The Relationship between Dietary Inflammatory Index, Pulmonary Functions and Asthma Control in Asthmatics

  • Ümüş Özbey Department of Nutrition and Diet, Health Science Faculty, Ankara University, Ankara, Turkey
  • Aslı Uçar Department of Nutrition and Diet, Health Science Faculty, Ankara University, Ankara, Turkey
  • Nitin Shivappa Cancer Prevention and Control Program, University of South Carolina, Columbia, U.S.A AND Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, U.S.A
  • James R Hebert Cancer Prevention and Control Program, University of South Carolina, Columbia, U.S.A AND Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, U.S.A
Keywords: Asthma, Diet, Inflammation, Pulmonary function


This cross-sectional study evaluates the relationship of the dietary inflammatory index (DII), a novel tool developed to measure the inflammatory capacity of a diet, with pulmonary functions and asthma control test (ACT) scores in asthmatic individuals. The study included 120 patients who were diagnosed with asthma for at least one year.  The anthropometric measurements, one-day long nutrition uptake records, pulmonary function tests, and ACT scores of the respondents were recorded and compared according to categories of the DII which was calculated from 24- hour recalls. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and ACT scores decreased with increasing DII tertiles (p<0.05). The total energy, carbohydrate, fat, and saturated fat uptake of the participants increased in parallel to DII (p<0.05); while vitamin A, C, and E uptakes, on the other hand, decreased as DII increased (p=0.0001). In conclusion, an increase in the inflammatory potential of diet among asthmatics decreases pulmonary functions and asthma control.


