Does the Mediterranean Dietary Pattern Promote Lower Sodium Urinary Excretion in Children?

An adequate sodium intake is related to various health benefits. Parallelly, the Mediterranean diet (MD) is a dietary pattern known for its many positive impacts on health. Nonetheless, the association between adherence to the MD and sodium urinary excretion is scarce, even more in children. This study aimed to assess the association between MD adherence and the excretion of sodium, as a proxy of intake. This cross-sectional analysis comprised 295 children (46.8% females, aged 7-11 years, mean age: 8.53 ± 0.73 years) from 20 schools within Porto, Portugal. MD adherence was evaluated utilizing the alternate Mediterranean score (aMED). Higher scores denote a healthier dietary pattern (0-8). Sodium excretion was estimated by 24-h urine collection. The association between adherence to MD and Na excretion was estimated by logistic regression, adjusting for confounders. Children in the higher sodium excretion group had a higher intake of legumes, a higher body mass index and parents with lower education levels compared to children in the lower sodium excretion group. In logistic regression analysis, sodium urinary excretion was not associated with higher MD adherence, even after adjustment for confounders. High MD adherence could not be associated with lower sodium excretion in children.

Mediterranean Diet and Airway Inflammation in School-Aged Children

There seems to exist an intricate relationship between airway inflammation, body mass index (BMI), and diet. The intake of specific foods or food groups has been suggested to suppress the oxidative stress and inflammatory processes that characterize airway inflammation, but little is known about dietary patterns and their complex interplay with BMI and airway inflammation. Therefore, this cross-sectional study aimed to explore the association between adherence to the Mediterranean diet (MD), a characteristic European diet, and levels of airway inflammation in school-aged children, taking into account their BMI. This cross-sectional analysis comprised 660 children: 49.1% females, 7-12 years old. Adherence to the MD was assessed through the alternate Mediterranean score (aMED). Higher scores represent a healthier diet (0-8). Airway inflammation was assessed measuring exhaled fractional nitric oxide (eNO). Two categories of BMI were considered: non-overweight/non-obese (p < 85th) and overweight/obese (p ≥ 85th). The associations between diet and airway inflammation were estimated using logistic regression models. Higher scores of the aMED were associated with decreased odds of having eNO ≥ 35 ppb, but only in non-overweight/non-obese children (OR = 0.77; 95% CI, 0.61-0.97). For overweight/obese children, the previous association was not significant (OR = 1.57, 95% CI, 0.88-2.79). Our findings suggest that adherence to the MD is associated with lower levels of airway inflammation among non-overweight/non-obese children.

Lung function, COPD and Alternative Healthy Eating Index in US adults

Background

There is a large burden of COPD in the US. The purpose of this study was to investigate the association between diet quality with lung function, spirometric restriction and spirometrically defined COPD in a nationally representative sample of US adults.

Methods

Adults (19–70 years of age) from the National Health and Nutrition Examination Survey 2007–2012 cycles were included (n=10 428). Diet quality was determined using the Alternative Healthy Eating Index (AHEI-2010). Pre-bronchodilator measurements of forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and the FEV₁/FVC were described. Calibrated lower limit of normal (LLN) estimates were derived to determine prevalence of spirometric restriction (FVC<LLN) and COPD (FEV₁/FVC ratio<LLN). Population-weighted linear and logistic regression models were used to investigate the association of AHEI-2010 and respiratory outcomes.

Results

The mean±SD AHEI was 45.3±12.2, equivalent to meeting 41% of the daily recommendations for optimal diet quality. Those in the highest quartile of AHEI had better FEV₁ (adjusted (a)β 47.92, 95% CI 2.27–93.57) and FVC (aβ 80.23, 95% CI 34.03–126.42; p-value interaction (*) of AHEI and smoking >0.05) compared to those in quartile 1. Higher AHEI was also associated with lower odds of spirometric restriction (OR 0.23, 95% CI 0.08–0.67; p-value AHEI*ethnicity >0.05).

Conclusions

Diet quality was independently associated with better FEV₁ and FVC and with lower odds of spirometric restriction. These findings highlight the need for research to further elucidate the possible beneficial role of diet in the preservation of lung function.

