Olive oil during pregnancy is associated with reduced wheezing during the first year of life of the offspring

Effects of the Mediterranean Diet during pregnancy on the onset of allergy in at risk children: A study protocol of a multi-center, randomized- controlled, parallel groups, prospective trial (the PREMEDI study)

Introduction

Maternal diet during pregnancy has been linked to offspring allergy risk and it could represent a potential target for allergy prevention. The Mediterranean Diet (MD) is considered one of the healthiest dietary models. Randomized-controlled trials on the effect of MD in preventing pediatric allergic diseases are still needed.

Methods and analysis

The Mediterranean Diet during Pregnancy study (PREMEDI) will be a 9-month multi-center, randomized-controlled, parallel groups, prospective trial. Healthy women (20–35 years) at their first trimester of pregnancy at risk for atopy baby, will be randomly allocated to Group 1 (standard obstetrical and gynecological follow-up and nutritional counseling to promote MD) or Group 2 (standard obstetrical and gynecological follow-up alone). 138 mother-child pair per group will be needed to detect a reduction in cumulative incidence of ≥1 allergic disease at 24 months of age. The primary study aim will be the evaluation of the occurrence of allergic disorders in the first 24 months of life. The secondary aims will be the evaluation of maternal weight gain, pregnancy/perinatal complications, growth indices and occurrence of other chronic disorders, mother-child pair adherence to MD and gut microbiome features, breastfeeding duration and breast milk composition, epigenetic modulation of genes involved in immune system, and metabolic pathways in the offspring.

Ethics and dissemination

The study protocol has been approved by the Ethics Committee of the University of Naples Federico II (number 283/21) and it will be conducted in accordance with the Helsinki Declaration (Fortaleza revision, 2013), the Good Clinical Practice Standards (CPMP/ICH/135/95), the Italian Decree-Law 196/2003 regarding personal data and the European regulations on this subject. The study has been registered in the Clinical Trials Protocol Registration System.

Clinical trial registration

[http://clinicaltrials.gov], identifier [NCT05119868].

Maternal Adherence to the Mediterranean Diet during Pregnancy: A Review of Commonly Used a priori Indexes

Currently, many a priori indexes are being used to assess maternal adherence to the Mediterranean diet (MD) during pregnancy but each with different components, cut-off points, and scoring systems. This narrative review aimed to identify all observational studies utilizing a priori indexes to assess maternal adherence to the MD during pregnancy. A systematic search was conducted in Pubmed until 1 July 2020. Among the 27 studies included, eight different a priori indexes were identified. Studies included a range of 5 to 13 dietary components in their indexes. Only three dietary components-vegetables, fruits, and fish-were common among all indexes. Dairy and alcohol were the only two components modified for pregnancy. All but one study either excluded alcohol from their index or reversed its scoring to contribute to decreased adherence to the MD. Approximately half of the studies established cut-off points based on the distribution of the study population; the others utilized fixed criteria. This review emphasizes the incongruent definitions of the MD impairing effective comparison among studies relating to maternal or offspring health outcomes. Future research should carefully consider the heterogeneous definitions of the MD in a priori indexes and the relevance of incorporating pregnancy-specific nutritional requirements.

Dietary factors during pregnancy and atopic outcomes in childhood: A systematic review from the European Academy of Allergy and Clinical Immunology

RATIONALE

Allergic diseases are an increasing public health concern, and early life environment is critical to immune development. Maternal diet during pregnancy has been linked to offspring allergy risk. In turn, maternal diet is a potentially modifiable factor, which could be targeted as an allergy prevention strategy. In this systematic review, we focused on non-allergen-specific modifying factors of the maternal diet in pregnancy on allergy outcomes in their offspring.

METHODS

We undertook a systematic review of studies investigating the association between maternal diet during pregnancy and allergic outcomes (asthma/wheeze, hay fever/allergic rhinitis/seasonal allergies, eczema/atopic dermatitis (AD), food allergies, and allergic sensitization) in offspring. Studies evaluating the effect of food allergen intake were excluded. We searched three bibliographic databases (MEDLINE, EMBASE, and Web of Science) through February 26, 2019. Evidence was critically appraised using modified versions of the Cochrane Collaboration Risk of Bias tool for intervention trials and the National Institute for Clinical Excellence methodological checklist for cohort and case-control studies and meta-analysis performed from RCTs.

RESULTS

We identified 95 papers: 17 RCTs and 78 observational (case-control, cross-sectional, and cohort) studies. Observational studies varied in design and dietary intakes and often had contradictory findings. Based on our meta-analysis, RCTs showed that vitamin D supplementation (OR: 0.72; 95% CI: 0.56-0.92) is associated with a reduced risk of wheeze/asthma. A positive trend for omega-3 fatty acids was observed for asthma/wheeze, but this did not reach statistical significance (OR: 0.70; 95% CI: 0.45-1.08). Omega-3 supplementation was also associated with a non-significant decreased risk of allergic rhinitis (OR: 0.76; 95% CI: 0.56-1.04). Neither vitamin D nor omega-3 fatty acids were associated with an altered risk of AD or food allergy.

CONCLUSIONS

Prenatal supplementation with vitamin D may have beneficial effects for prevention of asthma. Additional nutritional factors seem to be required for modulating the risk of skin and gastrointestinal outcomes. We found no consistent evidence regarding other dietary factors, perhaps due to differences in study design and host features that were not considered. While confirmatory studies are required, there is also a need for performing RCTs beyond single nutrients/foods.

Mediterranean diet during pregnancy and childhood for asthma in children: A systematic review and meta-analysis of observational studies

OBJECTIVES

To evaluate the relationship between high adherence to the Mediterranean diet in pregnancy and childhood and the risk of asthma and wheeze in children.

