1
|
Musiol S, Harris CP, Gschwendtner S, Burrell A, Amar Y, Schnautz B, Renisch D, Braun SC, Haak S, Schloter M, Schmidt-Weber CB, Zielinski CE, Alessandrini F. The impact of high-salt diet on asthma in humans and mice: Effect on specific T-cell signatures and microbiome. Allergy 2024. [PMID: 38798015 DOI: 10.1111/all.16148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/25/2024] [Accepted: 04/14/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The rise in asthma has been linked to different environmental and lifestyle factors including dietary habits. Whether dietary salt contributes to asthma incidence, remains controversial. We aimed to investigate the impact of higher salt intake on asthma incidence in humans and to evaluate underlying mechanisms using mouse models. METHODS Epidemiological research was conducted using the UK Biobank Resource. Data were obtained from 42,976 participants with a history of allergies. 24-h sodium excretion was estimated from spot urine, and its association with asthma incidence was assessed by Cox regression, adjusting for relevant covariates. For mechanistic studies, a mouse model of mite-induced allergic airway inflammation (AAI) fed with high-salt diet (HSD) or normal-salt chow was used to characterize disease development. The microbiome of lung and feces (as proxy for gut) was analyzed via 16S rRNA gene based metabarcoding approach. RESULTS In humans, urinary sodium excretion was directly associated with asthma incidence among females but not among males. HSD-fed female mice displayed an aggravated AAI characterized by increased levels of total IgE, a TH2-TH17-biased inflammatory cell infiltration accompanied by upregulation of osmosensitive stress genes. HSD induced distinct changes in serum short chain fatty acids and in both gut and lung microbiome, with a lower Bacteroidetes to Firmicutes ratio and decreased Lactobacillus relative abundance in the gut, and enriched members of Gammaproteobacteria in the lung. CONCLUSIONS High dietary salt consumption correlates with asthma incidence in female adults with a history of allergies. Female mice revealed HSD-induced T-cell lung profiles accompanied by alterations of gut and lung microbiome.
Collapse
Affiliation(s)
- Stephanie Musiol
- Center of Allergy & Environment (ZAUM), Technical University of Munich (TUM) and Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Carla P Harris
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Dr. von Hauner Children's Hospital, University Hospital, LMU of Munich, Munich, Germany
| | - Silvia Gschwendtner
- Research Unit for Comparative Microbiome Analysis, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Amy Burrell
- Department of Infection Immunology, Leibniz Institute for Natural Product Research & Infection Biology, Hans-Knöll-Institute, Jena, Germany
- Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University, Jena, Germany
| | - Yacine Amar
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Benjamin Schnautz
- Center of Allergy & Environment (ZAUM), Technical University of Munich (TUM) and Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Dennis Renisch
- Department of Chemistry - TRIGA site, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sonja C Braun
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Epidemiology, Faculty of Medicine, LMU of Munich, Munich, Germany
| | - Stefan Haak
- Center of Allergy & Environment (ZAUM), Technical University of Munich (TUM) and Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Michael Schloter
- Research Unit for Comparative Microbiome Analysis, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Carsten B Schmidt-Weber
- Center of Allergy & Environment (ZAUM), Technical University of Munich (TUM) and Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Christina E Zielinski
- Department of Infection Immunology, Leibniz Institute for Natural Product Research & Infection Biology, Hans-Knöll-Institute, Jena, Germany
- Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University, Jena, Germany
- Center for Translational Cancer Research & Institute of Virology, Technical University of Munich, Munich, Germany
| | - Francesca Alessandrini
- Center of Allergy & Environment (ZAUM), Technical University of Munich (TUM) and Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Member of the German Center of Lung Research (DZL), Munich, Germany
| |
Collapse
|
2
|
Rondanelli M, Faliva MA, Peroni G, Infantino V, Gasparri C, Iannello G, Perna S, Alalwan TA, Al-Thawadi S, Corsico AG. Food Pyramid for Subjects with Chronic Obstructive Pulmonary Diseases. Int J Chron Obstruct Pulmon Dis 2020; 15:1435-1448. [PMID: 32606652 PMCID: PMC7310971 DOI: 10.2147/copd.s240561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/20/2020] [Indexed: 02/02/2023] Open
Abstract
Nutritional problems are an important part of rehabilitation for chronic obstructive pulmonary disease (COPD) patients. COPD patients often present with malnutrition, sarcopenia, and osteoporosis with possible onset of cachexia, with an inadequate dietary intake and a poor quality of life. Moreover, diet plays a pivotal role in patients with COPD through three mechanisms: regulation of carbon dioxide produced/oxygen consumed, inflammation, and oxidative stress. A narrative review based on 99 eligible studies was performed to evaluate current evidence regarding optimum diet therapy for the management of COPD, and then a food pyramid was built accordingly. The food pyramid proposal will serve to guide energy and dietary intake in order to prevent and treat nutritionally related COPD complications and to manage progression and COPD-related symptoms. The nutrition pyramid described in our narrative review is hypothetical, even in light of several limitations of the present review; the main limitation is the fact that to date there are no randomized controlled trials in the literature clearly showing that improved nutrition, via the regulation of carbon dioxide produced/oxygen consumed, inflammation and oxidative stress, improves symptoms and/or progression of COPD. Even if this nutritional pyramid is hypothetical, we hope that it can serve the valuable purpose of helping researchers focus on the often-ignored possible connections between body composition, nutrition, and COPD.
Collapse
Affiliation(s)
- Mariangela Rondanelli
- IRCCS Mondino Foundation, Pavia 27100, Italy.,Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia, Pavia 27100, Italy
| | - Milena Anna Faliva
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona "Istituto Santa Margherita", University of Pavia, Pavia 27100, Italy
| | - Gabriella Peroni
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona "Istituto Santa Margherita", University of Pavia, Pavia 27100, Italy
| | - Vittoria Infantino
- Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia, Pavia 27100, Italy
| | - Clara Gasparri
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona "Istituto Santa Margherita", University of Pavia, Pavia 27100, Italy
| | - Giancarlo Iannello
- General Management, Azienda di Servizi alla Persona "Istituto Santa Margherita", Pavia 27100, Italy
| | - Simone Perna
- Department of Biology, College of Science, University of Bahrain, Sakhir 32038, Bahrain
| | | | - Salwa Al-Thawadi
- Department of Biology, College of Science, University of Bahrain, Sakhir 32038, Bahrain
| | - Angelo Guido Corsico
- Center for Diagnosis of Inherited Alpha 1-Antitrypsin Deficiency, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia 27100, Italy.,Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| |
Collapse
|
3
|
Abstract
Objective: To focus on the asthmatic pathogenesis and clinical manifestations related to epithelial sodium channel (ENaC)/chlorine ion channel. Data Sources: The data analyzed in this review were the English articles from 1980 to 2015 from journal databases, primarily PubMed and Google Scholar. The terms used in the literature search were: (1) ENaCs; cystic fibrosis (CF) transmembrane conductance regulator (CFTR); asthma/asthmatic, (2) ENaC/sodium salt; CF; asthma/asthmatic, (3) CFTR/chlorine ion channels; asthma/asthmatic, (4) ENaC/sodium channel/scnn1a/scnn1b/scnn1g/scnn1d/amiloride-sensitive/amiloride-inhibtable sodium channels/sodium salt; asthma/asthmatic, lung/pulmonary/respiratory/tracheal/alveolar, and (5) CFTR; CF; asthma/asthmatic (ti). Study Selection: These studies included randomized controlled trials or studies covering asthma pathogenesis and clinical manifestations related to ENaC/chlorine ion channels within the last 25 years (from 1990 to 2015). The data involving chronic obstructive pulmonary disease and CF obtained from individual studies were also reviewed by the authors. Results: Airway surface liquid dehydration can cause airway inflammation and obstruction. ENaC and CFTR are closely related to the airway mucociliary clearance. Ion transporters may play a critical role in pathogenesis of asthmatic exacerbations. Conclusions: Ion channels have been the center of many studies aiming to understand asthmatic pathophysiological mechanisms or to identify therapeutic targets for better control of the disease.
