Low Dietary Nutrient Intakes and Respiratory Health in Adolescents

doi:10.1378/chest.07-0038

Chest

Volume 132, Issue 1, July 2007, Pages 238-245

https://doi.org/10.1378/chest.07-0038 Get rights and content

Background:

Epidemiologic studies have indicated that a diet rich in fruit, antioxidants, and n-3 fatty acids may contribute to optimal respiratory health. We investigated whether low dietary nutrient intakes were associated with lower pulmonary function and higher reporting of respiratory symptoms in adolescents.

Methods:

We examined the association of dietary factors (fruit, vegetables, vitamins C and E, beta-carotene, retinol, n-3 fatty acids) with respiratory health in a cohort of 2,112 twelfth-grade students in 13 communities in the United States and Canada during the 1998 to 1999 school year. We assessed the associations between dietary factors and pulmonary function with linear mixed models, and respiratory symptoms with logistic regression using a generalized estimating equation adjusted for individual and group-level covariates.

Results:

Low dietary fruit intake was associated with lower FEV₁ (− 1.3% of predicted; 95% confidence interval [CI], − 2.4 to − 0.2% of predicted), and increased odds of chronic bronchitic symptoms (odds ratio [OR], 1.36; 95% CI, 1.03 to 1.73) compared with higher intake. Low dietary n-3 fatty acids intake was associated with increased odds of chronic bronchitic symptoms (OR, 1.37; 95% confidence interval [CI], 1.05 to 1.81), wheeze (OR, 1.34; 95% CI, 1.06 to 1.69), and asthma (OR, 1.68; 95% CI, 1.18 to 2.39) compared with higher intake. Smokers with lower dietary vitamin C intake had higher ORs of respiratory symptoms compared with smokers who had higher intake.

Conclusions:

Adolescents with the lowest dietary intakes of antioxidant and antiinflammatory micronutrients had lower pulmonary function and increased respiratory symptoms, especially among smokers, suggesting that adequate dietary intake may promote respiratory health and lessen the effects of oxidative stress.

Section snippets

Study Population

Twelfth-grade students in 13 communities in the United States (Oak Ridge, TN; Blacksburg, VA; Charlottesville, VA; Zanesville, OH; Uniontown, PA; State College, PA; Elkins, WV; Monterey, CA; Aberdeen, SD) and Canada (Leamington, ON; Egbert, ON; Yorktown, SK; Penticton, BC) were recruited and tested during the 1998 to 1999 school year. Dietary questionnaires were not distributed in Penticton, BC, which limited the dietary analyses to 12 communities.

Parental permission and student consent were

Sample Characteristics

There were 5,413 adolescents who were eligible to participate, 4,355 of whom (80%) completed respiratory questionnaires (Fig 1). We excluded adolescents who reported a history of a chest operation, heart disease, or a debilitating health condition that limited their physical activity (n = 64), those with age outside the range of 16 to 19 years (n = 22), and those missing information on covariates of interest (n = 280), leaving 3,989 adolescents. Among these respiratory questionnaire

Discussion

Most of the adolescents in this cohort had dietary intakes of fruit, vegetables, vitamins, and n-3 fatty acids below the recommended levels. Low dietary intakes of fruit, vitamins C and E, and n-3 fatty acids were associated with lower pulmonary function and increased odds of reported respiratory symptoms, especially chronic bronchitic symptoms and wheeze among smokers.

