Nutrition Bar Improves Lung Function in Patients With Both Obesity, Asthma

Obesity is a characteristic in 40% of patients with asthma, with most of the cases categorized as less-eosinophilic inflammation than nonobese asthma patients. Diet is part of the reason why obesity is prevalent in asthma. Western diets composed of high calorie, sugar, salt, and unhealthy fats lead to metabolic dysregulation, chronic inflammation, and weak antioxidant defenses, factors commonly seen in asthma.

There have been many studies that have shown improvements in asthma control and quality of life after exercise, weight loss, and a transition to a healthier diet, such as the Mediterranean diet. However, lung function was 1 end point that did not improve even after modifying these factors. The CHORI-Bar, a fiber dense nutritional bar similar in composition to foods from the Mediterranean diet, already has data on its beneficial effects on metabolic dysfunction in healthy-obese patients.

The purpose of the Supplemental Nutrition in Asthma Control pilot study (SNAC) was to determine if the CHORI-Bar affected asthma control, lung function, and quality of life (QOL) in patients with asthma who are obese adolescent, asthma patients.

Fifty-six patients were randomized to either receive the CHORI-Bar twice a day or nothing. Both groups had weekly exercise and nutritional classes. QOL was determined through questionnaires (asthma control test [ACT], pediatric quality of life [PedsQL], pediatric quality of life-asthma module [PedsQL-AM], pediatric asthma score [PAS], while lung function was measured through forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), and predicted forced expiratory flow between 25% to 75% of FVC (FEF, 25%-75%).

After a 2-month period, heart rate (P = .0036), insulin (P = .008), and homeostatic model assessment- insulin resistance (P = .011) were all significantly lower in the control group. Significant differences observed in both groups included triglyceride levels, very low-density lipoproteins, and questionnaire-based measures on ACT, PedsQL, PedsQL-AM. However, these findings could also be attributed to exercise. Patients who ate the CHORI-bar did have increased lung function measures, but they were not significant.

A follow-up subgroup analysis was done for patients with noneosinophilic asthma (fractional exhaled nitric oxide [FENO] <50 parts per billion) to determine if there were significant lung function changes in this population. The CHORI-Bar group had significantly (P < .05) improved lung function measures within the group of FVC% (+2.84%) and FEV₁% (+3.68%), while the control group did not (FVC%, +0.87%; FEV₁%, —0.26%).

This subgroup analysis helped determine that CHORI-Bars mainly benefited lung function in obese patients with asthma categorized as noneosinophilic.

Inflammation was another factor that has been shown to diminish the response of CHORI-Bars. In this study, the biomarker high specific C-reactive protein (hsCRP) was used to determine inflammation. After categorizing the patients with respect to inflammation, investigators observed that lower hsCRP level in the CHORI-Bar group had significantly better improvements in lung function. This observation was not seen in the control group.

From this study, CHORI-Bars seem to have a beneficial effect on lung function in patients with noneosinophilic, low-inflammation asthma and obesity. Similar results for QOL improvements in both groups may be contributory to exercise or nutritional classes provided to all patients. Because this study had a minimal number of participants, future studies are needed to substantiate the results that this study provided.

Reference

Bseikri M, Mccann JC, Lal A, et al. A novel nutritional intervention improves lung function in overweight/obese adolescents with poorly controlled asthma: the Supplemental Nutrition in Asthma Control (SNAC) pilot study [published online July 19, 2018]. FASEB J. doi:10.1096/fj.201700338.