WELCOME TO DAY TWO.
WE HAD AN INTELLECTUALLY
STIMULATING DAY YESTERDAY.
WE HEARD FROM A NUMBER OF
OUTSTANDING SPEAKERS WHO
FOCUSSED ON EPIDEMIOLOGICAL
EVIDENCE AS WELL AS MECHANISMS
AND ALSO THE GLOBAL CRISIS WE'RE
AWARE OF FOR CLIMATE CHANGE AND
THE IMPACT ON FOOD PRODUCTION,
THE LIFE CYCLE OF FOOD
CONSUMPTION AND WASTE AND
DISEASE.
I WANT TO TURN IT OVER TO YOU
DR. GARCIA-LARSEN TO GIVE US A
RECAP.
>> THANK YOU AND HELLO EVERYONE
WELCOME TO DAY TWO OF THE
ADVANCING NUTRITION RESEARCH FOR
RESPIRATORY HEALTH IN ADULTS.
WE HAD AN EXCITING FIRST DAY
PACKED WITH VERY INFORMATIVE
TALKS ADDRESSING VARIOUS ASPECTS
OF NUTRITION AND RESPIRATORY
RESEARCH.
TODAY WE'RE ORGANIZED INTO THREE
SESSIONS.
WE'LL START WITH THE PREVALENCE
AND MORTALITY FOR RESPIRATORY
DISEASES WORLDWIDE FROM AN
EPIDEMIOLOGICAL APPROACH AND
THEN TALKS ON VARIOUS NUTRITION
RESEARCH IN RELATION TO
RESPIRATORY OUTCOMES.
WE REVIEWED THE EVIDENCE ON
DIETARY PATTERNS.
WE DISGUST AND MODULATE THE RISK
OF CHRONIC RESPIRATORY DISEASES
AND MICRONUTRIENTS.
AND PRETTY MUCH THE EVIDENCE IS
EMERGING IS CONSISTENT AND WE
HAVE SCIENTIFIC GAPS WE'LL NEED
TO ADDRESS.
WE HAVE THE OPPORTUNITY TO
DISCUSS THEIR ROLE OF CLIMATE
CHANGE.
THE IMPACT OF CLIMATE CHANGE ON
FOOD SYSTEMS AS A WHOLE.
THE ROLE OF GLOBAL WARMING AS
WELL AS AND IN THE AFTERNOON WE
HAVE A VERY EXCITING SESSION ON
THE MECHANISMS UNDERLYING
NUTRITION AND DIET IMPACT ON
RESPIRATORY HEALTH AND DISEASE
WHERE WE LOOKED INTO MORE
DETAILS ABOUT THE SPECIFIC
ASPECT OF NUTRITION TO BE
INVOLVED IN THE PATHOGENESIS OF
RESPIRATORY DISEASES.
AND PERHAPS MORE IMPORTANTLY THE
CAPACITY OF THESE MECHANISMS TO
HAVE A BENEFICIAL IMPACT AGAINST
A PROGRESSION OF DISEASE AND BY
REMARKS WE PUT TOGETHER
YESTER
YESTERDAY.
SO WE LISTENED TO SEVERAL COMMON
THEMES, NUTRITION AND DIET IN
GENERAL ARE VERY INCLUSIVE IN
TERMS OF ASCERTAINING WHICH
SPECIFIC COMPONENTS MIGHT BE
RELATED TO HEALTH AND DISEASE.
WE LISTENED TO SEVERAL DIETARY
GROUPS, INDICES AND WHETHER IT
WAS HELPFUL TO LOOK AT CERTAIN
NUTRIENTS OR WHOLE FOODS AND THE
SCIENTIFIC EVIDENCE OF THE
ASSOCIATION OF DIET AND
RESPIRATORY DISEASES.
WE ADVANCED THE SCIENTIFIC
AGENDA IN TERMS OF ELUCIDATIEIN
THE MECHANISMS AND THE ROLE OF
INFLAMMATION WHICH INFLUENCE THE
ROLE OF NUTRITION AND
RESPIRATORY HEALTH.
THERE WERE SEVERAL OPPORTUNITIES
HIGHLIGHTED PARTICULARLY FOR
ASTHMA AND COPD AND WE ALSO
DISCUSSED THE POTENTIAL FOR
NUTRITION TO HAVE A PRETENDIVE
-- PREVENTIVE ROLE IN THE
PROGRESSION OF DISEASE AND
EXPANDING WHAT WE CONSIDER TO BE
HEALTHY LIVES.
WE ALSO CONSIDERED THE ISSUE OF
UNDERSTANDING ENVIRONMENTAL
SOCIAL INFLUENCES AROUND
NUTRITION AND RESPIRATORY HEALTH
AND THE POTENTIAL TO CONSIDER
THE REST OF LIFE RELATED FACTORS
AS THEY'RE INVOLVED IN WHAT WE
EAT AND HOW WE UNDERSTAND
NUTRITION FROM A RESEARCH POINT
OF VIEW.
WE LISTENED TO THE RESEARCH
METHODOLOGY ASPECTS RELATED TO
THE ASSESSMENT OF NUTRITION IN
THE GENERAL POPULATION.
WE DISCUSSED ISSUES AROUND
STRENGTHENING THE WAY IN WHICH
WE ASCERTAINED NUTRITION IN
CLINICAL AND EPIDEMIOLOGICAL
STUDIES AND THERE'S HUGE ROOM
HERE TO PROGRESSIVE AND RESEARCH
AGENDA TO EXPAND WHAT WE'RE
DOING AND STRENGTHEN MORE
SCIENTIFIC EVIDENCE.
WE HAVE TWO SESSIONS IF WE CAN
GO TO THE NEXT SLIDE.
WE HAVE TWO SESSIONS.
ONE IN THE MORNING AND ONE IN
THE AFTERNOON.
TODAY WE'RE GOING TO EXPAND ON
SOME OF THE EMERGING PRECISIONS
MEASURES OF DIET AND NUTRITION
IN EPIDEMIOLOGICAL AND
INTERVENTIONAL STUDIES OF LUNG
HEALTH AND DISEASE.
YESTERDAY WE DID TOUCH ON THE
NEEDS TO EXPAND THE TESTS AND
THE ACCURACY OF TOOLS THAT WE
USE FOR THE MEASUREMENT OF
NUTRITION AND I'M EXCITED TO
HEAR WHAT EXPERTS ARE GOING TO
PROPOSE.
WE'RE GOING TO LOOK TO A NUMBER
OF EMERGING TOOLS AS WELL AS
NOVEL DIETARY BIOMARKERS AND WE
HOPE TO ADDRESS THE QUESTION OF
WHETHER AVAILABLE AND
NUTRITIONAL BIOMARKERS CAN
PREDICT LUNG HEALTH AND VARIOUS
OUTCOMES OF LUNG DISEASES.
IN SESSION 5 THIS AFTERNOON
WE'RE GOING TO HEAR FROM SEVERAL
WORLDWIDE EXPERTS ON THEMES
RELATED TO DIETARY AND
NUTRITIONAL INTERVENTIONS FOR
THE PREVENTION AND MANAGEMENT OF
RESPIRATORY DISEASES.
QUITE OFTEN WE STRUGGLE AND
YESTERDAY WE DISCUSSED THIS IN
SELF OF THE SESSIONS HOW
SUSTAINABLE IT IS TO DO A FOOD
INTERVENTION.
CAN WE HAVE PEOPLE, PATIENTS,
THE GENERAL POPULATION TO
PARTICIPATE IN TRIALS THAT CAN
BE SUSTAINABLE OVER TIME.
SO TODAY WE'RE GOING TO HEAR
MORE ABOUT SOME OF THE STUDIES
THAT HAVE BEEN CONDUCTED AND
HOPEFULLY THEY'RE GOING TO HELP
US ADDRESS THE QUESTION OF
WHETHER THERE'S DISSEMINATION OF
DIETARY INTERVENTIONS CAN
SUPPORT RESPIRATORY DISEASE
PREVENTION AND CONTROL.
SO I THANK YOU ALL FOR JOINING
US TODAY.
I LOOK FORWARD TO THE
DISCUSSIONS WE ARE GOING TO HOST
IN THE SECOND DAY.
THANK YOU.
>> THANK YOU SO MUCH,
DR. GARCIA-LARSEN FOR THE RECAP
OF YESTERDAY AND THE OVERVIEW OF
WHAT YOU EXPECT TODAY.
IT'S MY GREAT PLEASURE TO
INTRODUCE MY CO-MODERATOR FOR
SESSION 4, DR. FELIPE MACHADO.
HE COMPLETED HIS DEGREE IN
PHYSIO THERAPY IN BRAZIL IN
2016.
HE WAS A MEMBER OF THE
LABORATORY OF RESEARCH ON
RESPIRATORY PHYSIO THERAPY FOR
THREE YEARS AS AN UNDERGRADUATE
RESEARCH STUDENT.
AFTER GRADUATION, DR. MACHADO
CONTINUED HIS ACTIVITIES AT THE
SAME LAB AS A MASTER STUDENT.
HE OBTAINED HIS MASTER'S DEGREE
IN REHABILITATION SCIENCES AT
INDIANA STATE UNIVERSITY IN
2018.
IN 2020, HE BEGAN HIS Ph.D. AT
THE DEPARTMENT OF RESPIRATORY
MEDICINE OF THE SCHOOL OF
NUTRITION AND TRANSLATIONAL
RESEARCH IN METABOLISM AT
HASSETT UNIVERSITY AND LOOKED AT
BODY COMPOSITION AND
ABNORMALITIES IN PATIENTS AND IS
A POSTDOCTORAL RESEARCHER IN
BELGIUM FOCUSSING HIS RESEARCH
ON BODY COMPOSITION AND EXERCISE
PHYSIOLOGY IN INDIVIDUALS WITH
METABOLIC DISEASES.
NOW I'LL TURN IT OVER TO YOU,
DR. MACHADO TO INTRODUCE SESSION
4 AND AN OBJECTIVE AND KEY
QUESTION.
>> THANK YOU VERY MUCH, DR. MA
FOR THE INTRODUCTION AND I'D
LIKE TO THANK THE ORGANIZATIONS
FOR THE INVITATION.
AND WELCOME ALL TO SECTION 4
MEASURES OF DIET AND NUTRITION
IN EPIDEMIOLOGICAL AND
INTEGRATIONAL STUDIES OF LUNG
AND LUNG HEALTH AND DISEASES.
WE ARE GOING TO HAVE FOUR
SPEAKERS AND I'LL INTRODUCE
DR. SHILPA BHUPATHIRAJU.
SHE'S AN ASSISTANT PROFESSOR OF
NUTRITION AND MEDICINE AT
HARVARD UNIVERSITY.
SO THANK YOU, VERY MUCH FOR
BEING HERE AND I'LL HAND IT TO
YOU.
>> THANK YOU.
THANKS, DR. MACHADO AND DR. MA.
GOOD MORNING EVERYONE, OR GOOD
EVENING.
HAPPY FRIDAY.
I'D LIKE TO BEGIN BY THANKING
THE CHAIRS AND THE CO-CHAIRS FOR
PUT TOGETHER THIS FANTASTIC
WORKSHOP.
YESTERDAY WAS A REAL TREAT FOR
ALL OF US WORKING IN THIS AREA.
I WILL SAY THAT I AM NOT A
RESPIRATORY EPIDEMIOLOGIST BUT I
AM A NUTRITIONAL EPIDEMIOLOGIST
AND I LOOK AT MEASURING DIET.
TODAY'S TALK WILL FOCUS ON HOW
WE CAN USE EMERGING BIOMARKERS
OF DIET AND NUTRITION AND
OPTIONAL STUDIES AND
INTERVENTIONAL STUDIES.
I DO NOT HAVE CONFLICTS OF
INTEREST TO DISCLOSE.
ONE OF THE THINGS WE GRAPPLE
WITH AS NUTRITIONISTS IS
ACCURATE DIETARY ASSESSMENT.
THAT'S A HUGE CHALLENGE.
SO TRADITIONAL DIETARY
ASSESSMENT TOOLS LIKE TREATMENT
QUESTIONNAIRES OR 24-HOUR
RECALLS OR NUTRITION THE GOLD
STANDARD, FOOD DIARIES HAVE ALL
KIND OF ERRORS.
THE RECALL BIAS IS AN ISSUE AND
MANY TOOLS DO NOT HAVE ALL TOOLS
AVAILABLE SO WHAT GET ON THE
FOOD FREQUENCY QUESTIONNAIRE AND
YOU HAVE MEASUREMENT ERROR.
IT CAN BE SYSTEMATIC OR RANDOM.
THIS IS WHERE NUTRITIONAL
BIOMARKERS COME IN TO REVISIT
THE DEFINITION OF A NUTRITION
BIOMARKER.
IT'S A BIOLOGICAL SPECIMEN IN
ANY FLUID OR IN HAIR OR
TOENAILS.
WE DO A LOT OF WORK IN TOENAILS
TO LOOK AT HEAVY METALS BUT ANY
BIOLOGICAL SPECIMEN AN INTAKER
AND A FUNCTIONAL OR CLINICAL
INDICATOR ORE BIO CHEMICAL AND
IT'S THOUGHT OF THE FOOD YOU
CONSUME.
AND THE REASON WE RELY ON
NUTRITIONAL BIOMARKERS IN
ADDITION TO TRADITIONAL DIETARY
MARKERS IS YOU'RE REALLY ABLE TO
LOOK AT DIETARY INTAKE
RETROSPECTIVELY.
IT REFLECTS THE BIO AVAILABILITY
FOR THE TRUE INTERNAL DOSE.
FROM A MEASUREMENT ERROR
STANDPOINT, BIOMARKERS HAVE
DIFFERENT SOURCES OF RANDOM
ERROR FROM TRADITIONAL DIETARY
ASSESSMENT METHODS.
THAT BECOMES IMPORTANT BECAUSE
WHEN YOU'RE TRYING TO CALIBRATE
YOUR DIETARY ASSESSMENT TOOLS
IT'S CRITICAL YOUR TEST AND YOUR
GOLD STANDARD HAVE VERY
DIFFERENT ERRORS.
SO THIS WILL ALLOW FOR
MEASUREMENT ERROR CORRECTION.
MOST IMPORTANTLY NUTRITIONAL
BIOMARKERS HAVE SMALLER ERRORS
COMPARED TO RECALLS SO YOU DO
GET A MORE POWERFUL ESTIMATE
GIVEN THE SMALLER ERROR AND THEY
CAN BE INDEPENDENTLY USED TO
CONFIRM RELATIONSHIP BETWEEN
DIET AND DISEASE RISK.
AND DESPITE THE ADVANTAGES
YOU'LL BE SHOCKED TO KNOW WE
REALLY ONLY HAVE ABOUT THREE
OBJECTIVE DIETARY BIOMARKERS FOR
NUTRITION THAT'S LABELLED FOR
ENERGY AND URINARY NITROGEN A
BIOMARKER OF PROTEIN INTAKE AND
SODIUM AND POTASSIUM FOR THAT
INTAKE.
SO THERE HAS BEEN A REAL PUSH TO
IDENTIFY MORE OBJECTIVE DIETARY
BIOMARKERS.
IF YOU THINK ABOUT IDENTIFYING
DIETARY BIOMARKERS IS SO
DIFFICULT OR ASSESSING DIET IS
SO DIFFICULT IS BECAUSE ALL
CONSUME FOODS HIGHLY COMPLEX AND
VARIABLE AND WE CONSUME NOT
FOODS BUT PATTERNS.
THE FOODS WE CONSUME HAVE MORE
THAN 25,000 COMPOUNDS MOST OF
WHICH ARE METABOLIZED IN THE
HUMAN BODY.
THE FOOD METABOLOME IS COMPLEX
AND VARIABLE.
THIS CONSTITUTES A UNIQUE AND
RICH SOURCE OF INFORMATION ON
THE HUMAN DIET THAT HAS BARELY
BEEN EXPLORED.
THIS IS WHERE OMICS COMES IN.
SO, IF WE USE THAT TO
CHARACTERIZE THE FOOD METABOLOME
SHOULD LOOK AT EXPOSURE AND
IDENTIFICATION OF FOODS THAT CAN
INFLUENCE DISEASE RISK HERE RISK
OF RESPIRATORY DISEASES IN
CLINICAL AND EPIDEMIOLOGICAL
DISEASES.
WHEN WE THINK ABOUT THE PLASMA
METABOLOME IT'S NOT THE HOST
METABOLOME AND THE FOOD
METABOLOME AND THE EXPOSOME.
THINKING ABOUT OMICS OF THE
TECHNOLOGIES WE HAVE,
METABOLOMICS HAS HELD THE
GREATEST PROMISE THUS FAR FOR
NUTRITIONAL BIOMARKER
DEVELOPMENT WITH THE INTEGRATION
OF ALL OMICS TECHNOLOGIES AND
CLOSEST TO THE PHENOTYPE.
THE END GOAL OF IDENTIFYING
NUTRITIONAL BIOMARKERS OF FOODS
AND DIETARY PATTERNS IS THIS
CONCEPT OF PRECISION NUTRITION
TO USE THE INFORMATION TO
STRATIFY INDIVIDUALS BASED ON
THEIR DISEASE RISK, IDENTIFY
DIETARY BIOMARKERS AND TO
IDENTIFY RESPONDERS AND
NON-RESPONDERS TO A GIVEN
INTERVENTION.
SO MUCH OF MY WORK FOCUSSED ON
BIOMARKER DISCOVERY IN
INTERVENTION STUDIES AND
OBSERVATIONAL DATA.
YOU CAN DISCOVER BIOMARKERS
USING STUDY DESIGNS.
IN INTERVENTION STUDIES THE
PIPELINE IS YOU HAVE
PARTICIPANTS COME FASTED.
YOU DO AN ACUTE INTERVENTION AND
GIVE THEM THE FEST FOOD AND THEN
YOU MEASURE THE BIO FLUIDS AT
SEVERAL TIME POINTS OVER A
PERIOD OF A DAY.
AND THEN YOU RUN OMICS ON THESE
BIOMARK
BIOMARKERS AND LOOK AT THE
PHARMACO KINETICS AND HOW IT
CLEARS OUT AND THIS IS ONE THAT
WAS DONE IN THE INTERMAP STUDY.
YOU CAN SEE THE OBJECTIVE
BIOMEDICAL FOR CITRUS FOOD
INTAKE IS CLEARED WITHIN 24
HOURS AND THE BIOMARKER IS OUT
AFTER CONSUMPTION.
THIS BECOMES IMPORTANT BECAUSE
THE RELEVANT EXPOSURE IS THE
USUAL DIET.
WHAT DO PARTICIPANTS CONSUME ON
AVERAGE.
MOST OF MY WORK IN BIOMARKER
DISCOVERY FOCUSSED ON DATA USING
OBSERVATIONAL STUDIES ESPECIALLY
THOSE IN THE HARVARD COHORTS,
THE NURSES HEALTH STUDY 1 AND 2
AND FOLLOW-UP STUDY.
SO WE ALREADY HAVE DIET MEASURED
ON A POPULATION USING A
COMBINATION OF FOOD FREQUENCIES,
24-HOUR RECALLS AND SOME
RECORDS.
WE CATEGORIZE THEM INTO LOW AND
HIGH CONSUMERS OF EITHER
NUTRIENT OF FOOD OR DIETARY
PATTERN.
ON THE RIGHT YOU SEE THE PIE
CHART.
THIS IS ACTUALLY A METABOLOMIC
SIGNATURE AND YOU RUN OMICS ON
ARCHIVED PLASMA SAMPLES AND YOU
RUN SAMPLES AND IDENTIFY
BIOMARKERS AND TEST FOR THE
SENSITIVITY AND WE IDENTIFIED A
PANEL OF 63 BIOMARKERS.
THE ADVANTAGE WITH THE
MULTI-METABOLITE BIOMARKERS CAN
INCREASE THE ACCURACY AND
PRECISION OF YOUR DIETARY TOOL.
AND AS I SAID BEFORE IT'S ALSO
IMPORTANT THESE BIOMARKERS HAVE
A SUFFICIENT HALF LIFE BECAUSE
AS YOU RECALL, THE MOST
IMPORTANT EXPOSURE OF
EPIDEMIOLOGY IS LONG-TERM DIET.
SO IF YOU HAVE A BIOMARKER THAT
IS CLEARED FROM YOUR SYSTEM
WITHIN 24 HOURS YOU WANT
REPEATED MEASURES OF THIS
BIOMARKER.
AND ANOTHER THING IS FOODS WE
CONSUME ARE HIGHLY CORRELATED.
YOU RUN TO THE RISK OF
IDENTIFYING BIOMARKERS WITH LOW
SPECIFICITY.
ANOTHER EXAMPLE WAS WHEN WE WERE
LOOKING AT COFFEE BIOMARKERS IN
OUR SAMPLE AND THE BIOMARKER
THAT POPPED UP WAS A NICOTINE
METABOLITE.
IF YOU THINK ABOUT COFFEE AND
THE BEHAVIORS THAT TRAVEL WITH
COFFEE, SMOKING IS A BEHAVIOR
THAT TRAVELS WITH COFFEE.
YOU HAVE TO MAKE SURE YOU
UNDERSTAND HOW FOODS ARE
CONSUMED, THE BEHAVIORS THAT
TRAVEL WOMEN -- WITH THE IT AND
CONTROL FOR THOSE.
SOME ISSUES USING OMIC
TECHNIQUES IS THE PARTICIPANT
METABOLOMIC VARIATION.
THIS CAN BE PERCEIVED AS AN
ADVANTAGE AS WELL BECAUSE OMICS
ALLOWS YOU TO CAPTURE THE
PARTICIPANT VARIATION WHICH
DIETARY ASSESSMENT TOOLS CANNOT.
AND THEN YOU ALSO HAVE
BIOMARKERS WHERE THERE ARE
MODULATIONS AGAINST RELATIVELY
LOW DOSES OF FOODS OR NEWT
REPRESENTS.
AGAIN GOING BACK TO THE ISSUE OF
METABOLITES HAVING A SHORT HALF
LIFE WHICH MAY NOT REPRESENT
USUAL INTAKE AND ARE THE
BIOMARKERS SENSITIVE TO THE
FOOD?
IS THE BIOMARKER SPECIFIC TO THE
FOOD AND LOW SPECIFICITY IS A
MAJOR ISSUE IN NUTRITIONAL
EPIDEMIOLOGY BIOMARKER DISCOVERY
AGAIN BECAUSE OF HOW
INTERCORRELATED FOODS ARE.
THEN IS IT EASY TO MEASURE?
IF YOU LOOK AT THE GRAPH DOWN
HERE, THIS IS A BIOMARKER FOR
VITAMIN A AND PLASMA RETINOL AND
YOU CAN SEE IT PLATEAUS.
THERE'S A LINEAR RELATIONSHIP AT
A LOW LEVEL OF INTAKE.
AND IF YOU LOOK AT THE PLATEAU,
THAT'S THE NORMAL RANGE OF
INTAKE AND IF YOU USE RETINOL AS
A BIOMARKER FOR VITAMIN A
SUFFICIENT POPULATION IT'S NOT
GOING TO WORK BECAUSE ALL YOU
SEE IS A PLATEAU.
THE OTHER ISSUE OR IMPORTANT
THING TO DO IS THE BIOMARKERS WE
IDENTIFY FROM OBSERVATIONAL
STUDIES AND ACUTE FEEDING
STUDIES HAVE TO BE VALIDATED IN
MEDIUM AND LONG-TERM
INTERVENTION STUDIES.
THAT'S CRITICAL BECAUSE WE'RE
DEALING WITH HIGH DIMENSIONAL
DATA.
AGAIN URINE OR SERUM SAMPLE
CANNOT CAPTURE THE TRUE
VARIATION INDICT AND LONG-TERM
PATTERNS WHICH IS WHAT WE'RE
REALLY INTERESTED IN NUTRITIONAL
EPIDEMIOLOGY.
ALSO KNOWING THAT THE
CONCENTRATIONS OF METABOLITES
ARE NOT ONLY EFFECTED BY DIET
BUT BY THE GUT MICROBIOME AND
UNDERSTANDING THAT VARIABILITY
IS VERY IMPORTANT.
SO IN THINKING ABOUT THE KEY
GAPS OR WHERE THE RESEARCH
SHOULD BE HEADED, MUCH OF WHAT
WE GET IN TERMS OF OMIC DATA IS
QUANTIFICATION OF METABOLITES OR
WHATEVER THE OMIC TECHNOLOGY IS.
SO WE LOOK AT ABSOLUTE
QUANTIFICATION.
GIVEN THIS IT'S HARD TO COMPARE
BIOMARKERS FROM ONE STUDY TO
ANOTHER BECAUSE IT'S ALL
RELATIVE QUANTIFICATION.
SO THERE'S AN URGENT NEED TO
ESTABLISH REFERENCE INTERVALS
BASED ON ABSOLUTE QUANTIFICATION
RATHER THAN OTHER QUANTIFICATION
WHEN WE LOOK AT MULTI-METABOLITE
PANELS TEA IMPORTANT TO LOOK AT
THE SPECIFICITY OF THE BIOMARKER
TO THE FOOD AND WHEN YOU LOOK AT
CERTAIN FOOD IS IT BECAUSE WE'RE
LOOKING AT RICE AS BIOMARKERS OF
RICE IS IT REALLY A BIOMARKER
BECAUSE YOU'RE CONSUMING MORE
RICE OR BECAUSE YOU'RE CONSUMING
LESS OF ANOTHER FOOD?
GIVEN THE HIGH DIMENSIONAL
NATURE OF THE WORK IT'S
IMPORTANT TO HAVE ADEQUATE
STATISTICAL POWER WITH
INDEPENDENT REPLICATION AND
DIVERSE COHORTS.
OFTEN WE SEE THE SAME BIOMARKER
THAT WE SEE IN SAY U.S. COHORTS
WHEN WE REPLICATE THEM AND SAY A
SOUTH ASIAN COHORT IT'S A VERY
DIFFERENT BIOMARKER.
CASE IN POINT A METABOLITE THAT
COMES FROM COFFEE CONSUMPTION IN
U.S. COHORTS BUT WHEN WE LOOK AT
IT IN HISPANIC OR SOUTH ASIAN
POPULATIONS IT COMES FROM
LEGUMES.
SO UNDERSTANDING AGAIN THE
SOURCES OF THESE METABOLITES OR
DIETARY BIOMARKERS IN DIFFERENT
POPULATIONS AND RECOGNIZING THAT
THEY CAN VARY IS IMPORTANT AND
FINANCE THIS GOES BACK TO THE
SPECIFICITY OF THE BIOMARKER TO
THE FOOD.
AGAIN IT'S IMPORTANT TO LOOK AT
METHODS AND WE'VE DONE SOME WORK
WITH THIS WITH METABOLOMICS.
WE HAVE MANY PLATFORMS AND
COMPANIES.
HOW WELL DO THEY COMPARE IF
YOU'RE LOOKING AT PROTEOMICS AND
HAVE HOW THEY COMPARE AND HOW DO
THE DATA MATCH IS IMPORTANT.
GIVEN THE ERA OF MULTI-OMICS AND
REALIZE COMBINING MORE OMIC
MEASURES CAN IMPROVE SPECIFICITY
BUT WHAT DO THE DATA MEAN?
UNDERSTANDING WHAT THE MULTI-OME
YOU CAN MEASURES MEAN AND ARE
THEY EASY TO MEASURE.
AND PUTTING TOGETHER A
CONSORTIUM IS IMPORTANT.
WE WERE FUNDED BY THE NIDDK AND
ESTABLISHED THE DIETARY
BIOMARKER DEVELOPMENT
CONSORTIUM.
WE HAVE THREE SITES.
THIS IS SIMILAR TO THE FOOTBALL
CONSORTIUM THE ALLIANCE
CONSORTIUM IN EUROPE WHICH HAS
CONCLUDED.
THE DBDC WAS FUNDED BY THE USDA
AND NIDDK AND WERE TASKED WITH
IDENTIFYING BIOMARKERS OF FOODS
FROM ME MY LATE.
AT HARVARD WE'RE LOOKING AT
DIETARY MARKERS FOR FOUR MAJOR
CARBOHYDRATE FOODS IN THE
U.S. AND FOUR MAJOR PROTEIN
FOODS IN THE U.S.
WE USE THE NHANES TO CHOOSE OUR
FOODS.
FRED HUTCH IS LOOKING AT A
DIETARY PATTERN AND DAVIS IS
FOCUSSING ON FRUITS AND
VEGETABLES AND DUKE IS OUR DATA
COORDINATING CENTER.
AND WITH THAT I'M HAPPY TO
TAKE -- I THINK WE SAVE
QUESTIONS FOR THE END.
THANK YOU ALL.
>> THANK YOU, DR. BHUPATHIRAJU
FOR THE GREAT PRESENTATION OF
THE CUTTING EDGE SCIENCE AND
NUTRITION PRECISION MEASURES AS
THEY MAY BE APPLICABLE TO USE AS
BIOMARKERS TO INDICATE DIETARY
QUALITY AND COMPOSITION.
I THINK WE'LL TAKE QUESTIONS
DURING THE PANEL DISCUSSION
SESSION.
AND WE'LL MOVE TO OUR NEXT
SPEAKER DR. JUSTIN OLDHAM.
A CLINICAL ASSOCIATE PROFESSOR
AT UNIVERSITY OF MICHIGAN AND
HE'S GOING TO TALK TO US ABOUT
DIETARY METABOLITES PREDICTIVE
OF LUNG HEALTH AND DISEASE.
>> THANK YOU.
I'M SO LUCKY TO GIVE A TALK
AFTER DR. BHUPATHIRAJU BECAUSE
SHE REALLY SET THE STAGE FOR
WHAT I'M GOING TO TALK ABOUT AND
HOPEFULLY I CAN BUILD ON HER
FANTASTIC TALK.
I'M AN ASSISTANT PROFESSOR AT
UNIVERSITY OF MICHIGAN AND
COMPLETED MY Ph.D. IN
EPIDEMIOLOGY.
I LIKE TO OPERATE AT THE
INTERSECTION OF EPIDEMIOLOGY AND
NUTRITION AND TRY NOT TO GO DOWN
THE EPIDEMIOLOGY RABBIT HOLE BUT
FOCUS MORE ON HIGH LEVEL
METABOLOMIC WORK BEING DONE AND
INDIVIDUAL METABOLITES AND HOW
THEY ARE POTENTIALLY INFORMATIVE
FOR PREDICTING LUNG HEALTH AND
DISEASE.
THESE ARE MY DISCLOSURES.
INTERESTINGLY I'M NOT A
METABOLOMIC RESEARCH I'M A
PROTEOMIC RESEARCHER IN FIBROTIC
LUNG DISEASE.
SO I'M NOT GOING TO SHOW MY OWN
WORK BUT SHOW NICE WORK DONE
ELSEWHERE AND PULL IN LESSONS
LEARN FROM MY PROTEOMIC RESEARCH
IN NUTRITION.
AND DR. BHUPATHIRAJU MENTIONED
THIS AND I'LL TRY TO EXPAND ON
THIS A LITTLE BIT.
WE'RE INTERESTED IN SOME TRUE
DIETARY INTAKE AS AN EXPOSURE
AND OUR OUTCOME BEING SOME
MEASURE OF LUNG HEALTH.
WE DON'T KNOW THE EXACT DIETARY
INTAKE.
WHAT WE OFTEN DO IS RELY ON
INTAKE AND SAW STANDARD
QUESTIONNAIRE USED IN THE PRIOR
TALK.
THERE'S MEASUREMENT ERROR BY
QUESTIONNAIRE AND INTAKE OF ANY
MEASURE AND SO IT CAN INTRODUCE
NOISE AND STILL HAS A BIASSED
EXPOSURE OUTCOME RELATIONSHIP.
THE PROBLEM ARISES WHERE THE
OUTCOME IMPACTS THE PRESSURE FOR
YOUR INTAKE AND WE DEVELOP
INFORMATION BIAS.
THIS IS A LESS BENIGN FORM
WHEREBY YOUR OUTCOME IS
IMPACTING OUR MEASUREMENT ERROR
WHICH IS THEN LEADING TO A
BIASSED RELATIONSHIP BETWEEN
YOUR EXPOSURE AND OUTCOME.
THIS CAN BIAS YOUR ASSOCIATION
YOU IDENTIFY TOWARDS OR AWAY
FROM THE NUL.
SAY WE HAVE FAT INTAKE AS A
MEASUREMENT WHICH HAS BEEN
STUDIED AND EMPHYSEMA COWL BE AN
OUTCOME WE'LL LEAVE FOR NOW.
AGAIN WE HAVE OUR REPORTED FAT
INTAKE.
YOU CAN'T MEASURE EXACTLY WHAT
THE FAT INTAKE IS BUT RELY ON
WHAT'S REPORTED AND HAVE THE
MEASUREMENT ERROR.
WHAT WE KNOW ABOUT EMPHYSEMA IS
PEOPLE WILL GET HYPOXEMIC AS IT
PROGRESSES AND IT CAN IMPACT
YOUR RECALL AND HOW MUCH FAT YOU
TOOK IN BECAUSE WE KNOW BRAIN
FUNCTION IS NOT AS GOOD WHEN
HYPOXIC ENVIRONMENTS AND
DEMENTIA IS HIGHER IN THOSE
INCIDENTS SO IT'S PLAUSIBLE THIS
OUTCOME OF INTEREST THROUGH THIS
MEDIATOR OF HYPOXEMIA IMPACT OUR
ERROR FOR FOOD INTAKE AFFECTS
THE EXPOSURE OUTCOME.
THIS PARTICULAR FORM WHICH WAS
ALLUDED TO IN THE PRIOR TALK AND
BIASSING OUR OUTCOME AND THIS IS
A BIG PROBLEM IN NUTRITION
RESEARCH.
AND SO INCOME BIOMARKERS AND
DIETARY METABOLITES IN
PARTICULAR COULD POTENTIALLY
OVERCOME SOME OF THIS PROBLEM
WHEREBY WE HAVE OUR TRUE DIETARY
INTAKE.
WE NOW HAVE RATHER THAN REPORTED
DIETARY INTAKE WE HAVE MEASURED
DIETARY METABOLITES AND STILL
HAVE MEASUREMENT ERROR BECAUSE
THERE'LL BE MEASUREMENT ERROR
FOR ANYTHING BUT HOPEFULLY A
MANAGEABLE OF ERROR IN A WAY
THAT DOES NOT INTRODUCE BIAS
ITSELF.
SO EVEN THOUGH WE HAVE SOME
MEASUREMENT ERROR WE'RE
HOPEFULLY STILL USING THE
APPROACH OVERCOMING THE RECALL
BIAS AND OBTAINING UNBIASSED
MEASURE OF THE RELATIONSHIP.
THERE'S OTHER TYPES OF BIAS THAT
CAN BE INTRODUCED I'LL GET TO IN
A LITTLE BIT BUT THAT'S THE
IDEA.
