Influence of Mediterranean diet on asthma in children: a systematic review and meta-analysis

Maternal dietary indexes are not linked to early childhood wheezing or atopic eczema

BACKGROUND

Several recent studies have investigated the association between maternal diet during pregnancy and wheezing or asthma in children. However, whether a specific dietary pattern during pregnancy protects children from wheezing or atopic diseases remains unclear. This study investigated the association between The Alternative Healthy Eating Index for Pregnancy (AHEI-P), the Dietary Inflammatory Index (DII), and the risk for wheezing and atopic eczema in children during the first year of life.

METHODS

This study included 1330 mother-child pairs who attended the Kuopio Birth Cohort (KuBiCo) study and had dietary information during the last trimester and information on children's health in the first year of life. AHEI-P and DII indicate a healthy diet and dietary inflammation potential during pregnancy. The AHEI-P and DII were compared with reported wheezing and doctor-diagnosed atopic eczema in children during the first year of life.

RESULTS

Neither AHEI-P nor DII is associated with wheezing or atopic eczema in children when analyzed by continuous variables and by tertiles. The odds ratio (95% CI) for AHEI-P and wheezing was 0.99 (0.98-1.01), for AHEI-P and atopic eczema1.01 (0.99-1.02), for DII and wheezing 1.02 (0.95-1.09), and for DII and atopic eczema 0.97 (0.91-1.04).

CONCLUSION

In this cohort study, AHEI-P and DII during pregnancy were not associated with wheezing or atopic eczema in the offspring during the first year of life.

Adherence to the Mediterranean Diet in Children and Adolescents and Association with Multiple Outcomes: An Umbrella Review

The Mediterranean Diet (MD) has been linked to numerous health benefits. This umbrella review aims to synthesize evidence from systematic reviews on the MD's impact on children and adolescents aged 6 to 19 years. Following Joanna Briggs Institute guidelines, we included 11 systematic reviews focusing on the MD's effects on health outcomes, such as asthma, anthropometric measures, physical fitness, and inflammatory markers. The results indicate a protective role of the MD against childhood asthma due to its antioxidant-rich components. However, evidence for its impact on allergic conditions like rhinitis and eczema is inconclusive. Findings regarding anthropometric outcomes, particularly BMI, are limited and inconsistent. A positive correlation was observed between MD adherence and increased physical activity, improved physical fitness, quality of life, and reduced sedentary behavior. Additionally, the MD showed an inverse relationship with pro-inflammatory biomarkers, suggesting anti-inflammatory benefits. The inconsistency in BMI findings and the potential anti-inflammatory properties of the MD warrant further longitudinal research. Future studies should explore the MD's impact on cognitive functions, academic performance, and mental health in this age group, highlighting the significance of establishing healthy eating habits early in life.

Greater fruit and vegetables consumption, and adherence to a Mediterranean type of diet reduces the risk for asthma in children; a systematic review and meta-analysis

The objective of this study was to explore the relationship between the consumption of fruits, vegetables and adherence to the Mediterranean diet with childhood asthma development and severity. A systematic literature search and synthesis of the results was performed throughout the last two decades. A total of 45 studies were analysed and 392,797 children were included. Greater adherence to a Mediterranean type of diet was inversely associated with asthmatic outcomes (OR:0.71,95% CI:0.54,0.88). Regarding fruits, vegetables consumption, a significant inverse association between increased fruits or vegetable intake and asthma was found (OR:0.82,95% CI:0.77,0.86; 0.84,95% CI:0.77,0.91, respectively). Fruits and vegetables consumption combined was also inversely related to all asthmatic outcomes (OR:0.65,95% CI:0.49,0.78). The level of heterogeneity was moderate-to-high (30%-97%). The present review and meta-analysis show a trend to an inverse association between adherence to the Mediterranean diet or a healthy diet rich in fruits and vegetables and the occurrence of childhood asthma but with a low level of certainty.

Nutrition in chronic inflammatory conditions: Bypassing the mucosal block for micronutrients

Nutritional Immunity is one of the most ancient innate immune responses, during which the body can restrict nutrients availability to pathogens and restricts their uptake by the gut mucosa (mucosal block). Though this can be a beneficial strategy during infection, it also is associated with non-communicable diseases-where the pathogen is missing; leading to increased morbidity and mortality as micronutritional uptake and distribution in the body is hindered. Here, we discuss the acute immune response in respect to nutrients, the opposing nutritional demands of regulatory and inflammatory cells and particularly focus on some nutrients linked with inflammation such as iron, vitamins A, Bs, C, and other antioxidants. We propose that while the absorption of certain micronutrients is hindered during inflammation, the dietary lymph path remains available. As such, several clinical trials investigated the role of the lymphatic system during protein absorption, following a ketogenic diet and an increased intake of antioxidants, vitamins, and minerals, in reducing inflammation and ameliorating disease.

Associations between combined urban and lifestyle factors and respiratory health in European children

INTRODUCTION

Previous studies identified some environmental and lifestyle factors independently associated with children respiratory health, but few focused on exposure mixture effects. This study aimed at identifying, in pregnancy and in childhood, combined urban and lifestyle environment profiles associated with respiratory health in children.

METHODS

This study is based on the European Human Early-Life Exposome (HELIX) project, combining six birth cohorts. Associations between profiles of pregnancy (38 exposures) and childhood (84 exposures) urban and lifestyle factors, identified by clustering analysis, and respiratory health were estimated by regression models adjusted for confounders.

RESULTS

Among the 1033 included children (mean ± standard-deviation (SD) age: 8.2 ± 1.6 years old, 47% girls) the mean ± SD forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) were 99 ± 13% and 101 ± 14%, respectively, and 12%, 12% and 24% reported ever-asthma, wheezing and rhinitis, respectively. Four profiles of pregnancy exposures and four profiles of childhood exposures were identified. Compared to the reference childhood exposure profile (low exposures), two exposure profiles were associated with lower levels of FEV1. One profile was characterized by few natural spaces in the surroundings and high exposure to the built environment and road traffic. The second profile was characterized by high exposure to meteorological factors and low levels of all other exposures and was also associated with an increased risk of ever-asthma and wheezing. A pregnancy exposure profile characterized by high exposure levels to all risk factors, but a healthy maternal lifestyle, was associated with a lower risk of wheezing and rhinitis in children, compared to the reference pregnancy profile (low exposures).

CONCLUSION

This comprehensive approach revealed pregnancy and childhood profiles of urban and lifestyle exposures associated with lung function and/or respiratory conditions in children. Our findings highlight the need to pursue the study of combined exposures to improve prevention strategies for multifactorial diseases such as asthma.

Unveiling the potent effect of vitamin D: harnessing Nrf2/HO-1 signaling pathways as molecular targets to alleviate urban particulate matter-induced asthma inflammation

BACKGROUND

Asthma is the most common allergic disease characterized by an inflammatory response in the airways. Mechanismly, urban particulate matter (PM) is the most widely air pollutant associated with increased asthma morbidity and airway inflammation. Current research found that vitamin D is an essential vitamin with anti-inflammatory, antioxidant and other medical efficacy. Inadequate or deficient vitamin D often leads to the pathogenesis and stability of asthma. NGF exacerbates airway inflammation in asthma by promoting smooth muscle cell proliferation and inducing the Th2 immune response. Activation of the Nrf2/HO-1 signaling pathway can exert a protective effect on the inflammatory response in bronchial asthma. However, the specific mechanism of this pathway in PM-involved asthmatic airway smooth muscle cells remains unclear.

