Associations of adherence to the DASH diet and the Mediterranean diet with chronic obstructive pulmonary disease among US adults

Abstract

BackgroundThe Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet are associated with reduced cardiovascular, tumor, and diabetes risk, but the effect on chronic obstructive pulmonary disease (COPD) is uncertain.ObjectiveTo investigate the association of the DASH diet and the Mediterranean diet with the risk of COPD in American adults.MethodsThis cross-sectional study included 28,605 participants from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 survey cycle who had complete dietary and other questionnaire data. The scores of healthy eating patterns (the DASH diet and the Mediterranean diet) were derived from a 24-h dietary recall interview [individual food and total nutrient data from NHANES and food pattern equivalents data from the United States Department of Agriculture (USDA)]. The primary outcome was the prevalence of COPD. COPD was defined based on participants self-reported whether or not a doctor or health professional had diagnosed chronic bronchitis or emphysema. Secondary outcomes were lung function and respiratory symptoms. All analyses were adjusted for demographics and standard COPD risk factors (primary tobacco exposure, secondhand smoke exposure, and asthma).ResultsThis study included 2,488 COPD participants and 25,607 non-COPD participants. We found that a higher DASH diet score was associated with a lower risk of COPD [odds ratio (OR): 0.83; 95% confidence interval (CI): 0.71–0.97; P = 0.021]. This association persisted in several subgroups [men (OR: 0.73; 95% CI: 0.58–0.93; P = 0.010), relatively young (OR: 0.74; 95% CI: 0.55–1.01; P = 0.050), and smoker (OR: 0.82; 95% CI: 0.67–0.99; P = 0.038)]. In contrast, the Mediterranean diet score was not significantly associated with COPD prevalence in this large cross-sectional analysis representative of the US adult population (OR: 1.03; 95% CI: 0.88–1.20; P = 0.697). In addition, we found a correlation between DASH diet adherence and lung function [β: −0.01; 95% CI: −0.01–0.00; P = 0.003 (FEV1: FVC)] or respiratory symptoms [OR: 0.80; 95% CI: 0.73–0.89; P < 0.001 (dyspnea); OR: 0.80; 95% CI: 0.70–0.91; P = 0.002 (cough); OR: 0.86; 95% CI: 0.74–0.99; P = 0.042 (expectoration)], especially in non-COPD populations.ConclusionA higher DASH diet score was associated with improved COPD prevalence, lung function and respiratory symptoms. This new finding supports the importance of diet in the pathogenesis of COPD and expands the scope of the association of the DASH diet score with major chronic diseases.

The association between diet quality and chronic obstructive pulmonary disease: a case-control study

“…Our study found that adherence to the HEI-2010 guidelines was linked to a decreased likelihood of COPD. These findings corroborate previous studies that have reported an inverse relationship between healthy dietary patterns and the incidence of COPD [ 19 – 21 , 24 , 26 , 49 – 53 ]. Several studies have investigated the relationship between dietary patterns and the risk of COPD.…”

“…It must be kept in mind that the associations between dietary intakes and risk of COPD were mainly examined in western countries [ 24 , 25 ] and limited information are available in this regard from developing nations [ 26 ]. This is particularly relevant when the dietary intakes of people in developing countries, especially those in the Middle East, are significantly different from those in western countries [ 27 ].…”

Epidemiological characteristics of asthma-COPD overlap, its association with all-cause mortality, and the mediating role of depressive symptoms: evidence from NHANES 2005–2018

“…By using the commonly used criteria of or available approaches to identifying the focused diseases and clinical conditions, and relying on the data availability within the NHANES 2005–2018, this study grouped participants as follows: 1) the asthma-only group ( N = 2352) [ 1 , 4 , 31 – 33 ], including participants who reported at least one of the following conditions: a) having an episode of asthma or an asthma attack during the past 12 months, b) ever being told by a doctor or other health professionals that they had asthma, and c) using drugs including selective phosphodiesterase-4 inhibitors, mast cell stabilisers, leukotriene modifiers or inhaled corticosteroids, and excluding participants with chronic bronchitis and emphysema; 2) the COPD-only group ( N = 853) [ 4 , 31 , 34 , 35 ], including participants who had at least one of the following conditions: a) reporting having emphysema, b) reporting ever being told they had emphysema, c) having a ratio of forced expiratory volume in 1 s (FEV1) and forceful lung volume (FVC) (FEV1/FVC) after bronchodilator use less than 0.70 in laboratory test, and d) reporting ever being told they had chronic bronchitis and used drugs including selective phosphodiesterase-4 inhibitors, mast cell stabilisers, leukotriene modifiers, inhaled corticosteroids, and excluding participants with asthma; 3) the ACO group ( N = 705) [ 4 , 6 , 36 , 37 ], including participants who met the identification criteria for both asthma and COPD (at least 1 characteristic from each); 4) the non-asthma/COPD group, including participants who did not meet any identification criteria for the asthma-only or COPD-only group. We formed the non-ACO group by combining participants from the asthma-only, COPD-only, and non-asthma/COPD groups.…”

The Role of Nutrition in the Development and Management of Chronic Obstructive Pulmonary Disease

“…Additionally, the interplay between a diet high in processed meat intake and other lifestyle behaviors, such as smoking and an overall unhealthy diet, have been linked to yielding the highest hazard ratio for COPD development [ 19 ]. Adhering to the Dietary Approaches to Stop Hypertension (DASH) diet (rich in fruits, vegetables, and grains and low in sodium, fatty meats, and sugar) was inversely associated with the risk of COPD [ 165 ], while mixed results regarding a Mediterranean diet (high intakes of vegetables, legumes, fruits, nuts, grains, fish, seafood, and extra virgin olive oil and a moderate intake of red wine) have been reported [ 165 , 166 ]. Currently, there is not enough information available to recommend a specific dietary pattern for patients with COPD.…”