vital.ly Education | Factors affecting the gut-lung axis

Factors affecting the gut-lung axis

23rd Sep, 2019

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Nutritional factors affecting the gut-lung axis
Dietary factor	Effects on gut-lung axis
Dietary fibre	Dietary fibre and resistant starch increase Roseburia, Ruminococcus and Eubacterium resulting in increased butyrate production. Dietary fibre reduces inflammation and shows beneficial effects in asthma, cystic fibrosis and COPD (1,2,3) Fibre-rich diets are associated with better lung function and decreased risk of lung disorders. The beneficial effect of fibre on lung function is clinically more significant in smokers (4) A healthy diet can lead to 33% decreased risk of COPD and a high fibre diet leads to a reduction in mortality from respiratory disease (4) A high fibre diet changes not only the intestinal microbiota but also affects the lung microbiota and lung immunity. Dietary fibre increases short-chain fatty acid (SCFA) levels in the blood, providing protection against airway inflammation in the lungs through the induction of T regulatory cells (5,6,7)
Saturated fat	Dysbiosis resulting from saturated fat results in reduced SCFA levels which enhances lung inflammation in response to allergens or infections (7,8,9)
Prebiotics, probiotics & synbiotics	Administration of probiotics in cystic fibrosis may improve clinical respiratory as well as GI outcomes (10,11,12). For example, L. reuteri (1 tablet per day containing 100 million CFU) significantly decreases intestinal inflammation and digestive discomfort (13). Probiotic administration over 6 months (2 tablets per day, each containing 6 billion CFU L. acidophilus, L. bulgaricus, B. bifidum and Streptococcus thermophiles) results in a reduction in pulmonary exacerbations rate (16). In children, one month of probiotic treatment (2 capsules per day each containing 1 billion CFU L. casei, L. rhamnosus, Streptococcus thermophilus, B. breve, L. acidophilus, B. infantis and L. bulgaricus) results in a decline in pulmonary exacerbations in children (14) Prebiotics and probiotics may be useful in treating asthma. For example, in children aged 6-14 with mild persistent asthma with L. reuteri for 60 days reduces bronchial inflammation (7,22). Supplementation with L. gasseri (2 capsules per day each containing 2 billion cells/capsule for 8 weeks) improves pulmonary function and symptoms in school children (23) Synbiotics hold promise to suppress allergic responses and asthmatic inflammation when used in conjunction with other immunotherapies. The efficacy of synbiotics is age-dependent and transient, and may require continuous use (7). Synbiotic supplementation (L. salivarius or B. breve and GOS/FOS) significantly improves lung function in children with asthma while reducing asthma-like symptoms and the use of medications (24,25)
Omega 3	Omega-3 fatty acid intake increases Roseburia, Ruminococcus and Eubacterium species in the gut resulting in increased butyrate production and reduced inflammation. Omega-3 has been shown to ameliorate asthma, pneumonia and COPD (8,26,27,28)
Western diet	A diet high in animal protein, saturated and trans fat and low in fibre results in decreased Bifidobacteria and Eubacterium species, reducing SCFA levels and increasing inflammation (8)
Flavonoids	Evidence is emerging that non-nutrient dietary constituents such as flavonoids can influence gut microbiota composition. Gallocatechin from black tea consumption is associated with changes in gut microbiota in cystic fibrosis (29)