METHODS

Mice were sensitized and challenged with Ovalbumin (OVA) to establish an asthma model. They were then exposed to either PM, vitamin D or a combination of both, and inflammatory responses were observed. Including, acetylcholine stimulation at different concentrations measured airway hyperresponsiveness in mice. Bronchoalveolar lavage fluid (BALF) and serum were collected for TNF-α, IL-1β, IL-6, and Nerve growth factor (NGF) analysis. Additionally, lung tissues underwent histopathological examination to observe alveolar structure and inflammatory cell infiltration. Specific ELISA kits were utilized to determine the levels of the inflammatory factors TNF-α, IL-1β, IL-6, and Nerve growth factor (NGF). Nrf2/HO-1 signaling pathways were examined by western blot analysis. Meanwhile, we constructed a cell system with low HO-1 expression by lentiviral transfection of airway smooth muscle cells. The changes of Nrf2, HO-1, and NGF were observed after the treatment of OVA, PM, and Vit D were given.

RESULTS

The in vivo results showed that vitamin D significantly alleviated pathological changes in lung tissue of PM-exposed mice models. Mechanismly, vitamin D decreased substantial inflammatory cell infiltration in lung tissue, as well as the number of inflammatory cells in BALF. Furthermore, vitamin D reduced the heightened inflammatory factors including of TNF-α, IL-1β, IL-6, and NGF caused by PM exposure, and triggered the activity of nucleus Nrf2 and HO-1 in PM-exposed asthmatic mice. Notably, knockdown HO-1 weakens the Vitamin D- mediated inhibition to pollution toxicity in asthma. Importantly, in vitro experiments on OVA-stimulated mice airway smooth muscle cells, the results showed that OVA and PM, respectively, reduced Nrf2/HO-1 and increased NGF's expression, while vitamin D reversed the process. And in the HO-1 knockdown cell line of Lenti-si-HO-1 ASMCs, OVA and PM reduced Nrf2's expression, while HO-1 and NGF's expression were unchanged.

CONCLUSIONS

The above results demastrate that vitamin D downregulated the inflammatory response and the expression of NGF by regulating the Nrf2/HO-1 signaling pathways in airway smooth muscle cells, thereby showing potent anti-inflammatory activity in asthma.

Winds of change a tale of: asthma and microbiome

The role of the microbiome in asthma is highlighted, considering its influence on immune responses and its connection to alterations in asthmatic patients. In this context, we review the variables influencing asthma phenotypes from a microbiome perspective and provide insights into the microbiome's role in asthma pathogenesis. Previous cohort studies in patients with asthma have shown that the presence of genera such as Bifidobacterium, Lactobacillus, Faecalibacterium, and Bacteroides in the gut microbiome has been associated with protection against the disease. While, the presence of other genera such as Haemophilus, Streptococcus, Staphylococcus, and Moraxella in the respiratory microbiome has been implicated in asthma pathogenesis, indicating a potential link between microbial dysbiosis and the development of asthma. Furthermore, respiratory infections have been demonstrated to impact the composition of the upper respiratory tract microbiota, increasing susceptibility to bacterial diseases and potentially triggering asthma exacerbations. By understanding the interplay between the microbiome and asthma, valuable insights into disease mechanisms can be gained, potentially leading to the development of novel therapeutic approaches.

Basis of preventive and non-pharmacological interventions in asthma

Asthma is one of the most common atopic disorders in all stages of life. Its etiology is likely due to a complex interaction between genetic, environmental, and lifestyle factors. Due to this, different non-pharmacological interventions can be implemented to reduce or alleviate the symptoms caused by this disease. Thus, the present narrative review aimed to analyze the preventive and non-pharmacological interventions such as physical exercise, physiotherapy, nutritional, ergonutritional, and psychological strategies in asthma treatment. To reach these aims, an extensive narrative review was conducted. The databases used were MedLine (PubMed), Cochrane (Wiley), Embase, PsychINFO, and CinAhl. Asthma is an immune-mediated inflammatory condition characterized by increased responsiveness to bronchoconstrictor stimuli. Different factors have been shown to play an important role in the pathogenesis of asthma, however, the treatments used to reduce its incidence are more controversial. Physical activity is focused on the benefits that aerobic training can provide, while physiotherapy interventions recommend breathing exercises to improve the quality of life of patients. Nutritional interventions are targeted on implement diets that prioritize the consumption of fruits and vegetables and supplementation with antioxidants. Psychological interventions have been proposed as an essential non-pharmacological tool to reduce the emotional problems associated with asthma.

GEMA 5.3. Spanish Guideline on the Management of Asthma

The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).

Prevalence and time trends of symptoms of allergic rhinitis and rhinoconjunctivitis in Spanish children: Global Asthma Network (GAN) study

INTRODUCTION

The time trends of the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy previously described in the ISAAC (International Study of Asthma and Allergies in Childhood) in 2002 are unknown; or if the geographical or age differences in Spain persist.

OBJECTIVE

To describe the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy in different Spanish geographical areas and compare them with those of the ISAAC.

METHODS

Cross-sectional study of the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy, carried out in 2016-2019 on 19943 adolescents aged 13-14 years and 17215 schoolchildren aged 6-7 years from six Spanish areas (Cartagena, Bilbao, Cantabria, La Coruña, Pamplona, and Salamanca), through a questionnaire based on the Global Asthma Network (GAN) protocol.

RESULTS

The prevalences of recent rhinitis and rhinoconjunctivitis (last 12 months), and nasal allergy/hay fever were 35.1%, 17.6%, and 14.6% in the adolescents and 20%, 8.5%, and 8.9% in the schoolchildren, respectively, with rhinoconjunctivitis in adolescents varying from 20.9% in Bilbao to 13.4% in Cartagena; and in schoolchildren, from 9.8% in La Coruña to 6.4% in Pamplona. These prevalences of rhinoconjunctivitis and nasal allergy in adolescents were higher than those described in the ISAAC (16.3% and 13%) and similar in schoolchildren to the ISAAC (9% and 9.4%).

CONCLUSIONS

There has been a stabilisation of rhinitis, rhinoconjunctivitis and nasal allergy in schoolchildren that slows the previous upward trend of ISAAC; and a slight non-significant increase in rhinoconjunctivitis and nasal allergy in adolescents. The variability found in adolescents would require local research to be better understood.

Air Pollution and Diet: Potential Interacting Exposures in Asthma

PURPOSE OF REVIEW

To provide a review of emerging literature describing the impact of diet on the respiratory response to air pollution in asthma.

RECENT FINDINGS

Asthma phenotyping (observable characteristics) and endotyping (mechanistic pathways) have increased the specificity of diagnostic and treatment pathways and opened the doors to the identification of subphenotypes with enhanced susceptibility to exposures and interventions. Mechanisms underlying the airway immune response to air pollution are still being defined but include oxidative stress, inflammation, and activation of adaptive and innate immune responses, with genetic susceptibility highlighted. Of these, neutrophil recruitment and activation appear prominent; however, understanding neutrophil function in response to pollutant exposures is a research gap. Diet may play a role in asthma pathogenesis and morbidity; therefore, diet modification is a potential target opportunity to protect against pollutant-induced lung injury. In particular, in vivo and in vitro data suggest the potential for diet to modify the inflammatory response in the airways, including impacts on neutrophil recruitment and function. Murine models provide compelling results in regard to the potential for dietary components (including fiber, antioxidants, and omega-3 fatty acids) to buffer against the inflammatory response to air pollution in the lung. Precision lifestyle approaches to asthma management and respiratory protection in the context of air pollution exposures may evolve to include diet, pending the results of further epidemiologic and causal investigation and with neutrophil recruitment and activation as a candidate mechanism.

