1. State your health outcome of interest. (It could be the one you used for week #2 or another one.) Pick two key behaviors that are important factors leading to your health outcome. Explain the importance of these behaviors either for etiology, prevention, or intervention. (If none of the behaviors in the readings are important for your health outcome, suggest another behavior that is.)
Sticking to one of my topics exploring food insecurity and non-alcoholic fatty liver disease –
1. Dietary choices are likely pathways that predispose individuals to risk of fatty liver. Specifically, reduced dietary quality and compensatory overconsumption of poor-quality foods, predisposing an individual to increased metabolic risk. Leslie et al 2014 assessed food environment by type and location of food correlation to NAFLD risk and found risk associated with fresh food and increased prepared foods access/intake. High fat diet has been associated with altered gut microbiota and lead to bacterial translocation and inflammation. (Maslowski and Mackay 2011 Weiser et al 2014). Hepatocyte injury can result from liver inflammation with accumulation of immune cells that produce hepatotoxic substance and promote destructive cascade (Diehl et al 2017). The usual wound-healing response is disrupted during NAFLD when injury is repetitive or repair is dysregulated, leading to futile regeneration promoting progressive scarring, organ dysfunction and neoplastic transformation (Angulo et al 2015).
2. Chronic disease self-management influence the control of metabolic risk factors that contribute to NAFLD risk and onset. It is theorized that competing force trade-offs between food and medical care and distract from chronic disease self-management (Seligman et al 2010). Cardiometabolic risk factors are considered the most important risk factors to the development of NAFLD (Pappachan et al 2013), with diabetes and hypertension linked to greater progression of disease (Adams et al 2005, LOria et al 2013). Emerging evidence supports a bi-directional relationship between NAFLD and diabetes and hypertension onset and progression (Lonardo et al 2017).
2. Describe how you would study the role of one of the behaviors described for question #1 and your health outcome of interest. Incorporate a social factor (e.g. race/ethnicity, social exclusion, stress) in the study approach.
I would be interested in further investigating the role of dietary choice as a result of built food environments to NAFLD risk. Similar to link between race/SES and obesity among children, similar metabolic risks associated with NAFLD persists among adults. Using Mai et al 2007, limited access to food choice (supermarkets) and increased exposure to processed, high-energy, high-fat meals (fast food) may fall along the causal pathway to fatty liver and progressive scarring through gut bacterial translocation, inflammation and insulin resistance. An ideal study design would incorporate prospective ultrasound liver monitoring to assess hepatic inflammation (CAP), 24 hour diet recall and through GIS, include exploring proximity to various food sources. Then investigators could explore the impact of diet quality and quantity by food environment, stratified by race/ethnicity and SES.
3. If key health behaviors (e.g. smoking, exercise, nutritious diet) are strongly influenced by neighborhood, income, and/or education, do we need to continue to study how these behaviors influence health outcomes? Why or why not?
Yes because if the objective of this research is to potentially modify behavior and reduce disparities in metabolic hepatic disease, one must address upstream factors that influence these behaviors. Under the Braveman construct, behavior is a function of living/working environment, which is under economic/social opportunities/resources. Under health belief model, interventions would address perceived benefits, barriers, self-efficacy and threat. Focusing solely on behavior and/or medical care without upstream factors would disconnect the potential confines that determine behavior change to promote health improvement and prevent and slow NAFLD disease progression among populations of interest.