METHODS

We conducted searches of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from inception to 30 October 2018. Observational studies providing risk estimates and corresponding confidence intervals on the association of high adherence to the Mediterranean diet in pregnancy or childhood and the risk of asthma or wheeze in childhood were included. The methodological quality of all included studies was assessed. Summary odds ratios (OR) were calculated using a random-effects model.

RESULTS

Eighteen observational studies were included in this review. All studies were of moderate to high quality. The pooled data suggested high adherence to the Mediterranean diet during pregnancy was associated with a reduced incidence of wheeze in the first 12 months (OR, 0.92; 95% confidence interval [CI], 0.88-0.95; P < 0.001), and there was an inverse association between the Mediterranean diet during childhood and the incidence of wheeze in the history (OR, 0.51; 95% CI, 0.37-0.70; P = 0.001) and current wheeze (OR, 0.97; 95% CI, 0.95-0.99; P = 0.013). However, there was no significant association between high adherence of the Mediterranean diet in pregnancy and childhood and any of the other meta-analysis end points including diagnosed asthma.

CONCLUSION

High adherence to the Mediterranean diet during pregnancy and childhood may have short-term effects on wheeze in children in early life. However, these findings should be interpreted with caution owing to the heterogeneity of the studies.

Gut microbiome-Mediterranean diet interactions in improving host health

The gut microbiota plays a fundamental role in host health and disease. Host diet is one of the most significant modulators of the gut microbial community and its metabolic activities. Evidence demonstrates that dietary patterns such as the 'Western diet' and perturbations in gut microbiome (dysbiosis) have strong associations with a wide range of human diseases, including obesity, metabolic syndrome, type-2 diabetes and cardiovascular diseases. However, consumption of Mediterranean-style diets is considered healthy and associated with the prevention of cardiovascular and metabolic diseases, colorectal cancers and many other diseases. Such beneficial effects of the Mediterranean diet might be attributed to high proportion of fibers, mono- and poly-unsaturated fatty acids, antioxidants and polyphenols. Concurrent literature has demonstrated beneficial modulation of the gut microbiome following a Mediterranean-style diet in humans as well as in experimental animal models such as rodents. We recently demonstrated similar positive changes in the gut microbiome of non-human primates consuming a Mediterranean-style diet for long term (30 months). Therefore, it is rational to speculate that this positive modulation of the gut microbiome diversity, composition and function is one of the main factors intermediating the health effects of Mediterranean diet on the host. The present perspective discusses the evidences that the Mediterranean diet induces gut microbiome modulation in rodents, non-human primates and human subjects, and discusses the potential role of gut microbiota and microbial metabolites as one of the fundamental catalysts intermediating various beneficial health effects of Mediterranean diet on the host.

Effect of Adherence to Mediterranean Diet during Pregnancy on Children's Health: A Systematic Review

The traditional Mediterranean diet has been shown to be a healthy eating pattern that protects against the development of many diseases in adults and children. Pregnancy is a critical period of plasticity during which foetal development may be significantly influenced by different environmental factors, including maternal nutrition. In this context, several studies have examined the potential benefits of adherence to a Mediterranean diet during pregnancy on birth outcomes, considering the Mediterranean diet as a whole rather than focusing on the effect of its individual components. In this review, we systematically summarized and discussed results of studies investigating the protective role of Mediterranean diet against foetal growth, prematurity, neural tube defects and other congenital pathologies, asthma and allergy, body weight and metabolic markers. Although current data are insufficient and randomized control trials are needed, growing evidence suggests the beneficial effect of the Mediterranean diet during pregnancy on children's health. In this sense, strategies aiming to promote adherence to this dietary pattern might be of considerable importance to public health.

Dietary fats, olive oil and respiratory diseases in Italian adults: A population-based study

BACKGROUND

Fat intake has been associated with respiratory diseases, with conflicting results.

OBJECTIVE

We studied the association between asthma and rhinitis with dietary fats, and their food sources in an Italian population.

METHODS

Clinical and nutritional information was collected for 871 subjects (aged 20-84) from the population-based multi-case-control study Genes Environment Interaction in Respiratory Diseases (GEIRD): 145 with current asthma (CA), 77 with past asthma (PA), 305 with rhinitis and 344 controls. Food intake was collected using the EPIC (European Investigation into Cancer and Nutrition) Food Frequency Questionnaire. The associations between fats and respiratory diseases were estimated by multinomial models. Fats and their dietary sources were analysed both as continuous variables and as quartiles.

RESULTS

Monounsaturated fatty acids and oleic acid were associated with a reduced risk of CA in both continuous (RRR = 0.68, 95%CI: 0.48; 0.96; RRR = 0.69; 95%CI: 0.49; 0.97, per 10 g, respectively) and per-quartile analyses (p for trend = 0.028 and 0.024, respectively). Olive oil was associated with a decreased risk of CA (RRR = 0.80; 95%CI: 0.65; 0.98 per 10 g). An increased risk of rhinitis was associated with moderate total fat and SFA intake.

CONCLUSIONS

High dietary intakes of oleic acid and of olive oil are associated with a lower risk of asthma but not of rhinitis.

Pregnant women's use and attitude toward herbal, vitamin, and mineral supplements in an academic tertiary care center, Riyadh, Saudi Arabia

BACKGROUND

Herbal medicine has been widely utilized by pregnant women despite the limited available evidence regarding the safety and efficacy of that practice. The current available studies, from different countries, estimated that the use of herbal medicine during pregnancy range from 7% up to 96%. The aim of this study is to determine the prevalence, attitude, source of information, and reasoning behind the use of herbal medicine among pregnant women in Saudia Arabia.