Collapse
Affiliation(s)
- Wen Wang
- Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100020, China; Department of Cellular and Molecular Biology, Texas Lung Injury Institute, University of Texas Health Science Center at Tyler, Tyler Texas 75708, USA,
| | | |
Collapse
|
4
|
|
5
|
Abstract
BACKGROUND There is a wide geographical variation in the prevalence of asthma and observational studies have suggested that dietary sodium may play a role. OBJECTIVES To assess the effect of dietary sodium manipulation on asthma control. SEARCH STRATEGY We carried out a search using the Cochrane Airways Group asthma register. We searched the bibliographies of included randomised controlled trials (RCTs) for additional studies. We carried out the most recent search in November 2010. SELECTION CRITERIA We considered only RCTs that involved dietary sodium reduction or increased sodium intake in patients with asthma. DATA COLLECTION AND ANALYSIS Both review authors assessed study and extracted data. We conducted data analyses in RevMan 5 using mean differences and random effects. MAIN RESULTS We identified a total of nine studies in relation to sodium manipulation and asthma, of which five were in people with asthma (318 participants), and four in people with exercise-induced asthma (63 participants). There were no significant benefits of salt restriction on the control of asthma. There was some evidence from the exercise-induced asthma studies that a low sodium diet may improve lung function after exercise and possibly baseline lung function, but this is based on findings from a very small numbers of participants. AUTHORS' CONCLUSIONS This review did not find any evidence that dietary sodium reduction significantly improves asthma control. Although dietary sodium reduction may result in improvements in lung function in exercise-induced asthma, the clinical significance of this effect is unclear.
Collapse
Affiliation(s)
- Zara Pogson
- Sherwood Forest NHS TrustRespiratory MedicineKings Mills HospitalSutton in AshfieldNottinghamshireUKNG17 4JL
| | - Tricia McKeever
- University of NottinghamDepartment of EpidemiologyCity HospitalNottinghamUKNG5 1PB
| | | |
Collapse
|
6
|
Arvaniti F, Priftis KN, Papadimitriou A, Yiallouros P, Kapsokefalou M, Anthracopoulos MB, Panagiotakos DB. Salty-snack eating, television or video-game viewing, and asthma symptoms among 10- to 12-year-old children: the PANACEA study. ACTA ACUST UNITED AC 2011; 111:251-7. [PMID: 21272699 DOI: 10.1016/j.jada.2010.10.051] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 05/07/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Salty-snack consumption, as well as the amount of time children spend watching television or playing video games, have been implicated in the development of asthma; however, results are still conflicting. OBJECTIVE The aim of this work was to evaluate the association of salty-snack eating and television/video-game viewing with childhood asthma symptoms. DESIGN Cross-sectional study. SETTINGS Seven hundred children (323 male), 10 to 12 years old, from 18 schools located in the greater area of Athens were enrolled. Children and their parents completed questionnaires, which evaluated, among other things, dietary habits. Adherence to the Mediterranean diet was evaluated using the KIDMED (Mediterranean Diet Quality Index for Children and Adolescents) score. STATISTICAL ANALYSIS The association of children's characteristics with asthma symptoms was performed by calculating the odds ratios and corresponding 95% confidence intervals. RESULTS Overall lifetime prevalence of asthma symptoms was 23.7% (27.6% boys, 20.4% girls; P=0.03). Forty-eight percent of children reported salty-snack consumption (≥ 1 times/week). Salty-snack consumption was positively associated with the hours of television/video-game viewing (P=0.04) and inversely with the KIDMED score (P=0.02). Consumption of salty snacks (>3 times/week vs never/rare) was associated with a 4.8-times higher likelihood of having asthma symptoms (95% confidence interval: 1.50 to 15.8), irrespective of potential confounders. The associations of salty-snack eating and asthma symptoms were more prominent in children who watched television or played video games >2 hours/day. In addition, adherence to the Mediterranean diet was inversely associated with the likelihood of asthma symptoms. CONCLUSIONS Unhealthy lifestyle behaviors, such as salty-snack eating and television/video-game viewing were strongly associated with the presence of asthma symptoms. Future interventions and public health messages should be focused on changing these behaviors from the early stages of life.
Collapse
Affiliation(s)
- Fotini Arvaniti
- Unit of Human Nutrition, Department of Food Science and Technology, Agricultural University of Athens, Athens, Greece
| | | | | | | | | | | | | |
Collapse
|
7
|
Abstract
Despite the heterogeneous treatment options for patients with asthma, there remains a substantial burden of unaddressed disease, even with optimal treatment. Epidemiological studies indicate that patients frequently resort to complimentary and alternative therapies when being treated for asthma and other chronic health conditions. Changes in diet associated with the development of a more affluent lifestyle is one of the environmental factors considered to contribute to the increased prevalence of asthma in the past few decades. Dietary sodium in particular has been considered to be a dietary constituent implicated in this phenomenon. This article reviews the studies conducted that have questioned whether reducing dietary salt intake potentially improves pulmonary function and airway hyper-responsiveness in asthmatics, as well as studies evaluating dietary salt intake on the severity of exercise-induced bronchoconstriction (EIB). The data presented supporting dietary salt restriction for reducing airway hyper-responsiveness in asthmatics is encouraging, though not clinically convincing. Studies conducted previously have been limited for a variety of reasons, including limitations related to the experiment and populations studied. However, in studies that evaluated the severity of EIB in asthmatic individuals and involved altered dietary salt intake, data have been more convincing. A low-sodium diet maintained for 1 to 2 weeks decreases bronchoconstriction in response to exercise in individuals with asthma. There are no data regarding the longer-term effects of a low-sodium diet on either the prevalence or severity of asthma or on EIB. As a low-sodium diet has other beneficial health effects, it can be considered a therapeutic option for adults with asthma, although it should be considered as an adjunctive intervention to supplement optimal pharmacotherapy, and not as an alternative.
Collapse
Affiliation(s)
- Timothy D Mickleborough
- Department of Kinesiology, Exercise Biochemistry Laboratory, Indiana University, Bloomington, IN 47401, USA.
| |
Collapse
|
8
|
Jackson L, Britton J, Lewis SA, McKeever TM, Atherton J, Fullerton D, Fogarty AW. A population-based epidemiologic study of Helicobacter pylori infection and its association with systemic inflammation. Helicobacter 2009; 14:108-13. [PMID: 19751435 DOI: 10.1111/j.1523-5378.2009.00711.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Infection with Helicobacter pylori is associated with a variety of non-gastrointestinal sequelae. These may be mediated by an increase in systemic inflammation. We assessed if serologic evidence of infection with H. pylori is associated with increased serum C-reactive protein (CRP) levels. METHODS The study design consisted of a randomly selected, cross-sectional population-based study of 2633 individuals phenotyped in 1991, of whom 2361 participants provided serum samples to permit measurement of H. pylori's serologic status and CRP levels. RESULTS Male gender (odds ratio (OR): 1.65; 95% confidence interval (CI): 1.23-2.21), age (OR per year: 1.05; 95% CI: 1.04-1.06), height (OR per meter: 0.05; 95% CI: 0.01-0.24), current smoking habit (compared with never smokers, OR: 1.46; 95% CI: 1.13-1.88), and less affluent socioeconomic status were associated with increased odds of being seropositive for H. pylori. Helicobacter pylori infection was associated with increased risk of having an elevated serum CRP (above 3 mg/L) after adjustment for gender, age, height, smoking status, and socioeconomic status (OR: 1.32; 95% CI: 1.05-1.67). Similar associations were seen using a threshold for elevated serum CRP of greater than 1 mg/L. CONCLUSIONS Our data suggest that infection with H. pylori is associated with increased systemic inflammation. This suggests one potential mechanism to explain the extra-gastrointestinal conditions associated with H. pylori infection.
