Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-05-18T01:07:14.400Z Has data issue: false hasContentIssue false

Dietary influences on chronic obstructive lung disease and asthma: a review of the epidemiological evidence

Published online by Cambridge University Press:  28 February 2007

Henriette A. Smit*
Affiliation:
Department of Chronic Disease and Environmental Epidemiology, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Linda Grievink
Affiliation:
Department of Chronic Disease and Environmental Epidemiology, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands Environmental and Occupational Health Group, Wageningen Agricultural University, The Netherlands Netherlands Institute of Health Sciences (NIHES), Rotterdam, The Netherlands
Cora Tabak
Affiliation:
Department of Chronic Disease and Environmental Epidemiology, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands Environmental and Occupational Health Group, Wageningen Agricultural University, The Netherlands Netherlands Institute of Health Sciences (NIHES), Rotterdam, The Netherlands
*
*Corresponding author: Dr H. A. Smit, fax +31 30 274 4407, email Jet.smit@rivm.nl
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The epidemiological evidence for a relationship between diet and indicators of asthma and chronic obstructive pulmonary disease (COPD) is evaluated. The review focuses on the intake of Na, n−3 fatty acids, and antioxidant vitamins as well as fruit and vegetables. Experimental studies suggest that a high-Na diet has a small adverse effect on airway reactivity in asthma patients. However, observational studies provide no clear evidence that high Na intake has adverse effects on airway reactivity or asthma symptoms in open populations. n−3 Polyunsaturated fatty acids, which are present in fish oils, are metabolized into less broncho-constricting and inflammatory mediators than n−6 polyunsaturated fatty acids. Studies in the general adult population suggest that a high fish intake has a beneficial effect on lung function, but the relationship with respiratory symptoms and clinically-manifest asthma or COPD is less evident. Also, experimental studies in asthma patients have not demonstrated an improvement in asthma severity after supplementation with fish oil. Several studies showed a beneficial association between fruit and vegetable intake and lung function, but the relationship with respiratory symptoms and the clinically-manifest disease was less convincing. A similar pattern was found for vitamin C in relation to indicators of asthma and COPD, but there are still conflicting results with respect to vitamin E and β-carotene. In conclusion, the epidemiological evidence for a beneficial effect on indicators of asthma and COPD of eating fish, fruit and vegetables is increasing. However, the effectiveness of dietary supplementation in open-population samples is often not demonstrated. Several unresolved questions are raised, which should be addressed in future studies on the relationship between diet and respiratory disease.

Type
Clinical Nutrition and Metabolism Group Symposium on ‘Nutrition and lung health’
Copyright
Copyright © The Nutrition Society 1999

References

Arm, JP, Horton, CE, Mencia-Huerta, JM, House, F, Eiser, NM, Clark, TJ, Spur, BW & Lee, TH (1988) Effect of dietary supplementation with fish oil lipids on mild asthma. Thorax 43, 8492.CrossRefGoogle ScholarPubMed
Balmes, J, Ngo, L, Keogh, J, Cullen, M, Brodkin, CA, Williams, J, Redlich, CA, Omenn, G & Barnhart, S (1998) Effect of supplemental β-carotene and retinol on rate of decline in lung function. American Journal of Respiratory and Critical Care Medicine 157, A46 Abstr.Google Scholar
Black, PN & Sharpe, S (1997) Dietary fat and asthma: is there a connection? European Respiratory Journal 10, 612.CrossRefGoogle ScholarPubMed
