Nutrients and foods for the primary prevention of asthma and allergy: systematic review and meta-analysis

U Nurmatov, Graham Stuart Devereux, Aziz Sheikh

Research output: Contribution to journalArticle

260 Citations (Scopus)

Abstract

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

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

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

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

Conclusion:
The available epidemiologic evidence is weak but nonetheless supportive with respect to vitamins A, D, and E; zinc; fruits and vegetables; and a Mediterranean diet for the prevention of asthma. Experimental studies of these exposures are now warranted.

Original languageEnglish
Pages (from-to)724-733.e30
Number of pages10
JournalJournal of Allergy and Clinical Immunology
Volume127
Issue number3
Early online date27 Dec 2010
DOIs
Publication statusPublished - Mar 2011

Fingerprint

Primary Prevention
Meta-Analysis
Hypersensitivity
Asthma
Odds Ratio
Food
Vitamin A
Vegetables
Mediterranean Diet
Fruit
Selenium
Vitamin E
Vitamin D
Ascorbic Acid
Zinc
Respiratory Sounds
Vitamins
Cohort Studies
Randomized Controlled Trials
Eating

Keywords

  • allergy
  • antioxidants
  • asthma
  • atopy
  • diet
  • foods
  • nutrients

Cite this

Nutrients and foods for the primary prevention of asthma and allergy : systematic review and meta-analysis. / Nurmatov, U; Devereux, Graham Stuart; Sheikh, Aziz.

In: Journal of Allergy and Clinical Immunology, Vol. 127, No. 3, 03.2011, p. 724-733.e30.

Research output: Contribution to journalArticle

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abstract = "Background Epidemiologic studies suggest that deficiencies of the nutrients selenium; zinc; vitamins A, C, D, and E; and low fruit and vegetable intake may be associated with the development of asthma and allergic disorders. Objectives To investigate the evidence that nutrient and food intake modifies the risk of children developing allergy. Methods We systematically searched 11 databases. Studies were critically appraised, and meta-analyses were undertaken. Results We identified 62 eligible reports. There were no randomized controlled trials. Studies used cohort (n = 21), case-control (n = 15), or cross-sectional (n = 26) designs. All studies were judged to be at moderate to substantial risk of bias. Meta-analysis revealed that serum vitamin A was lower in children with asthma compared with controls (odds ratio [OR], 0.25; 95{\%} CI, 0.10-0.40). Meta-analyses also showed that high maternal dietary vitamin D and E intakes during pregnancy were protective for the development of wheezing outcomes (OR, 0.56, 95{\%} CI, 0.42-0.73; and OR, 0.68, 95{\%} CI, 0.52-0.88, respectively). Adherence to a Mediterranean diet was protective for persistent wheeze (OR, 0.22; 95{\%} CI, 0.08-0.58) and atopy (OR, 0.55; 95{\%} CI, 0.31-0.97). Seventeen of 22 fruit and vegetable studies reported beneficial associations with asthma and allergic outcomes. Results were not supportive for other allergic outcomes for these vitamins or nutrients, or for any outcomes in relation to vitamin C and selenium. Conclusion: The available epidemiologic evidence is weak but nonetheless supportive with respect to vitamins A, D, and E; zinc; fruits and vegetables; and a Mediterranean diet for the prevention of asthma. Experimental studies of these exposures are now warranted.",
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N2 - Background Epidemiologic studies suggest that deficiencies of the nutrients selenium; zinc; vitamins A, C, D, and E; and low fruit and vegetable intake may be associated with the development of asthma and allergic disorders. Objectives To investigate the evidence that nutrient and food intake modifies the risk of children developing allergy. Methods We systematically searched 11 databases. Studies were critically appraised, and meta-analyses were undertaken. Results We identified 62 eligible reports. There were no randomized controlled trials. Studies used cohort (n = 21), case-control (n = 15), or cross-sectional (n = 26) designs. All studies were judged to be at moderate to substantial risk of bias. Meta-analysis revealed that serum vitamin A was lower in children with asthma compared with controls (odds ratio [OR], 0.25; 95% CI, 0.10-0.40). Meta-analyses also showed that high maternal dietary vitamin D and E intakes during pregnancy were protective for the development of wheezing outcomes (OR, 0.56, 95% CI, 0.42-0.73; and OR, 0.68, 95% CI, 0.52-0.88, respectively). Adherence to a Mediterranean diet was protective for persistent wheeze (OR, 0.22; 95% CI, 0.08-0.58) and atopy (OR, 0.55; 95% CI, 0.31-0.97). Seventeen of 22 fruit and vegetable studies reported beneficial associations with asthma and allergic outcomes. Results were not supportive for other allergic outcomes for these vitamins or nutrients, or for any outcomes in relation to vitamin C and selenium. Conclusion: The available epidemiologic evidence is weak but nonetheless supportive with respect to vitamins A, D, and E; zinc; fruits and vegetables; and a Mediterranean diet for the prevention of asthma. Experimental studies of these exposures are now warranted.

AB - Background Epidemiologic studies suggest that deficiencies of the nutrients selenium; zinc; vitamins A, C, D, and E; and low fruit and vegetable intake may be associated with the development of asthma and allergic disorders. Objectives To investigate the evidence that nutrient and food intake modifies the risk of children developing allergy. Methods We systematically searched 11 databases. Studies were critically appraised, and meta-analyses were undertaken. Results We identified 62 eligible reports. There were no randomized controlled trials. Studies used cohort (n = 21), case-control (n = 15), or cross-sectional (n = 26) designs. All studies were judged to be at moderate to substantial risk of bias. Meta-analysis revealed that serum vitamin A was lower in children with asthma compared with controls (odds ratio [OR], 0.25; 95% CI, 0.10-0.40). Meta-analyses also showed that high maternal dietary vitamin D and E intakes during pregnancy were protective for the development of wheezing outcomes (OR, 0.56, 95% CI, 0.42-0.73; and OR, 0.68, 95% CI, 0.52-0.88, respectively). Adherence to a Mediterranean diet was protective for persistent wheeze (OR, 0.22; 95% CI, 0.08-0.58) and atopy (OR, 0.55; 95% CI, 0.31-0.97). Seventeen of 22 fruit and vegetable studies reported beneficial associations with asthma and allergic outcomes. Results were not supportive for other allergic outcomes for these vitamins or nutrients, or for any outcomes in relation to vitamin C and selenium. Conclusion: The available epidemiologic evidence is weak but nonetheless supportive with respect to vitamins A, D, and E; zinc; fruits and vegetables; and a Mediterranean diet for the prevention of asthma. Experimental studies of these exposures are now warranted.

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KW - antioxidants

KW - asthma

KW - atopy

KW - diet

KW - foods

KW - nutrients

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SN - 0091-6749

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