SO WHICH DIETARY METABOLITES ARE
WE INTERESTED IN?
SORT ANSWER IS I DON'T KNOW.
THERE'S A LOT PUBLISHED THAT
CERTAINLY SEEM LIKE A GOOD PLACE
TO START AS WE HEARD THE
METABOLOMIC APPROACHES WILL
OVERCOME THE EARLIER TARGETED
STUDIES.
AND STARTING WITH SINGLE LIPIDS
THESE ARE SOME OF THE BEST
STUDIED METABOLITES AND THIS IS
JUST WHAT HAPPENS IN A DOSE WAY
RESPONSE AND THE AIRWAY GOES UP
AND WHEN YOU EXPOSE THE CELLS TO
CHOLINE YOU SEE A MORE
HYPERRESPONSIVENESS AS MEASURED
BY FORCE IN THE D PANEL THERE.
SO THAT'S IN ASTHMA.
ON THE RIGHT IS EMPHYSEMA FROM
THE COPD INVESTIGATE EORS THIS
A COHORT STUDY AND THIS GROUP IN
CROSS SECTION ASSESSED
RELATIONSHIP WITH SEVERITY OF
COPD.
THIS COULD RUN INTO POTENTIAL
ISSUES I'LL DISCUSS LATER BUT AT
LEAST IN CROSS-SECTION WE DO SEE
THERE APPEARS TO BE SOME DEGREE
OF DOSE RESPONSE BETWEEN SEVERAL
OF THE METABOLITES AND THE
SEVERITY OF EMPHYSEMA.
FOR FATTY ACID METABOLITES WE
KNOW CIGARETTE SPOKE CAN AFFECT
METABOLISM AND WHEN THAT OCCURS
WE SEE THERE'S PROBABLY
INCREASED IN APOPTOSIS.
THERE'S INTERACTION BETWEEN
CIGARETTE SPOKE AND APOPTOSIS SO
INDIVIDUALS WITH COPD MAY HAVE
CELL TURNOVER AS A BIPARTISAN OF
THIS IMPACT ON THE FATTY ACID
METABOLISM ON THE RIGHT IS
SOMETHING MORE IN MY WHEELHOUSE
PART OF OUR PRECISIONS TRIAL
ASSESSING A HANDFUL OF DIFFERENT
OMEGA 3 FATTY ACIDS FROM
PATIENTS FROM THE PULMONARY
FIBROSIS STUDY AND FOUND A
HANDFUL OF THE DIFFERENT OMEGA 3
FATTY ACIDS WERE FOUND TO CHANGE
LING FUNCTION.
-- LUNG FUNCTION.
THIS CHANGES THE GAS TRANSFER
WHICH IS HOW IT CROSSES IN THE
BLOOD.
AND THIS FIGURE IS ONE OF SELF I
CHOSE BECAUSE IT SHOWS A NICE
DISK RESPONSE BUT IT'S A
COMPOSITE MEASURE YOU SEE THE
STEP WISE IN THE COMPOSITION
RELATED TO THE COMPOSITION.
THE SMOKERS INTERESTINGLY HAD A
DIFFERENT PATTERN THERE AND THE
LAST TWO PANELS ARE LONGITUDINAL
MEASURES.
I DIDN'T WANT TO GET INTO
INTERVENTIONAL TRIALS BECAUSE WE
HAVE AN AFTERNOON OF THAT BUT
WANTED TO HIGHLIGHT THE L
CARNTINE GIVEN TO PREMATURE
INFANTS AND I'LL HIGHLIGHT THE
SECOND AND THIRD ROWS THAT THEY
HAD LESS DAYS ON THE VENTILATOR
WHICH IS A CRITICAL OUTCOME IN
THE RESEARCH.
SO RESEARCH GAPS.
I MENTIONED RECALL BIAS EARLIER
AND THERE'S ANOTHER BIAS
INHERENT TO CROSS SECTIONAL
STUDIES WHEREBY YOU GET REVERSE
CAUSATION AND THERE CAN BE
IMPACTS ON THE MEASUREMENT ERROR
WITH YOUR METABOLITES IN
FIBROTIC LUNG DISEASE, DISEASE
SEVERITY IS ACTUALLY A STRONG
CONFOUNDER BETWEEN BIOMARKER
LEVEL AND OUTCOME.
WE NEED TO KEEP THIS IN MIND
ESPECIALLY IN CROSS SECTIONAL
STUDIES.
THE OTHER ISSUE IS CONFOUNDING.
HYPOXEMIA CAUSES EVENTS
THROUGHOUT THE BODY, PULMONARY
AND NEUROLOGIC THAT WILL AFFECT
YOUR DIETARY METABOLITE LEVELS.
AND LOOK AT HOW CAUSAL DIAGRAMS
ASSESS HOW WELL THE METABOLITES
PREDICT OUTCOMES.
NEXT IS A LOT OF WHAT I'VE SHOWN
HAVE BEEN INDIVIDUAL
METABOLITES.
IT'S IMPORTANT TO KEEP IN MIND
NONE OF THIS HAPPENS IN A
VACUUM.
THIS IS AN EDITORIAL SHOWING
INFORMATION THAT SOME OF THEIR
METABOLITES YOU GET HIGHER
RESPONSIVENESS AND GET
REMODELLING AN KEEPING UNMIND
INDIVIDUAL METABOLITES MAY NOT
BE THE ANSWER BUT HOW THEY
INTERACT WITH OTHER METABOLITES.
A FOCUS ON ONE METABOLITE WILL
PROBABLY PAINT A MISLEADING
PICTURE AND WE NEED TO
UNDERSTAND HOW THEY FIT NEXT IT
ONE ANOTHER AND WHAT THEIR
IMPACT IS RELATIVE TO ONE
ANOTHER.
FINALLY FROM THE STUDY I SHOWED
ASSESSING THESE IN CROSS SECTION
PROBABLY IGNORES THE TEMPORAL
IMPORTANCE OF UPSTREAM AND DOWN
STREAM EFFECTS OF ANY ONE
METABOLITE.
OUR KEY OPPORTUNITIES AND
RESEARCH QUESTIONS FROM THE
CHICKEN OR THE EGG QUESTION IS
WE HAVE THESE NICE LUNG FOCUSSED
COHORTS, COPD AND MESA AND A NEW
INDUSTRY STUDY I'M LEADING
CALLED PRIME PROGRESSIVE
PULMONARY FIBROSIS WHICH WILL
HOPEFULLY HAVE NHLBI INVOLVEMENT
AT SOME POINT AND THESE ARE
PROSPECTIVE COHORT STUDIES WITH
CLINICAL DATA AND BIO SPECIMENS.
WE HAVE A GOOD OPPORTUNITY USING
THE BIO SPECIMENS WITH THE
ADVANCE IN METABOLOMICS TO GET
AROUND THE CROSS-SECTIONAL
STUDIES AND GETTING A STRONGER
SENSE AS TO POTENTIAL CAUSATION
JUST BECAUSE WE KNOW THE BLOOD
DRAW IS OCCURRING BEFORE THE
OUTCOMES AND WE HAVE MORE
GRANULAR CLINICAL DATA THAT'S
GOING TO INCREASE CONFIDENCE THE
BIOMARKERS ARE MEASURING A TRUE
OUTCOME.
>> TWO MINUTES REMAINING.
>> AND FINALLY WITH THESE WELL
DESIGN COHORT STUDIES LEADS TO
CLINICAL TRIALS WE'LL HEAR ABOUT
LATER BUT IF WE'RE LOOKING TO
BLOCK A CERTAIN METABOLITE OR
AUGMENT A CERTAIN METABOLITE
IT'S THE NATURE NEXT STEP FROM
WELL DESIGN COHORT STUDIES.
AND I THINK IT REMAINS UNCLEAR
AT THIS POINT BASED ON THE
AVAILABLE DATA WHETHER A
DEFICIENCY OR OVER ABUNDANCE OF
THESE REPRESENTS A CAUSAL
RELATIONSHIP ONE THE OUTCOMES.
BUT AS WE HEARD PREVIOUSLY I
THINK IN A MORE ELEGANT FASHION
THERE'S RAPID ADVANCES IN
METABOLOMIC INVESTIGATION AND
THE PLATFORMS AND THE ABILITY TO
GENERATE HIGH THROUGHPUT DATA
FROM THE GENOMIC AN PROTEOMIC
AND TRANSCRIPTOMICS TOO
STANDPOINT WILL MEASURE
NUTRITIONAL EXPOSURES AND START
TO PICK APART WHICH ONES ARE
MOST IMPORTANT, HOW THEY
INTERACT WITH OTHERS.
CERTAINLY PROVIDES AN OBJECTIVE
MEASURE ABLE TO AFFECT THE
RECALL BIAS AND NEED TO LEVERAGE
COHORT STUDIES IN EXISTENCE AND
THIS WILL SET THE STAGE FOR
HOPEFULLY INTERVENTIONAL TRIALS
TARGETING THE METABOLITES.
I'LL FINISH THERE AND THANKS FOR
YOUR ATTENTION.
>> THANK YOU SO MUCH.
NEXT I WANT TO WELCOME
DR. MACHADO BACK TO THE STAGE TO
SPEAK TO GIVE A TALK ON BOD MASS
RELATE -- BODY MASS RELATED
MARKERS PREDICTING OUTCOMES OF
RESPIRATORY DISEASES.
>> DURING MY Ph.D. I CONDUCTED
STUDIES ON BODY MASS RELATED
MARKERS ON RESPIRATORY DISEASE.
THAT'S GOING TO BE MY TOPIC AND
THANK YOU FOR THE OPPORTUNITY TO
BE HERE AND TALK A LITTLE BIT
ABOUT THIS INTERESTING TOPIC.
SO I'D LIKE TO BEGIN BY
DISCUSSING A SINGLE BIOMARKER OF
THE BODY MASS INDEX AND OVER 20
YEARS AGO A RESEARCH GROUP FROM
DENMARK SHOWED BMI AFFECTS BOTH
COPD IN MEN AND WOMEN AND WE CAN
ALSO SEE THERE WAS THIS LINK
BETWEEN BMI AND SURVIVOR WAS
DIFFERENT DEPENDING ON THE STAGE
OF THE DISEASE.
THE PATIENTS WITH COPD WAS MORE
SEVERE WE SEE HIGHER IMPACT OF
BEING UNDER WEIGHT.
IN COMPARISON WITH THOSE WITH
MODERATE OR MILD COPD.
AND A FEW YEARS LATER IN
2004BM200
2004BMIVE -- 2004, BMI WAS USED
TO PREDICT THE RISK OF DEATH
WITH THOSE IN COPD AND THIS IS
MORE CLOSELY RELATED OR
ASSOCIATED WITH MORTALITY THAN
THE STAGE OF THE DISEASE.
WE CAN ALSO SEE AND THE
CONTRIBUTION TO THE BMI INDEX IS
RATHER LOW.
IT CAN BE ATTRIBUTED TO BMI OR
LUNG FUNCTION OR EXERCISE
CAPACITY.
IT'S RAISED THE IMPORTANCE OF
LOOKING AT PATIENTS AND WE HAVE
A CLEAR UNDERSTANDING ABOUT THE
MUTATIONS OF BMI AND WE CAN SEE
IF WE APPLY BMI IN THE GROUP OF
PATIENTS WITH COPD AND LOOK AT
DATA FROM MORE THAN 50,000
PATIENTS WITH COPD FROM THE U.K.
BIO BANK.
WE'LL IDENTIFY LESS THAN 1% WITH
A FEEPT.
WHEN WE LOOK AT THE
-- WITH THE PHENOTYPE AND
PATIENTS CAN BE CLASSIFIED AND
IN PANEL C AND B WE OBSERVE D
CLASSIFIED THE PATIENTS AND WAS
ASSOCIATED WITH COPD RELATED
DEATH.
AND IT'S IMPORTANT TO LOOK AT
BODY MASS MARKERS TO BETTER
UNDERSTAND THE RACE MARKERS ON
DIFFERENT OUTCOMES IN THE
RESPIRATORY DISEASE.
THIS APPROACH OF INTEGRATING
DIFFERENT MARKERS IS ILLUSTRATED
IN THE FIGURE THAT IS FROM THE
NUTRITIONAL RISK FROM THE
STATEMENT ON NUTRITIONAL
ASSESSMENT AND THERAPY IN COPD.
THE THERE'S THREE MAIN PARKERS
AND THIS THOSE THE MARKERS UNTO
ACT AND ARE ASSOCIATED WOMEN
OUTCOMES WITH INCREASED
CARDIOVASCULAR RATES OR
DECREASED PHYSICAL PERFORMANCE
AND THIS ALSO HIGHLIGHTS THE
PRESENCE OF LOW MUSCLE MASS WAS
FOUND IN PATIENTS AS SHOWN BY
THE RECENT RELEASE OF THE FIRST
LOOKING AT OBESITY AND ONE
ASPECT IS LOW MUSCLE MASS IN
OBESITY.
THIS CAN BE CHALLENGING.
IN THIS STUDY WE FOUND THAT WE
CANNOT USE THE SAME FOR MUSCLE
MASS AS FOR PATIENTS WITH COPD
WHICH WE NEED TO APPLY BMI AND
LOW MUSCLE MASS IN THE BMI
GROUPS.
THIS FIGURE SHOWS THE MAIN
RESULTS OF OUR STUDY AND WE CAN
REVIEW IT WHEN WE AND IF WE
FOUND BLACK AND GRAY BARS WE CAN
SEE THEY DECREASED FROM LEFT TO
RIGHT AND THAT BASICALLY MEANS
AS THE BMI INCREASES THE
PRESENCE OF LOW MUSCLE PASS
DECREASES OR IS NOT POSSIBLE TO
IDENTIFY WHEN WE USE BMI
SPECIFIC GROUPS AND WE FOUND
BLACK BARS THE BMI SPECIFIC WE
SEE THE PREVALENCE OF MUSCLE
MASS IS SIMILAR AMONG THE
DIFFERENT BMI.
FOLLOWING THE STUDY WE HAVE A
COHORT OF PATIENTS WITH COPD.
THEY'RE COMING FROM A STUDY IN
GERMANY AND WE AGAIN CONFIRMED
USING BMI HELPS TO IDENTIFY
THOSE OVERWEIGHT AND OBESE
PATIENTS WITH LOW MUSCLE MASS.
THE PATIENTS WITH LOW FAT INDEX
IRRESPECTIVELY OF THEIR BMI
GROUPS REFLECT A REDUCED
EXERCISE CAPACITY AS
DEMONSTRATED BY LOWER WALKING
DISTANCE AND HIGHER SCORE
REPRESENTING A WORSE QUALITY OF
LIFE IN THOSE PATIENTS.
WE ALSO HAVE DATA SHOWING THE
INTENTIONAL WEIGHT LOSS WHICH IS
A KEY COMPONENT IN THE FINAL
PANEL B AND DID ON THE LEFT THE
PREVALENCE IS DISTRIBUTED ACROSS
THE DIFFERENT STAGES OF THE
DISEASE AND PATIENTS WITH
OVERWEIGHT AND OBESITY AND THE
FIGURE ON THE RIGHT IF WE FOCUS
ON PANEL B YOU CAN SEE RATES ARE
HIGHER IN PATIENTS WITH WEIGHT
LOSS HAVE A HIGHER RISK OF
MORTALITY COMPARED TO THOSE WITH
COPD WITH STABLE BODY WEIGHT AND
COMPARING PANELS A, B AND C WE
CAN CONCLUDE WEIGHT LOSS WHETHER
CONSIDERED ALONE OR INCORPORATED
IN THE DIAGNOSIS OF PROTECTION
IS ASSOCIATED WITH OUTCOME IN
PATIENTS WITH COPD.
WE CAN ALSO CONSIDER TRACKING
BODY COMPOSITION OVER TIME WE
FOLLOWED PATIENTS SMOKING AND
NON-SMOKING AND USED THE DEXI
SCAN AND AFTER TWO YEARS YOU CAB
SEE THE PATIENTS WITH COPD AND
THOSE PARTICIPANTS FROM THE
SMOKING CONTROLLED GROUP SHOWED
SIGNIFICANT DECLINE OVER TWO
YEARS ESPECIALLY COMPARED WITH
NON SMOKING ATROPHY AND
IDENTIFIED A SUB GROUP WITH
THOSE AT BASELINE AND AND A
DECLINE ON FAT MASS DURING THE
TWO YEARS.
AND DON'T UNDERSTAND WHETHER THE
GROUP ALSO HAS A WORSE
PROGNOSIS.
THIS IS THE FIRST RESEARCH GAP
THAT I'VE IDENTIFIED.
THERE'S OTHER CURRENT GAPS AND
OPPORTUNITIES ASSOCIATED WITH
THE CURRENT GAP.
I THINK CURRENTLY THERE'S
INEFFICIENT EVIDENCE ON THIS
INTERPLAY BETWEEN BODY RELATED
MARKERS UNPREDICTING ADVERSE
OUTCOME AND WE HAVE THE
OPPORTUNITY TO CONDUCT
LONGITUDINAL STUDIES WITH
LONG-TERM FOLLOW-UP AND THE
RESEARCH IS ON HOW TO ADAPT
METHODOLOGIES AND LOOK AT THE
SELECTION OF MUSCLE MASS
VARIABLES AND SHOULD WE IDENTIFY
LOW MUSCLE MASS IN INDIVIDUALS
WITH OBESITY.
I THINK THE ALGORITHM COULD BE
AN OPPORTUNITY SINCE WE CAN TEST
THE DIAGNOSTIC PERFORMANCE OF
THIS APPROACH.
FINAL HI THERE'S RESEARCH ON HOW
TO TAILOR REHABILITATION TO LOOK
AT PATIENTS IN TERMS OF DIET AND
SKERS AND THERE'S AN OPPORTUNITY
FOR RANDOMIZED TRIALS FOR
INTERVENTIONS.
AND FINALLY THERE REMAINS
UNCERTAINTY WHETHER IDENTIFYING
THE BODY MASS RELATED MARKERS
WILL LEAD TO MEANINGFUL CHANGE
IN THE COURSE OF THE DISEASE.
SO WE ALSO NEED TO FOCUS ON
INTERVENTION STUDIES WITH
LONG-TERM FOLLOW-UP TO ANSWER
THE QUESTION.
THAT'S THE END OF MY
PRESENTATION AND THANK YOU FOR
YOUR ATTENTION.
I CAN INTRODUCE THE NEXT SPEAKER
MELODY DUVALL ASSISTANT
PROFESSOR AT HARVARD MEDICAL
SCHOOL.
>> WONDERFUL.
MANY THANKS TO THE NHLBI FOR
ORGANIZING THE WORKSHOP AND
THANK YOU FOR THE OPPORTUNITY TO
SPEAK TO YOU TODAY.
I'LL SPECIAL ON SPECIALIZED PRO
RESOLVING MEDIATORS ON
PREDICTING RESPIRATORY DISEASE
AND HAVE NO CONFLICTS TO
DISCLOSE.
IN REVIEWING EVERYDAY FOR
PREVENTION OF RESPIRATORY
DISEASE THROUGH DIETARY
SUPPLEMENTATION AND HIGHLIGHT
THIS STUDY IN THE NEW ENGLAND
JOURNAL FROM 2016 IN THIS DOUBLE
RANDOMIZED CONTROL TRIAL WOMEN
RECEIVED A PLACEBO IN THIRD
TRIMESTER AND CHILDREN FOLLOWED
TO ABLE 5 YEARS.
MATERNAL SUPPLEMENTATION REDUCED
THE RISK OF WHEEZE OR ASTHMA IN
THEIR CHILDREN WITH OMEGA 3 AND
DRIVEN ALMOST EXCLUSIVELY WITH
CHILDREN OF MOTHERS WHO HAD THE
LOWEST BLOOD LEVELS OF THESE
RANDOMIZATION IN THE LEFT GRAPH.
IN THIS SUBGROUP ANALYSIS, THE
RISK OF PERSISTENT WHEEZE IN
THIS GROUP OF CHILDREN WAS
REDUCED BY HALF.
FURTHER, MATERNAL PROOF OF
SUPPLEMENTATION REDUCED THE RISK
OF RESPIRATORY TRACK INFECTIONS
IN FOLLOW-UP OF 5 YEARS OF THE
CHILDREN AND LOOKED AT
MECHANISTIC UNDER PINNINGS.
THE ACIDS MEDIATED BRONCO
CONSTRICTION AND FISH OILS
DISPLAY THE ACID IN PHOSPHO
LIPIDS AND CONVERTED TO PRO
RESOLVING MEDIATORS DAMPENING
RESPONSIVE.
AND PROMOTE THE RESOLUTION OF
INFLAMMATION.
ACUTE INFLAMMATION IS VITAL TO
HUMAN HEALTH AND IT PROCEEDS
UNAN ACTIVELY REGULATED SERIES
OF BIOLOGICAL PROCESSES MEDIATED
BY CLASS SWITCHING.
IN HEALTH A RAPID HOST RESPONSE
RESULTS IN EDEMA WITHIN SECONDS
AT THE SITE.
INFLAMMATORY MEDIATORS
PHYSIOLOGICALLY MEDIATE THE
REDNESS, SWELLING, WARMTH AND
CHEMO TRACTANTS OF NEUTROPHILS
THAT SWARM TO THE INFLAMMATION
THROUGH PHAGOCYTOSIS AND BIO
SYNTHESIS WITH PRO RESOLVING
ACTIVITY WITH K CELLS AND
MACROPHAGES TO RESTORE
HOMEOSTASIS.
THIS SUPER FAMILY OF PROTECTANTS
COMPRISES MORE THAN 30 DISTINCT
MEDIATORS THAT HAVE
ANTI-INFLAMMATORY PROPERTIES TO
BLOCK LEUKO TRIIN PRODUCTION AND
HALT NEUTROPHIL RECRUITMENT AS
WELL AS PRO RESOLVING FUNCTION
TO RECRUIT MONOCYTE AND
STIMULATE PHAGOCYTOSIS.
THE SIGN OF INFLAMMATION WAS
CITED IN THE FIRST CENTURY,
FEVER, EDEMA AND SENSE OF
FUNCTION.
AND WE BEGAN TO APPRECIATE THE
RESOLUTION OF RESOLUTION IS
CHARACTERIZED BY SPECIFIC CA
CARDINAL PROCESSES AND REMOVAL
OF DEAD CELLS AND DEBRIS AND
TISSUE PROFUSION AND
REGENERATION OF TISSUE,
REMISSION OF FEVER AND RELIEF OF
PAIN.
AND IN HEALTH SPMs FROM DIETARY
FATTY ACIDS ORCHESTRATE THE
PROCESS OF INFLAMMATION
RESOLUTION TO MAINTAIN AND
RESTORE TISSUE HOMEOSTASIS.
THERE ARE A NUMBER OF CHRONIC
RESPIRATORY DISEASES WITH
MEDIATORS.
RINE YOU SIGHT IS AND ALL THESE
DISEASES HAVE BEEN ASSOCIATED
WITH RELATIVE DEFICIENCIES IN
PRO RESOLVING SPMs IMBALANCED
WITH PRO-INFLAMMATORY MEDIATORS.
I'LL HIGHLIGHT SOME WORK IN
ASTHMA WHERE DYSREGULATED BIO
SYNTHESIS IS LINKED TO
HYPERACTIVITY AND INFLAMMATION.
WE HAVE A STUDY OF PARTICIPANTS
FUNDED BY NHLBI FOR NEARLY 20
YEARS.
AT THE PEAK IT INCLUDED 700
PARTICIPANTS FROM 7 LEADING
ASTHMA CLINICAL RESEARCH CENTERS
ACROSS THE UNITED STATES.
SPMs HAVE BEEN THE FOCUS OF MANY
STUDIES AND HIGHLIGHT THREE.
FIRST MEASURING AIR WAY
CONCENTRATIONS REL RELATIVE TO
THE PROINFLAMMATORY MEDIATOR
SERUM AMYLOID A.
AND LEUKOCYTES IN ASTHMA WITH
INTENTION TO NATURAL KILLER
CELLS AND AFFECT OF STEROIDS ON
M CELL FUNCTION AND RECEPTOR ON
P
PROINFLAMMATORY LEUKOCYTES.
ABOUT A THIRD OF OUR COHORT HAD
LOW LEVELS AND THEY HAD LOW SAA
LEVELS.
AND WHEN WE COMPARED THE TWO
OPPOSITE POPULATIONS OF SUBJECTS
WE REPORTED DIFFERENCES IN
ASTHMA CLINICAL MEASURES.
IN THE PATIENTS WITH LOW LXA4
REPORTED MORE ASTHMA SYMPTOMS
AND LOWER FUNCTION.
THE STUDY IDENTIFIED AN ENDOTYPE
OF SEVERE ASTHMA CHARACTERIZED
BY DEFICIENCIES AND MEASURES OF
RESPIRATORY DISEASE PATHOLOGY.
AND A NUMBER OF PROTEIN COUPLED
RECEPTORS HAVE BEEN IDENTIFIED
AS COGNATE RECEPTORS FOR
SPECIFIC GPR18 IDENTIFIED AS THE
RECEPTOR FOR THE DHA DERIVED
RESOLVENT D2.
OF INTEREST GPR18 NOW TERMED
DRV2 WAS RECENTLY IDENTIFIED AS
A CANDIDATE CAUSAL GENE FOR
ASTHMA SUSCEPTIBILITY IN THE
STUDY FROM THE U.K. BIO BANK.
IN ADDITION TO EVALUATING
CONCENTRATIONS OF SPMs INTH
ASTHMA WE'VE BEEN INTERESTED IN
AIRWAY LEUKOCYTES AND EXAMINED
DRD2 EXPRESSION ON BLOOD
EOSINOPHILS IN SARP 4 AND FOUND
THE EXPRESSION IN ASTHMA ON THE
RIGHT SIDE GRAPH WAS HIGHER WITH
MORE THAN THREE FOLD HIGHER
EXPRESSION OF D
-- DRB2 AND OUT WAS EFFECTIVE AT
REDUCING INFLAMMATORY RESPONSES
AND PROMOTING INFLAMMATION
RESOLUTION IN PARTICULAR BY
REGULATING EO SIN OFFICIAL
TYPES.
AND THE STUDIES I'LL HIGHLIGHT
FORCE ON NATURAL KILLER CELLS
AND INNATE CELLS CRITICAL FOR
HOST DEFENSE.
THE TRIAL DEMONSTRATED THE
BENEFIT OF PROOF OF
SUPPLEMENTATION ON INFECTION IN
CHILDREN.
IN ADDITION TO VIRAL HOST
DEFENSE IN THE CASE OF
INFLAMMATION, MK CELLS ARE
IMPORTED IN INDUCING APOPTOSIS
OF RECRUITIVE LEUKOCYTES FOR
DOWN STREAM MACROPHAGE
ENGULFMENT TO RETURN TO A RETURN
TO TISSUE HOMEOSTASIS IN THE
CARTOON ON THE LEFT.
IN SARK 3 THE RATIO TO NK CELLS
IN THE AIRWAY WAS DRAMATICALLY
INCREASED IN SEVERE ASTHMA
POPULATION.
THE FREQUENCY OF CYTOTOXIC CELLS
WAS CORRELATED WITH LOWER LUNG
FUNCTION IN ASTHMA AND ALOOKING
EX VIVO THERE'S FUNCTIONALLY
IMPAIRED IN ASTHMA WITH REDUCED
ABILITY OF APOPTOSIS.
WE HYPOTHESIZED STEROID EXPOSURE
MAY BE IMPACTED K CELL RECEPTOR
FUNCTION AND SHOWED IN VITRO THE
STEROID SUPPRESSED NK CELL
APOPTOSIS AND COMPARED TO THE
CYTOTOXICITY.
WE IDENTIFIED THE LIN KINASES
IMPACTED BY THESE.
SO OF ALL THOSE STUDIES PREVIOUS
STUDY I MENTIONED LOOKED AT
HUMAN PATHWAYS.
THERE'S BEEN STUDIES IN
PRECLINICAL RESPIRATORY DISEASE
MODEL DEMONSTRATING THE
BENEFICIAL EFFECTS OF SPMs ON
DAMPENING PRO-INFLAMMATORY HOST
RESPONSES IN PATHOBIOLOGY AND
STIMULATING RESOLUTION.
I'VE HIGHLIGHTED A FEW ALREADY
IN THE CATEGORY OF ALLERGIC LUNG
INFLAMMATION.
A NUMBER OF STUDIES IN
SMOKE-INDUCED LUNG JOURNAL
INJURY AND COPD.
VIRAL LUNG IN INFECTIONS, RSV
AND INFLUENZA, BACTERIAL
PNEUMONIA AND SEPSIS INDUCED
LUNG DISEASE AND THESE STUDIES
HIGHLIGHT A NUMBER OF DISTINCT
MOLECULES MEDIATING BENEFICIAL
AN
ANTI-INFLAMMATORY EFFECTS TO
REDUCE LUNG INFLAMMATION AND
INJURY.
SO HERE I'LL HIGHLIGHT KEY
POINTS IN THE STATE OF SCIENCE
IN RESPIRATORY HEALTH AND
DISEASE.
INFLAMMATION RESOLUTION IS AN
ACTIVE PROCESS ORCHESTRATED IN
PART BY ESSENTIAL DIETARY FATTY
ACID DERIVED SPMs WITH POTENT
PRO-RESOLVING AND
ANTI-INFLAMMATORY ACTIONS TO
RESTORE HOMEOSTASIS IN HEALTH.
THE REGULATION OF SPMs RELATIVE
TO MEDIATORS IS IN SEVERE ASTHMA
AND AASSOCIATED WITH IMPAIRED
LUNG FUNCTION INCREASED SYMPTOMS
AND CHRONIC AIRWAY INFLAMMATION.
LEUKOCYTE RECEPTORS INCLUDING NK
CELLS HAVE REGULATION BY SPMs
DISTINCT FROM THE
IMMUNOSUPPRESSIVE EFFECTS AND
EXOGENOUS SPMs CAN LOOK AT HOST
RESPONSES AND IMPACT BIOLOGY AND
STIMULATE INFLAMMATION
RESOLUTION IN PRE-CLINICAL AND
RESPIRATORY DISEASE MODELS.
FINALLY I'LL HIGHLIGHT THREE
CURRENT GAPS AND POTENTIAL KEY
RESEARCH QUESTIONS.
ONE, COULD DIETARY
SUPPLEMENTATION PROMOTE NATURAL
GAS RESOLUTION IN RESPIRATORY
DISEASES IN HUMANS.
EVERYDAY SUGGESTED RICH MARINE
OILS CAN INCREASE CIRCULATING
OILS OF SPMs IN PERIPHERAL BLOOD
BUT WHAT ABOUT THE AIRWAY.
CAN WE FEED THE LUNG THROUGH THE
GUT?
SECOND, WHAT UNDERLYING IMMUNE
PATHWAY ARE LINKED WITH
RESPIRATORY DISEASE ACTIVITY
PRIMED FOR REGULATION BY SPMs
AND COULD WE STUDY IN VITRO?
I'VE HIGHLIGHTED IN K CELLS A
SUB CLASS AND THERE'S INMATE
LYMPHOID CELLS, ADAPTIVE IMMUNE
CELLS AND CD4 AND CD 8 CELLS AND
ASTHMA BIOLOGY AND MACROPHAGES
AND IN PARTICULAR THIS
EPITHELIAL CELL CROSS TALK.
THIRD, ARE THERE RELATIONSHIPS
BETWEEN DYSREGULATED CIRCUITS
AND DISEASE ACTIVITY THAT COULD
BE INTERROGATED USING BIO BANK
SAMPLES FROM EXIST BEING
PATIENTS FROM INFLAMMATORY,
PRORESPIRATORY DISEASE AND I
MENTION THE SARP AND OTHERS
MENTIONED PREVIOUSLY IN THE COPD
ARENA AND RECOVER COHORT
FOCUSSED ON COVID AND OTHERS OF
RELEVANCE.
I'LL END WITH ACKNOWLEDGEMENTS
OF ALL OF OUR MEMBERS OF OUR A
WAY AND RESOLUTION LAB AT
HARVARD AND WOMEN AND BRIGHAM'S
HOSPITAL AND THOSE IN THE SARP
NETWORK AND NHLBI AND OTHERS FOR
FUNDING AND APPRECIATE YOU FOR
YOUR ATTENTION.
>> THANK YOU SO MUCH DR. DUVALL
FOR THE GREAT PRESENTATION
EXTENDING SOME OF THE MESSAGES
WE HEARD FROM A FEW SPEAKERS
FROM YESTERDAY ON THE TOPIC OF
FATTY ACIDS AND POTENTIAL
UNDERLYING MECHANISMS.
NOW DR. MACHADO, WOULD YOU LIKE
TO DO A BRIEF SUMMARY OF THE
PRESENTATIONS BEFORE WE OPEN IT
UP FOR PANEL DISCUSSION?
>> YES.
THE IDEA IS WE HIGHLIGHT KEY
POINTS BEFORE WE OPEN FOR
DISCUSSION.
WE DECIDED TO HIGHLIGHT A FEW
KEY POINTS.
FOR THE FIRST LECTURE WE NOTICED
BIOMARKERS FROM OBSERVATIONAL
STUDIES NEED TO BE VALIDATED IN
MEDIUM AND LONG-TERM
INTERVENTION STUDIES AND ALSO
SERUM SAMPLE CANNOT CAPTURE THE
TRUE VARIATION INDICT AND
LONG-TERM DIETARY PATTERNS.
AS WELL AS CONCENTRATIONS OF
NOTABLE FACTORS OTHER THAN DIET
SUCH
SUCH AS POLLUTION WE RESERVED
SEVERAL DIETARY METABOLITES
RELATED TO DISEASE SEVERITY AND
OUTCOMES AND CAUSAL
RELATIONSHIPS AND ALSO TOOLS
HAVE OPPORTUNITIES TO MEASURE
NUTRITIONAL EXPOSURES AND
CONSERVE BIASES AND MEASUREMENTS
OF INTERVENTION DRIVERS.
AND I'LL END BY EVIDENCE OF THE
INTERPLAY BETWEEN BODY MASS
RELATED MARKERS IN PREDICTING
ADVERSE OUTCOMES AND PROGNOSIS
AND RESERVE IS LIMITED ON HOW WE
ADAPT METHODOLOGIES TO IDENTIFY
LOW MUSCLE MASS IN INDIVIDUALS
WITH OBESITY.
AND DIFFERENT APPROACHES
INCLUDING THE NEW ALGORITHM IS
AN OPPORTUNITY.
AND NOW WE JUST SAW AND IT'S
ORCHESTRATED BY SPMs WITH
INFLAMMATORY ACTIONS AND THE
MEDIATORS ARE ACTIVE IN LUNG
DISEASE AND SOME EXAMPLES ARE
ASTHMA AND THERE'S MANY OTHERS
AND THIS IS ASSOCIATED WITH
LOWER LUNG FUNCTION AND AIRWAY
NATURAL GAS.
