Margarine consumption and allergy in children

The Effects of a Healthy Diet on Asthma and Wheezing in Children and Adolescents: A Systematic Review and Meta-Analysis

Background

Asthma is a public health problem requiring focused attention. This study aimed to systematically evaluate the association between dietary structure and asthma or wheezing in children.

Methods

The study protocol of this meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration code CRD42023390191. A total of 8397 articles were retrieved, searching PubMed, Medline, Embase, Web of Science, and Scopus databases as of November 21, 2022. Two independent authors were responsible for independently conducting the literature screening process. Effect-size estimates were expressed as odds ratio (OR) in cross-sectional studies and risk ratio (RR) in cohort studies with a 95% confidence interval (CI). Summary effect estimates were evaluated with random-effect models. Meanwhile, subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity and the robustness of the pooled estimation.

Results

A total of 65 studies, including 567,426 subjects had been analyzed. Overall analyses of cross-sectional studies revealed that a healthy diet was protective against asthma (adjusted OR=0.85, 95% CI: 0.80-0.89, P <0.001, I2=69.8%, Tau2=0.026) and wheezing (adjusted OR=0.85, 95% CI: 0.81-0.89, P <0.001, I2=66.8%, Tau2=0.015) in children and adolescents. Conversely, unhealthy diets can exacerbate asthma (adjusted OR=1.28, 95% CI: 1.20-1.36, P <0.001, I2=64.9%, Tau2=0.019) and wheeze (adjusted OR=1.09, 95% CI: 1.02-1.16, P =0.006, I2=75.2%, Tau2=0.023) in children and adolescents. The same trend was found in cohort studies (adjusted RR=0.72, 95% CI: 0.58-0.90, P =0.003, I2=83.5%, Tau2=0.105). A clear trend was observed between high-frequency healthy diets (OR=0.80; 95% CI: 0.71-0.89; P <0.001) is more protective against asthma than low-frequency healthy diets (OR=0.81; 95% CI: 0.70-0.94; P =0.007).

Conclusion

Our findings highlight the protective effects of a healthy diet on asthma and wheezing in children, including fruit, seafood, cereals, and the Mediterranean diet.

Dietary intake and plasma concentrations of PUFAs in childhood and adolescence in relation to asthma and lung function up to adulthood

BACKGROUND

PUFAs may influence the risk of asthma; however, long-term prospective studies including objective biomarkers of PUFA intake are lacking.

OBJECTIVES

The objective was to investigate the role of dietary intake and plasma concentrations of n-3 and n-6 (ω-3 and ω-6) PUFAs in childhood and adolescence for the development of asthma and lung function up to young adulthood.

METHODS

The study included participants from the Swedish prospective birth cohort BAMSE. Dietary intake of PUFAs was calculated from FFQs (n = 1992) and plasma proportions of PUFAs were measured in phospholipids (n = 831). We analyzed the n-3 PUFA α-linolenic acid (ALA; 18:3n-3); the sum of very-long-chain (VLC) n-3 PUFAs: EPA (20:5n-3), DHA (22:6n-3), and docosapentaenoic acid (22:5n-3); and the n-6 PUFAs linoleic acid (LA; 18:2n-6) and arachidonic acid (AA; 20:4n-6). Asthma was assessed by questionnaires at 8, 16, and 24 y and lung function was measured by spirometry at 24 y.

RESULTS

A high (≥median) self-reported dietary intake of LA at 8 y and AA at 16 y was associated with increased risk of prevalent asthma at 24 y (OR: 1.41; 95% CI: 1.10, 1.82 and OR: 1.32; 95% CI: 1.02, 1.70, respectively). In contrast, plasma proportions of ALA, ∑VLC n-3 PUFAs, and AA at 8 y, as well as LA at 16 y, were inversely associated with prevalent asthma at 24 y (e.g., OR: 0.55; 95% CI: 0.38, 0.81 for ∑VLC n-3 PUFAs). No consistent associations were observed with lung function.

CONCLUSIONS

High dietary intake of certain n-6 PUFAs in childhood or adolescence may be associated with increased risk of asthma up to young adulthood, whereas dietary biomarkers of certain n-3 and n-6 PUFAs in plasma may be associated with decreased risk. Thus, the role of diet compared with altered metabolism of PUFAs needs further investigation to improve dietary preventive strategies for asthma.

Prevalence of Asthma and Its Associating Environmental Factors among 6-12-Year-Old Schoolchildren in a Metropolitan Environment-A Cross-Sectional, Questionnaire-Based Study

We aimed to evaluate the prevalence of asthma and its associating environmental factors within a 6–12-year-old population. A cross-sectional, questionnaire-based study was conducted in primary schools located in the capital of Hungary; 3836 eligible parent-reported questionnaires were evaluated. Besides the International Study of Asthma and Allergies in Childhood (ISAAC) phase three core questions for asthma, the survey also assessed various potential risk factors. We introduced the umbrella term cumulative asthma as the union of physician-diagnosed asthma and current wheezing to estimate the lifetime prevalence of asthma. Current wheezing and physician-diagnosed asthma showed a frequency of 9.5% and 6.3%, respectively. They contributed to a cumulative asthma prevalence of 12.6% among the sampled population, with a girl-boy percentage of 37.4% to 62.6%. Air-pollution and weedy areas were associated with greater risk for asthma, while a suburban residence showed lesser odds. Indoor smoking, visible mold, and keeping a dog were defined as risk factors for asthma, while the presence of plants in the bedroom and pet rodents were associated with lower odds ratios. The consumption of fast food, beverages containing additives and margarine were significantly higher in asthmatics, while we found frequent sport activity and cereal intake associated with lower odds ratios for asthma. In this urban environment, we identified an increased asthma prevalence compared to some previously published studies, but the cross-sectional design and the different methodology did not permit us to draw timeframe-dependent conclusions.

Determination of the food dye indigotine in cream by near-infrared spectroscopy technology combined with random forest model

Artificial pigment is a common food additive in cream products. If added in excess, it will do harm to human body. At present, there is no research on the detection of cream pigment by Near Infrared (NIR) spectroscopy. In this paper, a method based on random forest was applied to determine the indigotine in cream. Weighting in the experiments was accomplished using analytical balances with precision as low as 0.0001 g. The NIR spectra data of cream with different concentration of indigotine were recorded. The original spectra was pretreated by SG smoothing, mean centering and second derivative. Random forest was applied to establish a quantitative analysis model for cream pigment content, and multiple evaluation criteria were selected to comprehensively evaluate the model. The R² was 0.9402, RMSEP was 0.2509 and RPD was 4.0893. Consequently, NIR spectroscopy, combined with data pretreatments and random forest model, was confirmed to be an interesting tool for non-destructive evaluation of pigment content in cream.

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.

Can Early Omega-3 Fatty Acid Exposure Reduce Risk of Childhood Allergic Disease?

A causal link between increased intake of omega-6 (n-6) polyunsaturated fatty acids (PUFAs) and increased incidence of allergic disease has been suggested. This is supported by biologically plausible mechanisms, related to the roles of eicosanoid mediators produced from the n-6 PUFA arachidonic acid. Fish and fish oils are sources of long chain omega-3 (n-3) PUFAs. These fatty acids act to oppose the actions of n-6 PUFAs particularly with regard to eicosanoid synthesis. Thus, n-3 PUFAs may protect against allergic sensitisation and allergic manifestations. Epidemiological studies investigating the association between maternal fish intake during pregnancy and allergic outcomes in infants/children of those pregnancies suggest protective associations, but the findings are inconsistent. Fish oil provision to pregnant women is associated with immunologic changes in cord blood. Studies performed to date indicate that provision of fish oil during pregnancy may reduce sensitisation to common food allergens and reduce prevalence and severity of atopic eczema in the first year of life, with a possible persistence until adolescence. A recent study reported that fish oil consumption in pregnancy reduces persistent wheeze and asthma in the offspring at ages 3 to 5 years. Eating oily fish or fish oil supplementation in pregnancy may be a strategy to prevent infant and childhood allergic disease.