Britton, J (1995) Dietary fish and airways obstruction. Thorax 50, S11S15.CrossRefGoogle ScholarPubMed
Britton, JR, Pavord, ID, Richards, KA, Knox, AJ, Wisniewski, AF, Lewis, SA, Tattersfield, AE & Weiss, ST (1995) Dietary antioxidants on lung function in the general population. American Journal of Respiratory and Critical Care Medicine 151, 13831387.CrossRefGoogle ScholarPubMed
Britton, JR, Pavord, ID, Richards, KA, Knox, AJ, Wisniewski, AF, Weiss, ST & Tattersfield, AE (1994 a) Dietary sodium intake and the risk of airway hyperreactivity in a random adult population. Thorax 49, 875880.CrossRefGoogle Scholar
Britton, JR, Pavord, ID, Richards, KA, Wisniewski, AF, Knox, AJ, Lewis, SA, Tattersfield, AE & Weiss, ST (1994 b) Dietary magnesium, lung function, wheezing, and airway hyperreactivity in a random adult population sample. Lancet 344, 357362.CrossRefGoogle Scholar
Bucca, C, Rolla, G & Farina, JC (1992) Effect of vitamin C on transient increase of bronchial responsiveness in conditions affecting the airways. Annals of the New York Academy of Sciences 669, 175187.CrossRefGoogle ScholarPubMed
Burney, P (1987) A diet rich in sodium may potentiate asthma: epidemiologic evidence for a new hypothesis. Chest 91, 143S148S.CrossRefGoogle Scholar
Burney, PGJ, Britton, JR, Chinn, S, Tattersfield, AE, Platt, HS, Papacosta, AO & Kelson, MC (1986) Response to inhaled histamine and 24 hour sodium excretion. British Medical Journal 292, 14831486.CrossRefGoogle ScholarPubMed
Burney, PGJ, Neild, JE, Twort, CHC, Chinn, S, Jones, TD, Mitchell, WD, Bateman, C & Cameron, IR (1989) Effect of changing dietary sodium on the airway response to histamine. Thorax 44, 3641.CrossRefGoogle ScholarPubMed
Carey, IM, Strachan, DP & Cook, DG (1998) Effect of changes in fresh fruit consumption on ventilatory function in healthy British adults. American Journal of Respiratory and Critical Care Medicine 158, 728733.CrossRefGoogle ScholarPubMed
Carey, OJ, Locke, C & Cookson, JB (1993) Effect of alterations of dietary sodium on the severity of asthma in men. Thorax 48, 714718.CrossRefGoogle ScholarPubMed
Chang, CC, Phinney, SD, Halpern, GM & Gershwin, ME (1993) Asthma mortality: another opinion - is it a matter of life and... bread? Journal of Asthma 30, 93103.CrossRefGoogle ScholarPubMed
Chatham, MD, Eppler, JH Jr., Saunder, LR, Green, D & Kulle, TJ (1987) Evaluation of the effects of vitamin C on ozone induced bronchoconstriction in normal subjects. Annals of the New York Academy of Sciences 498, 269279.CrossRefGoogle ScholarPubMed
Chuwers, P, Barnhart, S, Blanc, P, Brodkin, CA, Cullen, M, Kelly, T, Keogh, J, Omenn, G, Williams, J & Balmes, JR (1997) The protective effect of beta-carotene and retinol on ventilatory function in an asbestos-exposed cohort. American Journal of Respiratory and Critical Care Medicine 155, 10661071.CrossRefGoogle Scholar
Cook, DG, Carey, IM, Whincup, PH, Papacosta, O, Chirico, S, Bruckdorfer, KR & Walker, M (1997) Effect of fresh fruit consumption on lung function and wheeze in children. Thorax 52, 628633.CrossRefGoogle ScholarPubMed
Dow, L, Tracey, M, Villar, A, Coggon, D, Margetts, BM, Campbell, MJ & Holgate, ST (1996) Does dietary intake of vitamins C and E influence lung function in older people? American Journal of Respiratory and Critical Care Medicine 154, 14011404.CrossRefGoogle Scholar
Fluge, O, Omenaas, E, Eide, GE & Gulsvik, A (1998) Fish consumption and respiratory symptoms among young adults in a Norwegian community. European Respiratory Journal 12, 336340.CrossRefGoogle Scholar
Grievink, L, Jansen, SMA, van 't Veer, P & Brunekreef, B (1998 a) Acute effects of ozone on pulmonary function of cyclists receiving antioxidant supplements. Occupational and Environmental Medicine 55, 1317.CrossRefGoogle ScholarPubMed
