Current Allergy and Asthma Reports

, Volume 12, Issue 3, pp 201–210 | Cite as

Nutrition and Asthma

ASTHMA (WJ CALHOUN AND J BOUSQUET, SECTION EDITORS)

Abstract

Over the past four decades, the prevalence of asthma has markedly increased in Westernized countries and countries transitioning to this lifestyle. It has been hypothesized that these increases are a consequence of changing environmental and/or behavioral factors. The modification of dietary habits (ie, decreased intake of fruits/vegetables and increased intake of “Westernized” processed foods) and a decrease in sun exposure have led to decreased intake of antioxidant vitamins and fatty acids and to decreased circulating levels of vitamin D, and have been proposed to explain the rise in asthma prevalence. This article summarizes the main findings on foods and nutrients connected to asthma based on several exhaustive recent reviews on the topic, and examines the evidence for an effect of dietary patterns on asthma. Overall, findings underscore the importance of conducting prospective studies and clinical trials to better understand the role of diet in the etiology of asthma.

Keywords

Diet Asthma Wheeze Antenatal diet Childhood diet Adulthood diet Nutrition Childhood asthma Adulthood asthma Vitamin A Vitamin C Vitamin E Selenium Zinc Fruits Vegetables Omega-3 Fish Vitamin D Dietary patterns Diet score Mediterranean diet score Alternate Healthy Eating Index 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Devereux G. The increase in the prevalence of asthma and allergy: food for thought. Nat Rev Immunol. 2006;6:869–74.PubMedCrossRefGoogle Scholar
  2. 2.
    •• Allan K, Devereux G. Diet and asthma: nutrition implications from prevention to treatment. J Am Diet Assoc. 2011;111:258–68. This is a recent exhaustive review based on the association between asthma and diet. The authors concluded that until the results of ongoing and planned trials are available, the practical consequences of research linking diet with asthma are minimal, and based on the available evidence, people with asthma, pregnant women, parents, and children should not be advised to change or supplement their diet to treat or reduce the risk of developing asthma. PubMedCrossRefGoogle Scholar
  3. 3.
    •• Nurmatov U, Devereux G, Sheikh A. Nutrients and foods for the primary prevention of asthma and allergy: systematic review and meta-analysis. J Allergy Clin Immunol. 2011;127:724–33. This is a recent review and meta-analysis including 62 studies on the effect of foods and nutrients on the risk of children developing wheeze/asthma. The authors concluded that the available epidemiologic evidence is weak but nonetheless supportive with respect to vitamins A, D, and E, zinc, fruits and vegetables, and a Mediterranean diet for the prevention of asthma, and that experimental studies of these exposures are warranted. PubMedCrossRefGoogle Scholar
  4. 4.
    • Robison R, Kumar R. The effect of prenatal and postnatal dietary exposures on childhood development of atopic disease. Curr Opin Allergy Clin Immunol. 2010;10:139–44. This is a recent review regarding the effects of prenatal and early-life dietary exposures on atopic disease. The authors concluded that there are conflicting data on the effects of most prenatal and early-childhood dietary exposures, and that longitudinal studies with prospective measurements and clinical supplementation trials are warranted to make reliable recommendations in this vulnerable population of pregnant women and their infants. PubMedCrossRefGoogle Scholar
  5. 5.
    Chatzi L, Kogevinas M. Prenatal and childhood Mediterranean diet and the development of asthma and allergies in children. Public Health Nutr. 2009;12:1629–34.PubMedCrossRefGoogle Scholar
  6. 6.