Diet Hypotheses in Light of the Microbiota Revolution: New Perspectives

From an evolutionary standpoint, allergy has only recently emerged as a significant health problem. Various hypotheses were proposed to explain this, but they all indicated the importance of rapid lifestyle changes, which occurred in industrialized countries in the last few decades. In this review, we discuss evidence from epidemiological and experimental studies that indicate changes in dietary habits may have played an important role in this phenomenon. Based on the example of dietary fiber, we discuss molecular mechanisms behind this and point towards the importance of diet-induced changes in the microbiota. Finally, we reason that future studies unraveling mechanisms governing these changes, along with the development of better tools to manipulate microbiota composition in individuals will be crucial for the design of novel strategies to combat numerous inflammatory disorders, including atopic diseases.

Dietary patterns and the risk of rhinitis in primary school children: a prospective cohort study

This study was to investigate the association between dietary patterns and rhinitis in primary school children. 1,599 students without rhinitis at baseline survey were selected from a primary school children cohort. Information on food consumption, respiratory symptoms, and confounders was collected using questionnaires. Dietary patterns were defined using principal component analysis. Logistic regression was performed to calculate odds ratio (OR) with 95% confidence intervals (95% CI). The incidence of rhinitis during 12 months follow-up was 21.2%. Three patterns were extracted and labeled as pattern I, II and III. Dietary pattern II which had higher factor loadings of legumes, butter, nuts and potatoes was associated with an increased risk of rhinitis (OR: 1.34, 95% CI: 1.01-1.87) when the highest tertile of pattern score was compared to the lowest tertile, after adjusted for confounders. Besides, every 1-unit increase of score of pattern II was also associated with an increased risk of rhinitis (OR: 1.19, 95% CI: 1.05-1.35). Neither pattern I nor Pattern III was observed to be associated with risk of rhinitis. A diet with higher levels of consumption of legumes, butter, nuts and potatoes may increase the risk of allergic rhinitis in primary school children.

Fat intake and breast milk fatty acid composition in farming and nonfarming women and allergy development in the offspring

BACKGROUND

Children growing up on small family farms are at much lower risk of developing allergy than other children. We hypothesized that low intake of margarine and polyunsaturated fats among farming families could contribute to this protection.

METHODS

Twenty-eight mother-infant pairs living on small dairy farms and 37 nonfarm rural resident pairs were recruited in the FARMFLORA birth cohort. Food items expected to affect dietary fat composition were recorded by food frequency questionnaires during pregnancy and by 24-h recalls followed by 24-h food diaries during lactation. Allergy was diagnosed by doctors, using strict predefined criteria. Maternal diet and breast milk fat composition were compared between farming and nonfarming mothers and related to children's allergy at age 3 y.

RESULTS

Farming mothers consumed more butter, whole milk, saturated fat, and total fat than nonfarming mothers, who consumed more margarine, oils, and low-fat milk. Farming mothers' breast milk contained higher proportions of saturated and lower proportions of polyunsaturated fat. Allergy was eight times more common in nonfarm children. Mothers of allergic children consumed more margarine and oils than mothers of nonallergic children.

CONCLUSION

Low maternal consumption of margarine and vegetable oils might contribute to the allergy-preventive effect of growing up on small dairy farms.

Fast food consumption in pregnancy and subsequent asthma symptoms in young children

BACKGROUND

Recent cross-sectional studies suggested children's current fast food consumption to be related to frequency of asthma and allergies. Maternal prenatal diet has been suspected to contribute to children's asthma and atopic disease risks.

OBJECTIVES

We hypothesized that maternal fast food intake during pregnancy increases offspring's risk for asthmatic symptoms.

METHODS

We conducted a population-based study of 1201 mother/child pairs in Los Angeles, California. Detailed information about prenatal fast food intake and other dietary, lifestyle/environmental factors, and pregnancy was collected shortly after birth; further data were retrieved from birth certificates. Using the International Study of Asthma and Allergies in Childhood core questions, asthma and rhinitis symptoms were assessed, and doctor's diagnoses were recorded in offspring 3.5 years after birth. Poisson regression with robust error variance using a log link function was used to estimate relative risks (RRs). Models were adjusted using covariates or propensity scores.

RESULTS

Maternal prenatal fast food consumption related to increased relative risks of their children for severe, and current asthma symptoms (wheeze last 12 months combined with doctor's diagnosis) in a dose-dependent manner: 'once a month': RR: 0.99 (95% CI: 0.36, 2.75), 'once a week': 1.26 (0.47, 3.34); '3-4 days a week': 2.17 (0.77, 6.12); and 'every day' 4.46 (1.36 14.6) compared to 'never', adjusting for potential confounders (p for trend = 0.0025). There was also suggestion of increased risks for rhinitis symptoms.

CONCLUSIONS

These findings suggest that in utero exposure to frequent fast food through maternal diet may be a risk factor for asthmatic symptoms in young children.

Increased intake of vegetable oil rich in n-6 PUFA enhances allergic symptoms and prevents oral tolerance induction in whey-allergic mice

Increased intake of vegetable oils rich in n-6 PUFA, including soyabean oil, has been associated with an increase in allergic disease. The present study aimed to determine the effect of an increasing dose of dietary vegetable oil on allergic outcomes in mice. To study this, mice received a 7 v. 10 % soyabean oil diet before and during oral sensitisation with whey or whey hyperimmune serum transfer. Another group of mice received partial whey hydrolysate (pWH) while being fed the diets before oral sensitisation. The acute allergic skin response, serum Ig level, mouse mast cell protease-1 (mMCP-1) concentration and/or splenic T-cell percentages were determined upon whey challenge. When the diets were provided before and during oral sensitisation, the acute allergic skin response was increased in mice fed the 10 % soyabean oil diet compared with the 7 % soyabean oil diet. Whey IgE and IgG1 levels remained unaltered, whereas mMCP-1 levels increased in mice fed the 10 % soyabean oil diet. Furthermore, allergic symptoms were increased in naive mice fed the 10 % soyabean oil diet and sensitised with whey hyperimmune serum. In addition to enhancing the mast cell response, the 10 % soyabean oil diet increased the percentage of activated Th1 and Th2 cells as well as increased the ratios of Th2:regulatory T cells and Th2:Th1 when compared with the 7 % soyabean oil diet. Oral tolerance induction by pWH was abrogated in mice fed the 10 % soyabean oil diet compared with those fed the 7 % soyabean oil diet during pretreatment with pWH. In conclusion, increased intake of soyabean oil rich in n-6 PUFA suppresses tolerance induction by pWH and enhances the severity of the allergic effector response in whey-allergic mice. Dietary vegetable oils rich in n-6 PUFA may enhance the susceptibility to develop or sustain food allergy.

A Traditional Diet Is Associated with a Reduced Risk of Eczema and Wheeze in Colombian Children

Background: Diet might influence the risk of allergic diseases. Evidence from developing countries with high prevalence of childhood asthma is scant. Methods: Information on wheeze, rhinitis, and eczema was collected from 3209 children aged 6–7 years in 2005, who were taking part in the International Study on Asthma and Allergy in Children (ISAAC) in Colombia. Intake frequency of twelve food groups was assessed. Associations between each food group and current wheeze, rhino-conjunctivitis, and eczema were investigated with multiple logistic regressions, adjusting for potential confounders. Simes’ procedure was used to test for multiple comparisons. Results: 14.9% of children reported wheeze in the last 12 months, 16% rhino-conjunctivitis, and 22% eczema. Eczema was negatively associated with consumption of fresh fruits and pulses three or more times per week (adjusted Odds ratio (aOR): 0.64; 95% Confidence Interval (CI): 0.49 to 0.83; p value = 0.004; and aOR: 0.62, 95% CI: 0.47 to 0.80; p value < 0.001, respectively). Current wheeze was negatively associated with intake of potatoes (aOR: 0.44, 95% CI: 0.31 to 0.62, p value = 0.005), whilst this outcome was positively associated with consumption of fast food (aOR: 1.76, 95% CI: 1.32 to 2.35, p value = 0.001). These associations remained statistically significant after controlling for multiple comparisons. Conclusions: A traditional diet might have a protective effect against eczema and wheeze in Colombian children, whilst intake of fast foods increases this risk.

