Dietary changes in migrant adolescents with increasing length of stay in Australia and associated risk of wheeze--a retrospective, cross sectional study

Dietary patterns, nutrients, and risk of expiratory airflow limitation in children and adolescents

BACKGROUND

Increasing global pediatric respiratory diseases require understanding modifiable factors affecting lung function. We explored the association between dietary patterns, nutrients and the risk of expiratory airflow limitation (EAL) in children and adolescents.

METHODS

Dietary intake was collected using a validated food frequency questionnaire (FFQ) with 110 food items. Factor analysis was employed to determine dietary patterns. Pulmonary function was measured using a medical-grade pulmonary function analyzer. EAL was defined as the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV1/FVC) < 0.8.

RESULTS

A total of 611 EAL cases occurred in 3,204 participants, with a prevalence of 19.07%. Four primary dietary patterns were identified (animal, healthy, sweet, and plant foods), which explained 44% of the variance in food consumption. The plant foods pattern (fourth quartile vs. first quartile intake) was associated with a reduced risk of EAL (Odds Ratio [OR] = 0.71, 95% Confidence Interval [CI]: 0.53, 0.94; Pfor trend < 0.02). Higher fruit consumption (high vs. low) in plant foods pattern was associated with lower EAL risk (OR = 0.79, 95% CI: 0.62, 0.99, Pfor trend = 0.04). Every standard deviation increase in foods (Chinese sauerkraut, pickled foods) and nutrients (total dietary fiber, soluble dietary fiber, and pyridoxine) in plant foods was all positively associated with FEV1 /FVC (all P < 0.05).

CONCLUSIONS

Long-term intake of plant foods pattern enriched with dietary fiber and pyridoxine is promising for lung function protection in children and adolescents.

Dietary fibre in relation to asthma, allergic rhinitis and sensitization from childhood up to adulthood

Background

Dietary fibre may reduce the risk of allergy. Our aim was to investigate the association between fibre intake in childhood, asthma, allergic rhinitis and IgE sensitization up to adulthood.

Methods

The individual fibre intake of 2285 participants from the Swedish population-based birth cohort BAMSE was estimated between 98- and 107-item food frequency questionnaires at ages 8 and 16 years, respectively. At 8, 16 and 24 years, asthma and allergic rhinitis symptoms were assessed by questionnaires, and sensitization to common allergens by serum IgE. Longitudinal associations were analysed by generalized estimating equations, adjusting for potential confounders.

Results

An inverse overall association was indicated between fibre intake at 8 years and allergic rhinitis symptoms up to 24 years (OR per 5 g/d 0.86; 95% CI 0.77-0.96), particularly in combination with airborne (0.74; 0.62-0.89) and food (0.69; 0.54-0.88) allergen sensitization. Higher fibre intake was also associated with specific allergen sensitization, for example, birch (0.77; 0.67-0.88) and soy (0.68; 0.53-0.87). No association was observed with asthma. Regarding sources, fruit (0.79; 0.67-0.94) and other (potatoes, chips/popcorn, legumes, and nuts, 0.71; 0.50-0.99), but not cereal or vegetable fibre were associated with allergic rhinitis. In additional analyses, including long-term fibre intake at 8 and 16 years, excluding participants with food-related allergic symptoms to examine reverse causation, as well as adjusting for antioxidant intake, associations were attenuated and became non-significant.

Conclusion

Higher fibre intake in mid-childhood may be inversely associated with allergic rhinitis and sensitization to specific allergens up to adulthood. However, avoidance of food triggers of allergic symptoms in allergic rhinitis patients may contribute to the protective associations.