In this nationally representative population-based study of US adults, diet quality measured by the AHEI-2010 was low. Better diet quality was associated with better lung function, and with lower prevalence of spirometric restriction.https://bit.ly/3you2Tf

Higher diversity of vegetable consumption is associated with less airway inflammation and prevalence of asthma in school-aged children

BACKGROUND

A diet rich in fruits and vegetables has been suggested to counteract the oxidative stress and inflammation that characterize asthma. We aimed to assess the association between vegetable and fruit diversity consumption and asthma and its related outcomes in school-aged children.

METHODS

Participants included 647 children (49% females, aged 7-12 years) recruited from 20 public schools across the city of Porto, in Portugal. Vegetable intake and fruit intake were ascertained using a single self-reported 24-hour recall questionnaire. A diversity score was built taking into account the different number of individual vegetables and fruits consumed and categorized into two groups based on the total reported median consumption, which was rounded to the nearest whole number (≤3 and >3, for vegetables; and ≤1 and >1, for fruits). A questionnaire was used to enquire about self-reported medical diagnosis of asthma and respiratory symptoms. Airway inflammation was assessed measuring exhaled fractional nitric oxide concentration (eNO) and was categorized into two groups (<35 and ≥35 ppb). The association between fruit and vegetable diversity and respiratory outcomes was examined using logistic regression models, adjusting for confounders.

RESULTS

A higher vegetable diversity consumption per day was negatively associated with having self-reported asthma (OR = 0.67; 95% CI 0.47, 0.95), while having a vegetable diversity consumption superior to 3 items per day was negatively associated with levels of eNO ≥ 35 ppb (OR = 0.38; 95% CI 0.16, 0.88) and breathing difficulties (OR = 0.39; 95% CI 0.16, 0.97).

CONCLUSION

Eating a greater variety of vegetables was associated with a lower chance of airway inflammation and prevalence of self-reported asthma in school children.

Household Food Insecurity, Lung Function, and COPD in US Adults

Increasing epidemiological evidence suggests that optimal diet quality helps to improve preservation of lung function and to reduce chronic obstructive pulmonary disease (COPD) risk, but no study has investigated the association of food insecurity (FI) and lung health in the general population. Using data from a representative sample of US adults who participated in the National Health and Nutrition Examination Survey (NHANES) 2007–2012 cycles, we investigated the association between FI with lung function and spirometrically defined COPD in 12,469 individuals aged ≥ 18 years of age. FI (high vs. low) was defined using the US Department of Agriculture’s Food Security Scale). Population-weighted adjusted regression models were used to investigate associations between FI, and forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), their ratio, and spirometrically defined restriction (FVC below the lower limit of normal) and airflow obstruction (COPD). The prevalence of household FI was 13.2%. High household FI was associated with lower FVC (adjusted β-coefficient −70.9 mL, 95% CI −116.6, −25.3), and with higher odds (OR) of spirometric restriction (1.02, 95% CI 1.00, 1.03). Stratified analyses showed similar effect sizes within specific ethnic groups. High FI was associated with worse lung health in a nationally representative sample of adults in the US.

Dietary Inflammatory Index (DII®) and Lung Function in Adults from Ten European Countries – Evidence from the GA2LEN Follow-Up Survey

Objectives

To investigate the association between Dietary Inflammatory Index (DII®) and lung function in European adults.

Methods

The study sample was drawn from the Global Allergy and Asthma Network of Excellence (GA2LEN) screening survey, in which 55,000 adults aged 15 to 75 years answered a postal questionnaire on respiratory symptoms. A stratified random sample was obtained for follow-up. A cross-sectional study was conducted in this sample (n = 3241), which included ascertainment of dietary intake and measures of lung function. Participants completed the internationally validated GA2LEN food frequency questionnaire (FFQ), which enquired about usual intake of 245 food items. The dietary inflammatory index (DII®) was derived to ascertain the inflammatory potential of the diet (minimum and maximum reference range −8.87 to 7.98; i.e., the higher the score the more pro-inflammatory the diet). Participants performed post-bronchodilator spirometry, from which forced vital capacity (FVC), the ratio between the forced exhaled volume in 1 second (FEV1) and FVC (FEV1/FVC), FVC below lower limit of normal (FVC &lt; LLN; (restriction)) and FEV1/FVC &lt; LLN (airway obstruction) were calculated. Exposures and lung function outcomes were weighted to obtain estimated population parameters. Potential confounders included age, sex, height, body mass index, smoking status, country, education and employment. Adjusted regressions were used to investigate the associations between DII and respiratory outcomes.