Effects of dietary habits and risk factors on allergic rhinitis prevalence among Turkish adolescents

BACKGROUND

Allergic rhinitis (AR) is a global health problem affecting many people from childhood to adulthood. The aim of this study was to evaluate the prevalence of AR and related symptoms, and to assess the risk factors, dietary habits and the Mediterranean diet affecting AR.

METHODS

In a cross-sectional study design, 9991 children, aged 13-14 years in 61 primary schools in 32 districts of Istanbul were evaluated. The prevalence of AR symptoms among the children was evaluated using the ISAAC protocol.

RESULTS

In our study, total of 10,984 questionnaires were distributed to 13-14yr-old schoolchildren to 61 schools in 32 district of Istanbul and 9991 questionnaires were suitable for analysis with an overall response of 91.7%. The rates of lifetime rhinitis, rhinitis in last 12 months and lifetime doctor diagnosed AR prevalence were 53.5%, 38.3% and 4.5%, respectively. The variation among districts in the prevalence of doctor diagnosed AR was very high. The highest prevalence was about 10 times higher than in the district with the lowest prevalence (range: 1.4-14.5) of Istanbul. A family history of atopy, mother with a university degree, presence of cat at home during last 12 months and adenoidectomy were significant for increased doctor diagnosed AR risk. Additionally, although fish and other sea foods, fermented drinks made from millets and various seeds, animal fats and butter were independent risk factors for doctor diagnosed AR, fish oil and hamburger were protective foods for doctor diagnosed AR. The MD was not associated with the prevalence of doctor diagnosed AR.

CONCLUSIONS

This study shows that that there are wide variations for the prevalence of AR related symptoms in 13-14yr-old schoolchildren among districts of Istanbul in Turkey. Socio-economical, environmental factors, some dietary habits, but not Mediterranean diet may affect the prevalence of AR.

Lipid profiles in children with and without asthma: interaction of asthma and obesity on hyperlipidemia

AIMS

The joint effect of obesity and asthma on hyperlipidemia has never been explored. We aim to examine (1) the association of dyslipidemia and asthma, (2) the interaction effect of asthma and obesity on hyperlipidemia, and (3) whether a gender difference existed in the above relationships.

METHODS

Between 2009 and 2010, 10- to 15-year-old children were recruited from 7 schools and 2 hospitals in Northern Taiwan. The population consisted of 237 asthmatic children and 225 non-asthmatic controls, and was further divided into four groups: non-obese controls, obese controls, non-obese asthmatics, and obese asthmatics. Measurements included anthropometric measures and blood samples for analysis of metabolic factors. The Cook's criteria were used to define childhood metabolic syndrome. General linear models were used to analyze how lipid profiles were associated with obesity and asthma.

RESULTS

Total cholesterol and low density lipoprotein cholesterol levels increased progressively in the group order obese asthmatics>non-obese asthmatics>obese controls>non-obese controls. In boys, low density lipoprotein cholesterol levels were significantly higher in obese asthmatics compared to obese non-asthmatics, with a mean difference of 6.2 mmol/L in the general linear model. We also discovered a significant interactive effect of obesity and asthma on hyperlipidemia in boys (p for interaction=0.03).

CONCLUSIONS

Asthma was associated with higher low density lipoprotein cholesterol levels and this association was amplified in overweight and obese subjects. A gender difference was observed in the joint effect of obesity and asthma on hyperlipidemia.

Associations of intake of antioxidant vitamins and fatty acids with asthma in pre-school children

OBJECTIVE

Increasing childhood asthma rates may be due to changing dietary lifestyle. We investigated the association of dietary intake of antioxidant vitamins and fatty acids with asthma in Japanese pre-school children.

DESIGN

Cross-sectional study.

SETTING

School-based survey on lifestyle/diet and health status in children in Japan.

SUBJECTS

Parents of 452 children aged 3-6 years completed a questionnaire on the children's and parents’ lifestyle and demographics. Children were classified into asthma cases and non-asthma cases in accordance with the ATS-DLD(American Thoracic Society and Division of Lung Diseases of the National Heart, Lung, and Blood Institute) questionnaire. Children's diet was assessed using a 3 d dietary record completed by parents. Children's age, sex, BMI, history of food allergy, maternal age, parental history of allergy, maternal education,family size and second-hand smoking were included as covariates. Logistic regression models were used to examine the association between children's diet and asthma.

RESULTS

Compared with children with the lowest intake tertile for vitamin C and vitamin E, those in the highest were significantly inversely associated with asthma; adjusted OR (95% CI) were 0?35 (0?14, 0?88) and 0?32 (0?12, 0?85),respectively. A statistically significant trend was also observed. Fruit intake showed an inverse but insignificant association with asthma. There were no associations of any type of fatty acids with asthma.

CONCLUSIONS

These data suggest that children with high intakes of vitamins C and E may be associated with a reduced prevalence of asthma.

Maternal dietary fat and fatty acid intake during lactation and the risk of asthma in the offspring

AIM

To explore the association between maternal dietary fat and fatty acid (FA) intake during lactation, and the risk of asthma in the offspring by the age of 5 years.

METHODS

The subjects comprised 1798 mother-child pairs from the Type 1 Diabetes Prediction and Prevention (DIPP) Nutrition Study. Dietary intake was assessed by a validated 181-item food frequency questionnaire, which covered the third month of lactation. The cumulative incidence of asthma was assessed at the age of 5 years with a questionnaire modified from the International Study of Asthma and Allergies in Childhood (ISAAC). Cox proportional hazards regression was used for statistical analysis.

RESULTS

The maternal use of margarines during lactation was associated with a marginally increased risk of asthma [hazard ratio (HR) for user vs. nonuser 1.96, 95% confidence interval (CI) 1.01-3.82, p = 0.047] after adjusting for putative confounders. The maternal intakes of n-3 polyunsaturated FA (PUFA) and fish during lactation were not associated with the risk of asthma.

CONCLUSION

Maternal use of margarines during lactation was weakly associated with an increased risk of asthma in the offspring at the age of 5 years. Other fats or FAs during lactation were not associated with the risk of asthma. However, the nonadherence to dietary recommendations regarding especially fats of our study population may restrict the generalizability of our results.

Increased linoleic acid/α-linolenic acid ratio in Swedish cord blood samples collected between 1985 and 2005

BACKGROUND

Cord serum (CS) phospholipid fatty acid composition is associated with maternal diet during foetal life, and maternal intake of linoleic acid (LA, C18:2ω-6) and α-linolenic acid (LNA, C18:3 ω-3) has been shown to influence the LA and LNA levels in CS. A possible connection between the increased incidence of atopic diseases and increased intake of LA and decreased intake of LNA in the Western world has been proposed.

AIM

The aim of this study was to explore phospholipid fatty acid proportions and total IgE levels in CS from Swedish children, collected from 1985 to 2005, a period with increasing frequency of allergic diseases in Sweden, and reveal possible changes over time.

METHOD

Phospholipid fatty acids and total IgE antibodies were analysed with gas chromatography and UniCAP(®) technology, respectively, in 300 CS samples.

RESULTS

The proportions of LA and LNA decreased significantly from 1985 to 2005 (p < 0.001 for both). However, the LA/LNA ratio did increase (p < 0.001), revealing a relatively larger decrease in LNA than in LA. No correlations were found between ω-6 and ω-3 fatty acids and total IgE antibodies in CS from newborn children.

CONCLUSIONS

The LA/LNA ratio increased (p < 0.001) in cord serum samples collected between 1985 and 2005, and no correlations between fatty acids and total IgE were found.