1. Lambrecht B, Hammad H. The immunology of asthma. NatImmunol 2015; 16(1):45-56.
2. Scott HA, Gibson PG, Garg ML, Wood LG. Airway inflammation is augmented by obesity and fatty acids in asthma. Eur Respir J 2011;38(3):594-602.
3. Zein JG, Erzurum SC. Asthma is different in women. Curr Allergy Asthma Rep 20154; 15(6):28.
4. Allan, K., and G Devereux. Diet and asthma: nutrition implications from prevention to treatment. J AmDietAssoc 2015; 111(2):258-68.
5. Boulet LP. Asthma and obesity. ClinExpAllergy 2013; 43(1):8-21.
6. Sideleva O, Suratt BT, Black KE, Tharp WG, Pratley RE, Forgione P, et al. Obesity and asthma: an inflammatory disease of adipose tissue not the airway. Am J Respir Crit Care Med 2012; 86(7):598-605.
7. Rastogi D, Fraser S, Oh J, Huber AM, Schulman Y, Bhagtani RH, et al. Inflammation, metabolic dysregulation, and pulmonary function among obese urban adolescents with asthma. Am J Respir Crit Care Med 2015; 191(2):149-60.
8. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hébert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr 2014;17(8):1689-96.
9. Han YY, Forno E, Shivappa N, Wirth MD, Hébert JR, Celedón JC. The dietary inflammatory index and current wheeze among children and adults in the United States. J Allergy Clin Immunol Pract 2018; 6(3):834-41.
10. Phillips C, Shivappa N, Hébert JR, Perry I. Dietary Inflammatory Index and Biomarkers of Lipoprotein Metabolism, Inflammation and Glucose Homeostasis in Adults. Nutrients 2018; 10(8), 1033.
11. Wirth MD, Shivappa N, Davis L, Hurley TG, Ortaglia A, Drayton R, et al. Construct validation of the dietary inflammatory index among African Americans. J Nutr Health Aging 2017; 21(5):487-91.
12. Wood LG, Shivappa N, Berthon BS, Gibson PG, Hebert JR. Dietaryinflammatoryindex is related to asthma risk, lung function and systemic inflammation in asthma. Clin Exp Allergy 2015; 45(1):177-83.
13. Moxley RT, Pandya S, Ciafaloni E, Fox DJ, Campbell K. Change in natural history of Duchenne muscular dystrophy with long-term corticosteroid treatment: implications for management. J Child Neurol 2010; 25(9):1116-29.
14. Özbey Ü, Uçar A, Çalış AG. The effects of obesity on pulmonary function in adults with asthma. LungIndia: Official Organ of Indian Chest Society 2019; 36(5):404.
15. Pellegrino R1, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretativ estrategies for lung function tests. Eur Respir J 26(5):948-68.
16. Uysal MA, Mungan D, Yorgancıoglu A, Yildiz F, Akgun M, Gemicioglu T. The validation of the Turkish version of asthma control test. Qual Life Res 2013; 22(7):1773-9.
17. Rakıcıoğlu N, Acar N, Ayaz A, Pekcan G. Yemek ve Besin Fotoğraf Kataloğu. 2012. Ankara, Turkey: Ata Ofset Press.
18. Türkiye’ye Özgü Beslenme Rehberi (TÖBR). 2015. T.C. Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü,. 9-62. Ankara.
19. Del Chierico F, Vernocchi P, Dallapiccola B, Putignani L. Mediterranean diet and health: food effects on gut microbiota and disease control. Int J MolSci 2014; 15(7):11678-99.
20. Han YY, Forno E, Holguin F, Celedón JC. Diet and asthma: an update. Curr Opin Allergy Clin Immunol 2015; 15(4):369-74.
21. Wood LG, Garg ML, Smart JM, Scott HA, Barker D, Gibson PG. Manipulating antioxidant intake in asthma: a randomized controlled trial. Am J Clin Nutr 2012; 96(3):534-43.
22. Kanagaratham C, Kalivodova A, Najdekr L, Friedecky D, Adam T, Hajduch M, et al. Fenretinide prevents inflammation and airway hyperresponsiveness in a mouse model of allergic asthma. Am J Respir Cell MolBiol 2014; 51(6):783–92.
23. Li J, Li L, Chen H, Chang Q, Liu X, Wu Y, et al. Application of vitamin e to antagonize swcnts-induced exacerbation of allergic asthma. SciRep 4:4275.
24. McEvoy CT, SchillingClay D, Jackson K, Go MD, Spitale PC Bunten, et al. Vitamin C supplementation for pregnant smoking women and pulmonary function in their newborn infants: A randomized clinical trial. JAMA 2014; 311(20):2074–82.
25. Maisonneuve P, Shivappa N, Hébert JR, Bellomi M, Rampinelli C, Bertolotti R, et al. Dietary inflammatory index and risk of lung cancer and other respiratory conditions among heavy smokers in the COSMOS screening study. Eur J Nutr 2016; 55(3):1069-79.
26. Zhang XJ, Zheng L, Zhang Y, Liu GP, Chen L, Wang G, et al. Systemic inflammation mediates the detrimental effects of obesity on asthma control. Allergy Asthma Proc 2018; 39(1):43–50.
27. Monadi M, Firouzjahi A, Hosseini A, Javadian Y, Sharbatdaran M, Heidari B. Serum C-reactive protein in asthma and its ability in predicting asthma control, a case-control study. Caspian J Intern Med 2016; 7(1):37-42.
28. Leiria LO, Martins MA, Saad MJ. Obesity and asthma: beyond TH2 inflammation. Metabolism 2015;n 64(2):172-81.
29. Nakagome K, Nagata M. Pathogenesis of airway inflammation in bronchial asthma. Auris Nasus Larynx 2011; 38(5):555-63.
30. Özbey Ü, Balaban S, Sözener ZÇ, Uçar A, Mungan D, Mısırlıgil, Z. The effects of diet-induced weight loss on asthma control and quality of life in obese adults with asthma: a randomized controlled trial. J Asthma 2019; 1-9.
31. Lu Y, Van Bever HP, Lim TK, Kuan WS, Goh DY, Mahadevan M. Obesity, asthma prevalence and IL‐4: Roles of inflammatory cytokines, adiponectin and neuropeptide Y. Pediatr Allergy Immunol 2015; 26(6):530-36.
32. Farah CS, Kermode JA, Downie SR, Brown NJ, Hardaker SM, Berend N, Salome CM. Obesity is a determinant of asthma control independent of inflammation and lung mechanics. Chest 2011; 140(3):659-66.
33. Rabec C, De Lucas RP, Veale D. Respiratorycomplications of obesity. Arch Bronconeumol 2011; 47(5):252–61.
34. Steene-Johannessen J, Kolle E, Resel and JE, Anderssen SA, Andersen LB. Waist circumference is related to low-grade inflammation in youth. Int J Pediatr Obes 2010; 5(4):313-9.
35. Freitas PD, Ferreira PG, Silva AG, Stelmach R, Carvalho-Pinto RM, Fernandes FL, et al. The role of exercise in a weight-loss program on clinical control in obese adults with asthma. A randomized controlled trial. Am J Respir Crit Care Med 2017; 195(1):32-42.
36. Garcia‐Marcos L, Castro‐Rodriguez JA, Weinmayr G, et al. Influence of Mediterranean diet on asthma in children: A systematic review and meta‐analysis. Pediatr Allergy Immunol 2013; 24(4):330-8.
37. Wang YI, Schulze J, Raymond N, Tomita T, Tam K, Simon SI, et al. Endothelial inflammation correlates with subject triglycerides and waist size after a high-fat meal. Am J Physiol Heart Circ Physiol 2011; 300(3):H784-91.
38. Wood LG, Li Q, Scott HA, Berthon BS, Gibson PG, Baines KA. Saturated fatty acids, but not n-6 polyunsaturated fatty acids or carbohydrates, increase airway inflammation in non-obese asthmatics. Obesity and Nutrients in Lung Disease 2017;8(2):7467-A7467.
39. Wood LG, Li Q, Scott HA, Rutting S, Berthon BS, Gibson PG, Young P. Saturated fatty acids, obesity and the NLRP3 inflammasome in asthma. J Allergy Clin Immunol 2018; 6749(18):30773-5.
40. Sausenthaler S, Kompaue I, Borte M, Herbarth O, Schaaf B, Berg A, et al. Margarine and butter consumption, eczema and allergic sensitization in children. The LISA birth cohort study. Pediatr Allergy Immunol 2006; 17(2):85-93.
41. Rutting S, Xenaki DE, Lau J, Horvat C, Wood LG, Hansbro PM, et al. Dietary omega-6, but not omega-3 polyunsaturated or saturated fatty acids, increase inflammation in primary lung mesenchymal cells. Am J Physiol Lung Cell Mol Physiol 2018; 314(6): L922–L935.
42. Maslova E, Hansen S, Strom M, Halldorsson TI, Olsen SF. Maternal intake of vitamins a, e and k in pregnancy and child allergic disease: A longitudinal study from the danish national birth cohort. Br J Nutr 2014; 111(6):1096–1108.
How to Cite
Özbey Ümüş, Uçar A, Shivappa N, Hebert JR. The Relationship between Dietary Inflammatory Index, Pulmonary Functions and Asthma Control in Asthmatics. Iran J Allergy Asthma Immunol. :605-614.
Original Article(s)