Associate editor: Paul Foster
Diet and asthma — Can you change what you or your children are by changing what you eat?

https://doi.org/10.1016/j.pharmthera.2009.02.001Get rights and content

Abstract

In this review we focus on dietary fat content and subsequent effects on asthma. According to the World Health Organisation over 300 million people currently have asthma. The majority of asthma cases are ‘extrinsic’ and result from inappropriate ‘allergic’ immune responses to inhaled environmental substances. Whilst some individuals are allergic to particular food components it is becoming clear that the content of the diet can more generally affect the health of the immune system. Components of maternal and early life diets have been reported to influence offspring immune function and asthma. There has been speculation that different types of dietary fat have pro- and anti-inflammatory effects but the results of various studies are contradictory. Asthma and obesity are two conditions that have almost simultaneously reached epidemic levels in some societies. There is evidence that diet-induced obesity alters immune function and there is little doubt that consumption of a high caloric diet with high fat content leads to obesity. However, there is conflicting information over whether and how obesity is linked to asthma in children and adults. Whilst obesity is to be avoided there is accumulating evidence that dietary fat per se does not necessarily predispose towards allergic symptoms.

Section snippets

Introduction on diet and asthma

At some level we all accept that ‘we are what we eat’. Parents are encouraged to feed their children a ‘good balanced diet’ and pregnant women are encouraged to ‘eat healthily’. However, formulating these concepts into scientifically testable hypotheses and proving that individual constituents of diet can have profound long-term effects on health outcomes is far from trivial. There is little argument that diet affects health but there is controversy over what constitutes a healthy diet. Dietary

Obesity and asthma

Obesity has also increased dramatically in many societies in the last few decades. There have been a variety of studies linking obesity and asthma but the data is inconsistent and it remains unclear whether any association is causal (Sin and Sutherland, 2008, Sutherland, 2008, Berntsen et al., 2009). Obesity has been linked to decreased lung function (Li et al., 2003, Wannamethee et al., 2005, Lin et al., 2006, Boran et al., 2007, Koziel et al., 2007) and asthma in human (Thomsen et al., 2005,

Obesity and immunological health

Obesity has been well studied in rodents (Tschop & Heiman, 2001) and high fat diet-induced obesity has been linked to pathological metabolic changes particularly metabolic syndrome (Langley-Evans et al., 2005, Shankar et al., 2008). It is now well established that obesity also changes immune function. Diet-induced obesity has been linked with increased Th1 activity in mice (Rocha et al., 2008, Johnston et al., 2008) and obesity is reported to induce a low grade pro-inflammatory state within

High-fat diet and immunological health

Despite all the work on obesity and inflammation, there are only a few studies on effects of high-fat diet on immune responses and inflammation in the absence of obesity. Puertollano et al. (Puertollano et al., 2005) showed increased serum TNF- in L. monocytogenes infected mice fed high-fat diet for 4 weeks, although no data regarding weight change is given.

Dietary fat content and fatty acid constituents have been directly linked to allergy in some but not all published studies and links to

Maternal diet can ‘programme’ offspring health

Environmental signals during prenatal development often produce structural and functional effects that persist for the lifespan. Such effects are commonly dubbed fetal ‘programming’. Studies of fetal programming could potentially explain human epidemiological findings indicating that low birth weight and other markers of an adverse intrauterine environment associate with a substantially greater incidence of cardiovascular, metabolic and neuroendocrine disorders in later life (Hales and Barker,

Programming of immune responses

Evidence is also accumulating for a role of the in utero environment in development and programming of the immune system (e.g. (Brooks et al., 2001, Kiechl-Kohlendorfer et al., 2007). Cord blood cytokines, number of IL-13 positive T cells and IgE levels (which are indicative of an allergic response) are shown to be predictors of acute lower respiratory illnesses and of risk for atopic disorders in infants (Spinozzi et al., 2001, Ly et al., 2007, Scirica et al., 2007). Low parity, febrile