Dietary meat and fat intake and prevalence of rhinoconjunctivitis in pregnant Japanese women: baseline data from the Kyushu Okinawa Maternal and Child Health Study

Background

Dietary fat exerts numerous complex effects on proinflammatory and immunologic pathways. Several epidemiological studies have examined the relationships between intake of fatty acids and/or foods high in fat and allergic rhinitis, but have provided conflicting findings. The current cross-sectional study investigated such relationships in Japan.

Methods

Study subjects were 1745 pregnant women. The definition of rhinoconjunctivitis was based on criteria from the International Study of Asthma and Allergies in Childhood. Information on dietary factors was collected using a validated self-administered diet history questionnaire. Adjustment was made for age; gestation; region of residence; number of older siblings; number of children; smoking; secondhand smoke exposure at home and at work; family history of asthma, atopic eczema, and allergic rhinitis; household income; education; and body mass index.

Results

The prevalence of rhinoconjunctivitis in the past 12 months was 25.9%. Higher meat intake was significantly associated with an increased prevalence of rhinoconjunctivitis: the adjusted odds ratio between extreme quartiles was 1.71 (95% confidence interval: 1.25-2.35, P for trend = 0.002). No measurable association was found between fish intake and rhinoconjunctivitis. Intake of total fat, saturated fatty acids, monounsaturated fatty acids, n-3 polyunsaturated fatty acids, α-linolenic acid, eicosapentaenoic acid, docosahexaenoic acid, n-6 polyunsaturated fatty acids, linoleic acid, arachidonic acid, and cholesterol and the ratio of n-3 to n-6 polyunsaturated fatty acid intake were not evidently related to the prevalence of rhinoconjunctivitis.

Conclusions

The current results suggest that meat intake may be positively associated with the prevalence of rhinoconjunctivitis in young adult Japanese women.

Polyunsaturated fatty acid intake and prevalence of eczema and rhinoconjunctivitis in Japanese children: the Ryukyus Child Health Study

Background

The recent increase in the prevalence of allergic disorders might be a consequence of increased intake of n-6 polyunsaturated fatty acids (PUFAs) and reduced intake of n-3 PUFAs. The current cross-sectional study examined the association between intake levels and the prevalence of eczema and rhinoconjunctivitis in Japanese children.

Methods

Subjects were 23,388 schoolchildren aged 6-15 years residing in Okinawa. The presence of eczema and/or rhinoconjunctivitis was determined according to the criteria of the International Study of Asthma and Allergies in Childhood. A brief diet history questionnaire for children and adolescents was administered to acquire information on dietary factors. Adjustment was made for age, sex, residential municipality, number of siblings, smoking in the household, body mass index, paternal and maternal history of allergic diseases, and paternal and maternal educational level.

Results

The prevalences of eczema and rhinoconjunctivitis in the previous 12 months were 7.0% and 8.0%, respectively. Consumption of PUFAs, n-3 PUFAs, α-linolenic acid, n-6 PUFAs, and linoleic acid was positively associated with the prevalence of eczema: the adjusted odds ratios (ORs) between extreme quintiles (95% confidence intervals [CIs], P for trend) were 1.26 (1.07-1.48, 0.04), 1.31 (1.11-1.54, 0.009), 1.31 (1.12-1.55, 0.003), 1.26 (1.07-1.48, 0.01), and 1.27 (1.08-1.49, 0.01), respectively. Arachidonic acid intake was independently inversely related to eczema: the adjusted OR between extreme quintiles was 0.81 (0.69-0.95, 0.0008). Eczema was not associated with eicosapentaenoic or docosahexaenoic acid intake, or with the ratio of n-3 to n-6 PUFA intake. Only arachidonic acid intake was statistically significantly related to the prevalence of rhinoconjunctivitis, showing a clear inverse linear trend: the adjusted OR between extreme quintiles was 0.86 (0.74-0.997, 0.03).

Conclusions

Consumption of n-3 and n-6 PUFAs, especially α-linolenic acid and linoleic acid, may be positively associated with eczema. Arachidonic acid intake may be inversely related to eczema and rhinoconjunctivitis.

Fatty acids in breast milk and development of atopic eczema and allergic sensitisation in infancy

BACKGROUND

One of the explanations for the increasing prevalence of atopic diseases is a relative low perinatal supply of n-3 fatty acids. However, this does not explain the protective effects of whole-fat dairy products or high levels of transfatty acids in breast milk, observed in some studies. We evaluated the role of perinatal supply of fatty acids in the early development of atopic eczema and allergic sensitisation.

METHODS

Fatty acids, including n-3 long-chain polyunsaturated fatty acids (LCPs) as well as ruminant fatty acids (rumenic acid, cis-9,trans-11-C18:2 conjugated linoleic acid; and vaccenic acid, trans-11-C18:1), were determined in breast milk sampled at 1 month postpartum from 310 mother-infant pairs in the KOALA Birth Cohort Study, the Netherlands. Children were followed for atopic outcomes until 2 years of age.

RESULTS

Higher concentrations of n-3 LCPs as well as ruminant fatty acids were associated with lower risk of (1) parent-reported eczema, (2) atopic dermatitis (UK Working Party criteria), and (3) sensitisation at age 1 year (as revealed by specific serum IgE levels to cow's milk, hen's egg and/or peanut). In multivariable logistic regression analysis, the inverse associations between ruminant fatty acid concentrations in breast milk and atopic outcomes were found to be independent from n-3 LCPs.

CONCLUSIONS

The results confirm a protective role of preformed n-3 LCPs in the development of atopic disease. Moreover, this is the first study in humans confirming results from animal studies of protective effects of ruminant fatty acids against the development of atopic manifestations.

Early fish introduction is associated with less eczema, but not sensitization, in infants

OBJECTIVE

To investigate if the development of allergic diseases during the child's first 18 months of life is influenced by the time at which different food items were introduced into the child's diet.

METHOD

A birth cohort of 184 children was followed to 18 months of age. Diaries were used to document feeding practices, and parental interviews were performed at 6 and 12 months of age, probing for symptoms suggesting allergic disease, general health-related issues and food introduction regimes. Symptoms promoted prompt clinical examination, and all children were examined clinically, and tested for sensitization to common airborne and food allergens at 18 months of age.

RESULTS

The earlier the fish was introduced into the child's diet the lower was the frequency of eczema. This association remained after control for confounding factors. The timing of fish introduction and asthma development showed a similar pattern, but did not reach statistical significance. Sensitization was not influenced by the timing of fish introduction. Other food items or feeding practices did not seem to influence allergy development.

CONCLUSION

  Early introduction of fish into the child's diet was associated with less eczema development, and a tendency to less asthma. Sensitization was not associated with the timing of fish introduction.

Dietary supplementation with soybean lecithin increases pulmonary PAF bioactivity in asthmatic rats

The prevalence of asthma has risen over the last few decades, and some studies correlate this with the greater consumption of polyunsaturated fatty acids (PUFAs). Dietary PUFAs are known to increase the susceptibility of biological structures to lipid peroxidation, a process by which platelet-activating factor (PAF)-like lipids can be generated. These lipids functionally mimic the bioactivity of PAF, a potent proinflammatory mediator that exerts several deleterious effects on asthma. Thus, this work aimed to investigate if dietary supplementation with soybean lecithin (SL), a source of PUFAs, increases lipid peroxidation and PAF bioactivity in lungs of asthmatic Wistar rats. Animals were separated into groups: control, supplemented, asthmatic, asthmatic supplemented with SL (2 g/kg body weight), asthmatic supplemented with SL (2 g/kg body weight) and DL-alpha-tocopheryl acetate (100 mg/kg body weight). Asthmatic inflammation increased pulmonary lipid peroxidation, PAF bioactivity, alveolar-capillary barrier permeability and production of nitric oxide. In asthmatics, dietary supplementation with SL promoted an increase in pulmonary lipid peroxidation and PAF bioactivity, and an increase in the permeability of the alveolar-capillary barrier. Moreover, the treatment of asthmatic rats with DL-alpha-tocopheryl acetate inhibited the lipid peroxidation and decreased the PAF bioactivity. Therefore, the increase in pulmonary PAF bioactivity in asthmatic individuals elicited by the dietary supplementation with SL probably involves the generation of PAF-like lipids. This finding suggests that PAF-like lipids may account for the deleterious effects of dietary PUFAs on asthma.

