Friday, January 25, 2013

Fast food diet linked to asthma and eczema severity in kids, large study finds

Jan. 16, 2013 — Eating three or more weekly servings of fast food is linked to the severity of allergic asthma, eczema, and rhinitis among children in the developed world, indicates a large international study published online in the respiratory journal Thorax.
The findings prompt the authors to suggest that a fast food diet may be contributing to the rise in these conditions, and if proved causal, could have huge implications for public health, given the popularity of these foodstuffs.

The authors base their findings on data from more than 319,000 13-14 year olds from 107 centres in 51 countries, and more than181,000 six to seven year olds from 64 centres in 31 countries.
All the participants were involved in the International Study of Asthma and Allergies in Childhood (ISAAC), which is a collaborative research project involving more than 100 countries and nearly two million children, making it the largest study of its kind.

The teens and the children's parents were formally quizzed on whether they had symptoms of asthma (wheeze); rhinoconjunctivitis (which produces a runny or blocked nose accompanied by itchy and watery eyes); and eczema; and their weekly diet.

Questions focused particularly on the severity of symptoms over the preceding 12 months -- including frequency and interference with daily life and/or sleep patterns -- and certain types of food already linked to protective or damaging effects on health. These included meat, fish, fruits and vegetables, pulses, cereals, bread and pasta, rice, butter, margarine, nuts, potatoes, milk, eggs, and fast food/burgers. Consumption was categorised as never; occasionally; once or twice a week; and three or more times a week.

After taking account of factors likely to influence the results, the analysis showed that fast food was the only food type to show the same associations across both age groups, prompting the authors to suggest that "such consistency adds some weight to the possible causality of the relationship."
It was associated with current and severe symptoms of all three conditions among the teens -- across all centres in the participating countries, irrespective of gender or levels of affluence.

The pattern among children was less clear-cut, but a fast food diet was still associated with symptoms across all centres -- except for current eczema -- and poorer countries -- except for current and severe asthma.

And this difference might have to do with the fact that children have fewer options about their food choices, suggest the authors.

Three or more weekly servings were linked to a 39% increased risk of severe asthma among teens and a 27% increased risk among children, as well as to the severity of rhinitis and eczema, overall.
On the other hand, fruit seemed to be protective in both age groups across all centres for all three conditions among children -- both current and severe -- and for current and severe wheeze and rhinitis among the teens.

Eating three or more weekly portions was linked to a reduction in symptom severity of between 11% and 14% among teens and children, respectively.

The authors suggest that there are plausible explanations for the findings: fast food contains high levels of saturated and trans fatty acids, which are known to affect immunity, while fruit is rich in antioxidants and other beneficial compounds.

The authors emphasise that their results do not prove cause and effect, but they do warrant further investigation.

"If the associations between fast foods and the symptom prevalence of asthma, rhinoconjunctivitis and eczema is causal, then the findings have major public health significance owing to the rising consumption of fast foods globally," they conclude.

Fast food diet linked to asthma and eczema severity in kids, large study finds  

Monday, September 5, 2011

Researchers have found that climate change may lead to more asthma-related health problems in children

ScienceDaily (Aug. 30, 2011) — Mount Sinai School of Medicine researchers have found that climate change may lead to more asthma-related health problems in children, and more emergency room (ER) visits in the next decade.

The data, published in the current issue of the American Journal of Preventive Medicine, found that changing levels of ozone could lead to a 7.3 percent increase in asthma-related emergency room visits by children, ages 0-17.

The research team, led by Perry Sheffield, MD, Assistant Professor of Preventive Medicine at Mount Sinai School of Medicine, used regional and atmospheric chemistry models to reach its calculations. They linked regional climate and air quality information to New York State Department of Health records of pediatric, asthma-related emergency room visits in 14 counties that are part of the New York City metropolitan area. Then they simulated ozone levels for June through August for five consecutive years in the 2020s, and compared them with 1990s levels. The researchers found a median increase of 7.3 percent in ozone-related asthma emergency department visits, with increases ranging from 5.2 percent to 10.2 percent per county.

"Our study shows that these assessment models are an effective way of evaluating the long-term impact of global climate change on a local level," said Dr. Sheffield. "This study is a jumping off point to evaluate other outcomes including cost utilization, doctors' visits, missed school days, and a general understanding of the overall burden of climate change on children with asthma."

Dr. Sheffield and her team plan to continue using these models to understand the specific impacts of climate change. The authors conclude that better measures to reduce carbon pollution that contributes to global climate change as well as pollution that forms ozone need to be implemented.

Funding for this study was provided by the National Institutes of Health Research Training Program in Environmental Pediatrics.

Thursday, June 30, 2011

Size at Birth May Determine Asthma Risk in Children

Size of baby in womb as an indicator of childhood asthma and allergies

                                (Medical Xpress) -- In a paper published in the American Journal of Respiratory and Critical Care Medicine, the University of Aberdeen team also found links between the rate an unborn baby grows and its chances of developing eczema and hayfever.