-- INFLAMMATION AND POTENTIAL
FOR THE SUPPLEMENTATION TO
LEVELS AND PROMOTE INFLAMMATION
IN RESPIRATORY DISEASE.
THOSE ARE KEY POINTS.
WE WILL NOW ADDRESS THE KEY
QUESTIONS THE SECTION WHICH IS
CAN NUTRITIONAL BIOMARKERS
PREDICT LUNG HEALTH AND OUTCOMES
OF LUNG DISEASE?
>> SPEAKERS, TURN ON YOUR VIDEO
AND WELCOME DR. GARCIA-LARSEN TO
JOIN THE DISCUSSION AS WELL.
MAYBE WE CAN START WITH THE KEY
QUESTION AND FOR OUTCOMES OF
LUNG DISEASES.
I KNOW IT'S A BROAD QUESTION.
WE'LL START WITH THAT AND HAVE
SOME MORE SPECIFIC QUESTIONS
FOLLOWING.
WE CAN GO IN ORDER OF THE
SPEAKER AND
>> I THINK NUTRITIONAL
BIOMARKERS INHERENTLY ARE MORE
POWERFUL BECAUSE THEY CAN
CAPTURE THE VARIATION DIETARY
INSTRUMENTS CANNOT IN
METABOLISM.
FROM A STATISTICAL STANDPOINT IF
THERE IS AN ASSOCIATION BETWEEN
A NUTRITIONAL COMPONENT AND
RESPIRATORY HEALTH UTILIZING THE
BIOMARKER WOULD SHOW THAT
ASSOCIATION BECAUSE IT DOES
CAPTURE THE INTRINSIC VARIATION.
>> THE NICE PART IS PREDICTION
IS NOT INFERENCE.
EVEN IF A BIOMARKER IS NOT
CAUSALLY RELATED TO A DISEASE
PROCESS IT DOESN'T MEAN IT'S NOT
INFORM FOR OUTCOME PREDICTION.
I THINK MANY BIOMARKERS AND
NUTRITIONAL METABOLITES HAVE
HIGH POTENTIAL WHEN MEASURED IN
COMPOSITE.
I DON'T KNOW ANY STAND ALONE
BIOMARKER WILL DO THE TRICK.
THESE ARE THE HIGHEST POTENTIAL
TO PROVIDE A BIOMARKER WITH HIGH
TEST PURPOSE TO WARRANT CLINICAL
USE.
>> DR. MACHADO.
>> I A GGEE THEY OFFER AN
OPPORTUNITY TO LOOK AT SURVIVAL
AND OUTCOMES AND PARTICULAR TO
BIOMARKERS AND THE KNOWN PATTERN
OR PHYSICAL ACTIVITIES AND LOOK
AT BODY RELATED MARKERS.
>> DR. MA.
>> I AGREE WITH THE PANELISTS IN
PARTICULARLY AROUND THE CONCEPT
SINGLE BIOMARKERS ARE UNLIKELY
TO BE THE PAN SACEA OF RESPIRATY
DISEASES AND LOOK AT BIOMARKERS
IN CONJUNCTION WITH PRO
INFLAMMATORY MARKERS AND THAT
ABUNDANCE OF THOSE BIOMARKERS
COULD BE HELPFUL IN COMPOSITE.
FURTHERMORE I THINK THE CONCEPT
OF LOOKING FOR BIOMARKERS IN
AIRWAY SPECIFIC SAMPLES AND IT
WAS MENTIONED CONDENSATE IS THAT
A BETTER WINDOW TO WHAT'S
HAPPENING IN THE LUNG THAN
CIRCULATING BIOMARKERS?
A FOLLOW UP WITH A QUESTION
OBVIOUSLY THIS SESSION IS
FOCUSSED ON PRECISION NUTRITION
BIOMARKERS.
THE ADVANTAGE EACH OF YOU SPEAK
TO THE ADVANTAGE THEY HAVE FOR
TRADITIONAL MEASURES AND
ASSESSMENT TOOLS WHETHER IT'S BY
SELF-REPORT OR INTERVIEW.
I WANT TO POSE TO THE PANEL DO
YOU THINK THERE'S STILL A ROLE
OF TRADITIONAL DIETARY
ASSESSMENT TOOLS IF YOU THINK
THERE IS, WHAT THAT MIGHT BE
WITH THE BIOMARKER MEASURES THAT
YOU ALL SPOKE ELOQUENTLY ABOUT.
AGAIN, WE'LL DO THE ORDER OF THE
SPEAKERS.
>> ALL THESE EMERGING BIOMARKERS
ARE MEANT TO BE COMPLIMENTARY
RATHER THAN A REPLACEMENT OF
DIETARY TOOLS.
IF WITH USE THEM THE WAY WE'RE
SUPPOSED TO THEY PROVIDE
VALUABLE SOURCES OF INFORMATION
UP LARGE POPULATION STUDIES CAN
GET A LONG-TERM DIET AND CAN
DRIVE PEOPLE IN AN ADEQUATE
QUESTION AND THAT'S WHAT THE FAQ
IS DESIGN TO DO.
IT'S NOT DESIGN TO GET A TOTAL
ENERGY INTAKE.
THAT WAS NEVER THE OBJECTIVE.
I THINK TRADITIONAL DIETARY
ASSESSMENT TOOLS HAVE A ROLE AND
THE BIOMARKERS ARE MEANT TO BE
COMPLEMENTARY TO THE TRADITIONAL
DIETARY ASSESSMENT TOOLS.
>> THERE'S LIKE A GUT CHECK WE
CAN TRUST OVERSEEING.
>> I THINK THE INTEGRATION OF
DIFFERENT MARKERS IS THE WAY TO
GO TO BETTER UNDERSTAND WHAT THE
INT
INTERSECT OF OUTCOMES.
>> AS WE MOVE FORWARD IN THIS
WORLD OF OMIC AND IDENTIFY
POTENTIAL BIOMARKERS OF INTEREST
WORKING BACKWARDS TO THE DIETARY
HISTORY AND IDENTIFYING WHERE
IT'S LIKELY SOURCED COULD BE
POWERFUL.
>> YES, I'D LIKE TO START BY
THANKING DR. MACHADO AND
GARCIA-LARSEN IN TERMS OF
LEARNING NUTRITIONAL BIOMARKERS.
BRIEFLY YESTERDAY WE PRESENTED
ATTEMPTS IN OUR RESEARCH GROUP
TO UNDERSTAND WHETHER SPECIFIC
METABOLITES OF FLAVONOIDS CAN
HELP UNDERSTAND A BIT BETTER
TWLA THE DIETARY INTAKE OF THIS
GROUP OF BIO COMPOUNDS IS.
AND I TO PLAY DEVIL'S ADVOCATE
WE DO HAVE A LOT OF OPPORTUNITY
FOR ADVANCED KNOWLEDGE AND THE
BIOMARKERS ADDRESS RECALL BIAS
WHICH IS A MAJOR PROBLEM BUT
DON'T HELP US ADDRESS
MEASUREMENT BIAS.
NOT ENTIRELY AT LEAST AND WE
NEED SEVERAL BIOMARKERS TO HAVE
SPECIFIC INSIGHTS INTO WHAT
THEIR USUALLY DIETARY INTAKE IS.
IF WE HAD THE TOWN TO DO A WELL
DESIGNED COHORT STUDY WHAT WOULD
BE THE BEST COMBINATION OF
NUTRITIONAL TOOLS TO ASCERTAIN
DIETARY INTAKE?
SHOULD WE FOCUS ON NUTRITIONAL
BIOMARKERS ONLY
>>
>> WE GRAPPLED WITH THAT IN THE
NURSE PROFESSIONALS HEALTH
FOLLOW-UP STUDY.
WE HAVE A VOL DATED FFK WE USED
AND HAVE ARCHIVED BIO SPECIMENS
AND THE LIFESTYLE VALIDATION
STUDIES MEASURING WATER AND AN
OBJECTIVE MEASURE OF INTAKE AND
URINARY SODIUM AND POTASSIUM BUT
REALLY THE GOAL IS TO LOOK FOR
MEASUREMENT ERROR AND
RECALIBRATE TRADITIONAL DIETARY
ASSESSMENT TOOL.
IN TERMS OF BIOMARKERS WE SHOULD
BE MEASURES YOU CAN LOOK AT A
WIDE RANGE OF METABOLITES TO
REFLECT THE OVER ALL DIET
OPPOSED TO A CERTAIN CLASS OF
MASS TABL ITS FOR -- METABOLITES
REFLECTING A FOOD OR DIETARY
PATTERN.
IN DETERMINES OF DESIGNING A
STUDY I THINK HAVING A TOOL AND
UNDERSTANDING WHAT THE RELEVANT
EXPOSURE OF INTEREST IS IS IF
YOU'RE LOOKING AT RECENT AND YOU
CAN GO WITH THE FFY AND COLLECT
BLOOD SAMPLES AND RUN OMICS
MEASURES ON IT OR OR SODIUM OR
NITROGEN ARE EXPENSIVE TO DO.
HAVING THE ARCHIVED SAMPLES IN
COMBINATION WITH A DIETARY
ASSESSMENT TOOL WOULD BE THE WAY
TO GO.
>> AGAIN, PROBABLY SHOULDN'T
WEIGH IN ON THE NUTRITIONAL
ASPECT BUT WE OFTEN TALK ABOUT
THE HOLY GRAIL OF MUL
MULTI-BIOMARKERS AND WE SEE THE
MOLECULAR ASSESSMENTS ARE
GETTING TO A POINT WHERE
CONCURRENT LUNG FUNCTION OR
CHEST IMAGING IS NO LONGER
PROVIDING A WHOLE LOT OF BANG
FOR YOUR BUCKET AND CREATES
COMPLEXITY IN TRYING TO MERGE
THEM TO A SINGLE BIOMARKER.
I THINK THAT'S IMPORTANT FOR ANY
FIELD TO QUESTION HOW MUCH BY
ADDING THE LAYER OF COMPLEX WHEN
IT COMES TO BIOMARKER
DEVELOPMENT.
>> WE HAVE SOME QUESTIONS IN THE
CHAT AND THERE'S ONE RELATED TO
THIS DISCUSSION JUST NOW.
WHY DO WE NEED TO IMPROVE THE
SPECIFICITY OF BIOMARKERS FOR
FOOD?
IT SEEMS SUFFICIENT AND AN
ENORMOUS ADVANTAGE TO MEASURE
COMPONENT AND METABOLITES
REGARDLESS OF THE SOURCE FROM A
BIOLOGICAL PERSPECTIVE.
>> I CAN TAKE THAT.
I KNOW I SPOKE ABOUT
SPECIFICITY.
THE QUESTION WITH SPECIFICITY IS
DOING CORRECTION WITH THE
DIETARY ASSESSMENT TOOLS.
TALKING ABOUT WHAT DR. DUVAL
SAID TRACING TO WHAT THE DIETARY
COMPONENT COULD BE AND IN MAKING
RECOMMENDATIONS AND POLICY
CHANGES MAY BE IMPORTANT BUT IS
THE ROLE COFFEE OR LEGUMES CAN
INFLUENCE DIETARY
RECOMMENDATIONS AND CALIBRATE
YOUR OWN DIETARY ASSESSMENT
TOOLS.
ANY OTHER COMMENTS?
>> WE ALSO HAVE A QUESTION ABOUT
CAN THE PANEL COMMENT ON THE
IDEAL DIETARY ASSESSMENT OR DOES
THE PANEL BELIEVE THE MOST
WIDELY USED 24-HOUR RECALL IS
THE BEST WE HAVE?
DIETARY QUESTIONNAIRES HAVE
SPECIFIC FUNCTIONS.
IT ALL DEPENDS WHAT WE'RE TRYING
TO ADDRESS.
SO THE 24 HOUR RECALL QUESTION
CAN BE EXTREMELY USEFUL IF WE
WANT TO UNDERSTAND DIETARY
INTAKE THE PAST FEW DAYS BUT IF
IT'S REPEATED ENOUGH TIMES AND
RESEARCHERS PROPOSE UP TO SEVEN
QUESTIONNAIRES SHOULD BE
SUFFICIENT TO HAVE AN IDEA OF
THE USUAL DIETARY INTAKE.
THE OTHER STUDIES SUGGEST IF WE
WANT TO UNDERSTAND THE ISSUE OF
HABITS WE NEED TO CONSIDER
FREQUENCY QUESTIONNAIRE AND I'M
NOT SURE THERE'S UP WITH PERFECT
OR PREFERRED TOOL WHEN IT COMES
TO QUESTIONNAIRES.
WE KNOW SOME ARE PERFORMING BEST
SO FOR SOME AND WHEN WE WANT TO
DERIVE DIETARY PATTERNS BUT FOR
SOME OF THE NEW ER INDEX THEY
APPEAR TO PERFORM BETTER SO I
THINK IT ALL DEPENDS ON WHAT
WE'RE TRYING TO MEASURE.
I KNOW WE HAVE A FEW EXPERTS IN
NUTRITIONAL EPIDEMIOLOGY IN THE
ROOM SO I'D LIKE TO HEAR
PEOPLE'S THOUGHTS.
>> I AGREE WITH
DR. GARCIA-LARSEN JUST SAID.
IT COMES DOWN TO YOUR RESEARCH
QUESTION.
24-HOUR RECALL CAN APPROXIMATE
USUAL INTAKE IF YOU REPEAT YOUR
ASSESSMENT OVER TIME AND OVER
DIFFERENT SEASONS.
HAVING SAID THAT, I KNOW IT
TAKES UNDERSTANDING TO
UNDERSTAND WHAT FOOD ITEMS GET
IN THE QUESTIONNAIRE IS
IMPORTANT IN ITSELF AND THE
EXAMPLE I GIVE AS YOU WANT TO
INCLUDE FOODS WHERE THERE IS
ENOUGH PARTICIPATE POPULATION
AND IF THE POPULATION CONSUMES
THREE TOMATOES A DAY WILL NOT
ADEQUATELY CAPTURE.
OFTEN WE USE FOOD FREQUENCIES
VALIDATED FOR ONE POPULATION AND
ANOTHER POPULATION WITHOUT
REALLY VALIDATING THE EFFORTS.
I THINK THAT'S WHY OF THE OFTEN
FAQ'S GET A BAD WRAP AND MAB
THEY WEREN'T VALIDATED IN THE
FIRST PLACE.
>> WE HAVE A COUPLE QUESTIONS
FROM TERESA.
SHE ASKED DO YOU INCLUDE THE
DIETARY INTAKE RECORDING GIVEN
LIMITATIONS OF RECALL FOR SOME
PATIENTS AND ARE YOU ASKING
PATIENTS FOR PHOTOS OF MEALS OR
INTAKE WHICH COULD BE EASIER FOR
SOME AND THE TECHNOLOGY IS NOW
AVAILABLE FOR DOING SO.
>> THIS IS A CURIOUS QUESTION
SINCE THE RECALL BIAS IS APPLIED
PHYSICAL ACTIVITY QUESTIONNAIRES
AND AS HIGHLIGHTED.
THERE'S HYPOXIA AND OTHER
CORRECTORS AND LUNG DISEASE ARE
ASSOCIATED WITH THE DECLINE IN
REGULATORY FUNCTIONS.
IT COULD BE QUITE CHALLENGING TO
USE THIS APPROACH.
I'D BE CURIOUS TO KNOW WHAT CAN
BE DONE TO LOOK THE LIMITATIONS
OF THE TRADITIONAL DIETARY
ASSESSME
ASSESSMENTS
>> IS THERE ANYTHING YOU'D LIKE
TO COMMENT ON?
>> I'M LOOKING AT DR. PANDA'S
NEXT QUESTION.
IT'S A REALLY GOOD ONE.
HE SAYS NHANES USES ONLY ONE OF
TWO 24-HOUR RECALL
QUESTIONNAIRES AN THERE'S
THOUSANDS OF PAPERS PUBLISHED
FOR THE TWO DAYS OF RECALL WITH
HEALTH OUTCOMES.
IS THAT THE RIGHT USE?
I MYSELF HAVE USED NHANES DATA
TO LINK DIETARY INTAKE AT
VARIOUS DIETARY COMPONENTS IN
RESPIRATORY HEALTH.
QUITE OFTEN IN THE MANUSCRIPTS
WE ACKNOWLEDGE THE LIMITATION OF
COLLECTING DATA OR HAVING DATA
AVAILABLE FOR ONE OR TWO DAYS
AND SOMETIMES SOME OF THE DATA
IN NHANES IS FROM ONE DAY AND
NOT ALL PATIENTS HAVE DATA ON
TWO DAYS.
STILL IF THE METHODS HAVE BEEN
VALIDATED AND WE HAVE
INFORMATION ON A WIDE RANGE OF
VARIETIES CAN BE IMPORTANT TO
INVESTIGATE THE RELATIONSHIP
BETWEEN DIET AND HEALTH
OUTCOMES.
IT'S NOT PERFECT.
NONE OF THE INSTRUMENTS ARE.
I THINK EVEN FOR SURVEYS THAT
HAVE USED THREE, FIVE, 24-HOUR
RECALL QUESTIONNAIRES WE MATE
SEE THE SAME ISSUE WHEREBY WE'RE
NOT CAPTURING ALL THE INITIAL
DATA, DIETARY DATA.
SO THERE'S NOT -- I DON'T THINK
THERE'S A BINARY ANSWER TO THAT
QUESTION.
OFTEN THE MANUSCRIPTS
ACKNOWLEDGE THE LIMITATION OF UP
WITH OR TWO QUESTIONNAIRES BUT
STILL INFORMATIVE.
NHANES HAS AN EXCELLENT STUDY
FOR THE FRAMEWORK AND THE
COLLECTION OF DATA ON NUMEROUS
OTHER FACTORS MAKING IT A ROBUST
DATA SET TO USE.
>> DR. BHUPATHIRAJU I SEE YOUR
HAND UP.
>> YES, TO RESPOND TO
DR. PANDA'S QUESTION AND TO
FOLLOW-UP AND TO WHAT
DR. GARCIA-LARSEN SO ELEGANTLY
PUT, SO THE NCI HAS A MACRO YOU
CAN RUN ON YOUR NUTRIENT DATA TO
APPROXIMATE USUAL INTAKE.
YOU CAN TAKE THE AVAILABLE
ESTABLISHED METHODS THE NCI TEAM
HAS DONE WHERE YOU CAN USE THAT
TO APPROVXIMATE USUAL INTAKE.
WE USE THAT IN ALL OF OUR
STUDIES.
AND AGAIN ACKNOWLEDGING THIS
ISN'T PERFECT BUT THE METHOD
DOES A GOOD JOB OF APPROXIMATING
TAKING THE DATA FROM THE 24-HOUR
RECALL AND THE PROXIMAL INTAKE
AND THERE'S A FOOD PROPENSITY
QUESTIONNAIRE.
OFTEN WE USE IT IN CONJUNCTION
WITH THE 24-HOUR RECALL TO GET
AT USUAL INTAKE.
SO THERE ARE WAYS AROUND THAT.
AGAIN, IT'S SUCH A RICH DATA SET
HAVING THE INFORMATION AT THE
POPULATION LEVEL IS INCREDIBLY
HELPFUL.
>> THERE'S COPD AND PULMONARY
DISEASE AREAS AND OTHER AREAS IN
THE BIO SAMPLES WE HAVE TO
DIFFERENT MEANS.
I WAS WONDERING IF YOU COULD
SPEAK TO THE CHALLENGES OF
HARMONIZING ACROSS STUDIES AND
BOTH IN TERMS OF DATA COLLECTION
AND DATA ANALYSIS.
HOW DO WE REALLY GET TO
HARMONIZE CROSS STUDIES SO WE
KNOW IN WORKING WITH DATA AND
CERTAIN QUALITY ACCORDING TO A
SET OF STANDARDS.
I THINK IT'S AN IMPORTANT
QUESTION AND ONE WE GRAPPLE WITH
A LOT.
I POSE THE QUESTION BECAUSE I
FEEL SO MANY OF US HAVE
CONTRIBUTED TO ENROLLING
HUNDREDS AND THOUSANDS OF
PATIENTS WITH RESPIRATORY
DISEASES AND BIO BANKING
FREEZERS ACROSS THE WORLD.
RATHER THAN MOVING PROSPECTIVELY
TO ADDITIONAL COHORTS WHAT CAN
WE LEARN FROM THE DATA WE
ALREADY HAVE.
THE BENEFIT FROM COHORTS IS
THEY'RE RICHLY STUDIED IN TERMS
OF PARAMETERS, SPIROMETRY AND CT
SCANS AND DIETARY HISTORIES,
MARKERS OF OBESITY, ALL THESE
THINGS EXIST.
IN THE ASTHMA WORLD WE'RE
DEALING WITH THE EUROPEAN COHORT
AND WE GOT RELATIONSHIPS WITH
THAT GROUP SO HOW CAN WE GO TO
THE FREEZERS AND EVALUATE WITH A
TARGETED APPROACH MARKERS OF
INTEREST.
A COUPLE THINGS ACROSS THE WAY.
ONE IS BIO SAMPLE COLLECTION
STRATEGY SHOULD BE SIMILAR.
A LOT OF THESE THINGS ARE PRETTY
ROUTINE IN TERMS OF PLASMA.
THERE'S NOT SO MANY WAYS TO
ISOL
ISOLATE PLASMA.
NOT EVERYBODY UNDER GOES A
LEAVLEAVE
AGE -- LEVAGE AND THERE'S NOT A
LOT OF DIFFERENT WAYS TO DO IT
SO HARMONIZED PLASMA SHOULD BE
RELATIVELY STRAIGHTFORWARD
ACROSS THE BOARD.
BUT WE SHOULD BE ABLE TO
LEVERAGE BIO SPECIMENS ALREADY.
>> THERE'S A QUESTION FOR YOU
AND DR. DUVAL AND ASKED WHAT'S
IN THE DATA OVER TIME ASSUMING
IT'S FROM CROSS SECTIONING AND
HOW MUCH INTERVARIABILITY IS
THERE AND WE REFLECT DIET OVER
LONGER TERM.
>> THIS IS APE IMPORTANT
QUESTION BECAUSE I THINK LUNG
FUNCTION FLUCTUATES OVER TIME AS
DO METABOLITES.
PART OF WHAT WE'RE DOING IN THE
SARP COHORT IN PARTICULAR IS
LOOKING AT SOME OF THE MARKERS
LONGITUDINALLY.
ALL THE DATA WAS A SNAPSHOT IN
TIME.
LOOKING AT CHANGES OVER TIME IN
CLINICAL POSITION ARE IMPORTANT.
I'LL SPEAK TO IN SARP WE FELLOW
PATIENTS WHEN THEY'RE STABLE AND
I'M INTERESTED IN WHAT HAPPENS
DURING EXACERBATION.
WHEN THEY GET A VIRAL INFECTION
FOR INSTANCE WHAT HAPPENS TO THE
MEDIATORS OF INTEREST.
FOLLOWING LONGITUDINALLY AND
DURING SASEXACERBATION THAT
FLUCTUATION OVER TIME BASED ON
DIETARY INTAKE BUT HOW IT
RELATES TO DIETARY CHANGES WE'RE
IN THE INFANCY OF UNDERSTANDING
AND WE HAVE COHORTS WHERE WE
HAVE BIO BANK SAMPLES NOT JUST
FROM A SNAPSHOT IN TIME BUT
LONGITUDINALLY.
>> THERE'S A QUESTION WHETHER WE
INCLUDE THE DIETARY INTAKE AND
GIVEN THE LIMITATIONS OF RECALL
FOR SOME PATIENTS AND LOOK AT
MEAL INTAKE AND FOR THE PATIENTS
IN GENERAL.
I'VE BEEN INVOLVED IN SMALL
CLINICAL STUDIES WITH ASTHMA
PATIENTS AND WHAT WE DO IS WE
TRY TO CARRY OUT THE
QUESTIONNAIRE WITH THEM BUT WE
ALSO INVITE WHOEVER SPENDS MORE
TIME WITH THEM.
FOR EXAMPLE THERE'S A HOSPITAL
IN LONDON WE WOULD HAVE
ASTHMATIC CHILDREN SOME WITH
SEVERE ASTHMA AND WOULD TRY TO
ASK THE CHILD OR ADOLESCENT
DEPENDING ON THE AGE ABOUT THE
USUAL DIET AND WHAT THEY EIGHT
THE DAY BEFORE AND THE
DESIGNATED CAREGIVER WHO WASN'T
ALWAYS THE PARENT WOULD BE THERE
TO CORROBORATE SOME OF THE
INFORMATION.
IF THE CHILD WAS YOUNG WE WOULD
ASK THE CAREGIVER OR THE PARENT
SIMILAR TO THE NATIONAL
GUIDELINES FOR ADMINISTRATION OF
THE QUESTIONNAIRES TO CHILDREN.
AND FOR ADULTS I WOULD IMAGINE
IF ADULTS ARE BE PATIENTS WHO
HAVE A CAREGIVER IT MAY BE U
USEFUL TO HAVE IN THE ROOM
>> THERE'S A QUESTION OF
MEASUREMENT OF BODY COMPOSITION
AND ASKING RECOMMENDATIONS FOR
MEASURING BODY COMPOSITION THAT
MAY BE SUITABLE FOR PATIENTS
WITH LUNG DISEASE.
>> YES, CT SCANS ARE SOMETIMES
USED BECAUSE THE PATIENTS HAVE
TO UNDER GO CT SCANS AND THERE'S
MEASUREMENTS WHERE YOU CAN
MEASURE FOR MUSCLE THICKNESS OR
OTHER PARAMETERS THAT CAN BE
ASSESSED BY INTRACELL
MEASUREMENTS SUCH AS THE ECO
INTENSITY.
THESE ARE SOME OTHER OPTIONS IN
ADDITION.
>> GENETICS PLAY A ROLE IN
OBESITY AND MAYBE ABSORPTION IN
THE METABOLISM AND SHOULD MARKER
DATA BEING INTEGRATED?
YOU SPOKE TO THIS DURING YOUR
PRESENTATION, DO YOU WANT TO
ELABORATE ON WHAT YOU PRESENTED
AND THEN OTHER S TO ADD TO YOUR
COMMENTS AND PERSPECTIVE AS
WELL.
>> SURE.
TYPICALLY WHEN WE'RE ONLY
DEALING WITH OBSERVATIONAL DATA
IT'S HARD TO HAVE INTERVENTION
TRIALS BECAUSE THEY'RE DIFFICULT
AND EXPENSIVE TO CONDUCT.
WE USE THE GWAS DATA TO LOOK AT
CAUSALITY AND INTEGRATING
GENETICS DATA WITH METABOLOMICS
DATA WILL HELP IN THAT REGARD.
>> ANY OTHER COMMENTS?
I HAVE A QUESTION KIND OF
RELATED TO YOUR RESPONSE TO THE
QUESTION, DR. MA HADDO AND THIS
APPLIES TO THE PANEL --
TO YOUR RESPONSE, DR. MA CLADDO
AND USING PRECISION NUTRITIONAL
BIOMARKERS AT THE SAME TIME IT
REQUIRES BIO SPECIMEN COLLECTION
WHICH COULD BE CHALLENGES
ESPECIALLY FOR SOME OF OUR UNDER
SERVED POPULATIONS CAN BE A
PROBLEM TO COME TO A MEDICAL
CENTER OR RESEARCH CLINIC WHERE
BARRIERS CAN MAKE IT DIFFICULT
IF NOT IMPOSSIBLE POSSIBLE TO
HAVE THE BIO SPECIMENS ACCORDING
TO RIGOROUS RESEARCH PROTOCOL
AND DR. MACHADO YOU SPOKE TO THE
CHALLENGES OF DOING IMAGING AND
DEXA IN SOME OF THE MEASUREMENT
METHODS THAT WOULD ALLOW US TO
ADVANCE IN NUTRITIONAL
ASSESSMENT AT THE SAME TIME MAY
POSE BARRIERS TO PARTICIPANTS.
I WONDER IF EACH OF YOU COULD
SPEAK TO THAT AND THEN RELATED
TO IT IS THERE POINT OF CARE
TESTING METHODS THAT MIGHT BE
EVOLVED TO HELP US COLLECT THE
SAMPLES WE NEED FOR METABOLITE
ASSESSMENT WITHOUT LIMITATIONS
FROM PARTICIPANT CENTERED
RESEARCH PERSPECTIVE.
WE CAN GO IN ORDER OF THE
SPEAKERS.
>> FOR THE STRATEGIC PLAN FOR
NUTRITION RESEARCH.
ONE OF THE GOALS WAS TO REDUCE
HEALTH DISPARITIES.
I DO WORRY THAT WHEN WE'RE
LOOKING AT OMICS AND THE
PRECISION MEASURES WE
INADVERTENTLY EXACERBATE
EXISTING DESPAIRS BECAUSE OF THE
ISSUES AND COMING TO A CLINIC OR
IF YOU THINK ABOUT THOSE WHO ARE
PARTICIPATING UP RESEARCH
STUDIES IT'S NOT THE MINORITY.
I THINK THERE HAS TO BE A
CONSCIOUS EFFORT TO DO THESE
STUDIES AND POPULATIONS WITH
PUBLISHED DISPARITIES AND THOSE
UNDER REPRESENTED IN NUTRITION
RESEARCH AND CLINICAL RESEARCH
AND EVEN LOOKING AT SOME GROUPS
YESTERDAY ONE OF THE SPEAKERS
TALKED ABOUT LOOKING AT
HISPANICS AS A MONOLITH BUT WHEN
YOU LOOK AT THE SUB TYPES,
PUERTO RICANS HAVE A MUCH HIGHER
RISK OF RESPIRATORY DISEASES AND
SOME OF OUR WORK HAS SHOWN
PUERTO RICANS HAVE ESTABLISHED
HEALTH DEFICIENCIES AND WE NEED
TO LOOK AT POPULATIONS.
>> I AGREE.
I THINK THAT AS MUCH EMPHASIS ON
OBTAINING BIO SPECIMENS IN
CLINICAL DATA FROM UNDER SERVED
POPULATIONS EMPHASIS SHOULD BE
PUT ON IDENTIFYING WAYS TO
IDENTIFY THOSE.
BECAUSE A COLLEAGUE LAST WEEK
TOLL ME -- TOLD ME THEY OPENED
UP AN AFTER HOURS CLINIC AND
IT'S COMPANY A LONG WAY AND
THESE DECISION POINTS WOULD BE
HELPFUL TO OPTIMIZE RESEARCH IN
THESE UNDER SERVED POPULATIONS.
>> RELATED TO THE BODY
COMPOSITION MEASUREMENTS AND
MARKERS WITH ACCESS TO AN ACCESS
SCAN AND BIO IMAGING AND
TECHNIQUES SOMETIMES IT'S
EXPENSIVE AND NOT EASY TO HAVE
ACCESS TO THOSE ASSESSMENTS.
WE ALSO NEED TO LEARN HOW TO
UTILIZE THIS ASSESSMENT TO THOSE
PEOPLE WHO DONT HAVE ACCESS OR
TRYING TO DEVELOP MORE EASY WAY
TO CONDUCT ASSESSMENTS.
IN ORDER TO INCREASE ACCESS.
>> I'LL ADD THAT THERE ARE
TECHNIQUES THAT CAN BE DONE AT
HOME.
SO FOR INSTANCE RESPIRATORY
COLLECTION IS OFTEN DONE AT HOME
AND THOSE ARE THINGS THAT
ALREADY EXIST AND DRY BLOOD
SPOTS CAN BE CONDUCTED AT THE
HOME AND DONE IN THE COVID-19
GROUP.
MAYBE ONE OPPORTUNITY HERE IS TO
STRATEGIZE TO REDUCE DISPARITIES
IN ACCESS AS DISCUSSED TO FIGURE
OUT HOW WE COULD COLLECT BIO
SPECIMENS MORE EASILY AT HOME.
>> THANK YOU.
I WANT IT GIVE THE PANELISTS AN
OPPORTUNITY IF YOU HAVE
QUESTIONS OF EACH OTHER HOW --
NOW IS AN OPPORTUNITY TO RAISE
THOSE.
THERE'S A COMMENT IN THE CHAT DO
YOU WANT THEM TO SAY IT OR WANT
ME TO READ IT?
>> YOU CAN READ IT IF THAT'S
OKAY.
>> AND ANOTHER POTENTIAL BENEFIT
OF LOOKING AT THE COMPONENT OF
METABOLICS OF VIDEO INSTEAD OF
FOOD RECALL DATA IS DIFFERENT
NUTRITION MICROBIOME DEPENDING
ON THE SOIL WHERE IT'S GROWN.
HOW IS THE SOIL WITH THE FUNGI
AND NEMATODES LIKELY TO IMPACT
HUMAN MICROBIOME DIFFERENTLY
THAN A TOMATO TREAT WITH
FUNGICIDE OR OTHER METHODS.
>> THAT'S A GOOD POINT ACTUALLY.
IT'S OFTEN A BIG QUESTION WE ASK
OURSELVES AND I KNOW THE
COLLEAGUES WHO WORK IN THE
DEVELOPMENT OF SPECIFIC FOOD
POSITION TABLES HAVE THIS
QUESTION ALSO, WHICH TYPE OF
TOMATOES ETCETERA TO HAVE FOR
THE LAB ANALYSIS.
THERE ARE BENEFITS AND
ADVANTAGES WHEN TRYING TO
IDENTIFY THE EXACT NUTRIENT
COMPOSITION AND DON'T HAVE A
FULL PICTURE YET OF WHICH
SPECIFIC METABOLITES OF FOOD
HAVE A STRONGER IMPACT ON THE
MICROBIOME BUT IT'S A GOOD
POINT.
THIS YOU FOR THAT.
-- THANK YOU FOR THAT.
I HAVE A QUESTION FOR DR. DUVALL
ACTUALLY.
I FIND THE EVIDENCE ON THE
SUPPLEMENTATION WITH SPM AND
MARINE OILS PROMISING AND
WONDERING IF YOU CAN COMMENT HOW
CLOSE WE ARE TO THAT BEING
REPLICATED BECAUSE IT'S A
NUTRITIONAL SUPPLEMENT.
I WANT TO BE CAREFUL HOW I USE
MY WORDS HERE BUT IT DIDN'T
REQUIRE MEDICAL PRESCRIPTION BUT
I'M SURE THERE'S CLINICAL
CONSIDERATIONS BUT CLEARLY IF IT
ALLEVIATES INFLAMMATION AND
CONSISTENTLY DEMONSTRATING SO
WHAT DO YOU THINK ARE NEXT STEPS
TO MOVE FORWARD WITH THE
EVIDENCE ON THIS TYPE OF
SUPPLEMENTATION?
>>
>> THERE'S A HANDFUL OF CLINICAL
TRIALS.
SOME MIXED RESULTS AND SOME AT
THE END THAT DEMONSTRATE MARINE
OIL ENRICHED SUPPLEMENTATION CAN
INCREASE NOT JUST THE LEVELS OF
DHA AND EPA IN THE CIRCULATION
BUT DOWNSTREAM BIO CONVERTED
SPMs.