The Effect of Dietary Components of the Mediterranean Diet on Food Allergies: A Systematic Review

Allergies are a common and increasing health problem affecting millions of people worldwide. This increase is attributed to genetic predisposition, air pollution, climate change, lack of physical activity, and alterations in eating habits. The Mediterranean diet (MD), which includes a lot of fruits and vegetables, whole grains, legumes, nuts, olive oil, and fish, has been linked to a variety of health benefits, including a lower risk of chronic and allergic disease. This paper explores the effects of the dietary components of the MD on food allergies. Electronic databases PubMed, Scopus, Science Direct, and EBSCO were used to conduct this systematic review. Out of 696 studies initially identified, five human and four animal studies were included. Risk of bias was determined using the Office of Health Assessment and Translation tool. In human studies, when the intervention was given during pregnancy and lactation, a beneficial effect was observed. When the intervention was given during pregnancy and until birth or to the infant for six months, no effect was observed. The animal studies indicated a beneficial effect between the food components of the MD and food allergies. Although the results are promising, the limited number of studies highlights the need for more research.

Dietary prevention strategies for childhood asthma

Asthma is the most common chronic disease in childhood and a rise in prevalence has been observed concomitantly with changing dietary habits in the Western world. This change has favored a more Westernized diet characterized by high intake of processed food and fat in contrast to a Mediterranean diet high in fruit, vegetable and fish intake. This has resulted in a decreased intake of several antioxidants and micronutrients including n-3 long-chained polyunsaturated fatty acids and vitamin D that are speculated to have anti-inflammatory effects and hold immunoregulatory properties. Several observational studies have investigated associations between dietary intake and wheeze and asthma but only few large well-conducted randomized controlled trials (RCTs) have been performed investigating the primary preventive effect of micronutrient supplementations. Currently, the recommendations from the Global Initiative for Asthma (GINA) for primary prevention of asthma in children do not include maternal dietary changes or supplementations during pregnancy, although the most recent report mentions both specific dietary patterns and micronutrients as potential protective supplementation regimes. This review will present the current literature and future research needs focusing on primary and secondary prevention of both early and late childhood asthma from dietary intake during pregnancy and early childhood to highlight potential preventive effects of specific dietary patterns and micronutrient supplements, which may facilitate the planning of future clinical trials in search of a preemptive strategy.

Dietary parameters in patients with drug allergy: Assessing dietary inflammatory index

Background

Research on the increasing incidence of allergic diseases evidenced the role of diet as a potential key factor. Diet can modulate the low-grade systemic inflammation related to obesity and several diseases. There are no published data on drug allergy.

Aim

To investigate a potential association between diet, including dietary inflammatory index (DII), and drug allergy. Also, to evaluate correlations between diet and obesity, inflammatory and metabolic parameters in patients with drug allergy.

Methods

Ninety consecutive patients studied for suspected drug allergy were evaluated in terms of dietary parameters, anthropometric measurements, bioimpedance and biochemical analysis. DII was calculated based on information collected from a food frequency questionnaire.

Results

After diagnostic work-up, 39 patients had confirmed drug allergy and 45 excluded, representing the study group and the control group, respectively. The majority (79%) were female, with mean age of 39.58±13.3 years. The 84 subjects revealed an anti-inflammatory diet pattern. No significative difference was found in DII scores between drug allergic patients and controls (-3.37±0.95 vs -3.39±0.86, p = 0.985). However, the patients with drug allergy revealed higher obesity and inflammatory parameters. A significative negative correlation was found between DII and adiponectin levels, in the control group (r = -0.311, p = 0.040). In the patient group, a significative positive correlation was observed between DII and triglycerides (r = 0.359, p = 0.032). No other correlations were found between DII and the assessed parameters. Patients with drug allergy presented a significative higher intake of mono-unsaturated fatty-acids comparing to controls (19.8±3.7 vs 17.8 ± 4.0, p = 0.021). No other statistically significant differences were achieved in dietary parameters, between patients and controls.

Conclusion

The population assessed in this study revealed an anti-inflammatory diet profile. Although we have found in a previous work that the same patients with drug allergy revealed higher obesity and inflammatory parameters, the DII did not allow to distinguish between patients with drug allergy or controls. The DII scores correlated with triglycerides levels in the drug allergy patients and inversely with adiponectin levels in the control group. Larger studies are needed to clarify the potential role of the diet in drug allergy and its outcomes.

Nutrition, Gut Microbiota, and Allergy Development in Infants

The process of gut microbiota development in infants is currently being challenged by numerous factors associated with the contemporary lifestyle, including diet. A thorough understanding of all aspects of microbiota development will be necessary for engineering strategies that can modulate it in a beneficial direction. The long-term consequences for human development and health of alterations in the succession pattern that forms the gut microbiota are just beginning to be explored and require much further investigation. Nevertheless, it is clear that gut microbiota development in infancy bears strong associations with the risk for allergic disease. A useful understanding of microbial succession in the gut of infants needs to reveal not only changes in taxonomic composition but also the development of functional capacities through time and how these are related to diet and various environmental factors. Metagenomic and metatranscriptomic studies have started to produce insights into the trends of functional repertoire and gene expression change within the first year after birth. This understanding is critical as during this period the most substantial development of the gut microbiota takes place and the relations between gut microbes and host immunity are established. However, further research needs to focus on the impact of diet on these changes and on how diet can be used to counteract the challenges posed by modern lifestyles to microbiota development and reduce the risk of allergic disease.

The Potential of the Mediterranean Diet to Improve Mitochondrial Function in Experimental Models of Obesity and Metabolic Syndrome

The abnormal expansion of body fat paves the way for several metabolic abnormalities including overweight, obesity, and diabetes, which ultimately cluster under the umbrella of metabolic syndrome (MetS). Patients with MetS are at an increased risk of cardiovascular disease, morbidity, and mortality. The coexistence of distinct metabolic abnormalities is associated with the release of pro-inflammatory adipocytokines, as components of low-to-medium grade systemic inflammation and increased oxidative stress. Adopting healthy lifestyles, by using appropriate dietary regimens, contributes to the prevention and treatment of MetS. Metabolic abnormalities can influence the function and energetic capacity of mitochondria, as observed in many obesity-related cardio-metabolic disorders. There are preclinical studies both in cellular and animal models, as well as clinical studies, dealing with distinct nutrients of the Mediterranean diet (MD) and dysfunctional mitochondria in obesity and MetS. The term “Mitochondria nutrients” has been adopted in recent years, and it depicts the adequate nutrients to keep proper mitochondrial function. Different experimental models show that components of the MD, including polyphenols, plant-derived compounds, and polyunsaturated fatty acids, can improve mitochondrial metabolism, biogenesis, and antioxidant capacity. Such effects are valuable to counteract the mitochondrial dysfunction associated with obesity-related abnormalities and can represent the beneficial feature of polyphenols-enriched olive oil, vegetables, nuts, fish, and plant-based foods, as the main components of the MD. Thus, developing mitochondria-targeting nutrients and natural agents for MetS treatment and/or prevention is a logical strategy to decrease the burden of disease and medications at a later stage. In this comprehensive review, we discuss the effects of the MD and its bioactive components on improving mitochondrial structure and activity.

Prevalence and temporal evolution of asthma symptoms in Spain. Global Asthma Network (GAN) study

INTRODUCTION

The temporal evolution of the prevalence of asthma described in the ISAAC (International Study of Asthma and Allergies in Childhood) in 2002 is unknown, or if the geographical or age differences are maintained in Spain.

OBJECTIVE

To describe the prevalence of asthma symptoms in different Spanish geographic areas and compare it with that of those centers that participated in the ISAAC.

METHODS

Cross-sectional study of asthma prevalence, carried out in 2016-2019 with 19,943 adolescents aged 13-14 years and 17,215 schoolchildren aged 6-7 years from 6 Spanish geographical areas (Cartagena, Bilbao, Cantabria, La Coruña, Pamplona and Salamanca). Asthma symptoms were collected using a written questionnaire and video questionnaire according to the Global Asthma Network (GAN) protocol.

