Table of Contents

INTRODUCTION...........................................................................................................................................3
Background..............................................................................................................................................3
Problem Statement.................................................................................................................................4
Significance of The Study.........................................................................................................................5
Research Questions.................................................................................................................................5
OBJECTIVE OF STUDY...............................................................................................................................6
Main Objective....................................................................................................................................6
METHODOLOGY...........................................................................................................................................7
Literature Review....................................................................................................................................7
Prospective Cohort Study........................................................................................................................7
Data Analysis...........................................................................................................................................8
Experimental Approach...........................................................................................................................8
Practical Considerations..........................................................................................................................8
Ethical Considerations.........................................................................................................................8
EXPECTED OUTCOMES AND SIGNIFICANCE.................................................................................................9
APROXIMATE TIMELINE...............................................................................................................................9
REFERENCES..............................................................................................................................................10

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 PERSONALISING THE MANAGEMENT
OF
OBESITY-ASSOCIATED ASTHMA

USING

MEDICAL NUTRITION THERAPY

AND

PHYSICAL ACTIVITY PRESCRIPTION: THE IDEAL STUDY

Submitted

By

Deborah Clarice Andoh

Prospective Applicant, PhD Nutrition and Dietetics

The University of Newcastle

Callaghan, Australia

Email: [email protected]

2
 INTRODUCTION

Background

Despite the COVID-19 pandemic that resulted to more than 3.4 million deaths in the past year

from infection, has also led to severe acute respiratory syndrome. However, chronic non

communicable diseases (NCDs) continue to be the leading cause of morbidity and mortality

worldwide (Djuricic & Calder, 2021). According to estimates from the World Health

Organization (WHO), NCDs were responsible for 41 million deaths in 2018 (WHO, 2022).

Obesity is fast growing as a global pandemic and is associated with numerous comorbidities like

cardiovascular disease, hypertension, diabetes, gastroesophageal reflux disease, sleep disorders,

nephropathy, neuropathy, as well as asthma. Studies stated that obese asthmatic subjects suffer

from an increased risk of asthma, and encounter severe symptoms due to a number of

pathophysiology (Das, Pathak, & Pathak, 2023).

Obesity is both a major risk factor and a disease modifier of asthma in both children and adults.

Although obesity is defined according to a threshold body mass index (BMI), recent studies

suggest that BMI z-scores might be unreliable, particularly among children and adolescents with

severe obesity. In adults, obesity is defined as a BMI of 30kg/m 2 or greater, yet a given BMI

might reflect vastly differing physiology and metabolic health. This distinction is likely

important for asthma. Although serum IL-6 (produced by macrophages in adipose tissues and a

marker of metabolic health) is a marker of asthma severity, some subjects with BMIs in the non-

obese range have increased IL-6 levels; Sideleva et. al., found that adipose tissue inflammation is

increased in obese patients with asthma compared with obese control subjects. Obese subjects

have increased asthma risk, and obese asthmatic patients have more symptoms, more frequent

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and severe exacerbations, reduced response to several asthma medications, and decreased quality

of life (Ubong, Dixon, & Forno, 2018).

Problem Statement

In a study by (Baffi, Winnica, & Holguin, 2015), approximately 38% of current adult asthmatics

are also obese in the United States, and obesity has been shown to be risk factor for developing

asthma. Obese asthmatics reports worse asthma control despite traditional asthma therapy, worse

asthma-specific quality of life, and higher rates of healthcare utilization. It is vital to understand

the copious relationship between obesity and asthma. However, a clear and pinpoint

pathogenesis underlying the association between obesity and asthma is unclear and scarce. Also,

obesity may have a role in the severity and control of asthma, but it remains to be established if

obesity drives the development of asthma or is a cofounder or comorbidity. Current

understanding of asthma encompasses identification of multiple subgroups or phenotypes, based

on clinical characteristics, triggers or general inflammatory processes and response to therapy.

In a recent meta-analysis of 7 longitudinal cohort studies involving over 300,000 adults, there

was a dose response effect between increasing BMI and the odds ratio (OR) of incident asthma.

Compared to normal weight, a BM≥25 was associated with OR of 1.5 (95% Cl; 1.2 – 1.6),

whereas the OR for a BMI >30 was 1.9 (95% Cl; 1.4 – 2.6) while similar ORs were observed in

males and females. Although these results strongly suggest a potential causal relationship, they

were based on self-reported asthma and therefore more susceptible to diagnoses biases.

According to (Baffi, Winnica, & Holguin, 2015), when using stricter diagnostic criteria such as

bronchial hyper responsiveness, the obese-asthma association is less consistent, and obese

subjects may be erroneously diagnosed as having asthma. Therefore, the extent by which greater

BMI increases the likelihood of being diagnosed with asthma, independently of bias, remains

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unknown. In a recent study by (Ubong, Dixon, & Forno, 2018), many studies have reported

differing obesity-asthma associations by sex, although results on which sex is more affected have

been conflicting. There are limited data on how obesity may have a role in the development,

severity and control of asthma in Ghana. Although it is of the view that metabolic diseases

emanated from developed countries, current studies are reporting that the problem is steadily

increasing in developing countries of which Ghana is no exemption. This research is aimed at

examining obesity-associated asthma and personalizing the management.

Significance of The Study

The purpose of this project is to determine the efficacy of an individualized obesity management

intervention for improving body composition, dietary intake, physical activity levels and

metabolic health. Additionally, the project will determine the effect this intervention has on

asthma outcomes, including asthma symptoms and lung function. The WHO is currently revising

its recommendations for adults and children regarding the consumption of polyunsaturated fatty

acids. Hence, this research will add more insight and ideas to the already existing role of dietary

intake and metabolic health. The primary focus of these study is to examine individualized diet

and exercise intervention for optimizing asthma control and lung function. This study may

provide knowledge and insight to the Ministry of Health in Australia and other stakeholders on

how to promote the weight reduction. The result from this research may be useful to the Hunter

Medical Research Institute and the University at large.