1	Kan H, Stevens J, Heiss G, Rose KM, London SJ. Dietary fiber, lung function, and chronic obstructive pulmonary disease in the atherosclerosis risk in communities study. Am J Epidemiol. 2008 Mar 1;167(5):570–8.
2	Maier TV, Lucio M, Lee LH, VerBerkmoes NC, Brislawn CJ, Bernhardt J, et al. Impact of Dietary Resistant Starch on the Human Gut Microbiome, Metaproteome, and Metabolome. MBio. 2017 17;8(5).
3	Sagar S, Vos AP, Morgan ME, Garssen J, Georgiou NA, Boon L, et al. The combination of Bifidobacterium breve with non-digestible oligosaccharides suppresses airway inflammation in a murine model for chronic asthma. Biochim Biophys Acta. 2014 Apr;1842(4):573–83.
4	Varraso R, Chiuve SE, Fung TT, Barr RG, Hu FB, Willett WC, et al. Alternate Healthy Eating Index 2010 and risk of chronic obstructive pulmonary disease among US women and men: prospective study. BMJ. 2015 Feb 3;350.
5	Gray LEK, O’Hely M, Ranganathan S, Sly PD, Vuillermin P. The Maternal Diet, Gut Bacteria, and Bacterial Metabolites during Pregnancy Influence Offspring Asthma. Front Immunol. 2017 Mar 31;8.
6	Halnes I, Baines KJ, Berthon BS, MacDonald-Wicks LK, Gibson PG, Wood LG. Soluble Fibre Meal Challenge Reduces Airway Inflammation and Expression of GPR43 and GPR41 in Asthma. Nutrients. 2017 Jan 10;9(1).
7	McAleer JP, Kolls JK. Contributions of the intestinal microbiome in lung immunity. Eur J Immunol. 2018;48(1):39–49.
8	Singh RK, Chang H-W, Yan D, Lee KM, Ucmak D, Wong K, et al. Influence of diet on the gut microbiome and implications for human health. J Transl Med. 2017 08;15(1):73.
9	Statovci D, Aguilera M, MacSharry J, Melgar S. The Impact of Western Diet and Nutrients on the Microbiota and Immune Response at Mucosal Interfaces. Front Immunol. 2017;8:838.
10	Ananthan A, Balasubramanian H, Rao S, Patole S. Probiotic supplementation in children with cystic fibrosis-a systematic review. Eur J Pediatr. 2016 Oct;175(10):1255–66.
11	Anderson JL, Miles C, Tierney AC. Effect of probiotics on respiratory, gastrointestinal and nutritional outcomes in patients with cystic fibrosis: A systematic review. J Cyst Fibros. 2017 Mar;16(2):186–97.
12	Nikniaz Z, Nikniaz L, Bilan N, Somi MH, Faramarzi E. Does probiotic supplementation affect pulmonary exacerbation and intestinal inflammation in cystic fibrosis: a systematic review of randomized clinical trials. World J Pediatr. 2017 Aug;13(4):307–13.
13	del Campo R, Garriga M, Pérez-Aragón A, Guallarte P, Lamas A, Máiz L, et al. Improvement of digestive health and reduction in proteobacterial populations in the gut microbiota of cystic fibrosis patients using a Lactobacillus reuteri probiotic preparation: a double blind prospective study. J Cyst Fibros. 2014 Dec;13(6):716–22.
14	Jafari S-A, Mehdizadeh-Hakkak A, Kianifar H-R, Hebrani P, Ahanchian H, Abbasnejad E. Effects of Probiotics on Quality of Life in Children with Cystic Fibrosis; A Randomized Controlled Trial. Iran J Pediatr. 2013 Dec;23(6):669–74.
15	Bruzzese E, Callegari ML, Raia V, Viscovo S, Scotto R, Ferrari S, et al. Disrupted Intestinal Microbiota and Intestinal Inflammation in Children with Cystic Fibrosis and Its Restoration with Lactobacillus GG: A Randomised Clinical Trial. PLoS One. 2014 Feb 19;9(2).
16	Weiss B, Bujanover Y, Yahav Y, Vilozni D, Fireman E, Efrati O. Probiotic supplementation affects pulmonary exacerbations in patients with cystic fibrosis: a pilot study. Pediatr Pulmonol. 2010 Jun;45(6):536–40.
17	Toh ZQ, Anzela A, Tang MLK, Licciardi PV. Probiotic Therapy as a Novel Approach for Allergic Disease. Front Pharmacol. 2012 Sep 21;3.
18	Fiocchi A, Pawankar R, Cuello-Garcia C, Ahn K, Al-Hammadi S, Agarwal A, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics. World Allergy Organ J. 2015 Jan 27;8(1).
19	Cuello-Garcia CA, Fiocchi A, Pawankar R, Yepes-Nuñez JJ, Morgano GP, Zhang Y, et al. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Prebiotics. World Allergy Organ J. 2016 Mar 1;9.
20	Williams NC, Johnson MA, Shaw DE, Spendlove I, Vulevic J, Sharpe GR, et al. A prebiotic galactooligosaccharide mixture reduces severity of hyperpnoea-induced bronchoconstriction and markers of airway inflammation. Br J Nutr. 2016 Sep;116(5):798–804.
21	Konieczna P, Groeger D, Ziegler M, Frei R, Ferstl R, Shanahan F, et al. Bifidobacterium infantis 35624 administration induces Foxp3 T regulatory cells in human peripheral blood: potential role for myeloid and plasmacytoid dendritic cells. Gut. 2012 Mar;61(3):354–66.
22	Miraglia Del Giudice M, Maiello N, Decimo F, Fusco N, D’ Agostino B, Sullo N, et al. Airways allergic inflammation and L. reuterii treatment in asthmatic children. J Biol Regul Homeost Agents. 2012 Mar;26(1 Suppl):S35-40.
23	Chen Y-S, Jan R-L, Lin Y-L, Chen H-H, Wang J-Y. Randomized placebo-controlled trial of lactobacillus on asthmatic children with allergic rhinitis. Pediatr Pulmonol. 2010 Nov;45(11):1111–20.
24	Lee S-C, Yang Y-H, Chuang S-Y, Huang S-Y, Pan W-H. Reduced medication use and improved pulmonary function with supplements containing vegetable and fruit concentrate, fish oil and probiotics in asthmatic school children: a randomised controlled trial. Br J Nutr. 2013 Jul 14;110(1):145–55.
25	van der Aa LB, van Aalderen WMC, Heymans HSA, Henk Sillevis Smitt J, Nauta AJ, Knippels LMJ, et al. Synbiotics prevent asthma-like symptoms in infants with atopic dermatitis. Allergy. 2011 Feb;66(2):170–7.
26	Costantini L, Molinari R, Farinon B, Merendino N. Impact of Omega-3 Fatty Acids on the Gut Microbiota. Int J Mol Sci. 2017 Dec 7;18(12).
27	Gold DR, Litonjua AA, Carey VJ, Manson JE, Buring JE, Lee I-M, et al. Lung VITAL: Rationale, design, and baseline characteristics of an ancillary study evaluating the effects of vitamin D and/or marine omega-3 fatty acid supplements on acute exacerbations of chronic respiratory disease, asthma control, pneumonia and lung function in adults. Contemp Clin Trials. 2016 Mar;47:185–95.
28	Watson H, Mitra S, Croden FC, Taylor M, Wood HM, Perry SL, et al. A randomised trial of the effect of omega-3 polyunsaturated fatty acid supplements on the human intestinal microbiota. Gut. 2018;67(11):1974–83.
29	Li L, Somerset S. Associations between Flavonoid Intakes and Gut Microbiota in a Group of Adults with Cystic Fibrosis. Nutrients. 2018 Sep 7;10(9).