Is there a role for fatty acids in early life programming of the immune system?

There may be a causal relationship betweenn-6 PUFA intake and allergic disease and there are biologically plausible mechanisms, involving eicosanoid mediators of then-6 PUFA arachidonic acid, that could explain this. There is some evidence that high linoleic acid intake is linked with increased risk of atopic sensitisation and allergic manifestations. Fish and fish oils are sources of long-chainn-3 PUFA and these fatty acids act to oppose the actions ofn-6 PUFA. It is considered thatn-3 PUFA will protect against atopic sensitisation and against the clinical manifestations of atopy. All five epidemiological studies investigating the effect of maternal fish intake during pregnancy on atopic or allergic outcomes in infants/children of those pregnancies concluded protective associations. Epidemiological studies investigating the effects of fish intake during infancy and childhood on atopic outcomes in those infants or children are inconsistent, although the majority of the studies (9/14) showed a protective effect of fish. Fish oil provision to pregnant women is associated with immunologic changes in cord blood. Provision of fish oil during pregnancy may reduce sensitisation to common food allergens and reduce the prevalence and severity of atopic dermatitis in the first year of life. This effect may persist until adolescence with a reduction in prevalence and/or severity of eczema, hayfever and asthma. Fish oil supplementation in infancy may decrease the risk of developing some manifestations of allergic disease, but whether this benefit persists as other factors come into play remains to be determined.

Session 1: Allergic disease: Nutrition as a potential determinant of asthma

Asthma is characterised by chronic lung airway inflammation, increased airway responsiveness and variable airflow obstruction. In Westernised countries asthma is a public health concern because of its prevalence, associated ill health and high societal and healthcare costs. In recent decades there has been a marked increase in asthma prevalence, particularly in Westernised countries. It has been proposed that changing diet has contributed to the increase in asthma. Several dietary hypotheses exist; the first relates the increase in asthma to declining dietary antioxidant intake, the second to decreased intake of long-chain n-3 PUFA and increasing intake of n-6 PUFA. Vitamin D supplementation and deficiency have also been hypothesised to have contributed to the increase in asthma. Observational studies have reported associations between asthma and dietary antioxidants (vitamin E, vitamin C, carotenoids, Se, flavonoids, fruit), lipids (PUFA, butter, margarine, fish) and vitamin D. However, supplementing the diets of adults with asthma with antioxidants and lipids has minimal, if any, clinical benefit. There is growing interest in the possibility that childhood asthma is influenced by maternal diet during pregnancy, with studies highlighting associations between childhood asthma and maternal intake of some nutrients (vitamin E, vitamin D, Se, PUFA) during pregnancy. It has been suggested that maternal diet during pregnancy influences fetal airway and/or immune development. Further intervention studies are needed to establish whether modification of maternal nutrient intake during pregnancy can be used as a healthy low-cost public health measure to reduce the prevalence of childhood asthma.

Diet and asthma--can you change what you or your children are by changing what you eat?

In this review we focus on dietary fat content and subsequent effects on asthma. According to the World Health Organisation over 300 million people currently have asthma. The majority of asthma cases are 'extrinsic' and result from inappropriate 'allergic' immune responses to inhaled environmental substances. Whilst some individuals are allergic to particular food components it is becoming clear that the content of the diet can more generally affect the health of the immune system. Components of maternal and early life diets have been reported to influence offspring immune function and asthma. There has been speculation that different types of dietary fat have pro- and anti-inflammatory effects but the results of various studies are contradictory. Asthma and obesity are two conditions that have almost simultaneously reached epidemic levels in some societies. There is evidence that diet-induced obesity alters immune function and there is little doubt that consumption of a high caloric diet with high fat content leads to obesity. However, there is conflicting information over whether and how obesity is linked to asthma in children and adults. Whilst obesity is to be avoided there is accumulating evidence that dietary fat per se does not necessarily predispose towards allergic symptoms.

High-fat feeding redirects cytokine responses and decreases allergic airway eosinophilia

BACKGROUND

Dietary fat intake has been associated with obesity and obesity in its turn with attenuated airway function and asthma, but it is unclear whether or how high-fat intake per se alters immune function relevant to development of allergic asthma.

OBJECTIVE

To use a non-obese mouse model of mild to moderate allergic asthma to compare effects of high-fat with isocaloric control-diet on allergic immune responses.

METHODS

C57BL/6 mice weaned and maintained on control (11% fat calories) or isocaloric high-fat diet (58% fat calories) were systemically sensitized with ovalbumin and challenged in the lungs. Allergic airway inflammation was assessed by measuring lung inflammation; serum antibodies; and, cytokines in serum, bronchoalveolar lavage (BAL) fluid and in supernatants of in vitro stimulated lung draining lymph node and spleen lymphocytes.

RESULTS

There was a significant reduction in lung eosinophilia and IL-5 in high-fat fed mice. Lung draining lymph node cells from these mice showed reduced pro-inflammatory cytokine (MCP-1 and TNF-alpha) release after ovalbumin re-stimulation and reduced release of IL-13 after concanavalin-A stimulation, indicating a general rather than just an antigen-specific change. There was no difference in IFN-gamma release. In contrast, pro-inflammatory cytokine release was increased from splenocytes. Decreased eosinophilia was not due to increased regulatory T cell or IL-10 induction in draining lymph nodes or spleen, nor to changes in antibody response to ovalbumin. However, decreased levels of serum and BAL eotaxin were found in high-fat fed animals.

CONCLUSIONS

The data indicate that high-fat dietary content redirects local immune responses to allergen in the lungs and systemic responses in the spleen and serum. These effects are not due to changes in regulatory T cell populations but may reflect a failure to mobilize eosinophils in response to allergic challenge.

Impact of PUFA on early immune and fetal development

It has recently been reported that the increased prevalence in childhood allergy may be linked to deviations in fetal immune development. One reason may be impaired nutrient supply. Hence, a well-differentiated placenta together with an optimal fetal nutrition via the mother are important prerequisites for the establishment of a functional immune system with normal immune responses. Fatty acids and their derivatives can influence both the early immune development and immune maturation by regulating numerous metabolic processes and the gene expression of important proteins such as enzymes and cytokines. The present review summarises the impact of nutritional fatty acids on the development of the immune system as well as the fetal development. It describes the mechanisms of action of PUFA, trans fatty acids and conjugated linoleic acids in programming the fetus with regard to its risk of acquiring atopic diseases in childhood.

Diet among Japanese female university students and asthmatic symptoms, infections, pollen and furry pet allergy

OBJECTIVES

To study associations between diet, respiratory symptoms and allergy among female university students in Japan.

METHODS

A standardised questionnaire was distributed to students in Kobe and Kamakura (N=153). Multiple logistic/linear regression was applied, controlling for age, smoking, heredity and diet.

RESULTS

Totally 15.7% reported doctor-diagnosed asthma, 3.3% current asthma medication, 56.9% pollen allergy, 15.7% cat allergy, 11.1% dog allergy, 25.0% wheeze, 24.2% daytime and 9.3% nocturnal attacks of breathlessness. Meat consumption was related to wheeze (OR=2.00; 95% CI 1.12-3.60) and respiratory infections (OR=2.10; 95% CI 1.08-4.09). Fish consumption was related to less respiratory infections (OR=0.49; 95% CI 9.28-0.86), seafood to less pollen allergy (OR=0.66; 95% CI 0.44-0.99), and milk consumption to less daytime breathlessness (OR=0.72; 95% CI 0.55-0.95). Fast food consumption was related to wheeze (OR=1.89; 95% CI 1.23-2.91), daytime breathlessness (OR=1.50; 95% CI 1.00-2.28) and pollen allergy (OR=1.69; 95% CI 1.07-2.65). In total, 23.0% used butter, 21.7% margarine, 40.1% olive oil and 55.3% rapeseed oil. Those consuming butter (OR=2.65; 95% CI 1.11-6.32) and rapeseed oil (OR=2.35; 95% CI 1.03-5.38) had more wheeze. Those consuming margarine had more nocturnal breathlessness (OR=4.40; 95% CI 1.42-13.7). An asthma symptom score was related to fast food (p<0.05) and margarine consumption (p<0.01). Factor analysis identified five dietary patterns. A pattern including fast food, juice and soft drinks was related to wheeze and respiratory infections.

