Renata Barros

Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma control.

Background:  The traditional Mediterranean diet is claimed to possess antioxidant and immune‐regulatory properties in several chronic diseases. Typical Mediterranean foods have recently been associated with improvement of symptoms of asthma and rhinitis in children. However the effect of adherence to Mediterranean diet on adult asthma outcomes is unknown. We aimed to investigate the association between adherence to Mediterranean diet and asthma control.

Food Patterns According to Sociodemographics, Physical Activity, Sleeping and Obesity in Portuguese Children

Our study aimed to describe the association between food patterns and gender, parental education, physical activity, sleeping and obesity in 1976 children aged 5−10 years old. Dietary intake was measured by a semi quantitative food frequency questionnaire; body mass index was calculated and categorized according to the IOTF classification. Factor analysis and generalized linear models were applied to identify food patterns and their associations. TV viewing and male gender were significant positive predictors for fast-food, sugar sweetened beverages and pastry pattern, while a higher level of maternal education and longer sleeping duration were positively associated with a dietary patterns that included fruit and vegetables.

Dietary intake of α-linolenic acid and low ratio of n-6:n-3 PUFA are associated with decreased exhaled NO and improved asthma control.

As recently described, adherence to the Mediterranean diet is associated with improved asthma control. However, evidence of how specific nutrients such as fatty acids and antioxidants may affect this relationship remains largely unknown. We aimed to examine the association between dietary intake of fatty acids and antioxidants and asthma control. A cross-sectional study was developed in 174 asthmatics, mean age of 40 (SD 15) years. Dietary intake was obtained by a FFQ, and nutritional content was calculated using Food Processor Plus™ software (ESHA Research, Inc., Salem, OR, USA). Good asthma control was defined by the combination of forced expiratory volume during the first second, exhaled NO (eNO) and Asthma Control Questionnaire (ACQ) score (control: forced expiratory volume in the first second ≥80 %; eNO ≤35 ppb; ACQ <1·0, scale 0-6 score). Multiple linear and logistic regression models were performed to analyse the associations between nutrients and asthma outcomes, adjusting for confounders. A high n-6:n-3 PUFA ratio predicted high eNO, whereas high intakes of n-3 PUFA, a-linolenic acid (ALA) and SFA were associated with low eNO. Odds for controlled asthma improved along with an increased intake of n-3 PUFA (OR 0·14, 95% CI 0·04, 0·45; P for trend=0·001), SFA (OR 0·36, 95% CI 0·13, 0·97; P for trend=0·047) and ALA (OR 0·18, 95% CI 0·06, 0·58; P for trend=0·005). A high n-6:n-3 PUFA ratio increased the odds for uncontrolled asthma (OR 3·69, 95% CI 1·37, 9·94; P for trend=0·009), after adjusting for energy intake, sex, age, education and use of inhaled corticosteroids. Higher intakes of n-3 PUFA, ALA and SFA were associated with good asthma control, while the risk for uncontrolled asthma increased with a higher n-6:n-3 PUFA ratio. The present results introduce a protective effect of ALA in asthma control, independent of marine n-3 fatty acids, and provide a rationale to dietary intervention studies in asthma.

Physical activity in adults with controlled and uncontrolled asthma as compared to healthy adults: a cross-sectional study.

BackgroundThough exercise-induced bronchoconstriction is common among asthmatics, physical activity (PA) seems important in asthma management. Still, various studies point at avoidance of sports and certain daily life activities like walking stairs, even by patients with mild symptoms. We aimed to compare physical activity levels between healthy subjects and asthmatics with controlled and uncontrolled disease.MethodsData on asthma and PA were drawn from the Portuguese National Asthma Survey. The short telephone version of the International Physical Activity Questionnaire (IPAQ) was used to measure PA levels. Current asthma was defined as self-reported asthma and at least one of these criteria: one or more asthma symptoms in the last twelve months, currently taking asthma medication or an asthma medical appointment in the previous twelve months. Controlled asthma was defined as a CARAT global score > 24 or a CARAT second factor score ≤ 16. Healthy subjects were defined as individuals without atopy, heart disease or any respiratory symptom. X2 and Mann–Whitney/Kruskall-Wallis tests were used to compare groups. Logistic regression analyses were performed to assess relations between asthma status and PA dimensions.ResultsA total of 606 non-asthmatics, 125 controlled and 78 uncontrolled asthmatic subjects were included. In both genders, overall PA level did not differ significantly between groups. Controlled (men) and uncontrolled (women) asthmatics did more vigorous PA than healthy respondents. Male controlled asthmatics also did more moderate PA. Crude logistic regression showed positive relations between daily sitting time, vigorous and moderate PA and controlled asthma in men and between vigorous PA and uncontrolled asthma in women. After adjustments for confounders, moderate PA remained a predictor of controlled asthma in men, while vigorous PA doubled the risk of uncontrolled asthma in women.ConclusionOur study showed that adult asthmatics, independent of asthma control, do not seem to have a more sedentary lifestyle than their peers. Nevertheless, PA should be encouraged, as only about half of them reached activity recommendations.

