Nutrition as a modifying factor against cardiopulmonary effects of air pollution and air toxic exposure in socially advantaged and disadvantaged neighborhoods – proposed panel study
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In the US, outdoor air pollution is associated with 100,000 to 200,000 premature deaths annually. Modest increases in particulate matter (PM) are associated with increased all-cause mortality, including increased cardiovascular disease and pulmonary disease mortality, including COIVD-19 mortality. The burdens of air pollution exposure, morbidity, and mortality are not equitable, and disproportionately impact communities of color and low-income communities. The effects of air pollution may be further compounded by reduced access to nutritious food. Evidence points to the role of nutrition as a protective factor against air pollution induced cardiopulmonary health effects. Antioxidant vitamins, including vitamin C and E have demonstrated protective effects in the lung after ozone and PM exposures. Omega-3 polyunsaturated fatty acids (PUFAs) have been demonstrated to reduce the markers of cardiopulmonary dysfunction, cholesterol, and vascular injury markers after air pollution exposure. Levels of antioxidant vitamins and PUFAs, have been shown to be reduced among individuals with lower income and educational attainment. To investigate the potential for nutrition/nutritional status to modify the cardiopulmonary effects of air pollution the following panel study is proposed.
Approximately 125 individuals residing in the greater Triangle metropolitan area of North Carolina, will be recruited based on their residence in zip code tabulated areas with high or low social vulnerability index (SVI). SVI is a composite score derived from factors including urbanicity, education level, poverty, unemployment, single parent households, and vehicle ownership. Participants will be repeatedly assessed for spirometry, blood lipids, markers of coagulation and fibrinolysis, retinal imaging, vascular function, and heart rate variability (HRV) in up to three sessions, each separated by at least 7 days. Nutritional intake will be quantified via the Diet History Questionnaire II, and 24-hour dietary recalls at each visit and blood markers of select nutritional compounds, such as PUFAs. Air pollution exposure will be assessed via ambient air monitors as well as the TrackMyAir application, which integrates local air quality data, time spent in different microenvironments, and physical activity to estimate PM2.5 and ozone exposure. Participants will be provided with silicone wrist bands as passive air toxic samplers. Wrist bands will be analyzed for a range of compounds, including polycyclic aromatic hydrocarbons (PAHs), phthalates, perfluoroalkyl and polyfluoroalkyl substances (PFAS), and flame retardants.
Results will provide insight into whether nutritional access/status modifies air pollution cardiopulmonary indices, if the response to air pollution differs based on socioeconomic status, and if adequate nutrition can improve resiliency in communities exposed to air pollution. It will also further examine the burden of air pollution among advantaged and disadvantaged communities. Although previous research has examined disparities in air pollution exposure, no research to date has utilized ambient air monitoring paired with personal exposure monitors to investigate the combined role of socioeconomic factors and nutritional status on air pollution exposure and subclinical indices of cardiopulmonary disease.