Saturday, February 26, 2011

Asthma Management Model for Preschoolers Decreases ER Visits and Hospitalizations

Model for Managing Asthma in Preschoolers Leads to Dramatic Drop in ER Visits and Hospitalizations

ScienceDaily (Feb. 25, 2011) — Nearly one in eleven (8.6%) preschool children in the U.S. has been diagnosed with asthma and in some inner city neighborhoods, the figure is closer to one in seven. But, few asthma management programs are designed for parents of preschool children.

The Asthma Basics for Children (ABC) program, established by Columbia University's Mailman School of Public Health and a coalition of community service organizations, educators, parenting programs, and community pediatric providers, addressed this need with a multi-layered approach that offers educational activities to parents and children in 31 Northern Manhattan daycare centers as well as training to community pediatric providers. Following participation in the program, 85% percent of parents reported reducing their child's asthma triggers. The percent of children with asthma-related visits to emergency departments declined sharply from 74% to 47%, as did asthma-related hospitalizations, dropping from 24% to 11%.
Full study findings are published in the February 2011 Journal of Urban Health.

The ABC Program provided multiple opportunities for parents to learn about asthma signs and triggers in health units at the daycare centers. The multi-level intervention involved social workers, peer counselors and trained health educators, as in other community-based asthma coalitions ; but also promoted parent participation by offering flexible workshop scheduling; reinforcing messages to parents through daycare center activities for their children; and adding a provider-education component to improve communication between parents and providers. The Columbia researchers found that parent participation rates in the study exceeded rates found in most other preschool or school-based asthma programs.

"Although emergency room visits and hospitalization rates for this age group are more than twice that of older children with asthma, until we developed the ABC model, only a handful of programs had been designed to promote better asthma management by their parents," said Sally P. Findley, PhD, first author on the paper. "Our study suggests that the benefits of such a program are huge."

The study also found that over a two-week period the percentage of children reporting any daytime symptoms dropped from 78% to 42%, any nighttime symptoms fell from 81% to 49% during one month, and any daycare absences declined from 56% to 38% in the previous six months.

Another key element of the ABC strategy was linking asthma education activities in the daycare setting with improving the quality of asthma care by healthcare providers. Parents in this program confided that they were often reluctant to share concerns with their physician, especially about possible side effects of daily use of medications to control asthma. After participating in the program, 89% found it easier to talk to their doctor, and 80% said they were confident in their ability to manage their child's asthma. In the group without parent training, only 31% had taken at least one step toward reducing triggers, 49% reported that talking to their child's doctor was easier, and 49% expressed confidence in managing their child's asthma. When parents participated in the program, those reporting these behaviors increased to 40%, 62%, and 71%, respectively. Children with both parents and healthcare providers reported the greatest increases in these behaviors: 76%, 82%, and 86%, respectively. The two-pronged strategy of strengthening communication skills of parents and their child's healthcare provider is likely to have contributed to the changes in asthma management behaviors, improved confidence, and improved asthma control, observes Dr. Findley.

Asthma control outcomes improved progressively as the child's exposure to ABC's multi-layered interventions increased. "This study show that you can improve asthma outcomes for preschoolers with an approach that integrates activities for children, parents, teachers, and healthcare providers, noted Dr. Findley, clinical professor of Sociomedical Sciences and Population and Family Health at the Mailman School. "The greatest impact occurs when you combine education interventions at all of these levels."
The project was funded by the CDC's Controlling Asthma in America's Cities Project after an assessment by the Northern Manhattan Community Voices Collaborative, an academic-community partnership, documented the need for an asthma intervention targeting local preschoolers.
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Columbia University's Mailman School of Public Health, via EurekAlert!, a service of AAAS.

Journal Reference:
  1. Sally E. Findley, Gloria Thomas, Rosa Madera-Reese, Natasha McLeod, Sreelata Kintala, Raquel Andres Martinez, Benjamin Ortiz, Elizabeth Herman. A Community-Based Strategy for Improving Asthma Management and Outcomes for Preschoolers. Journal of Urban Health, 2011; 88 (S1): 85 DOI: 10.1007/s11524-010-9479-8

Monday, February 14, 2011

Babies Who are Given Antibiotics Have a 50% Increased Risk of Developing Asthma by Age 6

Early Antibiotic Use Can Lead to Increased Risk of Childhood Asthma, Study Suggests

ScienceDaily (Jan. 27, 2011) — When babies are given antibiotics, their risk of developing asthma by age 6 may increase by 50 percent. This relationship between antibiotic use in babies less than six months old and risk of developing asthma was documented in a study conducted by Norwegian University of Science and Technology (NTNU) researcher Kari Risnes.