MOSTLY THE DATA ARE IN HEALTHY
INDIVIDUALS.
ONE STUDY IN ATHEROCLEROSIS
PATIENTS BUT THAT'S THE NEXT
STEP.
CAN WE AND SHOULD WE EMPLOY
TRIALS.
THERE'S COMMERCIALLY AVAILABLE
PRODUCTS AND ONE IS CALLED SPM
ACTIVE THAT HAVE NOT JUST THE
PARENT FATTY ACID BUT THE
PATHWAY AND THOSE ARE IN
CLINICAL TRIALS.
THERE ARE INDIVIDUAL SPMs
STUDIED IN CLINICAL TRIALS AND
SEVERAL IN PERIODONTAL DISEASE,
DRY EYE, A TOPIC DERMATITIS IN
CHILDREN.
IT'S A PARTICULAR AREA OF
INTEREST.
AND SAFETY PROFILE WISE IS
FAVORABLE TO DO ADDITIONAL
CLINICAL TRIALS.
I'D BE SUPPORTIVE.
>> THANK YOU.
I THINK TAWNYA ROBINSON HAS
PRETTY MUCH THE SAME QUESTION.
IT'S QUITE STRIKING TO ME TO SEE
THAT CONSISTENT.
WE'VE SEEN WELL DESIGNED
INTERVENTION TRIALS AND YOU'VE
SEEN VITAMIN SUPPLEMENTS OF A, B
AND SELENIUM THAT DON'T CON FURM
THE FINDINGS FROM OBSERVATIONAL
STUDIES.
THEREFORE THE USUAL ASSUMPTION
IS THE NATURE SOURCES OF DIETARY
INTAKE ARE NOT OBSERVED IN
NUTRITIONAL SUPPLEMENTS BECAUSE
IT'S NOT THERE.
THERE MUST BE SOMETHING ELSE
INDICT BUT HERE LOOKING AT THE
MECHANISMS THE PANEL WAYS THAT
HAVE.
DESCRIBED -- PATHWAYS DESCRIBED
UNRICH MARINE OILS IT WOULD SEEM
IT'S QUITE PROMISING.
I LOOK FOR WARD TO READING THE
SCIENTIFIC LITERATURE IN THE
COMING MONTHS.
THERE MAY BE SOME FUTURE THERE.
>> I AGREE THE TRIAL I PRESENTED
AT THE BEGINNING OF MY TALK THE
INTERVENTION WAS VERY HIGH DOSE.
THE OUTCOME WAS CLEAR IN THE
WOMEN IN DEFICIENT IN THE LOWER
TERTILE PUT WHAT WE DON'T KNOW
FROM TRIALS LIKE THAT IS HOW DID
THAT IMPACT THE SPMs IN TERMS OF
MORE DOWN STREAM MECHANISTICALLY
RELEVANT MOLECULES TO BE
DETERMINED.
>> THANK YOU.
JUST TO BE COGNIZANT OF THE TIME
AS WE ARE APPROACHING THE END OF
THIS SESSION, I WANT TO GIVE ALL
THE SPEAKERS A CHANCE TO LEAVE
YOUR FINAL THOUGHTS WITH REGARD
TO THE MOST CRITICAL RESEARCH
GAP AND MOST PROMISING NEXT STEP
FROM YOUR PERSPECTIVE IN TERMS
OF PRECISION NUTRITION MEASURES.
>> IDENTIFYING BIOMARKERS FOR
FOODS AND DIETARY PATTERNS.
THE BIOMARKER CONSORTIUM IS
DOING THAT BUT WE'RE ONLY
TESTING SIX FOODS AT HARVARD AND
OTHER SITES ARE TESTING
ADDITIONAL FOODS.
WE CONSUME A LOT MORE.
PUTTING THE MONEY THERE AND
LOOKING AT OTHER OMIC
TECHNOLOGIES LIKE PROTEOMICS
WHICH IS A BIT MORE STABLE THAN
METABOLOMICS WOULD ALSO BE
USEFUL.
>> IT WOULD BE IMPORTANT TO GET
DOWN TO THE TEST PERFORMANCE
CHARACTERISTICS AND SEE IF THE
BIOMARKERS ARE SUFFICIENT TO
CHANGE DECISION MAKING.
THAT'S ONE PLACE WE HAVE FALLEN
SHORT IN BIOMARKER WORK.
WE DON'T HAVE A GREAT IDEA OF
THE DISCREET MEASURES OF TEST
PERFORMANCE AND ONCE WE EXPLORE
THOSE WE SEE WE'RE OFTEN
MODESTLY BETTER THAN A COIN FLIP
AND NOT IN THE REALM WHERE IT'S
GOING TO CHANGE WHAT WE DO IN
THE CLINIC.
NOT ONLY DISCOVERING NEW
BIOMARKERS BUT FORMATTING THEM
IN THE WAY THEY HAVE TEST
PERFORMANCE CHARACTERISTICS TO
CHANGE PRACTICE.
>> I'D LIKE TO HIGHLIGHT THE
RESEARCH GAP IDENTIFIED SO
CHANGING BODY MASS MARKERS I CAN
ALSO CHANGE OUTCOMES IN THE
FUTURE IS IN MY POINT OF VIEW
THE MOST IMPORTANT ONE.
I THINK WE SHOULD END OR TRY TO
CHANGE AND IMPROVE BODY RELATED
MARKERS.
FOR EXAMPLE INTERVENTIONS AS
PART OF MORE REHABILITATION
PROGRAM AND WHETHER THEY'RE
ASSOCIATED WITH BETTER OUTCOMES.
>> FROM MY PERSPECTIVE I WOULD
SAY THE KEY RESEARCH QUESTION IS
COULD DIETARY SUPPLEMENTATION
WITH MARINE OILS PROMOTE
INFLAMMATION IN INFLAMMATORY
DISEASES AND CAN WE FEED THE
LUNG THROUGH THE GUT AND CAN WE
GET A WINDOW INTO WHETHER
DYSREGULATED CIRCUITS ARE
INTERROGATED FROM COHORTS WE
FOLLOW LONGITUDINALLY.
THANK YOU ALL SO VERY MUCH FOR
YOUR INSIGHTS AND STIMULATING
DISCUSSION.
I THINK WE CAN BRING THIS
SESSION TO A CLOSE.
ALL THE SPEAKERS AND THE
MODERATORS INCLUDING THOSE FROM
YESTERDAY PLEASE DO PLAN TO JOIN
US THIS AFTERNOON IN THE OVER
ALL PANEL DISCUSSION WHERE WE'LL
HAVE SOME HIGH LEVEL STRATEGIC
QUESTIONS THAT HOPEFULLY WILL
GENERATE GREAT DISCUSSIONS.
THANK YOU ALL.
YOU I THINK NOW WE'LL GO INTO A
30-MINUTE BREAK.
SO WE'RE GOING TO KICK OFF
THE FINAL SESSION, SESSION 5 FOR
THIS WORKSHOP AND IT'S MY GREAT
PLEASURE TO INTRODUCE MY
CO-MODERATOR LISA WOOD IN THE
UNIVERSITY OF NEWCASTLE AND A
KEEN LEADER FOR NUTRITION AND
METABOLISM IN THE IMMUNE HALT
PROGRAM AT HUNTER MEDICAL
RESEARCH INSTITUTE.
SHE IS A REGISTERED NUTRITIONIST
AND CLINICAL RESEARCH SCIENTIST
WHOSE RESEARCH EXPLORE NON-F
NON-PHARMACOLOGIC STRATEGIES FOR
DISEASE CONDITIONS WITH A
PARTICULAR FOCUS ON ASTHMA.
DR. WOOD AND HER TEAM HAVE
PUBLISHED EXTENSIVELY WITH OVER
200 PEER-REVIEWED JOURNAL
ARTICLES AND THEIR RESEARCH HAS
CONTRIBUTED TO THE DEVELOPMENT
OF DISEASE MANAGEMENT GUIDELINES
SUCH AS THOSE PRODUCED BY THE
BRITISH THORACIC SOCIETY AND
ASTHMA CONSULT AND HAS BEEN
RECOGNIZED BY AWARD THE
NUTRITION SOCIETY OF AUSTRALIA
IN 2022 AND IS THE PAST
PRESIDENT OF THE NUTRITION
SOCIETY OF AUSTRALIA AND
DIRECTOR OF THE AUSTRALIAN
NUTRITION TRUST AND CURRENTLY ON
THE ASTHMA AUSTRALIA RESEARCH
ADVISORY COMMITTEE.
OVER TO DR. WOOD TO INTRODUCE
THE SESSION.
>> THANKS VERY MUCH, DR. MA.
IT'S GREAT TO BE HERE.
I DID WANT TO COMPLIMENT
YOURSELF AND THE COCHAIRS AND
NIH FOR PUTTING ON SUCH A
FABULOUS MEETING.
SO SESSION 5 IS TITLED DIETARY
AND NUTRITIONAL INTERVENTION IN
THE PREVENTION AND MANAGEMENT OF
RESPIRATORY DISEASES.
THE OBJECTIVES ARE TO PROVIDE
EVIDENCE ON THE EFFICACY,
DISSEMINATION AND IMPLEMENTATION
OF DIETARY AND NUTRITIONAL
INTERVENTIONS FOR RESPIRATORY
DISEASE PREVENTION AND CONTROL.
THIS KNOWLEDGE CAN GUIDE
DEVELOPMENT OF COMPREHENSIVE
DIETARY GUIDE LIPS.
SO WE'RE LOOKING FORWARD TO
ANOTHER GREAT SESSION AND I
WOULD PASS BACK TO DR. MA TO
INTRODUCE THE FIRST SPEAKER.
>> THANK YOU.
IT'S MY PLEASURE TO INTRODUCE
DR. NADIA HANSEL.
SHE'S A WILLIAM OSLER PROFESSOR
OF MEDICINE IN THE DEPARTMENT OF
MEDICINE AT JOHNS HOPKINS.
SHE ALSO SERVED AS THE PHYSICIAN
IN CHIEF AT JOHNS HOPKINS
HOSPITAL.
HER TALK WILL FOCUS ON EFFICACY
OF TARGETED NUTRITION
SUPPLEMENTATION IN THE
MANAGEMENT OF RESPIRATORY
DISEASES IN UNDER SERVED
POPULATIONS.
>> THANK YOU SO MUCH, DR. WOOD
AND DR. MA.
THE SESSION IS EXCITING AS WELL
AS INVITING ME TO SPEAK TODAY.
I WANT TO CONGRATULATION THE
SPEAKERS OF THE LAST SESSION FOR
SOMETHING THAT WAS PROVOCATIVE
AND HOPEFULLY THE SESSION WILL
ADD TO THE DISCUSSIONS THAT HAVE
ALREADY BEEN HAD.
I'M GOING TO START BY TALKING
THROUGH REALLY FIRST THE
IMPORTANCE OF FOCUSSING ON UNDER
SERVED POPULATIONS TO ADDRESS
HEALTH DISPARITIES.
AS THE UNDER SERVED POPULATION
THOSE THAT HAVE LOW INCOME OR
LOW FOOD ACCESS I THINK ARE
PARTICULARLY VULNERABLE TO
NUTRITIONAL DEFICIENCIES.
IN PARTICULAR THIS SLIDE REALLY
HIGHLIGHTS I THINK THE MULTIPLE
FACTORS IN WHICH CASE LOW INCOME
AND FOOD INSECURE PEOPLE CAN BE
SUSCEPTIBLE IN TERMS OF
RESPIRATORY DISEASE.
FIRST OF ALL WITH THE LIMITED
RESOURCES ARE CHALLENGED FOR THE
PURCHASING OF QUALITY FOODS,
LACK OF HEALTHY AND AFFORDABLE
FOOD ACCESS PROMINENT IN UNDER
SERVED COMMUNITY AND
NEIGHBORHOODS WHICH CAN LEAD TO
CHALLENGES IN BEHAVIORAL
ADAPTATIONS AND FOOD INTAKE.
IT CAN BE ASSOCIATED THEN ALSO
WITH THE HIGH LEVELS OF STRESS,
ANXIETY AND DEPRESSION THAT CAN
BE RELATED TO FOOD AND DIET.
ALL THESE FACTORS CAN ALSO BE
CONFOUNDED BY LIMITED ACCESS TO
HEALTH CARE OR PHYSICAL ACTIVITY
WHICH I THINK CAN COMBINE WITH
CHALLENGES ON HEALTHY FOOD
INTAKE TO LEAD TO CHALLENGES
WITH RESPIRATORY DISEASE.
AND OF COURSE WE ALL KNOW
THERE'S GREATER EXPOSURE TO FOOD
MARKETING AND FOOD AVAILABILITY
TO UNHEALTHY FOOD WHICH MAKES
ALL THESE CHALLENGES
PARTICULARLY NOTABLE IN LOW
INCOME AND UNDER SERVED
POPULATIONS.
COPD IS WHAT I'M GOING TO FOCUS
ON TRYING TO THINK HOW WE CAN IN
THE SPAN OF 12 TO 13 MINUTES
REALLY ADDRESS FOOD
SUPPLEMENTATION AND RESPIRATORY
DISEASE FOCUSSING MOST THE
PRESENTATION ON COPD WHICH IS A
CHRONIC RESPIRATORY DISEASE I'VE
FOCUSSED ON IN PARTICULAR.
IT'S APPLICABLE BEYOND COPD IF
YOU THINK OF CHRONIC LUNG
DISEASE IT MAKES ALL THE
CHALLENGES WE THINK IN TERMS OF
WHAT UNDER SERVED POPULATIONS
FACE MORE CHALLENGING WHEN YOU
THINK OF A CHRONIC LUNG DISEASE
WHERE PATIENTS HAVE PERHAPS
HIGHER NUTRITIONAL NEEDS OR MORE
CHALLENGES IN TERMS OF HAVING
ACCESS TO HEALTHY FOODS OR
MOBILITY.
MALNUTRITION IS VERY COMMON IN
PATIENTS WITH COPD WITH A HIGH
PREVALENCE AND THE MICRONUTRIENT
INTAKE IN STUDIES HAVE SHOWN
INADEQUATE AND MORE IMPORTANT TO
ADDRESS THE ANTI-INFLAMMATORY,
ANTIOXIDANT NEEDS TO CONTROL AND
COMBAT THE DISEASE.
IN PARTICULAR BEFORE I DIVE INTO
THE SUPPLEMENTATION, I THOUGHT
IT WAS WORTH PAUSING FOR TO
THINK OF ALL THE WAYS IN WHICH
THE CHALLENGES BECOME
POTENTIATED IN UNDER SERVED
COMMUNITIES.
I WORK WITH A FACULTY MEMBER TO
LOOK AT FOOD INSECURITY BY
QUESTIONNAIRE TO FOOD INSECURITY
HAS SUBDOMAINS OF INSUFFICIENT
FOOD INTAKE OR QUALITY OR
CHALLENGES ABOUT FOOD.
IT WASN'T CLEAR WHICH ONE OF
THESE WERE PRIMARILY DRIVING THE
CHALLENGES OR ASSOCIATE BETWEEN
FOOD INSECURITY AND COPD
OUTCOMES.
YOU CAN SEE WHEN WE LOOKED AT
MULTIPLE OUTCOMES, EXACERBATION
RISK NOT ONLY WAS IT ASSOCIATED
WITH THE OUTCOMES BUT SO WERE
ALL THREE DOMAINS.
IT MAY BE A COMPLEMENT THAT FOOD
QUALITY, ANXIETY AND
INSUFFICIENT FOOD INTAKE
COMBINED HAVE INDEPENDENT
ASSOCIATIONS.
THOUGH THE TOPIC IS FOCUSSED ON
FOOD SUPPLEMENTATION IT'S ONE
NARROW LOOK AT THE OPPORTUNITY
FOR SERVING UNDER SERVED
POPULATIONS IN TERMS OF OUR
DIETARY APPROACHES OR
INTERVENTIONS.
OF NOTE LOW FOOD ACCESS IN
PARTICULAR HAS BEEN SHOWN TO BE
ASSOCIATED WITH RESPIRATORY
DISEASE AND FOLKS IN LOW FOOD
ACCESS AREA HAVE EMPHYSEMA AND
GAS TRAPPING WHEN YOU THINK OF
OBJECTIVE MEASURES NOT JUST
SUBJECTIVE MEASURES ASSOCIATED
WITH LOWER LUNG FUNCTION AND
HIGHER EXACERBATION AND WORSE
RESPIRATORY SYMPTOMS AND IT'S
OCCURRING IN LINK WITH
RESPIRATORY OUTCOMES IS WHETHER
YOU LIVE IN HIGH POVERTY AREAS.
THINKING IT IS PARTICULARLY
LINKED TO BEING IN A LOW-FOOD
ACCESS AREA.
SO ONE OF THE WAYS WE THINK
LIVING IN A LOW FOOD ACCESS AREA
IS LINKED WITH RESPIRATORY
DISEASE IS BECAUSE IT MAKES IT
HARDER TO EAT HEALTHY FOODS.
WE LOOKED SPECIFICALLY AT A
BALTIMORE COMMUNITY AND SEE LOW
FOOD ACCESS RESIDENTS DID HAVE
LOWER EPA AND DHA INTAKE BOTH IN
TERMS OF FOOD FREQUENCY
QUESTIONNAIRE BUT ALSO AS WE
TALKED ABOUT IN THE LAST SESSION
THE CHALLENGES POTENTIALLY WITH
FOOD FREQUENCY QUESTIONNAIRES
AND OBJECTIVE MEASURES OF
PLASMA, EPA, DHA.
SO OMEGA FREE FATTY ACIDS SOME
PRESENTATIONS FOCUSSED ON THE
FACT THIS MAY BE LINKED TO ACUTE
RESPIRATORY DISPRESS SYNDROME OR
PULMONARY FIBROSIS AND OUR DATA
LINKS OMEGA 3 FATTY ACID TO COPD
AND RESPIRATORY SYMPTOMS.
IF YOU FOCUS ON THE FLEW YOU CAN
SEE INCREASING OMEGA 3 INTAKE IS
REPRESENTED WITH SCORES OF
BETTER HEALTH AND LOWER RISK OF
SEVERE EXACERBATIONS WHICH DOES
SUGGEST TARGETING OMEGA 3 FATTY
ACIDS IN NUTRITIONAL
SUPPLEMENTATION COULD BE
HELPFUL.
AND THE LEVELS ASSOCIATED WITH
RESPIRATORY SYMPTOMS AND THE
OBJECTIVE MEASURES WERE HELPFUL
TO CONFIRM BUT NOT STRICTLY
RECALLED OR LINKS WITH
ASSOCIATION OF WHAT PEOPLE ARE
SELF-REPORTING.
HOWEVER, THE LIMITATIONS OF THE
CROSS SECTIONAL STUDIES IN
DETERMINING CAUSALITY MOVE THE
FIELD FORWARD WITH MORE
INVENTION TRIALS.
IN THE INTEREST OF TIME I WAS
TRYING TO NOT NECESSARILY
HIGHLIGHT INDIVIDUAL STUDIES BUT
FOCUS ON PRESENTING THE
META-ANALYSIS.
A LOT OF THE META-ANALYSIS TO
DATE REALLY DO HIGHLIGHT IN MY
OPINION THE LIMITATIONS OF THE
WONDERFUL STUDIES DONE TO DATE
BUT WHERE OUR FIELD NEEDS TO GO.
OWE OMEGA 3 SUPPLEMENTATION AND
COPD HAS BEEN SHOWN TO HAVE
LOWER INTERLEUKIN 6 PANELS IN
THE SECOND PANEL IN THE
STATISTICALLY SIGNIFICANT MANNER
WHEN YOU LOOK AT META-ANALYSES.
THERE WERE TRENDS FOR OTHER
SYSTEMIC INFLAMMATORY MARKERS
BUT THEY DID NOT REACH
STATISTICAL SIGNIFICANCE.
IN ADDITION, THERE WAS NO
ASSOCIATION WITH OMEGA 3
SUPPLEMENTATION AND CRITICAL
COPD OUTCOMES SUCH AS 6 MINUTE
WALK DISTANCE AND THERE ARE SOME
EVIDENCE IN SOME OF OUR
RANDOMIZED CONTROL TRIALS TO
SUGGEST OMEGA 3 SUPPLEMENTATION
CAN RELATE TO MUSCLE MASS BUT
HOW IT RELATES TO COPD HEALTH IS
YET UNKNOWN AND A LOT OF THE
INTERPRETATION OF THE DATA SO
FAR IN RESPIRATORY ARE LIMITED
BY SMALL AND HETEROGENEOUS
STUDIES WIN SAMPLE SIZE,
POPULATION S AND DIFFERENCES IN
OUTCOMES MEASURED.
THIS WAS HIGHLIGHTED IN THE
PREVIOUS SESSION.
THE STUDY WAS DONE ABOUT EIGHT
YEARS AGO BUT THIS IS A LANDMARK
STUDY THAT HELPS ENCOURAGE
THERE'S PROMISE IN
SUPPLEMENTATION FOR LUNG
DISEASE.
THIS WAS DONE IN PREGNANT WOMEN
OFFSPRING SHOWING THAT
SUPPLEMENTATION HAS THE
POTENTIAL TO IMPROVE REDUCED
RISK OF WHEEZE OR PERSISTENT
WHEEZE.
IT'S CRITICAL TO REALLY THINK
ABOUT THE POPULATION AT RISK AND
WHO WOULD BENEFIT MOST WITH THE
PRODOMINANCE OF THE SIGNAL BEING
SEEN IN WOMEN THAT HAD LOW
LEVELS TO BEGIN WITH.
THIS IS WHERE IN TERMS OF THE
PRECISION NUTRITION BROUGHT UP
ALREADY WE NEED TO BE MORE
STRATEGIC IN THINKING ABOUT THE
POPULATION THAT CAN BENEFIT FROM
SUPPLEMENTATION.
THERE'S BEEN SELF STUDIES THAT
HAVE LOOKED AT VITAMIN D
SUPPLEMENTATION FOR EXACERBATION
RISK.
THIS WAS INCLUDED IN THE GOLD
GOOD LINES PREVIOUSLY A SMALL
NOTATION ABOUT VITAMIN D
SUPPLEMENTATION BUT
META-ANALYSIS DID NOT SHOW OVER
ALL BENEFIT IF YOU LOOK AT COPD
COHORTS OVER ALL.
AGAIN, SIMILAR TO THE STUDY WE
JUST SHOWED ON PROOF OF
SUPPLEMENTATION IN ASTHMA, YOU
CAN SEE THE BENEFIT WAS
PREDOMINANTLY AMONG THE
POPULATION WITH LOW VITAMIN D
LEVELS AT BASELINE.
I THINK AS WE MOVE FORWARD WE DO
OURSELVES A DISSERVICE BIT NOT
FULLY ADDRESSING WHAT OUR
BASELINE NUTRIENT STATUS IS.
IF WE LOOK MORE BROADLY NOT JUST
AT DISEASE OUTCOMES SUCH AS
EXACERBATION BUT FEB1 AS AN OVER
ALL MEASURE OF LUNG FUNCTION
RELEVANT FOR MANY CHRONIC
DISEASES, THERE'S A RECENT
PUBLICATION THIS YEAR PUBLISHED
ON THE META-ANALYSIS OF VITAMIN
D SUPPLEMENTATION IN FAV1.
YOU CAN SEE OVER ALL THERE'S A
VARIABILITY OF EFFECT SIZES
BASED ON STUDIES AND SEE THERE'S
A LARGE NUMBER OF STUDIES THAT
HAVE BEEN PUBLISHED THAT HAVE
LOOKED AT THIS QUESTION.
I THINK VERY ENCOURAGING IS THAT
WHEN YOU LOOK AT THE
META-ANALYSIS RESULTS IT DOES
SUGGEST BENEFIT OF VITAMIN D
SUPPLEMENTATION ON F EV1.
VITAMIN C IS AN ANTIOXIDANT.
NOT AS MANY STUDIES ON VITAMIN D
BUT IT HAS RECEIVED SOME
ATTENTION.
AGAIN, MUCH VARIABILITY IN THE
STUDIES THAT HAVE BEEN COMPLETED
TO DATE.
IF YOU LOOK AT THE TOP PART OF
THE PANEL YOU CAN SEE VITAMIN C
SUPPLEMENTATION LESS THAN 400
MILLIGRAMS, AGAIN, FEW STUDIES
SO HARD TO DRAW CONCLUSION BUT
THEY'VE BEEN INCONCLUSIVE TO
SHOW BENEFIT.
IF YOU THINK OF VITAMIN C OF
GREATER THAN 400 MILLIGRAM
SUPPLEMENTATION THERE'S A TREND
TO SUGGEST PERHAPS THIS
ANTIOXIDANT SUPPLEMENTATION
COULD HAVE BENEFIT IN PATIENTS
WITH CHRONIC LUNG DISEASE SUCH
AS COPD IN FE V1 AND THE STUDY
REMAINS QUITE SMALL.
AGAIN, LIMITING OUR ABILITY TO
DRAW DEFINITIVE CONCLUSIONS.
I WANT TO POINT TO ONE STUDY
THAT IS VERY OLD BUT SIMILAR TO
THE STUDY OF FATTY ACID
SUPPLEMENTATION IN PREGNANCY A
LANDMARK STUDY TO SHOW THE
BENEFIT OF NUTRIENT
SUPPLEMENTATION IN NEPAL LOOKING
AT PATIENTS SHOWING AN IMPROVED
LUNG FUNCTION IN OFFSPRING AND
TRULY THE VITAMIN A ARM THAT
SHOWED POTENTIAL FOR IMPROVEMENT
OF LUNG FUNCTION.
THANK YOU.
YOU CAN ALSO SEE THE POSTPARTUM
LEVELS OF RETINOL HAD A STRONG
CORRELATION WITH THE POSSIBLE
BENEFIT AND IMPROVEMENT OF LUNG
FUNCTION.
THE STUDY HIGHLIGHTS BOTH
IMPORTANT INTEREST IN TIMING OF
SUPPLEMENTATION WITH PREGNANCY
BEING A PARTICULARLY VULNERABLE
TIME THAT MAY IMPROVE OFFSPRING
AND LOOKING AT THE APPROPRIATE
LEVEL OF SUPPLEMENTATION SHOWING
ACHIEVING HIGHER LEVELS COULD
LEAD TO HIGHER BENEFIT.
ONLY A COUPLE MORE SLIDES.
I DO ALSO WANT TO NOTE THE
CARROT TRIAL WHERE WE ASSUME
SUPPLEMENTATION WITH CAROTENE
AND VITAMIN A WOULD BENEFIT LUNG
CANCER AND HAD SURPRISING RESULT
SHOWING A POTENTIAL INCREASE IN
LUNG CANCER DEATH MAKING US SURE
TO BE SURE FROM OBSERVATIONAL
STUDIES TO CLINICAL STUDIES WITH
PAUSE AND THOUGHT ABOUT DATA AND
THE NEED FOR INTERVENTIONAL
TRIALS TO DRAW CORRECT
CONCLUS
CONCLUSIONS.
THERE ARE OUTCOME IN SMALL
STUDIES THAT LOOKED AT NUTRITION
SUPPLEMENTATION IN TERMS OF
IMPROVING BODY WEIGHT AND GRIP
STRENGTH IN COPD AND
EXERCISE-INDUCED FATIGUE AND
PERHAPS COMBINED WITH MUSCLE
STRENGTH TRAINING IMPROVED
MUSCLE STRENGTH IN COPD.
AGAIN I THINK THE STUDIES ARE
LIMITED THAT OF AND NEED TO DO A
BETTER JOB MOVING FORWARD AS THE
FIELD HAS ADVANCED IN TERMS OF
IDENTIFYING THE PATIENTS THAT
COULD BENEFIT AND THINK WHAT
SUPPLEMENTATION COULD BE
BENEFICIAL AND THERE ARE
POTENTIAL NON-RESPIRATORY
OUTCOMES IN PATIENT WITH CHRONIC
LUNG DISEASE SUCH AS EXERCISE
ENDURANCE THAT MAY BE WORTH
CONSIDERING BUT FEW THAT LOOKED
AT STANDARDIZED RESPIRATORY
OUTCOMES TO BEST ADDRESS PATIENT
NEED.
FOR THE CONCLUSIONS, UNDER
SERVED POPULATIONS ARE AT
INCREASED RISK.
I BEG US AS A COMMUNITY TO MAKE
SURE THE INTERVENTION STUDY
ADDRESS HEALTH DISPARITIES TO
MAKE SURE WE ADDRESS THOSE MOST
VULNERABLE AND THEREFORE THOSE
MOST LIKELY TO BENEFIT.
OBSERVATIONAL EVIDENCE I THINK
IS QUITE LARGE BUT THERE IS
TRULY A NEED FOR INTERVENTION
STUDIES THAT ARE LARGER TO GUIDE
RECOMMENDATIONS.
FEW STUDIES HAVE SHOWN SUPPORT
FOR VITAMIN C OR D IN COPD.
I THINK PROMISING STUDIES EXIST
AND OTHERS SPHERES SUCH AS
ASTHMA AND LUNG FUNCTION BUT
AGAIN MANY CHRONIC LUNG DISEASES
I BELIEVE BASED ON THE DATA
SHOWN IN THIS SYMPOSIUM TO DATE
AND LITERATURE SUGGESTS THERE
COULD BE BENEFIT IN OTHER
CHRONIC LUNG DISEASES.
IT'S INTERESTING I WAS GIVEN A
TALK ON SUPPLEMENTATION OF
NUTRIENTS BECAUSE I TRULY
BELIEVE AS WE WERE TALKING ABOUT
HERE WITH METABOLOMICS AS A
FIELD WE SHOULD THINK OF MORE
COMPREHENSIVE DIETARY
INTERVENTIONS TO BE MOST
BENEFICIAL.
I'LL STOP THERE.
THANK YOU SO MUCH.
>> THANK YOU VERY MUCH,
DR. HANSEL.
WE'RE GOING TO MOVE TO OUR NEXT
SPEAKER NOW.
I'D LIKE TO INTRODUCE
DR. SALVATORE CARBONE ASSOCIATE
PROFESSOR FROM THE DEPARTMENT OF
KINESIOLOGY AND HEALTH SCIENCES,
VIRGINIA COMMONWEALTH
UNIVERSITY.
WELCOME AND I'LL HAND IT OVER TO
YOU.
>> WONDERFUL.
THANK YOU VERY MUCH FOR THE
INVITATION AND ALSO FOR THE
WONDERFUL PRESENTATION RIGHT
BEFORE MINE.
I THINK THERE WILL BE SOME MINOR
OVERLAP BUT THE ULTIMATE GOAL IS
TO IMPROVE THE QUALITY OF THE
EVIDENCE WITH NUTRITION AND
RESPIRATORY HEALTH.
I'LL TALK RIGHT NOW SPECIFICALLY
DISCUSS THE ROLE OF NUTRITION
INTERVENTION IN RESPIRATORY
FITNESS AND CARDIORESPIRATORY
FITNESS.
HERE ARE MY DISCLOSURES AND THE
MAIN TOPICS.
WE'LL FOCUS ON CARDIO FITNESS
AND DEFINITIONS AND WHY IT'S
IMPORTANT TO MEASURE WHEN
POSSIBLE AND WHY THIS IS
IMPORTANT ALSO CONSIDERING THE
CONTRIBUTION OF CARDY FITNESS IN
REGARDS TO REDUCED QUALITY OF
LIFE AND INTERVENTIONS WITHOUT
ENERGY RESTRICTION IN ABSENCE OF
WEIGHT LOSS IMPLEMENTED TO
IMPROVE CRF.
FIRST I WANT TO INTRODUCE CRF
WHICH IS THE CARDIOVASCULAR
RESPIRATORY AND MUSCULAR
RESPONSE TO EXERCISE.
IT'S IMPORTANT THAT A FEW YEARS
AGO THE AMERICAN HEART OF
ASSOCIATION RELEASED A STATEMENT
THAT MADE A CASE FOR
CARDIORESPIRATORY FITNESS TO BE
USED AS A CLINICAL VITAL SIGN.
THERE'S OXYGEN CONSUMPTION WITH
THE CARDIO PULMONARY EXERCISE
TESTING IN PATIENTS WITH COPD OR
OTHER CHRONIC DISEASE WE'RE
UNABLE TO REACH THE PLATEAU
BETWEEN THE WORK RATES DURING
THE EXERCISE TEST AND TALK ABOUT
PEAK OXEN CONSUMPTION IN
PRESENCE OF AN AN EFFORT.
FOLLOWING THE EQUATION IT'S
CALCULATED WITH THE PRODUCT OF
CARDIAC OUTPUT AND OXYGEN
DIFFERENCE WHICH PROVIDES AN
ASSESSMENT OF OXYGEN EXTRACTION.
YOU CAN SEE ON THE RIGHT YOU CAN
APPRECIATE LUNGS PLAY A ROLE IN
THE OXYGEN PATHWAY.
SO ANY LIMITATION COULD
CONTRIBUTE TO A REDUCED VO2
PEAK.
WHEN WE CONDUCT A CARDIO
PULMONARY TEST WE'RE ABLE TO
ASSESS OTHER PARAMETERS THAT
PROVIDE INSIGHTS TO THE
LIMITATIONS OF PATIENTS AND NOT
ONLY WE'RE ABLE TO ASSESS THE
OVER ALL VO2 PEAK OR CARDIO
FITNESS BUT DETERMINE WHAT'S
LIMITING AND SHOULD TARGET WITH
OUR INTERVENTION.
WHEN VO2 PEAK CAN BE MEASURED
DUE TO THE LACK OF GAS EXCHANGE
ANALYSIS WE CAN ESTIMATE THE
CARDIO FITNESS THROUGH METABOLIC
TASK WHERE ONE EQUALS TO
MILLIMETERS PER MINUTE OF VO2
PEAK.
SO LIKE I SAID CARDIO PULMONARY
TESTING PROVIDES INSIGHT INTO
THE UNDERLYING CAUSES.
WHY IS IT IMPORTANT?
WITH REGARDS TO RESPIRATORY
DISEASE, EVERY INCREASE WHICH IS
A SMALL NUMBER OF MET IS
ASSOCIATED WITH A 6% RELATIVE
RISK OF RELATED MORTALITY AND
LOOKING AT INCIDENTS
PARTICULARLY COPD INS DEPENDS
THERE'S AS A LINEAR RELATIONSHIP
BETWEEN RISK WITH EVERY MET
INCREASE BEING ASSOCIATED WITH A
10% RELATIVE RISK REDUCTION FOR
THE RISK OF COPD.
