Intakes of apple juice, fruit drinks and soda are associated with prevalent asthma in US children aged 2–9 years

Abstract

Objective: High soft drink consumption has been linked with asthma. Anecdotal evidence links high-fructose corn syrup with asthma. The receptor of advanced glycation end products (RAGE) has emerged as a mediator of asthma. The objectives of the present study were to: (i) assess the correlation between intake of beverages containing excess free fructose (EFF beverages) and asthma in children; and (ii) epidemiologically test the mechanistic hypothesis that intake of high EFF beverages, such as apple juice or beverages sweetened with high-fructose corn syrup, is associated with increased risk of asthma. This hypothesis is based on the possible effect of increases in the in situ intestinal formation of advanced glycation end products (enFruAGE) with EFF, which may be absorbed and play a role in RAGE-mediated asthma. Design: We examined cross-sectional associations between beverage intake and self-reported current or history of asthma. Exposure variables were EFF beverages, including apple juice (AJ), non-diet soft drinks (ndSD) and fruit drinks (FD). Orange juice (OJ), not an EFF beverage, was included as a comparison. Rao-Scott χ 2 analysis was used for prevalence differences and logistic regression for associations, adjusted for age, sex, race/ethnicity, BMI and total energy intake. Setting: Data are from the National Health and Nutrition Examination Survey 2003-2006, a nationally representative survey. Subjects: US children (n 1961) aged 2-9 years with complete responses on the dietary frequency questionnaire. Results: Intakes of EFF beverages were significantly associated with asthma in 2-9-year-olds. Adjusted odds of asthma in children consuming EFF beverages ≥5 times/week was more than five times that in children consuming these beverages ≤1 time/month (OR = 5·29, P = 0·012). Children consuming AJ ≥5 times/week v. ≤1 time/month, adjusted for the other beverages, were more than twice as likely to have asthma (OR = 2·43, P = 0·035). In contrast, there was a tendency for OJ to be protective. Conclusions: These results support the hypothesis that intake of high EFF beverages, including AJ and beverages sweetened with high-fructose corn syrup, is associated with asthma in children aged 2-9 years. Results support the mechanistic hypothesis that enFruAGE may be an overlooked contributor to asthma in children. Longitudinal studies are needed to provide evidence of causal association.

Intake of high fructose corn syrup sweetened soft drinks, fruit drinks and apple juice is associated with prevalent coronary heart disease, in U.S. adults, ages 45–59 y

“…There was no association with orange juice [26]. It is possible that enFruAGE contribute to inflammation beginning in childhood, as inflammation is commonly observed in children with asthma [9], including mild and moderate asthma [78].…”

“…It has been hypothesized that the association between SSB and prevalence of these chronic comorbid diseases may be due to underlying fructose malabsorption, which results after consumption of foods with a high fructose to glucose ratio (unpaired excess free fructose) -as occurs in high fructose corn syrup -but not after consumption of sucrose. Consumption of high fructose to glucose ratios results in elevated amounts of unabsorbed fructose in the gut that may contribute to the intestinal in situ formation of AGE [23][24][25][26][27]. Importantly, emerging science provides evidence that there may be a metabolic connection of unknown etiology with each of these comorbid conditions (asthma [28], chronic bronchitis [24], autoimmune arthritis [25], T2D [29], and CHD [30]), and that each should be redefined as a multi-system disorder involving the gut.…”

Dietary Sugars and Endogenous Formation of Advanced Glycation Endproducts: Emerging Mechanisms of Disease

“…Recent cross-sectional studies from DeChristopher and colleagues indicated that the consumption of HFCS or fructose sweetened beverages is associated to asthma and bronchitis in adults and to asthma in children [96][97][98]. Authors suggest an interesting mechanistic hypothesis, according to the in vitro observations of Bains and Gugliucci [99], of an intestinal formation of AGEs from excess free fructose intake which may be absorbed in the circulation and induce a systemic inflammatory condition through the binding to RAGE, thus contributing to lung diseases and impaired immune response.…”

RCT of the effect of berryfruit polyphenolic cultivar extract in mild steroid-naive asthma: a cross-over, placebo-controlled study

“…13 High fruit juice consumption has been associated with an increased risk of asthma in children 8. This association may be due to high excess fructose fruit juices such as apple, rather than other juices low in excess fructose such as orange, which may be protective 9. A possible mechanism for the variation in these findings is that consumption of fruits high in excess free fructose leads to the formation of proinflammatory advanced glycation end products (AGE) in the intestine, which are absorbed into the circulation, causing a systemic immune response.…”