Folate Deficiency, Atopy, and Severe Asthma Exacerbations in Puerto Rican Children

Blatter, Joshua; Brehm, John M.; Sordillo, Joanne E.; Forno, Erick; Boutaoui, Nadia; Acosta‐Pérez, Edna; Alvarez, María; Colón-Semidey, Angel; Weiss, Scott T.; Litonjua, Augusto A.; Canino, Glorisa; Celedón, Juan C.

doi:10.1513/annalsats.201508-549oc

Cited by 17 publications

(18 citation statements)

References 31 publications

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Section: Discussionmentioning

confidence: 99%

“…One study has recently shown that folate deficiency (defined as serum folate ≤ 20 ng/mL) is associated with increased degree of atopy and severe asthma exacerbations in school-aged Puerto Ricans 13 . Our data showed a similar finding to Blatter et al 13 and NHANES findings 15 of increased asthma risk when folate concentrations were ≤ 16.3 ng/mL. It should be noted, however, that clinical folate deficiency is not considered to exist until circulating serum folate falls below 3 ng/mL (based on development of neural tube defects in newborns), suggesting that the threshold at which the association of circulating folate with asthma exists is considerably higher than the threshold conventionally associated with folate deficiency.…”

Section: Discussionmentioning

confidence: 99%

“…However, few studies have examined whether folate status is associated with disease morbidity or disease severity in subjects with established asthma; whether folate status affects asthma control in individuals who already have asthma is also unclear 10,12 . Low folate levels have been shown to be associated with increased risks of wheeze, atopy, severe asthma exacerbations, or an elevated total IgE in cross-sectional studies of children and adults 13,14,15 .…”

Section: Introductionmentioning

confidence: 99%

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Serum folate concentrations, asthma, atopy, and asthma control in Peruvian children

Nicholson

Pollard

Lima

et al. 2017

Respiratory Medicine

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Background The relationship between folate status and asthma-related outcomes has not been carefully examined in low- and middle-income countries where folate deficiency is common. Methods Ancillary analysis of an unmatched case-control study in which we analyzed serum folate concentrations in 412 children with asthma and 342 controls living in peri-urban communities in Lima, Peru. We examined baseline associations between folate and asthma, atopy, total serum IgE, pulmonary function, and fractional exhaled nitric oxide. We then followed children with asthma longitudinally for 6–9 months and assessed associations between folate and odds of uncontrolled asthma (defined as Asthma Control Test score ≤ 19) and of ≥1 emergency visits during follow-up. Results A 10 ng/mL decrease in serum folate was associated with 45% higher adjusted odds of asthma (OR=1.45, 95% CI 1.05–2.02). The folate-asthma relationship differed by atopic status: a 10 ng/mL decrease in serum folate was associated with a 2.4-fold higher odds of asthma among children without atopy (2.38, 1.20–4.72) and 23% higher odds of asthma in children with atopy (1.23, 0.85–1.80). Among children with asthma, a 10 ng/mL decrease in serum folate was associated with 62% higher odds of uncontrolled asthma (1.62, 1.02–2.56) and 73% higher odds of ≥1 emergency visits during follow-up (1.73, 1.05–2.85). Conclusions Serum folate concentrations were inversely associated with asthma, but this effect was stronger in children without atopy. Among children with asthma, lower serum folate concentrations were associated with higher risk of uncontrolled asthma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Serum folate concentrations, asthma, atopy, and asthma control in Peruvian children

Nicholson

Pollard

Lima

et al. 2017

Respiratory Medicine

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“…Special Considerations: Vitamin D Vitamin D insufficiency, higher in black populations [111], has been associated with asthma prevalence and morbidity; however, a causal mechanism remains controversial. Multiple studies support a role for vitamin D via its anti-oxidant and immunomodulatory effects [112][113][114][115][116]. Two meta-analyses of randomized clinical trials demonstrate that vitamin D supplementation reduced the rate of asthma exacerbations requiring systemic corticosteroids in both children and adults in ethnically diverse populations [117•], [118].…”

