Effects of diet on the childhood gut microbiome and its implications for atopic dermatitis

Abstract

Effects of diet on the childhood gut microbiome and its implications for atopic dermatitisTo the Editor:Atopic dermatitis (AD) is a common childhood disorder with significant reductions in the child's quality of life. The composition and diversity of the early gut microbiota has been linked to the development of atopic conditions including AD. 1 Although the prevalence of atopic diseases is lower in Africa, 2 individuals of African origin who live in Western countries are at a significantly higher risk for atopic conditions like AD and food allergy, and suffer from more severe allergic diseases than do their white counterparts, 3 possibly reflecting an enhanced genetic predisposition to allergy that is kept in check by their ancestral environment. 2 In certain areas of Africa, people still live in an environment enriched in microbes through close daily contact with animals and plants in natural settings. Therefore, determining how their natural environment or diet protects these potentially atrisk populations should shed light on causes of the global rise in allergic conditions. In this study, we characterized gut microbiotas of black South African (Xhosa) children from the remote rural Mqanduli district of the Eastern Cape in association with AD.Patients with AD were recruited from the Dermatology Department of the Nelson Mandela Academic Hospital in Umtata, in the Eastern Cape. Control (nonallergic, non-foodsensitized) subjects were recruited from the areas surrounding 10 district community health clinics. Detailed clinical data were gathered on all toddlers. The fecal microbiota of these children was analyzed and compared in relation to AD, other clinical variables, and their diet. For details, see this article's Methods section in the Online Repository at www.jacionline.org. This study was approved by the institutional review boards of the

Environmental factors associated with allergy in urban and rural children from the South African Food Allergy (SAFFA) cohort

“…Amasi is a fermented milk rich in probiotics, which might contribute to gut microbial diversity, possibly compensating for deficient gut microbial diversity, which can be present in urban children. 36…”

“…A subsection of the rural cohort (47 children) were included as nonatopic control subjects in a study 36,47 comparing the diet and intestinal microbiome in black African children with and without AD. Significantly lower sugar and saturated fat consumption was reported in the diets of rural children without AD than in their atopic counterparts, and a significant association was found between higher consumption of sugar and AD.…”

“…Increased daily intake of sugar was associated with lower diversity of the gut microbiome and increased relative abundance of Prevotella copri, which in turn was inversely associated with AD. 36…”

Position Statement on Atopic Dermatitis in Sub‐Saharan Africa: current status and roadmap

“…It was also noted that a butyrate‐rich diet (enriched in fibre‐rich foods and milk fat) shaped the gut microbiome and reduced AD incidence . A recent study in South African children demonstrated differences in gut microbiome composition between rural children with AD compared with their healthy counterparts …”

“…27 A recent study in South African children demonstrated differences in gut microbiome composition between rural children with AD compared with their healthy counterparts. 28 Recent reports have indicated a multipolarity of immune axes in AD. Notably, Asian AD skin phenotypes included psoriatic features that were associated with a strong Th17 immune axis.…”