Collapse
Affiliation(s)
- Louisa Jackson
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1BP, UK
| | | | | | | | | | | | | |
Collapse
|
9
|
Fogarty AW, Lewis SA, McKeever TM, Britton JR. Is higher sodium intake associated with elevated systemic inflammation? A population-based study. Am J Clin Nutr 2009; 89:1901-4. [PMID: 19386745 DOI: 10.3945/ajcn.2008.27006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Observational epidemiologic studies have suggested that a low-sodium diet is associated with reduced mortality. OBJECTIVE The objective was to test the hypothesis that a higher dietary intake of sodium is associated with increased systemic inflammation--a potential risk factor for both cardiovascular disease and cancer. DESIGN The study design consisted of a randomly selected, cross-sectional, population-based study of 2633 individuals surveyed in 1991, of whom 1597 participants provided paired urinary and blood samples permitting measurement of 24-h urinary sodium excretion and serum C-reactive protein (CRP) concentrations. RESULTS The mean (+/-SD) 24-h sodium intake for the population was 177 +/- 69 mmol. In the basic model adjusted for age, sex, and smoking, higher levels of 24-h sodium excretion were directly associated with serum CRP, with an increase in serum CRP of 1.20 mg/L per 100-mmol increment in sodium excretion (95% CI: 1.11, 1.30). However, this association was reduced after adjustment for body mass index, with an increase in serum CRP of 1.06 mg/L per 100-mmol increment in sodium excretion (95% CI: -1.02, 1.15). CONCLUSIONS We observed a linear association between an objective measure of sodium intake and serum CRP that may be influenced by confounding by body mass index. The magnitude of these associations suggests that dietary sodium consumption is unlikely to be an important modifiable risk factor for increased systemic inflammation.
Collapse
Affiliation(s)
- Andrew W Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, United Kingdom.
| | | | | | | |
Collapse
|
10
|
McKeever TM, Lewis SA, Smit HA, Burney P, Cassano PA, Britton J. A multivariate analysis of serum nutrient levels and lung function. Respir Res 2008; 9:67. [PMID: 18823528 PMCID: PMC2565672 DOI: 10.1186/1465-9921-9-67] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 09/29/2008] [Indexed: 12/15/2022] Open
Abstract
Background There is mounting evidence that estimates of intakes of a range of dietary nutrients are related to both lung function level and rate of decline, but far less evidence on the relation between lung function and objective measures of serum levels of individual nutrients. The aim of this study was to conduct a comprehensive examination of the independent associations of a wide range of serum markers of nutritional status with lung function, measured as the one-second forced expiratory volume (FEV1). Methods Using data from the Third National Health and Nutrition Examination Survey, a US population-based cross-sectional study, we investigated the relation between 21 serum markers of potentially relevant nutrients and FEV1, with adjustment for potential confounding factors. Systematic approaches were used to guide the analysis. Results In a mutually adjusted model, higher serum levels of antioxidant vitamins (vitamin A, beta-cryptoxanthin, vitamin C, vitamin E), selenium, normalized calcium, chloride, and iron were independently associated with higher levels of FEV1. Higher concentrations of potassium and sodium were associated with lower FEV1. Conclusion Maintaining higher serum concentrations of dietary antioxidant vitamins and selenium is potentially beneficial to lung health. In addition other novel associations found in this study merit further investigation.
Collapse
Affiliation(s)
- Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
| | | | | | | | | | | |
Collapse
|
11
|
Wheeze and asthma in children: associations with body mass index, sports, television viewing, and diet. Epidemiology 2008; 19:747-55. [PMID: 18496466 DOI: 10.1097/ede.0b013e3181776213] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obesity, physical activity, and dietary habits are distinct but strongly interrelated lifestyle factors that may be relevant to the prevalence of wheeze and asthma in children. Our goal was to analyze the relationship of body mass index (BMI), regular sports participation, TV viewing, and diet with current wheezing and asthma. METHODS We investigated 20,016 children, aged 6-7 years, who were enrolled in a population-based study. Parents completed standardized questionnaires. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), while adjusting for several confounders and simultaneously considering BMI, regular sports activity, TV viewing and selected dietary items. RESULTS A total of 1575 children (7.9%) reported current wheezing and 1343 (6.7%) reported current asthma. In a multivariate model, an elevated BMI was associated with wheeze and current asthma: children from the highest quintile (compared with the lowest quintile) had an increased risk of wheeze (OR = 1.47; CI = 1.20-1.82) or current asthma (1.61; 1.28-2.01). Wheeze or asthma was not associated with regular sports activity. Subjects who spent 5 or more hours per day watching television were more likely to experience wheeze (1.53; 1.08-2.17) or current asthma (1.51; 1.04-2.2) compared with those who viewed TV less than 1 hour a day. Adding salt to food was strongly and independently associated with current wheeze (2.58; 1.41-4.71) and current asthma (2.68; 1.41-5.09). CONCLUSIONS Our data support the hypothesis that high body weight, spending a lot of time watching television, and a salty diet each independently increase the risk of asthma symptoms in children.
Collapse
|
12
|
Pogson ZEK, Antoniak MD, Pacey SJ, Lewis SA, Britton JR, Fogarty AW. Does a low sodium diet improve asthma control? A randomized controlled trial. Am J Respir Crit Care Med 2008; 178:132-8. [PMID: 18451321 DOI: 10.1164/rccm.200802-287oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Observational studies and initial randomized trials have indicated that a low sodium diet may improve asthma control. OBJECTIVES We tested the hypothesis that a low sodium diet would improve asthma control over a 6-week period. METHODS Participants with a physician diagnosis of asthma and measurable bronchial reactivity to methacholine entered a randomized double-blind placebo-controlled trial. All adopted a low sodium diet and were randomized to receive either 80 mmol/day of oral sodium supplements (normal sodium intake) or matched placebo (low sodium intake) for 6 weeks. The primary outcome was change in bronchial reactivity to methacholine; secondary outcomes were change in lung function, morning and evening peak expiratory flow, asthma symptoms score, daily bronchodilator use, Juniper Standardized Asthma Quality of Life Questionnaire score, and atopy. MEASUREMENTS AND MAIN RESULTS A total of 220 individuals entered the study, of whom 199 completed the protocol. In the low sodium-intake group, mean daily urinary sodium excretion decreased by 20 mmol (SD, 64 mmol) and in the normal-sodium-intake group increased by 28 mmol (SD, 74 mmol). There were no differences between the two groups in the primary or secondary outcome measures; the mean difference in bronchial reactivity between the low- and normal-intake groups was -0.03 doubling doses of methacholine (95% confidence interval, -0.60 to 0.53). CONCLUSIONS The use of a low sodium diet as an adjunctive therapy to normal treatment has no additional therapeutic benefit in adults with asthma and bronchial reactivity to methacholine.
