNS AND THE
COMPLEXITY OF DIET AS AND
EXPOSER IN THE CONTEXT OF THE
COMPLEXITY OF LIFE AS AN
EXPOSURE AND WHAT GOES ALONG
WITH SOME OF OUR DIETARY CHOICES
AND THE AVAILABILITY OF FOODS.
AS WE MOVE FORWARD IN
EPIDEMILOGICAL RESEARCH I WONDER
IF THERE ARE ANY COMMON
RECOMMENDATIONS WE CAN COME
FORTHWITH TRYING TO LOOK AT BOTH
WITHIN THE SAME STUDIES?
WHERE THERE IS POSSIBILITY TO DO
SO.
DR. GARCIA-LARSEN IN TERMS OF
YOUR -- APPROACH TO
HARMONIZATION OF DATA WOULD YOU
-- DO YOU HAVE ANY
RECOMMENDATIONS ABOUT DATA
COLLECTION AND REALLY ANALYSIS
OF THAT DATA PERHAPS LOOKING IN
PARALLEL AT BOTH NUTRIENTS AND
DIETARY PATTERNS TO ACCOUNT FOR
THAT COMPLEXITY?
>> PERHAPS AND THANK YOU
PROFESSOR BURNEY FOR YOUR
COMMENTS AS WELL.
SO THE CERTAIN TOOLS AND
INSTRUMENTS THAT ARE WIDELY
AVAILABLE.
8 AND FOR EXAMPLE THE U.S.D.A
HAS A WONDERFUL TABLE TO
ESTIMATE A WIDE RANGE OF POLLY
PHENOLS AND FLAVONOIDS AND
NUTRIENT CONTENT IN GENERAL.
HARMONIZING AND HAVING
COMPARABLE -- FOR US TO
UNDERSTAND.
IDENTIFY CRITICAL NUTRIENTS THAT
COULD BE -- WHEN MEASURED COULD
BE MADE COMPARABLE.
THAT IS WHY I WANTED TO SHARE
THAT TABLE -- TWO VERY DIFFERENT
STUDIES -- BOTH OUTCOMES AND
EXPOSURES WERE MEASURED USING
VERY SIMILAR -- OBJECTIVE TOOLS
FOR LUNG FUNCTION AND TO
DETERMINE THE CONTENT.
AND THAT IS THE FIRST STEPS TO
MAKE THINGS COMPARABLE.
WE DO NEED MORE RESOURCES TO
MEASURE FUNCTION IN COPD.
IT IS VERY COMPLEX TO DEFINE.
SO CLEARLY IT'S MUCH MORE
COMPLEX THAT MEASURING OTHER
OUTCOMES FOR OTHER
NONCOMMUNICABLE DISEASES.
AND FOR DIET THERE ARE SEVERAL
VERY NICE INTERNATIONAL
QUESTIONNAIRES.
SOME ARE LONGER.
SOME ARE SHORTER.
WE DEVELOPED -- GALEN AND IT HAS
A STANDARD APPROACH TO DERIVING
CONTENT.
FREE TO ACCESS.
ANYONE WHO IS INTERESTED CAN
ACCESS IT.
BUT OF COURSE IT REQUIRES TIME.
IT'S NOT A SHORT QUESTIONNAIRE
BUT IT'S FLEXIBLE IN TERMS OF
ADAPTATIONS.
IF WE IMPROVE THE OBSERVATIONAL
TOOLS AVAILABLE.
IT'S DIFFICULT TO DO HIGH
PRECISION MEDICINE IT'S FAR MORE
EXPENSIVE.
SO - I AGREE ON A FEW COMMON
TOOLS.
NUTRITIONAL EXPOSURES WOULD BE A
GOOD FIRST STEP IN MY VIEW.
>> THANK YOU.
AND IN LINE WITH THAT THERE IS A
SPECIFIC QUESTION IN THE Q&A FOR
DR. CELEDON ABOUT DIETARY
SCORES.
THE QUESTION WAS SPECIFICALLY
ABOUT D II AND ITS
APPROPRIATENESS FOR USE WITHIN
CHILDREN AND ALSO SOME QUESTIONS
COME THROUGH REGARDING THE HEI
AND THE AHEI.
COULD YOU COMMENT?
>> -- BOTH IN CHILDREN AND
ADULTS -- AND THE RESULTS APPEAR
TO BE RELATIVELY CONSISTENT.
AGAIN WHEN YOU ACCOUNT FOR
SAMPLE SIZE THE ONLY STUDY WHICH
WE USED AEHI WAS SALT BECAUSE
THEY DID HAVE IT.
AND ORIGINALLY IT WAS INTENDED
FOR STUDIES OF CANCER.
AND WE FOUND SIGNALS FOR LUNG
FUNCTION BUT NOT FOR ASTHMA
WHICH IS KIND OF INTERESTING.
THE OTHER QUESTION IN THE CHAT
WAS THIS STUDY WAS CROSS SEXUAL.
-- SECTIONAL.
WE DID HAVE LONGITUDINAL BUT IT
WAS A SIMPLER SCORE.
* DO ANY OTHER SPEAKERS WANT TO
COMMENT ON DIETARY SCORES
SPECIFICALLY?
>> I'LL JUST ADD THAT A CLASSIC
DIETARY PATTERNS IS THE
MEDITERRANEAN DIET.
AND ONE OF THE CONCERNS RAISED
ABOUT THESE STUDIES IS HOW DO
YOU GET PEOPLE TO FOLLOW A DIET.
THE CARDIOLOGIST HAVE BEEN DOING
IT SPECIFICALLY WITH THE
MEDITERRANEAN DIET.
IT WOULD BE EASIER TO GIVE
PEOPLE A PILL.
MAYBE A PILL THEY COULD TAKE
ONCE A MONTH.
THAT IS NOT JUST GOING TO
HAPPEN.
I'D ENCOURAGE US TO NOT BE TOO
NEGATIVE ABOUT THE DIETARY
INTERVENTIONS BECAUSE WE DO HAVE
COLLEAGUES THAT ARE DOING THIS
KIND OF WORK SUCCESSFULLY.
>> I WANT TO TRANSITION TO
PRIORITY POPULATIONS.
AND BY THAT I MEAN THOSE WHO ARE
EITHER KNOWN TO BE SUSCEPTIBLE
OR VULNERABLE.
DR. HANSON I MAY ASK YOU FIRST
BECAUSE YOU DISCUSSED A FAIR BIT
OF EFFECT MODIFICATION BUT ALSO
LOOKING AT SUBSETS OF
POPULATIONS.
CAN YOU COMMENT ON WHERE YOU SEE
IMPORTANT FUTURE DIRECTION?
>> ONE IS GENETIC.
THERE DO SEEM TO BE GENETIC
DIFFERENCES IN PEOPLE'S ABILITY
TO METABOLIZE FATTY ACIDS.
THAT WOULD BE ONE FUTURE FOCUS
OF RESEARCH AS FAR AS LIPIDS GO.
YOU SEE DIFFERENCES BY SEX AND
BY THE HEALTH OF THE MOTHER.
WHETHER OR NOT THE MOTHER HAD
ASTHMA AND SMOKING POPULATIONS.
I THINK THAT WOULD BE IMPORTANT
FOR LIPIDS.
SOME OF THE ACTIONS OF LIPIDS
INVOLVE THE RESOLUTION OF
INFLAMMATION.
SO POPULATIONS AT HIGH RISK OF
INFLAMMATION WOULD BE MAYBE A
VERY GOOD POPULATION TO TARGET
FOR INTERVENTIONS.
>> DR. CELEDON YOU HAD MENTIONED
ETHNIC AND RACIAL --
DISPARITIES.
>> SURE.
TWO THINGS.
ONE IS AGREE SMOKERS IS AN
IMPORTANT POPULATION.
THE OTHER ONE IS PEOPLE LIVING
IN AREAS THAT ARE HIGHLY
POLLUTED.
AND I REMEMBER WORK THAT
DR. CAMARGO DID IN MONGOLIA --
LOW VITAMIN D LEVELS.
WE HAD A PAPER THAT WAS
FAVORABLY REVIEWED DOING A
SECONDARY ANALYSIS OF OUR
VITAMIN D TRIAL.
WHAT WE'RE FINDING IS A SIGNAL
-- PARTICULATE MATTER MIGHT
MINUTE D MIGHT, PROTECTIVE.
PREGNANT SMOKERS.
THAT IS A HIGH RISK POPULATION
AND IN OUR STUDIES IN PUERTO
RICO NOW WE'RE STARTING TO LOOK
AT ENDO TYPES.
THE DIFFICULTY WITH THE
BIOMARKERS ON THE OUTCOME SIDE
BUT WE'RE HAVING ENCOURAGING
RESULTS.
WE ALSO HAVE DATA COMING UP IN
ADULTS AND DIET IS ONE OF THE
STRONGEST RISK FACTORS THAT WE
FIND.
IT APPEARS TO EFFECT OF THE TWO
ENDO TYPES.
IT'S PRELIMINARY.
7 BUT STUDYING THESE POPULATIONS
WITH HIGH BURDEN OF ASTHMA LIKE
PUERTO RICO HIGHLY EXPOSED TO
POLLUTANTS MAY BE A WAY TO GO.
>> DR. GARCIA-LARSEN YOU
EMPHASIZED RESEARCH NEEDS IN
LOW-INCOME COUNTRIES
CAN YOU ELABORATE MORE?
>> THANK YOU.
THAT IS A REALLY EXCITING
QUESTION.
AND ONE THAT HAPPENS I COULD
HOPE IN THE FUTURE GET FUNDING
SUPPORT BECAUSE WE REALLY DO
NEED EVIDENCE.
WE NEED TO -- HOW IMPORTANT
POVERTY IS IN TERMS OF ITS
INTERACTION WITH NUTRITION.
AND THERE IS A WHOLE SET OF
FACTORS THAT BEHAVE DIFFERENTLY.
POVERTY IS DEFINED DIFFERENTLY.
WHAT WE CAN SEE -- IN THE
SETTINGS IS DIFFERENT FROM
LOW-INCOME COUNTRIES.
AND SO I BELIEVE THERE IS A HUGE
NEED TO COLLECT OBJECTIVE DATA.
TO FIRST OF ALL UNDERSTAND MUCH
BETTER WHAT THE DISTRIBUTION OF
THIS IS AND HOW IT RELATES TO
RISK FACTORS.
IF THERE IS A CAUSAL
RELATIONSHIP -- IF WE DO BELIEVE
THAT NUTRITION HAS A CAUSAL ROLE
IN CHRONIC RESPIRATORY DISEASES
WE NEED TO UNDERSTAND HOW WHAT
HAPPENS IN LOW AND MIDDLE INCOME
COUNTRIES.
WE NEED TO UNDERSTAND DIETARY
PATTERNS.
WE COULD HAVE BASIC STANDARDIZED
INFORMATION ABOUT CERTAIN FOODS
AND COMPARE THAT AND SEE WHAT
HAPPENS.
IDEALLY WE SHOULD BE ABLE TO
COMPARE FINDINGS FROM HIGH
INCOME AND LOW-INCOME COUNTRIES
AND SEE USING THE SAME TOOLS
WHAT THE FINDINGS INDICATE.
AND YOU DID SAY SOMETHING VERY
IMPORTANT -- ABOUT INTERVENTION
STUDIES.
I DO THINK THEY ARE EXTREMELY
IMPORTANT.
THE CURRENT EVIDENCE HAS FOCUSED
ON SMALL TRIALS BECAUSE FOOD
INTERESTS CONVENIENCE IS VERY
DIFFICULT TO DO.
THE ATTRITION BIAS IS MASSIVE.
IT'S A DIFFICULT TO KEEP PEOPLE
ENGAGED IN SPECIFIC TYPE OF DIET
FOR TOO LONG.
IT'S HARD.
BUT WE DO SEE SOME PROMISING
RESULTS IN TERMS OF CHANGES IN
BIOMARKERS OF INFLAMMATION AND
THAT IS A VERY IMPORTANT PIECE
OF EVIDENCE I THINK IF WE CAN
ACTUALLY -- MULTIPLY OXIDATIVE
STRESS WE'RE GETTING FURTHER.
WE NEED TO HAVE SOLID
EPIDEMILOGICAL EVIDENCE.
WE NEED MORE STUDIES TO
UNDERSTAND WHAT ARE THE CRITICAL
PROBLEMS IN TERMS OF CHRONIC
DISEASE DISABILITY.
WHAT ARE THE DETERMINANTS OF
POOR LUNG FUNCTIONING ADULTS.
IT MIGHT BE COMPLETELY
DIFFERENT.
A COHORT STUDY IN NEPAL WHERE
PEOPLE HAVE DISEASE IN THEIR
EARLY 30s.
AND CLEARLY THERE IS A MATERNAL
NUTRITION TO BLAME FOR IT IN
PART.
SO I THINK WELL DESIGNED --
COHORT STUDIES COMBINED WITH
GOOD PRECISION TOOLS TO BETTER
ASSESS OUTCOMES AND NUTRITIONAL
EXPOSURES AND OTHER RISK FACTORS
IS CRITICAL.
>> THANK YOU.
WE'VE HAD A SPECIFIC QUESTION
BUT I MAY CIRCLE BACK FOR TO YOU
CATCH YOUR BREATH AND VOICE.
DR. CAMARGO, ARE THERE ANY
POPULATIONS THAT YOU HAVE WANT
TO HIGHLIGHT AS HIGH PRIORITY
FOR INVESTIGATION OR ONGOING
WORK
>> YES.
IT DEPENDS ON THE OUTCOME THAT
YOU'RE INTERESTED IN.
IF IT'S POSITIVE LUNG HEALTH YOU
CANNOT STUDY PEOPLE WITH
DISEASE.
IF YOU'RE TRYING TO PREVENT THE
DISEASE YOU NEED PEOPLE WITHOUT
THE DISEASE BUT WHO ARE AT
HIGHER RISK OF GETTING IT.
AND IF YOU'RE FOCUSING ON
DISEASE MODIFICATION YOU NEED
PEOPLE WITH THE DISEASE.
THESE ARE DIFFERENT CONCEPTS AND
THE ONLY THING THAT UNITES THEM
IS SOMEHOW WE'RE LOOKING AT
LUNGS.
WE SHOULD NOT BE SURPRISED IF AT
THE END OF THE EXPERIENCE WE'RE
CONFUSED.
IT COULD BE HELPFUL FOR ONE BUT
NOT THE OTHER TWO.
IF WE'RE LUCKY IT'S GOOD FOR ALL
OF THEM BUT THAT IS A LOT TO
ASK.
>> AND I AGREE AND YOU'VE
TRANSITIONED SO NICE KNEE INTO
OUTCOMES.
AND I THINK RATHER THAN ASKING
WHERE OUR PRIORITY OUTCOMES CAN
AND SHOULD BE GIVEN THE ABILITY
TO LOOK AT SO MANY OUTCOMES
WHERE DO WE THINK EPIDEMIOLOGY
HAS SPECIFIC STRENGTHS TO ANSWER
QUESTIONS.
I WONDER DR. GARCIA-LARSEN YOU
HAD BEGUN TO SPEAK TO THIS SO I
HESITATE TO ASK YOU TO SPEAK SO
SOON BUT DO YOU MIND STARTING TO
COMMENT ON THIS?
>> NOT AT ALL.
THANKS.
I THINK THAT WELL I'M LOOKING AT
THE QUESTION FROM MICHELE FREE
MAN HERE AND -- CAN OFFER HUGE
INSIGHTS FOR CHRONIC RESPIRATORY
DISEASES.
THERE ARE THINGS THAT WE CANNOT
MEASURE.
WE KNOW THAT LOW BIRTH WEIGHT IS
A RISK FACTOR FOR POOR LUNG
FUNCTION SO WE NEED TO
UNDERSTAND MORE ABOUT WHAT
INFLUENCES POOR LUNG FUNCTION.
GROWTH OR SUFFICIENT LUNG
FUNCTION GROWTH.
EXAMINE WHAT HAPPENS DURING
PREGNANCY AND CHILDHOOD AND
ADULTHOOD.
WE KNOW THAT FOR INSTANCE FOOD
ALLERGIES SET IN THE FIRST YEAR
OF LIFE.
THAT ASTHMA IS NOT REALLY ASTHMA
IF CHILDREN HAVE WHEEZING BEFORE
AGE 3.
ASTHMA IS USUALLY DIAGNOSED
BETWEEN THE AGES OF 4-6 AND WE
KNOW THE NORMAL TRAJECTORY OF
LUNG FUNCTION.
WE CAN COMPANY GOOD COHORT
STUDIES LOOKING AT SUSCEPTIBLE
VULNERABLE POPULATIONS.
HOW THIS INTERACTS WITH VARIOUS
DOMAINS OF POVERTY.
AND IT INFLUENCES BODY MASS
INDEX.
EDUCATION OPPORTUNITIES ETC. AND
ALL OF THAT IN TURN AFFECTS OUR
NUTRITIONAL CHOICESES.
AND FOOD ACCESS.
COHORT STUDIES CAN HELP TO
FURTHER ELUCIDATE HOW THESE
FACTORS INTERACT AND HOW THEY
TOGETHER MAY OR MAY NOT
INFLUENCE LUNG HEALTH LATER ON.
WE CAN ALSO SEE FOR RESPIRATORY
-- RESILIENCE IF THE LUNGS CAN
RECOVER FROM EARLIER GADGETS.
AND INTERVENTION STUDIES CAN
ALSO ANSWER EXTREMELY IMPORTANT
MECHANISTIC QUESTIONS AND
ADDRESS WHICH NUTRIENTS CAN BE
MORE POWERFUL IN TERMS OF HAVING
THE GREATEST CAPACITY TO REDUCE
ACUTE INFLAMMATION.
IN LOW AND MIDDLE INCOME
COUNTRIES WE NEED TO HAVE
ADEQUATE TOOLS TO MEASURE
POVERTY, BODY WEIGHT DEVELOPMENT
IN CHILDREN AND BODY MASS INDEX,
OBESITY.
FOOD SECURITY, FOOD INSECURITY.
ETC. AND THAT CAN BE VERY WE'LL
ADDRESSED WITH REPRESENTATIVE
POPULATIONS IN DIFFERENT
SETTINGS AND I DON'T THINK THE
COPD OR THE CAUSES THAT LEAD TO
POOR LUNG FUNCTION ARE RESTRICT
TO ONE SPECIFIC COUNTRY.
THERE ARE COMMON FACTORS THAT WE
KNOW THAT AFFECT DISEASE.
I THINK THAT WE MUST --
NONCOMMUNICABLE DISEASES WHERE
WE SEE A PATTERN.
AND TO UNDERSTAND WHICH ONES IN
PARTICULAR AND HOW IMPORTANT
THEY ARE.
I THINK WE NEED COHORT STUDIES.
AND REPLICATE -- TO SEE IF THE
ASSOCIATION IS OUT THERE.
THE DATA IS OUT THERE.
IT'S HELPFUL.
IN DEMONSTRATING THAT THERE IS A
CLEAR ASSOCIATION THERE AND
THERE IS A SIGNAL.
WE DID HAVE SIGNS HERE THAT
SOMETHING IS HAPPENING.
>> EXCELLENT.
THANK YOU.
DR. HANSON, I WONDER WHERE YOU
SEE THE STRENGTHS OF
EPIDEMIOLOGY AND ADVANCING THE
KNOWLEDGE OF LIPIDS IN LUNG
HEALTH
>> I'M NOT SURE I HAVE MUCH TO
ADD.
THAT WAS A WONDERFUL RESPONSE TO
THAT QUESTION.
I WOULD IDENTIFY MANY OF THE
SAME STRENGTHS.
ONE OF THEM BEING TIME THAT
YOU'RE ABLE TO FOLLOW.
OVER THE TRAJECTORY OF LUNG
FUNCTION.
TO DR. CAMARGO'S POINT AGAIN
CAPTURING -- WHICH OF THE
OUTCOMES YOU'RE INTERESTED IN.
SO I'M NOT SURE I HAVE ANYTHING
SUBSTANTIAL TO ADD TO THAT.
>> IF I MAY BRIEFLY SO I AGREE
WITH EVERYTHING
DR. GARCIA-LARSEN SAID.
THAT WAS EXCELLENT.
HUMANS ARE NOT MICE.
TRIALS ARE VERY EXPENSIVE.
SO THE COHORT STUDIES -- IS TO
REMEMBER THE RELATIONSHIP
BETWEEN DIET AND LUNG HEALTH ARE
VERY COMPLEX.
SO OBESITY IS A MEASURING
FACTOR, FOR ASTHMA -- YOU HAVE
INTERACTIONS WITH POO
POLLUTANTS.
SMOKING.
* SO IN THAT REGARD COHORT
STUDIES ARE VERY POWERFUL.
WE HAVE THESE TOOLS TO ASSESS
DIET AND ONCE YOU START TO
TRANSLATE THESE TOOLS INTO
DIFFERENT LANGUAGES YOU HAVE TO
BE VERY CAREFUL.
SO I WILL SPEAK TO SPANISH.
THERE ARE NUMEROUS DIALECTS.
PUERTO RICO -- TRANSLATING INTO
PUERTO RICO OR MEXICO.
YOU HAVE TO BE COGNIZANT OF
THESE DIFFERENCES.
>> THAT IS A GREAT POINT.
7 THANK YOU.
DR. BURNEY, YOU HAVE YOUR HAND
RAISED.
>> JUST A SMALL POINT.
-- EVERYBODY IS BEING A BIT
PESSIMISTIC ABOUT THE VIABILITY
OF TRIALS BUT THERE IS A VERY
LARGE NUMBER OF TRIALS THAT ARE
BEING DONE FOR OTHER REASONS.
CARDIOVASCULAR TRIALS BECAUSE
CARDIOVASCULAR HAVE MORE MONEY.
ACTUALLY USING THOSE AND ADDING
A RESPIRATORY OUTCOME IS A VERY
CHEAP WAY OF DOING A VERY
EXPENSIVE STUDY SO IT MIGHT BE
WORTH LOOKING AT ALL OF YOUR
TRIALS AT THE NIH AND SEEING
WHETHER -- IF AN ADDITIONAL
OUTCOME COULD BE ADDED.
MIGHT BE -- VERY INFORMATIVE.
>> I LOVE THAT SUGGESTION.
THAT IS FANTASTIC.
AND I THINK THAT IS WHERE WE
FIND SOME OF THE MOST
INTERESTING DISCOVERIES IS THE
ADD ONS TO ALMOST ESTABLISHED
STUDIES MOVING FORWARD.
THANK YOU FOR THAT.
I DO WANT TO NOTE THAT THOUGH
OUR SPEAKERS DID NOT ADDRESS
THIS DIRECTLY WE DID DISCUSS
PULMONARY INFECTIONS AND
PULMONARY TUBERCULOSIS HAS BEEN
RAISED AS A MORBID DISEASE TIED
CLOSELY TO NUTRITION.
WE MAY NOT BE ABLE TO GO NIGHT
GIVEN TIME FOR THIS DISCUSSION
BUT SOMETHING THAT BEARS
MENTIONING AND RAISING DURING
OTHER SECTIONS.
BUT I DO WONDER WHETHER ANY OF
THE SPEAKERS HERE HAVE THE --
FEEL THAT THEY CAN SPEAK TO THIS
TOPIC IN RELATION TO THE
EXPOSURES THEY'VE MENTIONED.
7 AND IF NOT THAT MIGHT
HIGHLIGHT ANOTHER GAP AND
RESEARCH DIRECTION.
SOMETHING THAT I'M SO GLAD THAT
OUR AUDIENCE HAS BROUGHT
FORWARD.
DR. CAMARGO, I WANT TO GIVE YOU
THE OPPORTUNITY.
YOU SEEM LIKE YOU MIGHT HAVE
SOME CLOSING REMARKS.