Dietary Fibers: Effects, Underlying Mechanisms and Possible Role in Allergic Asthma Management

The prevalence of asthma is increasing, but the cause remains under debate. Research currently focuses on environmental and dietary factors that may impact the gut-lung axis. Dietary fibers are considered to play a crucial role in supporting diversity and activity of the microbiome, as well as immune homeostasis in the gut and lung. This review discusses the current state of knowledge on how dietary fibers and their bacterial fermentation products may affect the pathophysiology of allergic asthma. Moreover, the impact of dietary fibers on early type 2 asthma management, as shown in both pre-clinical and clinical studies, is described. Short-chain fatty acids, fiber metabolites, modulate host immunity and might reduce the risk of allergic asthma development. Underlying mechanisms include G protein-coupled receptor activation and histone deacetylase inhibition. These results are supported by studies in mice, children and adults with allergic asthma. Fibers might also exert direct effects on the immune system via yet to be elucidated mechanisms. However, the effects of specific types of fiber, dosages, duration of treatment, and combination with probiotics, need to be explored. There is an urgent need to further valorize the potential of specific dietary fibers in prevention and treatment of allergic asthma by conducting more large-scale dietary intervention trials.

Dietary Fibre Intake in Relation to Asthma, Rhinitis and Lung Function Impairment-A Systematic Review of Observational Studies

A high intake of dietary fibre has been associated with a reduced risk of several chronic diseases. This study aimed to review the current evidence on dietary fibre in relation to asthma, rhinitis and lung function impairment. Electronic databases were searched in June 2021 for studies on the association between dietary fibre and asthma, rhinitis, chronic obstructive pulmonary disease (COPD) and lung function. Observational studies with cross-sectional, case–control or prospective designs were included. Studies on animals, case studies and intervention studies were excluded. The quality of the evidence from individual studies was evaluated using the RoB-NObs tool. The World Cancer Research Fund criteria were used to grade the strength of the evidence. Twenty studies were included in this systematic review, of which ten were cohort studies, eight cross-sectional and two case–control studies. Fibre intake during pregnancy or childhood was examined in three studies, while seventeen studies examined the intake during adulthood. There was probable evidence for an inverse association between dietary fibre and COPD and suggestive evidence for a positive association with lung function. However, the evidence regarding asthma and rhinitis was limited and inconsistent. Further research is needed on dietary fibre intake and asthma, rhinitis and lung function among adults and children.

Strategies and Future Opportunities for the Prevention, Diagnosis, and Management of Cow Milk Allergy

The prevalence of food allergy has increased over the last 20-30 years, including cow milk allergy (CMA) which is one of the most common causes of infant food allergy. International allergy experts met in 2019 to discuss broad topics in allergy prevention and management of CMA including current challenges and future opportunities. The highlights of the meeting combined with recently published developments are presented here. Primary prevention of CMA should start from pre-pregnancy with a focus on a healthy lifestyle and food diversity to ensure adequate transfer of inhibitory IgG- allergen immune complexes across the placenta especially in mothers with a history of allergic diseases and planned c-section delivery. For non-breastfed infants, there is controversy about the preventive role of partially hydrolyzed formulae (pHF) despite some evidence of health economic benefits among those with a family history of allergy. Clinical management of CMA consists of secondary prevention with a focus on the development of early oral tolerance. The use of extensive Hydrolysate Formulae (eHF) is the nutrition of choice for the majority of non-breastfed infants with CMA; potentially with pre-, probiotics and LCPUFA to support early oral tolerance induction. Future opportunities are, among others, pre- and probiotics supplementation for mothers and high-risk infants for the primary prevention of CMA. A controlled prospective study implementing a step-down milk formulae ladder with various degrees of hydrolysate is proposed for food challenges and early development of oral tolerance. This provides a more precise gradation of milk protein exposure than those currently recommended.

Lifestyle Habits and Health Indicators in Migrants and Native Schoolchildren in Chile

