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NUTRITION AND ASTHMA
ผศ.พญ. รพ�พร โรจน์แสงเร�อง
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• asthma - the result of interaction genetic + environmental factors
• increasing prevalence - result of changes in environmental factors (westernization)
• Diet - role in asthma
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Role of diet in asthma
1.a food allergen can cause asthma2. role of breast-feeding for prevention of
asthma later in life
3. a low intake of antioxidative diet - a risk factor(- cations such as Na, K and Mg)(- omega-3 and omega-6 fatty acids)
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• USA (1980) 6-8% of infants and 1.5% of adults are allergic to food
• skin tests - negative + history - not helpful.• symptoms - gradually hours or days after
ingestion
• Sensitivity - ingestion of small quantities , inhalation of food allergens , in cooking fumes
• Children -sensitive to foods > adults
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• Food allergy can cause both immediate and delayed patterns of asthma.
• Immediate food reaction (Type-I allergy mediated by Ig-E) : acute asthma
• Delayed patterns of food allergy (Non-Ig-E-mediated) : chronic asthma
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Common foods causing asthma
• milk• eggs• Fish• Peanuts• soy• yeast• Cheese• wheat• rice• chocolates
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Eggs
• Oral + non oral route• the major allergens in egg white - ovalbumin,
ovomucoid, and ovotransferrin
Milk• กิ�น์ หร�อ ส�ดดม
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Wheat
• Wheat is most rich in gluten, with the other grains containing a lesser mixture of gluten and gliadin .
• กิ�น์ oats, rice, rye, barley หร�อ corn แทน์
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Peanuts
• Peanuts are one of the most allergenic foods and death
Fish • Avoid all fish species• Though fish oils have beneficial role in asthma
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Sulfites and sulfating agents
Common food sources are• dried fruits and vegetables• potatoes (some packaged and prepared)• wine, beer, bottled lemon or lime juice, • pickled foods
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• there is no definite and reliable tests to diagnose food allergy.
• demonstration of the relief of symptoms on removal of a given food item and recurrence of symptoms on its reintroduction
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oxidative-antioxidative imbalance
• The oxidants (cigarette smoke and air-pollution / generated through inflammatory process -allergen and viral infection)
• endogenous antioxidant defense system - depends on adequate nutritional antioxidants
• Reactive oxygen species- contract airway smoothMuscles+ stimulate histamine release from mast
cells + mucus secretion
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Antioxidants
• vitamin-A/βcarotene• vitamin-C• vitamin-E • selenium
• which may prevent oxidative injury.
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Vitamin-C
Lower plasma and leukocyte concentration of vitamin-C : • a high prevalence of asthma • increased respiratory symptoms• reduced pulmonary functions• increased airway responsiveness
• Supplementation : decrease asthma severity and frequency, exercise induced bronchospasm + airway responsiveness to methacholine
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• Vit C 100 mg /day : FEV1 10-50 ml• Source- citrus fruits , red and yellow pepper
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Vit C
• free radical scavenger present in intracellular and extracellular lung fluids
• a general antihistamine effect• inhibits the prostaglandins production
• vitamin-C reduces the duration of episodes and the severity of symptoms of the common cold
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Vitamin-E• High vitamin-E intake reduced asthma
incidence.บทบาท1.a membrane stabilizer and defence against
oxidant induced membrane injury2.suppress neutrophil migration and inhibits Ig-E
production3.influence T-helper cell development
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Vitamin-A and b-Carotene
• the development, maintainance, differentiation, and regeneration of lung epithelial cells
• antioxidant action
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Vitamin-B complex
• vitamin-B6 deficiency : in many asthma • asthma inhalers interfere with the absorption
of vitamin-B6• vitamin-B6 supplement lessen the asthma
attacks
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Flavones and Flavanoids
• Found in fruits and red wine
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Fruits and Vegetables
• a high fruit intake –reduce risk of asthma, decline in FEV1
• a high intake of fruits (>1/week) : FEV1 80-100 ml higher than a low intake
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• Fruits and vegetables are better than vitamins pills.
• Fruits increase lung functions more than vegetable.(Fruits are high in vitamin-C)
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Fast Food
• frequent consumption of hamburger showed a dose dependent association with asthma symptoms
• In an Indian study, pasta, noodles and the like fast foods and meat increases the risk of asthma/wheeze among children
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Minerals
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Selenium
• Selenium deficiency may greatly increase the risk of asthma
Selenium functions • cofactor for the antioxidant enzyme glutathione
peroxidase to reduce the synthesis and release of leukotriene B4
• along with vitamin-C, attenuate the activation of nuclear factor kappa-β, a transcription factor that upregulates inflammatory cytokines associated with the asthmatic immune response
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Magnesium• smooth muscle relaxation and mast cell
stabilization.• Bronchodilatation when IV in acute severe
asthma. • strong evidence of protection by dietary
magnesium against asthma
• Milk and other dairy products, whole grains, nuts, leafy green vegetables
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Sodium
• increase salt intake - worsening asthma• sodium restriction in three double blind clinical
trials- improvements in FEV1+ symptoms
• Dietary sodium cause bronchoconstriction through potentiation of the electrogenic sodium pump in the membrane of the airway smooth muscles
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Trace Minerals
• Copper and zinc have role in antioxidant defense as cofactor in superoxide dismutase.
