Dietary patterns contribute to chronic diseases, lung health

Key takeaways:

• Oncology, cardiology and endocrinology organizations have nutrition guidelines for disease prevention.
• Diet has a direct and indirect impact on lung health.
• SMART goals can help improve food choices.

Editor’s Note: This is part one of a two-part Healio Exclusive series on nutrition and lung health. Part two will be linked here once published.

Every specialty needs to acknowledge diet because nutrition affects every part of the body.

“Our food choices can have a positive and negative impact on our health, including contributing to chronic diseases,” Mariah K. Jackson, PhD, RDN, LMNT, assistant professor in the medical nutrition program in the College of Allied Health Professions at the University of Nebraska Medical Center, told Healio.

“There is no one food that causes or prevents disease, but an overall diet pattern consumed over time does contribute to our health status,” she said.

Food choices, multiple areas of health linked

Knowing the wide impact food can have, Kathleen Garcia-Benson, RDN, CSSD, LD, NASM-CPT, NBC-HWC, registered dietitian specializing in PCOS/women’s health, sports nutrition and digestive health at Top Nutrition Coaching, emphasized the importance of establishing a strong nutritional foundation in both those with and without disease.

Kathleen Garcia-Benson

“If we can have a foundation that is nourishing and prioritizes nutrient dense foods, that can help in so many different ways with inflammation, balancing blood sugar levels and digestive health,” Garcia-Benson told Healio.

For different types of health, Garcia-Benson said individuals may want to focus on specific building blocks within this foundation. One example of this is prioritizing omega-3 fatty acids found in fish, nuts and seeds and fiber found in fruits, vegetables, legumes and whole grains to aid in heart health.

According to the 2025 U.S. News & World Report ranking of the best diets for a heart-healthy lifestyle, heart-healthy diets are composed of whole foods high in fiber, lean protein and healthy fats, with reduced levels of sodium, unhealthy fats and added sugars. The top five diets included:

• Dietary Approaches to Stop Hypertension (DASH) diet;
• Mediterranean diet;
• Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet;
• vegan diet; and
• flexitarian diet.

In terms of eye health, Garcia-Benson told Healio it is important to achieve a balanced blood sugar.

As Healio previously reported, a study in Nutrients by José Francisco López-Gil, PhD, and colleagues found that higher consumption of ultraprocessed foods, particularly sweets, was associated with an increased risk for glaucoma.

Foods rich in beta-carotene (a precursor to vitamin A), such as carrots and sweet potatoes, as well as omega-3s are recommended for eye health, according to Garcia-Benson.

“Omega-3s can be supportive for vision and help with reducing the risk of those conditions we think of with eye health concerns like macular degeneration and anything that might come as a side effect from uncontrolled diabetes,” she said.

For skin health, Garcia-Benson noted that she focuses on foods that aid in hydration and collagen production.

“Healthy fats, like avocados and olive oil, can help with moisture [and] healthy skin elasticity,” she told Healio.

“Vitamin C [and] vitamin E — those are going to be from plants, nuts and seeds — can be really helpful to collagen production,” Garcia-Benson added.

Notably, Steve Daveluy, MD, recently gave a presentation at the American Academy of Dermatology Annual Meeting in which he highlighted the benefits diet brings to patients being treated for skin disease.

According to Daveluy, patients with skin disease adhering to a proper diet may experience better treatment responses and a reduced risk for adverse events. He highlighted that patients with psoriasis treated with tumor necrosis factor inhibitors should adhere to a Mediterranean diet, and patients with melanoma treated with immune checkpoint inhibitors should increase their fiber intake.

When working to regulate digestive health, foods with fiber and fermented foods are beneficial, Garcia-Benson said.

“There’s so much focus on protein in social media, but fiber is next,” Garcia-Benson told Healio. “More people are talking about it, and I think for good reason because it is so helpful and beneficial for digestive health, especially with concerns about colon cancer increases and issues like loose stools and constipation.”

In addition to the body, nutrition also impacts the mind. Garcia-Benson recommends foods rich in omega-3s, magnesium and vitamin D for mental health, as well a sufficient intake of fat, carbohydrates and protein.

“It’s not to say that if someone is having some mental challenges, that when you give them vitamin D or magnesium that they’re going to be cured or anything,” Garcia-Benson said. “It’s just that if there is a deficiency going on, that can make those symptoms that much more of a challenge.”