METHODS

A cross-sectional study conducted using a convenience sample including pregnant women who visited the obstetric clinics at King Abdulaziz Medical City in Riyadh, Saudi Arabia. A survey was administered in order to evaluate the prevalence and perception toward herbal medicine use among pregnant women in Saudi Arabia.

RESULTS

A total of 297 pregnant women completed the survey. The results showed that 56% of the respondents have used some type of herbal medicine during their pregnancy. Olive oil was utilized in 26% of the respondents followed by cumin 20% and garlic 15%. In addition, 37% of the respondents used herbal medicine by their own initiative, while 33% and 12% used herbal medicine based on recommendations from their families and friends, respectively. Furthermore, 19% of the respondents reported a positive attitude toward herbal medicine use during pregnancy. In addition, the percentage of women with positive attitude was marginally higher among respondents with lower educational level.

CONCLUSION

The prevalence of using herbal medicine is considerably high among pregnant women in Saudi Arabia. Unfortunately, the majority of the users relied on informal sources to use herbal medicine during pregnancy.

Food consumption and the risk of childhood allergy

Background

The prevalence of allergic conditions is increasing in most countries. One possible explanation may be childhood nutrition.

Objective

The aim of the study was to investigate the relationship between consumption of pre-specified types of food in school-aged children and presence of respiratory and allergic symptoms.

Methods

A total of 191 students aged 9-11 years were recruited from 5 schools to geographically cover all of Malta. Data was collected between October 2011 and February 2012. This was part of a bigger study which included clinical and environmental tests besides standardized health questionnaires. For the purposes of this part of the study only the health questionnaires were used. These standardized health questionnaires based on the International Study of Asthma and Allergies in Childhood (ISAAC) were used to identify the presence of respiratory and allergic symptoms and to identify the types of foods and the frequency of consumption of various types of foods.

Results

We found that milk, meat, butter, olive oil, and yoghurt consumption had a negative association with allergic symptoms in children, whilst fish consumption had a detrimental effect. These relationships remained significant after correction for paternal level of education.

Conclusion

The study highlights the fact that nutrition in early childhood may have a significant effect on the risk of allergic conditions. Our results, taken together with data in the literature, suggest that different types of fish might have had different effects. This is probably related to their different fatty acid constitution thus warranting further studies.

Prenatal Diet and the Development of Childhood Allergic Diseases: Food for Thought

PURPOSE OF REVIEW

The development of allergic disease is shaped by genetics and the environment, including diet. Many studies suggest a role for maternal diet during pregnancy. In this article, we discuss potential mechanisms by which specific nutrients, particular foods, and dietary patterns may influence allergic disease development and review studies examining the relationship between prenatal diet and the risk of childhood allergy.

RECENT FINDINGS

The combination of in utero exposures and genetic predisposition may contribute to the development of allergic disease by altering immune and organ development. Inflammation predominates in the first and third trimesters whereas the second trimester is characterized by anti-inflammatory and Th2 immune responses. Maternal dietary exposures during pregnancy may interact with inherited genetic risk factors influence immune system development. There are varied results regarding the impact of maternal prenatal diet on the development of childhood allergies. Well-designed randomized controlled studies are needed to clarify this area.

As You Eat It: Effects of Prenatal Nutrition on Asthma

Asthma most frequently develops early in life, and increased recognition of the role of lifestyle and environmental factors in asthma susceptibility raises the possibility that dietary exposures during pregnancy may influence the risk of asthma in offspring. This review discusses the latest evidence with regard to the effect of diet during pregnancy on childhood asthma risk, including potential mechanisms, outcomes of randomized clinical trials, and results from observational studies. Vitamin D and polyunsaturated fatty acid intake during pregnancy are highlighted as areas with large and growing bodies of literature to support a potential role in prenatal modulation of subsequent asthma risk. Several other nutritional interventions are under active investigation, and recommendations regarding dietary modifications during pregnancy will likely need to be personalized based on factors such as maternal smoking and genetic variants. Although nutrition during pregnancy is uniquely challenging to investigate, and definitive recommendations cannot be made without additional high-quality evidence and knowledge regarding long-term effects of interventions, the modifiable nature of the diet and sizeable potential reduction of morbidity supports ongoing research to determine how to optimize nutrition during pregnancy to prevent asthma in offspring.

Influence of the Mediterranean diet during pregnancy in the development of wheezing and eczema in infants in Pamplona, Spain

BACKGROUND

This study examined the relationship between different food groups and the adherence to a Mediterranean diet during pregnancy and the risk of wheezing and eczema in children aged 12-15 months.

METHODS

The study involves 1087 Spanish infants from the International Study of Wheezing in Infants (Estudio Internacional de Sibilancias en Lactantes, EISL). The study of the association of the different food consumption and Mediterranean diet with wheezing, recurrent wheezing and eczema was performed using different models of unconditional logistic regression to obtain adjusted prevalence odds ratios (OR) and 95% confidence intervals (95% CI).

RESULTS

No association was found between a good adherence to the Mediterranean diet during pregnancy and the development of wheezing (p=0.372), recurrent wheezing (p=0.118) and eczema (p=0.315). The consumption once or twice a week of white fish (OR: 1.95[1.01-3.75]), cooked potatoes (OR: 1.75[1.22-2.51]) and industrial pastry (OR: 1.59[1.13-2.24]), and the consumption more than three times a week of industrial pastry (OR: 1.47 [1.01-2.13]) during pregnancy increases the risk of "wheezing" at 12 months. Instead, high fruit consumption during the pregnancy has a protective effect against "wheezing" in 12-month-old infants (OR: 0.44 [0.20-0.99]). No statistically significant differences were observed between food intake during pregnancy and "recurrent wheezing". No statistically significant differences were observed between the consumption of any food during pregnancy and the presence of eczema at 12 months.

