The Role of Nutritional Factors in Asthma: Challenges and Opportunities for Epidemiological Research

Abstract

The prevalence of asthma has nearly doubled over the last decades. Twentieth century changes in environmental and lifestyle factors, including changes in dietary habits, physical activity and the obesity epidemic, have been suggested to play a role in the increase of asthma prevalence and uncontrolled asthma worldwide. A large body of evidence has suggested that obesity is a likely risk factor for asthma, but mechanisms are still unclear. Regarding diet and physical activity, the literature remains inconclusive. Although the investigation of nutritional factors as a whole (i.e., the “diet, physical activity and body composition” triad) is highly relevant in terms of understanding underlying mechanisms, as well as designing effective public health interventions, their combined effects across the life course has not received a lot of attention. In this review, we discuss the state of the art regarding the role of nutritional factors in asthma, for each window of exposure. We focus on the methodological and conceptual challenges encountered in the investigation of the complex time-dependent interrelations between nutritional factors and asthma and its control, and their interaction with other determinants of asthma. Lastly, we provide guidance on how to address these challenges, as well as suggestions for future research.

Healthy diet associated with better asthma outcomes in elderly women of the French Asthma-E3N study

“…Diet, physical activity, and body composition are nutritional factors that are not only closely interrelated (at a given time t) but also time-dependent, which makes it difficult to disentangle their separate effects on asthma outcome [60].…”

“…Diet, physical activity, and body composition are nutritional factors that are not only closely interrelated (at a given time t ) but also time-dependent, which makes it difficult to disentangle their separate effects on asthma outcome [ 60 ]. Regarding interrelations (at a given time t ), although obesity can result from multiple factors (e.g., genetic predispositions, certain disease status, or medication use), it is most often a result of unhealthy lifestyle, including excessive dietary energy intakes and insufficient physical activity [ 61 ].…”

“…It has been shown that individuals with lower overall diet quality have higher risk of obesity [ 36 ]. The established evidence that links diet to obesity and that links obesity to asthma [ 10 ] and asthma control [ 62 ] can illustrate the role of obesity as a potential mediator in the diet–asthma association [ 60 ]. In this context, several studies provided results with and, in addition, without adjustment for BMI [ 63 , 64 ] but it could lead to biased results [ 65 ].…”

Nutrition in Asthma

“…The relationship between dietary exposure and asthma risk as well as asthma symptoms is affected by many factors including genetics, social determinants, and complex interactions between body composition and physical activity. 140 It is important that future studies recognize that these determinants, such as obesity, smoking, or gene polymorphisms may modify the effect of dietary exposures on asthma outcomes. 141 Further, these effects may change over time, and may be distinct in adults versus children.…”

Review – Nutraceuticals Can Target Asthmatic Bronchoconstriction: NADPH Oxidase-Dependent Oxidative Stress, RhoA and Calcium Dynamics

“…Asthma is thought to afflict about 300 million people worldwide, and its prevalence over the last several decades has increased markedly. 2 There is no definitive cure for the disease. Symptoms can be prevented by avoiding allergens and irritants, or treated by inhaled corticosteroids, long-acting beta agonists or anti-leukotriene agents.…”