Collapse
Affiliation(s)
- Zara E K Pogson
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, UK.
| | | | | | | | | | | |
Collapse
|
13
|
Fogarty AW, Glancy C, Jones S, Lewis SA, McKeever TM, Britton JR. A prospective study of weight change and systemic inflammation over 9 y. Am J Clin Nutr 2008; 87:30-5. [PMID: 18175734 DOI: 10.1093/ajcn/87.1.30] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND An increase in weight is a risk factor for cardiovascular disease and cancer. This increased risk may be mediated by inflammation, but no long-term data are available on the effect of weight gain on systemic inflammation. OBJECTIVE We tested the hypothesis that weight gain is associated with an increase in systemic inflammation during a 9-y period. DESIGN In 1991 data on body weight and a blood sample were collected from a random sample of 2425 randomly selected adults from a community-based cohort in Nottingham, United Kingdom. In 2000, these measures were repeated in 1301 of these participants. The main outcome measure was change in systemic inflammation as measured by serum C-reactive protein (CRP) from the 1222 participants who provided paired samples. RESULTS The mean change in weight from 1991 to 2000 was 2.9 kg (95% CI: 2.6, 3.2 kg). The geometric mean of CRP in 1991 was 1.22 mg/L (95% CI: 0.03, 125.0 mg/L), and it increased to 1.76 mg/L (95% CI: 0.09, 62.0 mg/L) in 2000 (P<0.001). A linear association was observed between increase in weight and serum CRP, with a 1-kg increment in weight being associated with an additional increase in CRP of 0.09 mg/L (95% CI: 0.02, 0.16 mg/L) during this time period. CONCLUSION During a 9-y period, an increase in weight is associated with an increase in systemic inflammation. This provides a mechanism that may explain some of the previously reported association of weight gain with an increased risk of both cancer and cardiovascular disease.
Collapse
Affiliation(s)
- Andrew W Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, and the Department of Clinical Chemistry, Nottingham City Hospital, Nottingham, United Kingdom.
| | | | | | | | | | | |
Collapse
|
14
|
Hirota SA, Janssen LJ. Sodium and asthma: something borrowed, something new? Am J Physiol Lung Cell Mol Physiol 2007; 293:L1369-73. [PMID: 17905852 DOI: 10.1152/ajplung.00379.2007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Some early studies have called attention to the potential contribution of sodium (both dietary and serum levels) in airway-related disease, although the picture was not entirely clear. Two recent developments may now allow a more careful consideration of this: first, the greatly improved understanding of the role of salt in hypertension (particularly the identification of subgroups of salt-sensitive individuals within the general population), and second, the recent discovery of the role of the Na(+)/Ca(2+) exchanger in smooth muscle function. Here, we first review those two developments and then apply them to airway smooth muscle and asthma.
Collapse
Affiliation(s)
- Simon A Hirota
- Smooth Muscle Research Group, University of Calgary, Calgary, Alberta, Canada
| | | |
Collapse
|
15
|
Abstract
It has been hypothesized that the recent increase in the prevalence of asthma may, in part, be a consequence of changing diet. There is now increasing interest in the possibility that childhood asthma may be influenced by maternal diet during pregnancy and/or diet during early childhood. A number of observational studies and a childhood fish oil supplementation study provide little support for the notion that early childhood intake of polyunsaturated fatty acids (PUFAs) influence the development of childhood asthma. Recent work however, suggests that supplementation of maternal diet with fish oil is associated with altered neonatal immune responses to allergens. Further work is required to establish whether this immunological observation is translated into clinical outcomes. Two birth cohorts have now reported reduced maternal intake of vitamin E, zinc and vitamin D during pregnancy to be associated with increased asthma and wheezing outcomes in children up to the age of 5 years. Early life diet could modulate the likelihood of childhood asthma by affecting fetal airway development and/or influencing the initial early life interactions between allergens and the immune system. In animal models, vitamin E, zinc and vitamin D have been shown to modify fetal lung development and vitamin E, zinc, vitamin D and PUFA can modulate T-cell responses. Further research, particularly, early life intervention studies need to be carried out to establish whether early life dietary intervention can be used as a public health measure to reduce the prevalence of childhood asthma.
Collapse
Affiliation(s)
- Graham Devereux
- Department of Environmental and Occupational Medicine, University of Aberdeen, Aberdeen, UK.
| |
Collapse
|
16
|
Fogarty AW, Jones S, Britton JR, Lewis SA, McKeever TM. Systemic inflammation and decline in lung function in a general population: a prospective study. Thorax 2007; 62:515-20. [PMID: 17251312 PMCID: PMC2117221 DOI: 10.1136/thx.2006.066969] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND An increase in levels of C-reactive protein (CRP), a marker of systemic inflammation, is associated with reduced forced expiratory volume in 1 s (FEV1), supporting the hypothesis that the pathophysiology of chronic obstructive pulmonary disease has a systemic inflammatory component. However, few large studies have assessed the relationship between systemic inflammation as measured by CRP and decline in lung function prospectively in a randomly selected population. METHODS In 1991, data were collected on FEV1 and forced vital capacity (FVC) and a blood sample was taken from 2442 randomly selected adults in a community-based cohort. In 2000 these measures were repeated in 1301 individuals. The level of serum CRP was analysed in these samples from 1991 and 2000. RESULTS In cross-sectional analyses of data from 1991 and 2000, serum CRP levels were inversely related to FEV1 and FVC. After adjustment for smoking and other confounders, the difference in FEV1 was reduced by -9 ml (95% CI -13 to -5) and -7 ml (95% CI -13 to -2) for each mg/l increment in serum CRP in 1991 and 2000, respectively. There was no significant association between baseline serum CRP levels and decline in FEV1 and FVC over 9 years. CONCLUSIONS Although serum CRP levels are inversely associated with lung function in cross-sectional studies, there was no effect of a marker of systemic inflammation on decline in lung function over 9 years.
Collapse
Affiliation(s)
- Andrew W Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK.
| | | | | | | | | |
Collapse
|
17
|
Abstract
The changes in diet associated with the development of a more affluent lifestyle have been considered one of the environmental factors that may have contributed to the rise in the prevalence of asthma over the past few decades, and dietary sodium has been considered to be a dietary constituent which may be implicated in this phenomenon. The data presented in this review demonstrate that adoption of a low sodium diet for a period of 2-5 weeks may improve lung function and decrease bronchial reactivity in adults with asthma, while sodium loading appears to have a detrimental effect. Similarly, a low sodium diet maintained for 1-2 weeks decreases bronchoconstriction in response to exercise in individuals with asthma. There is no data as to the longer-term effect of a low sodium diet on either the prevalence or severity of asthma or on exercise-induced bronchoconstriction. As a low sodium diet has other beneficial health effects, it can be considered as a therapeutic option for adults with asthma, although it should be considered as an adjunctive intervention to supplement optimal pharmacological management of asthma and not as an alternative. If the relationship between higher sodium intake and increased prevalence and severity of asthma is causal, then there are potential population benefits for asthma as well as cardiovascular disease to be derived from public health measures to reduce sodium consumption.
Collapse
Affiliation(s)
- T D Mickleborough
- Department of Kinesiology, Human Performance and Exercise Biochemistry Laboratory, Indiana University, Bloomington, Indiana 47401, USA.
| | | |
Collapse
|
18
|
Abstract
Since about 1960, the prevalence of asthma and allergic disease has increased sufficiently to become a major public-health concern. Concurrently, there have been marked changes in our diet, and it has been proposed that these changes have contributed to the increase in the prevalence of asthma and allergy. In this article, these hypotheses about diet are described, together with the postulated mechanisms and the evidence for and against, leading to the most recent evidence indicating that maternal diet during pregnancy might be particularly important in the development of childhood asthma.
