Research
Review
Diet and Asthma: Nutrition Implications from Prevention to Treatment

https://doi.org/10.1016/j.jada.2010.10.048Get rights and content

Abstract

Asthma is characterized by lung airway inflammation initiated and perpetuated by an inappropriate immune response, increased airway responsiveness, and variable airflow obstruction. In Western countries there has been a marked increase in asthma prevalence such that it has become a public health concern. It has been hypothesized that the increase may be due to changing antioxidant intake, increasing dietary ratio of n-6:n-3 polyunsaturated fatty acids (PUFA), and vitamin D deficiency (and supplementation). Observational studies have reported associations between asthma and dietary antioxidants (vitamin E, vitamin C, carotenoids, selenium, polyphenols, and fruit), PUFA, and vitamin D. However, supplementing the diets of adults with asthma with antioxidants and n-3 PUFA has minimal, if any, clinical benefit. Currently there is insufficient evidence to support the use of nutrient supplements to complement conventional treatment; however, results of ongoing studies are awaited, and additional research is required, particularly in children. Interest in the potential of dietary intervention during pregnancy to reduce the likelihood of childhood asthma has increased. A small number of cohort studies have highlighted associations between childhood asthma and reduced maternal intake of some nutrients (vitamin E, vitamin D, selenium, zinc, and PUFA) during pregnancy. Although vitamin D intervention studies during pregnancy are ongoing and two intervention studies suggest that dietary PUFA manipulation during pregnancy may be advantageous, further trials are needed to establish if modification of maternal nutrient intake during pregnancy can be used as a healthy, low cost, public health measure to reduce the prevalence of childhood asthma.

Section snippets

Increasing Prevalence of Asthma

The prevalence of asthma has been rapidly increasing within Westernized countries, with increases of between 25% and 75% per decade being observed since 1960 (4). A recent survey by Moorman and colleagues (5) reported that the prevalence of self-reported asthma in the United States increased from 3.1% in 1980 to 5.6% in 1995, being more marked in children (an increase from 3.5% to 7.5%) than adults (an increase from 2.9% to 5.0%). The increase in asthma has probably been greater in the United

Early Life Influences in the Etiology of Asthma

Although antioxidant and/or n-3 PUFA supplementation currently appear to have minimal, if any, clinical benefit in established asthma, there is increasing interest in the potential of dietary modification (particularly during pregnancy) in the primary prevention of childhood asthma. Early life factors play a critical role in the development of asthma (71): measurements of length, head circumference, and lung function at birth are associated with the subsequent development of childhood asthma (72

Conclusions

The generally weak observational and very limited intervention data suggest that while there are associations between diet and asthma, the nature of the associations (with PUFA, antioxidants, nutrients, and food), the timing (antenatal, infancy, childhood, and adulthood) and the therapeutic potential of the associations are far from clear; indeed, it remains a distinct possibility that the observed associations are a consequence of confounding by complex social and behavioral factors. From the

K. Allan is a doctoral degree student, Institute of Health Sciences, University of Aberdeen, Aberdeen, Scotland

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    K. Allan is a doctoral degree student, Institute of Health Sciences, University of Aberdeen, Aberdeen, Scotland

    G. Devereux is a professor of respiratory medicine and honorary consultant physician, Royal Aberdeen Children's Hospital Department of Child Health, University of Aberdeen, Aberdeen, Scotland

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