Is asthma prevention possible with dietary manipulation?
What we know: Primary prevention of asthma should be possible because the recent increase in asthma is due to environmental factors. The major modifiable dietary environmental risk factors for childhood asthma are lack of breastfeeding and low intake of omega-3 fatty acids. Randomised controlled trials (RCTs) have shown that interventions using probiotics, hydrolysed milk formulas, and combined dietary manipulation plus airborne allergen avoidance reduce asthma and/or atopy in newborns. Observational studies have shown a 30%-50% reduction in childhood asthma with exclusive breastfeeding for three months, and similar reductions in children who eat fish regularly (ie, have a high intake of omega-3 fatty acids). What we need to know: Will further RCTs using intervention with probiotics reveal identifiable subgroups of children who respond and children who do not respond? Will supplementation of the diet with omega-3 oil reduce the rate of significant clinical atopic disease, particularly asthma? If so, for how long will supplements need to be given? Will effective primary prevention require multiple intervention strategies? If so, how feasible are these as public health interventions? What are the benefits and harms of allergen-avoidance diets in high-risk women who are breastfeeding? Can protein hydrolysate formulas reduce rates of atopy and/or asthma?
Mellis
Craig M
CM
Department of Clinical Epidemiology, The Children's Hospital at Westmead, NSW. craigm@chw.edu.au
D000485:Allergens; D001249:Asthma / Q000517:prevention & control*; D001942:Breast Feeding; D002648:Child; D002675:Child, Preschool; D004032:Diet; D004781:Environmental Exposure; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D006801:Humans; D006969:Hypersensitivity, Immediate; D007223:Infant; D019936:Probiotics; D016032:Randomized Controlled Trials as Topic
D000485:Allergens; D015525:Fatty Acids, Omega-3