Dietary Intake and Asthma in Preschoolers: A Logistic Lasso Regression Analysis

Multivitamin consumption and childhood asthma: a cross-sectional study of the NHANES database

BACKGROUND

Dietary intakes of vitamins are associated with asthma. However, previous studies mainly explored the association between a single vitamin intake and asthma, which did not take the multivitamins into consideration. Herein, this study aims to explore the overall effect of dietary multivitamins consumption on childhood asthma.

METHODS

Data of children and adolescents (aged 2-17 years old) were extracted from the National Health and Nutrition Examination Survey (NHANES) database in 2015-2018 in this cross-sectional study. Weighted univariate logistic regression analysis was used to screen covariates. The association between multivitamins (including vitamin A, C, D, E, B1, B2, B6, B12, K, niacin, folic acid, and choline) and childhood asthma was explored using univariate and multivariate logistic regression analyses. The evaluation indexes were odds ratio (OR) and 95% confidence interval (CI). We further introduced the Bayesian kernel machine regression (BKMR) to assess the joint effect of the twelve vitamins on childhood asthma, the impact of an individual vitamin as part of a vitamin mixture, and the potential interactions among different vitamins.

RESULTS

Among 4,715 eligible children and adolescents, 487 (10.3%) had asthma. After adjusting for covariates including race, family history of asthma, pregnant smoking, BMI Z-score, energy intake, breast feeding, and low birth weight, we found that for each 1-unit increase in vitamin K consumption, the odds of childhood asthma decreased 0.99 (P=0.028). The overall effect analysis reported a trend of negative relationship between the multivitamins and childhood asthma, especially at the 75th percentile and over. According to the BKMR models, when other vitamins are fixed at the median level, the odds of childhood asthma increased along with the elevated vitamin D (VD) and vitamin B2 (VB2), whereas along with the depressed vitamin C (VC). In addition, no potential interaction has been found between every two vitamins of multivitamins on childhood asthma.

CONCLUSION

Among children and adolescents who have high-risk of asthma, it may be beneficial to increase dietary consumption of multivitamins. Our findings recommended that children and adolescents should increase the intake of VC-rich foods, whereas control the dietary consumption of VD and VB2 in daily life.

Association of body mass index with asthma occurrence and persistence in adolescents: A retrospective study of NHANES (2011-2018)

Objective

To investigate the association of body mass index (BMI) with asthma and analyze the risk factors of asthma persistence among overweight/obese adolescents and those with a high risk for obesity.

Methods

In this cross-sectional study, adolescents aged 11-17 years with complete general information and asthma diagnoses were selected from the National Health and Nutrition Examination Survey database. For adolescents without self-reported asthma, we performed matching according to age and sex at a case-to-control ratio of 1:3. Logistic regression analysis was employed to identify independent predictors of asthma occurrence followed by constructing a nomogram and comparing its efficacy to independent factors in predicting asthma occurrence. Besides, associations of BMI with asthma occurrence and persistence were evaluated. Finally, we obtained risk factors for asthma persistence in overweight/obese individuals and those at a high risk for obesity.

Results

Totally 753 adolescents with asthma and 2259 adolescents without asthma were included to analyze the occurrence of asthma. BMI and Hispanic Ethnicity were independent predictors of asthma occurrence and were included in nomogram construction. BMI had an efficiency comparable to that of the nomogram model in predicting asthma occurrence, which is superior to that of Hispanic Ethnicity. Of the 753 adolescents diagnosed with asthma, 464 were still diagnosed with asthma of at least a year's duration. Interestingly, BMI may have the ability to predict asthma persistence. Further, Hispanic Ethnicity and household income were significantly related to asthma occurrence among overweight/obese and high-risk obese individuals.

Conclusions

High BMI could independently predict increased asthma occurrence. Additionally, BMI may play an essential role in predicting asthma persistence. This study may help improve the diagnosis and reduce the occurrence of asthma.