CONCLUSIONS

The present study showed that the consumption of Mediterranean diet during pregnancy did not have a protective effect for wheezing, recurrent wheezing or eczema.

Early-life nutritional exposures and lifelong health: immediate and long-lasting impacts of probiotics, vitamin D, and breastfeeding

Pregnancy and infancy comprise the most critical stages for conditioning an individual's health, with a number of implications for subsequent risks of morbidity, mortality, and reproductive health. Nutrition may influence both the overall pregnancy outcome and the growth trajectory and immune system of the fetus and infant, with short- and long-term effects on the health of the offspring. Within this context, leading experts at Expo Milano 2015 in Milan, Italy, discussed up-to-date knowledge while providing suggestions and challenges before, during, and after pregnancy. This narrative review summarizes the key issues raised by the experts concerning the interplay between the nutritional environment from conception to early infancy and the offspring's immediate and lifelong health, with a particular focus on epigenetic mechanisms, probiotics, vitamin D, and breastfeeding. Taken together, the findings strengthen the awareness that nutritional exposures occurring from preconception to the postnatal period may be strong determinants of the offspring's health and may provide supportive evidence for current nutritional recommendations and guidelines for pregnant women and infants. Critical topics to be addressed in future research and translated into recommendations of public health relevance are also highlighted.

Dietary patterns and the risk of obesity, type 2 diabetes mellitus, cardiovascular diseases, asthma, and neurodegenerative diseases

Diet and lifestyle play a significant role in the development chronic diseases; however the full complexity of this relationship is not yet understood. Dietary pattern investigation, which reflects the complexity of dietary intake, has emerged as an alternative and complementary approach for examining the association between diet and chronic diseases. Literature on this association has largely focused on individual nutrients, with conflicting outcomes, but individuals consume a combination of foods from many groups that form dietary patterns. Our objective was to systematically review the current findings on the effects of dietary patterns on chronic diseases. In this review, we describe and discuss the relationships between dietary patterns, such as the Mediterranean, the Dietary Approach to Stop Hypertension, Prudent, Seventh-day Adventists, and Western, with risk of obesity, type-2 diabetes mellitus, cardiovascular diseases, asthma, and neurodegenearive diseases. Evidence is increasing from both observational and clinical studies that plant-based dietary patterns, which are rich in fruits, vegetables, and whole grains, are valuable in preventing various chronic diseases, whereas a diet high in red and processed meat, refined grains and added sugar seems to increase said risk. Dietary pattern analysis might be especially valuable to the development and evaluation of food-based dietary guidelines.

Prevalence and risk factors for wheezing and allergic diseases in preschool children: A perspective from the Mediterranean coast of Turkey

OBJECTIVES

The aim of the present study was to determine the prevalence and risk factors of allergic diseases in preschool children from one of the biggest cities in the Mediterranean Region of Turkey.

METHODS

The study population included 396 preschool children attending to urban daycare centres in Mersin. In the first stage, a comprehensive standardised questionnaire modified from the International Study of Asthma and Allergies in Childhood (ISAAC) was employed. In the second stage, serum food and inhalant specific IgE, and skin tests were performed in 45 children with frequent wheezing and 28 children with no wheezing.

RESULTS

The prevalence of ever wheezing, current wheezing, physician-diagnosed asthma, allergic rhinitis and eczema were 53% (210), 33.3% (132), 27.3% (108), 13.4% (53) and 8.3% (33), respectively. A family history of atopy (OR=2.5, 95% CI: 1.3-4.7, p=0.004), dampness at home (OR=2.4, 95% CI: 1.2-4.8, p=0.008), a history of intestinal parasites (OR=4.3, 95% CI: 1.7-10.9, p=0.002), previous history of pneumonia (OR=6.9, 95% CI: 1.9-25.9, p=0.004), initiation of complementary foods before the age of three months (OR=6.1, 95%CI: 1.4-26.9, p=0.02) and presence of food allergy (OR=3.1, 95% CI: 1.1-9.2, p=0.03) were found to be significant risk factors for physician-diagnosed asthma. The risk factors for frequent wheezing were maternal smoking during pregnancy (OR=5.2, 95% CI: 0.9-28.7, p=0.05) and high serum IgE levels (OR=2.9, 95% CI: 0.9-9.0, p=0.05) at borderline significance.

CONCLUSION

Our study was the first epidemiological study in preschool children in the Mediterranean region of Turkey and demonstrated a high prevalence of asthma and allergic diseases, probably related to humid climatic properties in addition to other environmental and genetic factors.

Maternal dietary intake in pregnancy and lactation and allergic disease outcomes in offspring

As the prevalence of allergic disease dramatically rises worldwide, prevention strategies are increasingly being considered. Given the potential modulatory effect of nutritional factors on disease, altering maternal diet during pregnancy and/or lactation has been considered in preventing allergic disease in offspring. Although there are a number of observational studies that have examined possible associations between maternal diet and allergic outcomes in offspring, interventional trials are limited. Furthermore, there is a paucity of studies that have prospectively studied maternal dietary intake as well as measuring maternal and infant biologic samples (blood, urine, breast milk) and their relation to allergic outcomes in infants. There is also a particular need to define terminology such as 'fruit and vegetables intake', 'healthy diet', and 'diet diversity' in order to make studies comparable. In this review, we discuss current evidence of maternal dietary factors during pregnancy and/or lactation that may play a role in the offspring developing allergic disease, including factors such as overall dietary intake patterns, specific whole food consumption (fish, fruit and vegetables, and common allergic foods), and individual immunomodulatory nutrient intakes. Additionally, we discuss the limitations of previous studies and propose improvements to study design for future investigation.

