The Effects of a Healthy Diet on Asthma and Wheezing in Children and Adolescents: A Systematic Review and Meta-Analysis

Abstract

Background Asthma is a public health problem requiring focused attention. This study aimed to systematically evaluate the association between dietary structure and asthma or wheezing in children. Methods The study protocol of this meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration code CRD42023390191. A total of 8397 articles were retrieved, searching PubMed, Medline, Embase, Web of Science, and Scopus databases as of November 21, 2022. Two independent authors were responsible for independently conducting the literature screening process. Effect-size estimates were expressed as odds ratio (OR) in cross-sectional studies and risk ratio (RR) in cohort studies with a 95% confidence interval (CI). Summary effect estimates were evaluated with random-effect models. Meanwhile, subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity and the robustness of the pooled estimation. Results A total of 65 studies, including 567,426 subjects had been analyzed. Overall analyses of cross-sectional studies revealed that a healthy diet was protective against asthma (adjusted OR=0.85, 95% CI: 0.80–0.89, P <0.001, I 2 =69.8%, Tau 2 =0.026) and wheezing (adjusted OR=0.85, 95% CI: 0.81–0.89, P <0.001, I 2 =66.8%, Tau 2 =0.015) in children and adolescents. Conversely, unhealthy diets can exacerbate asthma (adjusted OR=1.28, 95% CI: 1.20–1.36, P <0.001, I 2 =64.9%, Tau 2 =0.019) and wheeze (adjusted OR=1.09, 95% CI: 1.02–1.16, P =0.006, I 2 =75.2%, Tau 2 =0.023) in children and adolescents. The same trend was found in cohort studies (adjusted RR=0.72, 95% CI: 0.58–0.90, P =0.003, I 2 =83.5%, Tau 2 =0.105). A clear trend was observed between high-frequency healthy diets (OR=0.80; 95% CI: 0.71–0.89; P <0.001) is more protective against asthma than low-frequency healthy diets (OR=0.81; 95% CI: 0.70–0.94; P =0.007). Conclusion Our findings highlight the protective effects of a healthy diet on asthma and wheezing in children, including fruit, seafood, cereals, and the Mediterranean diet.

Adherence to the Mediterranean Diet in Children and Adolescents and Association with Multiple Outcomes: An Umbrella Review

“…Starting from asthma and allergies, the findings suggested an inverse association. As confirmed by a recently published systematic review [39] that aimed to underline the effects of a healthy diet on asthma and wheezing in children and adolescents, the effect of the MD on asthma was more prominent. The Mediterranean Diet has been linked to a lower risk of asthma in numerous epidemiological studies [40].…”

Winds of change a tale of: asthma and microbiome

“…In a meta-analysis conducted by Garcia-Marcos et al, it was found that the Mediterranean diet was significantly associated with a reduced prevalence of asthma (OR: 0.86; 95% CI 0.78–0.95; p = 0.004) ( Garcia-Marcos et al, 2013 ). Similarly, a meta-analysis by Zhang et al, reported protective effects of a Mediterranean diet on asthma (OR = 0.88; 95% CI: 0.79–0.97; p = 0.014) ( Zhang et al, 2023 ). However, further research is required to gain a deeper understanding of the specific role of the microbiome in individuals with asthma who adhere to a Mediterranean diet.…”

Dietary Polyphenols, Plant Metabolites, and Allergic Disorders: A Comprehensive Review

“…In addition, based on the diet hypothesis, nutrients and food components may have a significant impact on the immune system and pathways related to allergic inflammation [12]. This influence can occur directly or indirectly through the modulation Pharmaceuticals 2024, 17, 670 2 of 31 of gut microbiota [14,15]. Consequently, these factors can either contribute to or protect against allergic diseases [14][15][16][17].…”

“…This influence can occur directly or indirectly through the modulation Pharmaceuticals 2024, 17, 670 2 of 31 of gut microbiota [14,15]. Consequently, these factors can either contribute to or protect against allergic diseases [14][15][16][17]. Given that diet is a highly changeable and easily available intervention, it is crucial to identify specific nutrients, food components, or dietary patterns that might be used as preventive or therapeutic measures for allergic diseases.…”