Can diet- & exercise-induced weight loss improve asthma control in obese adults?

可以节食吗——

• 批准号: 7841060
• 负责人: Jun Ma
• 金额: $ 28.21万
• 依托单位: PALO ALTO MEDICAL FOUNDATION RES INST
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7841060
• 关键词: Activities of Daily Living; Acute; Address; Adherence; Adrenal Cortex Hormones; Adult; Adverse effects; Age; Animals; Area; Asthma; Behavior Therapy; Behavioral; Body Weight decreased; Body mass index; California; Caloric Restriction; Caring; Case Manager; Characteristics; Child; Clinical; Consultations; Diabetes Mellitus; Diagnosis; Diet; Diet Modification; Dietitian; Dimensions; Disease; Dose; Education; Enrollment; Ensure; Epidemiologic Studies; Ethnic Origin; Ethnic group; Exercise; Female; Future; Goals; Guidelines; Health Benefit; Health Maintenance Organizations; Hospitalization; Human; Hypertension; Impairment; Individual; Intervention; Juniper; Lead; Life Style; Link; Measures; Medical; Medical center; Modeling; Morbid Obesity; Morbidity - disease rate; Nationalities; Nature; Obesity; Office Visits; Operative Surgical Procedures; Oral; Outcome; Outcome Measure; Overweight; Participant; Pathway interactions; Patients; Pharmaceutical Preparations; Phenotype; Physical activity; Physicians; Prevalence; Prevention; Prevention program; Professional counselor; Prospective Studies; Public Health; Pulmonary Function Test/Forced Expiratory Volume 1; Quality of life; Questionnaires; Race; Randomized; Randomized Controlled Trials; Relative (related person); Reporting; Research; Respiratory physiology; Risk; Sample Size; Self Management; Site; Symptoms; Techniques; Telephone; Testing; Time; Treatment Protocols; United States National Institutes of Health; Weight; Woman; base; clinical practice; diet and exercise; evidence base; experience; health care quality; health care service utilization; improved; intervention effect; men; mortality; obesity treatment; prevent; primary outcome; public health relevance; racial and ethnic; response; sex; standard of care; weight loss intervention

DESCRIPTION (provided by applicant): Project Summary Scientific evidence continues to accumulate on the relation between obesity and asthma. More recent efforts are increasingly focused on the nature of the relation, as opposed to trying to determine whether such a relation exists. Many, although not all, epidemiological studies report a temporally correct and dose-response relationship between obesity and asthma. Animal studies support a causal link between the two disorders; however, the causal pathway remains to be understood in humans. In the new NIH asthma diagnosis and management guidelines, obesity is explicitly recognized, for the first time, as an important co-morbidity, and treatment of obesity is deemed to have potential benefits on asthma control based on limited studies. Although current evidence of the effects of weight loss on asthma outcomes is encouraging, it is far from being conclusive. The overall goal of the proposed randomized controlled trial (RCT) is to investigate the efficacy of an evidence-based lifestyle weight loss intervention on asthma control among obese adults. The intervention will involve a combination of dietary and physical activity changes and behavioral modification. This approach has demonstrated efficacy in preventing and controlling well-recognized obesity-related co- morbidities such as diabetes and hypertension. We will randomize 324 patients ages 18-70 years who have suboptimally controlled, persistent asthma and a body mass index of 30.0 to 39.9 kg/m2 from ~20,000 potentially eligible asthma patients at four medical centers of Kaiser Permanente in Northern California (KPNC), a large, group-model health maintenance organization. All participants will complete an office visit and a phone consultation, pre-randomization, with an on-site KPNC asthma care manager, and all will continue to receive KPNC standard of care from their physician post-randomization. Those randomly assigned to the experimental group will receive the comprehensive lifestyle weight loss intervention. The primary outcome will be the overall score at 12 months on the Juniper Asthma Control Questionnaire. The specific aims are to: 1) Determine whether the intervention improves measures of current impairment associated with asthma (asthma symptoms, spirometric lung function, activity limitations, rescue medication use, and asthma-related quality of life); 2) Determine whether the intervention improves measures of future risk associated with asthma (asthma exacerbations and adverse effects of asthma medication); 3) Examine potential mechanisms of intervention effects, focusing on the relative contributions of changes in weight, physical activity, and diet composition, after controlling for asthma medication potency and adherence; and 4) Explore potential effect modifiers, e.g. sex, race/ethnicity, education, and other baseline characteristics. This project will help advance current understanding of the nature of obesity-asthma relationship. If the weight loss intervention is proven to improve asthma outcomes, it will add to the other medical and environmental strategies available to manage asthma in obese adults, which may, in turn, lead to reduced morbidity and mortality associated with asthma and obesity. PUBLIC HEALTH RELEVANCE: Although the underlying mechanisms remain unclear, growing scientific evidence suggests that children and adults who are obese are at elevated risk of developing asthma or, for those who already have the disease, having worse symptoms. The new national asthma management guidelines recommend that clinicians consider advising asthma patients who are overweight or obese to lose weight, based on very limited studies showing that weight loss may improve asthma control, in addition to its other known health benefits. The current study aims to rigorously investigate whether weight loss, through recommended strategies for dietary modification, physical activity, and behavioral change, has significant clinical benefits for the management of asthma in obese adults. If successful, this project will help advance the current clinical guidelines for treating obese adults with asthma, which, in turn, may lead to reduced morbidity and mortality associated with asthma and obesity.