RESULTS

The prevalence of recent wheezing (last 12 months) was 15.3% at 13-14 years and 10.4% at 6-7 years, with variations in adolescents, from 19% in Bilbao to 10.2% in Cartagena; and in schoolchildren, from 11.7% in Cartagena to 7% in Pamplona. These prevalences were higher than those of the ISAAC (10.6% in adolescents and 9.9% in schoolchildren). 21.3% of adolescents and 12.4% of schoolchildren reported asthma at some time.

CONCLUSIONS

There is a high prevalence of asthmatic symptoms with an increase in adolescents and a stabilization in Spanish schoolchildren with respect to the ISAAC. Geographic variations in asthma prevalence are not so clearly appreciated, but areas with high prevalences maintain high numbers.

Parental Education Moderates the Relation between Physical Activity, Dietary Patterns and Atopic Diseases in Adolescents

Background: Atopic diseases, particularly asthma, eczema, and rhinitis, are among the most common chronic diseases in childhood, with several factors implicated in their pathogenesis. Our study examined the role of parental education in the association between diet, physical activity, and atopy in adolescents. Methods: 1934 adolescents (47.5% boys) aged 13−14 years old reported information about their diet and physical activity and their parents reported their highest educational level. The moderating role of parental education level (primary/secondary vs. tertiary) in the relation between lifestyle patterns and atopic diseases was examined with logistic regression analyses. Results: High consumption of dairy products was inversely associated to adolescents’ asthma and rhinitis symptoms overall, but this relation was almost 50% stronger for the adolescents with high parental education level background. The same pattern of reduction of the odds was noticed also regarding the association among the high intake of fruits, vegetables, pulses, with all three atopic diseases and the adherence to a physically active lifestyle only with current asthma and eczema (all p < 0.05). Conclusion: Adolescents who are physically active and consume a higher intake of fruits, vegetables, and pulses and a lower intake of fast-food and sweets, and their parents/guardians having higher education, are less likely to have any current symptoms of asthma, eczema, and rhinitis than the ones who have low educated parents.

Does Adherence to the Mediterranean Diet Have a Protective Effect against Asthma and Allergies in Children? A Systematic Review

Dietary pattern may potentially impact on the pathogenesis of asthma and allergies. The Mediterranean Diet (MD) has significant health benefits due to its antioxidant and anti-inflammatory properties. The aim of this systematic review was to investigate the effectiveness of adherence to the MD against asthma and allergies in childhood. Hence, a systematic literature search was conducted on PubMed, ESBCO (Cinahl), Scopus, and the Cochrane Library databases up to 26 January 2022. The total number of articles obtained, after the initial search on the databases was conducted, was 301. Twelve studies were included, after the removal of duplicates and screening for eligibility. Our findings indicated a protective role of the MD against childhood asthma, but they also imply that the MD probably does not affect the development of allergies. Nevertheless, the heterogeneity and limitations of the studies highlight the need for randomized controlled trials that will focus on the pediatric population and hopefully provide more robust evidence.

Nutrition in Asthma

An emerging body of evidence suggests that diet plays an important role in both the development and management of asthma. The relationship between dietary intake and asthma risk has been explored in epidemiological studies, though intervention trials examining the effects of nutrient intake and dietary patterns on asthma management are scarce. Evidence for diets high in fruits and vegetables, antioxidants, omega-3 fatty acids and soluble fiber such as the Mediterranean diet is conflicting. However, some studies suggest that these diets may reduce the risk of asthma, particularly in young children, and could have positive effects on disease management. In contrast, a Westernized dietary pattern, high in saturated fatty acids, refined grains, and sugars may promote an inflammatory environment resulting in the onset of disease and worsening of asthma outcomes. This review will summarize the state of the evidence for the impact of whole dietary patterns, as well as individual nutrients on the prevalence and management of asthma.

Primary Prevention of Pediatric Asthma through Nutritional Interventions

Asthma is the most common chronic non-communicable disease in children, the pathogenesis of which involves several factors. The increasing burden of asthma worldwide has emphasized the need to identify the modifiable factors associated with the development of the disease. Recent research has focused on the relationship between dietary factors during the first 1000 days of life (including pregnancy)—when the immune system is particularly vulnerable to exogenous interferences—and allergic outcomes in children. Specific nutrients have been analyzed as potential targets for the prevention of childhood wheeze and asthma. Recent randomized controlled trials show that vitamin D supplementation during pregnancy, using higher doses than currently recommended, may be protective against early childhood wheezing but not school-age asthma. Omega-3 fatty acid supplementation during pregnancy and infancy may be associated with a reduced risk of childhood wheeze, although the evidence is conflicting. Data from observational studies suggest that some dietary patterns during pregnancy and infancy might also influence the risk of childhood asthma. However, the quality of the available evidence is insufficient to allow recommendations regarding dietary changes for the prevention of pediatric asthma. This review outlines the available high-quality evidence on the role of prenatal and perinatal nutritional interventions for the primary prevention of asthma in children and attempts to address unmet areas for future research in pediatric asthma prevention.

Exploring the Relation between Atopic Diseases and Lifestyle Patterns among Adolescents Living in Greece: Evidence from the Greek Global Asthma Network (GAN) Cross-Sectional Study

Introduction: Diet and physical activity might be associated with the risk of allergic diseases in childhood. However, evidence in literature is sparse and diverse. We aim to examine the associations between four healthy dietary consumption pattern drinks, plus the adherence to a physically active lifestyle with atopic diseases (asthma, allergic rhinitis and eczema) in adolescence and their relative importance. Methods: A total of 1934 adolescents (921 boys, 47.5%) and their parents completed a validated questionnaire assessing atopic diseases’ symptoms prevalence in the past 12 months, as well as nutritional and physical activity information. Four healthy dietary and one physical active lifestyle patterns were identified and logistic regression was applied to assess their relation with allergic diseases. Results: A high weekly consumption of fruits, vegetables and pulses and low consumption of unhealthy foods was negatively associated with all atopic symptoms while adherence to a physical active lifestyle was inversely associated with asthma and allergic rhinitis symptoms and dairy products with asthma and eczema symptoms in the past 12 months after adjustment for several confounders (all p < 0.05). Fruits, vegetables and pulses consumption per week emerged as the most important lifestyle pattern negatively associated for all atopic diseases, after the adjustment for all the remaining lifestyle patterns and confounders (all p < 0.05) Conclusions: Our findings suggest that a high fruit, vegetable and pulse intake should be the first lifestyle intervention every clinician and public health care worker evolving in the management of atopic adolescents should encourage and promote.

Mediterranean diet and lung function, sensitization, and asthma at school age: The PARIS cohort

BACKGROUND

The Mediterranean diet (MD) has known health benefits, but its specific impact on allergy development is unclear. As part of the PARIS birth cohort follow-up, we aimed to investigate the adherence of 8-year-old children to the MD and its association with allergic/respiratory morbidity at school age.

METHODS

Diet was assessed using a food frequency questionnaire completed by the parents. Adherence to the MD was assessed based on two scores: the KIDMED index and the Mediterranean Diet Score (MDS). Current allergic diseases (asthma, rhinitis, eczema), lung function indices (FEV₁ and FVC), FeNO and specific IgE levels were determined during a health check-up at 8 years. Associations between levels of adherence to the MD and respiratory/allergic morbidity were studied using multivariable logistic and linear regression models adjusted for potential confounders.

RESULTS

A total of 975 children were included in the present study, 35.6% with low adherence to the MD, 55.7% with moderate adherence and 8.7% with high adherence according to the KIDMED index. High family socioeconomic status, any breastfeeding at 6 months and consumption of organic food were associated with higher adherence to the MD. Compared with low adherence, high adherence was associated with lower risk of asthma and sensitization at 8 years, as well as higher FEV₁ and FVC.

CONCLUSION

This study suggests a protective effect of high adherence to the MD on allergic and respiratory morbidity at school age. These results need to be confirmed by further longitudinal analyses. A healthy diet may prevent allergic and respiratory morbidity in school-aged children.