The Impact of an Intervention Taught by Trained Teachers on Childhood Overweight

The purpose of this study was to assess the effects of a six-months’ nutrition program, delivered and taught by classroom teachers with in-service nutrition training, on the prevention of overweight and obesity among children in grades 1 to 4. In this randomized trial, four hundred and sixty four children from seven elementary schools were allocated to a nutrition educational program delivered by their own teachers. Intervened teachers had 12 sessions of three hours each with the researchers throughout six months, according to the topics nutrition and healthy eating, the importance of drinking water and healthy cooking activities. After each session, teachers were encouraged to develop activities in class focused on the learned topics. Sociodemographic, anthropometric, dietary, and physical activity assessments were performed at baseline and at the end of the intervention. In the intervention group the increase in Body Mass Index (BMI) z-score was significantly lower than in the control group (p = 0.009); fewer proportion of children became overweight in the intervened group compared with the control (5.6% vs. 18.4%; p = 0.037). Our study provides further support to decrease the overweight epidemic, involving classroom teachers in a training program and making them dedicated interventionists.

The impact of an intervention taught by trained teachers on childhood fruit and vegetable intake: A randomized trial

Our study aimed to assess the impact of a six-months nutrition program, taught by trained teachers, on fruit and vegetable consumption among children in grades 1 to 4. Four hundred and sixty-four children (239 female), 6 to 12 years old, from seven elementary schools were assigned to this randomized trial. Teachers were trained by researchers over six months, according to the following topics: nutrition, healthy eating, and strategies to increase physical activity. After each session, teachers were encouraged to develop activities in the classroom on the topics learned. Childrens sociodemographic, anthropometric, dietary, and physical activity data were assessed at baseline and at the end of the intervention. The effect sizes ranged between small (Cohens d = 0.12 on “other vegetables”) to medium (0.56 on “fruit and vegetable”), and intervened children reported a significantly higher consumption of vegetables and fruit. Interventions involving trained teachers offer promise to increase consumption of fruit and vegetable in children.

Dietary patterns and asthma prevalence, incidence and control

The increased asthma prevalence in westernized societies has been suggested to be related to environment exposures and lifestyle changes, particularly diet. We aimed to explore the association between dietary patterns and asthma prevalence, incidence and control in a nationally representative population.

Impact of an intervention through teachers to prevent consumption of low nutrition, energy-dense foods and beverages: a randomized trial.

OBJECTIVE To examine the effects of an intervention program held by teachers previously trained in nutrition, on the consumption of low nutrient, energy-dense (LNED) foods, of children attending elementary schools. METHOD 464 children (239 female, 6 to 12 years) from seven elementary Portuguese schools participated in this randomized trial. Three schools were allocated to the intervention, and four to the control group. The intervention program was based on the Health Promotion Model and social cognitive theory. Teachers previously trained by researchers in nutrition and healthy eating implemented the intervention in the classroom from November 2008 to March 2009. Sociodemographic, anthropometric, physical activity, and dietary assessments were performed before (2007/2008) and at the end of the intervention (2009). Dietary intake was gathered by a 24-hour dietary recall and two groups of LNED foods were defined, namely SSBs and solid LNED foods. RESULTS Children from intervention group reported a reduction whereas the control group reported an increase in solid LNED foods consumption. The odds of increasing solid LNED foods consumption was 0.48, 95%CI (0.24, 0.95) in the intervention schools. CONCLUSION Our study provides further support for the success of intervention programs aimed at limiting the consumption of solid LNED foods in children.

Assessing asthma control: questionnaires and exhaled nitric oxide provide complementary information

To the Editor: Current asthma guidelines propose the use of quantitative composite measures of asthma control for assessment and follow-up 1. The use of inflammatory markers within the definition of control in asthma guidelines has been recently suggested 2. Sputum eosinophilia has been proposed as a useful surrogate marker of airway inflammation 3 but it is time-consuming and unfeasible in many clinical settings. In contrast, exhaled nitric oxide fraction ( F eNO) is easily measured, well correlated with eosinophilic airway inflammation 4 and has been used in routine asthma care 5. However, to be included in the assessment of asthma control it should provide additional information. Factor analysis is a statistical method used to uncover which sets of variables form coherent subsets that are relatively independent of one another, and to obtain a small number of factors …

Dietary inflammatory index and inflammatory biomarkers in adolescents from LabMed physical activity study

Background/objectivesThe dietary inflammatory index (DII) is a tool to measure the diet’s inflammatory potential and has been used with adults to predict low-grade inflammation. The present study aims to assess whether this dietary score predicts low-grade inflammation in adolescents.Subjects/methodsThe sample comprises 329 adolescents (55.9% girls), aged 12–18 years, from LabMed Physical Activity Study. DII score was calculated based on a food-frequency questionnaire and categorized into tertiles. We collected blood samples to determine the follow inflammatory biomarkers: C-reactive protein (CRP), interleukin-6 (IL-6), complement component 3 (C3), and 4 (C4). In addition we calculated an overall inflammatory biomarker score. Odds ratios (OR) and 95% confidence intervals (95%CI) were computed from binary logistic regression models.ResultsDII score, comparing first with third tertile, was positively associated with IL-6 in crude model (OR = 1.88, 95%CI:1.09–3.24, ptrend = 0.011) and in fully adjusted (for biological and lifestyle variables) (OR = 3.38, 95%CI:1.24–9.20, ptrend = 0.023). Also, DII score was positively associated with C4, when fully adjusted (OR = 3.12, 95%CI:1.21–8.10, ptrend = 0.016). DII score was negatively associated with C3 in crude model, comparing first with second but not with third tertile, and no significant associations in fully adjusted model were observed, although a trend was found (OR = 1.71, 95%CI:0.63–4.66, ptrend = 0.044). No significant associations were observed between DII score and CRP. However, DII score was positively associated with the overall inflammatory biomarker score, when fully adjusted (OR = 5.61, 95%CI:2.00–15.78, ptrend = 0.002).ConclusionsDII score can be useful to assess the diet’s inflammatory potential and its association with low-grade inflammation in adolescents.