Obese pregnancies and offspring immunological health

If a woman is obese during pregnancy then her child has an increased risk of becoming obese (Epstein et al., 2000, Caluwaerts et al., 2007) as well as of developing childhood asthma (Epstein et al., 2000) and eczema (Kusunoki et al., 2008). A recent study showed that not only cord blood cytokines but also adipokines, cytokines known to be produced by adipose tissue, and which are increased in obesity, were correlated with risk of early life wheezing (Rothenbacher et al., 2007). Together, these

Fatty acids during pregnancy

Various publications show no effects of n-3 LCPUFAs early in life in reducing allergies (Prescott et al., 2007, Prescott and Dunstan, 2007). There is some preliminary evidence to suggest fish oil supplementation of maternal diet may reduce allergies in the offspring (Prescott et al., 2007, Prescott and Dunstan, 2007). One study reported that eating fish (which contain high levels of omega 3 fatty acids) and apples during pregnancy was associated with less allergy and asthma in children at

TLR-4 signalling—a potential mechanism for fat induced changes in immunity?

Why obesity should induce a pro-inflammatory state is not clear. Neither dietary fat nor adipose tissue contain any obvious ‘danger’ signals. However, it has been reported that long-chain saturated fatty acids can activate TLR-4 signalling leading to local cytokine release (Weatherill et al., 2005, Nguyen et al., 2007, Milanski et al., 2009). In contrast 'omega 3' fatty acid (the n-3 polyunsaturated fatty acid docosahexaenoic acid) inhibited TLR-4 mediated innate immune responses. It has been

Future perspectives

To improve child health and reduce future health care costs it would be beneficial to undertake longitudinal, epidemiological studies in human populations to investigate effects of dietary fat on the risk of developing asthma. It is equally important to establish whether or not programming of the fetal immune system in obese pregnancies affects the risk of developing allergies/wheezing in early and/or adult life. Delineation of relevant immune changes in human lean and obese pregnancies may

References (99)

  • LarcheM.

    Regulatory T cells in allergy and asthma

    Chest

    (2007)
  • MarksG.B. et al.

    Prevention of asthma during the first 5 years of life: A randomized controlled trial

    J Allergy Clin Immunol

    (2006)
  • MitoN. et al.

    Effect of diet-induced obesity on ovalbumin-specific immune response in a murine asthma model

    Metabolism

    (2002)
  • NguyenM.T. et al.

    A subpopulation of macrophages infiltrates hypertrophic adipose tissue and is activated by FFAS via TLR2, TLR4 and JNK-dependent pathways

    J BiolChem

    (2007)
  • PondC.M. et al.

    The activation of the adipose tissue associated with lymph nodes during the early stages of an immune response

    Cytokine

    (2002)
  • SciricaC.V. et al.

    Predictors of cord blood IgE levels in children at risk for asthma and atopy

    J Allergy ClinImmunol

    (2007)
  • SutherlandE.R.

    Obesity and asthma after period

    Immunol Allergy Clin North Am

    (2008)
  • ThomsenS.F. et al.

    The incidence of asthma in young adults

    Chest

    (2005)
  • WannametheeS.G. et al.

    Body fat distribution, body composition, and respiratory function in elderly men

    Am J Clin Nutr

    (2005)
  • WijgaA.H. et al.

    Breast milk fatty acids and allergic disease in preschool children: The Prevention and Incidence of Asthma and Mite Allergy Birth Cohort Study

    J Allergy Clin Immunol

    (2006)
  • WomackJ. et al.

    Obesity and immune cell counts in women

    Metabolism

    (2007)
  • AndersonH.R. et al.

    Trends in prevalence of symptoms of asthma, hay fever, and eczema in 12–14 year olds in the British Isles, 1995–2002: questionnaire survey

    BMJ

    (2004)
  • AstrupA.