    •• Allan K, Kelly FJ, Devereux G. Antioxidants and allergic disease: a case of too little or too much? Clin Exp Allergy. 2010;40:370–80. This is a recent review on the association between antioxidant intake and asthma, atopic dermatitis, and allergic rhinitis. The authors concluded that based on the available epidemiologic, animal, molecular, and immunologic data, and despite the notable inconsistencies and gaps in the evidence base, there are associations between antioxidants and asthma and to a much lesser extent atopic dermatitis and allergic rhinitis. PubMedCrossRefGoogle Scholar
  7. 7.
    Anandan C, Nurmatov U, Sheikh A. Omega 3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis. Allergy. 2009;64:840–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Klemens CM, Berman DR, Mozurkewich EL. The effect of perinatal omega-3 fatty acid supplementation on inflammatory markers and allergic diseases: a systematic review. BJOG. 2011;118:916–25.PubMedCrossRefGoogle Scholar
  9. 9.
    Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13:3–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Machlin LJ, Bendich A. Free radical tissue damage: protective role of antioxidant nutrients. FASEB J. 1987;1:441–5.PubMedGoogle Scholar
  11. 11.
    Bray TM, Bettger WJ. The physiological role of zinc as an antioxidant. Free Radic Biol Med. 1990;8:281–91.PubMedCrossRefGoogle Scholar
  12. 12.
    Sala-Vila A, Miles EA, Calder PC. Fatty acid composition abnormalities in atopic disease: evidence explored and role in the disease process examined. Clin Exp Allergy. 2008;38:1432–50.PubMedCrossRefGoogle Scholar
  13. 13.
    • Taylor CE, Camargo Jr CA. Impact of micronutrients on respiratory infections. Nutr Rev. 2011;69:259–69. This is a recent review regarding the association between nutrients and respiratory infections. The authors concluded that besides the importance of micronutrients in the prevention and treatment of infectious diseases, vitamin D is of global importance and that its effects are particularly relevant in specific populations. They also concluded that there is a clear need for RCTs of vitamin D, particularly in children, older adults, and individuals with asthma. PubMedCrossRefGoogle Scholar
  14. 14.
    •• Camargo Jr CA, Ingham T, Wickens K, et al. Cord-blood 25-hydroxyvitamin D levels and risk of respiratory infection, wheezing, and asthma. Pediatrics. 2011;127:e180–7. This recent study aimed to investigate the association between cord-blood level of 25-hydroxyvitamin D with respiratory infection by 3 months of age, childhood wheezing at 15 months and 3 and 5 years, and asthma incidence at 5 years among 922 mother–newborn pairs in New Zealand. The authors concluded that cord-blood levels of 25-hydroxyvitamin D had inverse associations with risk of respiratory infection and childhood wheezing, but no association with incident asthma. PubMedCrossRefGoogle Scholar
  15. 15.
    •• Morales E, Romieu I, Guerra S, et al. Maternal vitamin D status in pregnancy and risk of lower respiratory tract infections, wheezing, and asthma in offspring. Epidemiology. 2012;23:64–71. This recent study aimed to investigate the association between maternal circulating level of 25-hydroxyvitamin D in pregnancy with lower respiratory tract infections, childhood wheezing, and current asthma among 1,724 mother–newborn pairs in Spain. The authors concluded that higher maternal circulating 25-hydroxyvitamin D concentrations in pregnancy were independently associated with lower risk of lower respiratory tract infections in offspring in the first year of life, but not with wheezing or asthma in childhood. PubMedCrossRefGoogle Scholar
  16. 16.
    Brehm JM, Schuemann B, Fuhlbrigge AL, et al. Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study. J Allergy Clin Immunol. 2010;126:52–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Hollams EM, Hart PH, Holt BJ, et al. Vitamin D and atopy and asthma phenotypes in children: a longitudinal cohort study. Eur Respir J. 2011;38:1320–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Hyppönen E, Sovio U, Wjst M, et al. Infant vitamin d supplementation and allergic conditions in adulthood: northern Finland birth cohort 1966. Ann N Y Acad Sci. 2004;1037:84–95.PubMedCrossRefGoogle Scholar