Notably, the link between food and health/chronic disease prevention has been recognized in several specialties via guidelines, Jackson told Healio.

Some of the organizations and associations that have released guidelines include the American Institute of Cancer Research/World Cancer Research Fund, the American Heart Association and the American Diabetes Association.

“A common thread among these recommendations is that high fiber, nutrient-rich diets can lower the risk of chronic diseases,” Jackson told Healio. “While exact mechanisms are still being uncovered, a nutrient-rich plant-based diet can affect our gut microbiome in ways that ultimately decrease inflammation in our bodies.”

Jackson further highlighted that the American Institute for Cancer Research has a webpage showcasing 10 recommendations for cancer prevention. These recommendations “also are a great start for heart disease, diabetes and lung health,” Jackson said.

Food choices, lung health

Although there are no established guidelines on food choices for lung disease prevention, Robert Wharton, MD, pulmonary and critical care fellow at Johns Hopkins Hospital, told Healio there is evidence that food choices have a direct impact on lung inflammation.

Robert Wharton

“We know that plant-centered diets that are rich in fruits and vegetables contain antioxidants like vitamin C, flavonoids and proteinoids that attenuate oxidative stress and may play a role in the pathogenesis of, for example, COPD,” Wharton said. “Dietary fiber has also been shown to be anti-inflammatory, and diets higher in fiber have been shown to improve lung function over time.

“Vitamin C and anthocyanins, which are found in berries, are also linked to better lung function in humans, and omega-3 fatty acids have been shown to reduce asthma exacerbations,” Wharton continued.

In a longitudinal study conducted by Wharton and colleagues, annual lung function decline rates were lower in adults who had high adherence to a plant-centered diet.

This study included 3,787 adults without disease from the Coronary Artery Risk Development in Young Adults (CARDIA) study, and analysis took place over 30 years to uncover how a plant-centered diet impacted lung function over early and middle adulthood.

“We used A Priori Diet Quality Score (ADPQS), which gives a score to each of 46 food groups,” Wharton told Healio. “Fruits, vegetables, whole grains and nonfried fish and poultry are scored positively, whereas refined grains and red and processed meats are scored negatively. Some other foods with less certainty of evidence are rated as neutral.”

Compared with individuals with the lowest quintile of scores, researchers found those in the highest quintile had lower yearly reductions in FEV₁ (35 mL vs. 33.4 mL; P = .009) and FVC (37 mL vs. 34.6 mL; P < .001).

“Participants with the healthiest diet had small but measurable improvements relative to the worst diet in lung function over time, and that was true even after accounting for some confounders like age, smoking, socioeconomic status [and] the total amount of energy we’re taking in,” Wharton told Healio.

On a similar wavelength, a study published in American Journal of Respiratory and Critical Care Medicine found that higher levels of omega-3 fatty acids promoted lung health by lowering the rate of yearly lung function decline in healthy adults.

It is important to note that “nutrient levels do not quite capture the full benefits of consuming nutrient-rich whole foods,” Wharton told Healio.

For example, a study published in CHEST by John D. Brannan, PhD, and colleagues found that using omega-3 supplements yielded no improvements in lung function, asthma symptoms, asthma control or quality of life during a 3-week treatment period for patients with asthma.

“This study demonstrates that a high daily dose of an omega-3 fatty acid supplement has no effect on either [bronchial hyperresponsiveness] to mannitol or sputum eosinophil percentage in subjects with mild to moderate asthma in association with no changes in asthma symptom control,” Brannan and colleagues wrote.

Indirect impact of diet on lung health

In addition to the direct impact of diet on lung health, diet can also impact other factors that are important to track in patients with lung diseases, such as weight loss/gain and exercise tolerance, Wharton told Healio.

“From having a healthier diet, that gives you more energy and/or allows you to lose weight, so you’re able to exercise more and build muscle mass,” Wharton said. “Those muscles include the respiratory muscles, such as the diaphragm.”

According to Wharton, examples showcasing the benefits of exercise specifically in patients with lung diseases can be found in studies on pulmonary rehabilitation.

In a retrospective, inception cohort study published in JAMA, researchers found that the risk for all-cause mortality at 1 year among patients hospitalized for COPD went down when they started pulmonary rehabilitation within 90 days of discharge.