Consumption of ultra-processed products and wheezing respiratory diseases in children: The SENDO project

INTRODUCTION

The consumption of ultra-processed products (UP) is associated with many diseases in the adult, such as arterial hypertension, diabetes, or asthma.

OBJECTIVE

To determine whether the consumption of UP in children is associated with wheezing respiratory diseases (asthma or bronchitis/recurrent wheezing).

MATERIAL AND METHODS

A cross-sectional study was conducted within the Follow-up of the Child for Optimal Development (SENDO) project (an open, multidisciplinary and multiple outcome study of Spanish children). The consumption of UP was calculated using semi-quantitative questionnaires on the frequency of food consumption. The foods were grouped according to the NOVA classification, and the daily consumption was estimated along with the percentage of Kilocalories from the UP. The exposure was grouped into "high" and "low" from the median consumption. Odds Ratios and 95% confidence intervals were calculated for wheezing respiratory diseases associated with the high consumption UP, using low consumption as a reference. Crude and multi-adjusted estimators were calculated, and mixed regression models were used to take into account the correlation between siblings.

RESULTS

In the 513 children studied (51.8% males, mean age 5.2 years), the mean consumption of UP was 446.76 g/day, representing 39.9% of the total calories ingested. A high consumption of UP was associated with an increase of 87% in the prevalence of wheezing respiratory diseases (OR: 1.87, 95% CI: 1.01-3.45). It was found that a higher consumption of UP multiplied by 2.12 (95% CI: 1.10-4.05) the prevalence of bronchitis/recurrent wheezing.

CONCLUSIONS

The results of this study show a direct relationship between UP consumption and the prevalence of wheezing diseases in children.

Butyrate: A Link between Early Life Nutrition and Gut Microbiome in the Development of Food Allergy

Increased prevalence of food allergies in the last thirty years has been attributed to lifestyle changes in Westernized countries. Among the environmental factors, nutritional factors and their interaction with the gut microbiome in early life are thought to have an important role in the observed epidemiological change. The gut microbiome synthesizes bacterial metabolites, which represent a link among gut microbiome, nutrition, and immune system. The main metabolites produced by gut microbiome are short-chain fatty acids (SCFAs). SCFAs have multiple beneficial effects on human health including protective effects in autoimmune and inflammatory diseases. Among SCFAs, butyrate is essential for maintaining gut immune homeostasis and exerts a pivotal role in immune tolerance with strong anti-inflammatory effects in allergic diseases. Recent findings suggest that butyrate takes part in the development of immunological tolerance to food, especially in the first 1000 days of life. Herein, we provide a critical review of the scientific literature on the role of butyrate for prevention and treatment of food allergies with focus on the complex interplay among early life nutrition, gut microbiome, and immune system.

The role of nutrition in asthma prevention and treatment

Asthma is a chronic respiratory condition characterized by airway inflammation and hyperreactivity. Prevalence has continued to rise in recent decades as Western dietary patterns have become more pervasive. Evidence suggests that diets emphasizing the consumption of plant-based foods might protect against asthma development and improve asthma symptoms through their effects on systemic inflammation, oxidation, and microbial composition. Additionally, increased fruit and vegetable intake, reduced animal product consumption, and weight management might mediate cytokine release, free radical damage, and immune responses involved in the development and course of asthma. The specific aim of this review paper is to examine the current literature on the associations between dietary factors and asthma risk and control in children and adults. Clinical trials examining the mechanism(s) by which dietary factors influence asthma outcomes are necessary to identify the potential use of nutritional therapy in the prevention and management of asthma.

Adherence to the Mediterranean Diet and Determinants Among Pregnant Women: The NELA Cohort

The Mediterranean diet represents one of the most studied dietary patterns; however, there is no single tool for measuring the grade of adherence and no single set of criteria for adapting these indices to pregnant women. We characterized the adherence to the Mediterranean diet (MDA) of pregnant women participating in the NELA (Nutrition in Early Life and Asthma) cohort and identified the sociodemographic determinants and lifestyle habits associated with a higher risk of a low MDA. Maternal diet during gestation was assessed by a validated Food Frequency Questionnaire (FFQ) (n = 665). We estimated the Relative Mediterranean Diet score (rMED), Alternative Mediterranean Diet score (aMED), and the Alternate Healthy Eating Index-2010 (AHEI-2010). Multivariate regression models were performed to identify the sociodemographic and lifestyle factors associated with each index. Mothers with a lower age and more previous deliveries had a greater probability of low MDA (p < 0.05). For the aMED index only, mothers with university education and/or who practiced sport activities for two or more hours per week had a lower probability of a low MDA (p < 0.01). The three indices classified the NELA cohort as having a medium level of adherence. These results may be improved by designing intervention strategies and dietary recommendations for both maternal and offspring health.

Prevalence of asthma symptoms and associated factors in adolescents and adults in southern Brazil: A Global Asthma Network Phase I study

Background

The Global Asthma Network (GAN) aims to find out the current status of the prevalence and severity of asthma, rhinitis, and eczema using global surveillance to achieve worldwide recognition and improve the management of asthma, especially in low- and middle-income countries. The aim of this study was to verify the associated factors for asthma in adolescents and their respective parents/caregivers.

Methods

Adolescents (13–14 years old; n = 1058) and their respective parents/caregivers (mean age = 42.1 years, n = 896) living in the town of Uruguaiana, Southern Brazil fulfilled the standardized questionnaire.

Results

Although the prevalence of wheezing in the past 12 months was higher among adults than adolescents (18.4% vs. 15.8%, respectively), adolescents showed more severe wheezing and worse control over the disease revealed by higher consumption of short-acting beta-2 agonists; going to the emergency room; hospitalization in the last year and dry night cough. Smoking and paracetamol use were associated with risk for developing asthma symptoms and consuming seafood/fish was protective. For the adults smoking (10 or more cigarettes/day) and exposure to mould in the house were associated with risk for asthma symptoms.

Conclusions

Adolescents have a high prevalence of asthma symptoms and few have an action plan. Adults do not have their disease under control and they use more relief than preventive medication. Differences in associated factors could determine the outcomes in asthma control among adolescents and their parents.

Increased advanced glycation end product and meat consumption is associated with childhood wheeze: analysis of the National Health and Nutrition Examination Survey

We examined 4388 children from the 2003 to 2006 National Health and Nutrition Examination Survey and used survey-design-adjusted multivariable logistic regression to evaluate associations between dietary advanced glycation end product (AGE) and meat consumption frequencies and respiratory symptoms. Higher AGE intake was significantly associated with increased odds of wheezing (adjusted OR 1.18; 95% CI 1.02 to 1.36), wheeze-disrupted sleep (1.26; 95% CI 1.05 to 1.51) and exercise (1.34; 95% CI 1.08 to 1.67) and wheezing requiring prescription medication (1.35; 95% CI 1.13 to 1.63). Higher intake of non-seafood meats was associated with wheeze-disrupted sleep (2.32; 95% CI 1.11 to 4.82) and wheezing requiring prescription medication (2.23; 95% CI 1.10 to 4.54).

[Consumption of ultra-processed products and wheezing respiratory diseases in children: The SENDO project]

INTRODUCTION

The consumption of ultra-processed products (UP) is associated with many diseases in the adult, such as arterial hypertension, diabetes, or asthma.

OBJECTIVE

To determine whether the consumption of UP in children is associated with wheezing respiratory diseases (asthma or bronchitis/recurrent wheezing).

MATERIAL AND METHODS

A cross-sectional study was conducted within the Follow-up of the Child for Optimal Development ?SENDO? project (an open, multidisciplinary and multiple outcome study of Spanish children). The consumption of UP was calculated using semi-quantitative questionnaires on the frequency of food consumption. The foods were grouped according the NOVA classification, and the daily consumption was estimated along with the percentage of kilocalories from the UP. The exposure was grouped into "high" and "low" from the median consumption. Odds ratios and 95% confidence intervals were calculated for wheezing respiratory diseases associated with the high consumption UP, using low consumption as a reference. Crude and multi-adjusted estimators were calculated, and mixed regression models were used to take into account the correlation between siblings.

