The Role of Diet in COPD Rehospitalization

Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States, with a disproportionately high prevalence among individuals with low socioeconomic status (SES). Hospitalizations for acute exacerbations of COPD (AECOPD) are common and come with a high risk of rehospitalization. Among individuals hospitalized with COPD, 20% are rehospitalized within 30 days, and low SES is associated with increased risk of rehospitalization. Multiple causal mechanisms have been proposed for the association between low SES and COPD morbidity. Specifically, adverse dietary patterns and food insecurity can affect COPD morbidity and may be acutely worse following hospital discharge. Previous interventions aimed at preventing rehospitalization through COPD-specific treatments have had mixed results, and the American Thoracic Society (ATS) has recommended programs expand beyond solely focusing on guideline- recommended care for COPD to include issues related to social determinants of health. To investigate diet as a potentially modifiable factor linking SES to COPD morbidity, we propose to study the association of diet quality and food insecurity with rehospitalization risk in 120 individuals hospitalized for AECOPD. We will assess diet quality after hospital discharge in terms of general quality, using the Alternative Healthy Eating Index-2010, as well as specific patterns associated with COPD morbidity, such as low omega-3 fatty acid intake. We will additionally examine food insecurity, a household’s economic and social conditions resulting in limited or uncertain access to adequate food, which is related to SES and may influence diet quality and rehospitalization risk. Furthermore, we will conduct semi-structured interviews with a subset of participants to identify contributors to diet quality and food insecurity during the transition from hospital to home. Finally, we will conduct a randomized trial of prepared meal delivery following hospital discharge among 36 individuals admitted for AECOPD to determine if such interventions can improve diet quality, affect biomarkers associated with COPD morbidity, and potentially decrease rehospitalization rates. Completion of the proposed aims will elucidate the role of dietary factors on rehospitalization risk in COPD and inform the design of a larger randomized controlled trial of diet intervention following hospitalization for AECOPD. We will leverage infrastructure created for an ongoing cohort study of individuals hospitalized for AECOPD at the Johns Hopkins Bayview Medical Center as well as the Johns Hopkins COPD Precision Medicine Center of Excellence. My ultimate career goal is to be an independent clinical researcher focusing on interventions that address health disparities in COPD. My career development plan includes expert mentorship, formal coursework, and hands- on experience to develop new skills in cohort and clinical trials design, nutrition research, and qualitative research methods. Project Number: 1K23HL166766-01A1 | Fiscal Year: 2025 | NIH Institute/Center: National Heart Lung and Blood Institute (NHLBI) | Principal Investigator: Daniel Belz | Institution: JOHNS HOPKINS UNIVERSITY, BALTIMORE, MD | Award Amount: $198,654 | Activity Code: K23 | Study Section: NHLBI Mentored Patient-Oriented Research Study Section[MPOR (OA)] View on NIH RePORTER: https://reporter.nih.gov/project-details/1K23HL16676601A1