Another study, published in Annals of the American Thoracic Society, reported that pulmonary rehabilitation yielded better exercise capacity and quality of life vs. usual care in patients with COPD hospitalized with acute exacerbations.

When thinking about the indirect associations of diet and lung health, Wharton told Healio clinicians should also consider the role of socioeconomic factors, as these could have a negative impact on patients’ food choices and health.

“It’s important to recognize that people who have lower educational attainment or lower income often live in areas where they have very poor access to food, like food deserts or food swamps,” Wharton said.

This poor access to healthy foods can then lead to poor health outcomes. As Healio previously reported, people living in historically redlined neighborhoods with poor access to healthy foods were more likely to have type 2 diabetes, hypertension, coronary heart disease and obesity.

Additionally, research has shown that children living in a household that reportedly ran out of food faced heightened odds for asthma and signs of wheezing with exercise.

Working with patients to improve food choices

When asked how clinicians can work with patients to improve their food choices, Wharton recommended the 24-hour diet recall.

Through this exercise, “you can learn a lot about how people are thinking (or not thinking) about their diet,” Wharton told Healio.

Rather than solely focusing on the unhealthy foods the patient says they ate in the last 24 hours, Wharton suggests paying attention to their healthy food choices.

“People are always trying to cut XYZ out of their diet, but I find that to be kind of mean and unrealistic,” Wharton told Healio.

“It’s helpful to think about eating more of the things that you like and that are healthy, rather than trying to cut things out,” he said.

According to Wharton, the key is to pull out the healthy/beneficial foods the patient is already eating and encourage them to eat more of it.

“Find things that they’re doing well and build on them,” he said.

Clinicians can also help patients improve their food choices through specific, measurable, achievable, relevant and time-bound (SMART) goals, Wharton told Healio.

“People are not good at making sudden, drastic changes,” Wharton said. “People are much better making small, consistent changes and then feeling good about themselves when they’re able to stick with the change.”

Wharton said eating at least one vegetable every day for a week or not eating dessert one day a week are some examples of these types of goals.

“[Goals] can be something that you brainstorm with your patient depending on what kinds of things they usually eat, what their cultural background is [and] what they know how to cook,” Wharton said.

References:

• American Diabetes Association: Tips for eating well. Accessed April 3, 2025.
• American Institute for Cancer Research: How to prevent cancer: 10 recommendations. Accessed April 3, 2025.
• American Institute for Cancer Research: Setting your table to prevent cancer. Accessed April 3, 2025.
• Brannan JD, et al. CHEST. 2015;doi:10.1378/chest.14-1214.
• Daveluy S, et al. Pharm to Table: Impact of diet on dermatologic treatments. Presented at: American Academy of Dermatology Annual Meeting; March 7-11, 2025; Orlando.
• Lindenauer PK, et al. JAMA. 2020;doi:10.1001/jama.2020.4437.
• López-Gil JF, et al. Nutrients. 2024;doi:10.3390/nu16071053.
• Mediterranean diet. Reviewed March 7, 2024. Accessed April 2, 2025.
• Moecke DP, et al. Ann Am Thorac Soc. 2023;doi:10.1513/AnnalsATS.202206-545OC.
• Patchen BK, et al. Am J Respir Crit Care Med. 2023;doi:10.1164/rccm.202301-0074OC.
• SMART goals: A how to guide. Accessed April 7, 2025.
• The American Heart Association diet and lifestyle recommendations. Reviewed July 30, 2024. Accessed April 3, 2025.
• Walker R, et al. Abstract MDP440. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2024; Chicago.
• Wharton R, et al. Associations of a plant centered diet and lung function decline across early to mid-adulthood: The Cardia Lung study. Presented at: American Thoracic Society International Conference; May 19-24, 2023; Washington, D.C.
• Ye M, et al. Associations between food insecurity and assistance with asthma and symptomology burden among children in a safety-net practice. Presented at: American Thoracic Society International Conference; May 19-24, 2023; Washington, D.C.
• Zelman K. Best heart-healthy diets. Updated March 19, 2025. Accessed April 7, 2025.

For more information:

Kathleen Garcia-Benson, RDN, CSSD, LD, NASM-CPT, NBC-HWC, can be reached at [email protected].

Mariah K. Jackson, PhD, RDN, LMNT, can be reached at [email protected].

Robert Wharton, MD, can be reached at [email protected].