Collapse
Affiliation(s)
- Graham Devereux
- Department of Environmental and Occupational Medicine, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZB, UK.
| |
Collapse
|
19
|
Tricon S, Willers S, Smit HA, Burney PG, Devereux G, Frew AJ, Halken S, Host A, Nelson M, Shaheen S, Warner JO, Calder PC. Nutrition and allergic disease. ACTA ACUST UNITED AC 2006. [DOI: 10.1111/j.1365-2222.2006.00114.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
20
|
Gaga M, Papageorgiou N, Yiourgioti G, Karydi P, Liapikou A, Bitsakou H, Zervas E, Koulouris NG, Holgate ST. Risk factors and characteristics associated with severe and difficult to treat asthma phenotype: an analysis of the ENFUMOSA group of patients based on the ECRHS questionnaire. Clin Exp Allergy 2006; 35:954-9. [PMID: 16008684 DOI: 10.1111/j.1365-2222.2005.02281.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Severe and difficult to treat asthma impairs health status and accounts for about half of asthma expenditure. In 1994, a European Network For Understanding Mechanisms of Severe Asthma (ENFUMOSA) was formed. A large group of patients from nine European countries has been selected. OBJECTIVE To examine the risk factors and symptoms associated with a phenotype of severe/difficult to treat asthma. METHODS The present report presents data assessed through the use of the European Community Respiratory Health Survey (ECRHS) Questionnaire in 148 mild-moderate controlled and 155 severe asthmatics from the ENFUMOSA group. RESULTS There is a negative association of severe asthma with reported allergy and with a family history of allergy (Odds ratio (OR)=0.45). Sharing a bedroom before the age of five is associated with a higher risk of severe asthma (OR=1.5) while childhood infections, play school attendance and exposure to allergens or animals are not. A larger proportion of severe asthma patients report symptoms at work (OR=2.7) or have to change jobs (OR=4.3) and fewer severe than mild patients are currently employed (OR=0.39). Smoking and exposure to smoke is similar in mild and severe asthma. Dietary habits do not differ between the groups, but severe asthmatics report eating less savoury snacks and there is a trend for lower intake of sweets. CONCLUSIONS Analysis of the ECRHS questionnaire in the ENFUMOSA study shows that severe asthma patients experience more symptoms and their health status is impaired by their inability to work and perhaps eat freely. Personal and maternal history of allergy is associated with mild but not severe asthma. Other than sharing a bedroom before the age of 5 years, no childhood exposure risk factors associated with severe asthma could be identified from this analysis.
Collapse
Affiliation(s)
- M Gaga
- Respiratory Medicine Department, Sotiria Hospital, Athens University, Athens, Greece.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Pearson P, Britton J, McKeever T, Lewis SA, Weiss S, Pavord I, Fogarty A. Lung function and blood levels of copper, selenium, vitamin C and vitamin E in the general population. Eur J Clin Nutr 2005; 59:1043-8. [PMID: 16015272 DOI: 10.1038/sj.ejcn.1602209] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Increased dietary intake of antioxidants has been associated with higher lung function, but few studies have used biological markers of antioxidant intake. OBJECTIVE This study aimed to determine if antioxidant status, as measured by blood levels, influences lung function. DESIGN Using a random subsample of 479 participants, aged 18-65 y old, from a larger cross-sectional observational study, the association of forced expiratory volume in 1 s (FEV1) with plasma copper, vitamin C, vitamin E and serum selenium was assessed. RESULTS An s.d. increase in blood copper level was associated with a difference in FEV1 of -48 ml (95% confidence intervals: -95, -2 ml, P = 0.04), vitamin C +49 ml (+4, +94, P = 0.03), vitamin E -15 ml (-62, +32, P = 0.53) and selenium +52 ml (+7, +96, P = 0.02). The sizes of association were not appreciably altered in a mutually adjusted model. CONCLUSIONS Higher levels of serum vitamin C and selenium appear to be associated with higher FEV1. The association between higher serum copper and lower FEV1 requires further study in view of the ubiquitous exposure to this mineral.
Collapse
Affiliation(s)
- P Pearson
- Division of Respiratory Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | | | | | | | | | | | | |
Collapse
|
22
|
Sausenthaler S, Kompauer I, Brasche S, Linseisen J, Heinrich J. Sodium intake and bronchial hyperresponsiveness in adults. Respir Med 2005; 99:864-70. [PMID: 15939248 DOI: 10.1016/j.rmed.2004.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several investigations suggested a relationship between sodium intake and asthma and bronchial hyperresponsiveness (BHR), respectively. However, clinical and epidemiological studies did not show consistent finding. OBJECTIVE We analysed the association between dietary sodium intake and BHR to methacholine among 613 adults aged 20-65 years as one of the two German centres of the European Community Respiratory Health Survey (ECRHS). METHODS Dietary sodium intake was estimated from a 3-day weighed record of food intake. We applied multiple logistic regression models contrasting the three higher quartiles of sodium intake versus the lowest to assess the risk of BHR and mild BHR estimated by PD20 and PD10, respectively, controlling for potential confounders and stratified for sex. In addition, we analysed PD20 (dose of methacholine causing a fall of 20% in forced expiratory volume in 1s) as continuous variable expressed as transformed dose-response slope (tDRS) in the linear model. RESULTS Women were as expected more likely to be bronchial hyperresponsive (PD20: 26.1%; PD10: 52.2%) than men (PD20:15.8%; PD10: 34.8%) and had a lower mean daily sodium intake (2.36 g) compared with men (3.15 g). Logistic regression did not show any significant relationship between sodium intake and BHR in terms of PD20 after adjustment for age group, education, smoking status, body mass index and height in men or women. However, mild BHR assessed as PD10 was statistically significant positively related to the third (OR: 2.35; CI: 1.11-5.00) and highest quartile of sodium intake (OR: 2.28; CI: 1.06-4.88) in women, but not in men for third quartile (OR: 1.29; CI: 0.68-2.44) and for fourth quartile (OR: 1.07; CI: 0.56-2.07), respectively. CONCLUSION Sodium intake by several food items does not alter BHR assessed as PD20 to methacholine but may increase mild BHR assessed as PD10. We conclude that, in addition, PD10 has to be considered when the effect of sodium intake on BHR is studied.
Collapse
Affiliation(s)
- Stefanie Sausenthaler
- GSF-National Research Centre for Environment and Health, Institute of Epidemiology, Neuherberg, Germany
| | | | | | | | | |
Collapse
|
23
|
Mickleborough TD, Gotshall RW. Dietary salt intake as a potential modifier of airway responsiveness in bronchial asthma. J Altern Complement Med 2004; 10:633-42. [PMID: 15353019 DOI: 10.1089/acm.2004.10.633] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
While pharmacologic treatment of chronic asthma is usually highly effective, medications often have significant side-effects or exhibit tachyphylaxis. Alternative and/or complementary treatments that reduce dependence on pharmacologic medications are of interest in reducing the severity of asthma. This review analyzes the literature that has evaluated dietary salt intake as a potential modifier of the severity of asthma and airway responsiveness. High dietary intakes of salt, greater than 9 g/d, are common in Western civilizations, as is asthma. The question is whether reducing dietary salt intake potentially would improve pulmonary function and airway responsiveness in individuals with asthma. This review details the existing studies in this regard and includes the studies that have evaluated dietary salt on the severity of exercise-induced asthma (exercise-induced bronchoconstriction [E1B]). From a critical analysis of the existing literature, the data that support a role for dietary salt reduction for reducing severity of asthma and airway responsiveness in individuals with asthma is considered encouraging but not clinically convincing. The existing studies have suffered from a variety of experimental and population limitations. In contrast, the data from studies that have altered dietary salt and evaluated severity of EIB in nonatopic individuals is much more convincing. In each study so far, lowering dietary salt has reduced the severity of EIB to subclinical levels. Correspondingly, the supplementing of diets to higher than normal salt intake increased EIB significantly. This review concludes that the data are sufficient to warrant a clinical trial that is properly controlled and randomized to further investigate the influence of dietary salt intake on pulmonary function, airway responsiveness, symptoms, quality of life, and medication requirements in asthma and EIB.
