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Musiol S, Harris CP, Karlina R, Gostner JM, Rathkolb B, Schnautz B, Schneider E, Mair L, Vergara EE, Flexeder C, Koletzko S, Bauer CP, Schikowski T, Berdel D, von Berg A, Herberth G, Rozman J, Hrabe de Angelis M, Standl M, Schmidt-Weber CB, Ussar S, Alessandrini F. Dietary digestible carbohydrates are associated with higher prevalence of asthma in humans and with aggravated lung allergic inflammation in mice. Allergy 2022; 78:1218-1233. [PMID: 36424672 DOI: 10.1111/all.15589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 10/07/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dietary carbohydrates and fats are intrinsically correlated within the habitual diet. We aimed to disentangle the associations of starch and sucrose from those of fat, in relation to allergic sensitization, asthma and rhinoconjuctivitis prevalence in humans, and to investigate underlying mechanisms using murine models. METHODS Epidemiological data from participants of two German birth cohorts (age 15) were used in logistic regression analyses testing cross-sectional associations of starch and sucrose (and their main dietary sources) with aeroallergen sensitization, asthma and rhinoconjunctivitis, adjusting for correlated fats (saturated, monounsaturated, omega-6 and omega-3 polyunsaturated) and other covariates. For mechanistic insights, murine models of aeroallergen-induced allergic airway inflammation (AAI) fed with a low-fat-high-sucrose or -high-starch versus a high-fat diet were used to characterize and quantify disease development. Metabolic and physiologic parameters were used to track outcomes of dietary interventions and cellular and molecular responses to monitor the development of AAI. Oxidative stress biomarkers were measured in murine sera or lung homogenates. RESULTS We demonstrate a direct association of dietary sucrose with asthma prevalence in males, while starch was associated with higher asthma prevalence in females. In mice, high-carbohydrate feeding, despite scant metabolic effects, aggravated AAI compared to high-fat in both sexes, as displayed by humoral response, mucus hypersecretion, lung inflammatory cell infiltration and TH 2-TH 17 profiles. Compared to high-fat, high-carbohydrate intake was associated with increased pulmonary oxidative stress, signals of metabolic switch to glycolysis and decreased systemic anti-oxidative capacity. CONCLUSION High consumption of digestible carbohydrates is associated with an increased prevalence of asthma in humans and aggravated lung allergic inflammation in mice, involving oxidative stress-related mechanisms.
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Affiliation(s)
- Stephanie Musiol
- Center of Allergy & Environment (ZAUM), Technical University of Munich (TUM) and Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Carla P Harris
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Dr. von Hauner Children's Hospital, University Hospital, LMU of Munich, Munich, Germany
| | - Ruth Karlina
- RG Adipocytes & Metabolism, Institute for Diabetes & Obesity, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Johanna M Gostner
- Institute of Medical Biochemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Rathkolb
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Benjamin Schnautz
- Center of Allergy & Environment (ZAUM), Technical University of Munich (TUM) and Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Evelyn Schneider
- Center of Allergy & Environment (ZAUM), Technical University of Munich (TUM) and Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Lisa Mair
- Institute of Medical Biochemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Ernesto Elorduy Vergara
- Institute of Lung Biology and Disease, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Center of Lung Research (DZL), Munich, Germany
| | - Claudia Flexeder
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Sibylle Koletzko
- Dr. von Hauner Children's Hospital, University Hospital, LMU of Munich, Munich, Germany.,Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
| | - Carl-Peter Bauer
- Department of Pediatrics, Technical University of Munich, Munich, Germany
| | - Tamara Schikowski
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Dietrich Berdel