RESULTS

In the 513 children studied (51.8% males, mean age 5.2 years), the mean consumption of UP was 446.76g/day, representing 39.9% of the total calories ingested. A high consumption of UP was associated with an increase of 87% in the prevalence of wheezing respiratory diseases (OR 1.87; 95% CI 1.01-3.45). It was found that a higher consumption of UP multiplied by 2.12 (95% CI 1.10-4.05) the prevalence of bronchitis/recurrent wheezing.

CONCLUSIONS

The results of this study show a direct relationship between UP consumption and the prevalence of wheezing diseases in children.

Diet: A Specific Part of the Western Lifestyle Pack in the Asthma Epidemic

The Western lifestyle is a complex concept that includes the diet as the main axis of different factors which contribute to a detrimental effect on health, lower life expectancy and low quality-of-life. This type of diet is characterized by being high in calories, mainly provided by saturated fats, and rich in sugars that can lead to changes in immune cells and their responsiveness, by different mechanisms that have yet to be totally clarified. Inflammatory processes are perpetuated through different pathways, in which adipose tissue is a major factor. High fat stores in overweight and obesity accumulate energy but the endocrine function is also producing and releasing different bioactive compounds, adipokines, known to be pro-inflammatory and which play an important role in the pathogenesis of asthma. This review therefore explores the latest evidence regarding the adverse effect of the Western diet on adipose tissue inflammation and its causative effect on the asthma epidemic.

The Secrets of the Mediterranean Diet. Does [Only] Olive Oil Matter?

Diet plays a key role in the maintenance and optimal functioning of immune cells. The Mediterranean dietary pattern is an example of a prudent choice of lifestyle and scientifically accepted to help preserve human health by protecting against major chronic and inflammatory diseases. Mediterranean diets (MedDiets) are characteristically high in the consumption of fruits, vegetables and salad, bread and whole grain cereals, potatoes, legumes/beans, nuts, and seeds. Their common central feature is the usage of olive oil as the main source of fat. The health benefits attributed to olive oil are specifically related to extra virgin olive oil (EVOO) intake with its high nutritional quality and multiple positive effects on health. Overall, MedDiets have direct (mono-unsaturated fatty acids (MUFAs), tocopherols, polyphenols) and indirect (low saturated fats, well-balanced linoleic/alpha linolenic acid) effects on the immune system and inflammatory responses. In the present paper, we summarize the current knowledge on the effect of olive oil per se and MedDiets generally on immune-mediated and inflammatory diseases, such as coronary heart disease (CHD)/cardiovascular diseases (CVD), obesity, type-2 diabetes, cancer, asthma, and allergies.

Mediterranean diet and health status: Active ingredients and pharmacological mechanisms

The Mediterranean diet (MedDiet) is one of the most widely described and evaluated dietary patterns in scientific literature. It is characterized by high intakes of vegetables, legumes, fruits, nuts, grains, fish, seafood, extra virgin olive oil, and a moderate intake of red wine. A large body of observational and experimental evidence suggests that higher adherence to the MedDiet is associated with lower risk of mortality, cardiovascular disease, metabolic disease, and cancer. Current mechanisms underlying the beneficial effects of the MedDiet include reduction of blood lipids, inflammatory and oxidative stress markers, improvement of insulin sensitivity, enhancement of endothelial function, and antithrombotic function. Most likely, these effects are attributable to bioactive ingredients such as polyphenols, monounsaturated and polyunsaturated fatty acids, or fibre. This review will focus on both established and less established mechanisms of action of biochemical compounds contained in a MedDiet. LINKED ARTICLES: This article is part of a themed section on The Pharmacology of Nutraceuticals. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v177.6/issuetoc.

Mediterranean diet during pregnancy and childhood for asthma in children: A systematic review and meta-analysis of observational studies

OBJECTIVES

To evaluate the relationship between high adherence to the Mediterranean diet in pregnancy and childhood and the risk of asthma and wheeze in children.

METHODS

We conducted searches of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from inception to 30 October 2018. Observational studies providing risk estimates and corresponding confidence intervals on the association of high adherence to the Mediterranean diet in pregnancy or childhood and the risk of asthma or wheeze in childhood were included. The methodological quality of all included studies was assessed. Summary odds ratios (OR) were calculated using a random-effects model.

RESULTS

Eighteen observational studies were included in this review. All studies were of moderate to high quality. The pooled data suggested high adherence to the Mediterranean diet during pregnancy was associated with a reduced incidence of wheeze in the first 12 months (OR, 0.92; 95% confidence interval [CI], 0.88-0.95; P < 0.001), and there was an inverse association between the Mediterranean diet during childhood and the incidence of wheeze in the history (OR, 0.51; 95% CI, 0.37-0.70; P = 0.001) and current wheeze (OR, 0.97; 95% CI, 0.95-0.99; P = 0.013). However, there was no significant association between high adherence of the Mediterranean diet in pregnancy and childhood and any of the other meta-analysis end points including diagnosed asthma.

CONCLUSION

High adherence to the Mediterranean diet during pregnancy and childhood may have short-term effects on wheeze in children in early life. However, these findings should be interpreted with caution owing to the heterogeneity of the studies.

Gut microbiome-Mediterranean diet interactions in improving host health

The gut microbiota plays a fundamental role in host health and disease. Host diet is one of the most significant modulators of the gut microbial community and its metabolic activities. Evidence demonstrates that dietary patterns such as the 'Western diet' and perturbations in gut microbiome (dysbiosis) have strong associations with a wide range of human diseases, including obesity, metabolic syndrome, type-2 diabetes and cardiovascular diseases. However, consumption of Mediterranean-style diets is considered healthy and associated with the prevention of cardiovascular and metabolic diseases, colorectal cancers and many other diseases. Such beneficial effects of the Mediterranean diet might be attributed to high proportion of fibers, mono- and poly-unsaturated fatty acids, antioxidants and polyphenols. Concurrent literature has demonstrated beneficial modulation of the gut microbiome following a Mediterranean-style diet in humans as well as in experimental animal models such as rodents. We recently demonstrated similar positive changes in the gut microbiome of non-human primates consuming a Mediterranean-style diet for long term (30 months). Therefore, it is rational to speculate that this positive modulation of the gut microbiome diversity, composition and function is one of the main factors intermediating the health effects of Mediterranean diet on the host. The present perspective discusses the evidences that the Mediterranean diet induces gut microbiome modulation in rodents, non-human primates and human subjects, and discusses the potential role of gut microbiota and microbial metabolites as one of the fundamental catalysts intermediating various beneficial health effects of Mediterranean diet on the host.

Adherence to the Mediterranean diet and inflammatory markers in children with asthma

INTRODUCTION

There is accumulated evidence supporting a beneficial role of Mediterranean diet (MD) in the control of asthma symptoms. The aim of this study was to investigate the relationships between adherence to MD and serum levels of certain cytokines namely, interleukin (IL)-4, and IL-17 known to have a pathogenetic role in the airway changes associated with asthma.

METHODS

We measured serum IL-4, IL-33, and IL-17, in 44 asthmatic and 26 healthy children, 5-15 years old. Their adherence to MD was estimated with the Mediterranean Diet Quality Index for children and adolescents (KIDMED) score.

RESULTS

KIDMED score did not differ between the two groups (P=0.59) and was not correlated with any of the three measured cytokines. However, when the analysis was restricted only to asthmatic children, the KIDMED score was correlated with IL-4, IL-33, and IL-17 (Beta: -0.56, P=0.007; Beta: 0.57, P=0.010; Beta: -0.62, P=0.017, respectively).