Collapse
|
24
|
Abstract
BACKGROUND There is a wide geographical variation in asthma prevalence and one explanation may be in dietary salt consumption. OBJECTIVES To assess the effect of dietary sodium reduction in patients with asthma. SEARCH STRATEGY A search was conducted using the Cochrane Airways Group asthma register. Bibliographies of included randomised controlled trials (RCTs) were searched for additional studies. Authors of identified RCTs were contacted for other studies. The most recent search was carried out in February 2004. SELECTION CRITERIA All studies were to be RCTs that involved dietary salt reduction or increased salt intake in patients with asthma. Studies of other allergic conditions such as hay fever, allergic rhinitis and eczema were considered patients with asthma were separately identified. DATA COLLECTION AND ANALYSIS Study quality was assessed and data extracted by two reviewers. All data analysis was conducted using the Cochrane Collaboration software (RevMan). MAIN RESULTS Six RCTs were included in this review. All studies were small size and of short duration. Data from only four studies could be pooled. Low sodium diet was associated with a significantly lower urine sodium excretion than normal or high salt diets. There were no significant differences in any asthma outcome between low salt and normal or high salt diets, however the confidence intervals were wide. FEV(1) with low salt compared to normal diet showed a WMD 0.09 L with a 95% confidence interval (95%CI) -0.19 L to 0.38 L, and compared to a high salt diet WMD 0.18 L; 95%CI -0.11 L to 0.48 L. Daily PEFR was also non-significantly higher with low salt diet compared to normal (WMD 19.52 L/min; 95% CI -21.22 to 60.25) and high salt diet (WMD 7.57 L/min; 95% CI -37.52 to 52.67). Reliever bronchodilator with the low salt diet when compared to both the normal and high salt diets showed WMD -0.07 puffs/day; 95%CI -0.94 to 0.81 & WMD -0.65 puffs/day; 95%CI -1.75 to 0.45, respectively. REVIEWERS' CONCLUSIONS Based on currently available evidence it is not possible to conclude whether dietary salt reduction has any place in the treatment or management of asthma. The results of this review do indicate an improvement in pulmonary function with low salt diet, however further large scales trials are required before any firm conclusions can be reach.
Collapse
Affiliation(s)
- K D Ardern
- Department of Public Health, Liverpool Health Authority, Liverpool, UK
| |
Collapse
|
25
|
Woods RK, Walters EH, Raven JM, Wolfe R, Ireland PD, Thien FCK, Abramson MJ. Food and nutrient intakes and asthma risk in young adults. Am J Clin Nutr 2003; 78:414-21. [PMID: 12936923 DOI: 10.1093/ajcn/78.3.414] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Some aspects of diet are relatively newly recognized potential risk factors for asthma, but the evidence to date is conflicting. OBJECTIVE The goal was to determine whether the food and nutrient intakes of adults with asthma differ from those of adults without asthma. DESIGN This was a community-based, cross-sectional study of 1601 young adults ( +/- SD age: 34.6 +/- 7.1 y) who were initially recruited by random selection from the federal electoral rolls in Melbourne in 1999. Subjects completed a detailed respiratory questionnaire, a validated semiquantitative food-frequency questionnaire, skin-prick testing, and lung function tests, including a methacholine challenge test for bronchial hyperreactivity (BHR). A total of 25 nutrients and 47 food groups were analyzed by using multiple logistic regression with alternate definitions of asthma and atopy as the outcomes. RESULTS Whole milk appeared to protect against current asthma (odds ratio: 0.66; 95% CI: 0.46, 0.97), doctor-diagnosed asthma (0.73; 0.54, 0.99), BHR (0.68; 0.48, 0.92), and atopy (0.71; 0.54, 0.94). Conversely, soy beverage was associated with an increased risk of current asthma (2.05; 1.19, 3.53), doctor-diagnosed asthma (1.69; 1.04, 2.77), and BHR (1.65; 1.00, 2.71). Apples and pears appeared to protect against current asthma (0.83; 0.71, 0.98), asthma (0.88; 0.78, 1.00), and BHR (0.88; 0.77, 1.00). CONCLUSIONS The consumption of dairy products, soy beverages, and apples and pears, but not of nutrients per se, was associated with a range of asthma definitions. Dietary modification after diagnosis is one possible explanation for this finding. Intervention studies using whole foods are required to ascertain whether such modifications of food intake could be beneficial in the prevention or amelioration of asthma.
Collapse
Affiliation(s)
- Rosalie K Woods
- Department of Epidemiology & Preventive Medicine, Central and Eastern Clinical School, Monash University, and The Alfred Hospital, Melbourne, Victoria, Australia
| | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
The evidence for an association between asthma and obesity in adults, and in children and adolescents, is reviewed. Few studies in adults measured height and weight, whereas the majority in children did. Evidence for the association is strong, but that for a gender interaction is weak. There is sufficient evidence to rule out asthma preceding obesity as an explanation, and that increased perception of symptoms in the obese, or a purely mechanical effect, is responsible. However, direct causality is unlikely, because in children the association is of recent origin, and trends in obesity do not explain the rising prevalence of asthma. Atopy was not associated with obesity in a large adult study. Potential explanations that require further investigation are that gastroesophageal reflux as a result of obesity causes asthma, that physical inactivity may promote both obesity and asthma, and that the diets of obese subjects may potentiate asthma.
Collapse
Affiliation(s)
- Susan Chinn
- Department of Public Health Sciences, King's College, London, UK.
| |
Collapse
|
27
|
Abstract
BACKGROUND There is no standardised protocol for the measurement of bronchial responsiveness. Results from different studies are difficult to compare and combine. METHODS Analyses are divided between those of a continuous outcome, which can be directly standardised as effect size, and those based on a binary outcome. A published method is used to convert an odds ratio to equivalent effect size. RESULTS The use of effect size allows comparison between studies using a continuous outcome but different protocols, provided the relevant standard deviation is reported. Effect size from a continuous outcome and that derived from an odds ratio from an equivalent analysis gave similar results. CONCLUSIONS Systematic reviews which include both continuous effect estimates and odds ratios can include both in one meta-analysis, provided relevant standard deviations are published for the former. Authors are encouraged to report these in all fields in which measurement protocols vary.
Collapse
Affiliation(s)
- Susan Chinn
- Department of Public Health Sciences, King's College, Capital House, 42 Weston Street, London SE1 3QD, UK.
| |
Collapse
|
28
|
McKeever TM, Scrivener S, Broadfield E, Jones Z, Britton J, Lewis SA. Prospective study of diet and decline in lung function in a general population. Am J Respir Crit Care Med 2002; 165:1299-303. [PMID: 11991883 DOI: 10.1164/rccm.2109030] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We have investigated the relationship between decline in lung function and dietary intakes of magnesium, vitamin C, and other antioxidant vitamins in a general population cohort in Nottingham, United Kingdom. In 1991, we measured dietary intake by semiquantitative food frequency questionnaire, forced expiratory volume in 1 second (FEV1), and respiratory symptoms in a cross-sectional survey of 2,633 adults aged 18-70. Nine years later we repeated these measures in 1,346 of these individuals. In cross-sectional analyses, after adjustment for smoking and other confounders, higher intakes of vitamin C and magnesium, but not vitamins A or E, were associated with higher levels of FEV1 in both 1991 and 2000. In longitudinal analysis with adjustment for confounders, decline in FEV1 between 1991 and 2000 was lower amongst those with higher average vitamin C intake by 50.8 ml (95% confidence interval, 3.8-97.9) per 100 mg of vitamin C per day, but was unrelated to magnesium intake. There was no relationship between decline in FEV1 and intake of vitamins A or E. This study suggests that a high dietary intake of vitamin C, or of foods rich in this vitamin, may reduce the rate of loss of lung function in adults and thereby help to prevent chronic obstructive pulmonary disease.
