Intended for healthcare professionals

CCBYNC Open access

Rapid response to:


Alternate Healthy Eating Index 2010 and risk of chronic obstructive pulmonary disease among US women and men: prospective study

BMJ 2015; 350 doi: (Published 03 February 2015) Cite this as: BMJ 2015;350:h286

Rapid Response:

Varraso, et al. (2015) found that a healthier diet (Alternate Healthy Eating Index 2010) was associated with a lower risk of COPD (1). I found Varraso et al.’s (2015) study fascinating, especially since in my work experience in a nursing home I have seen the toll that COPD takes on individuals and the need to minimize the risk. I found that this study also brought to mind the impact that the environment has on the epigenome. Smoking appears to influence disease risk by its effect on the epigenome (2, 3, 4). It has been speculated that smoking might influence COPD risk in part through epigenetic mechanisms (2, 5). Diet influences the epigenome (6, 7). Dietary components might nudge the epigeome either directly or indirectly through their impact on the gut ecosystem. Whole plant foods, including produce and whole grains, contain phytochemcials that are believed to play roles in epigenetic maintenance (8, 9, 10, 11). Whole plant foods are also important for maintaining a healthy, diverse gut ecosystem (12, 13). In contrast, an overly processed, sugary diet is believed to cause an imbalanced gut ecosystem (13). The gut ecosystem influences the epigenome through chemical signaling which may influence chronic disease risk (14, 15, 16). Thus it seems plausible that diet might influence COPD risk in part through epigenetic mechanisms.

About the author:


(1) Varraso R, Chiuve SE, Fung TT, Barr RG, Hu FB, Willett WC, Camargo CA. Alternate Healthy Eating Index 2010 and risk of chronic obstructive pulmonary disease among US women and men: prospective study. BMJ. 2015 Feb 3;350:h286.

(2) Wan ES, Qiu W, Carey VJ, et al. Smoking Associated Site Specific Differential Methylation in Buccal Mucosa in the COPDGene Study. Am J Respir Cell Mol Biol. 2014 Dec 17. [Epub ahead of print]

(3) Tsaprouni LG, Yang TP, Bell J, et al. Cigarette smoking reduces DNA methylation levels at multiple genomic loci but the effect is partially reversible upon cessation. Epigenetics. 2014;9(10):1382-96.

(4) Ross CM. Letter regarding article by Weitzman et al, "tobacco smoke exposure is associated with the metabolic syndrome in adolescents". Circulation. 2006 Mar 7;113(9):e393

(5) Vucic EA, Chari R, Thu KL, et al. DNA methylation is globally disrupted and associated with expression changes in chronic obstructive pulmonary disease small airways. Am J Respir Cell Mol Biol. 2014 May;50(5):912-22.

(6) Bouchard-Mercier A, Paradis AM, Rudkowska I, et al. Associations between dietary patterns and gene expression profiles of healthy men and women: a cross-sectional study. Nutr J. 2013 Feb 12;12:24.

(7) Palmer JD, Soule BP, Simone BA, et al. MicroRNA expression altered by diet: can food be medicinal? Ageing Res Rev. 2014 Sep;17:16-24.

(8) Yang P, He X, Malhotra A. Epigenetic targets of polyphenols in cancer. J Environ Pathol Toxicol Oncol. 2014;33(2):159-65.

(9) Pan MH, Lai CS, Wu JC, Ho CT. Epigenetic and disease targets by polyphenols. Curr Pharm Des. 2013;19(34):6156-85.

(10) Fardet A. New hypotheses for the health-protective mechanisms of whole-grain cereals: what is beyond fibre? Nutr Res Rev. 2010 Jun;23(1):65-134.

(11) Ross AB, Zangger A, Guiraud SP. Cereal foods are the major source of betaine in the Western diet--analysis of betaine and free choline in cereal foods and updated assessments of betaine intake. Food Chem. 2014 Feb 15;145:859-65.

(12) Tuohy KM, Conterno L, Gasperotti M, Viola R. Up-regulating the human intestinal microbiome using whole plant foods, polyphenols, and/or fiber. J Agric Food Chem. 2012 Sep 12;60(36):8776-82.

(13) Payne AN, Chassard C, Lacroix C. Gut microbial adaptation to dietary consumption of fructose, artificial sweeteners and sugar alcohols: implications for host-microbe interactions contributing to obesity. Obes Rev. 2012 Sep;13(9):799-809.

(14) Remely M, Aumueller E, Merold C, et al. Effects of short chain fatty acid producing bacteria on epigenetic regulation of FFAR3 in type 2 diabetes and obesity. Gene. 2014 Mar 1;537(1):85-92.

(15) Huller MA, Fu BC. Diet, the gut microbiome, and epigenetics. Cancer J. 2014 May-Jun;20(3):170-5.

(16) Kumar H, Lund R, Laiho A, et al. Gut microbiota as an epigenetic regulator: pilot study based on whole-genome methylation analysis. MBio. 2014 Dec 16;5(6).

Competing interests: I write about health issues.

07 February 2015
Celia M. Ross
Wilmington Delaware, USA