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Andrea von Berg
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Gunda Herberth
- Department of Environmental Immunology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | - Jan Rozman
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Czech Centre for Phenogenomics, Institute of Molecular Genetics of the Czech Academy of Sciences, Průmyslová 595, 252 50 Vestec, Czech Republic
| | - Martin Hrabe de Angelis
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Chair of Experimental Genetics, TUM School of Life Sciences (SoLS), Technische Universität München, Freising, Germany
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Center of Lung Research (DZL), Munich, Germany
| | - Carsten B Schmidt-Weber
- Center of Allergy & Environment (ZAUM), Technical University of Munich (TUM) and Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,German Center of Lung Research (DZL), Munich, Germany
| | - Siegfried Ussar
- RG Adipocytes & Metabolism, Institute for Diabetes & Obesity, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany.,Department of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Francesca Alessandrini
- Center of Allergy & Environment (ZAUM), Technical University of Munich (TUM) and Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
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DeChristopher LR, Auerbach BJ, Tucker KL. High fructose corn syrup, excess-free-fructose, and risk of coronary heart disease among African Americans- the Jackson Heart Study. BMC Nutr 2020; 6:70. [PMID: 33292663 PMCID: PMC7722296 DOI: 10.1186/s40795-020-00396-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/31/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Researchers have sought to explain the black-white coronary heart disease (CHD) mortality disparity that increased from near parity to ~ 30% between 1980 and 2010. Contributing factors include cardiovascular disease prevention and treatment disparities attributable to disparities in insurance coverage. Recent research suggests that dietary/environmental factors may be contributors to the disparity. Unabsorbed/luminal fructose alters gut bacterial load, composition and diversity. There is evidence that such microbiome disruptions promote hypertension and atherosclerosis. The heart-gut axis may, in part, explain the black-white CHD disparity, as fructose malabsorption prevalence is higher among African Americans. Between 1980 and 2010, consumption of excess-free-fructose-the fructose type that triggers malabsorption-exceeded dosages associated with fructose malabsorption (~ 5 g-10 g), as extrapolated from food availability data before subjective, retroactively-applied loss adjustments. This occurred due to an industrial preference shift from sucrose to high-fructose-corn-syrup (HFCS) that began ~ 1980. During this period, HFCS became the main sweetener in US soda. Importantly, there has been more fructose in HFCS than thought, as the fructose-to-glucose ratio in popular sodas (1.9-to-1 and 1.5-to-1) has exceeded generally-recognized-as-safe levels (1.2-to-1). Most natural foods contain a ~ 1-to-1 ratio. In one recent study, ≥5 times/wk. consumers of HFCS sweetened soda/fruit drinks/and apple juice-high excess-free-fructose beverages-were more likely to have CHD, than seldom/never consumers. METHODS Jackson-Heart-Study data of African Americans was used to test the hypothesis that regular relative to low/infrequent intake of HFCS sweetened soda/fruit drinks increases CHD risk, but not orange juice-a low excess-free-fructose juice. Cox proportional hazards models were used to calculate hazard ratios using prospective data of 3407-3621 participants, aged 21-93 y (mean 55 y). RESULTS African Americans who consumed HFCS sweetend soda 5-6x/wk. or any combination of HFCS sweetened soda and/or fruit drinks ≥3 times/day had ~ 2 (HR 2.08, 95% CI 1.03-4.20, P = 0.041) and 2.5-3 times higher CHD risk (HR 2.98, 95% CI 1.15-7.76; P = 0.025), respectively, than never/seldom consumers, independent of confounders. There were no associations with diet-soda or 100% orange-juice, which has a similar glycemic profile as HFCS sweetened soda, but contains a ~ 1:1 fructose-to-glucose ratio. CONCLUSION The ubiquitous presence of HFCS in the food supply may pre-dispose African Americans to increased CHD risk.