In Chile, the migrant population has increased in the last years. Migrants adopt behaviors of this new culture, which can have an effect on their health. Contradictory results regarding differences between migrant and native children have been reported. The aim of this study was to explore the associations between nationality with health indicator and lifestyle habits among schoolchildren in Chile. A cross-sectional and observational study with a non-probabilistic sample was conducted in 1033 children (86.4% Chilean and 13.6% migrant) from second to fourth grade of seven public schools from low-income municipalities from the Metropolitan Region, Chile. Anthropometric measurements (weight, height, waist circumference, triceps and subscapular folds), handgrip strength, and standing long jump measurements, physical activity, self-esteem and food guidelines accomplishments were determined. Migrant children presented lower body mass index (BMI), Z-BMI, body fat% and waist circumference values; and higher handgrip strength, standing long jump, and more satisfactory compliance with food guidelines than natives (p < 0.05). No significant difference for physical activity and self-esteem was observed. In the adjusted models, migrants presented lower odds for overweight/obesity, risk of abdominal obesity, low handgrip strength and unsatisfactory food guidelines accomplishment in all models (p < 0.05). The nutritional and muscular fitness of migrant children was better than that of the Chilean ones.

Definitions of Culturally and Linguistically Diverse (CALD): A Literature Review of Epidemiological Research in Australia

Objective: To identify how Culturally and Linguistically Diverse (CALD) communities are defined in epidemiological research in Australia and provide a definition of CALD status that aids the consistency and interpretability of epidemiological studies. Methods: Peer-reviewed literature from January 2015 to May 2020 was searched via four databases (Ovid Medline combined with PubMed, Embase, Emcare, and CINAHL) to identify quantitative studies of CALD people in Australia. Results: A total of 108 studies met the criteria for inclusion in the review. Country of birth was the most commonly used CALD definition (n = 33, 30.6%), with combinations of two or more components also frequently used (n = 31, 28.7%). No studies used all the components suggested as core to defining CALD status. including country of birth, languages other than English spoken at home, English proficiency, and indigenous status. Conclusions: There was considerable inconsistency in how CALD status was defined. The review suggests that CALD status would best be defined as people born in non-English speaking countries, and/or who do not speak English at home. Additionally, indigenous peoples should be considered separately. This recommended definition will support the better identification of potential health disparity and needs in CALD and indigenous communities.

Health experiences of child migrants in the Western Pacific region

Migration is a key social determinant of health affecting children's life chances and health outcomes. Yet, relatively little is known about young migrants' own health experiences. This paper reports findings from a systematic review examining the health experiences of children who migrated in the Western Pacific region. A systematic search of the peer-reviewed literature from 2007-17 was conducted using MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews, Web of Science, ASSIA and IBSS. Included articles reported data generated with children up to 18 years and who had migrated across international borders to the Western Pacific region (predominantly Australasia). The Mixed Methods Appraisal Tool was used to assess study quality. Eleven of 499 articles identified were included in the review and focused on three areas: diet and body size; mental health; and social integration. The review exposes the paucity of research on the health experiences of child migrants in the Western Pacific region. More child-centred research that examines the health-related impacts of migration on young people, and from their own perspectives, is urgently needed.

The Frequency of Fast Food Consumption in Relation to Wheeze and Asthma Among Adolescents in Gauteng and North West Provinces, South Africa

The prevalence of asthma and allergic diseases have been on the rise, especially in developing countries due to life-style changes. The study aimed to investigate the association between the frequency of fast food consumption with wheeze and asthma among adolescents. A previously validated self-completed questionnaire from the International Study of Asthma and Allergies in Childhood was used to collect information on demographics, socioeconomic status, house characteristics, adolescent respiratory health and diet. The prevalence of wheeze was 38.2% and of asthma was 16.37% among the adolescents. The results from the adjusted regression analyses indicated that eating fast foods three or more times per week was a statistically significant risk factor for wheeze (OR = 1.60; 95% CI: 1.26–2.03) and asthma (OR = 1.37; 95% CI: 1.04–1.91). The study found an association between eating fast foods three or more times per week and wheeze and asthma among adolescents in South Africa. Unhealthy diet plays a crucial role in respiratory health among adolescents; healthy eating habits are encouraged to reduce the burden of respiratory symptoms and diseases.

Asian children living in Australia have a different profile of allergy and anaphylaxis than Australian-born children: A State-wide survey

BACKGROUND

Asian children born in Australia have higher rates of eczema and nut allergy than non-Asian children. However, it is not known whether this country of birth differential exists for other allergies or anaphylaxis risk.