  19. 19.
    •• Keet CA, McCormack MC, Peng RD, Matsui EC. Age- and atopy-dependent effects of vitamin D on wheeze and asthma. J Allergy Clin Immunol. 2011;128:414–6. In this recent study, the authors investigated the association between vitamin D levels and wheeze, history of asthma, and asthma exacerbations among 6,857 adults from the NHANES study. The authors reported that lower vitamin D levels were associated with increased risk of current wheeze, and that this relationship varied by age. PubMedCrossRefGoogle Scholar
  20. 20.
    Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, et al. Diet and overall survival in elderly people. BMJ. 1995;311:1457–60.PubMedCrossRefGoogle Scholar
  21. 21.
    Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348:2599–608.PubMedCrossRefGoogle Scholar
  22. 22.
    Fung TT, McCullough ML, Newby PK, et al. Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr. 2005;82:163–73.PubMedGoogle Scholar
  23. 23.
    •• Lange NE, Rifas-Shiman SL, Camargo Jr CA, et al. Maternal dietary pattern during pregnancy is not associated with recurrent wheeze in children. J Allergy Clin Immunol. 2010;126:250–5. In this recent study, the authors investigated the association between overall maternal dietary patterns during pregnancy and recurrent wheeze in children among 1,376 mother–infant pairs from the Viva study. Using a priori and a posteriori dietary patterns, the authors concluded that overall dietary pattern during pregnancy is not associated with recurrent wheeze in children. PubMedCrossRefGoogle Scholar
  24. 24.
    Serra-Majem L, Ribas L, Ngo J, et al. Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr. 2004;7:931–5.PubMedGoogle Scholar
  25. 25.
    McCullough ML, Feskanich D, Stampfer MJ, et al. Adherence to the dietary guidelines for Americans and risk of major chronic disease in women. Am J Clin Nutr. 2000;72:1214–22.PubMedGoogle Scholar
  26. 26.
    Rifas-Shiman SL, Rich-Edwards JW, Kleinman KP, Oken E, Gillman MW. Dietary quality during pregnancy varies by maternal characteristics in Project Viva: a US cohort. J Am Diet Assoc. 2009;109:1004–11.PubMedCrossRefGoogle Scholar
  27. 27.
    Chatzi L, Torrent M, Romieu I, et al. Mediterranean diet in pregnancy is protective for wheeze and atopy in childhood. Thorax. 2008;63:507–13.PubMedCrossRefGoogle Scholar
  28. 28.
    Shaheen SO, Northstone K, Newson RB, et al. Dietary patterns in pregnancy and respiratory and atopic outcomes in childhood. Thorax. 2009;64:411–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Miyake Y, Okubo H, Sasaki S, Tanaka K, Hirota Y. Maternal dietary patterns during pregnancy and risk of wheeze and eczema in Japanese infants aged 16–24 months: the Osaka Maternal and Child Health Study. Pediatr Allergy Immunol. 2011;22:734–41.PubMedCrossRefGoogle Scholar
  30. 30.
    Hong SJ, Lee MS, Lee SY, et al. High body mass index and dietary pattern are associated with childhood asthma. Pediatr Pulmonol. 2006;41:1118–24.PubMedCrossRefGoogle Scholar
  31. 31.
    Garcia-Marcos L, Canflanca IM, Garrido JB, et al. Relationship of asthma and rhinoconjunctivitis with obesity, exercise and Mediterranean diet in Spanish schoolchildren. Thorax. 2007;62:503–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Castro-Rodriguez JA, Garcia-Marcos L, Alfonseda Rojas JD, Valverde-Molina J, Sanchez-Solis M. Mediterranean diet as a protective factor for wheezing in preschool children. J Pediatr. 2008;152:823–8.PubMedCrossRefGoogle Scholar
  33. 33.