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Affiliation(s)
- Luanne R. DeChristopher
- Independent Researcher, M.Sc. Biochemistry, Molecular Biology, P.O. Box 5542, Eugene, OR 97405 USA
| | | | - Katherine L. Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA USA
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DeChristopher LR, Tucker KL. Excess free fructose, apple juice, high fructose corn syrup and childhood asthma risk - the National Children's Study. Nutr J 2020; 19:60. [PMID: 32576181 PMCID: PMC7313206 DOI: 10.1186/s12937-020-00578-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recent research provides consistent evidence that the unexplained doubling of childhood asthma prevalence (1980-1995), its continued climb and 2013 plateau, may be associated with the proliferation of high-fructose-corn-syrup (HFCS) in the US food supply. The HFCS used in soft drinks has been shown to contain a higher fructose-to-glucose ratio than previously thought. This coincides with a preference shift from orange to apple juice among young children. Apple juice naturally contains a high (≥2:1) fructose-to-glucose ratio. Thus, children have received high excess-free-fructose doses, the fructose type associated with fructose malabsorption. Unabsorbed excess-free-fructose in the gut may react with dietary proteins to form immunogens that bind asthma mediating receptors, and/or alter the microbiota towards a profile linked to lung disorders. Studies with longitudinal childhood data are lacking. Therefore, we tested the hypothesis that excess-free-fructose intake is associated with childhood asthma risk. METHODS Cox regression models were used to analyze prospective early childhood data (12-30 months of age) from the National Children's Study. Intake frequencies for soda/sports/fruit drinks, and 100% juices were used for analyses. RESULTS Greater consumption of 100% juice, soda/sports/fruit drinks, and any combination, was associated with ~two (P = 0.001), ~ 2.5 (P = 0.001), and ~ 3.5 times (P < 0.0001) higher asthma incidence. CONCLUSIONS Given these results, prior research and case-study evidence, it is reasonable to suggest that the two-fold higher asthma risk associated with 100% juice consumption is due to apple juice's high fructose-to-glucose ratio, and that the ~ 2.5/~ 3.5 times higher risk associated with soda/sports/fruit drinks intake is with the excess-free-fructose in HFCS.
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Affiliation(s)
- Luanne R. DeChristopher
- Independent Researcher, M.Sc. Biochemistry, Molecular Biology, NY Medical College, Valhalla, NY USA
| | - Katherine L. Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA USA
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Sullivan K, Thakur N. Structural and Social Determinants of Health in Asthma in Developed Economies: a Scoping Review of Literature Published Between 2014 and 2019. Curr Allergy Asthma Rep 2020; 20:5. [PMID: 32030507 PMCID: PMC7005090 DOI: 10.1007/s11882-020-0899-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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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Affiliation(s)
- Kathryn Sullivan
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Neeta Thakur
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
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Villeneuve T, Guilleminault L. [Asthma and obesity in adults]. Rev Mal Respir 2019; 37:60-74. [PMID: 31866123 DOI: 10.1016/j.rmr.2019.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/06/2019] [Indexed: 12/31/2022]
Abstract
Asthma is a chronic inflammatory airway disorder characterized by a multitude of phenotypes. Epidemiological studies show an increase in asthma prevalence in obese patients regardless of age. The association of asthma and obesity is now considered as a phenotype with its own clinical, biological and functional characteristics. Regarding the pathophysiology of asthma and obesity, numerous factors such as nutrition, genetic predisposition, microbiome, ventilatory mechanics and the role of adipose tissue have been identified to explain the heterogeneous characteristics of patients with asthma and obesity. In adult patients with asthma and obesity, respiratory symptoms are particularly prominent and atopy and eosinophilic inflammation is uncommon compared to normal weight asthma patients. Obese asthma patients experience more hospitalizations and use more rescue medications than normal weight asthmatics. Management of asthma in obese patients is complex because these patients have less response to the usual anti-asthmatic treatments. Weight loss through caloric restriction combined with exercise is the main intervention to obtain improvement of asthma outcomes. Bariatric surgery is an invasive procedure with interesting results.
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Affiliation(s)
- T Villeneuve
- Pôles des voies respiratoires, hôpital Larrey, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France
| | - L Guilleminault
- Pôles des voies respiratoires, hôpital Larrey, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France; Centre de physiopathologie de Toulouse Purpan (CPTP-U1043, Inserm, équipe 12), UPS, Toulouse, France.
