Asthma and lower airway disease
Nutrients and foods for the primary prevention of asthma and allergy: Systematic review and meta-analysis

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Background

Epidemiologic studies suggest that deficiencies of the nutrients selenium; zinc; vitamins A, C, D, and E; and low fruit and vegetable intake may be associated with the development of asthma and allergic disorders.

Objectives

To investigate the evidence that nutrient and food intake modifies the risk of children developing allergy.

Methods

We systematically searched 11 databases. Studies were critically appraised, and meta-analyses were undertaken.

Results

We identified 62 eligible reports. There were no randomized controlled trials. Studies used cohort (n = 21), case-control (n = 15), or cross-sectional (n = 26) designs. All studies were judged to be at moderate to substantial risk of bias. Meta-analysis revealed that serum vitamin A was lower in children with asthma compared with controls (odds ratio [OR], 0.25; 95% CI, 0.10-0.40). Meta-analyses also showed that high maternal dietary vitamin D and E intakes during pregnancy were protective for the development of wheezing outcomes (OR, 0.56, 95% CI, 0.42-0.73; and OR, 0.68, 95% CI, 0.52-0.88, respectively). Adherence to a Mediterranean diet was protective for persistent wheeze (OR, 0.22; 95% CI, 0.08-0.58) and atopy (OR, 0.55; 95% CI, 0.31-0.97). Seventeen of 22 fruit and vegetable studies reported beneficial associations with asthma and allergic outcomes. Results were not supportive for other allergic outcomes for these vitamins or nutrients, or for any outcomes in relation to vitamin C and selenium.

Conclusion:

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. Experimental studies of these exposures are now warranted.

Section snippets

Methods

This work was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines.16, 17 Included studies were all those relevant to children (ie, pregnant women, infants, and children ≤16 years) that investigated the role of nutrients and foods for the primary prevention of asthma and atopic disorders in children—that is, cohort, case-control, and

Results

Our searches identified 14,747 potentially relevant published papers; 62 of these satisfied our inclusion criteria and were included in the systematic review (Fig 1).

We found no published RCTs; included studies used cohort (n = 21),18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 case-control (n = 15),39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53 cross-sectional (n = 25),54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73

Discussion

This systematic review and meta-analysis has investigated the role of nutrients and foods for the primary prevention of asthma and atopic disorders in children age ≤16 years. Critical appraisal of studies suggested that there was a substantial risk of bias in this overall body of knowledge. The results were nonetheless somewhat suggestive of potentially beneficial associations of vitamins A, D, and E; zinc; fruits and vegetables; and Mediterranean diet, particularly in relation to asthma. In

References (85)

  • Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee

    Lancet

    (1998)
  • N. Jenner et al.

    Morbidity and cost of atopic eczema in Australia

    Australas J Dermatol

    (2004)
  • A. Devenny et al.

    Respiratory symptoms and atopy in children in Aberdeen: questionnaire studies of a defined school population repeated over 35 years

    BMJ

    (2004)
  • N. Tagiyeva et al.

    Two main subtypes of wheezing illness? evidence from the 2004 Aberdeen schools asthma survey

    Pediatr Allergy Immunol

    (2008)
  • C. Anandan et al.

    Is the prevalence of asthma declining? systematic review of epidemiological studies

    Allergy

    (2010)
  • A. Seaton et al.

    Increase in asthma: a more toxic environment or a more susceptible population?

    Thorax

    (1994)
  • M. Wjst et al.

    Genes, factor X, and allergens: what causes allergic diseases?

    Allergy

    (1999)
  • S.T. Weiss et al.

    Maternal diet vs lack of exposure to sunlight as the cause of the epidemic of asthma, allergies and other autoimmune diseases

    Thorax

    (2007)
  • S. Tricon et al.

    Nutrition and allergic disease

    Clin Exp Rev

    (2006)
  • A. Sala-Vila et al.

    Fatty acid composition abnormalities in atopic disease: evidence explored and role in the disease process examined

    Clin Exp Allergy

    (2008)
  • C. Anandan et al.

    Omega 3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis

    Allergy

    (2009)
  • A. Liberati et al.

    The PRISMA statement for reporting systematic reviews and meta-analysis of studies that evaluate health care interventions: explanation and elaboration

    PLoS Med

    (2009)
  • D.F. Stroup et al.

    Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) Group

    JAMA

    (2000)
  • O. Bäck et al.

    Does vitamin D intake during infancy promote the development of atopic allergy?

    Acta Derm Venereol

    (2009)
  • L. Chatzi et al.

    Mediterranean diet in pregnancy is protective for wheeze and atopy in childhood

    Thorax

    (2008)
  • G. Devereux et al.

    Early childhood wheezing symptoms in relation to plasma selenium in pregnant mothers and neonates

    Clin Exp Allergy

    (2007)
  • G. Devereux et al.

    Low maternal vitamin E intake during pregnancy is associated with asthma in 5-year-old children

    Am J Respir Crit Care Med

    (2006)
  • M. Erkkola et al.

    Maternal vitamin D intake during pregnancy is inversely associated with asthma and allergic rhinitis in 5-year-old children

    Clin Exp Allergy

    (2009)
  • N. Fitzsimon et al.

    Mothers' dietary patterns during pregnancy and risk of asthma symptoms in children at 3 years

    Ir Med J

    (2007)
  • C.R. Gale et al.

    Maternal vitamin D status during pregnancy and child outcomes

    Eur J Clin Nutr

    (2008)
  • E. Hypponen et al.

    Infant vitamin D supplementation and allergic conditions in adulthood: northern Finland birth cohort 1966

    Ann N Y Acad Sci

    (2004)
  • S. Martindale et al.

    Antioxidant intake in pregnancy in relation to wheeze and eczema in the first two years of life

    Am J Respir Crit Care Med

    (2005)
  • J.D. Milner et al.

    Early infant multivitamin supplementation is associated with increased risk for food allergy and asthma

    Pediatrics

    (2004)
  • Y. Miyake et al.

    Dairy food, calcium, and vitamin D intake in pregnancy and wheeze and eczema in infants

    Eur Respir J

    (2010)
  • Y. Miyake et al.

    Consumption of vegetables, fruit, and antioxidants during pregnancy and wheeze and eczema in infants

    Allergy

    (2010)
  • M. Pesonen et al.

    Retinol concentrations after birth are inversely associated with atopic manifestations in children and young adults

    Clin Exp Allergy

    (2007)
  • S.O. Shaheen et al.

    Umbilical cord trace elements and minerals and risk of early childhood wheezing and eczema

    Eur Respir J

    (2004)
  • S.O. Shaheen et al.

    Dietary patterns in pregnancy and respiratory and atopic outcomes in childhood

    Thorax

    (2009)
  • R. Shaw et al.

    Risk factors for asthma symptoms in Kawerau children

    N Z Med J

    (1994)
  • S.M. Willers et al.

    Maternal food consumption during pregnancy and asthma, respiratory and atopic symptoms in 5-year-old children

    Thorax

    (2007)
  • S. Willers et al.

    Maternal food consumption during pregnancy and the longitudinal development of childhood asthma

    Am J Respir Crit Care Med

    (2008)
  • P. Arora et al.

    Vitamin A status in children with asthma

    Pediatr Allergy Immunol

    (2002)
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    This project was supported in its entirety by a project grant awarded by the Chief Scientist's Office of the Scottish Government Health Department (CZG/2/396).

    Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

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