Results

The mean age of participants was 48 years (SD ± 15.1), and the median DII was −1.53 (IQR difference 3.5). In the fully adjusted models, a one-unit increase in DII score was statistically significantly associated with a lower FEV1/FVC (β-coefficient −0.46, 95% CI −0.80, −0.12; P-value = 0.008) and with airway obstruction (odds ratio [OR] 1.17, 95% CI 1.03, 1.34; P-value = 0.018]. There was no association with the other lung function outcomes.

Conclusions

A more pro-inflammatory diet was associated with greater airway obstruction amongst European adults.

Funding Sources

FCM is funded by The Fulbright Commission and by the Fundação para a Ciência e Tecnologia (SFRH/BD/144,563/2019). This work was conducted as part of The GA2LEN Working Group WP1.2 Epi & Clinical Studies. GA2LEN was funded by the EU Framework Programme for Research, contract No FOOD-CT-2004–506,378.

Education and Socioeconomic Level of Mothers Are Negatively Associated with the Diet Quality of Their Offspring– Evidence from the 2015 Colombian Nutrition Survey

Objectives

To analyze the association between maternal education level and socio-economic status (SES), and diet quality of Colombian children.

Methods

The National Nutrition Survey (ENSIN) 2015 was a cross-sectional survey examining general health and dietary intake in a representative sample of Colombian children and adults. The Alternative Healthy Eating Index (AHEI), an indicator of adherence to diet quality, was calculated using a single 24 h recall questionnaire administered to 11,641 children aged 6–17y (5470 females, 6171 males). Diet quality was considered low, intermediate or high if the median AHEI score ranged between 17.0–44.0; 44.5–54.0; or 54.5–74.0, respectively. Maternal education was categorized as having: incomplete elementary school or less, complete primary or incomplete high school, complete high school or incomplete university, or professional degree or higher. A validated wealth index (quintiles) was used to define SES. These two risk factors were fitted in an adjusted linear regression model to investigate their association with children's diet quality.

Results

The median AHEI score was 43.7 (IQR: 35.7–51.5) A fifth of the mothers had the lowest educational level, whilst 5.7% reported having a professional degree or higher education. Increasing maternal education level was negatively associated with diet quality (p-trend &lt; 0.001). Children of women with the highest educational level had, on average, 2.7 lower units of AHEI compared to those of mothers with the lowest education level (P &lt; 0.001). Similarly, SES was negatively associated with diet quality (p-trend &lt; 0.001). Children in the highest SES quintile had a mean 4.7 lower units of AHEI compared those in the lowest SES (P &lt; 0.001).

Conclusions

Higher maternal education and SES were associated with lower diet quality in Colombian children. The findings suggest that Colombia is experiencing a pattern 4 of the Nutrition Transition (‘Western’ style diet), which is a known risk factor for non-communicable diseases.

Funding Sources

GMG was supported by the Departamento Administrativo de Ciencia, Tecnología e Innovación (COLCIENCIAS) (Fondo para Investigación en Salud-FIS-). MRD was funded by COLCIENCIAS (Convocatoria 647). FDCM was funded by the Fulbright Commission and the Fundação para a Ciência e Tecnologia (SFRH/BD/144,563/2019).

Awareness, Understanding and Use of the ‘Traffic Light’ Food Labelling Policy and Educational Level in Ecuador – Findings from the National Nutrition Survey 2018

Objectives

To examine the association between awareness, understanding and use of the traffic light food labelling policy (TLFL) and educational level in children and adults from Ecuador.

