Diet, Lung Function, and Asthma Exacerbations in Puerto Rican Children

Abstract

Changes in dietary patterns may partly explain the epidemic of asthma in industrialized countries. The objective of this study was to examine the relationship between dietary patterns and lung function and asthma exacerbations in Puerto Rican children. This is a case-control study of 678 Puerto Rican children (ages 6-14 years) in San Juan (Puerto Rico). All participants completed a respiratory health questionnaire and a 75-item food frequency questionnaire. Food items were aggregated into 7 groups: fruits, vegetables, grains, protein, dairy, fats, and sweets. Logistic regression was used to evaluate consumption frequency of each group and asthma. Based on the results, a dietary score was created [range from -2 (unhealthy diet: high consumption of dairy and sweets, low consumption of vegetables and grains) to 2 (healthy diet: high consumption of vegetables and grains and low consumption of dairy and sweet)]. Multivariable linear or logistic regression was used to assess the relationship between dietary score and lung function or asthma exacerbations. After adjustment for covariates, a healthier diet (each 1-point increment in dietary score) was associated with significantly higher %predicted forced expiratory volume in the first second (FEV) and %predicted forced vital capacity (FVC) in control subjects. Dietary pattern alone was not associated with asthma exacerbations, but children with an unhealthy diet and vitamin D insufficiency (plasma 25(OH)D <30 ng/mL) had higher odds of ≥1 severe asthma exacerbation [odds ratio (OR) = 3.4, 95% confidence interval (CI) = 1.5-7.5] or ≥1 hospitalization due to asthma (OR = 3.9, 95% CI = 1.6-9.8, OR = 3.4, 95% CI = 1.5-7.5) than children who ate a healthy diet and were vitamin D sufficient. A healthy diet, with frequent consumption of vegetables and grains and low consumption of dairy products and sweets, was associated with higher lung function (as measured by FEV and FVC). Vitamin D insufficiency, together with an unhealthy diet, may have detrimental effects on asthma exacerbations in children.

Carotenoids, fatty acids and disease burden in obese minority adolescents with asthma

“…As both obesity and asthma are characterized by increased oxidative stress in children, the anti‐oxidant effect of carotenoids is likely to be central to the protective effects of carotenoids in the airways. Fresh fruit and vegetable intake has been associated with higher FEV 1 and FVC in children, particularly in those with wheeze/asthma, suggesting that carotenoids may link with asthma via altered pulmonary function. While several of these studies used dietary recall to quantify carotenoid intake, here we show a direct association between serum carotenoids and FEV 1 , findings that were observed specifically in obese children with asthma and not among healthy weight children.…”

“…Fresh fruit and vegetable intake has been associated with higher FEV 1 and FVC in children, particularly in those with wheeze/asthma, suggesting that carotenoids may link with asthma via altered pulmonary function. While several of these studies used dietary recall to quantify carotenoid intake, here we show a direct association between serum carotenoids and FEV 1 , findings that were observed specifically in obese children with asthma and not among healthy weight children. We speculate that the protective effect of carotenoids was only observed in the obese asthma subgroup, as this group is most susceptible to oxidative stress and thus has most potential to benefit from the anti‐oxidative properties of carotenoids.…”

“…Low α‐carotene, β‐carotene and β‐cryptoxanthin have specifically been linked to both asthma and obesity in observational studies . Poor diet quality has been linked to low lung function in children with asthma . Diet modification, including increased consumption of fruits and vegetables, was found to improve asthma outcomes in adults, with a reduction in exacerbation risk .…”

Pediatric obesity‐related asthma: A prototype of pediatric severe non‐T2 asthma

“…Several studies have linked dietary intake to asthma disease burden, starting as early as dietary choices made by the mother during the antenatal period . A higher proportion of processed food relative to fruit and vegetable intake has been associated with higher asthma incidence and disease burden . Although vitamin A and D supplementation decreases the disease burden, few studies have quantified differences in these micronutrients in obese as compared with healthy‐weight children with asthma .…”

“…95 A higher proportion of processed food relative to fruit and vegetable intake has been associated with higher asthma incidence and disease burden. 96 Although vitamin A and D supplementation decreases the disease burden, 95 few studies have quantified differences in these micronutrients in obese as compared with healthy-weight children with asthma. 97,98 Both 25-OH cholecalciferol levels and circulating carotenoids as an objective measure of fruit and vegetable intake were lower in obese relative to healthyweight children with asthma Figure 1.…”