CLINICALLY WHAT IS AN IMPORTANT
IMPROVEMENT IN CRF IF WE ASSESS
IT OVER TIME IN AN INDIVIDUAL,
REALLY IN DATA FROM HEART
FAILURE STUDY LARGE RANDOMIZED
CONTROL TRIAL SUGGESTS ANY
IMPROVEMENT EVEN 5% OF CRF IS
CONSIDERED HIGHLY CLINICALLY
SIGNIFICANT ASSOCIATES WITH
LOWER RISK FOR CARDIOVASCULAR
MORTALITY AND HOSPITALIZATION.
BUT IN ADDITION TO PREVENTION OF
RESPIRATORY DISEASE MORTALITY
AND WHAT QUALITY OF LIFE AND IT
DRIVES QUALITY OF LIFE
PARTICULARLY IN PATIENT WITH
COPD.
IN A STUDY OVER 10 YEARS AGO IF
THE AUTHOR HAS SHOWN PATIENTS
WITH COPD PRESENT A DRAMATICALLY
LOWER VO2 PEAK COMPARED TO
HEALTHY CONTROLS IN ABSOLUTE
VALUE IN MILLIMETERS PER MINUTE
AND THE VO2 IS ADJUSTED TO
COMPARE BODY SIZES AND THE
AUTHORS ASSESSED OXYGEN
CONSUMPTION DURING ACTIVITIES OF
DAILY LIVING.
WHAT THEY FOUND IN PANEL A IS
PATIENTS WITH COPD UTILIZED A
SIMILAR AMOUNT OF OXYGEN TO
CONDUCT ACTIVITIES OF DAILY
LIVING BUT THE PERCENTAGE OF
PEAK VO2 IS HIGH IN SOME ALMOST
90% OF THEIR MAX WHICH YOU CAN
IMAGINE IS LIMITING THE
ACTIVITIES THAT YOU CONDUCT
BECAUSE EVEN JUST BY PUTTING
THEIR CLOTHES ON OUR CLEANING
THE DISHES OR FLOOR THEY'RE ALL
RIGHT ALMOST 70 TO 80% OF THEIR
MAX WHICH DOES NOT ALLOW THEM TO
CONDUCT THIS TYPE OF ACTIVITY
FOR A LONG PERIOD OF TIME.
THERE'S INDIVIDUALS PRESENTING
LOWER VO2 PEAK SUGGESTING BY
IMPROVING NUTRITIONAL STATUS WE
CAN IMPROVE VO2 PEAK AS WELL.
HOW CAN WE IMPROVE DIET QUALITY
AND CRF.
THERE'S A STUDY IN HEALTHY
INDIVIDU
INDIVIDUALS WE'RE SHOWING IN
INDIVIDUALS WITHOUT COPD OR
HEART DISEASE INDIVIDUALS THAT
PRESENTED GREATER ADHERENCE TO
HEALTHIER DIETARY PATTERN
SHOWING ADHERENCE TO A HEALTHY
INDEX AND MEDITERRANEAN SCORE
WAS ASSOCIATED WITH THE PEAK AND
GREATER ADHERENCE TO THE DIETARY
PATTERN WAS ALSO ASSOCIATED WITH
LOWER SLOPE SUGGESTING A GREATER
PULMONARY VASCULAR FUNCTION
THERE'S ANY ASSOCIATION WITH
GREATER PULMONARY VASCULAR
FUNCTION.
WHAT ABOUT IN PATIENTS WITH
ACTUAL DISEASE WITH COPD?
THE PEAK WAS USED MORE ROUTINELY
IN PATIENTS WITH COPD AND TEST
MORE CONSISTENTLY OVER STUDIES.
SOME DATA I'LL PRESENT WILL BE
FROM OVER 20 YEARS AGO BUT ONE
OF THE NUTRIENTS I WOULD SAY
INVESTIGATED THE MOST WITH
REGARDS TO PATIENTS WITH COPD IS
SUPPLEMENTATION.
IN THE META-ANALYSIS ON THE LEFT
SIDE OF THE SLIDE YOU CAN SEE
OVER ALL THE EVIDENCE DOES NOT
SUPPORT THAT SUPPLEMENTATION
IMPROVES PEAK IN PATIENTS WITH
COPD.
IN THE OTHER STUDY ON THE RIGHT
SIDE YOU CAN SEE ANOTHER STUDY
WHERE THE NITRATE IS
SUPPLEMENTED TO ENHANCE PATIENTS
WITH COPD AND THE PEAK MET WAS
NOT SIGNIFICANTLY GREATER IN
PATIENTS RANDOMIZED AND THERE
WAS SOME POTENTIAL TREND THAT
SUGGESTED PATIENTS MAY BE ABLE
TO MAINTAIN HIGHER LEVEL OF
EXERCISE CAPACITY FOR LONGER
PERIOD OF TIME.
HOWEVER, DID NOT RESULT IN
QUALITY OF LIFE.
THE EVIDENCE DOES NOT SEEM TO
SUPPORT THE SUPPLEMENTATION AT
LATEST WITH REGARDS TO VO2 PEAK.
IN ADDITION TO INTERVENTION AND
THIS HAS BEEN THOUGHT A BIT IS
THE POLY UNSATURATED FATTY
ACIDS.
PATIENTS WITH COPD WERE
RANDOMIZED TO RECEIVING
SUPPLEMENTATION OF A MIX OF
POLLEE UNSATURATED FATTY ACIDS
INCLUDING EPA AND DHA IN
ADDITION TO PULMONARY CAPACITY
IN THE POPULATION.
WHETHER THIS MIGHT BE DIFFERENT
IN PATIENTS NOT UNDERGOING THIS
IS UNKNOWN IN PATIENTS WITH VO2
PEAK.
ANOTHER INTERESTING STUDY WITH
YOU UTILIZING CREATINE
SUPPLEMENTATION AND THEY WERE
RANDOMIZED WITH GLUCOSE SOLUTION
AND CREATINE SUPPLEMENTATION
RESULTS IN MORE FAVORABLE BODY
COMPOSITION AND IMPROVEMENTS IN
SKELETAL MUSCLE STRENGTH AND
THERE WAS NO PEAK WITH CREATINE
SUPPLEMENTATION AND THE STUDY
WAS A SMALL SAMPLE AND
APPROPRIATELY POWERED TRIALS TO
LOOK AT DIFFERENCES IN VO 2 PEAK
ARE SOMETIMES IN THE HUNDREDS
AND THERE'S A POSSIBILITY THE
STUDY WAS LIKELY UNDER POWERED
AND WILL REQUIRE A RANDOMIZED
TRIAL TO SEE IF CREATINE
SUPPLEMENTATION WOULD BE
BENEFICIAL IN THIS POPULATION.
COLLECTED EVERYDAY IN REGARDS TO
THE INTERVENTION WITH VO2 PEAK
AND THERE HASN'T BEEN MACHINE
PROGRESS EXCEPT A COUPLE SMALL
STUDIES.
HOPEFULLY THIS WILL STIMULATE
SOME OF THE PEOPLE HERE IN THE
AUDIENCE TO CONDUCT MORE
RESEARCH FOCUSSING ON THE VO2
PEAK CONSIDERING THE IMPORTANCE
OF THE PARAMETERS IN THE
POPULATION.
SO AS I GROUP WE'RE PARTICULARLY
INTERESTED IN THE ROLE OF
UNSATURATED FATTY ACID IN THE
FORM OF FOOD.
THIS IS REALLY FOLLOWING THE
PRESENTATION AND MENTIONED THE
IMPORTANCE OF UTILIZING FOOD
INSTEAD OF DIETARY SUPPLEMENTS.
IN THIS WE'RE PARTICULARLY
INTERESTED IN WORKING WITH
PATIENTS WITH OVERLAPSE WITH
PATIENTS WITH COPD.
MANY PATIENTS DID HAVE COPD.
WHAT WE FOUND IN ANALYSIS AND
PRESENTED FAVORABLE EXERCISE
CAPACITY AND BETTER BODY
COMPOSITION AND FUNCTION.
WE CONDUCTED AND WE FOUND THAT
WHEN MICE WERE FED WITH HIGH FAT
DIETS THE ONES EATING HIGH
UNSATURATED FATTY ACIDED DID NOT
GAIN WEIGHT BUT HAD BETTER
CARDIAC FUNCTION AND THIS
PRELIMINARY DATA LED TO US THE
PILOT STUDY A SINGLE ARM STUDY
IN A SMALL STUDY SUPPLEMENTED
THE DIET WITH FOOD SUCH AS EXTRA
VIRGIN OLIVE OIL AND NUTS AND
WERE LOADING PATIENTS WITH THE
MINIMUM OF FOUR TABLESPOONS FOR
CONSUMPTION AND DIET WAS
IMPROVED WHICH WAS ACCESSIBLE
WITH DIETARY RECALL AS WELL AS
PLASMA FATTY ACID AND MO
MONOUNSATURATED FATTY ACID AND
CHANGES IN CAPACITY.
THIS LED US TO THE STUDY A
RANDOMIZED CROSSOVER STUDY TO
DETERMINE WHETHER OUR INITIAL
FINDING COULD BE REPLICATED IN A
RANDOMIZED CONTROL FASHION.
WE'RE ASSESSING BODY COMPOSITION
AND NON-INVASIVE OF DETERMINATES
AND WILL BREAK A CLINICAL
SESSION NEXT WEEK AT THE HEART
ASSOCIATION OF AMERICA.
IN CONCLUSION WE INVOLVE MORE
CLINICIANS SUCH AS REGISTERED
DIETITIANS TRAINED TO ASSESS
NUTRITIONAL STATUS IN OUR
PATIENTS INCLUDING PATIENTS WITH
RESPIRATORY DISEASE AND WERE
ABLE TO OPTIMIZE THE ENERGY AND
INTAKE WHICH WE KNOW WORKS AND
UNDERGOING THAT INTERVENTION
WILL IMPROVE IF IT MEETS THEIR
ENERGY AND PROTEIN REQUIREMENTS.
ONCE WE HAVE ACHIEVED THIS, WE
CAN FINALLY DETERMINE WHETHER WE
CAN OPTIMIZE THE DIETARY PATTERN
IN THE POPULATION WHICH AT THIS
POINT WE DO NOT KNOW WHETHER
THERE'S ANY DIETARY PATTERNS
WITH REGARDS TO IMPROVEMENT IN
RESPIRATORY FITNESS AND QUALITY
OF LIFE AND CLINICAL OUTCOMES.
SO I REALLY HOPE IN THE FUTURE
WE'LL SEE MORE MECHANISTIC TYPE
CLINICAL TRIALS USING VO2 PEAK
AS A SURROGATE OF OUTCOMES AND
UTILIZING DIETARY STRATEGIES BIG
CONTROL FEEDING STUDIES AND
LONG-TERM FREE LIVING STUDIES
AND THIS LACKS IN THE FIELD AND
WE TEND TO DO SHORT TERM STUDIES
AND MIGHT MISS THE OPPORTUNITY
TO REALLY ADDRESS THE BARRIERS
RELATED TO LONG-TERM ADHERENCE.
IF THE BARRIERS ARISE WE'RE
WILLING TO FIND ALTERNATIVE
STRATEGIES BUT IF IT WORKS IN
IMPROVING RESPIRATORY FITNESS WE
NEED TO SUPPORT MULTI-CENTERED
RANDOMIZED TRIALS FOR SUPPORT
AND FUNDING TO DETERMINE WHETHER
THE INTERVENTIONS WERE ALSO ON
CLINICAL OUTCOMES SUCH AS ALL
CAUSE MORTALITY AND RESPIRATORY
DISEASE RELATED MORTALITY.
THANK YOU FOR YOUR ATTENTION.
>> CAN NEXT DR. WOOD ON THE
EFFICACY OF HEALTHY DIETS IN
PREVENTION AND CONTROL OF
CHRONIC RESPIRATORY DISEASES.
I'LL TURN IT OVER TO YOU,
DR. WOOD.
>> THANKS VERY MUCH, DR. MA.
CAN YOU HEAR ME OKAY.
>> YES.
>> THANK YOU.
TODAY I'LL CONCENTRATE ON
HEALTHY DIETS.
I HAVE NO DISCLOSURES.
BEFORE I START I WANTED TO PAINT
A BIT OF A PICTURE WHEN I USE
THE TERM HEALTHY DIET AND THINGS
YOU LOOK FOR IN A PROFILE OF A
HEALTHY DIET.
ONE IS ENERGY BALANCE BUT
THERE'S OTHER THINGS SUCH AS
CONSUMPTION OF HEALTHY FATS SO
HIGH INTAKE OF OMEGA 3 AND LOW
IN TAKE OF UNHEALTHY FATS AND A
HIGH FIBER INTAKE AND HIGH
ANTIOXIDANT INTAKE AND LOW
INTAKE OF THINGS SUCH AS REFINED
CARBOHYDRATES, SODIUM AND
ALCOHOL.
SO NOW I'M GOING TO TALK THROUGH
A FEW DIFFERENT DIETS WHICH YOU
WOULD SEE THAT WOULD FIT IN THAT
PROFILE.
THE FIRST WAS ONE UNDERTAKEN IN
OUR LABORATORY USING A HIGH
VERSUS LOW FRUIT AND VEGETABLE
DIET IN ADULTS AN THE PEOPLE
WERE RANDOMIZED WITH HIGH FRUIT
AND VEGETABLE OR LOW FRUIT AND
VEGETABLE DIET, GREATER THAN
SEVEN SERVINGS A DAY OF VERSUS
LESS THAN THREE PER DAY.
AND THE RESULTS I WANTED TO
SHARE FROM THAT TRIAL WERE FIRST
IF YOU HOOK AT THE GRAPH ON THE
LEFT SIDE, THIG DEMONSTRATED
WHAT HAPPENS IN PEOPLE WHO
ADOPTED THIS DIET.
THEY HAD AN INCREASED IN
SYSTEMIC INFLAMMATION AND COPD
AND INCREASE IN AIRWAY
INFLAMMATION REFLECTED IN
INCREASING SPUTUM TOTAL CELL
COUNT.
THE OTHER THING INTERESTING ON
THE RIGHT SIDE DESCRIBING TIME
TO EXACERBATION.
WE FOUND IF YOU LOOK AT THE
SUBJECTS ON THE LOW FRUIT AND
VEGETABLE DIET THEY HAD A 1.36
TIMES INCREASED RISK OF HAVING
AN EXACERBATION DURING THE
INTERVENTION PERIOD.
IT WAS A THREE-MINUTE
INTERVENTION.
WE ALSO -- THREE-MONTH
INTERVENTION STUDY.
WE CONDUCTED A HIGH VERSUS LOW
FRUIT AND VEGETABLE DIET IN 67
CHILDREN AGE 3 TO 11 YEARS.
FOR ETHICAL REASONS WE ONLY
RECRUITED CHILDREN WHO WERE
USUALLY CONSUMING A LOW FRUIT
AND VEGETABLE DIET AND HALF
MAINTAINED THAT DIET WHERE THE
OTHER HALF CONSUMED A HIGH
VEGETABLE DIET AND 3.5 TO SEVEN
SERVINGS TO FRUIT AND VEGETABLES
ADJUSTED FOR AGE.
THE K RESULTS WERE WERE ABLE TO
ADJUST THIS IN THE COHORT.
ON THE FIRST THERE WAS THE GREEN
BARS ARE THE INTERVENTION GROUP
AND SEE INCREASE IN FRUIT AND
VEGETABLE INTAKE IN THE
INTERVENTION GROUP.
THE SECOND IS THE NUTRIENTS
DERIVED FROM FRUIT AND
VEGETABLES AND THE THIRD SHOWS
EXACERBATION RISK.
WHAT THIS IS SHOWING YOU IS THAT
THERE WAS IN THE INTERVENTION
GROUP ONCE AGAIN THE GREEN BARS
THERE WAS A DECREASE IN THE
NUMBER OF CHILDREN WITH TWO OR
MORE INTERVENTIONS DURING THE
SIX MONTH INTERVENTION PERIOD AS
A RESULT OF THE HIGH FRUIT AND
VEGETABLE DIET.
THERE'S THERE IS BEEN A COUPLE
TRIALS IN COPD USING THIS HIGH
FRUIT AND VEGETABLE THE FIRST
USED AN INTERVENTION WHERE THERE
WAS AN INCREASE OF ONE PORTION
PER DAY OF HIGH FRUIT AND
VEGETABLE AND THE RESULT IN THE
TOP RIGHT HAPPENED CORNER.
RIGHT HAND CORNER THE LUNG
FUNCTION THAT OCCURRED WAS
REDUCED IN THE FRUIT AND
VEGETABLE GROUP.IN THE COPD
POPULATION YOU EXPECT
PROGRESSIVE DECREASE IN LUNG
FUNCTION AND THAT OCCURRED IN
THE CONTROL GROUP BUT IN THE
FRUIT AND VEGETABLE IT WAS
REDUCED AND THAT'S PROMISING.
ANOTHER TRIAL PUBLISHED IN 2012.
IT'S A SMALL TRIAL IN COPD
PATIENTS FOR 12 WEEKS AND USED
AN INTERVENTION COMPARED TWO
VERSUS FIVE FRUIT AND VEGETABLE
SERVES PER DAY.
THEY DIDN'T SEE ANY EFFECT ON
LUNG FUNCTION OR INFLAMMATION OR
OXIDATIVE STRESS.
WHETHER IT'S DUE TO THE SMALLER
SAMPLE SIZE OR SHORT DURATION OF
THE TRIAL REMAINS TO BE SEEN.
SO NOW WE HAVE TO SWITCH GEARS
AND TALK ABOUT SOME BIG
CHALLENGES WE'VE DONE IN OUR LAB
WHERE WE USED IN ACUTE MODEL TO
LOOK AT A FIX OF A FAST FOOD
MEAL ON THE AIRWAYS.
WE USED 51A AAGE ASTHMATIC ADU
FOR FAST FOOD OR CONTROLLED
MEAL.
THEY CONSUMED THE FEEL AND WERE
GIVEN A BRONCHIAL DILATOR AND
THE FAST FOOD MEAL WAS TWO BRECK
MUFFINS AND THE CONTROL WAS
YOGURT.
THIS SHOWS THE K RESULTS.
ON THE LEFT SIDE WE'VE GOT THE
FIX ON AIRWAY INFLAMMATION AND
CAUSED AN INCREASE IN AIRWAY AND
AND THERE'S A RECEPTOR SHOWN TO
BE ACTIVATED BY SATURATED FAT.
IN FOUR HOURS BOTH OF THOSE
MARKERS OF AIRWAY INFLAMMATION
INCREASED.
IF YOU LOOK AT THE CHART ON THE
RIGHT-HAND SIDE THIS WAS AN
UNEXPECTED AND INTERESTING
FINDING.
LOOKING AT THE TIME COURSE THERE
YOU'VE GOT AT BASELINE AND
LOOKING AT BRONCHIAL DILATION
AND CONTROL THERE WAS AN
INCREASE IN LUNG FUNCTION
PROGRESS IN FOUR HOURS AND THERE
WAS AN INITIAL INCREASE IN LUNG
FUNCTION AT TWO HOURS BUT THEN
THAT DROPPED AWAY AT THREE AND
FOUR HOURS SO AT FOUR HOURS THEY
WERE BACK TO BASELINE.
THAT WAS QUITE CLINICALLY
IMPORTANT AND ONE SINGLE HIGH
FAT MEAL CAN LEAD TO AN IMPAIRED
BRANK YAL DEL-- BRONCHIAL DILAT
RESPONSE AND ADULTS WERE
CONSUMING AN ISO CALORIC MEAL
AND THE BASE VEHICLE WAS MARKED
POTATO.
WE ADDED THAT DOUBLE CREAM FOR
THE SATURATED FAT ARM AND
SEPARATED OUT OIL FOR THE OMEGA
6 FATTY ACID ARM AND SIMPLE
CARBOHYDRATE WE USED WHITE JELLY
BEANS.
ONCE AGAIN WE LOOKED AT WHAT
HAPPENED AFTER FOUR HOURS AND
THIS CHART IN THE MIDDLE SHOWS
WHAT HAPPENED SHOWS THE CHANGE
IN SPUTUM CELLS AFTER FOUR
HOURS.
AND SHOWS AND ONCE AGAIN THE
CELL TYPE EFFECTED WAS
NEUTROPHILS FOLLOWING THE FAT
INTERVENTION.
WE CONFIRMED THE STUDY WITH THE
SATURATED FAT COMPONENT DRIVING
THE INCREASED AIRWAY
NEUTROPHILS.
THAT NETWORK OF GENES YOU CAN
SEE ON THE RIGHT-HAND SIDE
DEMONSTRATES THIS IS ANALYSIS
WHICH SHOWS GENES AND SO NOW
I'LL MOVE ON TO ANOTHER TOPIC OF
DIET.
SO MEDITERRANEAN DIET IT
INCLUDES A HIGH INTAKE OF FRUIT
AND VEGETABLE, LEGUMES AND MOT
MODERATE INTAKE OF OMEGA 3 FISH
AND MEAT AND FATTY ACIDS.
AND IN ADULTS THERE WAS A 12
WEEK STUDY THAT USED THE DIET IN
38 PEOPLE.
THE DIETARY BEHAVIOR CHANGES
WERE ACHIEVED BUT THERE WERE
MINIMAL CHANGES ON CLINICALLY
OUTCOMES AND THE OFFICE
CONCLUDED A LARGER TRIAL WAS
NEEDED TO INTERROGATE THE
EFFICACY OF THAT DIET IN THAT
POPULATION.
IN CHILDREN THERE WAS ALSO A
MEDITERRANEAN STUDY DONE IN A
SIX-MONTH TRIAL, 64 CHILDREN SAW
A DECREASE IN AIRWAY
INFLAMMATION.
ENOUGH TO SUGGEST THAT'S A DIET
THAT WARRANTS FURTHER
EXPLORATION IN ASTHMA.
SO LAST ONE I'D LIKE TO TALK
ABOUT IS THE DASH FOR ASTHMA
DIET.
THIS IS A BODY OF WORK THAT'S
BEEN DRIVEN BY OUR CO-CHAIR
PROFESSOR MA AND I'M SURE IT
LOOKS FAMILIAR TO THE STUDY
ORIGINALLY PUBLISHED IN 2016.
THIS DIET HAS A NUMBER OF
DIFFERENT NUTRIENT TARGETS
INCLUDING FAT, SATURATED FAT,
PROTEIN, CHOLESTEROL, FIBER,
MAGNESIUM, SODIUM, POTASSIUM.
THE INTERVENTION IS DELIVERED BY
A DIETICIAN BY BEHAVIOR CHANGE
STRATEGIES AND THE FOCUS IS ON
FRUIT AND VEGETABLES, LOW FAT
DAIRY, TOTAL FAT AS A PERCENTAGE
OF ENERGY INTAKE AND SODIUM.
SO IN THE PILOT TRIAL THERE WAS
SOME REALLY PROMISING RESULTS
SHOWN THERE.
IT WAS A SIX-MONTH TRIAL OF 90
PARTICIPANTS AND THERE WERE
IMPROVEMENTS IN THE DASH DIET
SCORE AND INCREASE IN FOOT AND
VEGETABLES SERVED AND
IMPROVEMENT IN THE ASTHMA
QUALITY OF LIFE QUESTIONNAIRE
BOTH IN OVER ALL AND ACTIVITIES
DOMAIN.
ALSO INTERESTINGLY THERE WAS AN
INCREASE IN THE PROPORTION OF
PARTICIPANTS WHO SAW A
CLINICALLY IMPORTANT DIFFERENCE
IN ACQ ASTHMA QUALITY OF LIFE AT
SIX MONTHS.
THESE PROMISE IING RESULTS LED
FUNDING OF AN NIH PROJECT TO
FOLLOW UP AT THIS DIET IN A
LARGER COHORT OF 325
PARTICIPANTS.
I'M PRIVILEGED TO WORK ON THIS
AND THE TRIAL WILL BE COMPLETED
IN 2026.
WE'RE EXCITED TO SEE WHAT THE
RESULTS FROM THAT TRIAL ARE
GOING TO LEAD TO.
JUST TO SUMMARIZE IN TERMS OF
WHOLE FOOD INTERVENTIONS, HIGH
FRUIT AND VEGETABLE DIETS SHOW
PROMISING RESULTS IN ADULTS AND
CHILDREN WITH ASTHMA AND COPD.
THE MEDITERRANEAN DIET SHOWS
PROMISING RESULTS IN CHILDHOOD
ASTHMA AND THE DASH DIET HOLDS
PROMISE IN TRIALS FOR ADULT WITH
ASTHMA AND CONVERSELY FAST FOOD
AND SATURATED FAT IN PARTICULAR
HAVE NEGATIVE OUTCOMES IN
ASTHMA.
SO JUST TO FINISH WITH CURRENT
RESEARCH GAPS.
SO THERE'S EXTENSIVE GAPS IN
THIS SPACE.
IT'S REALLY LARGELY DUE TO THE
COMPLEXITIES OF DELIVERING THESE
TYPES OF WHOLE FOOD
INTERVENTIONS.
SO MANY MANY OPPORTUNITIES TO
FILL IN SOME OF THOSE GAPS.
THE OPPORTUNITIES IN RESEARCH
QUESTIONS SO I GUESS AS I'VE
BEEN LISTENING TO SOME
PRESENTATIONS, ONE OF THE KEY
RESEARCH QUESTIONS THAT I THINK
AND I HAVE IT INCLUDED ON THE
LIST BUT HOW DO WE GET PEOPLE TO
MAKE THESE LONG-TERM AND
SUBSTANTIAL CHANGES TO THEIR
DIETS ON AN ONGOING BASIS?
I THINK WE NEED TO WORK WITH OUR
PUBLIC HEALTH COLLEAGUES IN HOW
TO GET PEOPLE TO ADOPT HEALTHY
DIETS AND BREAK DOWN BARRIERS
THERE.
OTHER THINGS THAT I'VE LISTED
ARE PROSPECTIVE STUDIES AND
HEALTHY DIETS FOR DISEASE
MANAGEMENT.
WE NEED MORE WORK UNDERSTANDING
MECHANISMS OF HEALTHY DIET AND
DISEASE PHENOTYPES.
THE IDEA OF PRECISION MEDICINE
IS VERY LIKELY THAT DIFFERENT
DISEASE PHENOTYPES WILL RESPOND
TO DIETARY APPROACHES.
ONE EXAMPLE IS THE SATURATED FAT
HAS THE BIGGEST INFLUENCE ON
AIRWAY NEUTROPHILS AND DISEASE
FEEPT
PHENOTYPES AND HEALTHY DIET FOR
OBESITY.
INDEPENDENT HOW CAN WE IMPROVE
OBESITY JUST WITH DIET AND
WEIGHT LOSS.
I'LL STOP THERE AND THANK YOU
VERY MUCH AND I THINK UP TO ME
TO INTRODUCE THE NEXT SPEAKER.
DR. PANDA IS AT THE SALK
INSTITUTE AND TALK ABOUT TIME
RESTRICTED FEEDING.
>> THANK YOU.
THANK YOU FOR INVITING ME.
THERE'S MY DISCLOSURE AND ARE
TAKING ON TIME RESTRICTED
FEEDING FOR LUNG OUTCOME AND
DATA IN HUMAN INTERVENTION
STUDIES FOR LUNG FUNCTION OR
CARDIO PULMONARY FUNCTION.
HALF THE PRESENTATION IS FROM
MICE AND I'LL PRODUCE THE TIME
FEEDING.
BY REDUCE CALORIE INTAKE WE CAN
IMPROVE HEALTH IN ANIMAL MODELS
AND HUMANS ALSO IN ANIMALS TO
HUMANS BY IMPROVING QUALITY OF
DIET WE CAN IMPROVE HEALTH.
AND THE IDEA OF TIME RESTRICTED
FEEDING CAN GO TO CIRCADIAN
RHYTHM WITH AT DIFFERENT TIME OF
THE DAY THEY CAN LOOK AT
DETOXIFICATION OF MOLECULES AND
PHYSIOLOGIC METABOLISM BEHAVIOR
EVEN LUNG FUNCTION.
ALMOST 12 YEARS AGO WE DID A
VERY SIMPLE EXPERIMENT.
WE HAD FOUR GROUPS OF MICE SAME
AGE.
MALE MICE.
THEY WERE FED NORMAL CHOW AND
WERE GIVEN ACCESS EIGHT TO TEN
HOURS AND EAT FOOD IN THAT TIME
INTERVAL AND TWO HIGH-FAT DIET
COHORT.
THE FOOD INTAKE AND LOOK AT THE
SENSORY AND HOI -- HOW THE BODY
METABOLIZES.
AND AFTER 18 WEEKS THERE WAS A
BIG DIFFERENCE IN BODY WEIGHT.
THE HIGH FAT MICE HAD TIME
INDUCED OBESITY AND BECAME VERY
OBESE AND THE NORMAL CHOW TIME
RESTRICTED HAD NO STATISTICAL
SIGNIFICANCE IN BODY WEIGHT AND
THE TIME RESTRICTED MICE WERE AS
HEAVY AS THE CHOW FED MICE.
THE EXPERIMENT WAS REPEATED
THREE OR FOUR TIMES AND THEN THE
NEXT QUESTION WAS AND WHETHER
THE FAT MICE HAD TIME RESTRICTED
FEEDING.
AND THEY LOST BODY WEIGHT IN THE
NEXT FEW WEEKS AND THE DARK BLUE
IS THE TIME OF THE TIME
RESTRICTED GROUP THAT SUSTAINED
LOW BODY WEIGHT AND AMONG THE
NORMAL CHOW FED MICE THERE WAS
NO DIFFERENCE IN THE BODY WEIGHT
BUT CHANGE IN LEAN MASS.
MICE THAT ATE NORMAL CHOW OR
HIGH FAT IN TIME RESTRICTED
GAINED MORE LEAN MASS AND TOO
IMPACT THE MULTIPLE TISSUES WE
DID A SIMPLE EXPERIMENT.
WE COLLECTED 22 ORGANS AND EVERY
TWO HOURS OF SAMPLES OF ORGANS
AND BELIEVE YOU'LL GET DIFFERENT
TYPE OF DIFFERENCES IN GENE
EXPRESSION THAT'S WHY THE
24-HOUR SAMPLING WAS VERY
IMPORTANT.
WE FOUND WHEN YOU DO THIS
EXPERIMENT NEARLY 70% OF GENES
ARE DIFFERENTIALLY EXPRESSED AND
ONE OF THE 22 IN YOUNG MALE
MICE.
THEY REPEATED THIS IN FEMALE
MICE.
THE MAGNITUDE IS DIFFERENT BUT
THEN THE MESSAGE IS SIMILAR.
AND THIS EXPERIMENT IF YOU JUST
LOOK AT ALL TIME POINTS AND FEED
THEM THEN THERE ARE FEW GENES
LESS THAN 150 OR SO IN LUNGS
THAT CHANGE BETWEEN BUT COULD DO
ANALYSIS WHERE WE ASKED
SPECIFICALLY THE TIME DEPENDENT
CHANGE IN GENE EXPRESSION.
THEN WE SEE A DIFFERENT RESULT.
BUT ANYWAY WITH THIS DIFFERENCE
KEEPING IN MIND I'LL GIVE A
SUMMARY.
SO NEXT SLIDE.
SO IF WE LOOK AT THE GENES
UPREGULATED ARE MOSTLY A PROTEIN
FOLDING AND ALSO METABOLISM OF
FATTY ACIDS.
AND THE GENES AND LEPTIN ARE
NUMBER 1 AND IT'S PRODUCED FROM
ADIPOSE TISSUES AND THE NEXT
ONES ARE ALL INFLAMMATORY LIPIDS
SO I'M RESTRICTED EATING CAN
REDUCE INFLAMOSOME.
IF WE LOOK AT THE PATHWAYS UNDER
EXPRESSED IN FIVE OR MORE
TISSUES WE SEE A FEW THINGS AND
POINT YOUR ATTENTION TO LUNGS
BECAUSE OF THE THEME OF THE
CONFERENCE.
WE FIND IT'S LESS IMMUNE
RESPONSE IN LUNG TISSUE AND WE
SEE THE GENE EXPRESSION DOESN'T
CHANGE MUCH DURING DAY AND NIGHT
BUT WE HAVE GENE EXPRESSION AND
ONE AT THE END OF THE DAY WHERE
MICE ARE SLEEPING AND FASTING
AND ONE RESPONSIBLE SO THESE
SYNCHRONIZED PHYSIOLOGY AND
METABOLISM AND PAPERS HAVE SHOWN
THIS BUT THEY ALSO HAVE PATHWAYS
ONLY FOR A FEW HOURS AND EXPRESS
FOR A FEW HOURS.
THAT'S THE TAKE HOME MESSAGE
FROM THE ANALYSIS AND THEN I'LL
SEE ADHERENCE AND FOR EXAMPLE IF
YOU'RE DOING A GENE EXPRESSION
IN LUNGS YOU SEE THE GROUPS AND
IF YOU DON'T TAKE TIME INTO
CONSIDERATION BUT IF YOU DO THIS
IN LUNGS IT'S STRONGLY CIRCADIAN
A
AND HAVE SIMILAR RESULTS IN
YOUNG ADOLESCENT FEMALES.
AND IF WE LOOK AT THE ANALYSIS
THE ONES THAT ARE RESTRICTED FOR
EXAMPLE YOU SEE CELL ADHESION,
NEW BLOOD VESSEL SIGNALLING.
WE'RE IN THE EARLY STAGE OF THE
RESEARCH AND WE HAVEN'T LOOKED
INTO THE LUNGS EXPRESSION
CHANGES.
YOU CAN SEE THERE'S A HUGE MICE
RESPONSE TO TIME-RESTRICTED
FEEDING.
AND GENE EXPRESSION PATTERN FROM
DIFFERENT TIMES.
THIS IS THE HEAT MAP AND FOR
EXAMPLE YOU CAN SEE THE TOP PART
IS IMMUNE AND INFLAMMASOME LIPID
GENES ARE MOSTLY HIGHLY
EXPRESSED DURING THE DAYTIME
WHEN MICE TYPICALLY SLEEP.
AND THE INITIAL PATHWAYS WHICH
ARE ACTUALLY NOT INVOLVED IN SPM
BUT DO PRODUCE THESE WHETHER
THEY FEED INTO PRO INFLAMMATORY
RESULTS WOULD BE INTERESTING IN
OTHER MOUSE MODELS.
THANK YOU.
OVER THE LAST 12 YEARS IN TIME
RESTRICTED FEEDING AND ARE THERE
EFFECTS IN HUMANS?
ALMOST 12 YEARS AGO I WANTED TO
ASK WHEN DO PEOPLE EAT AND IS
THERE A DIFFERENCE FROM ONE DAY
TO ANOTHER.
SO WE STARTED THIS AND PEOPLE
CAN AND CAN RUN A STUDY AND RUN
MULTIPLE STUDIES WITH MULTIPLE
OUTCOMES AND INTERVENTIONS AND
HAVE A PUBLIC FACING APP PEOPLE
CAN DOWNLOAD AND SHARE DATA.