What Are the Effects of a Mediterranean Diet on Allergies and Asthma in Children?

This review updates the relationship between the adherence to Mediterranean diet (MedDiet) assessed by questionnaire and asthma, allergic rhinitis, or atopic eczema in childhood. It deals with the effect of MedDiet in children on asthma/wheeze, allergic rhinitis, and atopic dermatitis/eczema, and also with the effect of MedDiet consumption by the mother during pregnancy on the inception of asthma/wheeze and allergic diseases in the offspring. Adherence to MedDiet by children themselves seems to have a protective effect on asthma/wheezing symptoms after adjustment for confounders, although the effect is doubtful on lung function and bronchial hyperresponsiveness. By contrast, the vast majority of the studies showed no significant effect of MedDiet on preventing atopic eczema, rhinitis, or atopy. Finally, studies on adherence to MedDiet by the mother during pregnancy showed some protective effect on asthma/wheeze symptoms in the offspring only during the first year of life, but not afterward. Very few studies have shown a protective effect on wheezing, current sneeze, and atopy, and none on eczema. Randomized control trials on the effect of the adherence to MedDiet to prevent (by maternal consumption during pregnancy) or improve (by child consumption) the clinical control of asthma/wheezing, allergic rhinitis, or atopic dermatitis are needed.

Factors associated to recurrent wheezing in infants under one year of age in the province of Salamanca, Spain: Is intervention possible? A predictive model

OBJECTIVES

Wheezing is a very common problem in infants in the first months of life. The objective of this study is to identify risk factors that may be acted upon in order to modify the evolution of recurrent wheezing in the first months of life, and to develop a model based on certain factors associated to recurrent wheezing in nursing infants capable of predicting the probability of developing recurrent wheezing in the first year of life.

METHODS

The sample was drawn from a cross-sectional, multicentre, descriptive epidemiological study based on the general population. A total of 1164 children were studied, corresponding to a questionnaire response rate of 71%. The questionnaire of the Estudio Internacional de Sibilancias en Lactantes (EISL) was used. Multiple logistic regression analysis was used to estimate the probability of developing recurrent wheezing and to quantify the contribution of each individual variable in the presence of the rest.

RESULTS

Infants presenting eczema and attending nursery school, with a mother who has asthma, smoked during the third trimester of pregnancy, and did not consume a Mediterranean diet during pregnancy were found to have a probability of 79.7% of developing recurrent wheezing in the first year of life. In contrast, infants with none of these factors were seen to have a probability of only 4.1% of developing recurrent wheezing in the first year of life. These results in turn varied according to modifications in the risk or protective factors.

CONCLUSIONS

The mathematical model estimated the probability of developing recurrent wheezing in infants under one year of age in the province of Salamanca (Spain), according to the risk or protective factors associated to recurrent wheezing to which the infants are or have been exposed.

Effect of foods and Mediterranean diet during pregnancy and first years of life on wheezing, rhinitis and dermatitis in preschoolers

BACKGROUND

There is a conflictive position if some foods and Mediterranean diet (MedDiet) consumed by the mother during pregnancy and by the child during the first years of life can be protective for current wheezing, rhinitis and dermatitis at preschool age.

METHODS

Questionnaires of epidemiological factors and food intake by the mother during pregnancy and later by the child were filled in by parents in two surveys at two different time points (1.5 yrs and 4 yrs of life) in 1000 preschoolers.

RESULTS

The prevalences of current wheezing, rhinitis and dermatitis were 18.8%, 10.4%, and 17.2%, respectively. After multiple logistic analysis children who were low fruit consumers (never/occasionally) and high fast-food consumers (≥3 times/week) had a higher risk for current wheezing; while intermediate consumption of meat (1 or 2 times/week) and low of pasta by mothers in pregnancy were protected. For current rhinitis, low fruit consumer children were at higher risk; while those consuming meat <3 times/week were protected. For current dermatitis, high fast food consumption by mothers in pregnancy; and low or high consumption of fruit, and high of potatoes in children were associated to higher prevalence. Children consuming fast food >1 times/week were protected for dermatitis. MedDiet adherence by mother and child did not remain a protective factor for any outcome.

CONCLUSION

Low consumption of fruits and high of meat by the child, and high consumption of potatoes and pasta by the mother had a negative effect on wheezing, rhinitis or dermatitis; while fast food consumption was inconsistent.

Maternal Dietary Patterns and Pregnancy Outcome

Maternal nutritional status during pregnancy will affect the outcomes for the mother and the baby. Many analyses of the relationship between diet and outcome are often based on a single or a few food items or nutrients. However, foods are not consumed in isolation and dietary patterns can be used to assess the whole diet consumed. The use of dietary pattern analysis to understand nutritional intake and pregnancy outcome is becoming more and more popular. Many published studies have showed the association between maternal dietary patterns and pregnancy outcome. This review examined articles about the relationship between maternal dietary patterns and pregnancy outcome. As a modifiable factor, dietary patterns may be more applicable to clinical and pregnant health interventions.

Epigenetics: The New Frontier in the Landscape of Asthma

Over the years, on a global scale, asthma has continued to remain one of the leading causes of morbidity, irrespective of age, sex, or social bearings. This is despite the prevalence of varied therapeutic options to counter the pathogenesis of asthma. Asthma, as a disease per se, is a very complex one. Scientists all over the world have been trying to obtain a lucid understanding of the machinations behind asthma. This has led to many theories and conjectures. However, none of the scientific disciplines have been able to provide the missing links in the chain of asthma pathogenesis. This was until epigenetics stepped into the picture. Though epigenetic research in asthma is in its nascent stages, it has led to very exciting results, especially with regard to explaining the massive influence of environment on development of asthma and its varied phenotypes. However, there remains a lot of work to be done, especially with regard to understanding how the interactions between immune system, epigenome, and environment lead to asthma. But introduction of epigenetics has infused a fresh lease of life in research into asthma and the mood among the scientific community is that of cautious optimism.