>> I WOULD POINT OUT AGAIN THAT
MANY EXPOSURES MANY OUTCOMES
LET'S DECIDE WHAT WE THINK IS
MOST PROMISING AND CHASE IT.
WE CANNOT DO ALL OF THEM AT THE
SAME TIME.
THERE IS A DESIRE TO MAKE REAL
WORLD INTERVENTIONS LIKE DIETS
AND FOODS.
BUT AT THE SAME TIME A LOT OF
INTEREST IN SPECIFIC PILLS THAT
MIGHT BE A LOT EASIER TO
IMPLEMENT.
SO WE DON'T HAVE TO NECESSARILY
CHOOSE BETWEEN THESE TWO
EXTREMES.
WE COULD PURSUE BOTH.
LOOK AT A MEDITERRANEAN DIET AND
ASK OURSELVES WHAT IS THE MOST
PROMISING PILL.
MAYBE A FLAVONOID PILL.
MAYBE ANNAL CYST TEEN PILL.
*.
WE NEED CLARITY ABOUT THE
PLAYING FIELD.
WHAT ARE WE ACTUALLY STUDYING
AND WHO AND WHEN ETC. AND WHAT
IS THE MOST PROMISING AND IF YOU
THINK ABOUT THE WAY PEOPLE
DEVELOP MEDICATIONS THAT IS WHAT
GOES INTO EVERY SINGLE
MEDICATION DEVELOPMENT PROGRAM.
IT'S NOT JUST LIKE LET'S LOOK AT
EVERYTHING.
AT SOME POINT YOU NEED TO MOVE
ON AND THAT IS WHERE WE'RE AT
NOW.
WE'VE GOT TO START CHOOSING AND
I HOPE THAT IS WHAT COMES OUT OF
THIS WORKSHOP.
>> THANK YOU SO MUCH.
THANK YOU TO ALL OF THE
SPEAKERS, THE ORGANIZERS.
THE NIH FOR HOSTING US FOR THIS
DISCUSSION.
I THINK WE HAVE A LOT OF WORK TO
DO AND LOOK FORWARD TO ONGOING
DISCUSSIONS.
I BELIEVE AT THIS TIME WE ARE
CONCLUDING SESSION ONE AND THERE
WILL BE A BREAK UNTIL 1:00
EASTERN STANDARD TIME WHERE WE
WILL RESUME
>> I WILL SEE YOU AT 1:00.
>> THANK YOU, EVERYONE.
WELCOME BACK, EVERYONE.
WE'RE GOING TO START WITH THE
AFTERNOON SESSION NOW AND WE'RE
GOING TO START WITH SECTION TWO
WHERE WE'RE GOING TO EXAMINE THE
IMPACT OF CLIMATE CHANGE ON FOOD
SYSTEMS AND SECURITY AND THE
IMPLICATIONS IN RESPIRATORY
HEALTH AND DISEASE.
THE OBJECTIVE IS TO DISCUSS THE
IMPACT THAT CLIMATE CHANGE MIGHT
HAVE ON FOOD SYSTEMS AND ALSO
FOOD SECURITY AND DIET QUALITY
OF NUTRIENTS AND -- SUBSEQUENT
TO RESPIRATORY HEALTH.
AND I'M DELIGHTED TO WELCOME MY
CO-MODERATOR DR. PAULINE
SCHEELBEEK.
SHE IS AN ASSOCIATE PROFESSOR IN
CLINICAL HEALTH AT THE LONG DON
SCHOOL OF LONDON.
SHE SERVES AS THE DIRECTOR AND
IS THE PROGRAM DIRECTOR OF THE
MSC AND PLANETARY HEALTH AT LONG
DON SCHOOL.
SHE IS FOCUSED ON FINDING
HEALTHY, SUSTAINABLE AND
REALISTIC SOLUTIONS.
HER CURRENT RESEARCH STUDIES ARE
FOCUSED ON MODELING FUTURE FOOD
SYSTEMS FOR THE UK, SOUTH
AFRICA, AND COLUMBIA.
SO WELCOME, PAULINE.
THANK YOU FOR BEING HERE WITH US
>> THANK YOU SO MUCH FOR
INVITING ME.
>> WITH THAT WE CAN OPEN THE
FLOOR TO OUR FIRST SPEAKER.
IT'S AN ABSOLUTE PLEASURE TO
INTRODUCE HER.
WE'RE VERY LUCKY TO HAVE HER
PARTICIPATING IN THIS WORKSHOP.
PROFESSOR MAUREEN LICHTVELD.
THE DEAN OF 9 SCHOOL OF PUBLIC
HEALTH.
AND PROFESSOR FOR ENVIRONMENTAL
AND OCCUPATIONAL HEALTH AT THE
UNIVERSITY OF PITTSBURGH.
SHE HAS OVER 35 YEARS OF
EXPERIENCE IN ENVIRONMENTAL
HEALTH AND HER RESEARCH HAS
FOCUSED MOSTLY ENVIRONMENTALLY
INDUCED DISEASES, HEALTH
DISPARITIES, CLIMATE AND HEALTH,
ENVIRONMENTAL HEALTH POLICY,
DISEASE PREPAREDNESS.
PUBLIC HEALTH SYSTEMS AND
COMMUNITY RESILIENCE.
HER EXPERTISE IN CLIMATE AND
HEALTH IS LOCALLY AND NATIONALLY
AND GLOBALLY RECOGNIZED AND SHE
HAS BEEN THE RECIPIENT OF
NUMEROUS HONORS.
>> PLEASED TO BE HERE.
THAT. THANK YOU FOR BEING HERE.
>> SO WE CAN MOVE THE SLIDES
FORWARD NOW.
DO WE HAVE -- -- I BEG YOUR
PARDON, PROFESSOR LICHTVELD.
I THINK -- -.
PAULINE, WE'RE READY FOR YOU.
>> EXCELLENT.
THANK YOU VERY MUCH.
AND THANKS SO MUCH FOR INVITING
ME.
IT WAS REALLY INTERESTING TO
HEAR THE PRESENTATION AND THE
DISCUSSION THIS MORNING.
I'M GOING TO SHARE A SLIGHTLY
DIFFERENT LIGHT ON THE
DISCUSSION AT THE LONDON SCHOOL
OF MEDICINE WE DO A LOT OF
RESEARCH AFTER ROUND THE
INTERACTION OF CLIMATE CHANGE
AND HEALTH AND I'M ORIGINALLY --
AN EPIDEMIOLOGIST BY TRAINING
BUT I'VE BEEN VERY INTERESTED IN
HUMAN NUTRITION AND WORK IN A
NUTRITION GROUP.
BEFORE -- LOOKING AT HOW CLIMATE
CHANGE HAS AN IMPACT ON THE FOOD
AND THE AVAILABILITY OF FOOD BUT
ALSO WHAT HUMANS CAN DO TO
ALLEVIATE SOME OF THE PRESSURE
ON THE FOOD SYSTEM.
SO I'LL GIVE YOU A BIT OF A
WHISTLE STOP TOUR HOW CLIMATE
CHANGE HAS AN IMPACT AND ALSO
THAT THIS LINK IS BI-DIRECTIONAL
AND THE SOLUTIONS THAT WE AT THE
SCHOOL ARE WORKING ON AT THE
MOMENT.
SO WHEN WE SPEAK ABOUT FOOD
SYSTEMS THAT IS SLIDELY WIDER
THAN JUST HUMAN CONSUMPTION.
EVERYTHING FROM FARM TO
PROCESSING AND PACKAGING AND
WHOLESALING AND RETAILING TO
COOKING IN THE HOUSE, CONSUMING
AND WASTE.
YOU CAN IMAGINE THAT CLIMATE
CHANGE CAN HAVE AN IMPACT ON ALL
OF THESE PROCESSES BUT WE FOCUS
ON CLIMATE CHANGE IMPACT MORE ON
THE FARM SIDE IMPACTS WHICH I
WILL DO NOW AS WELL.
SO HOW DOES CLIMATE CHANGE MAKE
IT MORE DIFFICULT TO PRODUCE
FOOD.
WHEN WE TALK ABOUT MITIGATION
HOW CAN WE STOP CLIMATE CHANGE
FROM HAPPENING OR CAN WE REVERSE
SOME OF THE IMPACTS THAT WE
OFTEN LOOK AT THE CONSUMER.
WHAT SORT OF DIFFERENCES CAN
THEY MAKE IN THEIR DIETS SO THAT
THEIR DIETARY FOOTPRINT IS
LOWER.
AND SO THAT I WILL DO IN THIS
PRESENTATION AS WELL.
BUT IT DOESN'T MEAN THAT THERE
ARE NOT ANY OTHER WAYS.
YOU CAN FOR EXAMPLE THINK ABOUT
COOL CHAIN ALONG THE WAY OR EVEN
FUEL FOR COOKING.
SO THERE IS ANOTHER WAY CLIMATE
HAS AN IMPACT ON FOOD BUT
PREDOMINATELY WHAT WE'RE DEALING
WITH ARE ON THE FARM.
THIS IS -- AN OVERVIEW OF HOW
THE IMPACTS OF CLIMATE CHANGE.
THERE IS SOME DIRECT EFFECT.
YOU CAN IMAGINE THAT HEAT COULD
HAVE AN IMPACT ON AGRICULTURAL
WORKERS.
THEY MIGHT SUFFER MORE FROM HEAT
STRESS OR STROKES AND ALSO IN
DIRECT EFFECT ETC.
CLIMB CHANGE CAN LOWER CROP
YIELDS AND QUALITY AND CAN
AFFECT LIVESTOCK AND * INTRODUCE
DIFFERENT PESTS AND POLLINATORS.
THE HABITATS CHANGE.
SOIL FERTILITY FOR EXAMPLE AND
THAT ALSO DISRUPTS THE SUPPLY
CHAIN.
AND EXTERNAL FACTORS.
ALSO TO OTHER SECTORS.
SUCH AS FUEL AND RESOURCE
SHORTAGES OR CONFLICT THAT MIGHT
HAVE BEEN PARTIALLY OR FULLY
CAUSED BY CLIMATE CHANGE.
SO ALL OF THESE THINGS TOGETHER
DISRUPTS THE SUPPLY CHAIN,
CAUSES LESS FOOD TO BE PRODUCED
OF A LOWER QUALITY AND THAT
AFFECTS DOMESTIC SUPPLY BUT ALSO
IMPORTED FOODS AND THE GLOBAL
FOOD TRADE MARKET.
AND DEPENDING ON FOOD PRICES AND
AVAILABILITY AND THE LOCAL
ENVIRONMENT THAT COULD HAVE AN
IMPACT ON HOUSEHOLDS.
77 AND WITHIN THE HOUSEHOLDS ON
WHO IS EATING WHAT?
HOW HEALTHY THOSE FOODS ARE AND
HOW THAT AFFECTS THE NUTRITIONAL
STATUS FOR EACH OF THE
INDIVIDUALS IN THE HOUSE HOLD.
7 SO THESE ARE SOME OF THE MAPS
THAT YOU MIGHT HAVE SEEN.
SO THIS IS A PROJECTION OF
CHANGES IN MAZE.
SO, ITS A PERCENTAGE CHANGE SO
THE RED ONES MEANS BY 2070 IS
THE YIELD WILL BE LOWER.
IN SOME PARTS OF THE WORLD
BECAUSE OF HIGHER CO2
FERTILIZATION YOU GET BETTER
YIELDS.
BUT ALSO A LOT OF REDS IN
COUNTRIES THAT WE KNOW ARE
STRUGGLING ALREADY WITH
SUFFICIENT AVAILABILITY OF
STAPLE CROPS OR FOOD IN GENERAL
FOR THEIR POPULATION.
AND IT'S NOT ONLY THE YIELDS
THAT WE'RE TALKING ABOUT BUT
CLIMATE CHANGE AND AGAIN THE
EXAMPLE OF CO2 FERTILIZATION --
CAN HAVE AN IMPACT ON THE
NUTRITIONAL QUALITY OF CROPS AND
THIS WAS A STUDY DONE BY SOME
COLLEAGUES AT HARVARD WHO LOOKED
AT THE REDUCED QUANTITY -- OR
COMPOSITION OF IRON, ZINC AND
PROTEIN.
AND SO YOU SEE AGAIN THAT IT
DOESN'T HAPPEN TOO MUCH IN
EUROPE AND NORTHERN AMERICA AND
AUSTRALIA BUT THERE ARE VERY
DARK BITS WITH VERY HIGH SCORE
MEANING A LOT OF IRON, ZINC AND
PROTEIN FROM COUNTRIES THAT WE
KNOW ARE SUFFERING IN
MICRONUTRIENTS.
IF THESE ARE DIETS THAT ARE
ALREADY SHORT IN SOME OF THE
MICRONUTRIENTS THEN A FURTHER
DROP COULD BE QUITE
CATASTROPHIC.
AND WE TALKED ABOUT CROPS BUT OF
COURSE LIVESTOCK CAN BE
AFFECTED.
NOT ONLY THE FEED BUT ALSO
LIVESTOCK BY HEAT FOR EXAMPLE.
AND SO, THAT IS ALSO SOMETHING
THAT IS CERTAINLY WILL AFFECT
LIVESTOCK BOTH IN TERMS OF MILK
AND MEAT IN THE FUTURE.
CURRENTLY ALREADY BUT MORE SO IN
THE FUTURE.
AND THEN THERE ARE SOME OTHER
PATHWAYS THAT WE'RE LESS
FAMILIAR WITH.
HERE I'VE PUT AN EXAMPLE OF A
STUDY THAT WE WORKED ON A NUMBER
OF YEARS AGO IN BANGLADESH WHERE
CLIMATE CHANGE HAS AN A EFFECT
ON SALINE TEE OF WATER *.
MORE STORMS -- TROPICAL CYCLONES
AND THE WATER WAS VERY SALTY.
NOT ONLY THE DRINKING WATER.
YOU SEE THE GIRLS ARE HOLDING --
WHICH LED TO QUITE A HIGH LEVEL
OF -- HYPERTENSION IN THE
POPULATION BUT ALSO SOME CROPS
DON'T DO VERY WELL IN MUCH MORE
SALTY WATER AND THAT WATER WAS
ALSO BLACK ISSUE WATER.
THAT WATER WAS ALSO USED TO
IRRIGATION SOME OF THE CROPS.
BUT ALSO OTHER PATHWAYS SUCH AS
POLLINATORS.
BECAUSE OF CLIMATE CHANGE WE SEE
A DECLINE IN POLLINATORS AND YOU
SEE A MAP TWOS PUBLISHED IN THE
LANCET -- WHICH SHOWS YOU THE
ADDITIONAL HEALTH BURDENS FROM
POLLINATION REMOVAL.
THAT WOULD BE THE CASE OF ALL OF
THE POLLINATORS WOULD BE GONE.
WOULD NO LONGER EXHIBIT IN THAT
PARTICULAR AREA AND WHAT IS
INTERESTING IS THIS IS MOSTLY
IMPACTING ON THE GLOBAL FRUIT
SUPPLIES THAT ARE POLLINATED BY
FOR EXAMPLE BEES SO GLOBAL FRUIT
SUPPLIES COULD FALL BY 23%.
WHICH IS ESTIMATED IN THIS PAPER
AND VEGETABLES BY 16%.
SO THESE ADDITIONAL HEALTH
BURDENS ARE THE DIRECT RESULT OF
THESE HEALTHY FOODS LES MOONVES-
AVAILABLE OR AT A MUCH HIGHER
PRICE.
AND ANOTHER PATHWAY THAT IS
PERHAPS LESS KNOWN IS HOW
CLIMATE CHANGE IS ALSO AFFECTING
THE QUALITY OF WATER.
AVENUE THERE WITH THE FISHERIES.
THIS HAS A HUGE IMPACT ON
POPULATIONS THAT ARE FOR A LARGE
PART DEPENDENT ON FISH FOR
CONSUMPTION BUT SOMETIMES ALSO
IN TERMS OF FISHERIES AND THEIR
INCOME AND SO HERE AGAIN YOU SEE
THAT IN SOME PARTS OF THE WORLD
THE WATERS ARE MORE AFFECTED
THAN IN OTHERS BUT IT'S SLIGHTLY
LESS WELL-KNOWN IMPACT OF
CLIMATE CHANGE ON NUTRITION.
UNFORTUNATELY WE SEE IF WE LOOK
AT NUTRITIONAL PROBLEMS FOR
EXAMPLE THIS IS A MAP SHARE OF
CHILDREN UNDER 5 WHO ARE STUNTED
-- AND UP FORTUNATELY THE
COUNTRIES THAT WE SEE ARE MOSTLY
HIT BY CLIMATE CHANGE ARE THOSE
WHERE THE HIGHEST PREVALENCE OF
FOOD INSECURITY IS ALREADY
CURRENTLY IN PLACE.
AND SIMILARLY YOU SEE THAT IT
OVERLAPS WITH MICRO NUTRIENT
DEFICIENCY IN THE WORLD.
SO, IT'S NOT ONLY EXACTLY
CLIMATE CHANGE IS AN IMPACT
WHERE WE SEE THESE
VULNERABILITIES.
WE SEE THAT CREATES A
VULNERABILITY EVERYWHERE AND
EVEN IN THE UK.
THIS WAS A REPORT THAT WE WORKED
ON THE HEALTH ASPECTS OF CLIMATE
CHANGE.
WHAT PERCENTAGE OF HEALTHIER AND
UNHEALTHIER FOODS ARE IMPORTED
TO THE UK FOR EXAMPLE AND YOU
SEE FRUITS AND LEGUMES AND NUTS
AND SEEDS, THEY ARE COMING FROM
MORE CLIMATE VULNERABLE AREAS
THAN THE UK ITSELF OR EUROPE.
SO YOU SEE THAT AT THE MOMENT
PERHAPS THERE ARE NO DISRUPTIONS
EVEN THOUGH WE SEE IN THE UK IN
THE SUPERMARKETS WHEN THERE HAS
BEEN A HEATWAVE OR A STORM AND
ALL OF A SUDDEN THERE ARE
CERTAIN PRODUCTS THAT YOU CANNOT
FIND ANY MORE OR AT A HIGHER
PRICE BECAUSE WE'VE BECOME MORE
DEPENDENT ON CLIMATE VULNERABLE
AREAS FOR OUR IMPORTS.
THE LIKELIHOOD THAT THESE
SUPPLIES WILL BE DISRUPTED WILL
BE HIGHER.
THEY WILL HAPPEN MORE
FREQUENTLY.
WHICH IS FOR QUITE A NUMBER OF
HOUSEHOLDS NOT A PROBLEM.
BUT AGAIN FOR THE POORER
HOUSEHOLDS CONSUMPTION IS
ALREADY VERY LOW AND THAT DOES
NOT HELP WITH TRYING TO GET THEM
TO EAT MORE HEALTHY FOODS.
>> YOU HAVE TWO MINUTES
REMAINING.
>> AND PERHAPS IMPORTANT TO
MENTION -- THAT THE IMPACTS OF
CLIMATE CHANGE -- ARE NOT
EVERYWHERE THE SAME.
SO CERTAIN AREAS WHERE PEOPLE
CAN DO A LOT ABOUT CLIMATE
CHANGE FOR EXAMPLE BY GROWING
FOODS INSIDE.
PROTECTING TREES OR OTHER PLANTS
FROM HEAT OR COLD ETC.
WHEREAS IN OTHER PLACES THIS IS
NOT THE CASE.
SO CAN YOU GO TO THE NEXT SLIDE,
PLEASE.
AND UNFORTUNATELY THE SYSTEM
KEEPS ITSELF IN PLACE.
THEY ARE NOT ONLY IMPACTED BY
CLIMATE CHANGE BUT THEY ARE ALSO
ONE OF THE BIG CAUSES OF CLIMATE
CHANGE.
GREENHOUSE GASES COMING FROM
FOODS.
A LARGE PORTION OF LAND USE BY
AGRICULTURE ALSO.
WATER.
AND 94% OF ALL MAMMALS -- ARE
USED -- OUR LIVESTOCK.
IF YOU CAN GO TO THE NEXT SLIDE
-- I'LL SKIP THE NEXT SLIDE IN
THE INTEREST OF TIME.
THERE ARE OBVIOUSLY A LOT OF
SOLUTIONS.
SO YOU MIGHT BE FAMILIAR WITH
THE CLIMATE SENATOR AGRICULTURE
WHERE PEOPLE LOOK * LOOK AT
SUSTAINABLE MANAGEMENT.
AND CROPS THAT DO MUCH BETTER
UNDER THESE MORE STRESSED
CIRCUMSTANCES.
FOR EXAMPLE DROUGHT AND HEAT.
AND HERE YOU SEE -- A FEW OF THE
EXAMPLES OF SUCH CROPS IN SOUTH
AFRICA OFTEN THESE ARE MUCH MORE
WATER EFFICIENT AND ALSO OFTEN
CONTAIN LOTS OF THE
MICRONUTRIENTS THAT ARE MISSING
SUCH AS VITAMIN A, ZINC, IRON
ETC.
I'LL SKIP THIS ONE AS WELL IN
THE INTEREST OF TIME.
AND SO WE ARE QUITE FAMILIAR
WITH HOW THE -- SOLUTIONS ON THE
CONSUMER SIDE.
LOTS OF FRUITS AND VEGETABLES.
STILL WITH ANIMAL SOURCED FOOD
BUT SMALLER QUANTITIES.
HERE ON THE RIGHT-HAND SIDE THE
DOTTED LINE IS THE 100%
RECOMMENDED AMOUNT OF EACH FOOD
AS RECOMMEN RECOMMENDED BY THE T
COMMISSION.
TO SHOW THE WORLD WHAT THE WORLD
COULD EAT IF WE WERE TO STAY
WITHIN THE PARRIS AGREEMENTS.
AND WHILE THIS IS ALSO SEEN AS A
DIET THAT MEANS WE NAMED TO
REDUCE MEAT AND DAIRY AND
EVERYONE NEEDS TO BECOME VEGAN.
IT'S NOT LIKE THAT.
IN DIFFERENT PARTS IN THE WORLD
IT WOULD MEENEN INCREASE IN
POULTRY AND DAIRY AND FISH AND
RED MEAT.
ALL OF THOSE PARTS OF THE WORLD
WHERE THE CURRENT BAR IS LOWER.
BUT IN OTHER PARTS OF THE WORLD
SUCH AS EUROPE AND NORTH AMERICA
AND AUSTRALIA FOR EXAMPLE THAT
WOULD MEAN QUITE A SUBSTANTIAL
REDUCTION.
SO TO END WITH IF YOU CAN GO TO
THE NEXT SLIDE.
THERE IS QUITE A NUMBER OF
TECHNOLOGICAL SOLUTIONS AS WELL.
YOU MIGHT BE FAMILIAR WITH
REGENERATIVE AGRICULTURE WHICH I
THINK IN THE U.S. IS QUITE UP
AND COMING.
OTHER WAYS OF MAKING PLANT BASED
FOODS.
YOU SEE A FEW EXAMPLES ON THE
RIGHT AND IF YOU GO TO THE NEXT
SLIDE -- ALSO MANY TECHNOLOGICAL
POSSIBILITIES SUCH AS
BIOTECHNOLOGY, POSITION
AGRICULTURE AND MORE PRECISE
DATA ANALYTIC SO YOU CAN EMBED
THAT INTO THE AGRICULTURAL
SYSTEM.
I THINK I'LL LEAVE IT -- I HAD
TWO SLIDES BUT I WOULD SAY IT'S
VERY IMPORTANT TO EMBED ALL OF
THIS INTO NUTRITION POLICIES AND
TO MAKE SURE IT ALIGNS AND IT IS
SUPER IMPORTANT TO INCLUDE THE
PUBLIC IN THIS AS WELL BECAUSE
THEY ALL EAT THE FOODS THAT
WE'RE STUDYING ABOUT.