Methods

Data from the National Health and Nutrition Survey (ENSANUT) 2018 (40,938 participants aged 10y–98y) was used. Awareness, understanding and use of TLFL were ascertained with the questions ‘do you know/have you seen the TLFL in foods? [yes/no]’; ‘do you understand the TLFL in foods’ [yes/no]; and ‘do you consider that the TLFL helps you with food purchase decisions? (a little or nothing [reference]/some/a lot)’, respectively. Education was categorized as illiterate [reference]; primary school [incomplete/complete]; high school [incomplete/complete]; and higher education. Age, sex, residence (rural/urban), income, poverty index (unsatisfied basic needs) were included as potential confounders. Adjusted multivariable regressions were used to investigate the association of TLFL and education (reported as odds ratios [OR] and 95% confidence intervals [95%CI]), using sampling weights, and Akaike's Information Criterion to select the most optimal models.

Results

31,028 participants (79%) reported to be aware of the TLFL, of whom 88% said they understood. Amongst the latter, only 21% reported to use TLFL when purchasing foods. Increasing education was associated with increased odds of awareness and understanding of TLFL (p-values: 0.004, 0.005, respectively) but not with its use. Compared to the lowest education, those with the highest educational level had the highest odds of being aware of and understanding the TLFL, OR 1.54 (95% CI 1.48; 1.61) and OR 1.28 (95% CI 1.19;1.39), respectively.

Conclusions

Whilst awareness and understanding of TLFL is relatively high in the Ecuadorian population, its use remains low. These findings highlight the need to strengthen public health policies that increase the use of food labelling as reference to make healthier decisions about food purchase, particularly amongst individuals from more vulnerable educational and socio-economic background.

Funding Sources

AR is funded by an MPH Fellowship and FDCM by a Grant for Research, both awarded by the Fulbright Commission; GMG is funded by COLCIENCIAS (Fondo para Investigacion en Salud -FIS-).

The inflammatory potential of diet impacts the association between air pollution and childhood asthma

BACKGROUND

Inhalation of fine particulate matter (PM) can cause systematic inflammation and oxidative stress, which may further aggravate the development and progression of asthma. Although nutritional intake of fatty acids and antioxidants may attenuate some effects of fine PM, the role of the inflammatory potential of diet has not been addressed. Therefore, we aimed to investigate possible modulatory effects of dietary inflammatory potential on the association between indoor air pollution and childhood asthma-related outcomes.

METHODS

In a sample of 501 children (48.1% females, aged 7-12 years) from 20 public schools located in Porto, Portugal, we evaluated airway reversibility, exhaled nitric oxide levels, atopy, and current respiratory symptoms. Dietary inflammatory index was calculated based on information collected through a reported 24-hour recall questionnaire, and participants were categorized as having an anti-inflammatory or pro-inflammatory diet. Concentrations of indoor PM2.5 and PM10 were measured to assess indoor air quality. Generalized linear mixed models were used to investigate the proportion of effects explained by the exposure to PM2.5 and PM10.

RESULTS

After adjustment, the exposure effect of PM2.5 and PM10 levels on children with asthma was higher for those having a pro-inflammatory diet (OR = 1.44, 95% CI: 1.01-2.21; and OR = 1.29, 95% CI: 1.03-1.68, respectively) compared to those having an anti-inflammatory diet.

CONCLUSION

These findings suggest that the quality of diet might affect the association between indoor pollution and asthma in children, highlighting the relevance of children's diet as a potential protective factor to pollutant exposure in childhood asthma.

Asthma and body mass definitions affect estimates of association: evidence from a community-based cross-sectional survey

Asthma and obesity have been on the rise for the past few decades, becoming the most prevalent chronic conditions in children [1, 2]. Obesity has been suggested to increase asthma incidence and prevalence, and change asthma towards a more difficult-to-control phenotype [3]. Yet, the impact of heterogeneous asthma and obesity definitions on the suggested association has been poorly explored. As such, we aimed to evaluate the influence of different asthma and obesity definitions on the obesity–asthma relationship.

Differing body mass classifications challenge the strength of the epidemiological evidence suggesting asthma and obesity are linked. The relationship between asthma and overweight in children depends on the body mass definitions adopted.http://bit.ly/2lSxhC5