CONCLUSION

Fish, seafood and milk consumption seems to be beneficial, while butter, margarine, rapeseed oil, fast food and soft drinks could be risk factors for allergy and respiratory health.

Environmental factors and allergic disorders

Despite numerous studies on possible associations between environmental exposure and allergic disorders, any conclusions made remain a matter of controversy. We conducted a review of evidence in relation to environmental and nutritional determinants and wheeze, asthma, atopic dermatitis, and allergic rhinitis. Identified were 263 articles for analysis after consideration of 1093 papers that were published since 2000 and selected by electronic search of the PubMed database using keywords relevant to epidemiological studies. Most were cross-sectional and case-control studies. Several prospective cohort studies revealed inconsistent associations between various environmental factors and the risk of any allergic disorder. Therefore, the evidence was inadequate to infer the presence or absence of a causal relationship between various environmental exposures and allergic diseases. However, evidence is suggestive of positive associations of allergies with heredity. Because almost all the studies were performed in Western countries, the application of these findings to people in other countries, including Japan, may not be appropriate. Further epidemiological information gained from population-based prospective cohort studies, in particular among Japanese together with other Asians, is needed to assess causal relationships between various environmental factors and allergic diseases.

Inverse association of farm milk consumption with asthma and allergy in rural and suburban populations across Europe

BACKGROUND

Dietary interventions as a means for atopy prevention attract great interest. Some studies in rural environments claimed an inverse association between consumption of farm-produced dairy products and the prevalence of allergic diseases, but current evidence is controversial.

OBJECTIVE

To investigate whether consumption of farm-produced products is associated with a lower prevalence of asthma and allergy when compared with shop-purchased products.

METHODS

Cross sectional multi-centre study (PARSIFAL) including 14,893 children aged 5-13 years from five European countries (2823 from farm families and 4606 attending Steiner Schools as well as 5440 farm reference and 2024 Steiner reference children). A detailed questionnaire including a dietary component was completed and allergen-specific IgE was measured in serum.

RESULTS

Farm milk consumption ever in life showed a statistically significant inverse association with asthma: covariate adjusted odds ratio (aOR) 0.74 [95% confidence interval (CI) 0.61-0.88], rhinoconjunctivitis: aOR 0.56 (0.43-0.73) and sensitization to pollen and the food mix fx5 (cut-off level of >or=3.5 kU/L): aOR 0.67 (0.47-0.96) and aOR 0.42 (0.19-0.92), respectively, and sensitization to horse dander: aOR 0.50 (95% CI 0.28-0.87). The associations were observed in all four subpopulations and independent of farm-related co-exposures. Other farm-produced products were not independently related to any allergy-related health outcome.

CONCLUSION

Our results indicate that consumption of farm milk may offer protection against asthma and allergy. A deepened understanding of the relevant protective components of farm milk and a better insight into the biological mechanisms underlying this association are warranted as a basis for the development of a safe product for prevention.

The relation between dietary intake of individual fatty acids, FEV1 and respiratory disease in Dutch adults

BACKGROUND

A reduced dietary intake of n-3 fatty acids, in association with increased n-6 fatty acid intake, has been proposed as a potential aetiological factor for chronic obstructive pulmonary disease (COPD) and asthma. However, the relative importance of individual fatty acids within the n-3 and n-6 categories on this effect has not been widely investigated. We have studied the relation between individual fatty acid intakes, lung function and self-reported respiratory symptoms and diagnoses in a representative sample of more than 13,000 Dutch adults.

METHODS

Intake of individual fatty acids was estimated by a food frequency questionnaire and analysed in relation to measures of forced expiratory volume in 1 s (FEV1) and to questionnaire reported wheeze, asthma and COPD symptoms.

RESULTS

After adjusting for confounding, we found no protective association between individual n-3 fatty acid intakes and FEV1. Higher intakes of some n-6 fatty acids were associated with lower FEV1, this effect being most marked for c22:4 n-6 docosatetraenoic acid (reduction in FEV1 between the highest and lowest quintile of intake 54.5 ml (95% CI -81.6 to -27.4)). Most of the n-6 fatty acid effects interacted significantly with smoking, their effects being strongest in current smokers. Individual n-3 fatty acid intakes were generally associated with a higher risk of wheeze in the past year, but otherwise there was little or no association between fatty acid intake and wheeze, doctor diagnosed asthma or other respiratory symptoms.

CONCLUSIONS

A high intake of n-3 fatty acids does not appear to protect against COPD or asthma, but a high intake of several n-6 fatty acids is associated with a significant reduction in FEV1, particularly in smokers. These findings indicate that high dietary intake of n-6 fatty acids, rather than reduced n-3 intake, may have an adverse effect on lung health.

Consumption of organic foods and risk of atopic disease during the first 2 years of life in the Netherlands

We prospectively investigated whether organic food consumption by infants was associated with developing atopic manifestations in the first 2 years of life. The KOALA Birth Cohort Study in the Netherlands (n 2764) measured organic food consumption, eczema and wheeze in infants until age 2 years using repeated questionnaires. Diet was defined as conventional ( 90 % organic). Venous blood samples taken from 815 infants at 2 years of age were analysed for total and specific IgE. Multivariate logistic regression models were fitted to control for potential confounding factors. Eczema was present in 32 % of infants, recurrent wheeze in 11 % and prolonged wheezing in 5 %. At 2 years of age, 27 % of children were sensitised against at least one allergen. Of all the children, 10 % had consumed a moderately organic diet and 6 % a strictly organic diet. Consumption of organic dairy products was associated with lower eczema risk (OR 0.64 (95 % CI 0.44, 0.93)), but there was no association of organic meat, fruit, vegetables or eggs, or the proportion of organic products within the total diet with the development of eczema, wheeze or atopic sensitisation. Further studies to substantiate these results are warranted.

The dietary habits of non-asthmatic schoolchildren in Lhasa, Tibet

The occurrence of asthma symptoms and food consumption frequencies in 13- to 14-year-old schoolchildren was investigated in Lhasa, Tibet (3,658 meters above sea level). A total of 99.2% of the schoolchildren reported that they had not experienced any wheezing during the prior 12 months. Among these students, more than 50% had consumed rice, meat, fruits, and vegetables at least three times per week in the preceding year. More than 70% of the non-asthmatic students rarely consumed margarine; 50% of these students rarely ate fast food; and 40% only occasionally ate fish during the prior 12 months. The dietary habits of the schoolchildren in Lhasa may have some potential beneficial roles in contributing to the low prevalence of asthma in this high altitude region.

Influence of organic diet on the amount of conjugated linoleic acids in breast milk of lactating women in the Netherlands

The aim of the present study was to find out whether the incorporation of organic dairy and meat products in the maternal diet affects the contents of the conjugated linoleic acid isomers (CLA) and trans-vaccenic acid (TVA) in human breast milk. To this purpose, milk samples from 312 breastfeeding mothers participating in the KOALA Birth Cohort Study have been analysed. The participants had documented varying lifestyles in relation to the use of conventional or organic products. Breast milk samples were collected 1 month postpartum and analysed for fatty acid composition. The content of rumenic acid (the main CLA) increased in a statistically significant way while going from a conventional diet (no organic dairy/meat products, 0.25 weight % (wt%), n 186) to a moderately organic diet (50-90 % organic dairy/meat, 0.29 wt%, n 33, P = 0.02) and to a strict organic diet (>90 % organic dairy/meat, 0.34 wt%, n 37, P </= 0.001). The levels of TVA were augmented among the participants with a moderately organic diet (0.54 wt%) and those with a strict organic diet (0.59 wt%, P </= 0.001), in comparison with the conventional group (0.48 wt%). After adjusting for covariables (recruitment group, maternal age, maternal education, use of supplements and season), statistical significance was retained in the group of the strict organic dairy users (P < 0.001 for rumenic acid). Hence, the levels of CLA and TVA in human milk can be modulated if breastfeeding mothers replace conventional dairy and/or meat products by organic ones. A potential contribution of CLA and TVA to health improvement is briefly discussed.

