Dairy and nondairy beverage consumption for childhood atopic eczema: what health advice to give?

Impact of Replacing Soft Drinks with Dairy Products on Micronutrient Intakes of Chinese Preschool Children: A Simulation Study

At present, energy surplus and micronutrient deficiency coexist in preschool children in China. The low intake of dairy products accompanied by an increased consumption of soft drinks in this age group reveals some of the reasons for this phenomenon. The purpose of this study was to evaluate the improvement of key micronutrients in preschool children by quantifying the dietary nutritional gap before and after simulating the use of dairy products instead of equal amounts of soft drinks. In the cross-sectional dietary intake survey of infants and young children in China (2018-2019), 676 preschool children aged 3-6 years were randomly selected. Four days of dietary data were collected through an online diary for simulation. The individual intake of soft drinks was substituted at a corresponding volume by soymilk, cow's milk, or formulated milk powder for preschool children (FMP-PSC). In these three models, the simulated nutrient intake and nutrient inadequacy or surplus were compared with the actual baseline data of the survey. The results of this study indicated that all three models made the nutrient intakes of this group more in line with the recommendations. For the whole population, the replacement of soymilk improved the intake of zinc (from 4.80 to 4.85 mg/d), potassium (from 824.26 to 836.82 mg/d), vitamin A (from 211.57 to 213.92 μg retinol activity equivalent/d), and vitamin B9 (from 115.94 to 122.79 μg dietary folate equivalent/d); the simulation of cow's milk improved the intake of calcium (from 311.82 to 330.85 mg/d), zinc (from 4.80 to 4.87 mg/d), potassium (from 824.26 to 833.62 mg/d), vitamin A (from 211.57 to 215.12 μg retinol activity equivalent/d), vitamin B2 (from 0.53 to 0.54 mg/d), and vitamin B12 (from 1.63 to 1.67 μg/d); and the substitution of FMP-PSC improved the intake of calcium (from 311.82 to 332.32 mg/d), iron (from 9.91 to 9.36 mg/d), zinc (from 4.80 to 4.96 mg/d), potassium (from 824.26 to 828.71 mg/d), vitamin A (from 211.57 to 217.93 μg retinol activity equivalent/d), vitamin B2 (from 0.53 to 0.54 mg/d), vitamin B9 (from 115.94 to 118.80 μg RA dietary folate equivalent/d), and vitamin B12 (from 1.63 to 1.70 μg/d). Therefore, correct nutritional information should be provided to parents and preschool children. In addition to changing the consumption behavior of soft drinks, it is also necessary to have a diversified and balanced diet. When necessary, the use of food ingredients or nutritional fortifiers can be encouraged.

Atopic Dermatitis and Water: Is There an Optimum Water Intake Level for Improving Atopic Skin?

Water is a vital nutrient with innumerable functions for every living cell. The functions of human skin include protection against dehydration of the body. Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease that presents with dry skin, erythematous and eczematous lesions, and lichenification. This paper discusses the question of whether extra water intake in children with AD affects skin hydration and the skin barrier function. Among the methods used to treat dry skin, topical leave-on products are the first-line treatment, intended to improve hydration and the skin barrier function. The effectiveness of adequate water intake as a measure to treat dry skin is still under debate. Normal skin hydration increases with dietary water intake, particularly in those with prior lower water consumption. Skin dryness in AD is instrumental to the itch and inflammation cycle, contributing to barrier impairment and aggravating disease severity and flares. Certain emollients provide significant hydration to AD skin, with relief of dryness and reduction in barrier impairment, disease severity, and flares. Further investigations are needed to evaluate the optimum water intake levels in children with AD, as important questions remain unanswered, namely, does oral hydration provide relief of skin dryness and reduce barrier impairment, disease severity, and flares; is there any additional benefit from using mineral or thermal spring water; or is there a need to specifically study the fluid/water intake in children with AD and food allergy (FA) restrictions?

Quality of life in atopic dermatitis in Asian countries: a systematic review

Atopic dermatitis (AD) is a common chronic inflammatory skin condition which impacts psychological wellbeing and social relationships. There have been studies of AD's impact on quality of life (QoL) in Western countries, but these findings cannot be directly extrapolated to Asian populations with genetic, environmental and cultural differences. Therefore, we aimed to systematically review the literature pertaining to QoL impairment in AD in East and Southeast Asia to characterize the impact of AD on patients and their families, and to identify the factors affecting the degree of QoL impairment. A search of English language papers was conducted on MEDLINE, EMBASE, PSYCInfo, Global Health and Web of Science. Observational studies measuring QoL using single or multi-item instruments in people with self-reported or physician diagnosed atopic dermatitis were included. 27 studies from 29 articles were included and synthesized. There is data documenting QoL impairment in AD sufferers and their families, across a wide range of Asian countries, healthcare settings and ages. Aspects of QoL impacted to a greater extent included symptoms of itch, feelings of embarrassment, and sleep disturbance. Severity of disease affects the degree of impairment of QoL, but there is no apparent link between QoL impairment and patient demographic factors, or other medical factors such as age at diagnosis or duration of illness. Our findings also highlighted the need for clinicians to actively explore the impact of patient's symptoms, especially in an Asian context where healthcare communications are traditionally doctor-centric.