• Zinc is an essential trace mineral for immune mechanisms
• Manganese has been found deficient in bronchial biopsies of asthmatic patients, indicating manganese replishment could help
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Fatty acid(omega-3, omega-6)
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• Omega36: fish oil , canola and flaxseed oils• Omega-6: soybean, corn, safflower, and
sunflower oils
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• Inflammatory cells begins with the release of arachidonic acid from membrane phosphollpid by phospholipase enzymes
• subsequent metabolism by cycloxygenase or lipoxygenase enzymes prostaglandin or leukotrience products
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Fatty Acids
• omega-3 fatty acids in fish oil• omega-3 fatty acids-inhibiting arachidonic acid
metabolism
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omega-3
• omega-3 is a substrate for the less active prostanoids (e.g. thromoxane A3) and LT (LTB5)
• to reduce airway inflammation, airwayHyperresponsiveness
fish oil,fish, shellfish and leafy vegetables
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Fish oil
• inflammatory respiratory diseases• preserve normal airway resistance• allergic sensitization
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omega-6
• derivatives of arachidonic acid ( omega-6) are leukotriene B4 (LTB4) and
LTC4, D4, E4 and PGE2 • LTB4 - potent neutrophil chemoattractant• LTC4, D4, E4 – Potent bronchoconstriction• PGE2- promote lymphocyte response + Ig-E
vegetable fats such as margarine
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Amino Acids
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• cystine, methionine, glycine and glutamic acid- to glutathione metabolism
• increase in the proportion of protein from animal sources rise in asthma prevalence
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Breast feeding
• WHO : For the first 4-6 months breast feeding significantly decreases the risk of asthma and other allergic diseases among children
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Role of Maternal Diet
• maternal dietary avoidance is unlikely to reduce the risk of atopy in the child
• maternal oily fish intake during pregnancy may protect offsprings from asthma
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• promotion of Lactobacillus and other gut micro-organisms protect against the development of atopic disease.
• Breast feeding promotes gut colonization with bifi dobacterium + reduces chances of atopy and/or asthma
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Dietary supplementation with probiotics
• In a double blind, randomized, placebo controlled trial
• lactobacillus (given prenatally to mothers and then postnatally for 6 months to their infants) resulted in 50% reduction in the rate of atopic eczema at the age of two years ( ยั�งไม�แน์�น์อน์)
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COPD
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• Cigarette smoke, a major risk factor for COPD, is a significant source of oxidants; smokers have been found to have decreased levels of plasma ascorbate, p-carotene, and vitamin E
• antioxidant intake could modulate the lung damage induced by oxidative stress .
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• Fresh fruits and vegetables contain vitamin C (e.g., broccoli, spinach, tomatoes, and citrus fruits)
• carotenoids (e.g., carrots, tomatoes, grapefruit,beans, broccoli, oranges, and mangos)
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• vitamin E are oil products such as mayonnaise, vegetable and seed oils (corn, safflower, and soybean), butter, and eggs.
• Flavonoids are in fruits and vegetables (apples, lemons, oranges, potatoes, and cauliflower) and tea
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• Selenium is found in grain, meat, seafood
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Recommended Dietary Allowance requirements
• 60 mg/day for vitamin C (100 mg/day for smokers)
• 800-1,000 retinol equivalents /day• 55-70 u.g/day for selenium
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Magnesium
• In a study conducted among 2,633 adults aged 18-70 years reported that a 100- mg/day higher magnesium intake was associated with a higher FEV1
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Antioxidants
• 10 cross-sectional studies conducted in adults reported that vitamin C intake had a protective effect against decline in lung function
• In a study of 1,502 lifelong smokers and 1,357 current smokers aged 18-69 years, FEV1was< 78 ml among subjects who drank no fruit juice or who ate fresh fruit < once /week during the winter
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• In a cross-sectional study that included 1,860 adults aged 45-75 years,higher plasma vitamin C levels were associated with higher pulmonary function.
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• an increase of 1 mg/day in vitamin E intake was related to increases of 42 ml in FEV, and 54 ml in forced vital capacity
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• 2 studies confirmed the positive association between FEV, and antioxidant nutrients, particularly vitamin E, vitamin C, and some carotenoids
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• long-term vitamin C intake is significantly related to lung function.
• A real association between fresh fruit consumption and lung function
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Fish oil
• In a cross sectional analysis of data from the Atherosclerosis Risk in Communities (ARIC) Study, which was conducted among 9,000 male smokers aged 45-64 years, results suggested that dietary fish intake had a protective effect on COPD risk.
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• Among 6,346 male smokers aged 45-68 years, after adjustment for cigarettes per day, age, height, and daily caloric intake, these authors found FEV, to be higher among subjects with a high dietary fish intake than among those with a low fish intake.
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SUMMARY
• the impact of nutrition on obstructive lung disease is most evident for antioxidant vitamins, particularly vitamin C and, to a lesser extent, vitamin E.
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• vitamin C supplementation : a short-term protective effect on airway responsiveness and pulmonary function.
• to be proven a protective effect on the evolution of chronic asthma.
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• omega-3 fatty acids have aprotective effect against airway hyperreactivity and lung function decrements(uncertain)
• fresh fruit may reduce risk of airway limitation(uncertain)
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• higher levels of oxidative stress, such as cigarette smokers: benefit from dietary supplementation( antioxidant intake )
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• magnesium infusion may have a place in the acute treatment of asthma, but it does not seem to have long-term benefits
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COPD
Daily intake of vitamin C • 60 mg/day among nonsmokers • 100 mg/day among smokers
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Effective method
• increase their daily consumption of fresh fruits and vegetables
• to stop smoking cigarettes• to minimize their environmental and
occupational exposure to pollutants and other agents