Maternal nutrition during pregnancy and risk of asthma, wheeze, and atopic diseases during childhood: a systematic review and meta-analysis

BACKGROUND

Epidemiologic studies suggest a relationship between maternal nutrition during pregnancy and the occurrence of asthma and atopic conditions during childhood. However, individual study results are conflicting. The objective of this meta-analysis was to critically examine the current evidence for an association between nutrition (dietary patterns, food groups, vitamins, or oligo-elements) ingestion during pregnancy and asthma, wheeze, or atopic conditions in childhood.

METHODS

The inclusion criteria were as follows: (i) systematic recording of diet during the gestational period and (ii) documentation of asthma, wheezing, eczema, or other atopic disease in the offspring. The primary outcomes were prevalence of asthma or wheeze among the offspring during childhood; and secondary outcomes were prevalence of eczema, allergic rhinitis, or other atopic conditions.

RESULTS

We found 120 titles, abstracts, and citations, and 32 studies (29 cohorts) were included in this analysis. Data on vitamins, oligo-elements, food groups, and dietary patterns during pregnancy were collected. A meta-analysis revealed that higher maternal intake of vitamin D [odds ratio (OR) = 0.58, 95% confidence interval (CI) = 0.38-0.88], vitamin E (OR = 0.6, 95% CI = 0.46-0.78), and zinc (OR = 0.62, 95% CI = 0.40-0.97) was associated with lower odds of wheeze during childhood. However, none of these or other nutrients was consistently associated with asthma per se or other atopic conditions.

CONCLUSIONS

Current evidence suggests a protective effect of maternal intake of each of three vitamins or nutrients (vitamin D, vitamin E, and zinc) against childhood wheeze but is inconclusive for an effect on asthma or other atopic conditions.

Dietary pattern and asthma: a systematic review and meta-analysis

Background

The literature on the relationship between diet and asthma has largely focused on individual nutrients, with conflicting results. People consume a combination of foods from various groups that form a dietary pattern. Studying the role of dietary patterns in asthma is an emerging area of research. The purpose of this study was to systematically review dietary patterns and asthma outcomes in adults and children, to review maternal diet and child asthma, and to conduct a meta-analysis on the association between asthma prevalence and dietary patterns in adults.

Methods

We searched Medline, Scopus, and ISI Web of Knowledge up to January 2014. Two researchers independently reviewed studies meeting the inclusion criteria using the American Dietetic Association quality criteria. A linear mixed model was used to derive the pooled effect size (95% confidence interval) for each of three dietary pattern categories (healthy, unhealthy, and neutral).

Results

Thirty-one studies were identified (16 cross-sectional, one case-control, 13 cohort, and one randomized controlled trial), including 12 in adults, 13 in children, five in pregnant woman–child pairs, and one in both children and pregnant woman–child pairs. Six of the 12 adult studies reported significant associations between dietary patterns and asthma outcomes (eg, ever asthma and forced expiratory volume in one second). Seven of ten studies examining the Mediterranean diet showed protective effects on child asthma and/or wheeze. Four of the six studies in mother-child pairs showed that maternal dietary patterns during pregnancy were not associated with child asthma or wheeze. The meta-analysis including six adult studies, the primary outcome of which was the prevalence of current or ever asthma, showed no association with healthy, unhealthy, or neutral dietary patterns.

Conclusion

The evidence suggests no association of dietary patterns with asthma prevalence in adults or of maternal diet with child asthma or wheeze. The Mediterranean diet in children may prevent asthma or wheeze, but randomized controlled trials are lacking.

Mediterranean diet and health: food effects on gut microbiota and disease control

The Mediterranean diet (MD) is considered one of the healthiest dietary models. Many of the characteristic components of the MD have functional features with positive effects on health and wellness. The MD adherence, calculated through various computational scores, can lead to a reduction of the incidence of major diseases (e.g., cancers, metabolic and cardiovascular syndromes, neurodegenerative diseases, type 2 diabetes and allergy). Furthermore, eating habits are the main significant determinants of the microbial multiplicity of the gut, and dietary components influence both microbial populations and their metabolic activities from the early stages of life. For this purpose, we present a study proposal relying on the generation of individual gut microbiota maps from MD-aware children/adolescents. The maps, based on meta-omics approaches, may be considered as new tools, acting as a systems biology-based proof of evidence to evaluate MD effects on gut microbiota homeostasis. Data integration of food metabotypes and gut microbiota “enterotypes” may allow one to interpret MD adherence and its effects on health in a new way, employable for the design of targeted diets and nutraceutical interventions in childcare and clinical management of food-related diseases, whose onset has been significantly shifted early in life.

Does maternal diet during pregnancy and lactation affect outcomes in offspring? A systematic review of food-based approaches

OBJECTIVES

The aim of this study was to investigate the relationship between maternal diet during pregnancy and lactation and development of atopic disorders in childhood.

METHODS

We included studies published up to August 2011 that assessed food-based maternal dietary interventions or that examined associations between maternal dietary intake during pregnancy and/or lactation and allergic outcomes (eczema, asthma, hay fever, and sensitization) in their children.

RESULTS

We included 42 studies (>40 000 children): 11 intervention studies (including 7 randomized control trials), 26 prospective cohort studies, 4 retrospective cohort studies, and 1 case-control study. In the randomized control trials, no significant difference was noted overall in the prevalence of eczema and asthma in the offspring of women on diets free from common food allergens during pregnancy. The prospective cohorts investigated a large number of potential associations, but reported few significant associations between maternal dietary intake and development of allergy. Maternal diets rich in fruits and vegetables, fish, and foods containing vitamin D and Mediterranean dietary patterns were among the few consistent associations with lower risk for allergic disease in their children. Foods associated with higher risk included vegetable oils and margarine, nuts, and fast food.