MAYBE IF YOU CAN SKIP TO THE
LAST SLIDE TO THANK MY
COWORKERS.
THANK YOU SO MUCH.
>> THANK YOU SO MUCH.
WE KNOW CLIMATE CHANGE IS SUCH A
COMPLEX ISSUE TO ADDRESS AND WE
KNOW THAT THE INTERACTION WITH
FOODS AND FOOD SYSTEMS IN
GENERAL IS FASCINATING AND NOW
PROFESSOR LICHTVELD, THANK YOU
AND WE CAN MOVE TO THE NEXT
SLIDE
>> THANK YOU AND WE CAN START MY
SLIDES.
THANK YOU.
AND AS WE STARTLED SAY TO DR.
DR. SCHEELBEEK YOUR NAME IS VERY
DUTCH.
I'M PLEASED TO FOLLOW HER TO
FOCUS ON THE IMPACT OF CLIMATE
CHANGE ON RESPIRATORY SYSTEMS.
HOW CLIMATE CHANGE IMPACTS THE
FOOD SYMPTOM.
WHAT I WANTED TO POINT OUT IS
THAT IT'S A SYSTEM.
AND SO IT REQUIRES A
TRANSDISCIPLINARY
MULTI-SECTORIAL APPROACH.
WE'RE NOT GOING TO SOLVE THIS AS
INDIVIDUAL DISCIPLINES.
SO YOU'VE HEARD THE PANEL WAS
VERY INFORMATIVE TO THAT BUT
HERE YOU SEE OF ALL OF THE
THREATS THAT WE'RE FACING,
CLIMATE AND THE IMPACT ON HUMAN
HEALTH REQUIRES A SYSTEMS
APPROACH BECAUSE WE'RE GETTING
BOTH IMPACT ON QUALITY AND
SAFETY OF THE FOOD BUT ALSO THE
IMPACT ON SECURITY AND
VOLATILITY OF FOOD PRICES THAT
LEAD TO HUNGER AND MALNUTRITION.
AND SO WHEN WE LOOK AT THE
IMPACT OF CLIMATE CHANGE ON THE
FOOD SECURITY AND NUTRITION WE
CANNOT DO IT JUST BY OURSELVES.
AND I'M COMING FROM A COMMUNITY
PERSPECTIVE AS AN ENVIRONMENTAL
EPIDEMIOLOGIST.
BUT PARTICULARLY HERE WE BEGIN
TO APPRECIATE THE COMPLEXITY AND
THE INTERCONNECTEDNESS OF THE
PIECES SO IF YOU CONSIDER THIS A
PIE NOT A PIZZA PIE THEN THE --
REGARDLESS OF HOW WHICH PART OF
THE PIZZA AND WHICH PART OF THE
PIE -- WHICH SLICE YOU TAKE AND
WHICH DRIVER YOU SELECT
ULTIMATELY IT IMPACTS IN MANY
CASES DIRECTLY RESPIRATORY
HEALTH OR IN DIRECTLY
RESPIRATORY HEALTH.
SO YOU COULD GO ALONG THE PIE
AND YOU COULD SEE THAT FROM AIR
POLLUTION THAT IS A DIRECT
IMPACT.
NOT ONLY ON RESPIRATORY HEALTH
BUT ALSO ON CARDIOVASCULAR
DISEASE.
AND INCREASING -- BUT SO IS
WATER AND THE FOOD SUPPLY
SYSTEM.
THE NOTION IS THAT WE CANNOT DO
IT BY OURSELVES.
WHEN I WAS ASKED TO SHARE THE
REPORT OR WHAT KEEPS ME UP AT
NIGHT WHEN WE HIT $8 BILLION --
I WISH WE HAD THAT -- 8 BILLION
PEOPLE IN THE WORLD THERE ARE
FOUR ISSUES.
IT IS CLIMATE CHANGE AND WITHIN
CLIMATE CHANGE INFECTIOUS
DISEASE, EXTREME HEAT, FOOD AND
WATER SECURITY AND POOR AIR
QUALITY.
YOU CAN LINK ALL OF THESE FOUR
TO A CUMULATIVE EFFECT ON THE
RESPIRATORY SYSTEM.
AND SO IF WE UNRAVEL WHAT THE
IMPACT IS ON CLIMATE ON HUMAN
HEALTH IS THERE ARE TWO MAJOR
SYSTEMS THAT ARE IMPACTED.
AGAIN THAT SYSTEMS APPROACH.
THE DISRUPTION OF THE ECOSYSTEM
WHERE WHEN ULTIMATELY WE'RE
FACED WITH INCREASED ALLERGIES
AND FOODBORNE DISEASES.
IN ADDITION TO MALNUTRITION I
WANT TO FOCUS ON WORKFORCE
CAPACITY.
WE DO NOT HAVE ENOUGH PEOPLE WHO
ARE TRAINED IN UNRAVELING THE
IMPACT OF CLIENT ON HEALTH.
IN PUBLIC HEALTH WE'RE MAKING
PROGRESS.
IN MEDICINE TINY BIT.
WHERE CLIMATE IS NOT BEING
TAUGHT AS AN ESSENTIAL COMPONENT
OF WHAT WE NEED THOUGH KNOW AS
PRACTICING CLINICIANS AND
PARTICULARLY HERE YOU'VE HEARD
ABOUT CONFLICT AND THE FORCED
MIGRATION.
I WANT TO FOCUS ON THE IMPACT OF
MENTAL HEALTH.
AND I WANT TO TALK ABOUT --
POPULATIONS AND I COULD NOT
AGREE MORE.
I HAVE A STUDY OF 1200 MOM AND
CHILDREN'S DIET.
I COULD NOT AGREE MORE ON
PREGNANT WOMEN AS THE KEY
POPULATION TO FOCUS ON.
I WANT TO FOCUS ON THE PEOPLE
WHO ARE MOST IMPACTED AND WHO
ARE MOST VULNERABLE WHO PROVIDE
MUCH OF THE FOOD THAT IS ON OUR
TABLES AND THAT IS IMMIGRANTS,
MINUTE GRANT WORKERS AND
AGRICULTURAL WORKERS.
SO IF YOU LOOK AT EACH OF THE
CLIMATE DRIVERS AND THE IMPACT
ON RESPIRATORY HEALTH WHETHER
YOU TAKE HEAT, WILDFIRES,
POLLEN, EXTREME VIRUSES
ULTIMATELY THEY ALL IMPACT THE
RESPIRATORY HEALTH SYSTEM.
SOME EVIDENCE IS MORE
PRONOUNCED.
THAN OTHER PIECES OF EVIDENCE SO
WE HAVE WORK TO DO.
SO I'LL COME BACK TO THE KIND OF
RESEARCH THAT I WOULD BE
PROPOSING.
NOW LET'S LOOK AT OUR NEIGHBORS.
OUR NEIGHBORS IN THE STATES THAT
WE LIVE AND CONSIDER WHERE THE
AIR POLLUTION IS COMING FROM.
IF WE THOUGHT THAT WE COULD HAVE
-- SET UP TO KEEP THE AIR
POLLUTION AWAY WE CANNOT.
SO FIND THE STATE WHERE YOU LIVE
IN AND SEE HOW MUCH OF THAT
POLLUTION IS COMING FROM WITHIN
YOUR STATE BECAUSE OF
PRACTICEs WITHIN YOUR STATE
VERSUS OUTSIDE OF YOUR STATE.
IF YOU'RE BLUE IN COLOR THEN
IT'S COMING FROM WITHIN.
IF IT'S ORANGE IT'S COMING FROM
SOMEWHERE ELSE.
IT'S A REALIZATION OF A A-HA
MOMENT.
SO EACH OF US HAVE A
RESPONSIBILITY TO TAKE.
SO IN THE FIRST PANEL YOU HEARD
ABOUT THE EXPOSURE AND WHAT
EXPOSURES WE SHOULD CONSIDER.
HERE I'M HEARING JUST AND THIS
LOOKS LIKE A COMPLICATED SLIDE
BUT JUST AN EXAMPLE OF WHAT AN
EXPOSER PATHWAY WOULD LOOK LIKE.
SO AGAIN TAKING THE CLIMATE
DRIVERS AND HERE WE CAN LOOK AT
CHANGE IN TEMPERATURES BUT ALSO
CHANGE IN PRECIPITATION.
WHETHER IT'S MORE OR LESS
PRECIPITATION HAS DIRECT IMPACT
ON ULTIMATELY WHAT THE FOOD
SYSTEM IS BUT ALSO IF YOU LOOK
AT THE ENVIRONMENTAL CONDITIONS
RELATED TO THESE DRIVERS WHETHER
IT'S LONGER SPRING, MORE
FLOODING.
WHETHER IT'S PROLONGED EXPOSURE
TO HEAT.
WE HAVE A SERIES OF HEALTH
OUTCOMES AND ASTHMA, ALLERGIES
AND RESPIRATORY ILLNESSES ARE
RIGHT IN THERE.
I'M GOING TO SKIP QUICKLY
THROUGH THESE SLIDES BECAUSE I
WANT TO EMPHASIZE -- WHAT IS --
YOU KNOW THE CASES IN LUNG
CANCERS.
ALSO THE DIFFERENCES IN BY SEX
IN TERMS OF LUNG CANCER.
ASTHMA AND ASTHMA BASED ON RACE
AND ETHNIC DIFFERENCES.
NEXT PLEASE.
COPD.
MEN AND WOMEN.
AND THEN OF COURSE ACROSS MANY
OF THE OTHER AREAS AND ACROSS
TIME.
ONE OF THE REASONS I PUT UP THIS
SLIDE IS TO REMIND US THAT WE'RE
ALWAYS RUNNING BEHIND WITH DATA.
SO THERE IS A LOT OF
CONVERSATION -- THIS MAKES IT
DIFFICULT FOR US TO GET ON TO
THE FRONT LINE.
WHAT I WANT TO FOCUS ON IS
BEGINNING FOR US TO REALIZE WHAT
THAT CUMULATIVE RISK FACTOR
LOOKS LIKE.
IT IS AN INCREASED BURDEN
AFFECTING PARTICULARLY
COMMUNITIES WHO ARE ALREADY
IMPACTED BY INEQUITIES.
THEIR INABILITY TO COUNTER THESE
RISK, THE EVERY DAY RISK BUT
PARTICULARLY THE RISK FROM
CLIMATE IS INTENSE AND SEVERE
AND IT IS THAT FOCUS THAT WE'RE
MISSING.
IT IS THE FOCUS ON COMMUNITIES
OF COLORS AND OTHER MARGINALIZED
GROUPS AND IT IS TAKING A CLOSER
LOOK AT THE ROLE OF EQUITY AND
LOOKING AT THESE PROBLEMS
THROUGH THE LENS OF EQUITY.
BECAUSE EQUITY DOESN'T ONLY CUT
ACROSS THE ENTIRE RESEARCH
CONTINUUM BUT ALSO IS IMPORTANT
WHEN WE LOOK AT THE INTERCON
INTERCONNECTEDNESS OF HEALTH.
SO WHEN YOU LOOK AT INEQUITIES
THERE ARE THREE DIMENSIONS THAT
I AM TAKING YOU NOW TO THE
COMMUNITY FOCUS WHERE I LIVE
FROM A PUBLIC HEALTH
PERSPECTIVE.
IN TERMS OF -- EQUITY OF WHAT
AND I'LL COME BACK TO WHAT IS
UNDER THE WHAT?
EQUITY BETWEEN ALL WHETHER IT'S
CLASS, OCCUPATION, GENDER AND
GEOGRAPHY.
AND INTRA AND INTERGENERATIONAL.
PREGNANCY AND LOOKING DOWN AND
UP THE GENERATION BECOMES SUCH A
SPECIAL FORMIDABLE POPULATION.
LAST YEAR WE WERE ASKED TO FOCUS
ON CLIMATE AND RESPIRATORY
HEALTH FROM AN EXPOSURE
VULNERABILITY AND RISK
PERSPECTIVE.
IF YOU LOOK AT THE EXPOSURE
CAUSED BY THE DRIVERS OF CLIMATE
CHANGE THEN THE RISK IS THAT
DIAGRAM AMONG THE EXPOSURES, THE
SENSITIVITY NOT ONLY AT THE
INDIVIDUAL LEVEL WE ALL KNOW
WHAT PRECISION MEDICINE DOES FOR
US.
THIS IS PRECISION PUBLIC HEALTH.
RAZOR SHARP FOCUS ON THE
COMMUNITY THAT IS MOST AFFECTED
AND THE COMMUNITIES -- CAPACITY.
WITHIN THE VULNERABILITY IT IS
THE RISK OF WHERE THESE THREE
AREAS COME TOGETHER THAT WE
SHOULD BE FOCUSING ON.
SO IF YOU ASK ME WHAT KIND OF
RESEARCH NEEDS TO BE DONE --
REGARDLESS OF WHAT TYPE OF
RESEARCH ACROSS THE RESEARCH
CONTINUUM IT IS IMPORTANT THAT
WE FOCUS ON AND I KNOW NHLBI
AND OTHER INSTITUTES FOCUS ON
IMPLEMENTATION SCIENCE AS A
STRATEGY TO GET TO INTERVENTIONS
BUT IMPLEMENTATION SCIENCE
REQUIRES THAT BEGIN WITH
IDENTIFYING WHO THE STAKEHOLDERS
ARE.
THAT WE FOCUS ON THE COMMUNITIES
THAT ARE AT RISK AND THAT THEY
COLLABORATE WITH US THROUGHOUT
THE DEVELOPMENT AND
IMPLEMENTATION AND EVALUATION
BEGINNING WITH IDENTIFYING
COMMON GOALS NOT WHAT WE THINK
IS IMPORTANT TO KNOW BUT WHAT
THEY THINK IS IMPORTANT FOR US
TO INTERVENE TOGETHER WITH THEM.
SO CO-CREATION, CO-ANALYSIS, DID
OUR RESEARCH MAKE A DIFFERENCE?
DID OUR INTERVENTION MAKE A
DIFFERENCE AND BACK TO WHAT WE
DO TO SEE WHAT IS THE NEXT STEP
AND HOW DO WE CREATE ULTIMATELY
A MOTION OF RESILIENCE.
AND SO WHEN WE LOOK AT WHAT IS
THE CAPACITY OF COMMUNITIES TO
RESPOND?
WE SELDOM FOCUS ON WHAT THE
ASSETS ARE.
WE'RE QUICK TO TALK ABOUT WHAT
THE GAPS ARE.
BUT HERE ARE THE ASSETS AND
WHERE WE FIND THE GAPS.
WHETHER IT'S IN THE NATURAL
ENVIRONMENT.
WHAT IS THE HEALTH OF THE
ENVIRONMENT AROUND THEM AND WE
FOCUS MORE AND MORE ON THE
HEALTH.
THE HEALTH OF ENVIRONMENT AND
PEOPLE AND ANIMALS AND PLANTS
AND HOW THOSE COME TOGETHER.
WHAT IS THE HEALTH AND THE GAPS
ON THE INFRASTRUCTURE?
PARTICULARLY THE PUBLIC HEALTH
INFRASTRUCTURE.
WHAT IS THE CAPACITY TO DELIVER
THE INTERVENTION IN LOWER AND
MIDDLE INCOME COUNTRIES.
I COME FROM A COUNTRY IN SOUTH
AMERICA.
AND THERE THE CAPACITY TO
DELIVER SERVICES IN THE AMAZON
RAINFOREST WHERE I USED TO
PRACTICE AS A YOUNG PHYSICIANS
NOT EASY.
WHEN WE SEE THAT BECAUSE OF
CLIMATE CHANGES AND INCREASED
FLOODING TAKES PEOPLE AWAY FROM
GROWING THEIR FRUITS AND
VEGETABLES ON THE RICH RIVER
BANK SOIL MOVING UPSTREAM WHERE
THE SOIL IS LESS HEALTHY THAN
REVERTING TO USING PESTICIDES.
WE HAVE 50% ANEMIA OF PREGNANT
WOMEN.
SO WHAT IS THE FINANCIAL
CAPACITY.
AND I'M GLAD THAT MY COLLEAGUE
JUAN TALKED ABOUT THE IMPORTANCE
OF CULTURE.
THERE ARE COMMUNITIES WHERE I
COME FROM WHERE VEGETABLES ARE
TOO EXPENSIVE TO AFFORD.
SO WHAT IS THE --
>> YOU HAVE ONE MINUTE
REMAINING.
>> WHAT IS THE FOCUS THAT WE
HAVE ON EATING FISH EATING
PROTEINS VERSUS CONTAMINATED
FISH.
PEOPLE ARE FORCED TO EAT
CONTAMINATED FISH BECAUSE THAT
IS THE ONLY SOURCE OF PROTEIN.
ULTIMATELY WHAT IS THE POLITICAL
OR GOVERNMENT STRUCTURE.
WHEN YOU THINK ABOUT
INTERVENTIONS AND YOU THINK
ABOUT THE IMPACT OF CLIMATE ON
THE RESPIRATORY HEALTH WE NEED
TO THINK ABOUT WHAT IS OUR
COMMUNITY FOCUS AND HOW DO WE DO
THIS TOGETHER SO LET ME LEAVE
YOU WITH INVITING YOU TO COME --
AND ENJOY THE RICH FOOD OF MY
COUNTRY AND I WOULD BE PLEASED
TO ANSWER QUESTIONS LATER.
THANK YOU.
>> THANK YOU SO MUCH PROFESSOR
LICHTVELD FOR THAT VERY
INTERESTING INTRODUCTION TO THE
TOPIC.
WE HAVE APPROXIMATELY 10 MINUTES
NOW TO OPEN THE DISCUSSION.
7 WE HAVE SUMMARIZED THE MAIN
POINTS THAT WE FELT WERE
CRITICAL TO THE PRESENTATIONS
YOU GAVE.
DR. SCHEELBEEK ADDRESSED THE
ISSUE OF CLIMATE CHANGE
IMPACTING LIFE DOMAINS AND
RESOURCES.
GLOBALIZATION CREATES
VULNERABILITY EVERYWHERE AND
SEVERAL CLIMATE CHANGE FRIENDLY
ADAPTATIONS CAN SUPPORT FOOD
AVAILABILITY.
-- SO THE KEY TO THE DISCUSSION
-- WHAT IS THE IMPACT OF CLIMATE
CHANGE ON FOOD SYSTEMS, FOOD
SECURITY, DIET QUALITY AND
NUTRIENTS.
PERHAPS I CAN START WITH
PROFESSOR LICHTVELD WHO NICELY
SUMMARIZED THE SITUATION.
AND IN THAT PART OF SOUTH
AMERICA.
HOW DO YOU SEE THE IMPACT OF
CLIMATE CHANGE AFFECTING
RESPIRATORY HEALTH AND WHAT DO
YOU PROPOSE IN TERMS OF
ADVANCING THE RESEARCH.
>> I MENTIONED EARLIER THAT THE
FOCUS ON PREGNANT WOMEN IS --
WILL GIVE US THE GREATEST YIELD
OF WHERE WE WANT TO GO BECAUSE
IF YOU HAVE THE DEFICIENCIES
DURING PREGNANCY WE'RE SEEING
SMALLER GESTATION -- AND
DECREASED APKAR SCORES.
7 TWO, BY INTEGRATING -- A
MULTI-SECTORIAL AND
TRANSDISCIPLINARY APPROACH WE
CAN WORK WITH NUTRITIONIST AND
ALSO CULTURAL LEADERS AND
WHETHER SCIENTISTS.
PEOPLE WHO ADDRESS SOIL.
ENVIRONMENTAL HEALTH SCIENTISTS
AND LIKE WHAT I DO ENVIRONMENTAL
EPIDEMIOLOGIST.
THIRDLY IT IS NOT -- ANOTHER --
WE WOULD WANT TO FOCUS ON A
SINGLE ASPECT.
A SINGLE HEALTH OUTCOME.
HERE IT IS IMPOSSIBLE.
HERE WE NEED TO TAKE THAT
TRANSDISCIPLINARY APPROACH AND
SEE HOW A MILL YA IMPACTS
LEARNING AND HOW LEARNING
IMPACTS TO JOBS THAT ULTIMATELY
LEADS TO POVERTY AND
MALNUTRITION.
SO BY USING THAT PRECISION
PUBLIC HEALTH APPROACH THAT IS
LOOKING THROUGH THE LENS OF
THOSE WHO ARE MOST VULNERABLE
NOT ONLY AT THE INDIVIDUAL LEVEL
BUT HOW THE COMMUNITY COMPONENTS
AND THE ASPECTS OF COMMUNITY
RESILIENCE ULTIMATELY IMPACTS
WHAT IS GOING ON WITH THE
INDIVIDUAL IN THE COMMUNITY.
I THINK THAT IS THE APPROACH
THAT WILL GIVE US THE GREATEST
YIELD.
>> THANK YOU VERY MUCH.
TO DR. SCHEELBEEK.
YOU PRESENTED A VERY NICE
OUTLINE OF THE AFFECTS OF
CLIMATE CHANGE AND HOW IT MIGHT
AFFECT FOOD PRODUCTION.
DO YOU HAVE ANY SUGGESTIONS
ABOUT KEY RESEARCH QUESTIONS
THAT WE COULD THINK OF TO
ADVANCE THE SCIENTIFIC -- AGENDA
AND HOW THIS IS LINKED TO
RESPIRATORY DISEASES IN THE
FUTURE?
>> FIRST IT IS IMPORTANT BECAUSE
I DON'T THINK THE DIFFERENT
AGENDAS OF FOR EXAMPLE PLANETARY
HEALTH SCIENTISTS, AGRICULTURE
SCIENTIST AND RESPIRATORY
RESEARCHERS IS VERY MUCH LINKED.
AND I WOULD BE SURPRISED IF
PEOPLE THAT LOOK AT MORE
RESILIENCE IN FOOD PRODUCTION
AND CONSUMPTION KNOW A LOT ABOUT
WHAT FOODS ARE PARTICULARLY
IMPORTANT IN TERMS OF PREVENTION
RESPIRATORY ILLNESS AND I THINK
FINDING THESE CO-BENEFITS
BECAUSE I'M SURE THERE WILL BE
MANY.
WE SEE LOTS OF COACH BENEFITS
WHEN IT COMES TO FOODS THAT ARE
HEALTHY FOR PEOPLE AND ALSO
CAUSE LESS OF AN IMPACT ON THE
ENVIRONMENT TO PRODUCE.
I'M SURE THERE ARE MORE OF THESE
WIN-WINS WHERE THEY WOULD ALSO
CONTRIBUTE TO A DIET THAT WOULD
PREVENT MORE RESPIRATORY ILLNESS
OR CARDIOVASCULAR DISEASE IN
GENERAL.
AND SO NOT SO MUCH A RESEARCH
QUESTION PER SAY BUT ALIGNING
THESE AGENDAS AND HAVING PEOPLE
IN DIFFERENT RESEARCH FIELDS
TALK TO EACH OTHER.
AND I MIGHT BE BIASED BECAUSE
THIS IS THE AREA THAT I WORK IN.
BUT CLIMATE CHANGE IS GOING TO
BE SO IMPACTFUL IN EVERY HEALTH
DOMAIN SO HAVING THAT CLIMATE
ANGLE AS PART OF THE DISCUSSION
EVERYWHERE WOULD REALLY HELP.
>> THANK YOU.
THAT IS REALLY HELPFUL.
WE HAVE A QUESTION IN THE CHAT
AND WE HAVE ONLY THREE MINUTES
BEFORE THE NEXT SESSION.
WHICH MODELS DO YOU THINK ARE
BEST PLACED TO PREDICT THE
PREVALENCE OF UNDER WEIGHT
INDIVIDUALS WORLDWIDE?
>> SO FROM -- THERE ARE SEVERAL
MODELS.
