Epidemiological studies show promising associations between vitamin D and lung health; however the mechanisms responsible for these effects are poorly understood. The lungs are pyramid-shaped, paired organs that are connected to the trachea by the right and left bronchi; below the lungs is the diaphragm, a flat, dome-shaped muscle located at the base of the lungs and thoracic cavity. Creatinine, found in meat and fish, did not have additive effects to rehabilitation, while sulforaphane, found in broccoli and wasabi, and curcumin, the pigment in turmeric, may have beneficial antioxidant properties [ , , ]. This study by Wassall et al. Decreased concentration of adiponectin together with a selective reduction of its high molecular weight oligomers is involved in metabolic complications of myotonic dystrophy type 1.
Adiponectin exists in several isoforms, which have varied biological effects [ ] and interact with two receptors present in the lungs AdipoR1 and AdipoR2 that have opposing effects on inflammation [ ]. Single nucleotide polymorphisms in the gene encoding adiponectin are associated with cardiovascular disease, obesity and the metabolic syndrome [ ].
The role of adiponectin in COPD however is not well understood. In COPD, serum adiponectin is increased and directly relates to disease severity and lung function decline [ ]. There is an alteration in the oligomerisation of adiponectin in COPD resulting in increased concentrations of the anti-inflammatory higher-molecular weight isoform [ ], and the expression of adiponectin receptors in the lung is also altered in comparison to healthy subjects [ ].
However under certain conditions in cell lines and animal models adiponectin has been shown to have pro-inflammatory effects [ , ].
As both detrimental and protective effects have been seen, the complex modulation of adiponectin isoforms and receptors in COPD requires further exploration. Obesity, the resulting systemic inflammation and alterations in adipokines have significant negative effects in both asthma and COPD. While work examining the mechanisms of effect is extensive, evidence for interventions to improve the course of disease are limited to weight loss interventions in asthma at this stage.
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 [ ].
While there is widespread acknowledgement that malnutrition in pregnant women adversely effects of the lung development of the fetus [ ], a recent review reported that the offspring of mothers who were underweight did not have an increased risk of asthma. Amongst the obstructive lung diseases, undernutrition is most commonly recognised as a feature of COPD.
Weight loss, low body weight and muscle wasting are common in COPD patients with advanced disease and are associated with reduced survival time and an increased risk of exacerbation [ ]. The causes of undernutrition in COPD are multifactorial and include reduced energy intake due to decreased appetite, depression, lower physical activity and dyspnoea while eating [ ].
In addition, resting energy expenditure is increased in COPD, likely due to higher energy demands from increased work of breathing [ ]. Also, systemic inflammation which is a hallmark of COPD, may influence energy intake and expenditure [ ]. Cigarette smoke may also have deleterious effects on body composition in addition to the systemic effects of COPD.
Smoking causes muscle fibre atrophy and decreased muscle oxidative capacity shown in cohorts of non-COPD smokers [ , ] and in animal models of chronic smoke exposure [ , ].
The mechanisms underlying muscle wasting in COPD are complex and multifaceted [ ]. Increased protein degradation occurs in the whole body, though it is enhanced in the diaphragm [ ].
Protein synthesis pathways are altered, indeed insulin like growth factor-1 IGF-1 which is essential for muscle synthesis is decreased in cachectic COPD patients [ ] and is lower in COPD patients during acute exacerbation, compared to healthy controls [ ]. Furthermore myostatin induces muscle atrophy by inhibiting proliferation of myoblasts and mRNA expression of myostain is increased in cachectic COPD patients and is related to muscle mass [ ].
Nutritional supplementation therapy in undernourished COPD patients has been shown to induce weight gain, increase fat free mass, increase grip strength and exercise tolerance as well as improve quality of life [ ]. Further studies point out the importance of not only high energy content, but also macronutrient composition of the nutritional supplement and inclusion of low intensity respiratory rehabilitation exercise [ , ].
Other dietary nutrients have been investigated for the benefits in COPD. Creatinine, found in meat and fish, did not have additive effects to rehabilitation, while sulforaphane, found in broccoli and wasabi, and curcumin, the pigment in turmeric, may have beneficial antioxidant properties [ , , ]. Branched chain amino acid supplementation in COPD is associated with positive results including increases in whole body protein synthesis, body weight, fat free mass and arterial blood oxygen levels [ , ].
Undernutrition is not a significant problem in asthma, though is a major debilitating feature of COPD. 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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Gasp-worthy Facts about the Respiratory System. Fun Facts about the Respiratory System! Hairs in the nose help clean and warm the air we breathe. Women and children breathe at a faster rate than men. The surface area of the lungs is roughly the same size as a tennis court! If all the alveoli in both lungs were flattened out, they would have a total area of about square feet! We lose about 12 oz of water of water a day through breathing. In addition to exhaling carbon dioxide, you also exhale water.
Lungs are the only human organ that can float in water!