    De Batlle J, Garcia-Aymerich J, Barraza-Villarreal A, Antó JM, Romieu I. Mediterranean diet is associated with reduced asthma and rhinitis in Mexican children. Allergy. 2008;63:1310–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Arvaniti F, Priftis KN, Papadimitriou A, et al. Adherence to the Mediterranean type of diet is associated with lower prevalence of asthma symptoms, among 10–12 years old children: the PANACEA study. Pediatr Allergy Immunol. 2011;22:283–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Nagel G, Weinmayr G, Kleiner A, Garcia-Marcos L, Strachan DP. ISAAC Phase Two Study Group. Effect of diet on asthma and allergic sensitisation in the International Study on Allergies and Asthma in Childhood (ISAAC) Phase Two. Thorax. 2010;65:516–22.PubMedCrossRefGoogle Scholar
  36. 36.
    Gonzalez Barcala FJ, Pertega S, Bamonde L, et al. Mediterranean diet and asthma in Spanish schoolchildren. Pediatr Allergy Immunol. 2010;21:1021–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Varraso R, Fung TT, Barr RG, et al. Prospective study of dietary patterns and chronic obstructive pulmonary disease among US women. Am J Clin Nutr. 2007;86:488–95.PubMedGoogle Scholar
  38. 38.
    Varraso R, Fung TT, Hu FB, Willett W, Camargo CA. Prospective study of dietary patterns and chronic obstructive pulmonary disease among US men. Thorax. 2007;62:786–91.PubMedCrossRefGoogle Scholar
  39. 39.
    Butler LM, Koh WP, Lee HP, et al. Prospective study of dietary patterns and persistent cough with phlegm among Chinese Singaporeans. Am J Respir Crit Care Med. 2006;173:264–70.PubMedCrossRefGoogle Scholar
  40. 40.
    Barros R, Moreira A, Fonseca J, et al. Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma control. Allergy. 2008;63:917–23.PubMedCrossRefGoogle Scholar
  41. 41.
    Takaoka M, Norback D. Diet among Japanese female university students and asthmatic symptoms, infections, pollen and furry pet allergy. Respir Med. 2008;102:1045–54.PubMedCrossRefGoogle Scholar
  42. 42.
    Bakolis I, Hooper R, Thompson RL, Shaheen SO. Dietary patterns and adult asthma: population-based case–control study. Allergy. 2010;65:606–15.PubMedCrossRefGoogle Scholar
  43. 43.
    Hooper R, Heinrich J, Omenaas E, et al. Dietary patterns and risk of asthma: results from three countries in European Community Respiratory Health Survey-II. Br J Nutr. 2010;103:1354–65.PubMedCrossRefGoogle Scholar
  44. 44.
    • McKeever TM, Lewis SA, Cassano PA, et al. Patterns of dietary intake and relation to respiratory disease, forced expiratory volume in 1 s, and decline in 5-y forced expiratory volume. Am J Clin Nutr. 2010;92:408–15. In this study, the authors investigated the association between a posteriori dietary patterns (cosmopolitan diet, traditional diet, and refined-foods diet) with forced expiratory volume in 1 second, forced expiratory volume in 1 second decline, wheeze, and asthma among 12,648 adults from The Netherlands. The authors reported a positive and significant association between the cosmopolitan diet pattern and prevalence of wheeze and asthma. PubMedCrossRefGoogle Scholar
  45. 45.
    • Varraso R, Kauffmann F, Leynaert B, et al. Dietary patterns and asthma in the E3N study. Eur Respir J. 2009;33:33–41. In this study, the authors investigated the association between a posteriori dietary patterns (prudent, Western, nuts and wine) and adult-onset asthma, ever having had and current asthma, and with frequent asthma attacks among 54,672 women from the E3N study. The authors reported no association between dietary patterns and asthma incidence, ever having had asthma, or current asthma. However, they reported a positive and significant association between the Western pattern and frequent asthma attacks, and a negative and significant association between the nuts and wine pattern and frequent asthma attacks. PubMedCrossRefGoogle Scholar
  46. 46.
    Birch LL, Fisher JO. Development of eating behaviours among children and adolescents. Paediatrics. 1998;101:539–49.Google Scholar
  47. 47.
    Varraso, et al. Dietary patterns and asthma in the E3N study. Eur Respir J. 2009;33:1–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Inserm CESP/U1018Respiratory and Environmental Epidemiology TeamVillejuif CedexFrance
  2. 2.Université Paris Sud 11VillejuifFrance

Personalised recommendations