Diet linked to respiratory health

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Nutrition and Respiratory Health—Feature Review

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There is promising evidence that nutritional supplementation in COPD is important and can help to alleviate some of the adverse effects of the disease, particularly muscle wasting and weight loss. Dietary intake appears to be important in both the development and management of respiratory diseases, shown through epidemiological and cross-sectional studies and supported by mechanistic studies in animal models.

Although more evidence is needed from intervention studies in humans, there is a clear link for some nutrients and dietary patterns. The dietary patterns associated with benefits in respiratory diseases include high fruit and vegetable intake, Mediterranean style diet, fish and omega-3 intake, while fast food intake and westernised dietary patterns have adverse associations.

Figure 1 shows a diagrammatic representation of the relationships of nutrition and obstructive lung diseases. Relationship of Nutrition and Obstructive Lung Diseases: Dietary factors that have been linked to respiratory disease. Though antioxidants are associated with positive effects on inflammation, clinical outcomes and respiratory disease prevention, intervention studies of individual antioxidants do not indicate widespread adoption of supplementation [ ].

Differences in results from individual studies including whole foods such as fruit and vegetables and fish could be influenced by the nutritional profile owing to the region it was grown or produced. In considering studies using single nutrients it is also important to acknowledge that nutrients in the diet are consumed as whole foods that contain other micronutrients, fibre and compounds with both known and unknown anti and pro-inflammatory potential.

Furthermore investigations of single nutrients should ideally control for other antioxidants and dietary sources of pro-inflammatory nutrients. While this limitation is common, it is a significant challenge to control for dietary intake of other nutrients in clinical trials. A whole foods approach to nutrient supplementation—for example, increasing intake of fruit and vegetables, has the benefit of increasing intake of multiple nutrients, including vitamin C, vitamin E, carotenoids and flavonoids and shows more promise in respiratory diseases in terms of reducing risk of COPD [ 3 ] and incidence of asthma exacerbations [ 25 ].

The evidence for mechanisms of vitamin D in lung development and immune function are yet to be fully established.

It appears that vitamin D is important in respiratory diseases and infections, however the temporal role of vitamin D deficiency in disease onset, pathogenesis and exacerbations and whether supplementation is indicated is yet to be clarified. Overnutrition in respiratory disease is clearly associated with adverse effects, highlighted by detrimental effects induced by immunometabolism.

Further understanding of the relationship between mediators of immunometabolism and respiratory diseases and their mechanisms may provide therapeutic options.

Undernutrition still poses risk in some respiratory conditions. Appropriate nutritional supplementation in advanced COPD is indicated, and several nutrients appear to be beneficial in COPD development and exacerbation. The field of nutrition and respiratory disease continues to develop and expand, though further work is required in the form of randomised controlled dietary manipulation studies using whole foods to enable provision of evidence based recommendations for managing respiratory conditions.

Bronwyn Berthon and Lisa Wood contributed to the study concept and design and were both involved in the preparation and completion of the manuscript. National Center for Biotechnology Information , U. Journal List Nutrients v. Published online Mar 5. Berthon and Lisa G. Received Jan 19; Accepted Feb This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license http: This article has been cited by other articles in PMC.

Abstract Diet and nutrition may be important modifiable risk factors for the development, progression and management of obstructive lung diseases such as asthma and chronic obstructive pulmonary disease COPD.

Introduction Diet and nutrition are increasingly becoming recognised as modifiable contributors to chronic disease development and progression. Dietary Intake and Respiratory Diseases 2. Dietary Patterns Various dietary patterns have been linked to the risk of respiratory disease [ 7 ]. Fruit and Vegetables Fruit and vegetable intake has been investigated for potential benefits in association with respiratory conditions due to their nutrient profile consisting of antioxidants, vitamins, minerals, fibre and phytochemicals.

Omega-3 Fatty Acids and Fish Omega-3 polyunsaturated fatty acids PUFA from marine sources and supplements have been shown to be anti-inflammatory through several cellular mechanisms including their incorporation into cellular membranes and resulting altered synthesis of eicosanoids [ 31 ].

Nutrients and Respiratory Disease 3. Antioxidants and Oxidative Stress Dietary antioxidants are an important dietary factor in protecting against the damaging effects of oxidative stress in the airways, a characteristic of respiratory diseases [ 50 ]. Vitamin C Vitamin C has been enthusiastically investigated for benefits in asthma and links to asthma prevention.

Flavonoids Flavonoids are potent antioxidants and have anti-inflammatory as well as anti-allergic actions due in part, to their ability to neutralise ROS [ 95 ]. Vitamin D Epidemiological studies show promising associations between vitamin D and lung health; however the mechanisms responsible for these effects are poorly understood.

Minerals Some minerals have also been found to be protective in respiratory conditions. Obesity, Adipokines and Respiratory Disease Overnutrition and resulting obesity are clearly linked with asthma, though the mechanisms involved are still under investigation.

Undernutrition and Respiratory Disease Though underweight has not been well studied in asthma, an observational study in Japan reported that subjects with asthma who were underweight had poorer asthma control than their normal weight counterparts [ ].

Conclusions Dietary intake appears to be important in both the development and management of respiratory diseases, shown through epidemiological and cross-sectional studies and supported by mechanistic studies in animal models. Open in a separate window. Author Contributions Bronwyn Berthon and Lisa Wood contributed to the study concept and design and were both involved in the preparation and completion of the manuscript.

Conflicts of Interest The authors declare no conflicts of interest. Nutrients and foods for the primary prevention of asthma and allergy: Systematic review and meta-analysis.

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Food sources and bioavailability. Flavonoids such as luteolin, fisetin and apigenin are inhibitors of interleukin-4 and interleukin production by activated human basophils. Flavonoids and related compounds as anti-allergic substances. The flavonoid quercetin inhibits proinflammatory cytokine tumor necrosis factor alpha gene expression in normal peripheral blood mononuclear cells via modulation of the NF-kappa beta system.

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1. Introduction