Calcium Intake in Children with Eczema and/or Food Allergy: A Prospective Cohort Study

Eczema and food allergy may impact diet. Using data from a cohort of Manitoba children born in 1995, we examined calcium intake, defined as the frequency and quality of calcium products consumed (with the exception of cheese), amongst Manitoba adolescents (12-14 years) with eczema or food allergy in childhood (7-8 years) or adolescence. At both ages, children were assessed by a physician for eczema and food allergy. Adolescents completed food frequency questionnaires. Calcium intake was defined as 1+ vs. <1 weekly. Linear and logistic regression was used as appropriate, with adjustments for confounders. Overall, 468 adolescents were included, of whom 62 (13.3%) had eczema only in childhood, 25 (5.3%) had food allergy only, and 26 (5.6%) had eczema and food allergy. Compared to children without eczema, those with eczema only had poorer calcium intake in adolescence (β -0.44; 95%CI -0.96; 0.00). Girls, but not boys, with eczema in childhood had poorer calcium intake in adolescence than girls without eczema (β -0.84; 95%CI -1.60; -0.08). These patterns persisted even if children experienced transient vs. persistent eczema to adolescence. Similar but non-significant trends were found for food allergy. Childhood eczema is associated with significantly lower calcium intake and consumption in adolescence. These differences persist to adolescence, even if a child "outgrows" their allergic condition.

Association of frequent intake of fast foods, energy drinks, or convenience food with atopic dermatitis in adolescents

PURPOSE

Specific food consumption, besides food allergy, may aggravate atopic dermatitis (AD). However, previous reports on the association between AD and food intake in adolescents are scarce. The aim of this study was to determine the relationship between AD and specific food consumption frequency in adolescents.

METHODS

A cross-sectional analysis using data from the Korea Youth Risk Behavior Web-based Survey 2017 was performed. The frequency of food consumption in the recent-diagnosed AD group (AD diagnosed within 12 months) compared to those in the previous-diagnosed AD (AD diagnosed more than 12 months ago) or control group were investigated.

RESULTS

A total of 53,373 participants were eligible for this study. The weighted prevalence of the recent-diagnosed AD and the previous-diagnosed AD was 7.39% and 18.00%, respectively. When compared with subjects with the previous-diagnosed AD, those with the recent-diagnosed AD were significantly more likely to frequently consume fast foods (odds ratio OR 1.405; 95% CI 1.150-1.717), energy drinks (OR 1.457; 95% CI 1.175-1.807), or convenience food (OR 1.304; 95% CI 1.138-1.495). Patients of the recent-diagnosed AD were significantly more likely to frequently consume fast foods (OR 1.374; 95% CI 1.155-1.634) than the control group. The differences in the frequency of specific food consumption among groups were more pronounced in high school students than in middle school students.

CONCLUSIONS

Frequent intake of fast foods, energy drinks, and convenience food was related to the recent-diagnosed AD in adolescents. Prospective cohort and interventional studies are needed to identify causal relationships.

Patient impact and economic burden of mild-to-moderate atopic dermatitis

OBJECTIVE

To present a systematic review of studies conducted to evaluate patient impact and economic burden of mild-to-moderate atopic dermatitis.

METHODS

A MEDLINE (via PubMed), Excerpta Medica database (Embase), and Cochrane Library search for English-language articles published January 1, 1996-December 31, 2016 was performed. Abstracts were manually reviewed from 2015-2016 from 10 leading conferences and congresses associated with atopic dermatitis. Manuscripts were reviewed for inclusion in two main categories within the review: patient impact of mild-to-moderate atopic dermatitis and economic burden of atopic dermatitis. Excluded from this dataset were any patients in these studies who had severe atopic dermatitis, moderate-to-severe atopic dermatitis, or atopic dermatitis of unspecified severity.

RESULTS

In total, 222 studies qualified for inclusion in the analysis; this report focuses on the 76 studies that reported results stratified by disease severity. Measured by general and specific instruments, even mild-to-moderate atopic dermatitis reduces the overall quality-of-life of patients and their caregivers/families. Disease severity assessed by validated severity instruments directly correlated with quality-of-life. Treatment of atopic dermatitis can improve the quality-of-life of patients and their caregivers/families by alleviation of symptoms and reduction in severity. In general, total costs increased as disease severity increased; even mild atopic dermatitis imposed substantial costs.

CONCLUSIONS

The results emphasize the impact of atopic dermatitis, especially mild atopic dermatitis, on patient lives and finances, including education of clinicians, payers, and patients regarding benefits associated with treatment adherence.