FROM A CLINICAL MODEL AND HEALTH
CARE SERVICES MODEL WHAT WE'VE
DONE IN MANY COUNTRIES IS NOT
DEPEND ON PHYSICIANS TO PROVIDE
CARE BUT TO PROVIDE TO CREATE,
WE HAVE A SERIES OF WHAT YOU
CALL COMMUNITY HEALTH CARE
WORKERS WHO WOULD THEN AND ARE
DIRECTLY CONNECTED.
IF YOU CONNECT A COMMUNITY
HEALTH WORKER WITH A PREGNANT
WOMAN WE HAVE INCREASED
CONNECTION BUT THAT MODEL HAS
SHOWN THAT WE HAVE TWO-THIRDS
FEWER ADVERSE BIRTH OUTCOMES.
SO PROMISING.
VERY LOW COST.
THAT IS ONE MODEL.
THE SECOND IS THAT WE INTEGRATE
IN PRENATAL SCREENING.
ALSO QUESTIONS ABOUT EXPOSURES.
ENVIRONMENTAL EXPOSURES.
AND THIRDLY AND THIS AS WHAT I'M
DOING NOW.
WE HAVE BEGIN TO TEACH
PHYSICIANS HOW TO TAKE A CLIMATE
AND HEALTH HISTORY.
SO THAT WE CAN INTERVENE AS
EARLY AS POSSIBLE.
THREE MODELS.
>> THANK YOU.
THAT IS EXTREMELY INSIGHTFUL AND
THANK YOU AGAIN FOR YOUR TIME IN
THIS SESSION.
I THINK WE'RE JUST ON TIME NOW.
I'M GOING TO HAND THE FLOOR %VR
TO-- MY COLLEAGUE FOR SESSION
THREE.
>> NOW WE'LL PROCEED TO NEXT
SESSION WHICH WILL FOCUS ON
MECHANISMS AND NUTRITION AND
DIETARY IMPACT RESPIRATORY
HEALTH AND DISEASES AND IT'S MY
GREAT PLEASURE TO INTRODUCE
DR. MATTHEW POYNTER.
HE IS A PROFESSOR OF MEDICINE AT
THE UNIVERSITY OF VERMONT.
HIS RESEARCH USES PRECLINICAL
CELL CULTURE AND ANIMAL MODELING
EQUIPPED WITH THE TRANSLATIONAL
AND CLINICAL APPROACHES TO
EXAMINE THE IMPACT OF THE
IMMUNE, ENDOCRINE AND NUTRITION
AND LIFESTYLE FACTORS ON ASTHMA,
AND DIABETES.
AND I TURN IT OVER TO YOU
DR. POYNTER.
>> THANK YOU FOR THE
INTRODUCTION AND THANK YOU TO
THE AUDIENCE MEMBERS AND
PARTICIPANTS FOR STILL BEING ON
THIS SESSION.
I APPRECIATE THAT THE
CONFERENCE ORGANIZERS HAVE
PRESENTED A PROGRAM THAT IS
MULTI-LEVEL IN APPROACH.
OUR OBJECTIVE IS TO EXPLORE
MECHANISMS UNDERLING NUTRITIONAL
AND DIETARY IMPACTS BOTH ON
NORMAL LUNG FUNCTION, LUNG
FUNCTION DECLINE AND IN LUNG
DISEASE.
WE INTEND TO EXAM UP NUTRITIONAL
METABOLIC PROGRAMMING,
INFLAMMATION, OXIDATIVE STRESS,
GUT MICROBIOME.
I WILL BE PROVIDING THE FIRST OF
THESE.
MY TALK IS ENTITLED METABOLIC
PROGRAMMING.
AND I HAVE NO CONFLICTS TO
DECLARE.
MY TALK ALSO TAKES A MULTI-SCALE
APPROACH.
WE'VE HEARD ABOUT SOCIETAL AND
GLOBAL IMPACTS.
WE'RE GOING TO MOVE INTO ORGAN
AND CELL.
AND THE CHOICE IS DELIVERED --
THERE IS POWER IN CONTROLLING
ENERGY.
THE ILLUSTRATION DEPICTS THAT
THE DROPS OF WATER ARE REALLY
WHAT COMPRISE THE WAVE.
ENERGETICS AT EVERY SCALE.
OUR BODIES AND CELLS RELY ON
NUTRIENTS NOT ONLY AS FUEL BUT
THEY ALSO SENSE THESE NUTRIENTS
AND THEIR METABOLITES TO AFFECT
DIFFERENT ACTIVITIES.
WE CONSIDER THAT CARBOHYDRATES
ARE THE MAJOR CELLULAR FUEL.
AND WE USE THAT BECAUSE IT
GENERATES ATP -- EASILY.
THE BRAIN AS AN EXAMPLE RELIES
ON GLUCOSE FOR ITS ENERGY.
ON THE OTHER HAND THERE ARE MANY
TUMORS THAT ALSO CONSUME SUGAR
SUCH AS GLUCOSE AND THIS FUELS
THEIR GROWTH.
WE NOW KNOW THAT PROCESSED
SIMPLE CARBOHYDRATE LADEN AND
EASILY AVAILABLE FOODS HAVE
FUELED THE OBESITY ESPECIALLY
DEMOCRATIC AND THAT HAS
NEGATIVELY AFFECTED RESPIRATORY
HEALTH.
NUTRITION GUIDELINES HAVE
FOCUSED ON HOW MUCH DO WE EAT?
CONSIDERING TOTAL CALORIES.
WHAT DO WE EAT?
FATS, CARBOHYDRATES?
WESTERN OR MEDITERRANEAN DIET.
UNREFINED FRESH FOODS.
HOW MUCH POLYUNSATURATED FATTY
ACIDS AND HOW MUCH FIBER CONTENT
ARE PART OF OUR DIETS.
WHEN DO WE EAT?
ALSO THE IMPORTANCE OF LANGUAGE.
THINKING ABOUT THE TERM DIET
MORE AS A NOUN RATHER THAN A
VERB.
I'M TELLING PEOPLE TO THINK
ABOUT THE DIET THAT THEY
CONSUME.
MY PRESENTATION COMES FROM MY
OWN PERSPECTIVE IN WHICH OUR LAB
STUDIES OBESITY.
A RISK FACTOR CONTRIBUTING TO
ASTHMA.
DEFINED AS HAVING ACCESS --
LACTATE PRODUCTION, CHRONIC
SYSTEMATIC LOW GRADE
INFLAMMATION.
THEY HAVE WORSE SYMPTOMS IN
ASTHMA CONTROL DESPITE BEING ON
INCREASED STANDARD TREATMENT.
THESE ARE SEVERE ASTHMATICS.
WE ALSO KNOW THAT STUDIES HAVE
SHOWN THAT 5% OR MORE WEIGHT
LOSSES LISETTES ASTHMA
PROTECTION.
THERE ARE IMPROVEMENTS.
AS A RESULT OF LOSING GREATER
THAN 5% OF THE BODY WEIGHT.
THOSE WHO DO ABOUT 50% OF THEM
DISCONTINUE MEDICATIONS
ENTIRELY.
THERE IS A LOT OF WAYS TO ELICIT
WEIGHT LOSS TO IMPROVE ASTHMA.
WE'VE USED BARIATRIC SURGERY TO
ELICIT THIS TYPE OF BENEFIT AND
I CONSIDER IT TO BE A METABOLIC
CRISIS.
THE REASON FOR THIS IS BECAUSE
AS A CONSEQUENCE OF BARIATRIC
SURGERY THE BODY DOES NOT
SYNTHESIZE THE SAME AMOUNT OF
HUNGER PRODUCING HORMONES.
IT PROMOTES FULLNESS AND ABSORBS
IS COMPROMISED.
AND SO METABOLISM CHANGES DURING
ENERGETIC CRISIS.
REPROGRAMMING IS ELICITED.
THIS IT SHOWS THAT DURING FASTIG
WHICH OCCURS IN THREE PHASES
OVER TIME YOU CAN SEE THAT THE
RELATIVE LEVELS OF GLUCOSE
DECLINE.
PROTEIN AND U REMARKS ERA GOES
DOWN.
METABOLIC RATE INCREASES.
THERE IS A MOLECULE ILLUSTRATED
IN RED THAT ELEVATES QUITE
QUICKLY AND QUITE SUBSTANTIALLY.
IN FACT DURING STARVATION OR
FASTING THIS IS THE MOST HIGHLY
INDUCED METABOLITE PRESENT
WITHIN OUR CIRCULATION.
ON THE LEFT IS AN ILLUSTRATION
OF WHAT HAPPENS DURING FASTING
BUT ON THE RIGHT THIS IS A BOOK
CALLED THE LORE OF RUNNING WHICH
TALKS ABOUT THE SAME BIOCHEMICAL
PROCESSES OCCURRING IN ULTRA
ATHLETES, ENDURANCE RUNNERS AND
PEOPLE PRACTICING AND DOING
MARATHONS.
BUT THEY DON'T ONLY HAPPEN
DURING FASTING AND EXERCISE.
THEY ALSO HAPPEN DURING FEVER
AND INFLAMMATION AND DISEASES.
THIS COMES ABOUT DURING WHAT IS
CALLED KETOSIS.
7 WHAT I CONSIDER TO BE A
THERAPEUTIC KETOSIS. SO
THERAPEUTIC IS A FORM OF
METABOLIC REPROGRAMMING THAT CAN
BENEFIT RESPIRATORY HEALTH.
IT CAN COME ABOUT DURING FASTING
OR DURING CRITICAL ILLNESS AS A
RESULT -- FATTY ACIDS THAT
TRAVEL TO THE LIVER AND ARE
CONVERTED INTO THE KETONE
BODIES.
THE KETONE BODIES CAN THEN CROSS
THE BLOOD BRAIN BARRIER AND
SERVE IS A AN ALTERNATIVE SOURCE
OF FUEL BUT ALSO FUEL THE HEART,
SKELETAL MUSCLES AND HAVE AN
IMPACT WITHIN THE LUNG ITSELF.
AND IN THE UPPER RIGHT IS A
DIAGRAM -- THIS IS CONSTITUTING
APPROXIMATELY 80% OF THE
CIRCULATING KETONES.
WE HAVE SHOWN THAT IN
INDIVIDUALS UNDERGOING BARIATRIC
SURGERY WE CAN SEE THAT BMI
WHETHER INDIVIDUALS ARE OBESE,
HAVE OBESE ASTHMA THEIR BMI
DECREASES AND YOU SEE A
SUBSTANTIAL DECREASE IN THEIR
BMI.
THIS CONTINUES TO IMPROVE OVER
THE COURSE OF SIX MONTHS TO A
YEAR.
A LONG THIS TIME COURSE
ESPECIALLY VERY EARLY AND WHEN
WE'VE LOOKED AT TWO WEEKS YOU
CAN SEE THERE IS A TRANSIENT
INCREASE IN THE CIRCULATION OF
THESE INDIVIDUALS.
NOW OTHER PUBLICATIONS HAVE
SHOWN THAT THERE IS A TRANSIENT
AND SUBSTANTIAL INCREASE IN THE
LEVELS THAT FASTING ELEVATES
THIS AND EVEN TREATMENT WITH A
RECEPTOR AGONIST -- WHICH CAUSES
WEIGHT LOSS AND IMPROVEMENTS IN
ASTHMA ALSO HAS THE INCREASE.
HYDROXYCHLOROQUINE
INTEREST MITT EVENT FASTING CAN
BE A * MEANS TO --
AND ONE CAN PROVIDE DIETARY
SUPPLEMENTS -- OR A KETONE
ESTHER THAT CONTAINS -- -- TO
AUGMENT CIRCULATING KETONE BODY
CONCENTRATIONS.
IN OUR PRECLINICAL STUDIES WE'VE
SHOWN THAT AS ILLUSTRATED IN
PANEL "A" A NUMBER OF OBESE OR
ALLERGIC ASTHMA MOUSE MODELS WE
CAN ELEVATE HYDROXYBUTYRATE AND
AS A CONSEQUENCE REDUCE --
RESPONSIVENESS.
AND SO WHAT WE SEE IS THAT BY
EVOKING THERAPEUTIC AND RAISING
HYDROXYBUTYRATE LEVELS REDUCES
RESPONSIVENESS AND AIRWAY
INFLAMMATION.
OUR GROUP IS NOT THE ONLY ONE TO
HAVE PUBLISHED THIS.
THIS CAN ALSO DECREASE AIRWAY
INFLAMMATION THROUGH THE
REGULATION OF MASS CELLS.
SO KETONE BODIES -- I BELIEVE
HAVE AN IMPACT ON RESPIRATORY
HEALTH.
RECENT REVIEW SUGGESTED A NUMBER
OF OTHER ORGAN SYSTEMS AND
CELLULAR MECHANISMS WHEREBY
KETONE BODIES CAN ELICIT
BENEFIT.
WE KNOW THAT KETONE BODIES WORK
THROUGH A NUMBER OF DIFFERENT
PATHWAYS.
THEY CAN DECREASE PRO
INFLAMMATORY GENE -- THERAPY.
THEY CAN CAUSE HIS STONE --
MODIFICATION THROUGH A PROCESS.
THEY CAN ACTIVATE CELL SURFACE
RECEPTORS.
AND THEY CAN ALSO CHANGE -- --
ACTIVITY.
THEY'VE GOT A NUMBER OF
DIFFERENT MECHANISMS AND
PATHWAYS WHERE THEY MAY INTERACT
WITH THE RESPIRATORY SYSTEM.
>> YOU HAVE -- MINUTES REMAINING
>> WE'VE DEMONSTRATED THAT LUNG
FUNCTION IS BENEFICIALLY
AFFECTED THROUGH THIS DES TO US.
-- KETOSIS.
7 *.
AND EVEN LOOKING AT THE SUB
CELLULAR LEVEL WE CAN SEE THAT
MITOCHONDRIAL ARE AFFECTED.
THIS IS DONE IN AN INVITRO
CULTURE SETTING USING
TRANSFORMED CELLS INVITRO.
THIS IS HAVING AN IMPACT.
AND I WANT TO LEAVE YOU WITH A
PIECE OF DATA -- SHOWING THAT AN
INDIVIDUAL WHO CONSUMES -- THIS
KETONE ESTHER YOU CAN SEE THAT
IN GREEN THE LEVELS -- AND
AIRWAY RESISTANCE IS RELIEVED
WHICH SHOWS AN ACUTE EFFECT.
AND I'M GOING TO JUMP TO THE ONE
AFTER.
SO THIS MIGHT SEEM LIKE THIS IS
A NOVEL MECHANISM.
BUT IN FACT THIS IS NEARLY 100
YEARS OLD.
THERE ARE TWO PAPES ILLUSTRATED
THAT A KETOGENIC DIET WAS
ATTEMPTED IN CHILDREN TO
CHEETAHS MAY AND IT HAD MIXED
RESULTS.
WE WERE AT A TIME WHEN WE DIDN'T
UNDERSTAND ENDO TYPING.
THERE IS A TYPE OF ASTHMA THAT
IS BEING TARGETED USING
NUTRITIONAL -- KETOSIS.
AND SOME OF THE DATA HAVE BEEN
PRESENTED IN ABSTRACT FORM AT
ATS IN 2013 AND THEY LOOK VERY
PROMISING.
SO THERE IS A NUMBER OF RESEARCH
GAPS FOR RESPIRATORY HEALTH.
I'D LIKE TO KNOW WHETHER KETONE
BODIES ARE NECESSARY.
WHETHER ELEVATED LEVELS CAN BE
SUSTAINED AND CONTINUED TO
PROVIDE BENEFIT AND CAUSE NO
HARM.
WE NEED TO UNDERSTAND IN WHICH
PARENTS THIS IS TO BE AVOIDED
SUCH AS DIBS OR INDIVIDUALS THAT
ARE LACTATING.
*.
I'D LIKE TO UNDERSTAND THE
COURSE OF KETONE BODIES.
THEIR TARGETS AND MECHANISMS OF
ACTION AND I THINK REALLY
IMPORTANT TO CONSIDER THE
IMPORTANCE OF POWER
TRANSFORMATION AND WE'RE
BEGINNING TO RELY ON MULTIPLE
SOURCES OF ENERGY AND I THINK
METABOLIC FLEXIBILITY -- ON THE
CELLULAR LEVEL MAY BE IMPORTANT.
SO THE OPPORTUNITIES AND KEY
RESEARCH QUESTIONS.
WE WONDER WHETHER THERAPEUTIC
KETOSIS COULD BE APPLIED TO A
MULTIPLE OF RESPIRATORY
CONDITIONS.
WHAT ABOUT COPD.
PULMONARY HYPERTENSION.
ETC.
THERE WAS A PAPER THAT CAME OUT
-- REDUCES COVID-19 DEATHS.
WHAT ARE THE MECHANISMS
UNDERLYING THAT?
CAN WE HAVE A NUTRITIONAL
RECOMMENDATION OR THROUGH
SUPPLEMENTATION THAT CAN A
PROVIDE A AN ATTRACTIVE MEANS.
DO WE NEED IT TO BE LONG-TERM?
AFTER ADDITIONAL TYPES OR SCALES
OF METABOLIC PROGRAMMING THAT
ARE ALTERNATIVES.
AND I BRING UP THE -- FACES OF
THERAPEUTIC KETOSIS.
THERE IS NO FREE RUN.
POTENTIAL CAVEATS.
YOU CANNOT JUST EAT FAT.
THERE ARE SATURATED FATS THAT
ARE VERY BAD FOR CARDIOVASCULAR
HEALTH.
-- AND -- PART OF THE CHRONIC
CONDITION IS PART OF AN OVER
EXUBERANT INFLAMMATORY SYSTEM.
AND I WOULD LIKE TO THANK THE
OPPORTUNITY TO SPEAK TO THIS
WORK.
AND WITH THAT WE'RE GOING TO
MOVE ON TO OUR NEXT SPEAKER.
DR. KYMBERLY GOWDY AT THE OHIO
STATE UNIVERSITY.
>> THANK YOU VERY MUCH TO THE
ORGANIZERS FOR ALLOWING ME TO
SPEAK IN THIS VERY EXCITING
WORKSHOP.
I'M GOING TO TELL THE AUDIENCE
ABOUT ONE OF THE PROJECTS WE'VE
GOT IN MY LAB TO GET YOU TO
APPRECIATE HOW DIET MIGHT CHANGE
THE LIPID HOME OF THE LUNGS.
MY LAB IS VERY INTERESTED IN
UNDERSTANDING THE MECHANISMS
BEHIND HOW AIR POLLUTION CAN
CONTRIBUTE TO CHRONIC LUNG
DISEASES.
THIS WAS NICELY HIGHLIGHTED BY
THE CLIMATE CHANGE SESSION
BEFORE THIS.
I DO WANT YOU TO APPRECIATE THAT
ON THIS GRAPH WHICH IS FROM THE
STATE OF GLOBAL AIR IF YOU LOOK
AT WHAT PEOPLE ARE DYING FROM --
ON THE AXIS -- THE LEFT AXIS OF
THE BAR GRAPH.
YOU CAN SEE WHAT -- ARE
INFLUENCING WHAT PEOPLE ARE
DYING FROM.
WHEN WE LOOK AT THOSE GREEN BARS
IN THE TOP 10 BASICALLY HAS A
LOT TO DO WITH THE AIR QUALITY
THAT WE'RE BREATHING IN.
AMBIENT PARTICULATE MATTER.
OZONE IS KNOWN TO INFLUENCE
MORTALITY RATES FROM CHRONIC
LUNG DISEASE.
AND SO HOW THIS HAPPENS.
I WILL SAY THAT WE STILL HAVE A
LOT TO LEARN BUT WE CAN SAY IN
PART AIR POLLUTION IS KNOWN TO
INDUCE PULMONARY INFLAMMATION.
THIS IS A SIMPLE SCHEMATIC OF
WHAT WE DO KNOW HAPPENS WHEN YOU
INHALE THESE.
BASICALLY THESE POLLUTANTS CAN
CARRY IN -- PATHOGEN ASSOCIATED
MOLECULAR PATTERNS OR THEY CAN
REACT WITH THE LUNG LINING
FLUID.
AND THESE -- THEY SET OFF AN
INFLAMMATORY CASCADE IN THE
LUNGS.
WHICH THEN ALLOW THEM TO SECRETE
CITE KINDS MAKING IT MORE RICO
*.
SO WE'VE BEEN ABLE TO SHOW THIS
NOT ONLY IN A LOT OF PATIENT
STUDIES BUT ALSO IN LABORATORY
STUDIES THAT AIR POLLUTION DOZEN
INTRODUCE AN INFLAMMATORY
RESPONSE.
AND SO WE AS WELL AS OTHERS HAVE
BEEN ABLE TO RECAPITULATE THIS
RESPONSE TO AIR POLLUTION
SPECIFICALLY OZONE IN RODENT
MODELS IN A LABORATORY SETTING.
THIS WAS A PAPER THAT MY GROUP
PUBLISHED WHERE WE WERE ABLE TO
SHOW THAT 24 HOURS POST AN ACUTE
AMBIENT INCREASE IN OZONE -- HAD
AN INCREASE IN MACROPHAGIAS IN
THE LUNG.
THIS WAS ALSO AUGMENTED
FOLLOWING EXPOSURE.
THIS RECAPITULATES WHAT WE SEE
IN HUMANS.
AND SO AROUND THE TIME THAT WE
GOT INTERESTED IN LIPID
METABOLISM AND INFLAMMATION AND
AIR POLLUTION THERE WERE SOME
NICE STUDIES COMING OUT LOOKING
AT DIET AND THE EFFECT THAT DIET
MIGHT HAVE ON THE HEALTH EFFECTS
OF AIR POLLUTION.
ONE IS BY DR. BRIGHAM.
AND THEY WERE ABLE TO SHOW THAT
WHEN CHILDREN CONSUMED A DIET
THAT WAS HIGH IN -- ON POOR AIR
QUALITY DAYS THOSE CHILDREN
ACTUALLY HAD A SIGNIFICANT
DECREASE IN THEIR FVE1.
PEOPLE THAT ADHERED TO A
MEDITERRANEAN DIET HAD LESS
CARDIOVASCULAR OR PULMONARY
EFFECTS ON BAD AIR POLLUTION
DAYS.
THEY MIGHT BE ONE OF THE WAYS
WHERE WE MIGHT BE ABLE TO
INTERVENE.
AND AS WE HEARD BEFORE WE ARE --
POOR CONSUMERS OF PUFA.
BUT AGAIN THE DATA AS TO WHAT
THE MECHANISMS IS STILL AT
LARGE.
SO ONE OF THE INTERESTING
CAVEATS ABOUT STUDYING PUFA
INTAKE AND AIR POLLUTION, IS AIR
POLLUTION IS KNOWN TO ALTER
LIPID METABOLISM.
YOU SEE POST EXPOSURE IN RODENT
MODELS AS WELL AS HUMANS.
EVEN THE ENZYMES THAT ARE KNOWN
TO METABOLIZE THESE MEDIATORS
CAN HAVE ALTERED EXPRESSION AS
WELL AS ACTIVITY IN THE LUNG
FOLLOWING AIR POLLUTION EXPOSURE
AND THIS NICE STUDY IN 2016 WHEN
THEY HAD A HUMAN VOLUNTEERS THAT
WERE EXPOSED TO OZONE THEY WERE
ABLE TO SEE THERE WAS A
SIGNIFICANT INCREASE IN
CIRCULATING AS WELL AS
POLYUNSATURATED FATTY ACIDS.
IT WAS COUPLED WITH A DECREASE
IN THE PRODUCTION OF THE M3
DERIVED LIPID MEDIATORS IN THE
LUNG.
HIGHLIGHTING AN IMBALANCE.
SO THIS IS TO THE QUESTION -- IF
DIETARY N3PUFAs DECREASE
HEALTH EFFECTS IS THIS DUE TO A
DIFFERENTIAL -- LIPID
METABOLISM.
