The Association Between Dietary Flavonoid Intake and Chronic Obstructive Pulmonary Disease, Systemic Inflammation, and Comorbidity Burden

The Association Between Dietary Flavonoid Intake and Chronic Obstructive Pulmonary Disease, Systemic Inflammation, and Comorbidity Burden by Tennador A. Sanderson MBA, Rosemont College, 2009 BS, Thomas Jefferson University (formerly Philadelphia University), 2004 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University November 2017 Abstract Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States. Dietary habits may have an impact on COPD through antiinflammatory mechanisms. For this cross-sectional secondary data analysis study, the advanced model of the epidemiology triangle was used as a guide to assess the association between total daily flavonoid intake and COPD diagnosis, COPD severity, systemic inflammation, and comorbidity burden. Data from over 5,100 male and female participants aged 30 and older were obtained from the 2007-2010 National Health and Nutrition Examination Survey. The prevalence of COPD was 5.2% according to spirometry data. Multiple logistic regression analysis showed that a 1% increase in total daily flavonoid intake resulted in a 5.9% decrease (95% CI [0.940, 0.943]) in the odds of having COPD after controlling for age, BMI, dietary fiber intake, education level, gender, race/ethnicity, and smoking status. After controlling for the same variables, multiple linear regression analyses showed that a 1% increase in total daily flavonoid intake among those with COPD resulted in a . 00001 (95% CI [.001, .002], p < .001) increase in the percentage of the predicted FEV1 and a 0.076% decrease in C-reactive protein (95% CI [-.078, -.074], p < .001). A one-way ANOVA showed that total daily flavonoid intake was significantly (p < .001) different for each comorbidity burden level, and those with 2 or 3 comorbid diseases had significantly (p < .001) lower flavonoid intake than those with 1 or no comorbid diseases. These findings expand the knowledge of this topic and may effect positive social change by informing public health policies and interventions that aim to reduce COPD prevalence, morbidity, and mortality.Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States. Dietary habits may have an impact on COPD through antiinflammatory mechanisms. For this cross-sectional secondary data analysis study, the advanced model of the epidemiology triangle was used as a guide to assess the association between total daily flavonoid intake and COPD diagnosis, COPD severity, systemic inflammation, and comorbidity burden. Data from over 5,100 male and female participants aged 30 and older were obtained from the 2007-2010 National Health and Nutrition Examination Survey. The prevalence of COPD was 5.2% according to spirometry data. Multiple logistic regression analysis showed that a 1% increase in total daily flavonoid intake resulted in a 5.9% decrease (95% CI [0.940, 0.943]) in the odds of having COPD after controlling for age, BMI, dietary fiber intake, education level, gender, race/ethnicity, and smoking status. After controlling for the same variables, multiple linear regression analyses showed that a 1% increase in total daily flavonoid intake among those with COPD resulted in a . 00001 (95% CI [.001, .002], p < .001) increase in the percentage of the predicted FEV1 and a 0.076% decrease in C-reactive protein (95% CI [-.078, -.074], p < .001). A one-way ANOVA showed that total daily flavonoid intake was significantly (p < .001) different for each comorbidity burden level, and those with 2 or 3 comorbid diseases had significantly (p < .001) lower flavonoid intake than those with 1 or no comorbid diseases. These findings expand the knowledge of this topic and may effect positive social change by informing public health policies and interventions that aim to reduce COPD prevalence, morbidity, and mortality. The Association Between Dietary Flavonoid Intake and Chronic Obstructive Pulmonary Disease, Systemic Inflammation, and Comorbidity Burden by Tennador A. Sanderson MBA, Rosemont College, 2009 BS, Thomas Jefferson University (formerly Philadelphia University), 2004 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University November 2017