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The Association Between Dietary Flavonoid Intake and Chronic Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2017 The Association Between Dietary Flavonoid Intake and Chronic Obstructive Pulmonary Disease, Systemic Inflammation, and Comorbidity Burden Tennador Sanderson Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Epidemiology Commons, and the Human and Clinical Nutrition Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Tennador A. Sanderson has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Angela Prehn, Committee Chairperson, Public Health Faculty Dr. Patricia Risica, Committee Member, Public Health Faculty Dr. James Rohrer, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2017 Abstract 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 anti- inflammatory 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 FEV 1 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 Table of Contents List of Tables .......................................................................................................................v List of Figures .................................................................................................................... vi Chapter 1: Introduction to the Study ....................................................................................1 Background ....................................................................................................................2 Problem Statement .........................................................................................................7 Purpose of the Study ......................................................................................................8 Research Questions and Hypotheses .............................................................................9 Theoretical Framework ................................................................................................11 Nature of the Study ......................................................................................................12 Definitions....................................................................................................................12 Assumptions .................................................................................................................16 Scope and Delimitations ..............................................................................................17 Limitations ...................................................................................................................17 Significance of the Study .............................................................................................19 Summary ......................................................................................................................20 Chapter 2: Literature Review .............................................................................................22 Introduction ..................................................................................................................22 Literature Search Strategy............................................................................................24 Theoretical Framework ................................................................................................26 Literature Review Related to Key Variables/Concepts ...............................................28 COPD Burden ....................................................................................................... 28 i Leading Causes ..................................................................................................... 32 Effects of Diet on COPD ...................................................................................... 35 Flavonoids ............................................................................................................. 46 Measurement Tools ............................................................................................... 70 Summary and Conclusions ..........................................................................................78 Chapter 3: Research Method ..............................................................................................80 Introduction ..................................................................................................................80 Research Design and Rationale ...................................................................................80 Methodology ................................................................................................................81 Population ............................................................................................................. 81 Sampling Procedures ............................................................................................ 82 Instrumentation ............................................................................................................87 Dietary Measurement ............................................................................................ 87 Demographics and Diseases ................................................................................. 89 Medical Examinations .......................................................................................... 90 Operationalization of Study Variables .........................................................................93 Independent Variable ............................................................................................ 93 Dependent Variables ............................................................................................. 95 Covariates ............................................................................................................. 98 Statistical Analysis .....................................................................................................101 Dataset preparation ............................................................................................. 102 Descriptive Analysis ........................................................................................... 105 ii Bivariate Analysis ............................................................................................... 105 Analysis of Research Questions and Hypotheses ............................................... 108 Threats to Validity .....................................................................................................113 Ethical Considerations ...............................................................................................116
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