CONCLUSION

Our results indicate that MD can modulate the production of some of the main inflammatory mediators of asthma, in asthmatic children.

Dietary Pattern and Their Association With Level of Asthma Control Among Patients With Asthma at Al-Shifa Medical Complex in Gaza Strip, Palestine

Background:

This study was conducted to identify major dietary patterns and their association with level of asthma control among patients with asthma in Gaza Strip, Palestine.

Methods:

This cross-sectional study was conducted among a representative sample of Palestinian patients with asthma (both sex, aged 19-64 years) receiving care in chest department at Al-Shifa Medical Complex. Asthma control level was obtained using asthma control test. Data regarding other variables were obtained using an interview-based questionnaire and a semi-quantitative food frequency questionnaire. Statistical analysis was performed using SPSS version 20.

Results:

Two major dietary patterns were identified including (1) Prudent pattern characterized by a high intake of whole grains, beans and legumes, fish and shellfish products, vegetables, tomatoes, fruits, and vegetable oils, and (2) Western pattern characterized by a high intake of refined grains, red meat, poultry, fast foods, eggs, low-fat dairy product, high-fat dairy products, hydrogenated fats, olive, sugar, sweets, desserts, and snacks. After adjustment for confounding variables, patients in the lowest tertile (T1) of Prudent pattern had a lower odds for poorly controlled asthma (odds ratio [OR] = 0.044, 95% confidence interval [CI] = [0.002-1.316], P value < 0.05), whereas patients in the lowest tertile (T1) of Western pattern had a higher odds for poorly controlled asthma (OR = 2.499, 95% CI = [1.288-4.850], P value < 0.05), compared with those in the highest tertile (T3).

Conclusion:

A Prudent pattern may be associated with a lower prevalence of poorly controlled asthma, whereas a Western pattern may be associated with a higher prevalence of poorly controlled asthma.

Dietary fats, olive oil and respiratory diseases in Italian adults: A population-based study

BACKGROUND

Fat intake has been associated with respiratory diseases, with conflicting results.

OBJECTIVE

We studied the association between asthma and rhinitis with dietary fats, and their food sources in an Italian population.

METHODS

Clinical and nutritional information was collected for 871 subjects (aged 20-84) from the population-based multi-case-control study Genes Environment Interaction in Respiratory Diseases (GEIRD): 145 with current asthma (CA), 77 with past asthma (PA), 305 with rhinitis and 344 controls. Food intake was collected using the EPIC (European Investigation into Cancer and Nutrition) Food Frequency Questionnaire. The associations between fats and respiratory diseases were estimated by multinomial models. Fats and their dietary sources were analysed both as continuous variables and as quartiles.

RESULTS

Monounsaturated fatty acids and oleic acid were associated with a reduced risk of CA in both continuous (RRR = 0.68, 95%CI: 0.48; 0.96; RRR = 0.69; 95%CI: 0.49; 0.97, per 10 g, respectively) and per-quartile analyses (p for trend = 0.028 and 0.024, respectively). Olive oil was associated with a decreased risk of CA (RRR = 0.80; 95%CI: 0.65; 0.98 per 10 g). An increased risk of rhinitis was associated with moderate total fat and SFA intake.

CONCLUSIONS

High dietary intakes of oleic acid and of olive oil are associated with a lower risk of asthma but not of rhinitis.

Effects of Mediterranean Diet and Physical Activity on Pulmonary Function: A Cross-Sectional Analysis in the ILERVAS Project

A few studies showed that both adherence to Mediterranean diet (MedDiet) and physical activity practice have a positive impact on pulmonary function in subjects with lung disease. These associations are not well studied in subjects free from lung disease. In a cross-sectional study conducted in 3020 middle-aged subjects free of lung disease, adherence to the MedDiet using the Mediterranean Diet Adherence Screener, and physical activity practice using the International Physical Activity Questionnaire short form were recorded. Respiratory function was assessed using forced spirometry and the results were evaluated according to the Global initiative for Chronic Obstructive Lung Disease. Logistic regression models were used to analyze the associations between adherence to the MedDiet and physical activity practice with the presence of ventilatory defects. Participants with a high adherence to MedDiet, in comparison to those with low adherence, had both higher forced vital capacity (FVC; 100 (87–109) vs. 94 (82–105) % of predicted, p = 0.003) and forced expired volume in the first second (FEV1; 100 (89–112) vs. 93 (80–107) % of predicted, p < 0.001). According to their degree of physical activity, those subjects with a high adherence also had both higher FVC (100 (88–107) vs. 94 (83–105) % of predicted, p = 0.027) and FEV1 (100 (89–110) vs. 95 (84–108) % of predicted, p = 0.047) in comparison with those with low adherence. The multivariable logistic regression models showed a significant and independent association between both low adherence to MedDiet and low physical activity practice, and the presence of altered pulmonary patterns, with differences between men and women. However, no joint effect between adherence to MedDiet and physical activity practice on respiratory function values was observed. Low adherence to MedDiet and low physical activity practice were independently associated with pulmonary impairment. Therefore, the lung mechanics seem to benefit from heart-healthy lifestyle behaviors.

Oxidative stress in asthma: Part of the puzzle

An imbalance between the production of reactive oxygen species and the capacity of antioxidant defense mechanisms favoring oxidants is called oxidative stress and is implicated in asthmatic inflammation and severity. Major reactive oxygen species that are formed endogenously include hydrogen peroxide, superoxide anion, hydroxyl radical, and hypohalite radical; and the major antioxidants that fight against the endogenous and environmental oxidants are superoxide dismutase, catalase, and glutathione. Despite the well-known presence of oxidative stress in asthma, studies that target oxidative burden using a variety of nutritional, pharmacological, and environmental approaches have generally been disappointing. In this review, we summarize the current knowledge on oxidative stress and antioxidant imbalance in asthma. In addition, we focus on possible biomarkers of oxidative stress in asthma and on current and future treatment strategies using the modulation of oxidative stress to treat asthma patients.

Dietary patterns and respiratory health in adults from nine European countries-Evidence from the GA2 LEN study

BACKGROUND

Dietary patterns defined using principal component analysis (PCA) offer an alternative to the analysis of individual foods and nutrients and have been linked with asthma and allergic disease. However, results have not been reproducible in different settings.

OBJECTIVE

To identify dietary patterns common to different European countries and examine their associations with asthma and allergic symptoms.

METHODS

In sixteen study centers in nine European countries, 3206 individuals aged 15-77 years completed a common, internationally validated, food frequency questionnaire and a respiratory symptoms questionnaire. The outcomes of interest were current asthma, asthma symptoms score (derived based on responses to 5 asthma symptom-related questions), atopy (positive skin prick test). Spirometry was used to estimate forced expiratory volume in 1 second (FEV₁ ), forced vital capacity (FVC), the FEV₁ /FVC, spirometric restriction (FVC below the lower limit of normal (<LLN)) and FEV₁ /FVC < LLN. A novel meta-analytic approach was used to identify dietary patterns using PCA and to examine associations with asthma and allergic symptoms.

RESULTS

Two dietary patterns emerged, generally correlating with the same foods in different countries: one associated with intake of animal proteins and carbohydrates; the other with fruit and vegetables. There was evidence that the former pattern was associated with a higher asthma score (RR 1.63, 95% CI: 1.33-2.01), current asthma (RR 2.03, 95% CI: 1.52-2.71), wheeze (RR 1.84, 95% CI: 1.30-2.60), atopic status (RR 1.68, 95% CI: 1.16-2.44) and with decreased lung function, including an FVC <LLN (RR 4.57, 95% CI: 2.27-9.21).

CONCLUSIONS AND CLINICAL RELEVANCE

Our findings suggest an increase in sensitisation to common allergens, an increase in asthma symptoms, and a reduction in lung function in those eating a diet rich in animal proteins and carbohydrates. We found little evidence of an association between these outcomes and eating a diet rich in fruits and vegetables.