TO TEST THIS -- WE WERE FOCUSED
ON OZONE.
IF YOU'RE NOT FAMILIAR OZONE IS
A CRITERIA AIR POLLUTE
APARTMENT.
IT IS GOING TO INCREASE WITH
CLIMATE CHANGE.
STUDIES HAVE SHOWN THAT IT
INCREASES CARDIOVASCULAR
MORTALITY.
YOU CAN SEE THAT SUSCEPTIBLE
POPULATIONS SUCH AS ELDERLY AND
CHILDREN HAVE DECREASED LUNG
FUNCTION.
INCREASED EMERGENCY ROOM VISITS.
AND SOME OF THE NEWER DATA WITH
OZONE IS SHOWN THAT YOU'RE
SEEING AN INCREASE IN INCIDENTS
OF SEVERITY IN CHRONIC LUNG
DISEASES.
NOW WE'RE STARTING TO SEE THIS
WITH IPF.
THIS IS AN IMPORTANT POLLUTANT
THAT WE NEED TO BE COGNIZANT OF
WITH RESPIRATORY DISEASES.
AND SO TO MODEL THIS WE'RE USING
A RODENT MODEL.
FEEDING THEM A NORMAL CHOW DIET
OR AN EPA SUPPLEMENTED DIET.
WE START FEEDING THIS RIGHT
AFTER WEANING SO IT'S SUPPOSED
TO RECAPITULATE GROWING UP
EATING A DIET RICH IN THIS RICH
EPA.
THIS HAS ABOUT 2% KILL CALORIES
OF EPA AND IT'S A HIGH QUALITY
EPA.
THIS GETS THAT WAY FROM THE
CONTAMINANTS.
THE 2% CALORIE SHOULD MODEL
ABOUT A 2-GRAM -- CALORIE.
AND THEN WE'RE GOING TO EXPOSE
-- THEM TO FILTERED AIR FOR
THREE HOURS.
RECAPITULATING WHAT YOU WOULD
SEE ON AN OZONE ACTION DAY.
WE'RE GOING TO LOOK IN THE LUNG
-- FOR MARKERS OF INFLAMMATION
AS WELL AS WE DID TARGETED LIPID
MIX ON THE LUNG TISSUE.
AND SO THIS IS DATA THAT WAS
GENERATED BY A VERY TALENTED
GRADUATE STUDENT IN MY LAB.
HANNAH LOVINS.
IS THAT IN FACT EPA IN THE DIET
DOES SEEM TO BLOCK THE RESPONSE
TO OZONE AND THAT IS PICKED IN
THE GRAPH ON THE LEFT.
HOWEVER WHEN WE LOOKED AT
MARKERS -- WE DID NOT SEE THAT
THIS WAS ABLE TO PROTECT THAT
WHICH I FIND VERY INTERESTING
BECAUSE MAYBE THIS INDICATES A
SPECIFICITY OF HOW THIS FATTY
ACID IN THE DIET MIGHT BE
CAUSING SOME OF ITS EFFECTS AND
SO THEN -- WE LOADED THE DIET
WITH EPA.
WHAT ARE THE LIPID MEDIATORS
BEING METABOLIZED IN THE LUNGS?
AND IT CAN BE ME TAPLIZED -- OR
EVEN -- INTO DIFFERENT HEAPS.
OR THE DIHETES.
JUST DO KNOW THAT A LOT OF THESE
ARE ANTIINFLAMMATORY IN NATURE
AS WELL AS HAVE SOME RULES IN
GLUCOSE HOMEOSTASIS.
7 NOT ALL WERE UP IN THE LUNG
WITH EMPA IN THE DIET.
IF YOU LOOK AT THE BLUE BARS --
-- THEY HAD AN INCREASE IN THE
AMOUNT OF -- HEPS.
SO THESE ARE SPECIFICALLY EPA
MEDIATORS -- INDICATING THAT
MAYBE THE ENZYME ACTIVITY
ACTUALLY WAS PLAYING A ROLE IN
THE EPA -- METABOLISM IN THE
LUNG.
WE DID NOT SEE THE OZONE CHANGED
-- THE PRODUCTION OF THESE LUNGS
BUT I DO THINK THIS IS
INTERESTING DATA THAT SHOWS THAT
THE LUNG TISSUE IS MALLEABLE TO
DIETARY FATTY ACIDS.
7 AND SO THEN WE ASKED THE
QUESTION -- WHAT IS THIS DOING
TO SOME OF THE LIPID MEDIATORS
-- AND THE DATA WE GOT BACK WAS
VERY INTERESTING.
OZONE IN THE CONTROLLED DIET YOU
ARE SEEING THAT THEY HAVE AN
INCREASE IN THE PRO INFLAMMATORY
MEDIATORS BUT IT WAS BLUNTED
WITH EPA IN THE DIET.
WE'RE GETTING MORE OF THE ONES
THAT ARE DOWNSTREAM OF EPA THAT
IS IN A DIET WHEN THE MICE ARE
FED AN EPA SUPPLEMENTED DIET.
IS THIS DUE TO THE FACT THAT EPA
IS PUSHING SOME OF THE PUFAs
OUT OF THE LUNG?
WE DID -- A TEST IN LUNG TISSUE
AND WHAT WE SAW WAS SIMILAR TO
THE HEAT DATA THAT I SHOWED YOU
EARLIER.
IT DOES SEEM TO RESULT IN MORE
EPA IN THE LUNG TISSUE WHICH IS
GREAT.
EPA CAN BE METABOLIZED.
WE'RE SEEING MORE DHA IN THE
LUNG BUT WHEN WE LOOK AT -- --
THERE SEEMS TO BE A DISPLACEMENT
WITH EPA IN THE DIET INDICATING
THAT WHEN YOU EAT THESE FATTY
ACIDS PRESUMABLY WHAT MIGHT BE
HAPPENING IS THAT THE EPA MIGHT
BE PUSHING THESE OUT OF THE
MEMBRANES.
THE FUEL THAT IS THERE FOR THESE
ENZYMES TO PRODUCE IS PROBABLY
MORE INDICATIVE OF WHAT WAS IN
THE DIET.
>> SPEAKER, YOU HAVE TWO MINUTES
REMAINING.
>> I'D LIKE TO SUMMARIZE WHAT
I'VE SHOWN YOU.
I WANTED TO SHOW YOU MORE OF A
STORY THAT WE'RE WORKING ON TO
HIGHLIGHT HOW DIET CAN INFLUENCE
THE LIPID CONTENT IN THE LUNG.
WE HAVE DATA THAT DHA DOES THE
SAME THING.
WE SEE THAT WE GET MORE DHA ROXY
LINE INS IN THE * LUNG.
IT DOES SEEM TO MEDICATE SOME OF
THE INFLAMMATORY RESPONSES.
AND WE THINK THIS MIGHT BE A
RESULT OF SOME OF THESE -- BEING
DECREASED IN THE LUNG.
BUT JUST THINKING FORWARD OF
WHERE THE FIELD COULD GO --
BECAUSE I THINK THAT IS ONE OF
THE THINGS THIS WORKSHOP IS
TRYING TO GET AT.
OUR LUNGS ARE NEVER THOUGHT OF
AS A TARGET OF DIET.
WE'VE THOUGHT OF THEM AS A
BYSTANDER UNTIL RECENTLY.
I'M VERY CURIOUS TO SEE HOW WHAT
WE EAT IS GETTING TO THE LUNGS.
WHAT ARE THE TRANSPORTERS AS
WELL AS WE'VE BEEN FOCUSING ON
THE FATTY ACIDS TO ENRICH THE
DIET AND WATER SOLUBLE -- THESE
ARE OVER-ALL QUESTIONS THAT
STILL NEED TO BE ANSWERED AND I
WILL SAY THAT WE'RE IN THE
PROCESS OF RECAPITULATING THIS
IN HUMANS.
WITH THAT I'D LIKE TO THANK MY
GROUP ESPECIALLY HANNAH WHO DID
THE MAJORITY OF THE RESEARCH I
SHOWED.
WE'RE VERY FORTUNATE TO HAVE
SOME NUTRITIONAL COLLABORATORS.
THANK YOU.
>> WE CAN NOW MOVE TO THE NEXT
SPEAKER.
DR. TARA NORDGREN FROM COL.
STATE UNIVERSITY.
SHE WILL BE SPEAKING ON
INFLAMMATION AND THE IMMUNE CELL
DYSFUNCTION UNDERLYING
NUTRITIONAL AND DIETARY IMPACTS
ON RESPIRATORY HEALTH AND
DISEASES.
>> SO THANK YOU SO MUCH TO THE
ORGANIZERS FOR LETTING ME TO
COME HERE AND TALK ABOUT THIS
TOPIC.
I DON'T HAVE ANY CONFLICTS OF
INTEREST TO DISCLOSE.
NEEDLESS TO SAY THE CONCEPT OF
HOW NUTRITION AND DIET IMPACTING
CELL AND INFLAMMATION IS A BROAD
TOPIC.
SO I WANT TO FOCUS IN ON A FEW
NUTRIENTS.
AS REGULATORS -- AS AN EXAMPLE.
AND THAT WORK IN UNIQUE LEEWAYS
TO SHOW HOW NUTRITION AND DIET
MAY IMPACT IMMUNITY.
* HOW THEY LEAD TO DYSFUNCTION.
I THINK THAT THE PREVIOUS
SPEAKERS HAVE SET ME UP WELL TO
SAY AN INDIVIDUAL'S DIET HAS THE
CAPACITY TO EXACERBATE OR
MITIGATE RESPONSES.
THEY CAN HAVE DIFFERENCES IN
INFLAMMATION, REPAIR CAPACITY
AND MUCH MORE.
SO, ITS IMPORTANT TO NOTE THAT
MALNUTRITION AND WHEN I SAY
MALNUTRITION -- PROTEIN CALORIE
INTAKE.
IT'S BEEN WELL ESTABLISHED THAT
MALNUTRITION WHICH CAN BE OVER
OR UNDER NUTRITION CAN
NEGATIVELY IMPACT IMMUNITY.
AND I ALSO WANT TO POINT OUT
THAT THERE IS CROSS TALK BETWEEN
NUTRITION AND INFLAMMATION AND
IMMUNITY.
I'M GOING TO FOCUS ON HOW
NUTRITION IMPACTS THIS.
INFLAMMATION CAN ALSO LEAD TO
MALNUTRITION.
IN GENERAL THE TAKE HOME MESSAGE
IS THERE IS SUBSTANTIAL DATA --
AND SOME OF THIS IS ALSO SHOWN
IN VULNERABLE POPULATIONS AS
OTHERS HAVE MENTIONED SO FAR
TODAY.
INDIVIDUALS OVER 50 YEARS OF AGE
AT LEAST 35% HAVE DEFICIENCIES
IN SOME KIND OF MICRO NUTRIENT
AND SUPPLEMENTING THEM HAVE
SHOWN TO IMPROVE IMMUNE
RESPONSES.
SO I DO WANT TO GO THROUGH FIVE
CLASSES OF NUTRIENTS AND GIVE
YOU EXAMPLE MECHANISMS OF HOW
THEY PROMOTE IMMUNE FUNCTION OR
DYSFUNCTION.
AND SO ANTIOXIDANT COMPOUNDS WE
BRIEFLY MENTIONED TODAY.
THEY ARE WELL-KNOWN TO SCAVENGE
FREE RADICALS AND REDUCE THEM.
AND REGULATE IMMUNITY IN OTHER
WAYS SUCH AS WORKING AS
CO-FACTORS IN AND ALSO METAL
COLLATION.
* CHELATION.
IT CAN BE REALLY IMPORTANT AS
VITAMIN C DEFICIENCY CAN
CONTRIBUTE TO AREA INFLAMMATION
AND RISK FOR THINGS LIKE --
INFECTION.
AND SOME IMPORTANT AND
REGULATING -- AND ALSO PROMOTING
ANTI-- IT ENHANCES THEIR
CAPACITY.
AND IT'S ALSO THOUGHT THAT IN
CELLS THAT HAVE OXIDATIVE BIRTH
STIMULATED THEY ACCUMULATE HIGH
LEVELS OF VITAMIN C AND THAT IS
THOUGHT TO BE PROTECTIVE AS WELL
AS SUPPORTING LIMB GO SIGHT
PRODUCTION.
*.
IT'S REALLY IMPLEMENTING.
ZINC IS HIGHLY REGULATED IN THE
BODY.
DOZENS OF PROTEINS THAT ARE
EXPRESSED IN TISSUE.
AND ALLOW IT TO DO A GREAT JOB.
IN TERMS OF REGULATING
SIGNALING, GENE ACTIVATION.
AND ZINC IS REQUIRED FOR ALL
ENZYME PROCESSES AND UP TO 10%
-- MIGHT BIND IN ZINC.
ZINC PLAYS A REALLY IMPORTANT
ROLE.
AND ALL OF THIS LEADS DIRECTLY
TO THE ABILITY OF IMMUNE CELLS
TO FUNCTION PROPERLY.
SO CERTAINLY DEFICIENCY IS
ASSOCIATED WITH ALTERED RATIOS
-- AND ACTIVITIES.
AND SO WE'VE SHOWN THAT ON THE
OTHER SIDE ZINC SUPPLEMENTATION
HAS BEEN SHOWN TO -- IN ELDERLY
POPULATIONS.
7 IT CAN LEAD TO INCREASED
INFLAMMATORY OUTCOMES BASED ON
VARIOUS ANIMAL MODELS OF
EXPOSESSER.
7 SO TALKING ABOUT VITAMIN D.
VITAMIN D IN ADDITION TO OTHER
KNOWN ROLES HAS BEEN RECOGNIZED
AS AN IMPORTANT MODULATOR.
VITAMIN D BINDS TO A RECEPTOR --
AND THAT IS HOW IT MEDIATES ITS
EFFECTS.
MACROPHAGES -- CAN STIMULATE
EXPRESSION.
ALSO FOUND TO PROMOTE --
INTEGRITY AND TO PROMOTE T CELL
-- MIGRATION.
AND WITH VITAMIN D SUN POLICE--O
BRIEFLY MENTIONED EARLIER.
FIBER CERTAINLY IS FOUND IN MANY
DIFFERENT WHOLE FOODS, FRUITS
AND VEGETABLES AND GRAINS.
WE TALK ABOUT IT AS BEING A
PREBIOTIC.
BUT I WON'T BE LABOR THIS
BECAUSE THERE IS TALK AFTER THIS
THAT WILL GO INTO THIS IN MORE
DETAIL.
THE GUT CAN FERMENT -- FIBER AND
THESE ARE KNOWN TO ACTIVATE
SIGNALING PATHWAYS -- THAT
REDUCE INFLAMMATORY RESPONSES.
THROUGH THESE MECHANISMS IT
PLAYS A ROLE IN SYSTEMATIC
INFLAMMATION BUT ALSO WITHIN THE
LUNG AND SUCH AS WHAT HAS BEEN
SHOWN THAT LOW FIBER DIETS DO
HAVE THIS ELEVATED RISK FOR
AIRFLOW OBSTRUCTION, INCREASED
RISK WITH PULMONARY DISEASES AS
WELL.
THIS CAN PREVENT IMMUNE
RESPONSES FROM EXCESSIVE
PROTEINS AND THINGS CROSSING
THAT BARRIER.
AND THEN DIETARY FAT.
WE JUST HEARD ABOUT DIETARY FAT.
INCLUDE POLYUNSATURATED FATTY
ACIDS.
THEY HAVE STRONG LINK TO IMMUNE
RESPONSE REGULATION.
THEY CAN HAVE IMPACTS GENE
EXPRESSION THROUGH RESEM SCEPTER
BINDING AS WELL.
* RECEPTOR AS WELL.
WHILE OMEGA 3 POLYUNSATURATED
FATTY ACIDS HAVE BEEN CONSIDERED
TO CREATE THESE -- AFFECTS SUCH
AS THE RESOLVING AND PROTECTANTS
AND THE LIKE.
AND SO WHAT ABOUT THE OTHER
DIETARY FATS?
WE HAVE ALSO TALKED ABOUT
SATURATED FATS.
LONGER CHAIN SATURATED FATS.
THE HIGH FAT MEALS INCLUDE THOSE
WITH HIGH SATURATED FATS ARE
ASSOCIATED WITH INFLAMMATORY
STATES.
THERE IS AN ASSOCIATION BETWEEN
THIS AND TLR4.
AND IT USED TO BE THOUGHT THAT
SATURATED FATS DIRECTLY SERVE AS
-- IT'S LESS CLEAR NOW IF SOME
SATURATED FATS DO THAT BUT THEY
WORK IN DIRECTLY OR IN A
SYNERGISTIC FASHION.
THEY CAN INDUCE ER STRESS.
AND THIS LEADS TO THIS
INFLAMMATORY ENVIRONMENT AND
THEY CAN ALSO ACTIVATE THESE
PROTEINS THAT SENSE SATURATED
FAT ACCUMULATION.
SO IN A STUDY ASSESSING DID I
TERRY FATS IN ASTHMATICS -- -- *
ONCE AGAIN GOING BACK TO THOSE
OTHER FACTORS THAT WE NEED TO
CONSIDER THAT MIGHT BE IMPACTING
OUTCOMES IN THESE STUDIES.
SO SOME REMAINING RESEARCH GAPS
AND CHALLENGES.
I THINK WE'VE HEARD THIS A
NUMBER OF TIMES TODAY.
7 BUT MANY STUDIES INVESTIGATING
THE MECHANISTIC IMPACTS -- RELY
ON DIETARY SUN -- SUN POLICE MEN
TAKES.
SUN POLICE MEN TAKES.
STAROSTA
-- THERE ARE SNIPS ASSOCIATED --
BUT THESE ARE SOMEWHAT RARELY
CONSIDERED IN SUPPLEMENTATION
TRIALS.
SO THESE ARE JUST ONE EXAMPLE OF
GENES SNIPS THAT SEEM TO BE
REALLY IMPORTANT WHEN THINKING
ABOUT WHETHER OR NOT A
SUPPLEMENT IS GOING TO BE AS
EFFECTIVE AS WE WOULD LIKE IT TO
BE.
SO THERE IS A CRITICAL NEED FOR
PRIORITIZE RESEARCH STUDIES.
AND THERE ARE GAPS IN
PRECLINICAL TO CLINICAL
TRANSLATION.
THIS IS DUE TO INCONSISTENT
OUTCOMES AT EACH RESEARCH LEVEL
THAT PREVENT NUTRITION RESEARCH
TO MOVE FORWARD TO CLINICAL
PRACTICE.
SU-- SUN HEMENTS ARE NOT FDA
REGULATED.
AND SO, I'VE SHARED SOME OF THE
BETTER RECOGNIZED COMPOUNDS AND
THEIR EFFECTS.
THERE ARE MANY OTHER NUTRIENTS
THAT WE KNOW MUCH LESS ABOUT BUT
EVEN IN THE CASE OF THE
NUTRIENTS I DISCUSSED TODAY.
THERE ARE A COUPLE OF PLACES
WHERE WE DON'T FULLY UNDERSTAND
WHAT IS GOING ON AND MANY
STUDIES ARE LACKING ESPECIALLY
WITHIN SPECIFIC SETTINGS OR
WITHIN RELATIVELY RECENT
CHARACTERIZED IMMUNE CELLS AND
PROCESSES.
EXAMPLES WOULD BE WHAT IS
HAPPENING TO TRAINED IMMUNITY.
OTHER CLASSICALLY CATEGORIZED
STRUCTURAL CELLS.
ESPECIALLY THIELIAL CELLS --
THEY HAVE IMPORTANT IMMUNE
MODULATING CAPACITIES.
* AND WITHIN SPECIFIC LUNG
CHALLENGES AND DISEASES IS
CERTAINLY NEEDED.
MANY STUDIES KIND OF LOOK AT
THINGS AS ONLY PRO VERSUS
ANTIINFLAMMATORY EFFECTS.
WITH MUCH MORE LIMITED
INVESTIGATION ON OTHER FACTORS
THAT COULD BE -- OTHERWISE
IMMUNE MOD OOOH, LA TORI.
-- MOD OOOH, LA TORI.
*.
IS HOW AND THE SETTING OF
INFECTIOUS DISEASE HOW PATHOGEN
HOST INTERACTIONS OCCUR.
THOSE STUDIES ARE REALLY WANTED
AND WE'VE JUST STARTED TO TOUCH
THE SURFACE OF HOW A HOST DIET
MAY EFFECT PATHOGEN HEALTH
THROUGH SHARING OF NUTRIENTS AND
RESOURCES.
THANK YOU FOR YOUR TIME.
>> THANK YOU FOR A FANTASTIC
TALK.
WE'RE GOING TO MOVE ON TO
DR. ARUN PRAKASH BUDDE.
>> THANKS SO MUCH.
I HAVE NO CONFLICTS OR
DISCLOSURES.
I WOULD LIKE TO THANK THE
ORGANIZERS FORGIVING ME THE
OPPORTUNITY TO SPEAK AT THIS
SESSION.
I'M NOT A NUTRITIONAL OR DIETARY
EXPERT NOR AM A DATA SCIENTIST.
I'M A PRACTICING
ANESTHESIOLOGIST.
BUT MORE RELEVANT TO THIS TOPIC
WE ALSO FOCUS ON THE GUT
MICROBIOME AND METABOLITES.
AND ALSO THE ROLE OF DIET IN
REGULATING THE GUT LUNG AXIS.
-- SOME OF WHICH ARE MOST
RELEVANT TO THIS TALK -- THE
DIET WHICH CAN BE CONTROLLED IN
SOME SENSE.
HEALTHY VERSUS UNHEALTHY DIETS
AND HOST FACTORS, GENETICS,
DELIVERY MECHANISM.
INFECTIONS, LIFESTYLES AND
STRESS AND CIRCADIAN RHYTHM.
AND ALSO THE MEDICATIONS AND THE
HEALTH CARE THAT WE PROVIDE TO
INDIVIDUALS.
ALL OF THIS CAN AFFECT THE
MICROBIOME.
AND WHAT IS STUDIED IS THE
BACTERIAL MICROBIOME BUT THERE
IS ALSO A VIRAL MICROBIOME AND
FUNGAL -- BIOME THAT IS NOT AS
WELL STUDIED BUT DOESN'T MEAN
THAT IT IS NOT IMPORTANT.
SO ALL OF THESE DIFFERENT
FACTORS CAN AFFECT THE GUT
MICROBIOME AND ALSO WHAT THEY
PRODUCE.
AND THAT IS WHAT WE CALL THE ME
TAB LOAM.
AND THIS REFERS TO HOW THE GUT
MICROBIOME -- TO THE LUNG.
77 MORE DIRECTLY ON THE
METABOLITES A LIST OF SOME OF
THE KEY METABOLITES THAT HAVE
BEEN MOST STUDIED IN HOW THE
MICROBIOME INFLUENCES THE LUNG
BIOLOGY AND I'VE LISTED THEM
OVER HERE.
AND OTHERS AS WELL AS COMPONENTS
FROM THE BACTERIA SUCH AS -- LPS
AND OTHER COMPONENTS THAT CAN
INFLUENCE LUNG FUNCTION AND LUNG
IMMUNITY.
THEY CAN TAKE PLACE DIRECTLY.
TRANSMIT TO THE LUNG AND AFFECT
LUNG RESPONSES AND LUNG FUNCTION
OR GO IN DIRECTLY THROUGH THE
BONE MARROW.
AND THESE DIFFERENT COMPOUNDS
CAN ACT AS -- SINCE THIS IS A
TALK ABOUT MECHANISM ON
DIFFERENT RECEPTORS CLASSES AS
WELL.
I'VE HIGHLIGHTED A COUPLE OF
THEM AS WELL.
