Wharton Robert C, Wang Jing Gennie, Choi Yuni, Eisenberg Elliot, Jackson Mariah K, Hanson Corrine, Liu Bian, Washko George R, Kalhan Ravi, Jacobs David R, Bose Sonali
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA.
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Respir Res. 2024 Mar 11;25(1):122. doi: 10.1186/s12931-023-02632-x.
Lung function throughout adulthood predicts morbidity and mortality even among adults without chronic respiratory disease. Diet quality may represent a modifiable risk factor for lung function impairment later in life. We investigated associations between nutritionally-rich plant-centered diet and lung function across early and middle adulthood from the Coronary Artery Risk Development in Young Adults (CARDIA) Study.
Diet was assessed at baseline and years 7 and 20 of follow-up using the validated CARDIA diet history questionnaire. Plant-centered diet quality was scored using the validated A Priori Diet Quality Score (APDQS), which weights food groups to measure adherence to a nutritionally-rich plant-centered diet for 20 beneficially rated foods and 13 adversely rated foods. Scores were cumulatively averaged over follow-up and categorized into quintiles. The primary outcome was lung function decline, including forced expiratory volume in 1 s (FEV) and forced vital capacity (FVC), measured at years 0, 2, 5, 10, 20, and 30. We estimated the association of APDQS with annual pulmonary function changes and cross-sectional differences in a repeated measures regression model, adjusting for clinically relevant covariates.
The study included 3,787 Black and White men and women aged 18-30 in 1985-86 and followed for 30 years. In multivariable repeated measures regression models, individuals in the lowest APDQS quintile (poorest diet) had declines in FEV that were 1.6 ml/year greater than individuals in the highest quintile (35.0 vs. 33.4 ml/year, ß ± SE per 1 SD change APDQS 0.94 ± 0.36, p = 0.009). Additionally, declines in FVC were 2.4 ml/year greater in the lowest APDQS quintile than those in the highest quintile (37.0 vs 34.6 ml/year, ß ± SE per 1 SD change APDQS 1.71 ± 0.46, p < 0.001). The association was not different between never and ever smokers (p = 0.07 for FVC and 0.32 for FEV). In sensitivity analyses where current asthma diagnosis and cardiorespiratory fitness were further adjusted, results remained similar. Cross-sectional analysis at each exam year also showed significant differences in lung function according to diet after covariate adjustment.
In this 30-year longitudinal cohort study, long-term adherence to a nutritionally-rich plant-centered diet was associated with cross-sectional differences in lung function as well as slower decline in lung function, highlighting diet quality as a potential treatable trait supporting long-term lung health.
即使在没有慢性呼吸道疾病的成年人中，整个成年期的肺功能也能预测发病率和死亡率。饮食质量可能是晚年肺功能受损的一个可改变的风险因素。我们通过青年成人冠状动脉风险发展研究（CARDIA研究）调查了成年早期和中期以营养丰富的植物性饮食与肺功能之间的关联。
在基线以及随访的第7年和第20年，使用经过验证的CARDIA饮食史问卷对饮食进行评估。以植物为中心的饮食质量使用经过验证的先验饮食质量评分（APDQS）进行评分，该评分对食物组进行加权，以衡量对20种有益评分食物和13种不利评分食物的营养丰富的植物性饮食的依从性。在随访期间对评分进行累积平均，并分为五分位数。主要结局是肺功能下降，包括在第0、2、5、10、20和30年测量的1秒用力呼气量（FEV）和用力肺活量（FVC）。我们在重复测量回归模型中估计了APDQS与年度肺功能变化以及横断面差异之间的关联，并对临床相关协变量进行了调整。
该研究纳入了1985 - 1986年年龄在18 - 30岁的3787名黑人和白人男性及女性，并随访了30年。在多变量重复测量回归模型中，APDQS五分位数最低（饮食最差）的个体FEV下降比五分位数最高的个体每年多1.6毫升（35.0对33.4毫升/年，APDQS每1个标准差变化的β±SE为0.94±0.36，p = 0.009）。此外，APDQS五分位数最低的个体FVC下降比五分位数最高的个体每年多2.4毫升（37.0对34.6毫升/年，APDQS每1个标准差变化的β±SE为1.71±0.46，p < 0.001）。从不吸烟者和曾经吸烟者之间的关联没有差异（FVC为p = 0.07，FEV为p = 0.32）。在进一步调整当前哮喘诊断和心肺健康状况的敏感性分析中，结果仍然相似。在每个检查年份的横断面分析中，经协变量调整后，根据饮食情况肺功能也存在显著差异。
在这项为期30年的纵向队列研究中，长期坚持营养丰富的植物性饮食与肺功能的横断面差异以及肺功能下降较慢有关，突出了饮食质量作为支持长期肺部健康的潜在可治疗特征。