CONCLUSION

This review did not find widespread or consistent links between mothers' dietary intake and atopic outcomes in their children. However, maternal consumption of Mediterranean dietary patterns, diets rich in fruits and vegetables, fish, and vitamin D-containing foods were suggestive of benefit, requiring further evaluation.

Preterm birth and childhood wheezing disorders: a systematic review and meta-analysis

BACKGROUND

Accumulating evidence implicates early life factors in the aetiology of non-communicable diseases, including asthma/wheezing disorders. We undertook a systematic review investigating risks of asthma/wheezing disorders in children born preterm, including the increasing numbers who, as a result of advances in neonatal care, now survive very preterm birth.

METHODS AND FINDINGS

Two reviewers independently searched seven online databases for contemporaneous (1 January 1995-23 September 2013) epidemiological studies investigating the association between preterm birth and asthma/wheezing disorders. Additional studies were identified through reference and citation searches, and contacting international experts. Quality appraisal was undertaken using the Effective Public Health Practice Project instrument. We pooled unadjusted and adjusted effect estimates using random-effects meta-analysis, investigated "dose-response" associations, and undertook subgroup, sensitivity, and meta-regression analyses to assess the robustness of associations. We identified 42 eligible studies from six continents. Twelve were excluded for population overlap, leaving 30 unique studies involving 1,543,639 children. Preterm birth was associated with an increased risk of wheezing disorders in unadjusted (13.7% versus 8.3%; odds ratio [OR] 1.71, 95% CI 1.57-1.87; 26 studies including 1,500,916 children) and adjusted analyses (OR 1.46, 95% CI 1.29-1.65; 17 studies including 874,710 children). The risk was particularly high among children born very preterm (<32 wk gestation; unadjusted: OR 3.00, 95% CI 2.61-3.44; adjusted: OR 2.81, 95% CI 2.55-3.12). Findings were most pronounced for studies with low risk of bias and were consistent across sensitivity analyses. The estimated population-attributable risk of preterm birth for childhood wheezing disorders was ≥3.1%. Key limitations related to the paucity of data from low- and middle-income countries, and risk of residual confounding.

CONCLUSIONS

There is compelling evidence that preterm birth-particularly very preterm birth-increases the risk of asthma. Given the projected global increases in children surviving preterm births, research now needs to focus on understanding underlying mechanisms, and then to translate these insights into the development of preventive interventions.

REVIEW REGISTRATION

PROSPERO CRD42013004965.

Influence of Mediterranean diet on asthma in children: a systematic review and meta-analysis

BACKGROUND

There is epidemiological evidence that Mediterranean diet exposure is associated with lower asthma prevalence in children. We aimed to summarize the available data and to know whether the Mediterranean setting modifies this association.

METHODS

The literature search, up to May 2012, was on epidemiological studies in the general population of children assessing whether adherence to Mediterranean diet (measured as a score) was associated with the prevalence of 'current wheeze'; 'current severe wheeze'; or 'asthma ever'. Odds ratios (OR) of the eight included studies compared the highest tertile of the score with the lowest. Random-effects meta-analyses for the whole group of studies and stratified by Mediterranean setting (centers <100 Km from the Mediterranean coast) were performed. Differences between strata were assessed using the Q test.

RESULTS

For 'current wheeze', there was a negative significant association with the highest tertile of Mediterranean diet score (OR 0.85, 95% CI 0.75-0.98; p = 0.02), driven by Mediterranean centers (0.79, 0.66-0.94, p = 0.009), although the difference with the non-Mediterranean centers (0.91, 0.78-1.05, p = 0.18) was not significant. The results for 'current severe wheeze' were as follows: 0.82, 0.55-1.22, p = 0.330 (all); 0.66, 0.48-0.90, p = 0.008 (Mediterranean); and 0.99, 0.79-1.25, p = 0.95 (non-Mediterranean); with the difference between regions being significant. For 'asthma ever', the associations were as follows: 0.86, 0.78-0.95, p = 0.004 (all); 0.86, 0.74-1.01, p = 0.06 (Mediterranean); 0.86, 0.75-0.98; p = 0.027 (non-Mediterranean); with the difference between regions being negligible.

CONCLUSIONS

Adherence to the Mediterranean diet tended to be associated with lower occurrence of the three respiratory outcomes. For current and current severe wheeze, the association was mainly driven by the results in Mediterranean populations.

International consensus on (ICON) pediatric asthma

Asthma is the most common chronic lower respiratory disease in childhood throughout the world. Several guidelines and/or consensus documents are available to support medical decisions on pediatric asthma. Although there is no doubt that the use of common systematic approaches for management can considerably improve outcomes, dissemination and implementation of these are still major challenges. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), recently formed by the EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus on (ICON) Pediatric Asthma. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences, thus providing a concise reference. The principles of pediatric asthma management are generally accepted. Overall, the treatment goal is disease control. To achieve this, patients and their parents should be educated to optimally manage the disease, in collaboration with healthcare professionals. Identification and avoidance of triggers is also of significant importance. Assessment and monitoring should be performed regularly to re-evaluate and fine-tune treatment. Pharmacotherapy is the cornerstone of treatment. The optimal use of medication can, in most cases, help patients control symptoms and reduce the risk for future morbidity. The management of exacerbations is a major consideration, independent of chronic treatment. There is a trend toward considering phenotype-specific treatment choices; however, this goal has not yet been achieved.