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Ibrahim AA, Qamar B, Fituri S, Akbar ZA, Al-Abdi T, Shi Z. Association between Soft Drink Consumption and Asthma among Qatari Adults. Nutrients 2019; 11:nu11030606. [PMID: 30871131 PMCID: PMC6471171 DOI: 10.3390/nu11030606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 01/19/2023] Open
Abstract
We aimed to examine the association between soft drink consumption and asthma and lung function among Qatari adults. In the cross-sectional study, we used data from 986 Qatari participants aged 20 years and above attending the Qatar Biobank Study. Usual consumption of soft drink was assessed using a food frequency questionnaire. Lung function was measured by spirometry and asthma was based on self-report. The associations between soft drink consumption and asthma and lung function were assessed using multivariable logistic and linear regression, respectively. In total, 65 participants out of 986 (6.6%) reported having asthma. A clear dose-response relationship between soft drink consumption and asthma was found. High soft drink consumers (≥7 times/week) were 2.60 (95% CI 1.20–5.63) times more likely to have asthma as compared to non-consumers. The association was partly mediated by BMI and inflammation. Diet soft drink consumption was positively associated with asthma (OR 1.12 (95% CI 1.02–1.23)) but not with lung function. Regular soft drink consumption was inversely associated with FEV1, but not with FVC. In conclusion, soft drink consumption is positively associated with asthma in Qatari adults. The association is partly mediated by obesity and inflammation. Limiting soft drink consumption should be taken into consideration for asthma prevention.
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Affiliation(s)
- Amna Al Ibrahim
- Human Nutrition Department, Qatar University, P.O. Box 2713 Doha, Qatar.
| | - Bushra Qamar
- Human Nutrition Department, Qatar University, P.O. Box 2713 Doha, Qatar.
| | - Sundus Fituri
- Human Nutrition Department, Qatar University, P.O. Box 2713 Doha, Qatar.
| | - Zoha Ali Akbar
- Human Nutrition Department, Qatar University, P.O. Box 2713 Doha, Qatar.
| | - Tamara Al-Abdi
- Human Nutrition Department, Qatar University, P.O. Box 2713 Doha, Qatar.
| | - Zumin Shi
- Human Nutrition Department, Qatar University, P.O. Box 2713 Doha, Qatar.
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Han YY, Forno E, Celedón JC. Health risk behaviors, violence exposure, and current asthma among adolescents in the United States. Pediatr Pulmonol 2019; 54:237-244. [PMID: 30614209 PMCID: PMC7032019 DOI: 10.1002/ppul.24236] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/27/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Asthma may worsen during adolescence, due to both health risk behaviors and psychosocial stressors commonly encountered during this life stage. METHODS Cross-sectional study of 24 612 high school students who participated in the 2009 and 2011 National Youth Risk Behavior Survey. Multivariable logistic regression was used to examine the relation between self-reported health risk behaviors or psychosocial stressors and current asthma. Mediation analysis was performed to assess whether depressive symptoms or suicidal behavior contribute to the link between psychosocial stressors and asthma. RESULTS Current asthma was reported by 13.1% of the study participants. In a multivariable analysis, female sex, obesity, shorter sleep duration, frequent soda/pop consumption, and marijuana use were each significantly associated with 14-36% increased odds of asthma. Any violent behavior (adjusted odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.02-1.24), any victimization (OR = 1.43, 95%CI = 1.29-1.58), any suicidal behavior (OR = 1.41, 95%CI = 1.22-1.64) and having felt sad or hopeless in the past year (OR = 1.57, 95%CI = 1.40-1.75) were each associated with current asthma. In a mediation analyses, having felt sad/hopeless and suicidal behaviors accounted for 21% and 14%, respectively, of the victimization-asthma association. CONCLUSION Potentially modifiable risk factors, including obesity, short sleep duration, frequent soda/pop consumption, and psychosocial stressors are associated with asthma in US adolescents. Promoting healthier lifestyles, as well as screening for violence exposure and treating depressive symptoms, could help reduce asthma burden in this population.
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Affiliation(s)
- Yueh-Ying Han
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
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