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

Published:December 27, 2010DOI:https://doi.org/10.1016/j.jaci.2010.11.001

      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.

      Key words

      Abbreviations used:

      ISAAC (International Survey of Allergies and Asthma in Childhood), OR (Odds ratio), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), RCT (Randomized controlled trial)
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