Protective effect of fruits, vegetables and the Mediterranean diet on asthma and allergies among children in Crete

BACKGROUND

Atopy is not uncommon among children living in rural Crete, but wheeze and rhinitis are rare. A study was undertaken to examine whether this discrepancy could be attributed to a high consumption of fresh fruit and vegetables or adherence to a traditional Mediterranean diet.

METHODS

A cross-sectional survey was performed in 690 children aged 7-18 years in rural Crete. Parents completed a questionnaire on their child's respiratory and allergic symptoms and a 58-item food frequency questionnaire. Adherence to a Mediterranean diet was measured using a scale with 12 dietary items. Children underwent skin prick tests with 10 common aeroallergens.

RESULTS

80% of children ate fresh fruit (and 68% vegetables) at least twice a day. The intake of grapes, oranges, apples, and fresh tomatoes-the main local products in Crete-had no association with atopy but was protective for wheezing and rhinitis. A high consumption of nuts was found to be inversely associated with wheezing (OR 0.46; 95% CI 0.20 to 0.98), whereas margarine increased the risk of both wheeze (OR 2.19; 95% CI 1.01 to 4.82) and allergic rhinitis (OR 2.10; 95% CI 1.31 to 3.37). A high level of adherence to the Mediterranean diet was protective for allergic rhinitis (OR 0.34; 95% CI 0.18 to 0.64) while a more modest protection was observed for wheezing and atopy.

CONCLUSION

The results of this study suggest a beneficial effect of commonly consumed fruits, vegetables and nuts, and of a high adherence to a traditional Mediterranean diet during childhood on symptoms of asthma and rhinitis. Diet may explain the relative lack of allergic symptoms in this population.

Maternal food consumption during pregnancy and asthma, respiratory and atopic symptoms in 5-year-old children

BACKGROUND

Associations between maternal vitamin E, vitamin D and zinc intakes during pregnancy and asthma, wheeze and eczema in 5-year-old children have previously been reported. A study was undertaken to investigate whether maternal intake of specific foods during pregnancy is associated with asthma and allergic outcomes in the same children.

METHODS

A longitudinal birth cohort study was conducted in 1,924 children born to women recruited during pregnancy. Maternal diet during pregnancy was assessed by food frequency questionnaire (FFQ). Cohort children were followed up at 5 years by symptom questionnaire and FFQ. Food groups of interest were fruit, vegetables, fruit juice, whole grain products, fish, dairy products and fat spreads. Trends across outcome groups defined by level of food intake are presented.

RESULTS

1,253 children participated at 5 years and maternal FFQ data were available for 1,212. No consistent associations were found between childhood outcomes and maternal intake of the analysed foods except for apples and fish. Maternal apple intake was beneficially associated with ever wheeze (OR highest vs lowest tertile 0.63, 95% CI 0.42 to 0.95), ever asthma (OR 0.54, 95% CI 0.32 to 0.92) and doctor-confirmed asthma (OR 0.47, 95% CI 0.27 to 0.82) in the children. Maternal fish consumption was beneficially associated with doctor-confirmed eczema (OR >or=1/week vs never 0.57, 95% CI 0.35 to 0.92).

CONCLUSION

There was no evidence for associations between maternal intake of most foods during pregnancy and asthma, respiratory and allergic outcomes in 5-year-old children, except for apples and fish. Consumption of apples and fish during pregnancy may have a protective effect against the development of childhood asthma and allergic disease.

An update and appraisal of the cilomilast Phase III clinical development programme for chronic obstructive pulmonary disease

Cilomilast (Ariflo, SB 207499) is an orally active, second-generation phosphodiesterase (PDE) 4 inhibitor that is being developed by GlaxoSmithkline for the treatment of chronic obstructive pulmonary disease (COPD). The results of Phase I and Phase II studies have demonstrated that cilomilast significantly improves lung function and quality of life to a clinically meaningful extent, which has led to a comprehensive Phase III programme of research evaluating efficacy, safety and mechanism of action. However, the results of those Phase III studies are unremarkable and disappointing, raising doubt over the future of cilomilast as a novel therapy for COPD. This review summarizes data obtained from the Phase III clinical development programme, highlights some of the potential concerns both specific to cilomilast and to PDE4 inhibitors in general and assesses the likelihood that cilomilast will reach the market.

Food choice, socio-economic characteristics and health in 4-year olds in a well-educated urban Swedish community

BACKGROUND AND AIMS

Dietary habits founded early in life might influence development of welfare diseases. The aim was to analyse food choice, socio-economic characteristics and health by questionnaires in healthy 4-year olds.

METHODS

Two hundred and thirty children were invited and 79% completed all questionnaires. Anthropometry was measured in 131 subjects.

RESULTS

The sample was characteristic for Swedish children except that more parents had university education. Most children attended pre-school; 52% >30 h/week. Almost all had been breast-fed until a mean age of 5 months. Fifteen per cent were overweight and 2% obese according to the IOTF cut-offs. A, D vitamin supplementation was not given to a third. Full fat dairy products, minced meat and sausages predominated, and only a fourth was served fat fish. Olive or rape seed oil was consumed regularly by 40% and a third consumed "junk food" regularly. Maternal immigrant status influenced the food choice.

CONCLUSION

In a Swedish urban community of 4-year olds, 17% were overweight or obese. The intake of vegetables, oils and "junk food" seemed to have increased, while the intake of dairy products, fruit, meat and fish seemed to be similar to earlier studies. Food choice was influenced by maternal origin.

Maternal diet during pregnancy in relation to eczema and allergic sensitization in the offspring at 2 y of age

BACKGROUND

Maternal diet during pregnancy might be one of the factors that influences fetal immune responses associated with childhood allergy.

OBJECTIVE

We analyzed the association between maternal diet during the last 4 wk of pregnancy and allergic sensitization and eczema in the offspring at 2 y of age.

DESIGN

Data from 2641 children at 2 y of age were analyzed within a German prospective birth cohort study (LISA). Maternal diet during the last 4 wk of pregnancy was assessed with a semiquantitative food-frequency questionnaire, which was administered shortly after childbirth.

RESULTS

High maternal intake of margarine [adjusted odds ratio (aOR): 1. 49; 95% CI: 1.08, 2.04] and vegetable oils (aOR: 1.48; 95% CI: 1.14, 1.91) during the last 4 wk of pregnancy was positively associated and high maternal fish intake (aOR: 0.75; 95% CI: 0.57, 0.98) was inversely associated with eczema during the first 2 y in the offspring. High celery (aOR: 1.85; 95% CI: 1.18, 2.89) and citrus fruit (aOR: 1.73; 95% CI: 1.18, 2.53) intakes increased the risk of sensitization against food allergens. In turn, sensitization against inhalant allergens was positively related to a high maternal intake of deep-frying vegetable fat (aOR: 1.61; 95% CI: 1.02, 2.54), raw sweet pepper (aOR: 2.16; 95% CI: 1.20, 3.90), and citrus fruit (aOR: 1.72; 95% CI: 1.02, 2.92).

CONCLUSIONS

We suggest that the intake of allergenic foods and foods rich in n-6 polyunsaturated fatty acids during pregnancy may increase and foods rich in n-3 polyunsaturated fatty acids may decrease the risk of allergic diseases in the offspring.