AND THESE VARIOUS DIFFERENT
COMPOUNDS CAN ACT ON SIGNALING
AS WELL.
SO THE METABOLITES AND THIS IS
TO LAYOUT AS I SEE IT THE
CURRENT SCIENCE IN THE FIELD.
ASSOCIATED WITH LUNG IMMUNITY --
-- AND THESE CAN CAUSE DIRECT
EFFECTS ON LUNG IMMUNITY AND
HAVE BEEN SHOWN IN PRELYNN CALL
MODELS THAT THEY ARE * EITHER
ADDED INTO THE DIET OR
INTRODUCED TO THE SYSTEM AND YOU
SEE DIFFERENT EFFECTS AND THIS
-- THE DIET CAN AFFECT THE LEVEL
EITHER THROUGH THE GUT
MICROBIOME WHICH EITHER PRODUCES
OR MODIFIES THESE COMPONENTS
SUCH AS FIBER.
AND ALSO SOME METABOLITES
THROUGH THE DIET CAN BE MODIFIED
THROUGH THE MICROBIOME.
AND OF COURSE AS YOU'VE HEARD
FROM MANY TALKS PRIOR TO THIS
ONE THEY ARE ALSO METABOLITES
THAT CAN AGAINST INDEPENDENT OF
THE GUT MICROBIOME.
THESE CAN MITIGATE OR WORSEN
LUNG DISEASES BOTH IN THE ON SET
AND PROGRESSION.
AND HERE IS SOME OF THE LUNG
DISEASES THAT HAVE BEEN SHOWN TO
BE ASSOCIATED EITHER THROUGH IN
PRECLINICAL STUDIES OR ACTUAL
CLINICAL STUDIES WITH THE GUT
LUNG AXIS.
INCLUDING ASTHMA AND COPD
COVID-19.
BUT ALSO OTHERS THAT HAVE NOT
BEEN MENTIONED SUCH AS LUNG
CANCER.
STERILE INJURY.
BACTERIAL AND VIRAL INFECTIONS.
CYSTIC FIBROSIS.
AND PULMONARY HYPERTENSION.
YOU CAN SEE THE DIFFERENT
METABOLITES AND ALSO THE GUT
BACTERIAL SPECIES WHERE THE
BACTERIA HAS BEEN ASSOCIATED
WITH THE INDIVIDUAL METABOLITES
HAVE NOT BEEN FULLY DISSECTED
OUT.
YOU SEE THE SHORT CHAIN FATTY
ACIDS ARE ONE OF THE MORE
STUDIES AND I INCLUDE RICO GUT
HERE WHERE UNKNOWN COMPOUNDS
INCLUDING LPS THAT CAN AFFECT
LUNG DISEASES.
SO AS I SEE THE CURRENT RESEARCH
GAPS -- THAT WE DON'T HAVE A
GOOD SENSE OF THE COMPREHENSIVE
METABOLOME.
AND THERE ARE SOME NEW
APPROACHES TO TRY TO ADDRESS
THIS.
AND I'LL INCLUDE A PAPER
REFERENCE ABOUT A METABOLOME
PIPELINE THAT CAN TRY TO
UNDERSTAND THESE EMERGING.
WE HAVE ALSO DON'T HAVE A GOOD
SEASONS SENSE OF MODIFIED VERSUS
UNMODIFIED AND THAT AFFECTS THE
LUNG RESPONSES AND LUNG
IMMUNITY.
AND FROM OUR LAB STANDPOINT WE
THINK IT'S IMPORTANT THAT WE
DON'T UNDERSTAND WHAT IS THE
RESTING METABOLIC IMMUNE STATE
FOR HEALTHY LUNGS.
AND IN TERMS OF INJURY AND
DISEASE WHAT ARE THE EFFECTS ON
ACUTE INJURY RESPONSES VERSUS
CHRONIC INJURY RESPONSES OF
THESE METABOLITES.
IT'S IMPORTANT TO CONSIDER THE
BALANCE OF INFLAMMATION CONTROL
VERSUS HOST DEFENSE AGAINST
INFECTION AND GETTING THE
BALANCE JUST RIGHT IS OBVIOUSLY
VERY IMPORTANT.
FOR LUNG HEALTH AND IN DISEASE
AND HOW THE DIET CAN IMPACT THAT
IS A BIG RESEARCH GAP AS WELL.
SO I WOULD LIKE TO FOCUS ON
SHORT CHAIN FATTY ACIDS.
THEY ARE IMPORTANT PRODUCTS THAT
COME OUT OF FIBER FERMENTATION.
AND A COUPLE OF DIFFERENT
MECHANISMS WHERE THEY MIGHT
WORK.
THESE ARE THREE OF THE MAIN ONES
BEING STUDIED RIGHT NOW.
YOU CAN SEE THE THREE MAIN SHORT
CHAIN FATTY ACIDS.
AND THESE CAN ACT THROUGH A
COUPLE OF DIFFERENT MECHANISMS
INCLUDING AT THE TOP SIGNALING
THROUGH RECEPTORS -- THEY CAN
ALSO ACT ON THE RIGHT SIDE
THROUGH METABOLISM.
SERVE AS FUEL SOURCES AND AFFECT
THE CELL'S CHOICE OF WHICH
METABOLIC PATHWAYS THEY MAY PLOY
AND ESPECIALLY GEMIC CONTROLS.
-- ESPECIALLY BEGINIC *.
AND THEY -- INTERACT WITH
VARIOUS OTHERS AS WELL.
I MENTIONED THE METABOLISM.
THE PRESENCE CAN EFFECT THE
BALANCE -- IN TERMS OF SIGNALING
DOWNSTREAM OF THE RECEPTORS
THERE COULD BE PPR GAMMA
ACTIVATION AND -- -- AND THEN --
IMPACT TC DIFFERENTIATION.
AND THESE EFFECTS ARE OCCURRING
IN ALL THREE OF THE LOCATIONS OR
TWO OR MORE.
THROUGH THE BONE MARROW AND THEN
ALSO IN THE LUNG AS IS THE FOCUS
OF THIS WORKSHOP.
7 AND THE RESULTS INDICATE THAT
THESE DIFFERENT MECHANISMS ARE
NOT ALSO OCCURRING IN ISOLATION.
THE METABOLISM EFFECTS CAN
AFFECT THE EPPIE GENETIC CELL AS
WELL.
SO THE CHALLENGES AND
OPPORTUNITIES.
AS I SEE THEM -- COUNTY POSITIVE
EFFECTS BE GENERALIZED TO ALL
INDIVIDUALS?
I THINK THE ANSWER IS NO.
THAT IS THE FIRST LINE --
APPROACH AS HAS BEEN MENTIONED
BY OTHER SPEAKERS AS WELL.
ANRESPIRATORY HEALTH IS DIFFICU.
IN HEALTH AND DISEASE AS YOU'VE
HEARD IN OTHER SESSIONS IS
IMPORTANT TO DISTINGUISH.
YOU'VE HEARD ABOUT THE USE OF
PULMONARY TESTS AND WE OFTEN USE
OXYGEN SATURATION WHICH IS NOT A
GOOD MEASURE OF LUNG HEALTH.
THERE ARE SOME CHALLENGES IN
TERMS OF HOW TO MEASURE
RESPIRATORY HEALTH.
TRYING TO DEVELOP NEW DEVICES
THAT CAN SOLVE THIS PROBLEM.
THERE ARE NO GOOD BIO MARKERS
FOR LUNG INJURY.
THERE ARE NEW APPROACHES COMING
OUT FOR EXPIRED BREATH
MEASUREMENTS AND THAT IS GOING
TO BE AN INTERESTING AND
IMPORTANT WAY TO MOVE FORWARD.
AND ESPECIALLY IF WE CAN DEVELOP
ONES THAT CAN GIVE US AN
ASSESSMENT OF THE IMMUNE AND
METABOLIC ACTIVITY HEALTH OF THE
LUNG.
USING PRECLINICAL MODELS WE CAN
SAMPLE LUNG TISSUE TO TRACK
THESE METABOLITES AS THEY MOVE
FROM THE GUT TO THE LUNG.
AND THEN AN OPPORTUNITY TO COME
UP WITH A WAY TO CREATE A
PERSONALIZED LUNG STRESS TEST TO
UNDERSTAND HOW AN INDIVIDUAL
MIGHT RESPOND TO AN INJURY OR
INFECTION.
SOME KEY RESEARCH QUESTIONS:
HOW QUICKLY CAN THE DIET CHANGE
LUNG IMMUNITY.
WE KNOW FROM PRECLINICAL MODELS
AND RODENT STUDIES THAT EVEN A
WEEK OR TWO WEEKS OF A DIETARY
CHANGE CAN CHANGE HOW LUNGS
RESPOND TO INJURY AND INFECTION.
QUESTIONS REMAIN AS FAR AS HOW
LONG THESE CHANGES LAST?
THE STABILITY OF THIS SYSTEM.
AND ALSO DOES THE DURATION OF
THE DIET CHANGE AND AFFECT THE
STABILITY.
HOW LONG YOU'RE ON A PARTICULAR
DIET DOES IT AFFECT HOW HOW LONG
IT LAST.
WE HAVE CERTAIN DIETS FOR OTHER
ORGAN HEALTH.
I THINK THAT IS AN IMPORTANT
PLACE TO ALSO FOCUS OUR WORK.
AND ARE THERE DIETS CAN IMPACT
LONGS LUNG DISEASE SUCH AS
PREBIOTICS AND THEN CAN THE
DIETARY SUPPLEMENTS BE GIVEN IN
ISOLATION.
FOR EXAMPLE THE SHORT CHAIN
FATTY ACIDS.
COULD THEY BE USED TO ALTER THE
INFLAMMATORY STATE OF THE LUNG
UNDER PARTICULAR CONDITIONS.
>> SPEAKER, YOU HAVE A MINUTE
REMAINING.
>> SO YES.
IMMEDIATE AND LONG-TERM RESEARCH
DIRECTIONS ON THIS TOPIC.
HOW DOES THE DIET AND MICROBIOME
ESTABLISH THE TONE.
7 MEASURE THE TONE NONINVASIVELY
WOULD BE A GREAT WAY TO TRACK
THIS IF POSSIBLE.
AND TO UNDERSTAND WHETHER THE
COMPOSITION COULD HELP SUB
CATEGORIZE -- AND WHETHER THAT
CAN EXPLAIN THEIR LUNG INJURY
AND MAYBE EVEN TARGET THERAPY.
AND UNDERSTANDING IF DIETS CAN
IMPROVE VARIOUS LUNG DISEASES.
THE IDEA OF FECAL MICROBIOME
TRANSPLANTS WHETHER THOSE CAN
STABLY CHANGE THE MICROBIOME AND
HOST IMMUNITY.
I HOPE I'VE CONVINCED YOU THE
IMPORTANCE.
I'LL LEAVE YOU WITH SOME AGE OLD
QUOTES FROM WISE PEOPLE.
WHO MANY CENTURIES SAID LET FOOD
BE THY FOOD AND FOOD BE THY
MEDICINE.
FROM HIPPOCRATES.
AND THEN TWO OTHERS THAT MAY
HAVE BEEN UNKNOWINGLY REFERRED
TO THE MICROBIOME.
NATURAL FORCES WITHIN US ARE THE
TRUE HEALERS OF DISEASE AND
LOUIE PASTURE SAID THE ROLE OF
IN FINISH NATELY SMALL IN NATURE
IS INFINITELY LARGE.
*.
ACKNOWLEDGING OTHER LABS WORKING
ON THE GUT LUNG AXIS AND OTHER
PLACES AROUND THE WORLD THAT ARE
UNCOVERING IMPORTANT ASPECTS OF
THIS NETWORK.
AND I'D LIKE TO ACKNOWLEDGE
MEMBERS OF MY OWN GROUP -- AND
SOME OF THE RECENT MEMBERS WHO
ARE DOING WORK T. HAVEN'T HAD A
CHANCE TO TALK ABOUT THE WORK
THAT WE'RE DOING IN THE LAB
DIRECTLY BUT THEY ARE THE FOLKS
THAT ARE WORKING HARD ON THIS
TOPIC.
AND KNOWLEDGE MY FUNDING SOURCES
AS WELL.
THANK YOU.
>> THANK YOU DR. PRAKASH BUDDE
FOR THAT OUTSTANDING
PRESENTATION AND NOW WE MOVE TO
THE LAST TALK AND IT'S MY
PLEASURE TO INTRODUCE DR. MARIE
PIERRE.
>> THANK YOU SO MUCH.
I WOULD LIKE TO THANK THE
ORGANIZERS FOR INVITING ME TO
SPEAK ON THIS TOPIC.
I HAVE NO CONFLICTS OF INTEREST
TO DISCLOSE.
I WOULD LIKE TO FOCUS ON SLEEP
AND THE IMPACT.
FOCUSING ON BREATHING DISORDERS
SUCH AS SLEEP APNEA.
SOME MECHANISMS AND OTHER HEALTH
OUTCOMES RELATED TO DIET AND
OBSTRUCTIVE SLEEP APNEA THROUGH
CLINICAL INTERVENTION STUDIES.
IT'S NOW PRETTY WELL ESTABLISHED
THAT SLEEP QUALITY AND SLEEP
DURATION HAVE A DRAMATIC IMPACT
ON DIETARY QUALITY.
WHERE INDIVIDUALS WHO HAVE POOR
QUALITY SLEEP TEND TO CONSUME AN
UNHEALTHY DIET RESULTING THAT
CAN LEAD TO A VICIOUS CYCLE.
WHERE DIET QUALITY CAN INFLUENCE
SLEEP QUALITY.
AND WE'VE PROPOSED THIS VICIOUS
CYCLE -- POOR SLEEP QUALITY
LEADS TO POOR DIET QUALITY.
HOW CAN WE LEVERAGE DIET TO
IMPROVE SLEEP QUALITY.
A HEALTHY DIET PROVIDES THE
FOUNDATION FOR HEALTHY SLEEP AND
HEALTHY CIRCADIAN RHYTHMS.
OUR GROUP AND OTHERS HAVE SHOWN
THAT INDIVIDUALS WHO CONSUME A
HEALTHY DIETARY PATTERN -- THE
MEDITERRANEAN DIET, THE
HYPERTENSION DIET OR MIND DIET
LEADS TO BETTER SLEEPY QUALITY.
MOSTLY THROUGH VARIOUS NUTRIENTS
WITHIN THESE PLANT BASED FOODS
THAT ARE CONTAINED.
SUCH AS MELATONIN -- AND THEN
ALSO THE DIETARY FIBER THAT
INFLUENCES THE GUT MICROBIOME AS
WE'VE HEARD IN PREVIOUS TALKS.
THE GUT MICROBIOME LEADS TO A
DIET IN FIBER AND SHORT CHAIN
FATTY ACID PRODUCTION WHICH
REDUCES INFLAMMATION BUT ALSO UP
RATES CIRCADIAN CLOCKS.
CONVERSELY CONSUMPTION OF ULTRA
PROCESSED FOODS AND UNHEALTHY
DIETARY PATTERNS CAN HAVE AN
ADVERSE EFFECT ON SLEEP QUALITY
AND INCREASE THE RISK OF
INSOMNIA.
SO SIMILARLY TO SLEEP QUALITY,
SLEEP DURATION AND RISK OF
INSOMNIA THERE IS A PATTERN OF
DIETARY QUALITY INFLUENCING
SLEEP APNEA.
HERE I'M SHOWING ASSOCIATIONS
FROM EPIDEMILOGICAL STUDIES
SHOWING INDIVIDUALS WITH SLEEP
APNEA CONSUME HIGHER INTAKES OF
RED MEETS AND ALSO UNHEALTHY
PATTERNS AND THIS HAS BEEN SHOWN
TO BE REMEDIATED -- -- SLOW WAVE
SLEEP.
THESE EPIDEMILOGICAL STUDIES
SHOW THAT INDIVIDUALS WHO
CONSUME A LOWER INFLAMMATORY
DIET AND ARE MORE ADHERENT TO
THE DIETARY GUIDELINES -- THESE
DIETS PROVIDING MORE FRUITS AND
VEGETABLES AND WHOLE GRAINS HAVE
A REDUCED RISK OF SLEEP APNEA.
THE POPULATION BASED STUDIES
PROVIDE INFORMATION ON
ASSOCIATIONS BETWEEN DIET AND
RISK OF SLEEP APNEA BUT ALSO
CAUSAL EVIDENCE FROM CLINICAL
INTERVENTION STUDIES.
FOUR SPECIFIC STUDIES THAT HAVE
BEEN DONE TO TEST THE IMPACT OF
DIET ON SLEEP APNEA.
THE LARGEST STUDY THAT HAS BEEN
CONDUCTED TO DATE -- RANDOMIZED
187 PARTICIPANTS -- TREATED WITH
C PAP.
AND TWO GROUPS WERE COUNSELED
TOWARD A WEIGHT LOSS
INTERVENTION WITH THE
MEDITERRANEAN DIET.
THE AUTHORS FOUND THAT A
LIFESTYLE INTERVENTION ON TOP OF
CPAP REDUCED THE APNEA -- EVEN
AFTER ADJUSTING FOR CHANGE IN
BODY WEIGHT SHOWING INDEPENDENT
EFFECT OF LIFESTYLE BEHAVIORS ON
THE SEVERITY.
ANOTHER STUDY EVALUATED A
MEDITERRANEAN DIET VERSUS A
LOW-FAT DIET AND RANDOMIZED 40
INDIVIDUALS.
ALL OF WHO WERE TREATED WITH
CPAP AND ADVICED TO WALK AT
LEAST 30 MINUTES PER DAY.
IN THIS STUDY THE PARTICIPANTS
RANDOMIZED TO THE MEDITERRANEAN
DIET GROUP, EXERCISED MORE AND
HAD GREATER REDUCTION IN THE
WAIST.
IT'S UNCLEAR IF THE EFFECT IS
INDEPENDENT IN CHANGES OF BODY
COMPOSITION AND OTHER LIFESTYLE
CHANGES.
ANOTHER STUDY EVALUATED HEALTHY
EATING AND PHYSICAL ACTIVITY
ADVICE.
SEVERITY --BOTH GROUPS TREATED
WITH CPAP.
ONE GROUP RECEIVING ADVICE.
ANOTHER GROUP RECEIVING MEDICINE
INTERVENTION THAT FOCUSED ON
KEEPING REGULAR FOOD HABITS AND
PHYSICAL ACTIVITY.
THIS WAS A PERSONALIZED INTEREST
CONVENIENCES IN THIS GROUP.
WE FOUND THAT MORE PARTICIPANTS
IMPROVED VERSUS THE CONTROLLED
GROUP AND THE ODDS OF
IMPROVEMENT WAS 4.5 FOR THE
INTERVENTION GROUP.
AGAIN HERE IT'S UNCLEAR WHAT
ASPECT OF THE BEHAVIORAL SLEEP
MEDICINE INTERVENTION LED TO THE
IMPROVEMENT IN OSA SEVERITY DUE
TO THE MULTI-DIMENSIONAL
ACTIVITY OF THIS INTERVENTION.
AND THIS LAST STUDY I'D LIKE TO
HIGHLIGHT EXAMINE THE PALEO
DIET.
ONLY TWO WAS TREATED WITH CPAP.
WOMEN WERE RANDOMIZED.
AND THEY FOLLOWED GROUP SESSIONS
WITH A DIETICIAN FOR THE FIRST
SIX MONTHS WITH A TWO-YEAR
FOLLOW-UP PERIOD.
THE WEIGHT LOSS WAS GREATER IN
THE PAL OHIO DIET GROUP AND THIS
WAS RELATED * TO THE CHANGE IN
THE INDEX.
BUT IN THE FOLLOW-UP PERIOD
THERE WAS NO DIFFERENCE BETWEEN
THE TWO GROUPS.
THE INVESTIGATORS FOUND THAT THE
REDUCTION IN AHI WAS MOSTLY
OBSERVED IN THOSE THAT LOST
8 KILOGRAMS OF BODY WEIGHT
REGARDLESS OF THE DIET.
AND SO AGAIN WE DON'T KNOW IF
THERE IS AN INDEPENDENT EFFECT
OF DIET ON ON STRUCK THE I HAVE
SLEEP APPEAR KNEE SEVERITY.
7 *.
THIS IS A FIGURE THAT WAS
PUBLISHED -- IN THE JOURNAL OF
CLINICAL SLEEP MEDICINE SHOWING
AN IMPACT OF HEALTHY LIFESTYLE
THROUGH HEALTHY DIET.
HAVING REGULAR PHYSICAL
ACTIVITY.
LOW ALCOHOL CONSUMPTION AND
NONSMOKING.
SO MOSTLY HAVING
ANTIINFLAMMATORY DIET OR OVER
HIGH DIETARY QUALITIEDING TO
REDUCED RISK OF CHRONIC DISEASE.
ALSO THROUGH REDUCTIONS IN
CHRONIC INFLAMMATION, INCREASED
MUSCLE MASS AND MUSCLE TONE
INCLUDING MUSCLES THAT KEEP THE
AIRWAY -- -- THAT CAN ALL LEAD
TO A REDUCTION IN SLEEP APNEA
RISK.
THESE AUTHORS FURTHER REPORTED
THAT INFLAMMATION IS RESPONSIBLE
FOR REMEDIATING.
IF YOU LOOK AT THE TWO TRIANGLES
IN THE MIDDLE -- THIS TENDS TO
MEDIATE ABOUT 25% OF THE
ASSOCIATION BETWEEN A HEALTHY
DIET AND SLEEP APNEA RISK AND TO
THE FAR RIGHT -- BMI MEDIATES --
-- -- SO BEYOND OSA SEVERITY
OTHER HEALTH OUTCOMES ARE
IMPROVED BY CONSUMPTION OF A
HEALTHY DIET.
PARTICIPANTS WHO CONSUMED A
GREATER WHOLE FOOD PLANT BASED
DIET HAVE REDUCED SLEEPINESS.
PATIENTS WERE RANDOMIZED WITH
THE MEDITERRANEAN DIET HAVE
REDUCED INFLAMMATION AND
OXIDATIVE STRESS.
FOLLOWING A HEALTHY DIET WITHIN
THE CONTEXT OF OSA A TIN OOOH,
IT'S THE RISK OF DEPRESSION AND
ALL CAUSE MORTALITIES WITHIN
THESE INDIVIDUALS.
SO TO SUMMARIZE EPIDEMILOGICAL
STUDIES SUPPORT AN ASSOCIATION
BETWEEN HEALTHY DIETARY
PATTERNS.
CLINICAL INTERVENTION STUDIES
FURTHER ADDRESS CAUSALITY
SUGGESTING AN IMPACT OF DIETED.
AND LONG-TERM LIFESTYLE
MANAGEMENT OF OSA INCLUDING DIET
AND PHYSICAL ACTIVITY
RECOMMENDATIONS CAN IMPROVE
OTHER HEALTH PARAMETERS AND
SHOULD BE CONSIDERED IN A
CLINICAL MANAGEMENT OF THESE
BRAIN DISORDERS DURING SLEEP.
I WOULD ALSO LIKE TO END BY
ADDRESSING SOME -- HIGHLIGHTING
SOME RESEARCH GAPS.
WE NEED MORE CAUSAL EVIDENCE FOR
MECHANISTIC CLINICAL STUDIES AND
BASIC SCIENCE STUDIES TO ADDRESS
THE ROLE OF DIET ON SLEEP APNEA
USING ANIMAL MODELS --
CONDUCTING STUDIES IN PATIENTS
WITH OSA.
BUT ALSO EVALUATING THE SEPARATE
IMPACT OF DIETARY QUALITY FROM
DIETARY QUANTITY.
SO DETERMINING WHETHER A DIETARY
PATTERN INFLUENCE OSA SEVERITY
INDEPENDENT OF CHANGE IN BODY
WEIGHT.