    Healthy lifestyles in Europe: Prevention of obesity and type II diabetes by diet and physical activity

    Public Health Nutr

    (2001)
  • AstrupA.

    The role of dietary fat in obesity

    Semin Vasc Med

    (2005)
  • AstrupA. et al.

    Nutrition transition and its relationship to the development of obesity and related chronic diseases

    Obes Rev

    (2008)
  • BarkerD.J.

    The fetal origins of type 2 diabetes mellitus

    Ann Intern Med

    (1999)
  • BarkerD.J.

    In utero programming of chronic disease

    Clin Sci (Lond)

    (1998)
  • BarnesP.J.

    Immunology of asthma and chronic obstructive pulmonary disease

    Nat Rev Immunol

    (2008)
  • BastardJ.P. et al.

    Recent advances in the relationship between obesity, inflammation, and insulin resistance

    Eur Cytokine Netw

    (2006)
  • BedfordP.A. et al.

    Adipose tissue of human omentum is a major source of dendritic cells, which lose MHC Class II and stimulatory function in Crohn's disease

    J LeukocBiol

    (2006)
  • BerntsenS. et al.

    Norwegian adolescents with asthma are physical active and fit

    Allergy

    (2009)
  • BlackP.N. et al.

    Dietary fat and asthma: Is there a connection?

    Eur Respir J

    (1997)
  • BolteG. et al.

    Margarine consumption and allergy in children

    Am J Respir Crit Care Med

    (2001)
  • BoranP. et al.

    Impact of obesity on ventilatory function

    J Pediatr (Rio J)

    (2007)
  • BrandacherG. et al.

    Chronic immune activation underlies morbid obesity: Is IDO a key player?

    Curr Drug Metab

    (2007)
  • BrooksA.M. et al.

    Impact of low birth weight on early childhood asthma in the United States

    Arch Pediatr Adolesc Med

    (2001)
  • BurrM.L. et al.

    Asthma prevalence in 1973, 1988 and 2003

    Thorax

    (2006)
  • Buske-KirschbaumA. et al.

    Blunted cortisol responses to psychosocial stress in asthmatic children: A general feature of atopic disease?

    Psychosom Med

    (2003)
  • CalabroP. et al.

    Obesity, inflammation, and vascular disease: The role of the adipose tissue as an endocrine organ

    Subcell Biochem

    (2007)
  • CurhanG.C. et al.

    Birth weight and adult hypertension, diabetes mellitus, and obesity in US men

    Circulation

    (1996)
  • DaniltchenkoM. et al.

    Allergic dermatitis is aggravated by stress and alters the hypothalamic stress-response in mice

    J Invest Dermatol Meeting Abstract

    (2005)
  • De Vries, A., Hazlewood, L., Fitch, P.M., Seckl, J.R., Foster, P., & Howie, S.E., (2009). High-fat feeding redirects...
  • de VriesA. et al.

    Prenatal dexamethasone exposure induces changes in nonhuman primate offspring cardiometabolic and hypothalamic–pituitary–adrenal axis function

    J Clin Invest

    (2007)
  • DelgadoJ. et al.

    Obesity and asthma

    J Investig Allergol Clin Immunol

    (2008)
  • EliakimA. et al.

    Reduced tetanus antibody titers in overweight children

    Autoimmunity

    (2006)
  • EnkeU. et al.

    Impact of PUFA on early immune and fetal development

    Br J Nutr

    (2008)
  • EpsteinL.H. et al.

    Asthma and maternal body mass index are related to pediatric body mass index and obesity: Results from the Third National Health and Nutrition Examination Survey

    Obes Res

    (2000)
  • GilA. et al.

    Altered signalling and gene expression associated with the immune system and the inflammatory response in obesity

    Br J Nutr

    (2007)
  • HalesC.N. et al.

    Type 2 (non-insulin-dependent) diabetes mellitus: The thrifty phenotype hypothesis

    Diabetologia

    (1992)
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