Research Questions

 What key factors contribute to the pathogenesis and severity of obesity-associated

asthma.

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  Does obesity play a role as risk factor for and disease modifier of asthma.

 What would be the potential personalized interventions in optimizing asthma

control and weight management in obese individuals.

 What would be the predictive model for personalized treatment response?

 What would be the feasibility and effectiveness of the personalized management

approach in a real-world clinical setting.

OBJECTIVE OF STUDY

1.4.1 Main Objective

The aim of this project is to determine the efficacy of an individualized obesity management

intervention for improving body composition, dietary intake, physical activity levels and

metabolic health.

1.4.2. Specific Objectives

 To identify the key factors that contribute to the pathogenesis and severity of

obesity-associated asthma.

 To understand the role that obesity plays as a risk factor for and disease modifier

of asthma.

 To explore the potential personalized interventions, including individual diet and

exercise interventions for optimizing asthma control and weight management in

obese asthmatic individuals.

 To develop a predictive model for personalized treatment response based on

patient-specific characteristics, including genetic, clinical and environmental

factors.

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  To evaluate the feasibility and effectiveness of the personalized management

approach in a real-world clinical setting.

METHODOLOGY
This section explains the procedure that the research will be carried out. This research will

constitute both qualitative and quantitative approaches to research. Utilizing qualitative

methodologies, different latent variable indicators will be derived, and a quantitative approach

will be employed for data collecting and further analysis. The entire section is explained in the

subsections below.

Literature Review

An extensive review of the existing literatures to identify the current understanding of the

pathophysiology, the risk factors, and treatment approaches for obesity-associated asthma. This

review will also identify gaps in knowledge and highlight potential areas for personalized

interventions.

Prospective Cohort Study

Recruit a cohort of obese asthmatic patients and collect detailed clinical, genetic, and

environmental data, including anthropometric measurements, lung function tests, inflammatory

biomarkers, genetic polymorphism and dietary intake.

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Data Analysis

Statistical analysis would be conducted to identify the association between patient’s

characteristics and treatment response. Develop a predictive model using machine learning

algorithms to guide personalized treatment selection and optimize therapeutic outcomes.

Experimental Approach

The personalized management approach would be implemented in a real-world clinical setting

and evaluate its feasibility, acceptability, and effectiveness in improving asthma control, lug

function and weight management. Assess patient satisfaction, quality of life, and healthcare

resource utilization.

Practical Considerations

Taking into consideration the importance of the study and the needed outcomes; a research lab

and group, electronic materials and devises (such as computers, and lab equipment), grants from

Department of Health and Aged Care and other stakeholders and as well as ethical

considerations.

Ethical Considerations
There are few ethical issues needed for considerations during the research.

 Ethical clearance for the study will be obtain from the Human Research Ethics

Committee of University of Newcastle.

 All participant of the study will sign an informed consent form, in accordance to HREC

regulations, before conducting the study.

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 EXPECTED OUTCOMES AND SIGNIFICANCE
This research proposal aims to contribute to the field of personalized interventions by developing

evidence-based strategies for the management of obesity-associated asthma. The anticipated

outcomes include:

 Identifying the key factors that contribute to the pathogenesis and severity of obesity-

associated asthma.

 Understanding the role that obesity plays as a risk factor for and disease modifier of

asthma.

 Exploring the potential personalized interventions, including individual diet and exercise

interventions for optimizing asthma control and weight management in obese asthmatic

individuals.

 Development of a predictive model for personalized treatment response, enabling

personalized treatment selection.

 Reduction in the burden of obesity-associated asthma on individuals, healthcare systems,

and society as a whole.

APROXIMATE TIMELINE
Start date: 2023.08 End Date: 2024.12

Time Period Main task at each stage Expected outcome of each

stage

2023.08-2023.12 Preliminary material Design of questionnaire and

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 collection and sorting research structure

2024.01-2024.04 Determination of conceptual Design of conceptual

framework and data framework.

collection Sample size estimation

2024.05-2024.09 Research context write-up First draft of research context

Data analysis

2024.09-2024.12 Revise and complete of the Submission of final draft

final draft of the dissertation.

REFERENCES
Baffi, C. W., Winnica, D. E., & Holguin, F. (2015). Asthma and obesity: mechanisms and clinical
implications. Asthma research and Practice. doi:10.1186/s40733-015-0001-7

Das, A., Pathak, M. P., & Pathak, K. (2023, 5 11). Herbal medicine for treatment of obesity-associated
asthma: a comprehensive review. (L. M. Nainwal, Ed.) Frontiers in Phamacology, 1.
doi:10.3389/fphar.2023.1186060

Djuricic, I., & Calder, P. C. (2021, 07 15). Beneficial Outcomes of Omega-6 and Omega-3 Polyunsaturated
Fatty Acids on Human Health: An Update for 2021. (k. Vafeiadou, Ed.) Nutrients 2021, 1.
Retrieved 06 2, 2023, from https://doi.org/10.3390/nu13072421

Organization, W. H. (2022). Noncommunicable disease. Retrieved 06 2, 2023, from

Ubong, P., Dixon, A. E., & Forno, E. (2018, 2 9). Obesity and asthma. (A. Apter, Ed.) Clinical reviews in
allergy and immunology. Retrieved 06 02, 2023, from https://doi.org/10.1016/j.jaci.2018.02.004

WHO. (2022). Noncommunicable diseases. World Health Organization. World Health Organization.
Retrieved 6 2, 2023, from
https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

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