OBJECTIVE

We investigated the influence of maternal and child's country of birth on the prevalence of parent-reported eczema, asthma, food allergy and being diagnosed by a doctor as being "at risk of anaphylaxis."

METHODS

We assessed the relationship between mother and child country of birth and allergies using the 2010 School Entrant Health Questionnaire, completed for 57 005 5-year old children (85.8% response rate) in Victoria, Australia. Analyses were conducted using logistic regression with results presented as odds ratios (OR) with 95% confidence intervals (CIs).

RESULTS

Children born in Australia to Asian-born mothers were more likely to have parent-reported food allergy (OR 2.33, 95%CI 1.96-2.77) and eczema (OR 2.04, 95%CI 1.73-2.41), but not more likely to have asthma (OR 0.87, 95% CI 0.74-1.02) than non-Asian children. By contrast, children born in Asia who subsequently migrated to Australia had a lower risk of food allergy (OR 0.33, 95%CI 0.20-0.55), eczema (OR 0.37, 95%CI 0.24-0.57) and asthma (OR 0.29, 95% CI 0.21-0.40). Patterns of anaphylaxis risk differed depending on the trigger. Compared with Australian-born non-Asian children, Australian-born Asian children were more likely to be diagnosed as being at risk of both food-induced and non-food-induced anaphylaxis. For children born in Asia, risk was lower for anaphylaxis to milk, peanut and tree nuts compared to non-Asian children, but higher for soy, wheat and non-food triggers.

CONCLUSIONS AND CLINICAL RELEVANCE

Patterns of allergy/anaphylaxis risk and their triggers differed according to both ethnicity and country of birth, suggesting a gene-environment factor is in play. The difference in patterns for asthma compared with other atopic diseases is surprising and warrants further exploration.

Is the consumption of fast foods associated with asthma or other allergic diseases?

The associations between the consumption of fast foods and asthma or allergic diseases have not been clarified. The aim of this study was to determine whether fast foods consumption is associated with asthma or allergic diseases. Databases were searched up to February 2018. Studies investigating the associations between fast foods consumption and asthma or allergic diseases were considered eligible. Included studies were assessed for quality using standardized critical appraisal checklists. The quality scores were 5.33 ± 1.16 in case-control studies and 5.69 ± 1.55 in cross-sectional studies. Adjusted odds ratios (aOR) with 95% confidence interval (CI) were pooled. Sixteen studies (13 cross-sectional and 3 case-control studies) were included. The consumption of fast foods was significantly related to current asthma (aOR: 1.58; 95% CI: 1.17-2.13 for case-control study and aOR: 1.58; 95% CI: 1.10-2.26 for cross-sectional studies), severe asthma (aOR: 1.34; 95% CI: 1.23-1.46), asthma ever (aOR: 1.36; 95% CI: 1.06-1.75), current wheeze (aOR: 1.21; 95% CI: 1.16-1.27), wheeze ever (aOR: 1.65; 95% CI: 1.07-2.52), physician-diagnosed allergic rhinitis (odds ratio: 1.43; 95% CI: 1.05-1.95), severe eczema (aOR: 1.51; 95% CI: 1.16-1.96) and severe rhino-conjunctivitis (aOR: 1.54; 95% CI: 1.18-2.00). The consumption of hamburgers was associated with current asthma (aOR: 1.59; 95% CI: 1.13-2.25), severe asthma (aOR: 1.34; 95% CI: 1.23-1.46), asthma ever (aOR: 1.47; 95% CI: 1.13-1.92), severe eczema (aOR: 1.51; 95% CI: 1.16-1.96), severe rhino-conjunctivitis (aOR: 1.54; 95% CI: 1.18-2.00) and rhino-conjunctivitis (aOR: 1.21; 95% CI: 1.15-1.27). The consumption of fast foods, especially hamburgers, ≥3 times/week, was more likely to be associated with severe asthma and current wheeze compared with the consumption of 1-2 times/week (both P < 0.001). In conclusion, the consumption of fast foods, particularly hamburgers, correlates to asthma in a dose-response pattern, which needs to be further validated in longitudinal and interventional studies.