Collapse
Affiliation(s)
- Tricia M McKeever
- Division of Respiratory Medicine, University of Nottingham, Nottingham, United Kingdom.
| | | | | | | | | | | |
Collapse
|
29
|
de Wardener HE, MacGregor GA. Harmful effects of dietary salt in addition to hypertension. J Hum Hypertens 2002; 16:213-23. [PMID: 11967714 DOI: 10.1038/sj.jhh.1001374] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2001] [Revised: 11/22/2001] [Accepted: 11/22/2001] [Indexed: 11/09/2022]
Abstract
In addition to raising the blood pressure dietary salt is responsible for several other harmful effects. The most important are a number which, though independent of the arterial pressure, also harm the cardiovascular system. A high salt intake increases the mass of the left ventricle, thickens and stiffens conduit arteries and thickens and narrows resistance arteries, including the coronary and renal arteries. It also increases the number of strokes, the severity of cardiac failure and the tendency for platelets to aggregate. In renal disease, a high salt intake accelerates the rate of renal functional deterioration. Apart from its effect on the cardiovascular system dietary salt has an effect on calcium and bone metabolism, which underlies the finding that in post-menopausal women salt intake controls bone density of the upper femur and pelvis. Dietary salt controls the incidence of carcinoma of the stomach and there is some evidence which suggests that salt is associated with the severity of asthma in male asthmatic subjects.
Collapse
Affiliation(s)
- H E de Wardener
- Department of Clinical Chemistry, Imperial College of Science, Technology and Medicine, Faculty of Medicine, Charing Cross Hospital, St Dunstan's Road, London W6 8RP, UK.
| | | |
Collapse
|
30
|
Tantisira KG, Weiss ST. Complex interactions in complex traits: obesity and asthma. Thorax 2001; 56 Suppl 2:ii64-73. [PMID: 11514709 PMCID: PMC1765987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- K G Tantisira
- Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | |
Collapse
|
31
|
Abstract
BACKGROUND There is a wide geographical variation in asthma prevalence and one explanation may be in dietary salt consumption. OBJECTIVES To assess the effect of dietary sodium reduction in patients with asthma. SEARCH STRATEGY A search was conducted using the Cochrane Airways Group asthma register. Bibliographies of included randomised controlled trials (RCTs) were searched for additional studies. Authors of identified RCTs were contacted for other studies. SELECTION CRITERIA All studies were to be RCTs that involved dietary salt reduction or increased salt intake in patients with asthma. Studies of other allergic conditions such as hay fever, allergic rhinitis and eczema were considered patients with asthma were separately identified. DATA COLLECTION AND ANALYSIS Study quality was assessed and data extracted by two reviewers. All data analysis was conducted using the Cochrane Collaboration software (RevMan 4.1.1). MAIN RESULTS Fifty-six abstracts were identified and 15 studies were reviewed in full text. Five fulfilled the inclusion criteria. Nine were excluded. One was published in duplicate. Complete agreement was reached between the reviewers on inclusion or exclusion of all studies. All studies were small and of short duration. Data from only three could be pooled. Low sodium diet was associated with a significantly lower urine sodium excretion than normal or high salt diets. There were no significant differences in any asthma outcome between low salt and normal or high salt diets, but FEV1 was slightly higher with low salt compared to normal, WMD 0.09 L (95% confidence interval (CI) -0.26, 0.44 L, n=88), as was daily PEFR, WMD 11 l/min (95% CI -81, 103 l/min, n=78). With low compared to high salt, FEV1 was slightly higher WMD 0.22 L (95% CI -0.14, 0.59 L, n=88), as was daily PEFR, WMD 14 l/min (95% CI -41, 68 l/min, n=78). Bronchodilator use was slightly lower, WMD 0.7 puffs/day (95% CI -1.8, 0.5 puffs/day, n=62). REVIEWER'S CONCLUSIONS Based on currently available evidence it is not possible to conclude whether dietary salt reduction has any place in the treatment or management of asthma.
Collapse
Affiliation(s)
- K D Ardern
- Department of Public Health, Liverpool Health Authority, Hamilton House, Pall Mall, Liverpool, UK, L3 6AL.
| | | |
Collapse
|
32
|
Gotshall RW, Mickleborough TD, Cordain L. Dietary salt restriction improves pulmonary function in exercise-induced asthma. Med Sci Sports Exerc 2000; 32:1815-9. [PMID: 11079508 DOI: 10.1097/00005768-200011000-00001] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Exercise-induced asthma (EIA) occurs in approximately 90% of persons with asthma. The mechanism has not been delineated. Epidemiological studies have suggested that dietary salt may play a role in airway responsiveness. Therefore, the purpose of this study was to determine the influence of both elevated and restricted salt diets on pulmonary function in subjects with EIA. METHODS Eight subjects with EIA and eight subjects without EIA (control) participated in a double-blind crossover study. Pulmonary function was determined pre- and post-exercise challenge before and after 2 wk on a normal salt, sodium chloride, diet (NSD), a low salt diet (LSD), and a high salt diet (HSD). A 1-wk washout occurred between diets. RESULTS Diet had no effect on preexercise pulmonary function values in either group and had no effect on postexercise pulmonary function values in control subjects. However, LSD improved and HSD worsened postexercise pulmonary function values in EIA subjects. Forced expiratory volume in 1 s (FEV1) decreased by at least 10% in EIA subjects with exercise. In EIA subjects, FEV1 decreased by 14+/-6% on LSD, 20+/-7% on NSD, and 24+/-6% on HSD at 15 min postexercise. Similar patterns were observed for forced vital capacity and peak expiratory flow rates. Although LSD did not normalize pulmonary function in EIA, it did improve it. CONCLUSIONS These data suggest that individuals with EIA might benefit from lower salt diets.
Collapse
Affiliation(s)
- R W Gotshall
- Department of Health and Exercise Science, Colorado State University, Fort Collins 80523-1582, USA.
| | | | | |
Collapse
|
33
|
Abstract
The role of food intolerance in asthma is well recognized, and where food avoidance measures are instituted considerable improvement in asthma symptoms and in reduction in drug therapy and hospital admissions can result. These benefits may have a greater impact in those patients with greater symptoms. However, the promise of such benefits should not result in an approach which ignores inhaled drug therapy, or in a dietary regime which is inappropriate in the face of mild symptoms. Whilst sub-optimal intake of dietary nutrients is also a recently recognized potential risk factor for asthma, available data are insufficient to implicate any as casual. A number of studies have sought to establish the role of the antioxidant vitamins, A, C and E and selenium, yet others of the elements sodium and magnesium. Sub-optimal nutrient intake may enhance asthmatic inflammation, consequently contributing to bronchial hyperreactivity. Prospective studies of supplementation therapy are needed to confirm this.
Collapse
Affiliation(s)
- J C Baker
- Heartlands Research Institute Birmingham, Birmingham Heartlands Hospital, UK. brittle.asthma@dial pipex.com
| | | |
Collapse
|
34
|
Affiliation(s)
- A Fogarty
- Division of Respiratory Medicine, University of Nottingham, City Hospital, Nottingham, UK
| | | |
Collapse
|
35
|
Abstract
It has been suggested that the increased prevalence of atopy and asthma observed in many developed countries over the past 30 y is in part the result of a decrease in the incidence and severity of early childhood infections. The immunologic consequence of this phenomenon has been the expansion of T-lymphocyte populations away from the T-helper 1 (Th1) subset and in the direction of the Th2 subset. This leads to the creation of a cytokine-mediated propensity for the development of an intense inflammatory response in the airways, resulting in oxidative stress, airway tissue injury, and the development of atopy and asthmatic symptomatology. Over this same period, there has been a decreased intake of dietary substances that contribute to antioxidant defense, and this appears to have contributed to the rise of atopy and asthma. Studies evaluating the efficacy of these antioxidant substances in the prevention of asthma and as adjuvants in the treatment of asthma are reviewed, and suggestions are made for the direction of future studies.