Diet and asthma in Dutch school children (ISAAC-2)

BACKGROUND

The rise in the prevalence of asthma in western societies may be related to changed dietary habits. Epidemiological studies in children have shown inverse associations of asthma related outcomes with intake of fruits, vegetables, dairy and whole grain products, and fish. In contrast to most previous studies, we used both questionnaire and clinical data to define asthma.

METHODS

Intake of the abovementioned foods was studied in relation to asthma in 598 Dutch children aged 8-13 years. Dietary intake was estimated using a parent completed semi-quantitative food frequency questionnaire. Current wheeze and current asthma were defined based on questionnaire data. More complex end points were defined using information on bronchial hyperresponsiveness (BHR) and atopic sensitisation as well. Linear associations were studied using logistic regression analysis and odds ratios presented for the highest versus the lowest tertile of intake. In the final models, adjustments were made for maternal educational level, foreign descent, and total energy intake.

RESULTS

The intake of whole grain products and of fish was inversely associated with asthma. Adjusted odds ratios for the independent associations with whole grains and fish were 0.46 (95% CI 0.19 to 1.10) and 0.34 (95% CI 0.13 to 0.85) for current asthma and 0.28 (95% CI 0.08 to 0.99) and 0.12 (95% CI 0.02 to 0.66) for atopic asthma with BHR. Similar results were observed for current wheeze and atopic wheeze with BHR. Intake of (citrus) fruits, vegetables, and dairy products showed no clear associations with asthma end points.

CONCLUSIONS

Our findings suggest that a high intake of whole grain products and fish may have a protective effect against asthma in children.

The vitamin D slant on allergy

Oral vitamin D supplementation has been introduced into modern medicine to prevent rickets without the knowledge that this may have profound immunological consequences. The main vitamin D metabolite calcitriol suppresses dendritic cell maturation and consecutive Th(1) cell development, which has independently described as a key mechanism of allergy development. Animal studies and epidemiological surveys now provide a first link of early vitamin D supplementation and later allergy where several vitamin D regulated genes seem to be involved. A randomized clinical trial of vitamin D supplementation could be a further step to follow up the vitamin hypothesis.

Serum, cheek cell and breast milk fatty acid compositions in infants with atopic and non-atopic eczema

BACKGROUND

The major theory implicating diet with allergic diseases is associated with altered food consumption and subsequent changes in fatty acid composition.

OBJECTIVE

To investigate fatty acid compositions among infants with atopic and non-atopic eczema and healthy infants and to evaluate the expediency of non-invasive cheek cell phospholipid fatty acid composition as a marker in patients with eczema.

METHODS

Diagnosis of eczema in infants was confirmed clinically and by positive (atopic eczema, n=6) or negative (non-atopic eczema, n=6) skin prick testing in comparison with controls (n=19). The fatty acid compositions of infant cheek cell and serum phospholipids and breast milk total lipids were analysed by gas chromatography.

RESULTS

The distinction between atopic and non-atopic eczema was manifested in cheek cell phospholipids as linoleic acid (14.69 (13.67-15.53)% of total fatty acids; the median (interquartile range)), the sum of n-6 fatty acids (19.94 (19.06-20.53)%) and the sum of polyunsaturated fatty acids (22.70 (21.31-23.28)%) were higher in infants with atopic eczema compared with non-atopic eczema (12.69 (10.87-13.93); 17.72 (15.63-18.91) and 19.90 (17.64-21.06), respectively; P<0.05) and controls (12.50 (12.16-13.42); 18.19 (17.43-18.70) and 20.32 (19.32-21.03), respectively; P<0.05). Serum phospholipid gamma-linolenic acid was lower in both atopic and non-atopic eczema compared with controls (P<0.05) and additionally eicosapentaenoic acid was higher in atopic eczema compared with controls (P<0.05).

CONCLUSION

These preliminary results suggest differences in fatty acid compositions between the two types of eczema, calling for further evaluation in a larger setting. The two types of eczema may be regulated by different immunological processes, and fatty acids may have a more profound role in the atopic type.

Emerging drugs for the treatment of chronic obstructive pulmonary disease

By 2020 chronic obstructive pulmonary disease (COPD) will be the third leading cause of mortality and fifth leading cause of morbidity. Research over the past two decades has shed important insights on the pathobiology of COPD, leading to the development of novel drugs. In the past, symptomatic treatment with bronchodilators was the predominant focus of COPD management. With increased awareness of the importance of airway inflammation in COPD progression, there has been a shift in emphasis to drugs that attack various targets in the inflammatory cascade. These drugs include phosphodiesterase 4 inhibitors, leukotriene modifiers and TNF antagonists, which are poised to enter the COPD market in the very near future. Tyrosine kinase antagonists, inhibitors of NF-kappaB, neutrophil elastase inhibitors, chemokine antagonists, mucolytics and novel antibiotics are being evaluated for possible effectiveness in COPD. Many of these drugs may enter the COPD market within the next decade. This paper reviews the molecular rationale for these emerging drugs and their potential efficacy in COPD.

Fatty acid composition of human milk in atopic Danish mothers

BACKGROUND

Atopic dermatitis has been related to a disturbed metabolism of polyunsaturated fatty acids (PUFAs).

OBJECTIVE

We tested whether the PUFA composition of breast milk differs significantly between mothers with atopic dermatitis, mothers with other types of atopy, and nonatopic mothers. We also investigated whether differences in diet can explain possible observed differences.

DESIGN

Mothers with current or previous asthma (n = 396) were divided into 3 groups according to history of atopic dermatitis and allergic rhinitis. Breast-milk samples were collected from 314 women approximately 3 wk after delivery. The habitual diet of the women was assessed with food-frequency questionnaires in the 25th week of gestation (n = 207). Breast-milk samples and simultaneous dietary data from 14 nonatopic mothers were used for comparison.

RESULTS

Compared with the milk of nonatopic mothers, that of atopic mothers had significantly higher concentrations of 22:5n-6 and lower concentrations of 20:5n-3; moreover, 20:4n-6/20:5n-3, 22:5n-6/22:6n-3, and long-chain n-3 PUFA/18:3n-3 were shifted toward n-6 PUFA and 18:3n-3 in nonatopic and atopic mothers, respectively. No differences in breast-milk PUFA composition were evident between the subject groups. The diets of the groups differed only slightly with respect to protein intake. However, the PUFA composition of the breast milk was associated with diet and time of milk sampling, and the above difference in milk PUFAs disappeared when those factors were taken into account.

CONCLUSION

Our data do not support the possibility that the fatty acid composition of breast milk is affected by atopic dermatitis or atopy in general, because most differences in breast-milk PUFA composition appear to be explained by the diet.

Dietary intake in sensitized children with recurrent wheeze and healthy controls: a nested case-control study

BACKGROUND

The rising prevalence of asthma and allergic disease remains unexplained. Several risk factors have been implicated including diet, in particular poly-unsaturated fats and antioxidant intake.

METHODS

A nested case-control study comparing the dietary intake of sensitized children with recurrent wheeze (age 3-5 years) and nonsensitized children who had never wheezed was carried out within an unselected population-based cohort. Cases and controls were matched for age, sex, parental atopy, indoor allergen exposure and pet ownership. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire and nutrient analysis program.

RESULTS

Thirty-seven case-control pairs (23 male, mean age 4.4 years) participated. Daily total polyunsaturated fat intake was significantly higher in sensitized wheezers (g/day, geometric mean, 95% confidence intervals: 7.1, 6.4-7.9) compared with nonsensitized nonwheezy children (5.6, 5.0-6.3, P = 0.003). Daily omega-3 and omega-6 fat intakes were not significantly different between the two groups. No significant differences were found in intake of any antioxidant or antioxidant cofactors between the groups.

CONCLUSIONS

Young sensitized wheezy children had a significantly higher total polyunsaturated fat intake compared with nonsensitized nonwheezy children. However, we were unable to distinguish a significant difference in specific poly-unsaturated fat intakes. Otherwise the children in both groups had a very similar nutritional intake.