Early life exposures: impact on asthma and allergic disease

PURPOSE OF REVIEW

To identify and discuss recent studies relating prenatal and early-life environmental exposures to the development of asthma and allergic disease.

RECENT FINDINGS

New studies show that prenatal and early-life stress can alter infant immune profiles, increasing risk for asthma and allergy. Mounting evidence implicates indoor and outdoor air pollution in the origins of allergic disease, while Vitamin D intake and a Mediterranean diet may be protective. The role of early-life fever and infection remain controversial, with recent studies yielding conflicting results and new evidence indicating that previous studies may have been confounded. New studies are increasingly focused on environmental 'imprinting' of the infant gut microbiota, which is a critical determinant of immune system development. Early exposures impacting the intestinal microbiota include mode of delivery, infant diet, and use of antibiotics - factors that are also associated with childhood asthma and allergic disease.

SUMMARY

This overview highlights environmental exposures during the in-utero and ex-utero time periods that are potential stimuli for the early programming of asthma and allergy. Special consideration is given for the potential role of intestinal microbiota. Future studies in this field promise to inform health policy and intervention strategies for the prevention of asthma and allergic disease.

The effect of perinatal omega-3 fatty acid supplementation on inflammatory markers and allergic diseases: a systematic review

BACKGROUND

Maternal supplementation with omega-3 polyunsaturated fatty acids (n-3 PUFA) may modulate immune responses and allergy in neonates and children.

OBJECTIVE

To determine if n-3 PUFA supplementation during pregnancy and lactation reduces risk for childhood allergic disease.

SEARCH STRATEGY

We searched Medline and all evidence-based medicine reviews for randomised controlled trials comparing the effects of n-3 PUFA and placebo supplementation during pregnancy and/or lactation on childhood allergic diseases and inflammatory cytokines.

SELECTION CRITERIA

We included studies reporting on food allergy, response to the egg skin prick test (SPT), atopy and asthma in infancy and childhood as well as production of interleukin-13 and interferon-gamma, two cytokines involved in the pathogenesis of asthma. For assessment of inclusion, two authors reviewed all abstracts for suitability and independently extracted data.

DATA COLLECTION AND ANALYSIS

Two-by-two tables were constructed and odds ratios (OR) were calculated for the outcomes: response to the SPT, food allergy, atopy and asthma in childhood. The assays differed so data on inflammatory markers were reported in narrative form.

MAIN RESULTS

Five randomised controlled trials (n = 949) were included. n-3 PUFA supplementation during pregnancy reduced 12-month prevalence of positive egg SPT (two trials, 12/87 versus 32/100, OR 0.33, 95% CI 0.16, 0.70) and childhood asthma (two trials, 10/303 versus 17/179, OR 0.349, 95% CI 0.154, 0.788) and significantly reduced cord blood interleukin-13 levels. Supplementation during lactation did not prevent asthma, food allergy or atopy.

CONCLUSION

n-3 PUFA supplementation during pregnancy decreases childhood asthma and response to SPT.

The influence of environment, as represented by diet and air pollution, upon incidence and prevalence of wheezing illnesses in young children

PURPOSE OF REVIEW

The purpose of this review is to consider the collective influence of factors affecting recurrent wheezing in young children.

RECENT FINDINGS

Specific allergen sensitization, upper respiratory infections, genetic polymorphisms and environmental factors have collectively been reported in the prevalence of and induction of recurrent wheezing in young children. Two examples of environmental factors are diet and exposure to air pollution, both of which are potentially modifiable. Recent investigations provide evidence that a 'Mediterranean diet' and a diet that emphasizes polyunsaturated fatty acids during pregnancy and early infancy, as well as breastfeeding, may be protective for wheezing, and that exposure to traffic-related pollution may be an independent factor in the incidence of wheezing in young children.

SUMMARY

Recent studies of early childhood wheezing demonstrate a potentially protective effect of diet and exposure to air pollution as a significant risk factor. An evaluation of collective factors influencing the presence of disease may help to broaden the clinical assessment and give parents and physicians the opportunity to potentially modify circumstances that promote the incidence of recurrent wheezing in infants and preschool aged children.

Adherence to the Mediterranean type of diet is associated with lower prevalence of asthma symptoms, among 10-12 years old children: the PANACEA study

Epidemiological studies have shown several associations between asthma symptoms and dietary factors. The aim of this work was to evaluate the relationship between adherence to the Mediterranean diet and childhood asthma. A cross-sectional analysis was performed on 700 children (323 boys), 10-12 yr old, selected from 18 schools located in Athens greater area. Children and their parents completed questionnaires, which evaluated, among others, dietary habits. Asthma was defined according to ISAAC II criteria. Adherence to the Mediterranean diet was evaluated using the KIDMED score (theoretical range 0-12). Higher KIDMED score corresponds to greater adherence to the Mediterranean diet. Greater adherence to the Mediterranean diet was inversely associated with ever had wheeze (p = 0.001), exercise wheeze (p = 0.004), ever had diagnosed asthma (p = 0.002) and with any asthma symptoms (p < 0.001). One-unit increase in the KIDMED score was associated with 14% lower likelihood of having asthma symptoms (odds ratio = 0.86, 95% confidence interval 0.75-0.98), after adjusting for various confounders. No significant associations were found between asthma symptoms and consumption of fruits (p = 0.25), vegetables (p = 0.97), legumes (p = 0.76), cereals (p = 0.71), dairy (p = 0.61), salty snacks (p = 0.53), or margarine/butter (p = 0.42) consumption, while increased fish and meat intake was associated with less asthma symptoms (p = 0.04 and p = 0.01, respectively). Our findings suggest an inverse relationship between level of adherence to the Mediterranean diet and prevalence of asthma in school-aged children.