Collapse
Affiliation(s)
- L S Greene
- Department of Anthropology, University of Massachusetts-Boston 02125-3393, USA.
| |
Collapse
|
36
|
Smit HA, Grievink L, Tabak C. Dietary influences on chronic obstructive lung disease and asthma: a review of the epidemiological evidence. Proc Nutr Soc 1999; 58:309-19. [PMID: 10466172 DOI: 10.1017/s0029665199000427] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The epidemiological evidence for a relationship between diet and indicators of asthma and chronic obstructive pulmonary disease (COPD) is evaluated. The review focuses on the intake of Na, n-3 fatty acids, and antioxidant vitamins as well as fruit and vegetables. Experimental studies suggest that a high-Na diet has a small adverse effect on airway reactivity in asthma patients. However, observational studies provide no clear evidence that high Na intake has adverse effects on airway reactivity or asthma symptoms in open populations. n-3 Polyunsaturated fatty acids, which are present in fish oils, are metabolized into less broncho-constricting and inflammatory mediators than n-6 polyunsaturated fatty acids. Studies in the general adult population suggest that a high fish intake has a beneficial effect on lung function, but the relationship with respiratory symptoms and clinically-manifest asthma or COPD is less evident. Also, experimental studies in asthma patients have not demonstrated an improvement in asthma severity after supplementations with fish oil. Several studies showed a beneficial association between fruit and vegetable intake and lung function, but the relationship with respiratory symptoms and the clinically-manifest disease was less convincing. A similar pattern was found for vitamin C in relation to indicators of asthma and COPD, but there are still conflicting results with respect to vitamin E and beta-carotene. In conclusion, the epidemiological evidence for a beneficial effect on indicators of asthma and COPD of eating fish, fruit and vegetables is increasing. However, the effectiveness of dietary supplementation in open-population samples is often not demonstrated. Several unresolved questions are raised, which should be addressed in future studies on the relationship between diet and respiratory disease.
Collapse
Affiliation(s)
- H A Smit
- Department of Chronic Disease and Environmental Epidemiology, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | | | | |
Collapse
|
37
|
Abstract
BACKGROUND We urgently need to take steps towards reducing the prevalence of asthma in countries where the prevalence has become unacceptably high in recent years. Because we do not have any good information about causes of the increased prevalence, we cannot act directly to reverse the trend. Therefore we need to take an indirect approach and use known information of etiologic factors to try to reduce asthma in the next generation, while acknowledging that we may be dealing with different factors from those responsible for the increased prevalence. Any successful strategies will also help to ensure that developing countries do not attain such high rates of asthma in their children in coming years. OBJECTIVE This article summarizes the roles of the risk factors that identify "high-risk" children, that provide insights into mechanisms, or that have potential for primary prevention. The factors with the most potential for primary prevention are allergen exposure, parental smoking, breast-feeding, and dietary fatty acids. CONCLUSION In other health models, information about risk factors has been used in successful public health interventions. It is disappointing that the important risk factors for asthma are well documented but that there have been few trials of primary prevention and no changes in public health policies.
Collapse
Affiliation(s)
- J K Peat
- Department of Paediatrics and Child Health, University of Sydney, Australia
| | | |
Collapse
|
38
|
Abstract
In the future, the important longitudinal studies will be those that divide the broad spectrum of asthma into phenotypic groups in order to provide more precise information about mechanisms and outcomes. Asthmatics who present in a clinical setting often have a combination of two or three different phenotypes, and may have more severe illness as a result, but subjects who are tested in epidemiological studies are frequently characterized by only one phenotype. Although the definition of asthma as a combination of symptoms plus either AHR or reduced lung function has greater predictive isolation for assessing the prognosis of respiratory illness that occurs in childhood (27,40,55,66-68), studies that are able to classify subjects according to their different phenotypes are more likely to lead to a better understanding of the factors that influence prognosis. More importantly, by using this approach, future research studies should be better able to separate the mechanisms whereby therapeutic or environmental interventions influence the prognosis of each phenotype. The potential benefits will be a better understanding and evaluation of the factors that make an important contribution to respiratory health.
Collapse
Affiliation(s)
- J K Peat
- Department of Medicine, University of Sydney, NSW, Australia
| |
Collapse
|
39
|
Abstract
The prevalences of bronchial asthma in the Asia-Pacific region range from 0 to 24% and appear to be increasing in some countries. The increased prevalence of asthma may be related to the urbanization of these countries or areas. Risk factors relating to the development of asthma are multiple and complex. These include: Predisposing or genetic factors: (atopy and bronchial hyperresponsiveness; BHR) that increase an individuals susceptibility. Longitudinal studies in children have shown that BHR precedes asthma in some individuals. A gene governing BHR is located near a major locus that regulates serum IgE levels on chromosome 5 q. An additional gene that determines the specificity of the immune response located in the human leukocyte antigen complex (HLA) may govern the specificity of the immune response to common aeroallengens in some individuals. Causal Factors: inhaled allergens are the most important causal factors of asthma, which include indoor allergens (domestic mites, animal, cockroach and fungus allergens), domestic mites being the most common potential allergen, and outdoor allergens (pollens from trees, grasses and weeds). Owing to the geographic location and different sensitivity to allergen between races, allergens vary from area to area. Certain drugs, food and food additives are also the cause of asthma attack. Contributing factors: smoking is an important trigger and a serious problem in most Asian-Pacific countries. Air pollution in particular sulfur dioxide (SO2), nitrogen dioxide (NO2) and respirating particles are common contributing factors. Very low concentration of SO2 (0.5 ppm) can cause bronhospasm in asthmatics. A combination of low concentration of SO2 and NO2 often encountered in heavy traffic further enhances the airway responsiveness to inhaled allergen. In addition, respiratory virus infection is closely associated to the development of asthma in childhood.
Collapse
Affiliation(s)
- N S Zhong
- Guangzhou Institute of Respiratory Disease, China
| |
Collapse
|
40
|
Devereux G, Beach JR, Bromly C, Avery AJ, Ayatollahi SM, Williams SM, Stenton SC, Bourke SJ, Hendrick DJ. Effect of dietary sodium on airways responsiveness and its importance in the epidemiology of asthma: an evaluation in three areas of northern England. Thorax 1995; 50:941-7. [PMID: 8539673 PMCID: PMC1021306 DOI: 10.1136/thx.50.9.941] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although several investigations have shown a relationship between asthma (or its surrogate, airways responsiveness) and dietary or urinary sodium, others have not, and the matter remains controversial. This "salt effect" has been investigated during two recent epidemiological surveys of men in northern England. The first assessed the possible effect on airways responsiveness of occupational exposure to welding fumes, and the second characterised airways responsiveness in two geographically distinct residential areas. Thus, three separate study areas/populations were involved. METHODS Investigation 1 involved 1059 shipyard workers aged 16-27 years who were exposed variously to welding fumes, and Investigation 2 involved 587 men aged 20-44 years who lived in rural West Cumbria or in urban Newcastle upon Tyne. In Investigation 1, a 24 hour urine specimen was requested from each subject with quantifiable airways responsiveness (PD20 < or = 6400 micrograms methacholine) and from an equal number of subjects without measurable airways responsiveness from the same occupational subgroup. In Investigation 2, every subject was asked to provide a 24 hour urine specimen. RESULTS Of the men undergoing methacholine tests, satisfactory 24 hour urine specimens were obtained from 234 (22.1%) in Investigation 1 and 232 (39.5%) in Investigation 2. Analysis using multiple linear regression, multiple linear logistic regression, and multiple regression for censored data produced consistent results within each study population but conflicting results between them, such that there was no hint of a relationship between airways responsiveness and 24 hour urinary sodium excretion in the shipyard workers of Investigation 1 nor in the rural West Cumbrian population of Investigation 2, but an association was found in the urban Newcastle population of Investigation 2. All study populations were sufficiently large to demonstrate anticipated relationships between airways responsiveness and atopy, baseline FEV1, and (Newcastle only) age. CONCLUSIONS If airways responsiveness is related to dietary sodium the relationship is not likely to be strong.
Collapse
Affiliation(s)
- G Devereux
- Chest Unit, Newcastle General Hospital, University of Newcastle upon Tyne, UK
| | | | | | | | | | | | | | | | | |
Collapse
|