Grievink, L, Smit, HA, Ocke, MC, van 't Veer, P & Kromhout, D (1998 b) Dietary intake of antioxidant (pro)-vitamins, respiratory symptoms and pulmonary function: The MORGEN-study. Thorax 53, 166171.CrossRefGoogle ScholarPubMed
Hackney, JD, Linn, WS, Buckley, RD, Jones, MP, Wightman, LH & Karusa, SK (1981) Vitamin E supplementation and respiratory effects of ozone in humans. Journal of Toxicological and Environmental Health 7, 383390.CrossRefGoogle ScholarPubMed
Heffner, JE & Repine, JE (1989) Pulmonary strategies of antioxidant defense. American Review of Respiratory Disease 140, 531554.CrossRefGoogle ScholarPubMed
Hodge, L, Salome, CM, Peat, JK, Haby, MM, Xuan, W & Woolcock, AJ (1996) Consumption of oily fish and childhood asthma risk. Medical Journal of Australia 164, 137140.CrossRefGoogle ScholarPubMed
Holtzman, MJ (1991) Arachidonic acid metabolism. Implications of biological chemistry for lung function and disease. American Journal of Respiratory Disease 143, 188203.CrossRefGoogle Scholar
Javaid, A, Cushley, MJ & Bone, MF (1988) Effect of dietary salt on bronchial reactivity to histamine in asthma. British Medical Journal 297, 454.CrossRefGoogle ScholarPubMed
Kirsch, CM, Payan, DG, Wong, MYS, Dohlman, JG, Blake, VA, Petri, MA, Offenberger, J, Goetzl, EJ & Gold, WM (1988) Effect of eicosapentaenoic acid in asthma. Clinical Allergy 18, 177187.CrossRefGoogle ScholarPubMed
Knox, AJ (1993) Salt and asthma: a high salt diet may make asthma worse in men. British Medical Journal 307, 11591160.CrossRefGoogle Scholar
LaVecchia, C, Decarli, A & Pagano, R (1998) Vegetable consumption and risk of chronic disease. Epidemiology 9, 208210.Google Scholar
Lieberman, D & Heimer, D (1992) Effect of dietary sodium on the severity of bronchial asthma. Thorax 47, 360362.CrossRefGoogle ScholarPubMed
McLaren, DS, Loveridge, N, Duthie, G & Bolton-Smith, C (1993) Fat-soluble vitamins. In Human Nutrition and Dietetics, pp. 208238 [Garrow, JS, James, WPT and Ralph, A, editors]. Edinburgh: Churchill Livingstone.Google Scholar
Medici, TC & Vetter, W (1991) Bronchialasthma und Kochsalz. Schweizerische Medizinische Wochenschrift 121, 501508.Google Scholar
Miedema, I, Feskens, EJM, Heederik, D & Kromhout, D (1993) Dietary determinants of long-term incidence of chronic nonspecific lung diseases: the Zutphen study. American Journal of Epidemiology 138, 3745.CrossRefGoogle ScholarPubMed
Mohensin, V (1987) Effect of vitamin C on NO2-induced airway hyperresponsiveness in normal subjects. American Review of Respiratory Disease 136, 14081411.Google Scholar
Mohensin, V (1991) Lipid peroxidation and antielastase activity in the lung under oxidant stress: role of antioxidant defenses. Journal of Applied Physiology 70, 14561462.Google Scholar
Monteleone, CA & Sherman, AR (1997) Nutrition and asthma. Archives of Internal Medicine 157, 2334.CrossRefGoogle ScholarPubMed
Morabia, A, Menkes, MJS, Comstock, GW & Tockman, MS (1990) Serum retinol and airway obstruction. American Journal of Epidemiology 132, 7782.CrossRefGoogle ScholarPubMed
Morabia, A, Sorenson, A, Kumanyika, SK, Abbey, H, Cohen, BH & Chee, E (1989) Vitamin A, cigarette smoking, and airway obstruction. American Review of Respiratory Disease 140, 13121316.CrossRefGoogle Scholar
Ness, AR, Khaw, KT, Bingham, S & Day, NE (1996) Vitamin C status and respiratory function. European Journal of Clinical Nutrition 50, 573579.Google ScholarPubMed
Pistelli, R, Forastiere, F, Corbo, GM, Dell'Orco, V, Brancato, G, Agabiti, N, Pizzabiocca, A & Perucci, CA (1993) Respiratory symptoms and bronchial responsiveness are related to dietary salt intake and urinary potassium excretion in male children. European Respiratory Journal 6, 517522.CrossRefGoogle ScholarPubMed
Rautalahti, M, Virtamo, J, Haukka, J, Heinonen, OP, Sundvall, J, Albanes, D & Huttunen, JK (1997) The effect of alpha-tocopherol and beta-carotene supplementation on COPD symptoms. American Journal of Respiratory and Critical Care Medicine 156, 14471452.CrossRefGoogle ScholarPubMed