Associations of ultra-processed food and drink products with asthma and wheezing among Brazilian adolescents

BACKGROUND

Although both consumptions of ultra-processed products and asthma are common during adolescence, the epidemiological evidence in regarding their association is unclear. We investigated the associations of ultra-processed products consumption with asthma and wheezing in a representative sample of Brazilian adolescents.

METHODS

We used data from a representative sample of 109 104 Brazilian adolescents enrolled in the National Survey of School Health, 2012. The consumption of ultra-processed products was based on the weekly consumption (0-2, 3-4, ≥5 d/wk) of sweet biscuits, salty biscuits, ultra-processed meats, sweets/candies, soft drinks, and packaged snacks over the previous 7 days. We also calculated an ultra-processed consumption score by adding partial scores corresponding to weekly frequency intake of each ultra-processed product. The ultra-processed consumption score ranged from 0 to 42, the higher score, the higher the intake of these products. The presence of wheezing in the previous 12 months and asthma at any time in the past was self-reported.

RESULTS

The adjusted odds ratios of asthma comparing the extreme categories ranged from 1.08 (95% CI 1.03-1.13) for sweets/candies to 1.30 (1.21-1.40) for ultra-processed meats. Similar magnitude of associations was found for wheezing outcome. The ultra-processed consumption score was positively associated with the presence of asthma and wheezing in a dose-response manner. The adjusted OR of asthma and wheezing comparing highest to lowest quintile of ultra-processed consumption score was 1.27 (95% CI 1.15-1.41) and 1.42 (1.35-1.50), respectively.

CONCLUSIONS

The consumption of ultra-processed products was positively associated with the presence of asthma and wheezing in adolescents.

Established and Emerging Environmental Contributors to Disparities in Asthma and Chronic Obstructive Pulmonary Disease

PURPOSE OF REVIEW

Multiple respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), display significant socioeconomic and racial/ethnic disparities. The objective of this review is to evaluate the evidence supporting a link between disproportionate environmental exposures and these health disparities.

RECENT FINDINGS

Studies suggest that various co-occurring factors related to the home environment, neighborhood environment, non-modifiable individual factors, and individual behaviors and attributes can increase or modify the risk of adverse respiratory outcomes among socioeconomically-disadvantaged and racially/ethnically diverse populations. Pollutants in the home environment, including particulate matter, nitrogen dioxide, and pesticides, are elevated among lower socioeconomic status populations and have been implicated in the development or exacerbation of respiratory-related conditions. Neighborhood crime and green space are socioeconomically patterned and linked with asthma outcomes through psychosocial pathways. Non-modifiable individual factors such as genetic predisposition cannot explain environmental health disparities but can increase susceptibility to air pollution and other stressors. Individual behaviors and attributes, including obesity and physical activity, contribute to worse outcomes among those with asthma or COPD.

SUMMARY

The root causes of these multifactorial exposures are complex, but many likely stem from economic forces and racial/ethnic and economic segregation that influence the home environment, neighborhood environment, and access to healthy foods and consumer products. Critical research needs include investigations that characterize exposure to and health implications of numerous stressors simultaneously, both to guard against potential confounding in epidemiological investigations and to consider the cumulative impact of multiple elevated environmental exposures and sociodemographic stressors on health disparities.

Progress in the understanding of the pathology of allergic asthma and the potential of fruit proanthocyanidins as modulators of airway inflammation

Allergic asthma is a chronic inflammatory lung disease characterized by sensitization of the airways, and the development of immunoglobulin E antibodies, to benign antigens. The established pathophysiology of asthma includes recurrent lung epithelial inflammation, excessive mucus production, bronchial smooth muscle hyperreactivity, and chronic lung tissue remodeling, resulting in reversible airflow restriction. Immune cells, including eosinophils and the recently characterized type 2 innate lymphoid cells, infiltrate into the lung tissue as part of the inflammatory response in allergic asthma. It is well established that a diet high in fruits and vegetables results in a reduction of the risk of developing inflammatory diseases. Secondary plant metabolites, such as proanthocyanidins which are found in apples, blackcurrants, boysenberries, cranberries, and grapes, have shown promising results in reducing or preventing allergic asthma airway inflammation. Recent evidence has also highlighted the importance of microbiome-mediated metabolism of plant polyphenols in modulating the immune system. In this review, we will discuss advances in our understanding of the pathophysiology of allergic asthma, including the role of the microbiome in lung immune function, and how proanthocyanidins modulate the airway inflammation. We will highlight the potential of dietary proanthocyanidins to impact on allergic asthma and the immune system.

The Dietary Inflammatory Index and Current Wheeze Among Children and Adults in the United States

BACKGROUND

A proinflammatory diet may increase allergic airway inflammation by affecting innate and adaptive immune responses.

OBJECTIVE

In this study, we examine the relation between the diet's inflammatory potential, measured by the Dietary Inflammatory Index (DII), and current asthma, current wheeze, and lung function in U.S. children and adults.

METHODS

We analyzed data from 8,175 children (aged 6-17 years) and 22,294 adults (aged 18-79 years) who participated in the 2007-2012 National Health and Nutrition Examination Survey. The DII was calculated by nutrient intake based on 24-hour dietary recalls, and normalized as per 1,000 calories of food consumed to account for total energy intake. Multivariable regression models were used for the analysis of the DII and current asthma, current wheeze, and lung function measures.

RESULTS

Higher DII (a proinflammatory diet) was associated with current wheeze among adults (eg, odds ratio [OR] for quartile 4 vs 1, OR = 1.41, 95% confidence interval [CI] = 1.17-1.70; Ptrend < .01) and among children with high fractional exhaled nitric oxide (a marker of eosinophilic airway inflammation; OR = 2.38, 95% CI = 1.13-5.02; Ptrend = .05). The DII also was associated with decreased forced expiratory volume in 1 second and forced vital capacity in adults without asthma or wheezing. The DII was not associated with lung function in children or current asthma in either age group.

CONCLUSIONS

Our findings suggest that a proinflammatory diet, assessed by the DII, increases the odds of current wheeze in adults and children with allergic (atopic) wheeze. These results further support testing dietary interventions as part of the management of asthma.

The nutrition-gut microbiome-physiology axis and allergic diseases

Dietary and bacterial metabolites influence immune responses. This raises the question whether the increased incidence of allergies, asthma, some autoimmune diseases, cardiovascular disease, and others might relate to intake of unhealthy foods, and the decreased intake of dietary fiber. In recent years, new knowledge on the molecular mechanisms underpinning a 'diet-gut microbiota-physiology axis' has emerged to substantiate this idea. Fiber is fermented to short chain fatty acids (SCFAs), particularly acetate, butyrate, and propionate. These metabolites bind 'metabolite-sensing' G-protein-coupled receptors such as GPR43, GPR41, and GPR109A. These receptors play fundamental roles in the promotion of gut homeostasis and the regulation of inflammatory responses. For instance, these receptors and their metabolites influence Treg biology, epithelial integrity, gut homeostasis, DC biology, and IgA antibody responses. The SCFAs also influence gene transcription in many cells and tissues, through their inhibition of histone deacetylase expression or function. Contained in this mix is the gut microbiome, as commensal bacteria in the gut have the necessary enzymes to digest dietary fiber to SCFAs, and dysbiosis in the gut may affect the production of SCFAs and their distribution to tissues throughout the body. SCFAs can epigenetically modify DNA, and so may be one mechanism to account for diseases with a 'developmental origin', whereby in utero or post-natal exposure to environmental factors (such as nutrition of the mother) may account for disease later in life. If the nutrition-gut microbiome-physiology axis does underpin at least some of the Western lifestyle influence on asthma and allergies, then there is tremendous scope to correct this with healthy foodstuffs, probiotics, and prebiotics.