WE ASKED PEOPLE TO TAKE A
PICTURE OF THEIR FOOD AND THEN
AND WE PUT IT ON A CALORIE FOOD
WE PUT IT ON THE PLOT AND WE
ASKED PEOPLE TO AND YOU CAN SEE
THIS OCCURS AND THIS WAS
PARTICIPANTS EMPLOYEES OF UC SD
AND YOU CAN COMBINE WEEKDAYS AND
WELCOME
WELCOME BACKS THAT'S THE TYPICAL
DURATION WE FOUND AND THIS IS
WHAT WE FOUND IN THE VALUE AND
THAT'S WHAT WE SEE PEOPLE UNDER
REPORT HOW MUCH THEY FAST OR
UNDER REPORT HOW MUCH THEY EAT
AND THIS IS FROM 157
INDIVIDUALS.
LOOK AT THE PACIFIC TOURS COMING
IN YOU CAN KEEP CLICKING AND SEE
THE NUMBER OF PICTURES AROUND
NUNE TIME AND DINNER TIME.
THERE'S FEW IN THE MIDDLE OF THE
NIGHT BUT GUESSTIMATING HOW MUCH
CALORIES ARE IN EACH PICTURE
WHAT IS SURPRISING IS THE
MIDNIGHT SNACKS ARE NOT SMALL,
THEY'RE EXTREMELY BIG.
AND LOOK AT WHAT PEOPLE EAT
NEARLY 50% OF ADULTS EAT DURING
THIS PERIOD.
WE'VE BEEN COLLECTING DATA AND
THERE ARE THOUSANDS OF
PARTICIPANTS AND LOOK AT 20,000
PLUS PARTICIPANTS AND THIS IS A
TYPICAL GRAM AND TWO WEEKS OF
DATA AND THIS PERSON IS 9.6
HOURS AND TAKE THE TIME WHERE
95% OF THE CALORIES CAME IN IT'S
12.1.
SO THIS IS THE MEDIUM IS
INTERVALS IN THE WINDOW AND THE
TIME SO AROUND 2:00 IN THE
AFTERNOON SO PEOPLE TYPICALLY
THAT'S THE MIDPOINT OF LOGGING
NOT NECESSARILY CALORIE INTAKE.
PEOPLE ON AVERAGE EAT FOUR TO
FIVE MEALS AND THE TOP 10% HAVE
SEVEN MEALS OR DIFFERENT TIMES
THEY LOG THUR FOOD.
AND SIMPLE THING IF WE ASK HOW
MANY UNIQUE FOOD PEOPLE LOG THE
NUMBER IS AROUND 55 OVER 14
DAYS.
WE LOOKED AT THIS AND FIVE TO
SIX DAYS OF DATA IS NOT ENOUGH.
AND IF WE TAKE THE TIME OF THE
DAY I EXPECT YOU'LL SEE THE
BREAKFAST ITEMS AT THE TOP AND
END THE DAY WITH BEER AND DRINK
WINE.
AND WE CAN ASK SIMPLE QUESTIONS
FOR EXAMPLE ASK WHAT IS THE
PREFERENCE OF THIS.
PEOPLE SAY YOU SHOULD NOT EAT
LATE HAVING TO DO WITH CIRCADIAN
RHYTHM OR SLEEP AND EATING MORE
PASTA AND BEER AND WIN AND ASK
THE MALE VERSUS FEMALE AND
SIMILARLY WE CAN ASK THE
DIFFERENCE OF YOUNG VERSUS OLD.
WE HAVE NEARLY 5,000 PEOPLE AND
WE CAN ALSO SEE THIS KIND OF
DATA.
WE'RE VERY INTERESTED IN THIS
STRATEGY WITH SHIFT WORKERS AND
SAW THUR FOOD PREFERENCE
DEPENDING ON TIME OF DAY WE GET
DIFFERENT DIETS AND THE PUN
ESTABLISHED SIGNAL.
WE HAD PEOPLE LOGGING THEIR
SUPPLEMENT DATA.
WE WAKE UP AND TAKE THE
MEDICATION AT THE TOP AND THEN
AFTER THAT PEOPLE ARE TAKING
ANTIHISTAMINES AND PEOPLE TAKE
MEDICATION FOLLOWED.
WE HAVE 12 MILLION RECORDS AND
TENS OF THOUSANDS OF INDIVIDUAL
TRIALS GOING ON.
NOW THAT WE HAVE THE DAILY FOOD
INTAKE AND MEDICATION AND
SUPPLEMENT INTAKE AND PEOPLE ARE
WILLING TO SHARE THIS THROUGH
THE APP AND NOW WE'RE USING A.I.
TO FIGURE OUT WHAT THAT YOU EAT
AND WE CAN LOOK AT SIMILAR
MEDICATIONS AND HOPEFULLY WE CAN
DO PERSONALIZED SUPPLEMENTS AND
MED FOR ANY GIVEN INTERVENTION.
THANK YOU AND THAT SHOULD BE THE
LAST ONE.
THESE ARE SUMMARIES AND BOTTOM
LINE IS WE NEED TRANSLATIONAL
PROJECTS FOR THE IMPACT FOR TRE
ON LUNG DISEASE.
>> THANK YOU, DR. PANDA.
NOW WE'LL MOVE TO THE LAST TALK
IN THIS SESSION WHICH WILL BE
PROVIDED BY DR. KATRI-TYPO AT
CHILDREN'S HOSPITAL AND BAYLOR
MEDICINE ON EFFICACY ON TARGETED
NUTRITION VEGS IN THE MANAGEMENT
OF INTENSIVE CARE PATIENTS.
I'LL TURN IT OVER TO YOU.
>> THANK YOU.
FIRST I'D LIKE TO THANK THE
ORGANIZERS FOR THE OPPORTUNITY
TO SPEAK AND CLOSE OUT THE
CONFERENCE AND TALK ABOUT
EFFICACY OF TARGETED NUTRIENT
INTERVENTION AND MANAGEMENT OF
INTENSIVE CARE PATIENTS AND THIS
IS WITH A BODY OF LITERATURE
I'LL ONLY BE ABLE TO TOUCH ON
BUT WE HIGHLIGHT THE KEY GAPS IN
KNOWLEDGE OR AREAS OF RESEARCH.
I'M NOT PRESENTING MY OWN
RESEARCH BUT SUMMARY AND MY
INTEREST IS PEDIATRIC PATIENT
POPULATION.
YOU HEARD QUITE A LOT ABOUT THE
ROLE OF MACRO AND MICRO NEWT
REPRESENT AND ANTIOXIDANT
THERAPIES FOR THE TREATMENT OF
CHRONIC RESPIRATORY ILLNESS.
I WANT TO START WITH A THE
VOLUME OF LITERATURE OF NEGATIVE
CLINICAL TRIALS OF
SUPPLEMENTATION IN CRITICAL
ILLNESS.
THERE'S THE SETTING OF ACUTE
CRITICAL ILLNESS WHERE YOU'RE
FACED WITH A PATIENT WITH A
RAPIDLY CHANGING INFLAMMATORY
PROFILE OR PATIENT POPULATION
WITH INDIVIDUAL DIFFERENCES IN
IMMUNE RESPONSE OR POTENTIAL TO
RESPOND TO TREATMENTS.
ALL OF THIS IN COMBINATION MAY
ALTER TREATMENT RESPONSE OF
CLINICAL TRIALS AND IN THE RE-OX
TRIAL WHICH ASSESSED RANDOMIZED
VENTILATED ICU PATIENTS TO
GLUTAMINE AND ANTIOXIDANTS AND
GLUTAMINE OR PLACEBO AND THERE
WERE 28 DAY MORTALITY AND SIX
MONTH MORTALITY ON PATIENTS WHO
RECEIVED GLUTAMINE.
AND THERE WERE ACIDS COMPARED TO
PATIENTS WITH ACUTE LINE INJURY
AND STOPPED FOR FUTILITY.
AND THE STUDY 14 ICUs HAD SAW AN
INCREASE IN THE GLUTAMINE
STUDIES AND THERE WERE SMALLER
RCTs COMPLETED AS WELL.
MACRO AND MICRO NUTRIENT RCTs
DEMONSTRATED NO BENEFIT OR HARM.
ASCORBIC ACID WAS FOUND TO HAVE
NO BENEFIT AND HOWEVER, THERE
ARE SUB POPULATIONS OF
CRITICALLY ILL PATIENTS WHO MAY
STILL BENEFIT.
I WOULD PROPOSE AFTER WE GO
THROUGH THE REST OF THE TALK
THERE MAY BE ADDITIONAL REASONS
TO PURSUE MICRO OR MACRO
NUTRIENT KNOWLEDGE AND THE BASIC
INFORMATION WAS NOT PRESENT AND
HAS BEEN WORKED ON SINCE.
AND SO FOR EXAMPLE SEVERE BURN
PATIENTS WHO RECEIVE AND THERE
WERE RCTs DONE AND ASSESSING THE
ROUTE OF NUTRITION IN 3,000 AND
4,000 PATIENTS IN FRANCE AND
THOSE IN SHOCK MORE HAD
VENTILATION AND THEY HAD
INCREASED COMPLICATIONS.
THE TRIALS FOLLOWED THE PRIOR
NEGATIVE CLINICAL TRIALS FOR
IMMUNONUTRITION.
IN REFLECT CRITICAL ILLNESS IT
WAS FUNDAMENTAL MACRO NUTRIENT
DELIVERY AND TIMING AND DOSE NOT
UNDERSTOOD.
WHEN OVERLAYING UPON ROUTE AND
DOSE OF NUTRIENT DELIVERY WHEN
OVERLAYING UPON THOSE UNKNOWNS
THE MICRONUTRIENT OR
ANTIINFLAMMATORY DIETS I THINK
YOU PROBABLY HAVE LITTLE HOPE OF
DEMONSTRATE BEING A BENEFIT TO
NUTRIENT DELIVERY IF YOU DON'T
UNDERSTAND THE FUNDAMENTALS OF
HOW IT WILL IMPACT PATIENT
OUTCOMES.
SO WHAT WAS PUBLISHED MORE THAN
3,000 PATIENTS IN FRANCE
COMPARED LOW DOSE TO STANDARD
DOSE NUTRITION AND NO DIFFERENCE
IN PRIMARY OUTCOMES BUT A TREND
TOWARD IMPROVED MORTALITY IN THE
LOWER DOSE ARM AND IMPROVED TIME
TO MECHANICAL VENTILATION IN THE
LOWER DOSE ARM.
EARLY AGGRESSIVE NUTRITION IN
CRITICAL ILLNESS SEEMS TO BE
ASSOCIATED.
IN FACT THE STUDIES HAVE
CONCLUSIONS BUT OTHERS HAVE ALSO
SHOWN PREVIOUSLY THAT THIS
FEEDING DEMONSTRATES NO BENEFIT
OR HARM AND THERE'S INTERACTION
BETWEEN PROTEINS AND CALORIC
DELIVERY THAT CRITICALLY ILL
ADULTS WILL TOLERATE UNDER
FEEDING IN THE SETTING OF
PROTEIN ADEQUACY.
THIS IS THE SURVIVAL SPIRAL
CURVE FROM A STUDY DEMONSTRATING
THE DIFFERENCE BETWEEN STANDARD
AN PERMISSIVE UNDER FEEDING IN
CRITICALLY ILL ADULTS.
AND THERE JOURNAL LOOKED AT THE
ISSUE OF TIMING OF NUTRITION AND
THE POTENTIAL REASONS FOR LACK
OF BENEFIT FROM EARLY FULL
FEEDING.
THERE WAS A LOT OF HOPE EARLY IN
THE LITERATURE THAT EARLY FULL
FEEDING IT ACHIEVING IT IN
ADULTS WOULD IMPROVE SARCOPENIA
AND VENTILATOR FREE DAYS AND THE
CONCEPT HAS EMERGED IN CRITICAL
ILLNESS VERSUS RECOVERY AND
PERHAPS PATIENTS DO NOT TOLERATE
EARLY AGGRESSIVE MACRO NUTRIENT
DELIVERY BECAUSE OF THE STAGE OF
ACUTE CRITICAL ILLNESS AND IT IS
SOME SORT OF RECOGNITION OF WHEN
THE PATIENTS ARE SHIFTING FROM
ACUTE CRITICAL ILLNESS TO
RECOVERY THEY MAY BE RESPONSIVE
AND READY TO RECEIVE FULL DOSE
OF MACRO NUTRIENT DELIVERY.
SHIFTING IN TERMS OF MORE OF THE
STORY OF CARBOHYDRATE AND
PROTEIN.
IN FACT RECENTLY THIS IS A STUDY
THAT I FOUND INTRIGUING
PUBLISHED IN 2024 PLACING 93
PATIENTS ON RANDOMIZED TO
KETOGENIC OR CONTROLLED DIETS
AND WHAT'S COMPELLING AND
INTERESTING ABOUT THIS IS THEY
ACHIEVED THE SAME CALORIC INTAKE
FOR THESE PATIENTS DID ACHIEVE
KETOSIS IN THE PATIENT
POPULATION AND HAD A LOWER
REQUIREMENT FOR INSULIN AND DID
NOT HAVE AN ELEVATION OF
LACTATE.
AND THIS IS A SMALL STUDY
DEMONSTRATED FEASIBILITY BUT NOT
EFFICACY AS A MANAGEMENT
STRATEGY FOR INFLAMMATION AND IN
TERMS OF THE APPROPRIATE PROTEIN
LOAD AND MINIMAL CARBOHYDRATE
LOAD ACHIEVED KETOSIS AND
SURVIVAL PROBABILITY WAS HIGHER
FOR THESE PATIENTS WHO RECEIVED
THE KETOGENIC DIET.
WHEN WE LOOK AT PROTEIN ADEQUACY
THERE ARE STILL REMAINING
SEVERAL QUESTIONS IN CRITICAL
ILLNESS IN TERMS OF
UNDERSTANDING OPTIMAL DOSE EARLY
AND LATE IN CRITICAL ILLNESS.
AND THE CURRENT GOALS THAT EXIST
ARE BASED ON LIMITED EVIDENCE.
NOR DO WE UNDERSTAND WHAT THE
APPROPRIATE PROTEIN SOURCE
SHOULD BE WHEY VERSUS SOY VERSUS
CASEIN AND IT WAS FOUND TO BE
SUPERIOR FOR EXERCISE PROGRAMS
DURING RECOVERY AND IT'S NOT
KNOWN WHETHER IT'S BENEFICIAL IN
CRITICAL ILLNESS.
WHAT'S CLEAR IS THE CONCEPT OF
ONE SIZE DOES NOT FIT ALL IN
CRITICAL ILLNESS, THERE'S NO
UNIVERSAL STANDARD.
WE HAVE GUIDELINES FOR NUTRITION
DELIVERY BUT LARGE PORTIONS OF
THOSE GUIDELINES ARE BASED ON
EXPERT OPINION OR LIMITED OR
POOR QUALITY OF EVIDENCE.
AND SO REALLY THERE'S A NEED TO
DEFINE PATIENT TYPE WITH
DIFFERENTIAL MACRO AND NUTRIENT
REQUIREMENTS IN RESPONSE TO
TARGETED THERAPY AND AS WE'VE
SEEN A FLUID RESPONSIVENESS AND
VARIOUS ENDYO TYPES DEFINED
WHERE PATIENTS MAY RESPOND
DIFFERENTIALLY AND ARE THERE
COMORBIDITIES THAT MAY INFLUENCE
NUTRITION AND THERE'S A NEED TO
DEFINE SOME SORT OF DYNAMIC
MARKER TO SELECT PATIENTS FOR
SPECIFIC NUTRIENT INTERVENTIONS
AND READINESS FOR ENHANCED
NUTRITION.
WE'VE LEARNED FROM PRIOR STUDIES
NOW THAT UNDER FEEDING CALORIES
AND APPROPRIATE PROTEIN
PRESCRIPTION OR CURRENTLY
UNDERSTAND PROTEIN PRESCRIPTION
CONFERS TO BENEFITS TO PATIENTS
BUT IN THE COURSE OF CRITICAL
ILLNESS DOES AN INDIVIDUAL
INCREASE READINESS FOR PROTEIN
DELIVERY AND A NEED TO DEFINE
ACUTE AND SUBACUTE AND CHRONIC
NUTRIENT STRATEGIES IN CRITICAL
ILLNESS ESPECIALLY WITH PATIENT
WITH CHRONIC ILLNESS AND LUNG
DISEASE.
THIS IS A GRAPHIC DESCRIPTION
FROM A SUMMARY IN INTENSIVE CARE
MEDICINE THAT IN FACT THE
INDIVIDUAL CONSIDERATIONS SUCH
AS PREMORBID CONDITIONS NOT ONLY
PREMORBID NUTRITIONAL STATUS BUT
PREMORBID COMORBIDITIES IN TERMS
OF RESPIRATORY ILLNESS FOR
PATIENTS WITH ACUTE LUNG INJURY
IN THE RDS AND ARE THEY IN A
RECOVERY OR POSTRECOVERY PHASE
AND NUTRITIONAL NEEDS VARY IN
POPULATIONS OF PATIENTS BUT
GREAT INTERINDIVIDUAL
DIFFERENCES IN PATIENT TOLERANCE
OF NUTRIENT INTERVENTIONS.
SO THERE'S BEEN SOME WORK TO TRY
TO UNDERSTAND BASELINE NUTRITION
RISK FOR PATIENTS WHO ARE
CRITICALLY ILL.
WE HAVE SEVERAL SCORES DEVELOPED
IN CRITICAL ILLNESS AND THE
NEWTRIC SCORE AND PANDORA AND
NRS AND SOMETHING COMPREHENSIVE
AT TIME OF ADMISSION TO THE ICU
AND OVER THE TIME COURSE OF
CRITICAL ILLNESS, SOME MARKER TO
ESTABLISH THAT SHIFT AND
READINESS FOR INCREASED MACRO
NUTRIENTS DELIVERY BECAUSE THE
INITIAL STUDIES WHICH
DEMONSTRATED EARLY UNDER
NUTRITION AND LOWER PROTEIN
TARGETS AS BEING BENEFICIAL TO
PATIENTS STILL DID NOT TAKE INTO
ACCOUNT THE OVER ALL POTENTIAL
DYNAMIC STATE OF INDIVIDUAL
PATIENTS.
YOU'RE LOOKING AT A POPULATION
OF PATIENTS WITH BENEFIT BUT WE
STILL DON'T KNOW OF INDIVIDUAL
PATIENTS.
SO WHAT THIS FIGURE IS
DEMONSTRATING THIS RELATIONSHIP
BETWEEN RISK OF HARM AND
POTENTIAL BENEFIT BASED ON MACRO
NUTRIENT DELIVERY AND MAY BE A
RISK OF HARM WHERE IN THE
PREVIOUS STUDIES ANYWHERE FROM
20% TO 50% OF CALORIE PROTEIN
REQUIREMENTS PROVIDED DURING THE
FIRST WEEK OF CRITICAL ILLNESS
AND THE POTENTIAL RISK OF HARM
GOING HIGHER AND THE SPECTRUM
DISEASE SEVERITY AND INDIVIDUAL
SEVERITY OF ILLNESS AND
RESPONSIVENESS WHERE THERE MAY
BE SOME SWEET SPOT WE CAN
IDENTIFY IN TERMS OF BALANCING
RISK OF HARM AND POTENTIAL
BENEFIT BASED ON SEVERITY OF
ILLNESS.
YOU'LL BRIEFLY TOUCH ON THE
MICROBIOME ON AACUTE ILLNESS AND
LITTLE IS DONE AND THERE'S
MICROBIOME SIGNATURES ASSOCIATED
WITH CRITICAL ILLNESS AND MORE
WORK TO DO AND WHETHER CHANGES
THE ENTEROTYPE IS ASSOCIATED
WITH IMPROVED OUTCOMES.
WE HEARD QUITE A LOT ABOUT THE
GUT LUNG ACCESS AND THIS IS A
FIGURE IN CELLULAR MICROBIOLOGY
IN 2018 AND DYSBIOSIS ASSOCIATED
WITH ALTERED MICROBIOTA AND
POTENTIATING LUNG DAMAGE AND
INFLAMMATION THROUGH DIRECT AND
SIGNALLING MOLECULES AND COULD
RESTORE THE MICROBIOTA AND
ALTER THE LUNG INFLAMMATION.
THIS IS ANOTHER FIGURE
DESCRIBING THE CONCEPT OF AN IN
FLAMED LEAKY GUT WHICH THEN IS
ASSOCIATED WITH FURTHER DOWN
STREAM SIGNALLING IN TERMS OF
LUNG INFLAMMATION AND COULD HAVE
POTENTIAL TREATMENTS AND
MICROBIOTA TRANSPLANTATION AND
PARTLY POTENTIALLY NEXT
GENERATION PRE OR PROBIOTICS AND
INCREASED FIBER INTAKE AND HAVE
BETTER PHENOTYPE ASSOCIATED WITH
A WAY OR METHODOLOGY TO IMPROVE
ACUTE LUNG INFLAMMATION THEREBY
WE COULD AFFECT THE GUT TO TREAT
ACUTE LUNG INJURY.
THIS IS SOME OF THE WORK I DO.
THIS IS NOT MY STUDY BUT LOOKING
AT WHETHER PREBIOTIC FIBER
IMPROVED CONCENTRATIONS TO
REDUCE LUNG INFLAMMATION AND
PEDIATRIC IN RVS AND THIS IS
FOUNDATIONAL WORK DESCRIBING HOW
SODIUM BUTYRATE IS A PRODUCT OF
MICRO ORGANISMS IN THE G.I.
TRACT INCREASE INFLAMMATION.
THERE ARE A WHOLE HOST OF
PREBIOTIC FIBERS AND THERE'S ONE
OF PARTICULAR INTEREST TO MYSELF
IS A SOLUBLE NON VISCOUS VIBER
AND HAS PREBIOTIC EFFECTS AND IN
EARLY STUDIES IS DEMONSTRATED TO
IMPROVE ORGANISM AND LOOK AT
FECAL BUTYRATE CONCENTRATION.
THERE'S A NUMBER OF GAPS IN NEED
ACROSS TRIALS IN TERMS OF MACRO
NUTRIENT DELIVERY COMPARING HIGH
VERSUS LOW PROTEIN AN ENERGY
DOSE AND THE SUBACUTE PHASE TO
DETERMINE MICRO AND MACRO DOSE
IN IL ILLNESS AND LOOKING AT
CRITICAL ILLNESS WITH AND
WITHOUT LUNG INJURY AND FURTHER
WORK IN THE POTENTIAL EFFICACY
OF KETO GENIC DIETS AND PRAG MAT
IG TRIALS UNTIL FULL NUTRITION
IS ACHIEVED.
THERE'S SIGNIFICANT WORK NEEDED
TO DETERMINE WHICH PATIENT
GROUPS MAY BENEFIT FROM
NUTRITIONAL INTERVENTIONS.
AND TO BE GUIDED BY CLINICAL OR
BIOMARKER ASSESSMENT TOOLS TO
DEFINE READINESS TO ADVANCE
MACRO NUTRIENT DELIVERY OR
READINESS FOR MICRO NUTRIENTS OR
OMEGA 3 FATTY ACIDS.
AND FURTHER WORK FOR THE
GUT-LUNG AXIS AND HOW IT MAY BE
USED TO IMPROVE CRITICAL
ILLNESS.
PARTICULAR KNOWLEDGE GAPS WITHIN
THE LUNG-GUT AXIS ARE TO DESIGN
NUTRIENT INTERVENTIONS TO
INFLUENCE ACUTE LUNG DISEASE BY
MANIPULATING THE MICROBIOME
NICHE AND ACUTE LUNG
INFLAMMATION AND INJURY AND
THERE ARE MULTIPLE PROMISING
ANIMAL STUDIES WE NEED TO
CONSIDER AN INFLUENCE
IMMUNONUTRITION OVERLAID
APPROPRIATE MACRO NEUTRIENT
DELIVERY.
THAT'S MY LAST SLIDE.
THANK YOU VERY MUCH.
>> THANK YOU VERY MUCH.
I THINK WE'LL HAVE A SUMMARY OF
THE SESSION.
>> THAT'S AN INTERESTING SESSION
AND AN INTERESTING GROUP OF
TALKS WHICH COVERED A LOT OF
TERRITORY.
WE STARTED OFF WITH DR. HANSEL
WHO SPOKE TO US ABOUT NUTRITION
INTERVENTIONS IN UNDER SERVED
POPULATIONS.
SHE PROVIDED EVIDENCE AROUND A
NUMBER OF INTERVENTIONS, VITAMIN
C, OMEGA 3 AND VITAMIN D AND A
AND COMING TO THE CONCLUSION
MORE WORK NEEDS TO BE DONE IN
UNDERSTANDING WHAT NUTRIENT
SUPPLEMENTATION MAY BE HELPFUL
IN COPD.
I THINK THAT THIS WOULD COME
AWAY WITH THE CONCLUSION FROM
DR. HANSEL'S WORK MORE NEEDS TO
BE DONE.
AND WE THEN MOVED ON TO DR
DR. CARBONE'S PRESENTATION FOR
INTERVENTIONS FOR
CARDIORESPIRATORY FITNESS AND
INTERESTING WORK TOWARD THE END
OF THE TALK WITH REGARD TO
CONTROLLED FEEDING STUDIES AND
POTENTIAL OPPORTUNITIES IN THAT
AREA.
MY TALK FOCUSSED ON HEALTHY
DIETS AND CLINICAL TRIALS THAT
HAVE BEEN USED TO UNDERSTAND THE
EFFECTS OF HEALTHY DIETS ON LUNG
DISEASE PARTICULARLY ASTHMA AND
COPD.
AND MORE WORK NEED TO BE DONE
THERE GIVEN THE LIMITED AMOUNT
OF EVIDENCE THAT'S BEEN
AVAILABLE TO DATE.
DR. PANDA TALKED TO US ABOUT
TIME RESTRICTED FEEDING.
INTERESTING OBSERVATIONS THERE
AROUND THE SYNERGISTIC
INTERACTIONS WITH NUTRITION
QUALITY AND CALORIC RESTRICTION
AND THE BENEFIT FOR ADULTS TO
BENEFIT FROM TIME-RESTRICTED
FEEDING.
MORE HUMAN INTERVENTION STUDIES
ARE NEEDED TO UNDERSTAND THE
EFFECTS ON CARDIORESPIRATORY
OUTCOMES.
AND TIMELY WE HEARD FROM
DR. TYPPO AND HER WORK IDENTIFY
LOTS OF IMPORTANT QUESTIONS
AROUND THE ROLE OF NUTRITION AND
CRITICAL ILLNESS AND THE NEED TO
COMPARE HIGH VERSUS LOW INTAKE
AND EFFICACY OF KETOGENIC DIETS
AND THE NEED FOR PRAGMATIC
TRIALS AND SUPPLEMENTING
MICRONUTRIENT NEEDS.
SHE RAISED THE QUESTION OF WHICH
PATIENT GROUPS MAY BENEFIT AND
THE GUT-LUNG AXIS AND MAY
BENEFIT PATIENTS OF CRITICAL
ILLNESS.
NOW WE'LL MOVE TO OPPORTUNITY
FOR COMMENTS AND QUESTIONS FOR
MATERIAL SHARED.
DR. MA, I DON'T KNOW IF YOU'VE
BEEN ABLE TO CHECK THE CHAT AND
SEE IF THERE'S ANY QUESTIONS.
>> I HAVEN'T SEEN SPECIFIC
QUESTIONS IN THE CHAT.
I CAN PUT YOUR QUESTIONS IN THE
CHAT AND IN THE MEANTIME IF THE
A/V TEAM CAN TAKE DOWN THE SLIDE
TO SEE THE PANELISTS.
I'LL START WITH A QUESTION FOR
THE PANEL WITH SEVERAL THEMES
THOUGH THE TALKS SPAN A BROAD
SPECTRUM BUT I THINK THERE'S A
COMMON THEME WHICH IS WE NEED
MORE DEFINITIVE TRIALS IN TERMS
OF LOOKING AT NUTRITION AND ITS
EFFECTS IN RESPIRATORY CELLS AND
DEFINE WHICH DISEASE AND
OUTCOMES BUT OVER ALL I THINK WE
HEARD FROM ALL THE SPEAKERS WE
NEED MORE TRIALS.
>> THERE'S NUTRITION
INTERVENTION WHETHER A DIETARY
PATTERN OR YOU THINK GIVEN THE
EVIDENCE PRESENTED CRASS THE
SESSION TO JUSTIFY A MULTI-SITE
DEFINITIVE INTERVENTION TRIAL TO
THE EFFICACY FOR SPECIFIC
OUTCOMES IN CERTAIN NON-DISEASE
AREAS.
>> MAYBE I CAN KICK OFF WITH A
COMMENT.
I THINK YES BUT I THINK THE BODY
OF EVIDENCE AROUND FRUIT AND
VEGETABLES AS A PRIMARY AND
SECONDARY INTERVENTION FOR
RESPIRATORY DISEASES IS VERY
STRONG AND NOT JUST BASED ON THE
CLINICAL TRIALS THAT I'VE
PRESENTED TODAY BUT BASED ON THE
FACT THAT THERE'S A HUGE BODY OF
LITERATURE THAT SHOWS FRUIT AND
VEGETABLES ARE ABLE TO REDUCE
SYSTEMIC INFLAMMATION.
I THINK THAT THAT BODY OF
EVIDENCE IN ADDITION TO THE
EPIDEMIOLOGY THAT WE HAVE IN
RESPIRATORY DISEASE AND THE
EARLY INTERVENTION TRIALS I
THINK IS READY TO BE TESTED.
TO ME THE REAL QUESTION IS NOT
WHETHER OR NOT IT'S GOING TO BE
AN EFFECTIVE INTERVENTION.
I THINK THE QUESTION IS HOW
WOULD WE EVER TRANSLATE THAT TO
EVERYDAY PRACTICE.
THERE'S BEEN INTERVENTIONS IN
AUSTRALIA AND I'M ASSUMING WE
USUALLY FOLLOW WHAT HAPPENS IN
THE U.S. SO I ASSUME IT'S BEEN
THE SAME IN THE U.S.
THERE'S BEEN SO MANY ATTEMPTS AT
TRYING TO CHANGE DIETARY HABITS
ACROSS THE COMMUNITY.
THERE'S BEEN INTERVENTION AND
STRATEGIES TO GET PEOPLE TO
IMPROVE THEIR DIETARY INTAKE AND
STILL LESS THAN 5% OF THE
POPULATION CONSUMES WHAT THE
DIETARY RECOMMENDATION IS.
MY QUESTION ISN'T WHETHER OR NOT
THERE'S SOMETHING THAT'S READY
TO BE TESTED IN A TRIAL.
MY QUESTION IS HOW WOULD WE THEN
ACTUALLY MAKE THAT STRATEGY THAT
COULD BE ADOPTED?
OR WOULD BE ADOPTED?
>> THAT'S A GOOD POINT AND AS A
FOLLOW-UP WHAT DO WE THINK THE
ROLE OF INDUSTRY -- WE TALKED
ABOUT SCIENTIFIC EVIDENCE
THROUGHOUT THIS WORKSHOP AND
WITH SOME CONNECTION TO HEALTH
POLICY BUT I DON'T THINK WE
NECESSARILY CAN COMMENT ON THE
ROLE OF INDUSTRY.
AS YOU POINTED OUT DR. WOOD
BEHAVIOR CHANGE IS HARD AND
HARDER TO MAINTAIN.
WE'RE NOT GIVING UP ON THE
SCIENCE OF BEING ABLE TO CHANGE
AS IT RELATES TO LIFESTYLE
BEHAVIORS IN EATING AND DIETARY
CHANGE.
AT THE SAME TIME IT MAY BE TOO
NARROW APPROACH AND MAY BE TOO
MANY BARRIERS.
WHAT ARE INFLUENCERS IN
TRANSLATING THE EVIDENCE WE
CONTINUE TO GENERATE INTO
ADOPTION?
>> ONE SPECIFIC ASPECT MAY BE
WHERE THE INDUSTRY IS HEAVILY
INVOLVED.
IF WE START THEY WOULD BE ABLE
TO IMPLEMENT THAT.
ONCE YOU START THERE THE
QUESTION IS CAN INDUSTRY
CONTINUE TO PROVIDE NUTRITION
FOOD.
STARTING FROM THE HOSPITAL STAY.
THAT'S ONE.
AND RECOGNIZING THE CHANGES AND
TRYING TO FIGURE OUT HOW TO
INCREASE FIBER AND PROTEIN
INTAKE.
THIS COULD BE ANOTHER SEGUE TO
GET ATTENTION FROM INDUSTRY
BECAUSE EVERYBODY'S TRYING TO
MARKET.
THOSE ARE MY THOUGHTS.
>> GRANTED I'M NOT AN ADULT
INTENSISTIST -- IN TENSIVIST BUT
WE DECIDE EVERYTHING OUR
PATIENTS ARE TAKING IN.
IT'S ALMOST SIMPLER IN SOME
DEGREE BECAUSE I DON'T HAVE TO
WORRY ABOUT PATIENT BEHAVIOR BUT
PRESCRIBER BEHAVIOR AND CREATING
A BODY OF EVIDENCE TO DETERMINE
WHAT APPROPRIATE NUTRITIONAL
STRATEGIES ARE AND IT'S A
DIFFERENT PHILOSOPHY BECAUSE THE
FRUIT AND VEGETABLE OUT PATIENT
MANAGEMENT IN TERMS OF
INTERVENTION IS ABOUT DISEASE
PRE PROGRESSION AND HEALTH AND
MIND SET RATHER THAN RESOLVING
AN ACUTE ILLNESS WHICH IS A
DIFFERENT PROBLEM THAT PROBABLY
REQUIRES DIFFERENT APPROACHES.
I THINK IN THE ADULT CRITICAL
CARE LITERATURE OF ESTABLISHING
FUNDAMENTAL ISSUES AND THE
PROBLEM IS OVERLAID WITH
MICRONUTRIENTS AND OMEG OMEGA 3
LOOKING AT THE TIMING FOR THE
INDIVIDUAL PATIENT FOR WHEN
THEY'RE READY TO RECEIVE OR WHEN
IS THE APPROPRIATE TIME FOR A
PARTICULAR MICRO NUTRIENT
NUTRITION.
I DON'T THINK THE STORY'S CLOSED
DESPITE WE SHOWED NEGATIVE
TRIALS.
THOSE WERE OVERLAID UPON A
PRACTICE WHERE THE COMMUNITY
DIDN'T KNOW WHAT WAS APPROPRIATE
DOSE TIMING AND NOW THAT HAS
STARTED TO BE INVOLVED.
IT MAY BE TIME TO ADDRESS THE
ISSUES OF IMMUNONUTRITION.
HOPEFULLY WE CAN BUILD THE TOOL
TO FY THE RIGHT PATIENT
POPULATION.
