Elsevier

Translational Research

Volume 162, Issue 4, October 2013, Pages 219-236
Translational Research

In-Depth Review: Unraveling the Complexity of COPD
Review Article
Diet and vitamin D as risk factors for lung impairment and COPD

https://doi.org/10.1016/j.trsl.2013.04.004Get rights and content

Epidemiologic and observational studies have shown an association between increased intakes of certain micronutrients and higher levels of lung function and health. The National Health and Nutrition Examination Surveys of the U.S. population have demonstrated repeatedly that increased intakes or serum levels of some micronutrients, including the vitamins E, D, C, and A, and carotenes are associated positively with forced expiratory volume in 1 second (FEV1). These findings are complemented by other observational studies, including the MORGEN study as well as the Seven Countries Study, both of which found micronutrient status had positive correlations with pulmonary function. In addition, epidemiologic studies have demonstrated that dietary intake patterns with increased intakes of fruit, vegetables, fish, vitamin E, and whole grains have been associated with a decreased development of chronic obstructive pulmonary disease (COPD) in smokers and nonsmokers, higher levels of FEV1, and decreased long-term COPD mortality. Diets high in refined food have been associated with accelerated longitudinal decline in FEV1 over 5 years. Taken together, these results suggest that micronutrient status may impact lung function, and that nutrition interventions could be a useful tool in a public health campaign aimed at the prevention of lung disease. Future research should focus on the effect of nutrition interventions on the natural history of lung disease.

Section snippets

Methods of Dietary Intake Assessment

There are several methods that can be used to assess dietary exposures. The most commonly used in epidemiologic studies is a food frequency questionnaire (FFQ). These questionnaires have the advantage of being able to assess long-term intake and are useful in large cohorts. They are also useful in longitudinal studies because the ease of administration allows for repeated measurements, and they are used in general for ranking subjects according to food or nutrient intake rather than for

Micronutrients of Relevance

There are several nutrients that have been associated with lung function, including the provitamin A carotenoids, vitamin C, vitamin E, and vitamin D. The provitamin A carotenoids function as sources of vitamin A and can prevent vitamin A deficiency. The beneficial effects of carotenoids are most likely a result of their role as antioxidants; studies have shown an association between serum carotenoid levels in the serum and the extent of lipid oxidizability.23 Many provitamin A carotenoids are

Search Strategy

A research librarian was consulted to help with the literature search. The search included the following Medical Subject Headings (MESH) terms and combinations of these terms: antioxidants/administration and dosage, antioxidants/therapeutic use, pulmonary disease, chronic obstructive, pulmonary disease, chronic obstructive/prevention and control, vitamin E, vitamin C, vitamin D, carotenes, and selenium. Excerpta Medica Database (EMBASE) and Cumulative Index of Nursing and Allied Health

Observational studies of nutrient intake and lung function

Epidemiologic and observational studies of nutrient intake have shown that higher intakes of certain micronutrients are associated with higher levels of lung function. Observational studies examining the relationships among vitamin C, vitamin E, carotenes, and vitamin D are summarized in Table II, Table III, Table IV, Table V. An analysis of the Third National Health and Nutrition Examination Survey (NHANES III) of the U.S. population demonstrated that increased intakes of vitamin E, vitamin C,

Conclusions and Future Directions

It is always difficult to separate the direct effect of a nutrient on an outcome from the overall effects of associated lifestyle factors. However, these results suggest the possibility that the intake of certain nutrients may impact lung function and the development of lung diseases, and may help attenuate the progressive decline in lung function over time. Given the importance of inflammation and oxidant stress in lung function—and, specifically, in lung function impairment—a direct effect of

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    Conflict of Interest: All the authors have read the journal's policy on disclosing potential conflicts of interest. S. Rennard discloses that he has had or currently has a number of relationships with companies that provide products and/or services relevant to outpatient management of chronic obstructive pulmonary disease. These relationships include serving as a consultant, advising regarding clinical trials, speaking at continuing medical education programs, and performing funded research both at basic and clinical levels. He does not own any stock in any pharmaceutical companies. Specific companies and institutions with whom he has had relationships as of 2012 include the following: as a consultant: Align2Action, GlaxoSmithKline, Almirall, HealthStar, Boehringer, Ingelheim, Lek, Under Decision Resources, McKinsey, Dunn Group, Navigant, Easton Associates, Penn Technology, Elevation Pharma, Strategic North, Forest, Synapse, Gerson, and Telecon SC; as a speaker: CME Incite, Nuvis, Forest, Pro-iMed, Incite, Takeda, and IntraMed (Forest); on an advisory board: AstraZeneca, Pearl, Forest, Pfizer, and Johnson & Johnson.

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