Low Vitamin B12 Levels and Its Association With Insulin Resistance: A Potent Cardiovascular Risk Indicator in Childhood Asthma

Introduction As insulin resistance metabolically affects the body mass index (BMI), obese asthma children have more severe diseases than children with normal body mass index. A low level of vitamin B12 (Vit B12) is a known atherogenic factor by increasing the homocysteine level and therefore promotes cardiovascular morbidity and mortality. Limited studies have evaluated the role of serum B12 and insulin resistance among poorly controlled asthma in children. The purpose of the study was to compare the cardio-metabolic risk factor such as BMI, waist-hip ratio (WHR), insulin resistance, and vitamin B12 in well-controlled and poorly-controlled asthma patients and to determine the relationship between these parameters with the severity of asthma as assessed by Pulmonary Function Test. Methodology Based on the asthma control questionnaire and Global Initiative for Asthma (GINA) criteria, chronic asthma patients (n=60) of age 10-15 years were divided into two groups, namely well-controlled and poorly-controlled (30 each). Anthropometry was assessed by BMI and waist-hip ratio, and fasting blood samples were collected for the estimation of blood glucose, insulin, and serum vitamin B12 levels. Insulin resistance (HOMA-IR) was calculated using the formula- fasting glucose (mg/dL) x fasting insulin (µIU/mL)]/405. Forced expiratory volume (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were measured to assess the pulmonary function test. Results There were significant differences in the values of the BMI, insulin resistance, vitamin B12, and pulmonary function tests between poorly controlled and well-controlled asthma (p<0.01). The FEV1: FVC% was negatively correlated with BMI (r=0.53), WHR (r=0.50), glucose (r=0.68), insulin (r=0.68), Insulin resistance (r=0.80), and positive correlation with Vit B12 (0.73). In addition, Vit B12 and HOMA-IR correlate negatively (r=0.76). Conclusion This study concludes that the level of Vit B12 is decreased and insulin resistance is increased in poorly controlled asthmatic children in comparison to well-controlled asthma. These factors along with the increased BMI in poorly controlled asthma can predispose to cardiometabolic risk which needs attention.

A Nomogram for Predicting Prognosis of Advanced Schistosomiasis japonica in Dongzhi County-A Case Study

BACKGROUNDS

Advanced schistosomiasis is the late stage of schistosomiasis, seriously jeopardizing the quality of life or lifetime of infected people. This study aimed to develop a nomogram for predicting mortality of patients with advanced schistosomiasis japonica, taking Dongzhi County of China as a case study.

METHOD

Data of patients with advanced schistosomiasis japonica were collected from Dongzhi Schistosomiasis Hospital from January 2019 to July 2022. Data of patients were randomly divided into a training set and validation set with a ratio of 7:3. Candidate variables, including survival outcomes, demographics, clinical features, laboratory examinations, and ultrasound examinations, were analyzed and selected by LASSO logistic regression for the nomogram. The performance of the nomogram was assessed by concordance index (C-index), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The calibration of the nomogram was evaluated by the calibration plots, while clinical benefit was evaluated by decision curve and clinical impact curve analysis.

RESULTS

A total of 628 patients were included in the final analysis. Atrophy of the right liver, creatinine, ascites level III, N-terminal procollagen III peptide, and high-density lipoprotein were selected as parameters for the nomogram model. The C-index, sensitivity, specificity, PPV, and NPV of the nomogram were 0.97 (95% [CI]: [0.95-0.99]), 0.78 (95% [CI]: [0.64-0.87]), 0.97 (95% [CI]: [0.94-0.98]), 0.78 (95% [CI]: [0.64-0.87]), 0.97 (95% [CI]: [0.94-0.98]) in the training set; and 0.98 (95% [CI]: [0.94-0.99]), 0.86 (95% [CI]: [0.64-0.96]), 0.97 (95% [CI]: [0.93-0.99]), 0.79 (95% [CI]: [0.57-0.92]), 0.98 (95% [CI]: [0.94-0.99]) in the validation set, respectively. The calibration curves showed that the model fitted well between the prediction and actual observation in both the training set and validation set. The decision and the clinical impact curves showed that the nomogram had good clinical use for discriminating patients with high risk of death.

CONCLUSIONS

A nomogram was developed to predict prognosis of advanced schistosomiasis. It could guide clinical staff or policy makers to formulate intervention strategies or efficiently allocate resources against advanced schistosomiasis.