描述（由申请人提供）： 项目摘要 关于肥胖与哮喘之间关系的科学证据不断积累。最近的努力越来越关注这种关系的性质，而不是试图确定这种关系是否存在。许多（尽管不是全部）流行病学研究报告了肥胖与哮喘之间的时间正确的剂量反应关系。动物研究支持这两种疾病之间存在因果关系。然而，人类的因果途径仍有待了解。在新的 NIH 哮喘诊断和管理指南中，首次明确承认肥胖是一种重要的合并症，并且基于有限的研究，肥胖治疗被认为对哮喘控制具有潜在益处。尽管目前减肥对哮喘结局影响的证据令人鼓舞，但还远未得出结论。拟议的随机对照试验（RCT）的总体目标是调查基于证据的生活方式减肥干预对肥胖成人哮喘控制的功效。干预措施将包括饮食和身体活动的改变以及行为改变的结合。这种方法已证明可以有效预防和控制众所周知的肥胖相关并发症，例如糖尿病和高血压。我们将从北加州 Kaiser Permanente (KPNC) 四个医疗中心的约 20,000 名可能符合条件的哮喘患者中随机抽取 324 名年龄在 18-70 岁、患有持续性哮喘、体重指数为 30.0 至 39.9 kg/m2 的患者，大型集团型健康维护组织。所有参与者都将在现场 KPNC 哮喘护理经理的陪同下完成办公室访问和电话咨询、随机分组前的工作，并且在随机分组后所有人都将继续接受其医生提供的 KPNC 标准护理。随机分配到实验组的人将接受综合生活方式减肥干预。主要结果将是 12 个月时杜松哮喘控制问卷的总分。具体目标是： 1) 确定干预措施是否改善当前与哮喘相关的损害指标（哮喘症状、肺功能、活动限制、救援药物的使用以及哮喘相关的生活质量）； 2) 确定干预措施是否改善了与哮喘相关的未来风险（哮喘加重和哮喘药物的不良反应）； 3) 在控制哮喘药物效力和依从性后，检查干预效果的潜在机制，重点关注体重、体力活动和饮食成分变化的相对贡献； 4) 探索潜在的效果调节剂，例如性别、种族/民族、教育程度和其他基线特征。该项目将有助于增进目前对肥胖与哮喘关系本质的理解。如果减肥干预被证明可以改善哮喘结果，它将增加可用于控制肥胖成人哮喘的其他医疗和环境策略，从而可能降低与哮喘和肥胖相关的发病率和死亡率。公共卫生相关性：尽管潜在机制尚不清楚，但越来越多的科学证据表明，肥胖的儿童和成人患哮喘的风险较高，或者对于那些已经患有该疾病的人来说，症状更严重。新的国家哮喘管理指南建议临床医生考虑建议超重或肥胖的哮喘患者减肥，因为非常有限的研究表明，除了其他已知的健康益处之外，减肥还可以改善哮喘控制。目前的研究旨在严格调查通过推荐的饮食调整、体力活动和行为改变策略减轻体重是否对肥胖成人哮喘的治疗具有显着的临床益处。如果成功，该项目将有助于推进当前治疗肥胖成人哮喘的临床指南，从而可能降低与哮喘和肥胖相关的发病率和死亡率。