AND ALL OF THE SPEAKERS AGREE
THAT WE NEED TO BE EVALUATING
WHOLE FOODS AND WHOLE DIETARY
PATTERNS AS OPPOSED TO DIETARY
SUPPLEMENTS.
I ALSO WOULD LIKE TO HIGHLIGHT
ANOTHER AVENUE OF RESEARCH --
CHRONO NUTRITION.
* MODERATING OR MODULATING
EVENING DIETARY INTAKE.
DETERMINING WHETHER IT HAS AN
IMPACT ON BREATHING DURING YOUR
SLEEP.
AND WITH THAT I WOULD LIKE TO
THANK YOU AND THE MEMBERS OF MY
LAB AND FUNDING AGENCIES FOR
SUPPORTING MY WORK.
>> THANK YOU FOR A WONDERFUL
TALK.
ACTUALLY STIMULATING WHEN YOU
TALK ABOUT SLEEPINESS.
THAT IS VERY HIGH PRAYS.
WE CAN MOVE INTO OUR PANEL
DISCUSSION.
SO IN THIS SESSION NUMBER THREE
WE'VE HEARD FROM FIVE SPEAKERS.
WHO HAVE TALKED ABOUT DISTINCT
ASPECTS THAT ARE RELATED TO
INTERACTIONS BETWEEN NUTRIENTS
AND EFFECTS ON THE RESPIRATORY
SYSTEM.
I SPOKE ABOUT THERAPEUTIC -- --
AND SOME OF THE BENEFITS AND
MAYBE SOME OF THE POTENTIAL
CAVEATS ASSOCIATED WITH THEIR
USE.
DR. GOWDY TALKED ABOUT DHA AND
EPA BEING USED TO CREATE
PULMONARY -- LIPID LEVELS THAT
ARE PROTECTIVE IN A NUMBER OF
STATES.
MITIGATING OZONE INDUCED LUNG
INJURY.
BUT NOT ALTERING MARKERS OF LUNG
INJURY.
ALTERATIONS OF -- ACID AS A
COMPONENT.
SHE TALKED ABOUT THE IMPORTANCE
OF ALTERING THE PULMONARY
LIPIDOME.
AND THE POTENTIALS FOR USING
OMEGA 3 FATTY ACIDS AS A WAY TO
DO SO.
DR. NORDEGREN SPOKE ABOUT IMMUNE
FUNCTION.
THE IMPORTANCE OF CONSIDERING
MULTIPLE NUTRIENTS.
SOME WAYS THAT WE MIGHT BE ABLE
TO CHANGE OUR STUDY DESIGN IN
ORDER TO CONSIDER ASPECTS OF
ABSORBS OR METABOLISM.
THINKING ABOUT THE INDIVIDUAL
SUSCEPTIBILITIES THAT AT A
POPULATION LEVEL -- MAY AFFECT
THE EFFICACY OF THE DIFFERENT
NUTRIENTS AS A CONSEQUENCE OF
THEIR DIFFERENTIAL METABOLISM
AND PROVIDING AN OPPORTUNITY FOR
PRECISION BASED NUTRITIONAL
APPROACHES THAT COULD BE
INCORPORATED INTO FUTURE
RESEARCH STUDIES.
DR. PRAKASH BUDDE TALKED ABOUT
THE GUT LUNG AXIS AND SHORT
CHAIN FATTY ACIDS.
THEY CAN AFFORD PROTECTION.
AND DR. MARIE PIERRE --
DIFFERENT STRATEGIES -- WITH
SLEEP APNEA.
COULD THERE BE A DIET.
LIKE WE HAVE A DASH DIET FOR
OTHER APPLICATIONS.
MEDITERRANEAN DIET APPEARS TO BE
PROTECTIVE.
AND I THOUGHT IT WAS INTERESTING
THAT SHE INCORPORATED OTHER
ASPECTS OF A HEALTHY LIFESTYLE
HAVE GREATER IMPACTS OVER-ALL.
ONE THING THAT I GOT OUT OF THE
FIVE TALKS THIS AFTERNOON AND
CONSIDERING MY OWN WORKING HOW
ESSENTIAL IT IS TO BE ABLE TO
INTEGRATE IN A
MULTI-DISCIPLINARY FASHION WITH
OTHER PEOPLE IN DIFFERENT
DISCIPLINES TO DO OUR WORK.
IN ORDER TO GENERATE THE DATA.
I'M SURE THAT OTHER PEOPLE HAVE
THE NEED AND THE OPPORTUNITY TO
WORK WITH OTHER INDIVIDUALS THAT
REALLY COMPLIMENT THEIR RESEARCH
PRODUCTIVITY AND I WONDER
WHETHER ONE OF THE THINGS THAT
THE NHLBI SHOULD CONSIDER IS
INTERACTING WITH OTHER
INSTITUTES IN ORDER TO SOLICIT
COMPETITIVE APPLICATION THAT'S
ADDRESS MULTIPLE ORGAN SYSTEMS.
I CAN THINK OF THE RESPIRATORY
THE ENDOCRINE AND PERHAPS OTHERS
THAT ARE IMPORTANT TO MOVE THIS
FIELD FORWARD.
I'LL SEND THAT OUT THERE TO
PANELIST TO DISCUSS INTEGRATING
OTHER DISCIPLINES AND OTHER
ORGAN SYSTEMS INTO THIS WORK
>> I'LL START.
I WILL SAY THAT WE WORK HAND IN
HAND WITH LIPID BIOCHEMIST AS
WELL AS NUTRITIONIST.
I WOULD BE LOST WITHOUT THEM SO
I FEEL LIKE THEIR EXPERTISE IS
INVALUABLE.
THE OFFICE OF DIETARY SUN
HEMEANT DOES HAVE THE
ADMINISTRATIVE SUN POLICEMENTS
WITH A GRANT
8
AND MAYBE I'LL CONTINUE.
YOU MENTIONE MENTION OH MI -- O-
DIFFERENT METABOLITES ON LUNG
HEALTH.
ESPECIALLY ONCE WE'RE ABLE TO
GENERATE IN THE PRECLINICAL
MODELS LARGE AMOUNTS OF DATA
COMING OUT OF THE LUNG AND THE
MICROBIOME AND MAKING SENSE OF
IT ALL TOGETHER IS VERY
CHALLENGING AND GETTING THAT
SUPPORT IS GOING TO BE VERY
IMPORTANT.
>> RIGHT.
THANK YOU.
APPRECIATE THAT.
RELATED COMMENTS TO THAT TOPIC.
>> I WILL JUST SAY THAT I
WHOLEHEARTEDLY AGREE.
SOMETIMES I FEEL LIKE
JACK-OF-ALL-TRADES.
EXPERT ON NONE.
I RELY HEAVILY ON MY COLLEAGUES
AND WORKING ON -- A QUESTION IN
SECLUSION THAT WE'RE NEVER GOING
TO SEE THE WHOLE BREATH OF THE
POTENTIAL OUTCOMES OF WHAT WE'RE
SEEING.
>> SINCE I'VE GOT YOU ON TARA
WOULD YOU BE WILLING TO TALK
MORE ABOUT POTENTIAL PRECISION
APPROACHES.
-- I DON'T KNOW IF
IMPLEMENTATION IS THE RIGHT
QUESTION TO ASK.
GENERATING COHORTS THAT ALLOW
US.
ENDO TYPING OF ASTHMA.
TAKING LARGE COHORTS AND
CONSTRAIN THEM SO WE CAN BETTER
UNDERSTAND WHERE WE MIGHT SEE
EFFICACY.
>> CERTAINLY I'LL START.
I THINK AND IT'S BEEN TALKED
ABOUT A LITTLE BIT THUS FAR IN
THE WORKSHOP THAT THINKING ABOUT
VULNERABLE POPULATIONS WHERE WE
KNOW THERE ARE CERTAIN FACTORS
THAT DO PREDISPOSE CERTAIN
POPULATIONS DO HAVE THESE POLLY
MORISMS THAT ARE ATTAR
REPRESENTATION.
SO * I COME FROM THE FATTY ACID
WORLD SO WE THINK ABOUT FOR
THOSE WHO MAY NOT HAVE AS GREAT
OF AN ABILITY TO METABOLIZE
FATTY ACIDS INTO THESE HELPFUL
LIPIDS SHOULD WE BE THINKING
ABOUT A DIETARY OR --
SUPPLEMENTATION APPROACH.
OR PROVIDING THE ACTUAL .
I DO ABSOLUTELY THINK THAT
BYPASSERRING OUT WHERE THE
VULNERABILITY LIES IN TERMS OF
EFFICACY -- WE CAN GET A MORE
CLEAR UNDERSTANDING OF WHO IS
GOING TO BENEFIT FROM WHAT.
>> ADDRESSING THE ENDO TYPING
PART.
I-- WE STARTED TO ENDO TYPE INTO
DIFFERENT CATEGORIES LIKE SUB
TIGHTS THAT BEHAVE DIFFERENTLY
AND I WOULD BE SURPRISED IF
THERE WAS NOT A GUT LUNG AXIS TO
THAT TOO.
METABOLITES ARE ALSO
CONTRIBUTING TO SEPARATE OUT
PATHOPHYSIOLOGY OF WHAT WE THINK
OF UNIFIED DISEASES BUT ARE MANY
DIFFERENT SUBCATEGORIES.
IN TERMS OF THE MICROBIOME THERE
HAS BEEN WORK IN THE CRITICAL
CARE FIELD ABOUT DIFFERENT
COMPOSITIONS THAT ARE -- THAT
TRACK WITH SURVIVAL OR NOT
SURVIVAL IN CRITICAL CARE
CONDITIONS BUT NOT YET WITH
SPECIFIC LUNG DISEASES OTHER
THAN CONNECTED TO THESE
INDIVIDUAL METABOLITES THAT
MIGHT BE CONNECTED TO THEM.
I THINK THERE IS A LOT OF SCOPE
FOR THAT IN THE FUTURE.
>> DOES ANYONE CARE TO COMMENT
ON THE NOTION OF UPSETTING A
BALANCE.
WE'VE TALKED ABOUT MALNUTRITION.
UNDER AND OVER NUTRITION.
WE'VE TALKED ABOUT
ANTIINFLAMMATORY EFFECTS OF
DIETARY CONSTITUENTS.
THE IMMUNE SYSTEMS PLACED TO
BLAME FOR A LOT OF DISEASES
WHERE IT'S DOING ITS JOB THAT IS
NECESSARY UNDER OTHER
CONDITIONS.
AND SO I CAN THINK OF MY OWN
WORK PROFOUNDLY IMPAIRING THE
ABILITY TO GENERATE PROTECTIVE
IMMUNE RESPONSES IF WIELD HELD
INAPPROPRIATELY.
HAVE WE EXPERIENCED TIPPING THE
BALANCE TOO MUCH WHERE WE SEE
COMPROMISE INSTEAD OF BENEFIT
>> ABSOLUTELY.
>> I CAN SPEAK FROM OUR OWN WORK
WHERE WHEN WE GIVE HEAVY FIBER
DIETS TO MICE WE CAN BLUNT THE
STERILE IN PLANATION BUT IN
ONGOING WORK IT MIGHT WORSEN IN
INFECTION AND PNEUMONIA MODELS.
AGGRESSIVELY GOING AFTER ONE
SINGLE ASPECT MAY UNBALANCE IT.
>> I'LL AMEND TO THAT.
WE HAD STARTED OFF DOING SOME
FISH OIL AND COCONUT OIL
SUPPLEMENTED DIETS AND WHAT WE
WERE STARTING TO SEES A LOT OF
MACROPHAGES -- I DO FEEL LIKE
THERE IS A TIPPING POINT AS WELL
AS I DO THINK OUR BODIES ARE
SMART.
YOU OVER LOAD ON ONE THING IT'S
GOT TO KICK SOMETHING ELSE OUT.
AND THAT MIGHT HAVE ADVERSE
EFFECTS.
DR. NORDEGREN YOU MENTIONED LIKE
THE HOST DEFENSE ASPECT AND I
THOUGHT THAT WAS A KEY THING TO
THINK ABOUT.
ANTIINFLAMMATORY IS GREAT IN THE
CONTEXT OF COPD OR ASTHMA BUT IN
THE CONTEXT OF INFECTION IT
COULD GO THE OPPOSITE WAY SO THE
CONTEXT OF WHAT THE CHALLENGE IS
ALSO VERY IMPORTANT.
>> OF COURSE I ABSOLUTELY AGREE.
WHEN I GIVE A SEMINAR MY VERY
FIRST SLIDE IS ALWAYS A REMINDER
THAT INFLAMMATION IS A GOOD
THING.
BECAUSE IT'S IMPORTANT TO TAKE
CARE OF INJURY.
TAKING CARE OF PATHOGENIC
INSULT.
EVERYTHING IN BALANCE AND WE
KNEELED THE RIGHT QUANTITIES IN
ORDER TO WORK EFFECTIVELY AND
THINKING ABOUT WHAT I WAS SAYING
IN TERMS OF THINKING ABOUT THE
HOST PATHOGEN INTERFACE.
PATHOGENS UTILIZE HOST NUTRIENTS
TO INFECT AND I THINK IT'S
SOMETHING THAT WE DON'T OFTEN
THINK B. THERE ARE OTHER STUDIES
LOOKING AT THINGS LIKE THINKING
OF GREEN TEA AS SOMETHING THAT
IS VERY HEALTHY BUT WHEN YOU
GIVE HIGH DOSES THERE CAN BE
NEGATIVE THINGS.
SO THE ADAGE OF ALL THINGS IN
BALANCE ALL THINGS IN MODERATION
IS REALLY IMPORTANT TO THINK
ABOUT HERE.
EVEN WHEN YOU THINK ABOUT THE
RECEPTOR SIGNALING MECHANISM.
THESE ROXY LIP INS THEY HAVE --
HIGH LEVELS CAN HAVE OFF TARGET
BINDING THAT CAN LEAD TO
NEGATIVE IMPACTS THAT WE DON'T
WANT TO HAPPEN.
>> THERE IS A QUESTION IN THE
CHAT FROM DR. -- BRIGHAM.
YOUR OPINION ON EMERGING
BIOMARKERS -- IN THE LONG HAUL.
>> I'M INTRIGUED BY SOME OF THE
DATA THAT I'VE SEEN.
THERE HAS BEEN SOME STUDIES OUT
OF ROCHESTER WHERE THEY'VE
LOOKED AT FATTY ACIDS AND I FEEL
LIKE THAT IS A NONINVASIVE
MEASUREMENT THAT WE KNOW HAS
SOME KIND OF TIE WITH LUNG
HEALTH THAT WE MIGHT BE ABLE TO
GET SOME MORE DIET DERIVED
INFORMATION OUT OF.
>> ABSOLUTELY.
THERE ARE SOME COMPANIES
MARKETING SOME OF THESE THINGS
DIRECTLY TO THE PUBLIC.
BUT THERE ALSO PEOPLE THAT ARE
STUDYING AT A RESEARCH LEVEL AND
I WOULD LOVE THAT THERE IS MORE
NONINVASIVE WAYS TO TRACK WHAT
IS GOING ON IN THE LUNG.
>> YOU SAID SOMETHING THAT
INTEREST ME.
THERE ARE COMPANIES THAT ARE
MARKETING TO PATIENTS OR
POPULATIONS.
I WONDER HOW MANY FOLKS HAVE
TAKEN ADVANTAGE OF THAT IN THEIR
OWN RESEARCH.
WE USE COMPOUNDS THAT ARE
MARKETED FOR WAYS THAT AS A
SCIENTIST I DON'T FEEL
COMFORTABLE ABOUT.
BUT THEY ARE THE SAME COMPOUNDS
YOU CAN BUY FROM SIGMA OR
SOMEWHERE ELSE.
A LOT OF PEOPLE THAT ARE BUYING
THOSE COMPOUNDS LIKE AT GNC.
I WONDER IF THOSE POPULATIONS
CAN BE A RESOURCE TO UNDERSTAND
OR IF THAT'S A WASTE OF TIME.
>> I DID LISTEN TO A TALK WHERE
THEY WERE -- THE DETAILS ESCAPE
ME.
THEY WERE STUDYING A COMPOUND
AND IT WAS USED IN PEOPLE WHO
ARE INTERESTED IN MUSCLE MASS
AND WEIGHT LIFTING.
THEY USED THAT INFORMATION TO
ACTUALLY GET MORE UNDERSTANDING
OF THE EFFECTS OF THOSE
COMPOUNDS.
THAT IS DEFINITELY A VERY
INTERESTING WAY TO GO.
>> ANY THOUGHTS ABOUT EXTENDING
PRECLINICAL MODELS BEYOND WHERE
WE ARE AT RIGHT NOW?
MOUSE WORK.
SOME SPOKE ABOUT HUMAN STUDIES.
DURING COVID -- ANY OTHER
ALTERNATIVES THAT NEED TO BE
CONSIDERED WITH MODEL
DEVELOPMENT?
AND WE CAN GO IN THE OTHER
DIRECTION.
THINK ABOUT SOMETHING THAT IS A
LITTLE LESS REFINED THAN AN
INTACT ANIMAL.
CHIP CULTURES OR MULTI-ORGAN
APPROACHES WHERE YOU CAN MODEL
-- POLLY CARBONATE A GUT LUNG
AXIS OR LIVER LUNG AXIS
>> AT LEAST WE'VE GOT A
COLLABORATOR THAT IS DOING SOME
-- MEMBRANES.
YOU CAN SEE HOW THE MEMBRANE
ASSEMBLES BASED ON WHAT IS IN
THE MIXTURE.
WE'VE BEEN ABLE TO RECAPITULATE
-- SO I THINK SOME OF THOSE NOT
LOWER MODELS BUT DO HAVE UTILITY
AND CAN BE VERY PREDICTIVE OF
WHAT SOME OF THE PRECLINICAL
MODELS MIGHT SHOW.
>> KEEPING WITH THE PRECLINICAL
IN VIVO MODELS -- TO A MORE
REFLECT WHAT IS BEING ABSORBED
IN THE GUT.
THAT HAS BEEN AN INTERESTING
PLACE TO BE LOOKING AT -- THE
DIFFERENT METABOLITES THAT ARE
GETTING THROUGH.
BECAUSE I THINK I FORGOT WHO
MENTIONED -- -- AS WELL BECAUSE
IT DOES NOT GET OUT INTO
CIRCULATION AS WELL BECAUSE IT
GETS ABSORBED.
BUT ASSAY DOES AND I THINK
SAMPLING THESE DIFFERENT SOURCES
IS GOING TO BE AN IMPORTANT WAY
TO UNDERSTAND WHAT GETS WHERE.
AND ALSO THEN SEEING LIKE WHAT
THE EXHALE IN THE BREATH
REFLECTS WHAT IS GOING ON.
I'M CURIOUS MORE ABOUT THE
PERSONALIZED APPROACH.
BECAUSE I CAN IMAGINE IN THE
NEAR FUTURE PATIENTS WHO ARE
GETTING DIFFERENT KINDS OF
SURGERIES INCLUDING LUNG SURGERY
-- WE MIGHT GIVE THEM DIFFERENT
DIETS THAT MIGHT HELP SUPPORT
THEIR LUNG HEALTH PRIOR TO --
THE SURGERY.
BUT HOW DO WE HAVE PERSONALIZED?
WHAT ARE WE USING AS THE READ
OUT?
WE CAN TRY DIFFERENT THINGS BUT
WHAT IS -- OUR -- WHETHER THE
LUNGS OR BETTER ARE NOT.
PFDs -- I'M JUST CURIOUS IF
PEOPLE HAVE THOUGHT MORE ABOUT
PERSONALIZED DIETS FOR LUNG
HEALTH WHAT THEIR THOUGHTS ARE.
>> I WOULD SAY WE'RE NOT DOING
SO MUCH OF THE PERSONALIZED WITH
DIET BUT AT LEAST SOME OF THE
SNIPS ASSOCIATED WITH RESPECT
LIPID METABOLISM AND TRYING TO
LOOK AT SEVERITY OF LUNG
DISEASE.
SO I IMAGINE THAT COULD BE
EXTRAPOLATED TO DIET.
A LOT OF THESE SNIPS ARE RARE.
BUT I THINK IT POINTS TO THE
FACT THAT WE ALL HAVE THE
POTENTIAL TO METABOLIZE THINGS
DIFFERENTLY.
>> AND TO ADD TO THAT POINT --
WHAT YOU HAD MENTIONED ABOUT HOW
DIFFERENT ENVIRONMENTAL FACTORS
CAN ALSO FURTHER IMPACT OUR
ABILITY TO METABOLIZE.
MAYBE IT'S THE OTHER
CO-EXPOSURES AND TO ADD THIS
ADDITIONAL LEVEL OF COMPLEXITY I
KNOW THIS IS NOT HELPING AT ALL
BUT THIS MORNING IN THE FIRST
SESSION TALKING ABOUT WE DON'T
KNOW HOW LONG SOME OF THESE
THINGS TAKE.
SO CHOOSING THESE OUTCOMES AND
DURATION OF DIETS AND THINGS
LIKE THAT IS GOING TO BE VERY
TRICKY.
AND WE DO NEED TO BE VERY
CAREFUL TO POWER I GUESS IN A
WAY POWER OUR STUDIES TO BE ABLE
TO DETECT THESE DIFFERENCES SO
THAT WE AREN'T BLOCKED BY
SEEMINGLY NULL EFFECTS BECAUSE
DOSES ARE NOT RIGHT.
TIMING IS NOT RIGHT SO IN THE
CONTEXT OF CHANGING DIET I DON'T
THINK WE HAVE ENOUGH DATA TO
KNOW OR TO ANSWER YOUR QUESTION.
>> I'D LIKE TO ADD TO THAT TARA.
IT'S IMPORTANT TO KNOW IF OUR
PARTICIPANTS ARE * ADHERING TO
THE DIET THAT WE'RE PRESCRIBING.
THERE HAVE BEEN NO CONTROLLED
FEEDING EXPERIMENTS THAT
ACTUALLY GIVE INDIVIDUALS FOODS
OF FIXED AMOUNTS TO ENSURE THAT
THEY DON'T CHANGE IN WEIGHT.
TO ENSURE THEY ARE EATING THE
DIETARY PROFILE SPECIFICALLY.
THERE IS ALSO RANDOMIZED
CROSSOVER DESIGN WHERE
INDIVIDUALS SERVE AS THEIR OWN
CONTROL SO WE COULD EVALUATE THE
IMPACT OF ONE DIET VERSUS
ANOTHER DIET.
SO I THINK ADHERENCE IS KEY.
DURATIONS KEY.
BUT IF WE'RE DOING CONTROLLED
DIETS WE CANNOT DO THESE
FOREVER.
BUT IN THE CONTEXT OF A
CONTROLLED DIET YOU'RE MORE
CERTAIN OF WHAT YOU'RE GETTING
IN TERMS OF THE CHANGE IN
DIETARY PROFILE AND THAT MAY
LEAD TO MORE ROBUST EFFECT SIZES
IN THE END.
>> DR. MA -- -- DO WE HAVE
SOMETHING THAT PEOPLE MIGHT WANT
TO STAY ON LONG-TERM
>> THAT IS A GREAT QUESTION.
NOT NECESSARILY IN PULMONARY --
DISEASE.
BUT AS WE HEARD OUR COLLEAGUES
IN OTHER CLINICAL AREAS IN TERMS
OF CARDIOVASCULAR DISEASE
PREVENTION AND CONTROL AND
METABOLIC DISEASE AREA AS WELL
THEY'VE DONE THE WORK TO LOOK AT
IMPACT OF DIFFERENT DIETARY
PATTERNS SUCH AS STASH AND IN
TERMS OF DASH AND HYPERTENSION
PREVENTION AND CONTROL OF COURSE
-- THERE ARE EFFICACY TRIALS
DEMONSTRATING -- AND ALSO
LONG-TERM STUDIES THAT ALSO
DEMONSTRATED THE SUSTAINED
EFFECTS.
