Associations between dietary factors, lung function and bronchial responsiveness in middle-aged and older Australians

Abstract

Studies of relationships between dietary factors, lung function and bronchial responsiveness (BR) are limited and findings inconsistent. My aim was to investigate these relationships in middle-aged and older adults. A secondary aim was to identify a more suitable statistical method to assess factors associated with BR and compare its findings to those from the common regression model of the log-transformed dose-response slope (logDRS).

I used data from two cross-sectional studies – the Tasmanian Longitudinal Health Study (TAHS) 2010 follow-up and the Chronic Obstructive Pulmonary Disease (COPD) Study. The TAHS is a respiratory study of Tasmanian school children born in 1961. In 2010-2012, an asthma and bronchitis enriched subsample completed spirometry, a methacholine challenge and a questionnaire. I used a linear mixed model (LMM) to examine “known” predictors of BR and compared the findings to those from regression of the logDRS. I used multivariable linear regression to investigate associations between fruit and vegetable intakes and lung function and LMMs to examine associations with BR.

The COPD study is a population-based cross-sectional study of adults aged 45-69 years living in inner south-east Melbourne. A random subsample completed spirometry, a methacholine challenge, and questionnaires including a semi-quantitative food frequency questionnaire. I derived dietary patterns from nutrient intakes using principal component analysis and calculated an energy-adjusted dietary inflammatory index (E-DII) as a measure of the inflammatory potential of the diet. I examined associations between these dietary factors and lung function and BR using linear regression and LMMs, respectively.

I explored sex, BMI, smoking, asthma status and atopy as effect modifiers of these associations.

Results from the LMM differed to those from regression of the logDRS. In particular, sex predicted BR in the regression model but not the LMM.

I found relationships between several dietary factors and lung function in those with current asthma only. In this group, higher vegetable intake, higher intakes of a “high potassium & magnesium” dietary pattern, indicating a diet high in fruits, vegetables and wholegrains, and higher intakes of a “low calcium & sugars” dietary pattern, indicating a diet high in vegetables and low in sugar and dairy products, were associated with better lung function. A higher E-DII, indicating a more proinflammatory diet high in animal products and low in fruits and vegetables, was associated with poorer lung function.

I also found higher fruit intake was associated with increased BR. Conversely, in those with current asthma, higher scores for several dietary patterns were associated with less BR.

In conclusion, I demonstrated results from an LMM can differ to those from regression of the logDRS, and recommend using the LMM to investigate factors associated with BR. My findings suggest a diet low in animal products and high in fruit, vegetables and wholegrains may be beneficial for lung function in adults with asthma. Therefore, a dietary modification program in this group may improve lung function and reduce the prevalence and severity of asthma and COPD. However, further studies are needed to establish causality of the diet-lung function associations and clarify relationships with BR.