Abstract
PurposeThe impact of a healthy diet on asthma prevention and management, particularly among elderly women, remains poorly understood. We investigated whether a healthy diet would be associated with fewer asthma symptoms, and, among women with asthma, with reduced uncontrolled asthma and metabolic-related multimorbidity.MethodsWe included 12,991 elderly women (mean age = 63 years) from the Asthma-E3N study, a nested case–control study within the French E3N cohort. Negative binomial regressions were used to analyse associations between a healthy diet [evaluated by the Alternate Healthy Eating Index-2010 (AHEI-2010)] and a validated asthma symptom score, and logistic regressions to analyse associations between the AHEI-2010 with the asthma control test and multimorbidity profiles previously identified by clustering methods on medications used.ResultsAfter adjustment for potential confounders, a linear inverse association was found between the AHEI-2010 score and the asthma symptom score [mean score ratio (95% CI) = 0.82 (0.75–0.90) for the highest versus lowest quintile; p for trend < 0.0001]. In addition, women in the highest versus lowest AHEI-2010 tertile were at a lower risk to belong to the “Predominantly metabolic multimorbidity-related medications profile” compared to the “Few multimorbidity-related medications" profile [OR 0.80 (0.63–1.00) for tertile 3; p for trend = 0.05; n = 3474].ConclusionOur results show that a healthy dietary intake could play an important role in the prevention and management of asthma over the life course.
Highlights
As recently underlined in the Lancet [1], given the immense societal and individual burden of asthma, there is an urgent need to further develop novel strategies to limit the disease and its consequences
After stratification for smoking (Fig. 4), similar associations were reported between the AHEI-2010 and multimorbidity-related medication profiles among never and ever smokers, with no interaction between the AHEI-2010 and the smoking status (p = 0.29 for the allergic profile, and 0.23 for the metabolic profile). In this large study of more than 12,000 elderly women, a stronger adherence to a healthy diet evaluated by the AHEI2010 was associated with a lower asthma symptom score, and among women with asthma, with disease characteristics associated with better asthma prognosis
These findings strengthen evidence supporting the promotion of a healthy diet to target reduction in asthma respiratory symptoms among elderly women, and confirm the importance of considering diet in the relation between asthma and comorbidities, especially cardiovascular diseases
Summary
As recently underlined in the Lancet [1], given the immense societal and individual burden of asthma, there is an urgent need to further develop novel strategies to limit the disease and its consequences. The main objective of asthma management, remains suboptimal in roughly one asthma patient out of two, with even higher rates among women [2, 3]. In this context, investigating the role of modifiable lifestyle factors such as diet is key for the primary and secondary prevention of this highly prevalent disease. Obesity is an established risk factor for asthma [10, 11], with recent studies supporting the hypothesis that obesity is causally related to asthma [12], and with a higher risk in elderly women as compared to men [13]. Allergic rhinitis, chronic obstructive pulmonary disease (COPD), gastroesophageal reflux, and sleep apnoea syndrome that are the most common asthma-related multimorbidities, recent studies have suggested that other chronic conditions such as cardiovascular diseases (CVD), metabolic syndrome, or type 2 diabetes mellitus are involved [14]
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