The research was conducted while Risnes was a visiting researcher at Yale University, and resulted in the recent online publication of the article in the American Journal of Epidemiology.
"Asthma is a very common disease. At the same time, about one-third of infants in our study were treated with antibiotics by the time they were six months old. This proportion is about 30 per cent in other Western countries," says Risnes.
The Yale study followed 1400 children and mothers from the beginning of pregnancy until the children were six years old.
"We found that the risk that children would have asthma as six year olds was 50 per cent higher when they had been given antibiotics as a baby. That is a significant increase," Risnes says.
While previous research has suggested an association between asthma and antibiotics, those studies may have been biased because antibiotics are used to treat respiratory tract infections that could themselves be early symptoms of asthma.
The study sought to eliminate this bias by excluding children who were treated for respiratory infections from the study. The study also considered a long list of other risk factors -- such as whether or not the mother, father or a sibling had asthma. That aspect also brought a surprise, Risnes said.
"We actually found that the relationship between antibiotic use in the first six months of life and asthma was particularly strong in children from families without a history of asthma," said Risnes.
"What we think is that antibiotics interfere with the beneficial bacteria found in the gut. These bacteria aid in helping the baby's immune system to mature. When the bacteria are affected, it can cause the child to have an "immature" immune system, which in turn leads to allergic reactions," says Risnes.
She believes that the results should remind doctors and policymakers of the consequences of overuse of antibiotics. While in Norway, for example, the policy is to limit the prescription of antibiotics "this is an additional reminder to doctors and parents that we should avoid unnecessary use whenever possible," she said.
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by The Norwegian University of Science and Technology (NTNU).

Journal Reference:
  1. K. R. Risnes, K. Belanger, W. Murk, M. B. Bracken. Antibiotic Exposure by 6 Months and Asthma and Allergy at 6 Years: Findings in a Cohort of 1,401 US Children. American Journal of Epidemiology, 2010; 173 (3): 310 DOI: 10.1093/aje/kwq400

Monday, January 24, 2011

Low levels of vitamin D are associated with lower lung function and greater medication use in children with asthma

Low Vitamin D Levels Associated With More Asthma Symptoms and Medication Use

ScienceDaily (Apr. 20, 2010) — Low levels of vitamin D are associated with lower lung function and greater medication use in children with asthma, according to researchers at National Jewish Health. In a paper published online this week in the Journal of Allergy & Clinical Immunology, Daniel Searing, MD, and his colleagues also reported that vitamin D enhances the activity of corticosteroids, the most effective controller medication for asthma.

"Asthmatic children in our study who had low levels of vitamin D were more allergic, had poorer lung function and used more medications," said Dr. Searing. "Conversely, our findings suggest that vitamin D supplementation may help reverse steroid resistance in asthmatic children and reduce the effective dose of steroids needed for our patients."

The researchers examined electronic medical records of 100 pediatric asthma patients referred to National Jewish Health. Overall, 47 percent of them had vitamin D levels considered insufficient, below 30 nanograms per milliliter of blood (ng/mL). Seventeen percent of the patients had levels below 20 ng/mL, which is considered deficient. These levels were similar to vitamin D levels found in the general population.

Patients low in vitamin D generally had higher levels of IgE, a marker of allergy, and responded positively to more allergens in a skin prick test. Allergies to the specific indoor allergens, dog and house dust mite, were higher in patients with low vitamin D levels. Low vitamin D also correlated with low FEV1, the amount of air a person can exhale in one second, and lower FEV1/FVC, another measure of lung function. Use of inhaled steroids, oral steroids and long-acting beta agonists were all higher in patients low in vitamin D.

"Our findings suggest two possible explanations," said senior author Donald Leung, MD, PhD. "It could be that lower vitamin D levels contribute to increasing asthma severity, which requires more corticosteroid therapy. Or, it may be that vitamin D directly affects steroid activity, and that low levels of vitamin D make the steroids less effective, thus requiring more medication for the same effect."

The researchers performed a series of laboratory experiments that indicated vitamin D enhances the action of corticosteroids. They cultured some immune cells with the corticosteroid dexamethasone alone and others with vitamin D first, then dexamethasone. The vitamin D significantly increased the effectiveness of dexamethasone. In one experiment vitamin D and dexamethasone together were more effective than 10 times as much dexamethasone alone.

The researchers also incubated immune-system cells for 72 hours with a staphylococcal toxin to induce corticosteroid resistance. Vitamin D restored the activity of dexamethasone. "Our work suggests that vitamin D enhances the anti-inflammatory function of corticosteroids,' said Dr. Leung. "If future studies confirm these findings vitamin D may help asthma patients achieve better control of their respiratory symptoms with less medication."

This study comes on the heels of another paper by National Jewish Health faculty, which showed that low levels of vitamin D in adult asthma patients are associated with lower lung function and reduced responsiveness to corticosteroids.