Romieu, I, Meneses, F, Ramirez, M, Ruiz, S, Perez Padilla, R, Sienra, JJ, Gerber, M, Grievink, L, Dekker, R, Walda, I & Brunekreef, B (1998) Antioxidant supplementation and respiratory functions among workers exposed to high levels of ozone. American Journal of Respiratory and Critical Care Medicine 158, 226232.CrossRefGoogle ScholarPubMed
Schwartz, J & Weiss, ST (1990) Dietary factors and their relation to respiratory symptoms: the second national health and nutrition examination survey. American Journal of Epidemiology 132, 6776.CrossRefGoogle ScholarPubMed
Schwartz, J & Weiss, ST (1994 a) Relationship between dietary vitamin C intake and pulmonary function in the first national health and nutrition examination survey (NHANES 1). American Journal of Clinical Nutrition 59, 110114.CrossRefGoogle Scholar
Schwartz, J & Weiss, ST (1994 b) The relationship of dietary fish intake to level of pulmonary function in the first national health and nutrition examination survey (NHANES 1). European Respiratory Journal 7, 18211824.CrossRefGoogle Scholar
Seaton, A, Godden, DJ & Brown, K (1994) Increase in asthma: a more toxic environment or a more susceptible population? Thorax 49, 171174.CrossRefGoogle ScholarPubMed
Shahar, E, Folsom, AR, Melnick, SL, Tockman, MS, Comstock, GW, Gennaro, V, Higgins, MW, Sorlie, PD, Ko, W-J & Szklo, M (1994 a) Dietary n-3 polyunsaturated fatty acids and smoking-related chronic obstructive pulmonary disease. New England Journal of Medicine 331, 228233.CrossRefGoogle ScholarPubMed
Shahar, E, Folsom, AR, Melnick, SL, Tockman, MS, Comstock, GW, Shimakawa, T, Higgins, MW, Sorlie, PD & Szklo, M (1994 b) Does dietary vitamin A protect against airway obstruction? American Journal of Respiratory and Critical Care Medicine 150, 978982.CrossRefGoogle ScholarPubMed
Sharp, DS, Rodriguez, BL, Shahar, E, Hwang, L-J & Burchfiel, CM (1994) Fish consumption may limit the damage of smoking on the lung. American Journal of Respiratory and Critical Care Medicine 150, 983987.CrossRefGoogle ScholarPubMed
Simopoulos, AP (1991) Omega-3 fatty acids in health and disease and in growth and development. American Journal of Clinical Nutrition 54, 438463.CrossRefGoogle ScholarPubMed
Soutar, A, Seaton, A & Brown, K (1997) Bronchial reactivity and dietary antioxidants. Thorax 52, 166170.CrossRefGoogle ScholarPubMed
Sparrow, D, O'Connor, GT, Rosner, B & Weiss, ST (1991) Methacholine airway responsiveness and 24-hour urine excretion of sodium and potassium. The Normative Aging Study. American Review of Respiratory Diseases 144, 722725.CrossRefGoogle ScholarPubMed
Sridhar, S (1995) Nutrition and lung health: should people at risk of chronic obstructive lung disease eat more fruit and vegetables? British Medical Journal 310, 7576.CrossRefGoogle Scholar
Strachan, DP, Cox, BD, Erzinclioglu, SW, Walters, DE & Whichelow, MJ (1991) Ventilatory function and winter fresh fruit consumption in a random sample of British adults. Thorax 46, 624629.CrossRefGoogle Scholar
Thien, FCK, Woods, RK & Walters, EH (1996) Oily fish and asthma: A fishy story? - Further studies are required before claims can be made of a beneficial effect of oily fish consumption on asthma. Medical Journal of Australia 164, 135136.CrossRefGoogle ScholarPubMed
Troisi, RJ, Willett, WC, Weiss, ST, Trichopoulos, D, Rosner, B & Speizer, FE (1995) A prospective study of diet and adult-onset asthma. American Journal of Respiratory and Critical Care Medicine 151, 14011408.CrossRefGoogle ScholarPubMed
von Mutius, E, Fritzsch, C, Weiland, SK, Röll, G & Magnussen, H (1992) Prevalence of asthma and allergic disorders among children in united Germany: a descriptive comparison. British Medical Journal 305, 13951399.CrossRefGoogle Scholar