AND THE IDEA WOULD HOPEFULLY BE
YOU WOULD THEN PROVIDE PATIENTS
WITH APPROPRIATE NUTRITIONAL
COUNSELING SO WHEN THEY'RE HOME
MANAGING THEIR CHRONIC LUNG
INJURY AND ILLNESS, HOW TO BEST
FEED THEMSELVES.
>> IT'S A DIFFERENT PROBLEM
YOU'VE GOT.
I WAS QUITE INTERESTED TO EXTEND
THIS THOUGHT TO DR. HANSEL.
SHE MUST HAVE HAD TO LEAVE.
DID SHE?
>> YES, SHE STEPPED AWAY
TEMPORARILY.
>> OKAY.
ONE THING THAT OCCURRED TO ME
WHEN DR. HANSEL WAS SPEAKING IT
WAS INTERESTING THE INFLAMMATION
AROUND FOOD SECURITY HAS BEEN A
KEY ISSUE FOR COPD PATIENTS AND
SOMETHING WE SEE IN PATIENTS WE
WORK WITH.
AGAIN IT MAKES YOU WONDER DO WE
ACTUALLY NEED TO TREAT THE ROOT
CAUSE AND ADDRESS THE FOOD
SECURITY.
IF PEOPLE ARE FED BETTER QUALITY
DIET THEY WON'T HAVE THE
MICRONUTRIENT DEEFFICIFICIENCIE
SO MUCH COMES DOWN TO PEOPLE
EATING POOR QUALITY DIETS.
DO WE NEED TO ADDRESS THAT
RATHER THAN TRYING TO FIX THE
PROBLEM THAT WE'VE GOT AT THE
END OF THE LINE?
>> THE IDEA OF THE FOOD INDUSTRY
AND LOOK AT PRODUCERS AND SEE
WHETHER HOSPITALS CAN AND
POPULATION HEALTH HAS ADDRESSED
FRUIT AND VEGETABLES.
>> AND USING STUDIES TO
CATEGORIZE PATTERNS IN SPECIFIC
POPULATIONS.
>> THERE'S QUITE A FEW
COLLABORATORS FROM AUSTRALIA
THAT REACHED OUT AND USING THE
APP.
OF COURSE THERE'S SOME COST
INVOLVED.
SOMETIMES FOR YOUNG FACULTY WE
HELP THEM BY GATHERING SOME DATA
IN FEASIBILITY STUDIES.
AND REACHING THAT POPULATION
HOPEFULLY BY EARLY NEXT YEAR.
>> THERE'S ANOTHER QUESTION
ABOUT TO OBTAIN PRELIMINARY DATA
TO A CERTAIN POPULATION MAYBE
THIS WAS STUDIED OR MAY OR NOT
BENEFIT FROM INTERVENTION.
WHAT'S THE BEST VALIDATED AND
FEASIBLE SURVEY TO CAPTURE
PATTERNS OF SPECIALIZED
POPULATIONS.
>> IT'S COUNTRY SPECIFIC.
I'D HAVE TO DEFER TO A
U.S. EXPERT ON THAT.
I DON'T KNOW IF OTHERS HAVE USED
U.S.-BASED TOOLS.
>> I DON'T KNOW THERE'S ONE BEST
SURVEY.
I THINK IT DEPENDS ON THE TOPIC
OF YOUR RESEARCH AND DIMENSIONS
YOU WANT TO CAPTURE AND THERE'S
DIFFERENT VALIDATED SURVEY
TOOLS.
THERE'S INTERESTING COMMENTS
WITH THE LINK IN
CARDIORESPIRATORY OUTCOME AND
THIS IS AN INTERESTING POINT
BECAUSE AS WE'RE TALKING ABOUT
DIFFERENT TYPES OF NUTRITIONAL
INTERVENTIONS, THEY'RE RELEVANT
TO PROBABLY MOST CHRONIC
INFLAMMATORY DISEASES INCLUDING
CARDIOVASCULAR DISEASE AND
DIABETES AND SO IT'S SOMETHING
WE NEED TO START THINKING ABOUT
SO MUCH IN ISOLATION ABOUT
EFFECTS ON RESPIRATORY AND
INTERVENTIONS THAT WILL HAVE
WHOLE BODY EFFECTS.
I HAVEN'T REALLY COME ACROSS
PEOPLE THINKING ALONG THESE
LINES APPLYING FOR GRANTS AND
SHARING CLINICAL TRIAL RESOURCES
TO USE ONE INTERVENTION TO
CONVERT MULTIPLE DISEASES AND
CONDITIONS.
I MEAN THEORETICALLY YOU COULD
DO THAT COULDN'T YOU BECAUSE
WITH YOU KNOW MOST PARTICULARLY
IN OLDER PEOPLE THEY ARE HAVE
MULTIPLE COMORBIDITIES.
THAT'S REALLY AN INTERESTING
IDEA THAT WE COULD DEVELOP.
>> I AGREE.
AND IF I COULD GET OTHER TWO
PANELISTS TO COMMENT ON THAT AS
WELL.
ONE OF THE THEMES COMING OUT UP
PRESENTATIONS IS THERE'S SOME OF
COMPLEXITY AND HETEROGENEITY
INSTEAD OF ONE APPROACH FOR ONE
CLINICAL CONDITION SPECIFIC
OUTCOME IN THE CONTEXT OF TRIAL
TO DEFINE THE PRIMARY OUTCOME DO
WE HAVE THE OPPORTUNITY TO THINK
ABOUT HOW WE RECONCEPTUALIZE
NUTRITION HEALTH AND RESPIRATORY
HEALTH AND DISEASE TO TAKE ON A
MORE TRANS DIAGNOSTIC AND TRANS
DISCIPLINARY PERSPECTIVE AND
WOULD THAT MOVE US FORWARD IN A
CONCRETE WAY.
I'D LIKE TO HEAR YOUR THOUGHTS.
>> CERTAINLY IN TERMS OF AN
ACUTE ILLNESS AND MANIPULATE THE
GUT MICROBIOME AND USING THE
G.I. TRACT AND THE GUT
MICROBIOME AND ASSOCIATED WITH
METABOLIC SYNDROME AND
ATHEROSCLEROSIS AND FORMATION.
FOR PATIENTS WHO COME IN WITH
COMORBIDITIIES THERE ARE WAYS T
SAY YOU CAN MANIPULATE THE GUT
MICROBIOME AND THERE BE IMPROVE
PULMONARY AND CARDIAC HEALTH.
>> WITH HUMANS I REALIZE THE
FRAMEWORK OF CLINICAL STUDY IS
STILL GEARED TOWARDS MEDICATIONS
THERE'S A DEFINE INCLUSIVE
CRITERIA DEFINED OUTCOME AND WE
USE A SIMILAR APPROACH FOR DIET
AND LIFESTYLE INTERVENTION AND
THAT HAS BENEFITS AND HOW TO
CAPTURE THAT BENEFIT IS
DIFFICULT WITHIN THE FRAMEWORK
BECAUSE YOU CANNOT HAVE MORE
THAN ONE OUTCOME RELATED TO EACH
OTHER.
IN THE STRUCTURE OF CLINICAL
TRIAL MOST OF THE STUDIES FOR
CARDIOVASCULAR OUTCOMES WE DO
EXCLUDE SLEEP APNEA AND THOSE
WHO ARE MODERATE OR MILD AND
THEN THEY REALIZE THAT THEY HAVE
BETTER SLEEP AND BREATHING BUT
WHEN IT COMES TO OUTCOMES IT
BECOMES DIFFICULT TO CONVINCE
THE REVIEWERS AND FUNDERS AND
IRB AND THE WHOLE FRAMEWORK IS
NOT GEARED TOWARDS DIET AND
LIFESTYLE INTERVENTION.
THERE NEEDS TO BE TALK IN HOW TO
STRUCTURE THESE TRIALS.
PEOPLE WITH METABOLIC RESPONSES
AND IMMUNE DYSFUNCTION SO THERE
ARE MULTIPLE BENEFITS AND WE'RE
MISSING TO CAPTURE THOSE
BENEFITS.
>> THANK YOU, WELL SAID.
NOW WE'LL CLOSE SESSION 5 AND
THE SPEAKERS IF YOU COULD STAY
BECAUSE WE'LL HAVE A FINAL
DISCUSSION SESSION WHERE WE'D
LOVE TO BRING YOU BACK INCLUDING
SPEAKERS FROM YESTERDAY AND
TODAY AND HAVE A STRATEGIC
DISCUSSION.
SO IF THE A/V CAN BRING BACK THE
SLIDES.
THANK YOU.
FOR THE NEXT 15 MINUTES I'LL TRY
TO PROVIDE A SUMMARY OF WHAT WE
HEARD BETWEEN THE TWO DAYS IN
TERMS OF STATE OF SCIENCE,
CHALLENGES AND OPPORTUNITIES IN
NUTRITION RESEARCH FOR PULMONARY
HEALTH PROMOTION AND DISEASE
PREVENTION AN CONTROL.
-- AND CONTROL.
I'LL TRY TO RECAP THE OBJECTIVES
AND STRUCTURE OF THE TWO-DAY
WORKSHOP AND PROVIDE A SUMMARY
OF THE CURRENT STAGE OF SCIENCE
AS WE HEARD FROM A NUMBER OF
OUTSTANDING PRESENTERS.
AS YOU ALL KNOW WE HAVE COVERED
QUITE A BIT OF TERRITORY.
THE PRESENTATION TOPICS ACROSS
MULTIPLE DOMAINS AND SCALES AND
MULTIPLE LEVELS AND IT'S REALLY
IMPOSSIBLE TO DO JUSTICE SO THE
DEPTH AND THE BREADTH OF THE
SCIENCE THAT'S BEEN PRESENTED
BETWEEN THESE TWO DAYS.
BUT I THINK I'LL GIVE SOME OF MY
TAKEAWAYS, GRANTED THEY'RE
INCOMPLETE AND POSSIBLY
INACCURATE BUT IT'S AN
OPPORTUNITY FOR OUR EXPERTS TO
PROVIDE CORRECTIONS AS
APPLICABLE AND TO EXTEND THE
DISCUSSIONS THAT'S BEEN
HAPPENING ACROSS THE SESSIONS.
I'LL ALSO TRY TO GIVE THOUGHTS
IN TERMS OF COMMON THEMES.
WE HAVE HEARD ABOUT MAJOR
CHALLENGES AND POTENTIAL
OPPORTUNITIES AND THEN WE'LL
OPEN FOR PANEL DISCUSSION WITH
REGARD TO WHAT ARE SOME
STRATEGIC QUESTIONS WE SHOULD
ADDRESS IN ORDER TO REALLY MOVE
THE FIELD FOR WARD.
THE GOAL IS TO ADVANCE NUTRITION
RESEARCH FOR LUNG DISEASE
PROGRESSION AND CONTROL.
TO ACCOMPLISH THAT OVER ALL GOAL
WE HAD FIVE OBJECTIVES HOW WE
STRUCTURED THE TWO-DAY WORKSHOP
AND WE HAD FIVE SESSIONS AND WE
HAD MULTIPLE PRESENTATIONS THAT
CENTERED AROUND A THEME.
THE FIRST SESSION CENTERED ON
EPIDEMIOLOGICAL EVIDENCE AND
SECOND SESSION WAS ON CLIMATE
CHANGE AND THIRD WAS ON
UNDERLYING MECHANISMS AND THEN
PROCESSED TO TALKING ABOUT
PRECISION MEASURES AND END THE
SESSION FOCUSSED ON INTERVENTION
TRIAL EVIDENCE.
SOME OF THE KEY TAKEAWAYS FROM
EPIDEMIOLOGICAL EVIDENCE WAS
CONSENSUS WE HEARD IN TERMS OF
DIET INCLUDING DIET COMPOSITION,
QUALITY AND QUANTITY AS MORE
IMPORTANT THAN ANY SINGLE FOOD
OR NUTRIENT.
AND AT THE SAME TIME I THINK WE
ALSO HEARD SOME INTERESTING
EXCHANGES WITH REGARD TO THE
POTENTIAL OF GOING TO IN ONE
DIRECTION WITH DIETARY PATTERN
STRATEGY TO FOCUS ON DIET OR
THINK ABOUT SINGLE NUTRIENT OR
FOODS GOING IN ONE DIRECTION TO
THE EXCLUSION OF OTHER
SCIENTIFIC AREAS THE DANGER IN
THAT AND SHOULD HAVE A BALANCE
AND MORE INTEGRATIVE APPROACHES
AS WE THINK HOW TO PROCEED.
WE HEARD ABOUT OBSERVATIONAL
EVIDENCE ON THE PROBABLE
BENEFITS OF MARINE OMEGA 3
PROFILES AND SHORT CHAIN FATTY
ACIDS WHILE DATA IS STILL
UNCLEAR ON THE POSSIBLE RISKS OF
SATURATED FATTY ACIDS.
AND THEN WE ALSO REALLY HEARD
FROM TWO OUTSTANDING SPEAKERS
WITH REGARD TO THE EVIDENCE OF
POTENTIAL BENEFIT OF DIETARY
ANTIOXIDANTS WHICH INCLUDE
MICRONUTRIENT AND PHYTO
NUTRIENTS FROM FOODS AND THROUGH
SUPPLEMENTATION AND THEIR
BENEFITS FOR LUNG FUNCTION,
ASTHMA CONTROL AND COPD
PREVENTION AND CONTROL AND
MANAGEMENT WHILE THERE'S NO
EVIDENCE OF CLEAR HARM OF EXCESS
INTAKE.
I BORROWED THIS FROM DR. CA
DR. CARBONE'S TALK WHICH IS A
THEME REPEATED THROUGHOUT THE
WORKSHOP.
WE HAVE MANY GAPS AND THE GAPS
ARE EXTENSIVE BECAUSE THERE'S
MANY POSSIBLE EXPOSURES AND
POSSIBLE OUTCOMES AND POSSIBLE
MECHANISTIC PATHWAYS.
WE HAD TWO OUTSTANDING SPEAKERS
WHO PRESENTED ON THE IMPACT OF
CLIMATE CHANGE HUMAN NUTRITION
AS WELL AS RESPIRATORY HEALTH.
AS WE KNOW CLIMATE CHANGE IS A
GLOBAL CRISIS THAT NOT ONLY
AFFECTS FOOD PRODUCTION AND
CONSUMPTION AND THE ENTIRE FOOD
SYSTEM LIFE CYCLE BUT ALSO OTHER
ASPECTS OF LIFE IN TERMS OF
WATER, AIR QUALITY.
THERE ARE DIRECT AND INDIRECT
EFFECTS OF CLIMATE CHANGE BOTH
OF HUMAN NUTRITION AND
RESPIRATORY HEALTH TO VARIOUS
PATHWAYS AND THESE EFFECTS CAN
BE MODIFIED BY EXTERNAL FACTORS
SUCH AS CONFLICT OR FUEL AND
OTHER RESOURCE SHORTAGES.
OF COURSE CLIMATE CHANGE AFFECTS
EVERYWHERE AND ALL PEOPLE AND
THE EFFECTS ARE DIFFERENTIAL DUE
TO SYSTEMIC INEQUITY.
WE HAD FIVE OUTSTANDING
PRESENTATIONS THAT WE CAN DRILL
DOWN DEEPER TO POTENTIAL
MECHANISMS UNDERLYING THE IMPACT
OF NUTRITION AND DIET AND LUNG
DISEASE.
THERE WAS A GREAT TALK THAT
PRESENTED RENEWED RESEARCH
INTERESTS IN THERAPEUTIC KETOSIS
IN RELATION TO RESPIRATORY
HEALTH AND DISEASE.
LOOKING AT MARINE FISH OILS AND
LOOKED AT MALNUTRITION AND OVER
AND UNDER NUTRITION AND HOW THEY
IMPACT CELL MEDIATED IMMUNITY
AND INFLAMMATION WHILE ALSO
POINTING OUT THERE'S A
RECIPROCAL RELATIONSHIP BECAUSE
INFLAMMATION LEADS TO
MALNUTRITION.
AND THERE'S IMMUNE PATHWAYS IN
PRO AND ANTI-INFLAMMATORY
RESPONSES BUT RESPONSES
SYSTEMICALLY INCLUDING IN THE
LUNG THE MECHANISTIC PATHWAYS
ARE BEING ADVOCATED AND THEY'RE
LOOKING AT ANTIOXIDANTS, ZINC,
DIETARY FIBER AND WE HEARD FROM
A NUMBER OF SPEAKERS IN TERMS OF
FEEDING THE LUMP THROUGH THE
GUT-LUNG AXIS AND METABOLITES
CAN CHANGE LUNG IMMUNITY AND
WOR
WORSEN LUNG DISEASE ONSET OR
PROGRESSION AND HEARD THE
IMPORTANCE OF TIME.
TIMING OF EATING OR CIRCADIAN
REGULATION AND HOW THE CIRCADIAN
CLOCK REGULATION INTERACTS AND
THE HEALTH IMPLICATION FOR
RESPIRATORY DISEASE WITH THE
EXAMPLE BY ONE OF OUR SPEAKERS
AND ALSO WE HEARD HOW IT MAY
ALSO EXPLAIN THE POTENTIAL
EFFECTS OF TIME-RESTRICTED
EATING.
THE NEXT SESSION DOVETAILED
NICELY WITH THE MECHANISMS AND
TALKS THAT FOCUSSED ON OMICS AND
HOW OMICS DATA HOLDS PROMISE FOR
NUTRITION BIOMARKER DEVELOPMENT
IN PARTICULAR METABLOOLOMICS AN
THERE'S A GREAT TALK THAT LOOKED
AT FATTY ACID DERIVED SPMs AND
HOW THE NOVEL CLASS OF THE
ENDOGENOUS REGULATORS OF
INFLECTION AND INFLAMMATION AND
THE EFFECT IN TERMS OF
PROINFLAMMATORY RESPONSES AND
STIMULATING INFLAMMATION
RESOLUTION IN RESPIRATORY
DISEASE.
AND A FOCUS OF BODY COMPOSITION
AND USING BMI AND OTHER TYPES OF
MUSCLE MASS INDICES INCLUDING
FAT FREE MASS INDEX AS WELL AS
TAKING INTO ACCOUNT WHETHER THAT
OCCURRED UNINTENTIONALLY.
WE ENDED WITH NUTRITION TRIALS
AND TERRITORY RANGING FROM
NUTRITION THERAPY USING
SUPPLEMENTATION AS WELL AS
DIFFERENT DIETARY PATTERNS WITH
A FOCUS ON INCREASED FRUIT AND
VEGETABLE INTAKE AND HEALTHY
FATS AND THEIR POTENTIAL
BENEFITS FOR CHRONIC RESPIRATORY
DISEASES SUCH AS ASTHMA AND
COPD.
AND ALSO A GREAT TALK IN TERMS
OF ANIMAL MODELS AND LEVERAGING
DIGITAL HEALTH TECHNOLOGIES TO
BETTER MEASURE TIMING AND
COMPOSITION OF DIETARY INTAKE
OVER THE COURSE OF LONGITUDINAL
FASHION AND HOW NUTRITION
THERAPY NOT ONLY IN TERMS OF THE
IMPLICATION FOR CHRONIC LUNG
DISEASE MANAGEMENT AND CRITICAL
ILLNESS SETTINGS AND HOW THE
EVIDENCE MAY HAVE GENERATED
NEGATIVE RESULTS BUT INSTEAD OF
WALKING AWAY FROM INTERVENTIONS
DEMONSTRATED TO BE INEFFECTIVE
IN THOSE PRIOR TRIALS HOW DO WE
BUILD ON THE NEGATIVE FINDINGS
AND LEVERAGE TOOLS AND
TECHNOLOGIES TO DRILL DEEPER AND
POTENTIALLY IDENTIFY SPECIFIC
SUBPOPULATIONS WHERE THOSE
INTERVENTIONS MAY INDEED
POTENTIALLY PROFILE BENEFIT.
IN TERMS OF CHALLENGES IF
THERE'S TWO WORDS TO SUMMARIZE
THE CHALLENGES ARE COMPLEXITY
AND HETEROGENEITY.
AND THE CHALLENGES MANIFEST
ACROSS ALL THREE MAJOR TOPICS
COVERED IN THE DISCUSSION
WHETHER IT'S NUTRITION AND
DISEASE ARE THE UNDERLYING
MECHANISMS AND THE SMALL CIRCLES
CAN REFLECT A SUBSET OF THE
POTENTIAL FACTORS IN DIMENSIONS
THAT MAKE THE DOMAINS COMPLEX
AND HETEROGENEOUS.
WE KNOW CONTEXT MATTERS A LOT
AND HEARD IN TERMS OF THE IMPACT
OF CLIMATE CHANGE ON NUTRITION
AND RESPIRATORY HEALTH AND ALSO
THE INFLUENCE OF SOCIAL
DETERMINATES AND HOW TO BE
INTENTIONAL AND TARGETED AS WE
THINK ABOUT GOING FORWARD IN THE
FIELD TO GENERATE EVIDENCE IN
UNDER SERVED POPULATIONS AND
THERE'S MULTIPLE LEVELS OF
INFLUENCES AND HOW DO WE HAVE
THE STUDY DESIGNS TO TAKE INTO
ACCOUNT GENERATE RIGOROUS
EVIDENCE.
OUR CHARGE TO ADVANCE
RESPIRATORY DISEASE IS A
CHALLENGE AT THE SAME TIME WE
HEARD ABOUT POTENTIAL
OPPORTUNITIES TO TAKE A STEP
FORWARD IN THIS FIELD.
WE HAD SOME DISCUSSION IN TERMS
OF OPPORTUNITIES THINKING ABOUT
REVOLUTIONARY WISE RESPIRATORY
HEALTH AND DISEASE WITH RELATION
TO DIET AS THEIR ROLE FOR
CONCEPTUALIZATION AND WE COULD
REALLY LOOK AT OUR COLLEAGUES
UNIN
RELATED DISCIPLINES IN THE
RESEARCH FRAMEWORK WHICH IS NOT
DIAGNOSTIC AND NOT MEANT TO
REPLACE CURRENT DIAGNOSTIC
SYSTEMS BUT TO TAKE INTO ACCOUNT
THE HETEROGENEITY IN EXPOSURE
AND OUTCOMES.
WE HEARD ABOUT ADVANCES IN TERMS
OF TECHNOLOGICAL AND
METHODOLOGICAL TECHNIQUE USING
A.I. AND MACHINE LEARNING AND
THE DIGITAL HEALTH TECHNOLOGIES
HOW THAT TECHNOLOGIES MAKE HELP
US ADVANCE HOW WE ASSESS HOW WE
MEASURE OVERTIME.
HOW DO WE LEVERAGE AND OPTIMIZE
EXISTING COHORT AND INTERVENTION
STUDIES AND THE AVAILABLE BIO
BANKS TO ADDRESS QUESTIONS ABOUT
NUTRITION AND THE UNDERLYING
MECHANISMS.
INSTEAD OF TRYING TO LOOK FOR
THE NEXT COHORT STUDY AND BIO
BANK WE COULD CREATE HOW COULD
WE LEVERAGE AND OPTIMIZE THE
RESOURCES THAT ALREADY EXIST.
WE HEARD ABOUT HOW DO WE
SYNERGIZE AND ARE THERE
OPPORTUNITIES TO PROMOTE
SYNERGISTIC CO-LEARNING AND
CO-DEVELOPMENT OF TRANSFORMATIVE
DISCOVERIES IN COLLABORATION
WITH RESEARCHERS RELATED FIELD
SUCH AS CARDIO METABOLIC
MEDICINE.
I THINK THE NEXT POINT WE CAN
HAVE DISCUSSION ON AS A PANEL IF
WE CAN PROVIDE RECOMMENDATIONS
TO NIH WITH FUNDING PRIORITIES
WHAT WOULD THOSE BE AND DO WE
HAVE EVIDENCE TO JUSTIFY A
CERTAIN TYPE OF STUDY FOR SEARCH
TYPES OF CONSORTIUM AND HOW DO
WE MOVE FORWARD IN A TARGETED
AND STRATEGIC FASHION.
I THINK I'LL END THERE AND THANK
YOU AND NOW WE'LL MOVE INTO THE
PANEL DISCUSSION.
IF THE SPEAKERS AND MODERATE ERS
FROM YESTERDAY AND TODAY WOULD
BE WILLING TO PARTICIPATE AND WE
CAN TAKE DOWN THE SLIDE.
AND I'LL INVITE THE SPEAKERS AND
MODERATORS STILL PRESENT.
>> PERHAPS WE CAN COPY THE
QUESTIONS INTO THE CHAT BOX.
>> THAT'S A GREAT IDEA.
VANESSA WOULD YOU LIKE TO KICK
OFF THE DISCUSSION.
WE DID PREPARE A FEW QUESTIONS
BUT WE CAN USE THOSE TO JUMP
START AND I'M SURE WE'LL HAVE
ADDITIONAL QUESTIONS FROM THE
PANEL AS WELL.
>> THANK YOU SO MUCH.
PERHAPS FIRST I'D LIKE TO THANK
YOU ALL AGAIN FOR SPENDING THE
TWO DAYS WITH US DISCUSSING YOUR
RESEARCH AND YOUR INSIGHTS INTO
HOW WE CAN ADVANCE THIS
IMPORTANT SCIENTIFIC AGENDA
NUTRITION AND RESPIRATORY
HEALTH.
ONE OF MY FIRST THOUGHTS IS
PERHAPS HOW CAN WE BUILD UP FROM
WHAT WE CURRENTLY HAVE TO
OPTIMIZE THE EVIDENCE ON THE
POSSIBLE LINK BETWEEN KNEW
TRYING AND RESPIRATORY DISEASES
AND LUNG HEALTH IN GENERAL
TAKING INTO ACCOUNT
OPPORTUNITIES FOR PRIMARY AND
SECONDARY PREVENTION?
DO WE HAVE TO START FROM SCRATCH
OR CREATE NEW INDICATORS,
BIOMARKERS.
THE IMPRESSION I HAVE SO FAR IS
PERHAPS THERE'S OPPORTUNITIES TO
COMBINE EXISTING TOOLS IN
EPIDEMIOLOGY WITH NOVEL
BIOMARKERS OF NUTRITION INTAKE
THAT CAN STRENGTHEN THE WAY IN
WHICH WE MEASURE NUTRITION?
WE HAVE MANY EXPOSURES AND
OUTCOMES.
HOW DO YOU THINK WE SHOULD
PRIORITIZE THE RESEARCH AGENDA?
WHAT ARE YOUR THOUGHTS?
>> I KNOW AT OUR INSTITUTION
WE'RE PARTICIPATING IN THE LUNG
COHORT STUDY A LONGITUDINAL
STUDY LOOKING AT FROM POST
ADOLESCENCE TO ADULT HAD THE IN
LUNG FUNCTION AND PRESUMABLY
BEHAVIOR MUST COME IN THE STUDY
AND DOES SOMEBODY KNOW IF
THERE'S QUESTIONNAIRES THROUGH
ALA AND I BELIEVE NHLBI IS
INVOLVED AS WELL.
>> I'LL JUMP IN.
I AGREE.
I THINK HAVING THESE CONSORTIUMS
OF STUDIES THAT ARE LOOKING AT
NUTRITIONAL BIOMARKERS WOULD BE
THE FIRST STEP TO LOOK AT WHAT
THE BIOMARKERS ARE, IF THEY CAN
BE CROSS VALIDATED IN DIFFERENT
STUDIES.
I THINK THAT WOULD BE THE
INITIAL STEP.
I DO THINK WHAT WE DO KNOW IS
SOME METABOLITES ARE MUCH MORE
TRANSIENT AND PROTEOMICS WE ARE
FINDING THE SIGNATURES ARE MUCH
MORE STABLE.
ALSO LOOKING AT OTHER OMIC
MEASURES I THINK SHOULD ALSO BE
AN AREA OF INVESTMENT.
>> TO DOVETAIL ON THAT IF THE
PANEL COULD SPEAK TO WHICH
EMERGING MEASURES OF DIETARY
INTAKE BASED ON URINE OR SERUM
BASED BIOMARKERS SHOULD BE
PRIORITIZED FOR FURTHER VALLING
DAY FOR FUTURE EPIDEMIOLOGICAL
STUDIES AND CLINICAL TRIALS?
>> I'M HAVING TROUBLE GETTING MY
VIDEO GOING.
I WAS GOING TO SPEAK TO THE
QUESTION ABOUT THE LUNG HEALTH
COHORT.
AS FAR AS I KNOW THERE IS NO
NUTRITION BEING COLLECTED AS
PART OF THE LUNG HEALTH COHORT.
SOME COLLEAGUES AND I HAVE
SUBMITTED A REQUEST FOR THAT AND
I AGREE IT'S A MISSED
OPPORTUNITY GIVEN THE POINT IN
THE LIFE SPAN THE LUNG HEALTH
COHORT IS COLLECTING DATA ON 25
TO 35 YEARS OF ABLE AND THE
ATTAINMENT OF FUNCTION.
THAT WOULD BE A GREAT THING FOR
THE NHLBI TO RE-EVALUATE AND
CONSIDER IN PURSUING THAT.
>> ABSOLUTELY.
CAN YOU REMIND ME WHAT THE
FOLLOW-UP TIME IS FOR BOTH
COHORTS?
>> I THINK THAT JUST RENEWED.
>> I THINK THERE'S A STUDY BUT
I'M ASSUMING AN ANCILLARY STUDY
CAN BE PROPOSED.
I'LL BRING THE RECOMMENDATION
BACK TO THE LEADERSHIP FOR THE
DISCUSSION.
>> THAT WOULD BE AMAZING.
WE DID PROPOSE IT AS AN
ANCILLARY STUDY.
WE HAVE NOT YET BEEN SUCCESSFUL.
IT WOULD BE GREAT IF IT WOULD BE
RECONSIDERED.
>> WE'VE ALSO BEEN WORKING IN
THE AREA FOR MANY YEARS AND IN
ONE OF THE THINGS I'VE ALWAYS
FOUND PECULIAR AND I KNOW SOME
OF MY COLLEAGUES AGREE WITH ME
IS HOW MANY IN THE PULMONARY
WORLD JUST DON'T WANT TO DEAL
WITH THE DIET.
IT'S ODD BECAUSE IT'S LIKE
SINGING TO THE CHOIR HERE
EVERYONE INFORMATIONS THERE'S
PROMISE AN DATA.
IT'S NOT PERFECT.
WE HAVE STRUGGLED IN RESPIRATORY
MEETINGS AND TRYING TO GET
ANYONE TO PAY ATTENTION AND
THINKING A CLOSE COLLEAGUE IN
PARIS WHO IS PULLING OUT HER
HAIR AT THIS.
THIS WORKSHOP WILL HELP.
ONE OF THE THINGS WE CAN DO AS
YOU KNOW YOU'RE PLANNING TO DO
IS WRITE IT UP AND TELL THE
NHLBI THIS IS IMPORTANT.
THAT I THINK WOULD REALLY HELP
MOVE THE FIELD FORWARD.
THAT'S ONE OF THE MAIN REASONS I
WAS HAPPY TO PARTICIPATE.
IT'S LONG OVERDUE SO THANK YOU.
>> WE ALSO HAVE THE SENTIMENT.
I COULD SEE PEOPLE'S SMILES WHEN
YOU WERE DESCRIBING THE FACT
THAT NUTRITION IS STILL NOT VERY
POPULAR AMONGST RESPIRATORY
EXPERTS.
I DO BELIEVE THERE IS AN
OPPORTUNITY THERE AND I'M NOT
SAYING BY ANY STRETCH NUTRITION
IS THE SOLUTION BUT IT'S
CERTAINLY SOMETHING THAT CAN
HELP AND WE HAVE A GROWING BODY
OF EVIDENCE THAT SUPPORTS THAT.
I THINK MAYBE NOW WE'VE INVITED
SUCH AN INTERNATIONAL CADRE OF
EXPERTS THERE MAY BE A STRONGER
VOICE AS A RESULT OF THE
MEETING.
THANK YOU.
OVER TO YOU.
>> I WANTED TO MAKE A COUPLE
COMMENTS.
ONE IS I'VE BEEN WORKING ON A
GRANT PROPOSAL WITH ANN DIXON
MULTIPLE YEARS ON GETTING
NUTRITION AND DIET INTO THAT
STUDY SO IT SOUND LIKE SOME
LOBBYING AND BREAKING DOWN SOME
POLITICAL BARRIERS MIGHT BE
IMPORTANT THERE.
AND CLINICAL CONTEXT AS WELL AS
NOT JUST IN THE RESEARCH CONTEXT
BUT GETTING DIETITIANS INTO THE
CLINIC AND BECAUSE REALLY THE
MAJORITY OF PATIENTS THAT COME
THROUGH THE RESPIRATORY CLINIC
HAVE NUTRITIONAL PROBLEMS.
A GOOD PORTION OF THEM AT LEAST
HALF ARE OBESE.
VIRTUALLY ALL OF THEM HAVE GOT
POOR DIET QUALITY AND SO THE
OPPORTUNITY THERE TO HAVE A
DIETITIAN IN A
MULTI-DISCIPLINARY CLINIC IS
HUGE.
IN AUSTRALIA WE HAD A LITTLE BIT
OF SUCCESS IN TERMS OF GETTING
THAT RECOMMENDATION INTO
GUIDELINES.
THE BRITISH THORACIC SOCIETY GOT
A DIETITIAN IN THE CLINIC TO
DEAL WITH OBESE PATIENTS BUT
IT'S A BIG OPPORTUNITY TO CHANGE
THE WAY THE RESPIRATORY
COMMUNITY THINKS ABOUT
NUTRITION.
>> IT'S SUCH A NARROW LIMITED
VIEW.
WHEN AND IT WAS INTERESTING AND
PEOPLE AT BASE NOW WITH
SARCOPENIA.
THESE ARE IMPORTANT POINTS FOR
THE WORKSHOP SUM I HAVE.
-- SUMMARY.
>> THIS IS BEING RECORDED.
>> THERE'S AN OPPORTUNITY TO
LOOK AT THE EXISTING BODY OF
EVIDENCE.
IF WE LOOK AT HOW NUTRITION AND
OTHER CHRONIC DISEASES HAVE BEEN
DEVELOPED AND IF WE HOPE TO
PRODUCE CLINICAL GUIDELINES OR
HEALTH POLICY RECOMMENDATIONS
WITH NEED TO SYNTHESIZE THE
EVIDENCE.
WE'RE ALL AWARE THERE'S NOT
SUFFICIENT RANDOMIZED CONTROL
TRIALS WHICH ARE CONSIDERED THE
GOLD STANDARD BUT I THINK
THERE'S COHORT STUDIES CARRIED
OUT AND THERE'S OPPORTUNITIES TO
SYNTHESIZE THAT INFLAMMATION AND
HOW STRONG IS THE BODY OF
EVIDENCE WE HAVE SO FAR FOR
VARIOUS RESPIRATORY OUTCOMES FOR
LUNG FUNCTION AND FOR ASTHMA OR
CYSTIC FIBROSIS OR COPD WOULD BE
HELPFUL TO DO AND MORE
CONSISTENTLY EXPLOIT DATA SETS
AND COHORTS THAT HAVE DATA ON
DIET AND RESPIRATORY OUTCOMES.