Low dietary fruit intake was associated with lower pulmonary function and higher reported chronic bronchitic symptoms and

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As for differences in sample size, those studies found that increased risk was clearly larger—>20 000 [13,14] versus 1000 to 2000 individuals [7–12]—indicating that increased risk did not occur by chance because of a small sample size. Considering cross-sectional studies conducted in Western countries that involve >1000 participants, one study showed a beneficial effect of ω-3 PUFAs [29] and four others showed no such benefit [30–33]; none of the five studies showed a negative effect (increased risk) from fish or ω-3 PUFA intake [29–33]. Outside of Japan, only one study has been conducted in an Asian country where fish consumption is high, namely Taiwan.
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Contrary to our hypothesis, an increased risk for allergy was found by multivariable logistic regression in females, especially in allergic rhinitis/pollinosis, allergic conjunctivitis, or atopic dermatitis for fish intake and in allergic rhinitis/pollinosis or allergic conjunctivitis for ω-3 PUFAs. As for male partners, risk for allergic rhinitis/pollinosis or atopic dermatitis was increased for both fish and ω-3 PUFA intake. No statistically significant results were observed for the risk for asthma in either women or men.
Fish and ω-3 PUFA intake were associated with increased risk for some allergic diseases. Further research is warranted to confirm these findings in individuals with high fish consumption.
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Prevalence of lifetime and current asthma, current rhinitis and sensitisation were higher in Thessaloniki compared to Athens. The AEI score of the entire cohort was 4.2 ± 1.2 (median 4.0) and was higher in Athens compared to Thessaloniki (4.3 ± 1.2 vs. 4.0 ± 1.2, p = 0.001) and in girls than boys (4.3 ± 1.1 vs. 4.0 ± 1.2, p = 0.001). AEI was inversely associated with lifetime asthma (OR: 0.87, 95%CI 0.77, 0.99) in either cities independently of other cofounders such as family history, sensitisation, exercise, house smoking, breast feeding, pet or dampness in houses. No association with other allergic disease or sensitisation was detected.
Antioxidant foods seem to be a non-pharmacological, protective dietary pattern for asthma development in children irrespectively of atopy or heredity; AEI was a rough indicator and the role of antioxidants in allergic diseases is still under consideration.
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This work was performed at the Harvard School of Public Health.

This document has been subjected to review by the U.S. Environmental Protection Agency and approved for publication. Approval does not signify that the contents reflect the views of the Agency, nor does mention of trade names or commercial products constitute endorsement or recommendation for use.

The Teen Lung Study was funded by a grant from the National Institute of Environmental Health Sciences (ES08391 and ES00002). The analysis of dietary impacts was supported in part by a contract from Health Canada. Dr. Burns was supported by National Heart, Lung, and Blood Institute training grant HL07427 and National Institute of Environmental Health Sciences training grant 32-ES007 069-25#.

The authors have no commercial or financial interests, or other conflicts of interest related to the substance of this article.

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Chest

ORIGINAL RESEARCHNUTRITIONLow Dietary Nutrient Intakes and Respiratory Health in Adolescents

Background:

Methods:

Results:

Conclusions:

Section snippets

Study Population

Sample Characteristics

Discussion

J Allergy Clin Immunol

Am J Clin Nutr

Mol Aspects Med

Prev Med

Am J Clin Nutrition

Am J Clin Nutr

Am J Clin Nutr

J Allergy Clin Immunol

Am J Clin Nutr

Respir Med

J Allergy Clin Immunol

J Allergy Clin Immunol

Nutrition and lung health

Int J Tuberc Lung Dis

Treating asthma with omega-3 fatty acids: where is the evidence? A systematic review

BMC Complement Altern Med

Prospective study of diet and decline in lung function in a general population

Am J Respir Crit Care Med

Nutrition and respiratory health in adults: findings from the health survey for Scotland

Eur Respir J

Lung function in relation to intake of carotenoids and other antioxidant vitamins in a population-based study

Am J Epidemiol

Dietary antioxidants and asthma in adults: population-based case-control study

Am J Respir Crit Care Med

Dietary anti-oxidants and symptomatic asthma in adults

Thorax

Dietary fiber and reduced cough with phlegm: a cohort study in Singapore

Am J Respir Crit Care Med

Nutrition and respiratory health in children in six Central and Eastern European countries

Thorax

Children's lung function and antioxidant vitamin, fruit, juice, and vegetable intake

Am J Epidemiol

ORIGINAL RESEARCH
NUTRITION
Low Dietary Nutrient Intakes and Respiratory Health in Adolescents