Section: Materials Circumstances: Food Insecurity and Nutritionmentioning

confidence: 99%

Structural and Social Determinants of Health in Asthma in Developed Economies: a Scoping Review of Literature Published Between 2014 and 2019

Sullivan

Thakur

2020

Curr Allergy Asthma Rep

128

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Purpose of Review Using the WHO Conceptual Framework for Action on the Social Determinants of Health, this review provides a discussion of recent epidemiologic, mechanistic, and intervention studies of structural and social determinants of health and asthma outcomes covering the period from 2014 to 2019. Recent Findings A majority of studies and interventions to date focus on the intermediary determinants of health (e.g., housing), which as the name suggests, exist between the patient and the upstream structural determinants of health (e.g., housing policy). Race/ethnicity remains a profound social driver of asthma disparities with cumulative risk from many overlapping determinants. A growing number of studies on asthma are beginning to elucidate the underlying mechanisms that connect social determinants to human disease. Several effective interventions have been developed, though a need for large-scale policy research and innovation remains. Summary Strong evidence supports the key role of the structural determinants, which generate social stratification and inequity, in the development and progression of asthma; yet, interventions in this realm are challenging to develop and therefore infrequent. Proximal, intermediary determinants have provided a natural starting point for interventions, though structural interventions have the most potential for major impact on asthma outcomes. Further research to investigate the interactive effect of multiple determinants, as well as intervention studies, specifically those that are cross-sector and propose innovative strategies to target structural determinants, are needed to address asthma morbidities, and more importantly, close the asthma disparity gap.

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“…The role of vitamins on asthma control is still debated in children. Although folate deficiency appears to be associated with severe exacerbations, no clinical study has assessed the efficacy of folate supplementation in improving asthma control [ 164 , 165 ]. Vitamin C supplementation (0.2 mg/day) has been shown to provide small improvements in asthma control in a cross-over trial, hence a definitive RCT is warranted to confirm this result [ 166 ].…”

Section: Diet and Asthma Controlmentioning

confidence: 99%

Diet and Asthma: Is It Time to Adapt Our Message?

et al. 2017

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Asthma is a chronic respiratory disorder which is associated with airway inflammation. Environmental factors, in association with genetic susceptibility, play a critical role in asthma pathophysiology. Inhaled allergens, smoke exposure, indoor and outdoor air pollution are common triggers of asthma symptoms. Although the role of diet has clearly established mechanisms in diseases such as cardiovascular disease, type 2 diabetes, and cancer, it is not commonly identified as a causal factor in asthma. However, some dietary patterns, such as the Western diet, which includes a high intake of refined grains, processed and red meats, and desserts, have pro-inflammatory effects. On the contrary, the Mediterranean diet, with high intake of fruits and vegetables has anti-inflammatory properties. The influence of food on asthma outcomes is of growing interest, but dietary habits of asthma patients are not commonly investigated in clinical practice. In this review, we focus on the impact of diet on asthma risk and asthma control. We also detail the influence of diet on obese patients with asthma.

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Folate Deficiency, Atopy, and Severe Asthma Exacerbations in Puerto Rican Children

Abstract: Folate deficiency is associated with increased degree of atopy and severe asthma exacerbations in school-aged Puerto Ricans. Vitamin D insufficiency may further increase detrimental effects of folate deficiency on severe asthma exacerbations.

Cited by 17 publications

References 31 publications

Serum folate concentrations, asthma, atopy, and asthma control in Peruvian children

Serum folate concentrations, asthma, atopy, and asthma control in Peruvian children

Structural and Social Determinants of Health in Asthma in Developed Economies: a Scoping Review of Literature Published Between 2014 and 2019

Diet and Asthma: Is It Time to Adapt Our Message?

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