>> YOU MADE A COMMENT IN THE
CHAT.
WOULD YOU LIKE TO ELABORATE HOW
THE COMMENTS AND CONDITIONS FROM
THIS WORKSHOP MAY BE USED FOR
STRATEGIC FUNDING DECISION GOING
FORWARD?
>> UM, I CANNOT PROVIDE ANYTHING
SPECIFIC AT THIS MOMENT BUT ANY
RECOMMENDATIONS, COMMENTS WE
WILL CERTAINLY BRING BACK FOR
INTERNAL STAFF DISCUSSION AND
HOPEFULLY WE'LL GET SOMETHING
ACTIONABLE BUT WE HAVE CRITICAL
QUESTIONS YOU GUYS RAISED SO
WE'LL TRY TO ADDRESS THAT.
THAT'S WHY WE HAVE THIS WORKSHOP
TO PROVIDE ON KEY ISSUES WE NEED
TO SOLVE AND ALSO WHAT IS URGENT
TO DO COMPLEXITY WHEN THEY TAKE
STEPS WHAT WE CAN DO NOW AND
THREE YEARS LATER.
WE'LL TRY TO ADDRESS.
I THINK THE WORKSHOP IS THE
BEGINNING OF THE WORK.
>> GREAT.
>> AND DR. PANDA.
>> I'D LIKE TO ADDRESS THE
IMPORTANCE OF NUTRITION TIMING.
IF WE LOOK AT OUR EXISTING DATA
WE COLLECT FROM WHAT WE FIND IS
WE'RE CONSUMING THE DIET BETWEEN
4:00 A.M. AND NOON AND 90% OF
OUR DIET AFTER 7:00 P.M. IN MANY
POPULATION.
AS THE DAY GOES ON AND GET
FURTHER TO THE BED TIME THE
QUALITY OF NUTRITION ALSO GOES
DOWN.
THAT MIGHT BE A POINT TO
CONSIDER WHEN COLLECTING
NUTRITION DATA AND LOOK AT
AVOIDING FOOD THREE HOURS BEFORE
BED TIME WHICH CAN HAVE MUCH FAT
BECAUSE WHAT WE'RE FINDING IN
MOST OF OUR STUDIES IT WILL
IMPROVE THEIR SLEEP QUALITY AND
WE KNOW THAT GETTING READY CLOSE
TO BED TIME HAS AN EFFECT ON
CARDIOVASCULAR OUTCOME.
THE TIMING OF NUTRITION WHAT PEM
ARE EATING THREE TO FOUR HOURS
BEFORE BED TIME AND HAS A HUGE
IMPACT.
>> WE HAVE A COMMENT FROM EMILY
IN THE CHAT.
>> THE CANADIAN INSTITUTES OF
LUNG HEALTH HAS RECENTLY FUNDED
SEVERAL LUNG HEALTH TEAM GRANTS
ONE LED BY THE NGLI NETWORK AND
HAS A ROLE AND INTENDS TO
SUPPORT A PLATFORM FOR
HARMONIZING AND IMPROVING ACCESS
TO NOT ONLY CANADIAN LUNG HEALTH
DATA.
IT'S AN EARLY PROCESS AND CAN
HELP FACILITATE CONNECTIONS OR
RESEARCH WITH NHLBI.
THAT'S PROMISING.
THANK YOU SO MUCH.
>> I GUESS I'LL MENTION ONE
THING THAT STOOD OUT TO ME
THOUGHT THE TALKS IN THE LAST
TWO DAYS IS THE NEED TO BE VERY
CAREFUL AND VERY SPECIFIC ABOUT
POPULATIONS THAT WE'RE STUDYING
AND MAKING SURE THAT WE'RE NOT
ONLY POWERED IN TERMS OF PEOPLE
IN THE STUDIES BUT TIME.
THERE'S SO MANY STUDIES THAT
SEEM LIKE THEY WERE DONE FOR 12
WEEKS AND SEEMS LIKE WE NEED TO
GO BACK TO THE DRAWING BOARD AND
FIGURE OUT HOW WE CAN DO LONGER
STUDIES IN THESE MORE VULNERABLE
POPULATIONS SUCCESSFULLY AND
LOOKING FOR PARTNERS TO HELP US
DO THAT BECAUSE I FEEL LIKE A
LOT OF THE DIFFICULTY WE'LL BE
DOING IN ASCERTAINING TRUE
EFFECT ARE DUE TO THOSE
LIMITATIONS.
>> DIET IS RELATED TO THE POINT
A NUMBER OF PRESENTERS MADE
WHICH IS HUMAN NUTRITION STUDIES
ARE HARD TO DO.
IT'S EVEN HARDER TO CONDUCT
NUTRITION INTERVENTION OVER AN
EXTENDED PERIOD OF TIME.
THERE'S ADHERENCE AND THEN ALSO
IN TERMS OF DATA COLLECTION AND
THE INTERVENTION AND AT THE SAME
TIME OUR COLLEAGUES IN OTHER
FIELDS HAVE DONE LARGE SCALE
NUTRITION INTERVENTIONS IN THE
REAL WORLD.
WE NEED TO THINK ABOUT IN ORDER
TO MOVE THIS FIELD FORWARD,
WHICH AREA HAS THE MOST
PROPOSITION FOR US TO DESIGN
DEFINITIVE TRIALS FOR NOVEL
COHORT STUDIES INCLUDING
POTENTIALLY AND STUDIES AND USE
THEM TO ANSWER NEW QUESTIONS.
I THINK TO ME WE'RE BEHIND THE
TIME IN TERMS OF THINKING ABOUT
INTERVENTION TRIALS THAT CAN
REALLY GENERATE DEFINITIVE
EVIDENCE FOR THE ROLE OF
NUTRITION IN RELATION TO
RESPIRATORY HEALTH.
>> I THINK WE'RE ALL AWARE OF
THE MANY FACTORS GOING INTO WHY
WE'VE IN THE BEEN GREAT AT IT
BUT I DO THINK THAT NO PRESSURE
TO NIH RIGHT NOW BUT THE MONEY
THAT IT TAKE TO DO LONG-TERM
NUTRITION STUDIES ESPECIALLY
ADDING IN OMICS APPROACHES IN
THE SAMPLES OVER TIME WITH
MULTIPLE SAMPLING PERIODS
BECOMES A VERY LARGE SUM OF
MONEY AS WELL AS TRYING TO GET
VULNERABLE POPULATIONS WHICH
REQUIRE DIFFERENT KINDS OF
BARRIERS WE NEED TO REMOVE FOR
THEM TO PARTICIPATE IN THE STUDY
AND INSENSITIVES AND NEED TO
THINK HOW TO FUND THOSE
EFFECTIVELY.
>> TO DOVETAIL ON WHAT YOU HAD
COMMENTED ON.
ONE OF THE EFFORTS WE'VE
UNDERTAKEN IN PEDIATRIC CRITICAL
CARE NUTRITION IS TO BRING AN
INTERNATIONAL WORK GROUP
TOGETHER AND COLLECT PATIENT
RISK FACTORS AND INDIVIDUAL
STUDIES AND WHEN YOU'RE DOING A
STUDY YOU COLLECT AND THEN LOOK
AT LATER AT LEAST IN OUR FIELD
THE EFFORT IS UNDERWAY SO THAT
WE CAN BETTER UNDERSTAND WHAT WE
ARE DOING BECAUSE THE STUDIES
ARE HARD.
>> THERE'S A TEAM WITH WELL
DEFINED COMMON DATA ELEMENT AND
THIS REMINDS ME OTHER INSTITUTES
AT NIH THAT HAVE DONE THIS FOR
EXAMPLE AND LONG-TERM REDUCTION
MULTIPLE HEALTH BENEFITS.
AND THERE'S STUDIES AND ALSO
THAT KIND OF OUTCOME WOULD MOVE
THE FIELD AND THE INSTITUTE
BEYOND WHAT THEY DO UNSMALL
STUDIES AND THOSE HAVE PRODUCED
ENOUGH EVIDENCE AND IT DOES
MATTER FOR LUNG HEALTH AND
HAVING THAT LAST STUDY WILL
BRING ALL THE DATA TO MOVE IT
FURTHER.
THANK YOU.
>> DO YOU THINK THERE ARE OTHER
QUESTIONS THAT WOULD PREPARE THE
WAY WE WOULD LIKE TO POSE TO THE
PANEL?
>> I DON'T HAVE ANY PRESSING
QUESTIONS TO SHARE.
I THINK WE CAN ADDRESS THE
WORKSHOP.
I WONDER WHETHER YOU THINK IT
WOULD BE USEFUL FOR US TO ASK
PEOPLE TO GO AROUND AND GIVE US
THEIR TOP TWO TAKEAWAYS AND TOP
TWO RECOMMENDATIONS.
>> ABSOLUTELY AND PLEASE
REMEMBER THIS IS BEING RECORDED
SO IT'S GOING TO BE GREAT TO
SHARE THAT WITH NHLBI AFTERWARD.
PLEASE FIRE AWAY.
>> I'LL OFFER MY PERSPECTIVE
FROM IT AND EPIDEMIOLOGICAL
POINT OF VIEW THERE'S WELL
DESIGN EPIDEMIOLOGICAL COHORT
STUDIES INCLUDING OPTIMIZING THE
WAY IN WHICH WE MEASURE DIETARY
INTAKE AND COMBINE TOOLS WITH
THE BIOMARKERS WE HAVE REVEALED
TODAY AND YESTERDAY.
THOSE ARE MY TWO TAKEAWAYS FROM
WHAT WE REVIEWED YESTERDAY.
AND INCORPORATE THE SCIENTIFIC
AGENDA WE'LL TALK ABOUT IN
COMMUNICABLE DISEASE PREVENTION
AND MANAGEMENT AND THAT
CONSIDERATION SHOULD BE GIVEN TO
THE STUDY OF RESPIRATORY HEALTH
AND NUTRITION.
WE MADE A CLEAR CONNECTION
YESTERDAY BETWEEN CLIMATE CHANGE
AND FOOD SYSTEMS.
>> I CAN CALL ON EACH OF YOU TO
GIVE YOUR REMARKS AS I SEE YOU
ON MY SCREEN.
DR. WOOD.
I THOUGHT I'D HAVE MORE TIME.
ONE THING THAT STOOD OUT IS A
LOT OF THE THINGS WE'VE BEEN
TALKING ABOUT DRUG TO RECTIFY
AND ESTABLISH PROBLEMS THAT
REALLY HAS STEMMED FROM
UNHEALTHY AND THERE'S THE
PRECISION NUTRITION.
THERE'S SO MUCH THERE TO USE
PRECISION NUTRITION IN SPECIFIC
POPULATIONS ONCE WE UNDERSTAND
WHAT THE PRESCRIPTIONS SHOULD BE
FOR INDIVIDUAL SUB GROUPS.
>> THANK YOU.
DR. TYPPO.
>> THE FUNDAMENTAL QUESTION OF
READINESS OR AN INCREASE IN
MACRO AND MICRO NUTRIENT
DELIVERY IS FUNDAMENTAL TO DO
ANY SUCCESSFUL CLINICAL TRIALS
MOVING FORWARD AND NUTRITION IN
THE ICU UNDERSTANDING SOME
DYNAMIC BIOMARKER OR COMBINATION
OF FEATURES ABOUT PATIENTS AND
THEIR ILLNESS THAT WOULD PREDICT
THEIR RESPONSE TO NUTRITIONAL
INTERVENTIONS.
AND HAS TO PREDATE ANY TYPE OF
PLANNING FOR AN INTERVENTIONAL
TRIAL AND FUNDAMENTALLY THE AREA
OF GUT LUNG AXIS AND HOW
NUTRITIONAL STRATEGIES INFLUENCE
THE GUT MICROBIOME IN PATIENTS
CRITICALLY ILL AND RECEIVING A
MULTITUDE OF OTHER THERAPIES AND
THERE'S INTERACTION AND
INFLUENCE BETWEEN THE GUT
INFLAMMATION AND INJURY AND HOPE
TO REDUCE ACUTE RESPIRATORY
ILLNESS AND UNDERSTANDING THE
ROLE OF THE GUT MICROBIOME IS
PROCESS TO MAKING PROGRESS
FORWARD.
>> THANK YOU.
DR. NORDGREN.
>> I THINK WE NEED TO THINK VERY
CAREFULLY AND PRACTICALLY ABOUT
STUDY DESIGNS IN THE RIGHT
POPULATIONS FOR THE RIGHT AMOUNT
OF TIME WITH THE RIGHT FOOD OR
SUPPLEMENTS.
I MENTIONED YESTERDAY I WORRY
ABOUT THE ISSUES OF THE LACK OF
REGULATION ON SUPPLEMENTS AND
THINGS LIKE THAT AND THERE IS
SOME FUNDING TO SUPPORT
CERTAINLY STANDARDIZING THAT AND
ACROSS THE FIELD IN GENERAL
THERE'S A LACK OF
STANDARDIZATION IN DOSING TIMING
AND THINGS LIKE THAT I THINK ARE
LIMITATIONS.
MY SECOND TAKEAWAY TO SPEAK FOR
THE MECHANISMS SESSION I WAS
PART OF WE NEED TO THINK
CAREFULLY HOW TO INTEGRATE
PRECLINICAL MODELLING TO EXPLORE
THINGS WE'RE SEEING IN CLINICAL
STUDIES AND EPIDEMIOLOGICAL
STUDIES WHERE WE'RE SEEING
EFFECTS BASED ON DIFFERENT
HEALTH DISPARITIES AND BASED ON
CO-EXPOSURES AND THINGS WE CAN
MODEL IF WE'RE CAREFUL ABOUT
THOSE MODEL SYSTEMS AND THEY'LL
BE IMPORTANT TO UNDERSTAND SOME
OF THOSE MORE COMPLEX AFFECTS
THINKING ABOUT THINGS LIKE GUT
LUNG AXIS OR HOST PRATH BETWEEN
NUTRIENTS AND THINGS LIKE THAT.
>> DR. PANDA.
>> I THINK I MY TAKE HOME
MESSAGE IS THERE'S A HUNGER FOR
UNDERSTANDING THE LINK BETWEEN
NUTRITION AND LUNG HEALTH BUT AT
THE SAME TIME ON THE CLINICAL
CARE THERE'S LESS IN HEALTH CARE
PROVIDERS THAT NUTRITION CAN
IMPROVE THE LUNG HEALTH.
ALONG THAT LINE I THINK WE NEED
MORE MECHANISTIC STUDIES AND
CLINICAL MODELS TO ESTABLISH
SOME OF THE CONNECTIONS IN THE
GUT LUNG AXIS WHETHER IT'S THE
IMMUNE SYSTEM LUNG AXIS
DIGESTIVE SYSTEM AND GUT AXIS
AND THOSE FINDINGS TO MAKE IT
MORE SOLID TO PRODUCE MORE
HYPOTH
HYPOTHESIS.
THAT'S MY TAKE HOME MESSAGE.
>> THANK YOU.
DR. POINTER.
>> FROM THE NIH PERSPECTIVE WHY
SIGNIFICANCE AND INNOVATION ARE
SCORE CRITERIA IN GRANT REVIEWS
AND THINKING ABOUT MAYBE WE NEED
TO MARKET IT AND MAYBE THERE IS
SOMETHING TO CONSIDER UNVERY
SMALL EFFECTS FOR A LARGE
PERCENTAGE OF THE POPULATION ARE
GOING TO HAVE A LARGE
SIGNIFICANCE IN IMPACT.
A LOT OF US USE ANIMAL MODELS OR
IN VITRO STUDIES THAT TRY TO HIT
WITH A HAMMER NUTRITIONAL TYPE
INTERVENTION AND MAYBE WE NEED
TO THINK ABOUT IMPLEMENTING MORE
STUDIES LOOKING AT LONG-TERM
OUTCOMES THAT RELATE TO NORM AL
NORMALISH DEVELOPMENT AND NOT
INITIATED ONE A BLUNT INSTRUMENT
AND THINKING HOW TO IMPLEMENT
HUMAN TRIALS THAT LIKE THE ONE
COHORT STUDY TO ASSESS LONG-TERM
DIFFERENT TYPES OF NUTRITIONAL
INTERVENTIONS.
DR. WOOD MAY HAVE BEEN THE ONLY
PERSON WHO CITED IN A LUNG
CANCER STUDY A NEGATIVE EFFECT
OF THE INTERVENTIONS WE TALKED
ABOUT TODAY.
CERTAINLY WE NEED TO BE CAREFUL
BUT THERE APPEARS TO BE A GREAT
DEAL OF SAFETY WITH THE
NUTRITIONAL INTERVENTIONS SO
MAYBE COMING UP WITH SOMETHING
THAT'S REMINISCENT OF THE DASH
DIET FOR THE LUNG AND
IMPLEMENTING IT WIDELY AND NOT
LOOKING AT CURING CANCER, CURING
COPD OR ASTHMA BUT PREVENTING
THE GENERATION OF SOME OF THESE
DECEASE OF -- DISEASES WOULD BE
SIGNIFICANT AND INNOVATIVE.
>> THANK YOU.
DR. PRAKASH.
>> HOW ARE WE MEASURING LUNG
HEALTH AND IT'S NOT SPECIFIC TO
NUTRITION BUT AS LUNG BIOLOGISTS
AND SOME THAT ARE LUNG BIOLO
BIOLOGISTS HOW CAN YOU TRACK IT
IN INTERVALS TO KNOW WHETHER
THESE DIETS ARE MAKING POSITIVE
IMPACTS OR NOT AND IN DOING THAT
IN PATIENTS IN A NONINVASIVE AND
EASY WAY IS STILL A BIG
CHALLENGE.
THERE ARE NO GOOD-BYE MARKERS NO
EASY MEASUREMENTS OR SOMETHING
YOU CAN TRACK HIKE YOUR WEIGHT
OR SOMETHING SIMPLE.
THAT'S SOMETHING THAT I WISH
THERE WAS MORE WORK BEING DONE
ON THAT.
AND THEN NOT CONNECTED TO THE
WORK I DO BUT LISTENING TO ALL
THE OTHER SPEAKERS MAYBE THE
APPROACH INSTEAD OF DOING THESE
INTERVENTION DIET STUDIES LIKE
WHAT INTEREST DR. PANDA IS DOING
COLLECTING INFORMATION FIRST AND
FOREMOST WHAT PEOPLE ARE EATING
AND WHEN AND DERIVE CALORIE AND
NUTRIENT INFORMATION FROM THAT
AND AT LEAST THAT MAY GIVE US
BROAD UNDERSTANDING OF WHICH
GROUPS GO ON TO DEVELOP WHAT
KIND OF LUNG DISEASES AND MAYBE
THAT IS CONNECTED TO THE KIND OF
FOOD THEY'RE EATING AND THEN I'M
HAPPY TO HEAR MULTIPLE SPEAKERS
ECHO THE IMPORTANCE OF THE GUT
LUNG AXIS AND INDIRECTLY I THINK
THEY'RE ALSO SAYING WE SHOULD
THINK ABOUT COLLECTING
MICROBIOME INFORMATION BECAUSE
THE DIET THERE'S PARTS THAT
EFFECT THE BODY NOT THROUGH THE
MICROBIOME BUT LARGE PARTS THAT
DEPEND ON WHAT BACTERIA AND
MICROBES THAT ARE PROCESSING
WHAT YOU'RE EATING AND THAT'S
CONVERTED TO WHAT THE BODY IS
ABSORBING.
INTEGRATING THAT INFORMATION IN
WITH THE DIET INFORMATION I
THINK IS GOING TO BE IMPORTANT.
>> YOU THANK YOU.
DR. DUVALL.
>> IT'S INTERESTING TO HEAR
EVERYBODY'S PERSPECTIVE.
I'M TRYING TO PULL TOGETHER THE
THREADS OF EMERGING BIOMARKERS
AND NEW TECHNOLOGIES TO UNCOVER
BIOMARKERS WITH PRECISION
NUTRITIONAL ASSESSMENTS AND
MECHANISMS UNDERLYING THAT.
WITH THE TAIL END OF WHAT WE
HEARD ABOUT TODAY WHICH IS WE
REALLY NEED ADDITIONAL
NUTRITIONAL INTERVENTION TRIALS
AND THINKING AS WAS JUST
MENTIONED FROM THE NIH'S
PERSPECTIVE ABOUT WHAT WHAT IS
ATTRACTIVE.
AND I KEEP COMING BACK TO THE
FACT THAT IN PARTICULAR THE
NHLBI HAS SPENT A LOT OF MONEY
SUPPORTING RESEARCH FOCUSSING ON
LUNG HEALTH AND DISEASE
LONGITUDINALLY.
LOTS OF LARGE COHORTS IN ASTHMA
AND ACOPD AND INFECTIOUS DISEASE
AND THOSE SORTS OF THINGS AND IN
TYING THOSE THREADS TOGETHER IN
THE WORKSHOP DO WE GO TO BIO
SPECIMENS THAT EXIST INTERROGATE
THEM WITH NEW EMERGING
TECHNOLOGIES WE'VE DISCUSSED IN
THIS FORUM.
IDENTIFY THE MOST PROMISING
POTENTIAL BIOMARKERS FOR
INTERVENTION AND THEN PROPOSE A
TARGETED INTERVENTION WHETHER IT
BE A DASH DIET FOR THE LUNG OR
MENTIONED OR OMEGA 3
INFLAMMATION IN DISEASE X AND Y
SEEMS THE THREADS COME TOGETHER
TOWARDS THAT AS A POTENTIAL
APPROACH.
>> THANK YOU.
DR. GOWDY.
>> I'D ECHO WHAT OTHER SPEAKERS
HAVE SAID AND WHERE MY MIND GOES
WITH THE MESSAGES IS PRECISION
NUTRITION BECAUSE I THINK
THERE'S VARIABILITY WHETHER IT'S
GENETIC OR EXPOSURE WITH PEOPLE
AND UNDERSTANDING HOW ONE PERSON
METABOLIZES THE DIETARY NUTRIENT
VERSUS ANOTHER MIGHT HELP US
UNDERSTAND IF THAT IS A GOOD
INTERVENTION WITH LUNG DISEASE
BASED ON WHAT THE PERSON IS
STARTING WITH.
I THINK THERE'S A LOT OF UTILITY
FOR INTEGRATING NUTRITIONAL
BIOMARKERS IN.
AS MENTIONED THERE'S A LOT OF
EXISTING BIO REPOSITORIES IF WE
KNEW WHAT WE COULD LOOK FOR WE
COULD UTILIZE.
THERE'S THE BIO LINK AT NHLBI
HAS WITH SEPSIS PATIENTS OR ARDS
PATIENTS THAT HAS MULTIPLE
COHORTS.
IF WE KNEW WHAT TO LOOK FOR WITH
DIET WE MAY BE ABLE TO UTILIZE
SOME OF THOSE EXISTING BIO
REPOSITORIES.
>> DR. BHUPATHIRAJU.
>> I THINK I AGREE WITH WHAT SHE
SAID MAKING USE OF THE BIO
REPOSITORIES WOULD BE CRITICAL
AND THE NIDDK IS ONE WHERE WE
DEPOSIT BIOMARKER DATA BUT
REALLY THE TAKEAWAYS ARE
EXPANDING BIOMARKER DISCOVERY
AND NOT IDENTIFYING DIETARY
BIOMARKERS FROM OBSERVATIONAL
DATA AND UNDERSTANDING THE
PHARMACO KINETICS AND HOW THEY
BEHAVE IS IMPORTANT TO BE
INTEGRATED IN CLINICAL PRACTICE.
I THINK ANOTHER KEY POINT I
WOULD LIKE TO EMPHASIZE IS
MAKING SURE WE INCLUDE ADEQUATE
REPRESENTATION IN UNDER
REPRESE
REPRESENTED POPULATIONS IN
RESEARCH.
>> DR. CAMARGO.
>> I TRIED TO IN MY PRESENTATION
OUTLINE A BASIC APPROACH I'LL
SUMMARIZE HERE AND IDENTIFY THE
MOST PROMISING EXPOSURES AND
OUTCOMES AND CHASE THAT.
I DON'T THINK WE HAVE TO LIMIT
OURSELVES TO ONE THING BUT I DO
HEAR AND I'LL PRESENT THIS BY
ANALOGY IMAGINE IF THE
CARDIOLOGISTS WERE TALKING ABOUT
HOW FRUIT AND VEGETABLE WERE
RELATED TO FIBRILLATION AND
SOMEBODY SAID I THINK FISH ARE
IMPORTANT FOR HEART FAILURE.
THERE'S SO MUCH GOING ON THAT
IT'S VERY HARD FOR ME TO EVEN
FOCUS.
WE HAVE TO ORGANIZE THIS AND THE
WORKSHOP DID IT WELL AND PARTLY
WHY I FOUND IT SO HELPFUL
BECAUSE YOU ORGANIZED THINGS SO
NICELY.
FOR EXPOSURES WE'RE TALKING
ABOUT DIETARY PATTERNS LIKE DASH
IS A GOOD ONE AND JUN YOU KNOW
THAT BECAUSE I'M WORKING WITH
YOU ON A PROJECT RIGHT NOW.
IN TERMS OF FOOD, FRESH FRUIT
AND VEGETABLES IS PROBABLY THE
BEST BET.
IN TERMS OF NUTRIENTS THERE'S
MANY BUT I WOULD SAY OMEGA 3
SEEMS LIKE A PROMISING ONE.
THEN WE GET TO THE OUTCOMES AND
ARE WE TALKING ABOUT ASTHMA,
COPD, LUNG CANCER?
I WOULD START WITH THINGS BIG
AND COMMON AND PEOPLE LIKE TO
FUND LIKE ASTHMA AND COPD.
KNOW ARE WE TALKING ABOUT
INCIDENT DISEASE OR MODIFICATION
AND KEEP MIXING THESE AND HOPING
THE APPLE WILL HELP EVERYONE AND
EVERYTHING.
IT WON'T.
MOREOVER WE DON'T FLOW IF WE
SHOULD GIVE ONE APPLE OR FIVE
AND DON'T KNOW IF WE SHOULD GIVE
IT DAILY OR ONCE A WEEK.
THERE'S SO MANY THINGS WE DON'T
KNOW.
ONCE WE HAVE THOSE PROMISING
EXPOSURES AND OUTCOMES AND WE
HAVE TO KNOW WHERE THEY ARE ON
THE GRID.
THEN WE CON NUMBER THE
ASSOCIATION OF EPIDEMIOLOGIC
STUDIES I'M ALL FOR DIET
MECHANISMS.
ONE THING I LEARNED IS HOW MUCH
PROGRESS IS MADE IN THE FIELD
OVER THE LAST DECADE.
I'VE BEEN DOING OTHER STUFF FOR
A WHILE AND IT'S FUN TO LISTEN
TO THE MECHANISTIC WORK WHICH
SUPPORTS THE IDEAS WE'RE TALKING
ABOUT.
WHAT'S THE POINT OF THE
MECHANISM?
IN MY OPINION I'D OPTIMIZE THE
INTERVENTION OF THAT FUTURE
TRIAL.
THAT'S WHAT I WANT.
PEOPLE WANT TO PROVIDE A PILL
THAT PROVIDES EVERYTHING.
MAYBE COME LATER BUT IF THAT'S
YOUR GOAL IT WILL FLATTEN THE
ENTIRE ENTERPRISE IN MY OPINION.
ULTIMATELY THEY COME TO TRIALS.
I'LL ARGUE WE TEND TO BE
PESSIMISTIC BECAUSE IT IS HARD
AND AND LOOK AT THE
CARDIOLOGISTS AND WHAT THEY'VE
DONE AND THE CANCER FOLKS AND
WHAT THEY'VE DONE.
AND WE PARTAKE AND SPIROMETRY
OME AND SO I'LL STOP THERE BUT
THANK YOU AND I THINK I'VE
TOUCHED AND THERE'S A TRIAL
THAT'S THE AGENDA I HOPE COMES
OUTS OF THE WORKSHOP.
>> THANK YOU SO MUCH.
I THINK IT BRING US CLOSE TO AND
I THINK WE THANK YOU FOR YOUR
PARTICIPATION AND GREAT
CONTRIBUTION AND TO THE AUDIENCE
WE THANK YOU FOR TAKING THE TIME
TO JOIN US AND AS YOU HEARD THIS
IS ONLY THE BEGINNING.
WE HOPE THIS IS THE BEGINNING
FOR US TO HOPE ELEVATE FURTHER
THE IMPORTANCE OF NUTRITION
RESEARCH AND RESPIRATORY HEALTH
AND AND THERE WILL BE A PROPOSAL
FROM THE WORKSHOP AND TRY TO
PUSH FORWARD AND GET GET
PUBLISHED IN A TIMELY FASHION
BUT I WILL GIVE YOU THE FLOOR,
TO CLOSE OUT THE WORKSHOP.
>> BEFORE I CLOSE OUT I DO SEE
ONE COMMENT IN THE CLASS.
MAYBE YOU ADDRESS THE QUESTION
FROM DR. PANDA AND OTHER
INDIRECT MEASUREMENT OF ON
INSTRUCTIVE SLEEP APNEA CAN GIVE
A WEALTH OF INFORMATION AND
INSIGHT TO INDIVIDUAL HEALTH.
AND MAYBE TO ELEVATE YOUR
COMMENTS AND HAVE MORE
DISCUSSION TO CLOSE OUT.
WE HAVE A LITTLE MORE TIME.
>> I WAS THINKING THERE'S MANY
WEARABLES THESE DAYS.
OF COURSE THE LONGITUDINAL DATA
HAS A WEALTH OF INFORMATION.
AND WHAT WE DO IN STUDIES
COMBINING TIMING WITH CONTINUE
GLUCOSE MEASURE AND ACTIVITY
FROM THERE WE WE'RE SEEING WHERE
TIMING EFFECTS BLOOD GLUCOSE AND
SLEEP.
IT WILL BE INTERESTING TO THINK
ABOUT HOW TO USE THE WEARABLES
AND HOW THAT DATA CAN BE
DEPOSITED AND THEY'VE PARTNERED
WITH COMPANIES LEADING TO THE
IDEA OF INPUT TO PLANNERS TO
DESIGN.
SIM LAURELL NOW THERE'S MANY
START PHONES AND WEARABLES
BEGINNING TO COLLECT QUALITY
DATA AND POLLUTION MIGHT EFFECT
HEALTH.
I'M MISSING A LOT OF OPPORTUNITY
HERE AND THIS IS WHERE I THINK
THEY ASKED ABOUT PARTNERSHIP
WITH INDUSTRY AND WHERE
PARTNERSHIP WITH INDUSTRY IS
PRODUCING OR COLLECTING THE
WEARABLE DATA AND WILL BE
USEFUL.
THANK YOU.
>> THANK YOU VERY MUCH.
WE A LAST COMMENT IN THE CHAT.
EVERYONE HAS ACKNOWLEDGED USING
NUTRITION AS A FACTOR IN FOOD
INTAKE TO BIOLOGY OUTCOME IS
DIFFICULT BECAUSE IT'S A LIFE
LONG CHANGE OVER THE LIFE SPAN
AND EVERYONE HAS TO EAT SO
DESIGNING A HUMAN STUDY IS
DIFFICULT BECAUSE YOU MUST
STANDARDIZE DATA COLLECTION AND
KNOWING ABOUT FOOD IN THE
CONTEXT OF OUR METRICS ON THE
INTERACTION OF THE COMPOUND IS
IMPORTANT BY VARIABLE AND
INDIVIDUAL RESPOND TO THE
DIETARY PATTERN BEING STUDY WE
MUST LOOK AT WHAT IS ON PLATE
AND DATA DESIGN AND ANALYSIS
NEED TO BE CONSIDERED FOR THE
VARIABILITY OF IMPACT.
SEEMS A GOOD POINT.
>> ALL TRUE AND ONLY SOLVED WITH
THOUGHTFUL CONSIDERATION AND
FUNDING.
THIS CONFERENCE IS NOT GOING TO
JUST SAY HEY CHEW ON SOME AM
APPLES OR SOMETHING THAT LOOKS
LIKE A VEGETABLE AND WE'LL CHECK
YOUR LUNG.
I HOPE NOT BECAUSE THE RESULT
WILL BE NUL.
ALL EXCELLENT POINTS AND TO DO
THE WORK WE REQUIRE PRELIMINARY
DATA WHICH SUPPORTS CHASING SOME
IDEA AND THEN WE NEED LARGE
AMOUNTS OF FUNDING TO IMPLEMENT
IT WITH THE RIGOR REQUIRED TO
MEET THE CHALLENGE.
IT'S POSSIBLE BECAUSE OTHER
PEOPLE ARE DOING IT.
WE CAN LEARN AND BE MOTIVATED BY
THEM AND THE MECHANISTIC WORK IS
PRETTY IMPRESSIVE.
THERE'S SOMETHING GOING ON.
>> I TOTALLY AGREE.
OKAY.
I THINK WE HAVE A FEW MINUTES
LEFT I'M GOING TO CLOSE OUT THE
MEETING.
THIS IS A VERY EXCITING
WORKSHOP.
I LEARNED A LOT FROM THE EXPERT.
I WANT TO THANK OUR CO-CHAIRS
FOR OUTSTANDING WORK FOR THE
ORGANIZATION OF THE ENTIRE
WORKSHOP AND THANK OUR
MODERATORS AND SPEAKERS WITH
THEIR EXTRAORDINARY INPUT FOR
THE WORKSHOP.
I CAN'T SAY THANK YOU ENOUGH AND
I WANT TO THANK THE PARTICIPANTS
FOR THE WORKSHOPS.
I THINK OUR DIVISION DIRECTOR
SAID WE'LL PUBLISH THE EXECUTIVE
SUMMARY A NOW WEEKS AND WE'RE
TRYING TO PUBLISH THE WHITE
PAPER HOPEFULLY WITHIN A YEAR OR
EARLIER WOULD BE GREAT.
I WANT TO MENTION THE WORKSHOP
WAS VIDEOCASTED IN THE NIH
VIDEOCAST PLATFORM AND THE
RECORDING WILL BE AVAILABLE IN
THE PAST EVENTS.
MAYBE JACKIE CAN POST THAT IN
THE CHAT.
IN CASE YOU WANT TO LOOK AT THAT
OR TRAINEES OR COLLEAGUES WANT
TO LOOK AT A SLIDE OR VIDEO YOU
CAN DO THAT.
AS SAID BEFORE WE'LL BRING ALL
THE IDEAS AND RECOMMENDATIONS
BACK TO OUR INTERNAL DISCUSSION.
WE HOPE SOME WILL BE IMPLEMENTED
IN THE NEXT FEW YEARS.
THANK YOU AND HAVE A GREAT REST
OF THE DAY.