I THINK -- THE POINTS THAT --
WERE MADE -- THE LONG-TERM
EFFECTS -- THAT IS VERY MUCH
WELL TAKEN AND WE NEED TO --
FULLY LOOK AT THOSE RESEARCH
QUESTIONS SPECIFICALLY IN THE
CONTEXT OF THE LONG HAUL AND THE
DISEASE.
I WANT TO TAKE THE CONVERSATION
TO REALLY ASK THE PANEL, THROUGH
YOUR PRESENTATIONS YOU TOUCHED
ON SEVERAL IMPORTANT MECHANISTIC
PATHWAYS.
YOU TALKED ABOUT THE IMPORTANCE
OF ENERGY CONTROL.
AND IN PARTICULAR IN TERMS OF
THERAPEUTIC KETOSIS AND SEVERAL
SPEAKERS FROM DIFFERENT ASPECTS
TALKED ABOUT INFLAMMATION
CONTROL AND THEN YOU TALKED
ABOUT CIRCADIAN CONTROL AND OSA
AS A SPECIFIC CONDITION.
IF YOU HAVE OPPORTUNITY TO THINK
ABOUT RESEARCH FRAMEWORK WHERE
YOU COULD TAKE AN INTEGRATIVE
APPROACH TO THINK ABOUT THESE
DIFFERENT MECHANISTIC PATHWAYS
SPECIFICALLY IN THE CONTEXT OF
THIS WORKSHOP IN RELATION TO
RESPIRATORY HEART AND DISEASE --
HOW YOU MIGHT CONCEPTUALIZE --
FOCUSING ON MECHANISTIC
INVESTIGATIONS TO MAKE A REAL
IMPACT IN ADVANCING THE RESEARCH
ON NUTRITION ON LONG HALL
PREVENTION.
>> I CAN THINK OF MULTIPLE
RESEARCH QUESTIONS.
THERE IS A QUESTION OF DIET
QUALITY.
AND THEN DIET QUANTITY AND THEN
DIETARY TIMING.
SO WE CAN ADDRESS ALL OF THESE
QUESTIONS WITH CONTROLLED
EXPERIMENTS SO -- PROVIDING A
CONTROLLED DIET WHERE WITH A
COMPARISON DIET WHERE BOTH DIETS
ARE PROVIDED IN WEIGHT
MAINTENANCE QUANTITIES SO YOU
TAKE OUT THE IMPACT OR CHANGE IN
BODY COMPOSITION WHERE BOTH
DIETS ARE PROVIDED WITHIN THE
SAME TIMING SO YOU TAKE THAT OUT
OF THE EQUATION AS WELL.
SO YOU CAN REALLY ZONE IN ON
DIET QUALITY AND IS THAT VERY
IMPORTANT.
THEN OTHER ISSUES YOU CAN LOOK
AT.
WITHIN THE CONTEXT OF A SINGLE
DIET IS IT IMPORTANT WHEN FOODS
ARE BEING CONSUMED AND THEN
SHIFT THE TIMING OF DIETARY
CONSUMPTION.
YOU CAN FIX A DIET AND CHANGE
QUANTITIES.
IS IT THE WEIGHT LOSS THAT IS
MOST RELEVANT.
ARE WE GOING TO HAVE AN
INDEPENDENT EFFECT ON OUR
OUTCOMES.
>> IT WOULD BE REALLY NICE IF WE
HAD SOME NONINVASIVE EASILY
ACCOMPLISHABLE ASSESSMENT OF
MULTIPLE END POINTS THAT ARE
COMPLIMENTARY.
SO WHEN WE'VE GOT SOMEONE
LOOKING AT A CARDIOVASCULAR END
POINT AND ONE AT A PULMONARY END
POINT.
MULTIPLE END POINTS FROM A
SUBJECT SO WE DON'T HAVE TO
REPEAT THE SAME EXPERIMENTS.
8
>> TO MAKE SURE WE KNOW BASELINE
LEVELS.
ESPECIALLY WHEN IT COMES TO
INFLAMMATION.
UNDERSTANDING WHAT THEIR CHANGE
IS MIGHT BE IMPORTANT.
>> TWO QUESTIONS IN THE CHAT.
ONE WAS ABOUT THE USE OF -- ANY
THOUGHTS FROM ANY OF THE
PANELISTS?
>> ANOTHER QUESTION -- IN THE
COMBINES OF DIETARY CHANGES
AFFECTING PULMONARY INFLAMMATION
IN DISEASES LIKE ASTHMA
>> THERE IS EVIDENCE THAT THE
AGONIST AUGMENT KETONE BODY
CONCENTRATIONS AND THOSE CAN
DECREASE PRO INFLAMMATORY EVENT.
AND EVEN -- SEE QUAIL COVID-19.
THERE IS A HUGE POPULATION OF
INDIVIDUALS ON THESE.
NOW WHAT IS NORMAL?
WE NEED TO CONSIDER OBESITY AS
THE NORMAL GOING INTO TRIALS.
WE NEED TO CONSIDER WHAT ARE THE
MEDICATIONS THAT OTHER
INDIVIDUALS ARE ON AS WELL.
SO THAT PROVIDES BOTH AN
OBLIGATION AND OPPORTUNITY TO
INCORPORATE THAT.
WE'RE GOING TO BE ASKING
OURSELVES CAN WE TREAT A
PARTICULAR CONDITION WHERE
INDIVIDUALS ARE ALREADY ON --
MEDICATIONS FOR THEM.
WHETHER IN THE CASE OF ASTHMA.
WHAT IMPACT DOES DIET HAVE ON
THE USE OF THOSE MEDICATIONS.
THE BARIATRIC SURGERY HAS A
BENEFICIAL IMPACT ON THE
REDUCTION OF USING THOSE.
BUT I THINK THAT THE COMMINGLING
OF MECHANISMS BY THE
THERAPEUTICS THAT PEOPLE ARE
ALREADY ON IS AN IMPORTANT
CONSIDERATION.
>> ALSO LOOK AT INCIDENT OF
THESE DIFFERENT CONDITIONS IN
THOSE POPULATIONS ONCE THEY GET
LARGE ENOUGH.
PEOPLE ARE TAKING -- IN THE
INSTANCE OF ASTHMA AND COPD AND
IF YOU HAVE A LARGE ENOUGH
SAMPLE SIZE
>> INFLUENCED BY WEIGHT STATUS.
SO THESE -- AGONIST LEADING TO
WEIGHT LOSS WOULD HAVE A
BENEFICIAL EFFECT ON OSA
SEVERITY.
>> I DO THINK THAT IT WOULD BE
INTERESTING TO CONSIDER THESE
GOP1s.
IN CO-MORBIDITIES THAT MAY NOT
BE LUNG RELATED.
SO I FEEL LIKE YOU HAVE THIS YEN
AND -- YANG EFFECT.
THIS GIVES US AN IDEA THAT THERE
MIGHT BE SOME MORE GOING ON --
THAT MIGHT HAVE SOME OFF TARGET
MECHANISMS THAT WE'RE NOT AWARE
OF.
>> I WAS WONDERING IF THERE IS
AN INDIVIDUAL IN SLEEP QUALITY
AND FOLKS THAT DON'T HAVE OSA?
>> I'M NOT AWARE OF ANY STUDIES.
>> LOW DOSE ASPIRIN.
IS THERE SUCH A BENEFIT OF A LOW
DOSE -- AGONIST.
>> -- SIDE EFFECTS.
SOME OF THOSE MAY ADVERSELY
IMPACT SLEEP IF YOU THINK ABOUT
IT.
LONG-TERM -- ONCE THOSE SUBSIDE
WOULD BE INTERESTING TO KNOW HOW
THAT INFLUENCES SLEEP.
SURE.
>> I WAS WONDERFUL WHAT THE
G-- WONDERINGWHAT THE GROUP THIE
COULD GET A BETTER SENSE OF WHAT
INDIVIDUAL PATIENTS OR
INDIVIDUALS ARE ACTUALLY EATING
USING EVERYONE HAS GOT A
SMARTPHONE IN THEIR POCKET.
MAYBE TAKING A PHOTO OF EVERY
MEAL THAT THEY EAT AND THEN
USING SOME KIND -- YOU CAN TAKE
A PICTURE OF SOMETHING AND
ESTIMATE HOW MUCH THERE IS OF
WHATEVER DIETARY COMPONENT
YOU'RE INTERESTED IN AND USE
THAT AS A WAY TO GET A BETTER
SENSE OF WHAT IS GOING INTO THE
SYSTEM.
>> I CAN SAY I KNOW THERE ARE
FOLKS WORKING ON THESE KIND OF
APPS.
THERE ARE STRATEGIES FOR TRYING
TO ESTIMATE TOTAL QUANTITIES.
WHERE THE ABILITY TO BE --
ESPECIALLY ACCURATE FALLS DOWN
IS REALLY UNDERSTANDING -- JUST
AS AN EXAMPLE IF SOMEBODY IS
EATING MASHED POTATOES IS IT
MADE WITH CREAM OR --
UNDERSTANDING THE TRUE DIETARY.
THOSE ARE SOME OF THE
LIMITATIONS.
WITH THE PICTURE APP BASED
APPROACHES BUT I THINK IT COULD
BE SO POWERFUL.
THAT COULD REALLY HELP WITH SOME
OF THESE QUESTIONS.
>> GIVE US INFORMATION ON
TIMING.
>> YEAH:
>> THEY STILL REQUIRE MUCH USER
INPUT.
WHO KNOWS HOW MUCH BUTTER OR
SALT WERE IN THE MASHED POTATOES
SO GETTING INPUT FROM THE USER
IS STILL NEEDED AT THIS POINT.
>> IF I MAY CHIME IN -- WE DO
HAVE AN APP THAT IS USED IN 20
DIFFERENT TRIALS CALLED MY
CIRCADIAN CLOCK.
IF YOU LOOK AT INSTAGRAM
PICTURES WE HAVE UNDERESTIMATE
HOW PEOPLE ARE ADDICTED TO
TAKING PICTURES OF WHAT THEY
EAT.
YOU CAN GET METADATA.
THE CHALLENGE IS -- SOME CAN GET
LOST IN HOW MUCH SUGAR OR SALT.
WHETHER ROCK SALT OR SEA TAUGHT.
IF YOU K -- SALT.
MASHED POTATO OR BROCCOLI.
THAT WOULD HAVE A HUGE IMPACT.
I GUESS WE ALSO HAVE TO FIGURE
OUT -- IF WE HAVE THE SEVEN DAYS
OF DATA THAT IS WAY MUCH BETTER
BECAUSE YOU GET FINER DETAIL --
-- ACTUALLY TOMORROW AFTERNOON
I'LL SHARE SOME OF OUR --
PUBLISHED DATA USING THIS APP.
WE HAVE COLLECTED SEVERAL
MILLIONS OF THE PICTURES.
HOPEFULLY I CAN SHARE SOME OF
THE STRENGTHS AND WEAKNESSES.
RIGHT NOW YOU CAN PUT ANY FOOD
PICTURE.
AND THEY EXTRACT -- VERY CLOSE
TO WHAT A DIETICIAN WOULD
EXTRACT.
THESE PICTURES ARE IMPROVING AND
IF WE GET PEOPLE HOOKED TO AN
APP THEY ARE READY TO SHARE A
LOT OF INFORMATION.
>> I THINK THAT IS A GREAT
POINT.
THIS WORK ALLOWS US TO GET THAT
LONGITUDINAL DATA.
AND WITH YOU KNOW -- SO MUCH
MORE BEING ON-LINE AND THESE
DAYS I THINK THAT IT REALLY IS
POTENTIALLY A POWERFUL TOOL.
WE SHOULD NOT GET COMPLETELY
CAUGHT UP IN THE WEEDS OF WHAT
THE OBSTACLES ARE BUT IT HAS A
LOT OF POTENTIAL
>> AND EVEN PROVIDING FOOD
INFORMATION -- YOU CAN TRACK
ACTUALLY WHEN YOU EXERCISE WHEN
YOU WENT TO BED WHEN YOU WOKE UP
-- WHEN YOU DRANK BEVERAGE
ANNUALS SO YOU CAN HAVE
INFORMATION ON ALL OF THESE
BEHAVIORS AT ONCE CAN GIVE YOU
INSIGHT.
>> CLEARLY I THINK THERE ARE
CONSISTENT THEMES THAT ARE
COMING THROUGH DIFFERENT TALKS
WE'VE HAD TODAY.
I THINK OF TWO WORDS.
7 COMPLEXITY AND PET GET NEAR
TEE.
-- PET GET NEAR TEE.
--
HETEROGENEITY.
YOU TALKED ABOUT HOW --
[ INDISCERNIBLE ]
MECHANISMs WHERE WE HAVE SOME
EVIDENCE.
YOU SEE THEY MIGHT,
CROSSCUTTING.
BE CONSISTENT MECHANISMS
UNDERLYING DIFFERENT NUTRIENTS
WHERE MAYBE THEY ARE A CANDIDATE
TO METABOLIZE IF WE CAN CREATE A
PANEL THAT MIGHT BE A POTENTIAL
INDICATOR OF DIET QUALITY FROM A
METABOLIC SPECIAL EXPECTATIVE.
-- PERSPECTIVE.
>> MAYBE I CAN START.
THERE IS DEFINITELY AN IDEA OF
THE COMPOSITION IN TERMS OF THE
BACTERIAS INTERESTING BUT MAY
NOT BE AS IMPORTANT AS WHAT THEY
ARE DOING.
SO CAN HAVE METABOLIC OUTPUT
THAT CAN COME FROM -- DIFFERENT
MEMBERS OF THE MICROBIOME
COMMUNITY.
SO EACH -- IT MAY BE MORE
IMPORTANT WHAT THEY ARE MAKING
AND WHAT THE BODY IS ABSORBING
THAN WHO'S ACTUALLY PRESENT.
BUT YEAH.
I THINK THAT IS ONE WAY OF
TRYING TO UNDERSTAND -- WHAT IS
IMPORTANT IN THE GUT LUNG AXIS.
>> I THINK I WOULD JUST SAY THAT
I HAVE A REALLY HARD TIME
PINPOINTING ONE THING OR A PANEL
OF THINGS.
WE'VE TRIED AND ONCE AGAIN LIKE
CERTAINLY VERY USEFUL MEASURES
OR INDEXES OF SYSTEMIC
INFLAMMATION AND FROM A LARGER
STANDPOINT THOSE CAN BE VERY
USEFUL.
BUT I ALSO THINK THAT WE NEED TO
BE CAREFUL ABOUT HOW WE
INTERPRET ANY DATASET THAT IS
LOOKING AT ONE CLASS OF
MEDIATORS.
OR SOMETHING LIKE THAT.
7 THE EXAMPLE THAT I'LL USE ONCE
AGAIN -- IS THESE OMEGA THREE
ROXY LIP INS.
WE ITO MAKING 53s AND THEN WE
HAVE A BETTER CAPACITY TO CREATE
THESE AND THEY ARE GOOD AND
PROTECTIVE AND WE'LL HAVE
REDUCED INFLAMMATION.
BUT THESE ARE ORIGINAL PRODUCED
IN SUBSTANTIAL LEVELS WHEN THERE
IS AN INFLAMMATORY INSULT.
SO THEIR ABILITY TO GO UPS
CRITICALLY IMPORTANT.
SO WE MIGHT SEE THEM AND
IDENTIFY THEM AS A MARKER OF
INFLAMMATION AND THEY WOULD GET
A BAD RAP.
WE NEED TO BE REALLY CAREFUL AND
I DON'T KNOW THAT I FEEL
COMFORTABLE SAYING THERE IS ONE
PANEL TO SAY THIS IS HEALTH
VERSUS THIS IS DISEASE.
>> MAYBE CONNECTED ALSO TO WHAT
MATTHEW WAS SAYING BEFORE WHICH
IS ABOUT ENERGY.
I STARTED THINKING MORE ABOUT
WHAT IS THE ENERGY STATE OF THE
LUNG MAYBE MORE THAN INDIVIDUAL
METABOLITES.
IF WE CAN GET A SENSE OF HOW THE
LUNG IS USING INPUTS TO GENERATE
ENERGY THAT COULD TELL US MORE
ABOUT HOW IT MIGHT -- HOW
HEALTHY IT MIGHT BE OR HOW IT
MIGHT RESPOND TO INJURY OR
INFECTION FOR EXAMPLE.
AND SO I THINK -- THAT COULD BE
ANOTHER APPROACH RATHER THAN
FOCUSING ON SPECIFIC
METABOLITES.
THE COMBINES OF THEM IS WHAT
MATTERS AND GETTING AND
UNDERSTANDING THE COMBINATION --
IT IS DIFFICULT.
WHAT IT IS DOING TO THE LUNG AND
SECONDARY TO THAT THE LUNG IS
NOT GENERALLY ONE HOMOGENEOUS
ACTIVITY.
IT'S SUBSEGMENTS THAT DO
DIFFERENT THINGS SO THAT ADDS TO
THE INCREDIBLE COMPLEXITY.
SO MUCH TO BE UNDERSTOOD AND
DISCOVERED HERE.
>> I THINK YOUR POINT TAKEN TO
THESE MICRO ENVIRONMENT TO THE
LUNG THAT WE'RE DISREGARDING AT
THIS MOMENT.
I'M NOT SURE THAT THAT HAS BEEN
DISCUSSED HERE.
SO THANK YOU FOR BRINGING THAT
UP.
>> JUST TO BE COGNIZANT OF THE
TIME.
AS WE'RE APPROACHING THE END OF
THIS FIRST DAY OF THIS TWO-DAY
WORKSHOP I WANT TO GIVE THE
PANELIST AN OPPORTUNITY FOR EACH
OF YOU TO COMMENT ON WHAT SEE AS
THE MOST CRITICAL RESEARCH GAP
AS FAR AS LOOKING AT DIFFERENT
MECHANISTIC PATHWAYS TO ADVANCE
THE SCIENCE ON NUTRITION AND
RESPIRATORY HEALTH AND DISEASE.
I'LL START WITH MATT.
>> RELATED TO MY OWN WORK IT HAS
TO DO WITH ASSESSING THE
POTENTIAL BENEFIT TO THE
POTENTIAL DETRIMENT OF TRYING TO
MANIPULATE DIETS AND IT'S EASY
TO DO IN A MOUSE MODEL AND
MEASURE THEM MONTHS LATER.
MICE ARE USED TO BE ON VERY
INFLEXIBLE DIETS AND MAYBE THE
FLEXIBILITY IS IMPORTANT.
CERTAINLY IT IS FOR OUR OWN
HAPPINESS AND HEALTHINESS.
I WONDER ABOUT THE DURABILITY
AND SAFETY AND COUPLED WITH
EFFICACY.
>> I COMPLETELY AGREE WITH YOU
MATT.
THAT'S AN EXCELLENT POINT.
THE ONLY THING THAT I WOULD ADD
IS HOW LONG THE LONG --
ADAPTABLE TO THESE DIETS.
THE MICROBIOME, RIGHT?
MICROBIOMES SOMEWHAT
IRREVERSIBLE.
SO IF YOU CHANGE YOUR DIET DOES
THE LUNG CHANGE WITH IT AND THEN
NOT CHANGE BACK OR DOES IT EBBS
AND FLOWS BASED ON WHAT
NUTRIENTS YOU'RE TAKING IN.
7
>> I THINK FOR ME ONE THING THAT
IS REALLY CRITICAL IS WHEN WE'RE
THINKING ABOUT PRECLINICAL TO
CLINICAL TRANSLATION AND
THINKING ABOUT THE
STANDARDIZATION OF WHAT WE HAVE
AND WHAT WE'RE USING FOR THESE
STUDIES UNDERSTANDING THAT THERE
IS A LACK OF STANDARDIZATION AND
REGULATION FOR SO MANY
SUPPLEMENTS.
THAT IS LEADING TO THESE ADVERSE
EFFECTS.
I HATE TO THINK THERE IS SO MUCH
RESEARCH OUT THERE THAT COULD
HAVE BEEN MOVED FURTHER ALONG TO
HELP US UNDERSTAND DIET IMPACTS
ON HEALTH THAT HAVE BEEN
THWARTED BY OUR INABILITY TO
PROVIDE A SUPPLEMENTAL GUIDELINE
THAT CAN BE USED EFFECTIVELY IN
THESE TRIALS.
>> FOR ME I THINK HUMAN DIETARY
INTERVENTION STUDIES ARE KEY
ESPECIALLY WHEN WE'RE TALKING
ABOUT SLEEP.
OUR GROUP HAS SHOWN THAT IN THE
CONTEXT OF SLEEP RESTRICTION --
OXIDATIVE STRESS AND
INFLAMMATION THAT IS NOT OFFSET
BY THE INCREASE IN RESPONSES.
SLEEP RESTRICTION UP REGULATES
RESPONSES SO IT'S VERY IMPORTANT
TO DO THESE STUDIES IN HUMANS.
7 FORECAST OR FIVE OR SIX WEEK
DIETARY INTERVENTIONS ARE PRETTY
WELL TOLERATED AND THEN TAKING
OUT INTO THE CLINIC TO SEE HOW
THAT CAN TRANSLATE INTO
SUSTAINED BEHAVIOR LONG-TERM.
>> FOR ME IT'S A THINK ON THE
OTHER SIDE OF IT ABOUT THE LUNG
AND REITERATING WHAT I SAID
BEFORE ABOUT HOW IN HEALTH IN MY
MIND WE DON'T HAVE GOOD WAYS OF
MEASURING LUNG HEALTH THAT ARE
SENSITIVE ENOUGH.
OXYGEN SATURATION IS NOT AND
EACH INDIVIDUAL CONDITION LIKE
ASTHMA WE HAVE SPECIFIC ONES
LIKE THE FE B-1 AND SO ON.
IT MAY BE THE CHALLENGE OF THE
SYSTEM THAT WE CHOSE TO STUDY
THAT THE LUNG IS SO RESILIENT
AND ALSO HAS HETEROGENEITY.
IT'S HARD TO STUDY IN A SIMPLE
INJURY MARKER WAY OR THE X-RAYS
ARE ALSO NOT GREAT.
YOU CANNOT DO THOSE ON EVERYBODY
ON A REGULAR BASES.
BUT THAT IS FOR ME ONE OF THE
BIG GAPS.
HOW DO YOU TRACK LUNG INJURY IN
A NONINVASIVE WAY AND IF WE
COULD DO THAT YOU COULD IMAGINE
SUDDENLY YOUR DIET STUDIES AND
INTERVENTIONS COULD REALLY --
YOU COULD GET MUCH MORE GRANULAR
INFORMATION ABOUT WHETHER IT'S
MAKING A DIFFERENCE OR NOT.
>> THANK YOU ALL ONCE AGAIN FOR
YOUR OUTSTANDING PRESENTATIONS
AND INSIGHTFUL REMARKS.
AT THIS POINT -- DR. LU, WOULD
YOU LIKE TO CLOSE OUTFITTER DAY
>> YEAH.
IT WAS A GREAT MEETING TODAY.
I LEARNED A LOT.
DEFINITELY.
I WANT TO THANK ALL OF OUR
COCHAIRS, THE MODERATORS AND
SPEAKERS FOR YOUR WONDERFUL
TALK.
I THINK THE WORKSHOP WAS WELL
ORGANIZED AND THANK YOU TO THE
CHAIRS AND THE MODERATORS.
I LOOK FORWARD TO THE SECOND DAY
TOMORROW.
THANK YOU.
WE CAN CLOSE THE WORKSHOP.
TOMORROW WOULD BE THE ZOOM OPEN
AGAIN AT 9:30.
AND DISCUSSION WILL START AT 10:00.
>> RECORDING STOPPED.