Global food environments affect asthma disease burden
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Key takeaways:
- A higher fat to carbohydrate ratio decreased asthma prevalence.
- There were no differences between plant-based and animal-based fat.
- Authors call for further study into macronutrient supply and asthma.
Macronutrient supply and socioeconomic status are emerging confounding variables for asthma, according to an analysis published in The European Journal of Allergy and Clinical Immunology.
Using generalized additive mixed models, analyses showed that carbohydrate supply was the most strongly associated with increases in asthma prevalence rates, whereas fat supply had the opposite effect, Duan Ni, BSc, a PhD student at Nepean Clinical School, Sydney Medical School, The University of Sydney, and colleagues wrote.
Data was used from 2018 to systematically review the relationship between macronutrient supply (protein, carbohydrate and fat), proxy of food environment, socioeconomic status, and asthma disease burden on a global scale over time.
The analysis found that gross domestic product per capita increased while the global nutritional landscape has also changed, increasing macronutrient supplies, most noticeably fat, when shown parallel to asthma burden.
In the modeling, researchers predicted association between asthma prevalence and macronutrient supplies using response surfaces on macronutrient supply plots. While focusing on fat and carbohydrate supplies, the researchers held protein at 25%, 50% and 75% quantiles of global supply.
Modeling showed carbohydrate supply to be associated with increased asthma prevalence. Increasing the fat to carbohydrate ratio in the modeling decreased overall asthma prevalence. The effect of protein only showed a mild fluctuation across low, medium and high protein supplies.
Similar patterns were observed for asthma incidences and were deemed to be not confounded by total macronutrient energy supply. No difference was found between plant-based or animal-based fat; however, extremely high or low animal-based protein appeared to demonstrate higher asthma burden.
The researchers emphasized that their results show a significant role in carbohydrate supply on asthma disease burden and how this analytical framework should instruct further asthma research and public health policymaking.
Also, the researchers drew attention to further investigation, as the sources of macronutrients were not considered in this study, adding that in future analyses, other factors such as ancestry/ethnicity, physical activity, sleep, dietary patterns and qualities should be considered.
Perspective
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I think that these findings are interesting, more than anything. To state significance, further studies would need to be extrapolated confirming the relationship between macronutrient intakes, specifically carbohydrate intakes, with relation to asthma prevalence.
To be honest, I have not experienced or observed this in my practice as a registered dietitian nutritionist (RDN) providing nutritional counseling, which is my main line of work. I do recall from my experience as a critical care RDN in an acute care setting for several years that excessive carbohydrate intake from enteral nutrition sources, specifically, would occasionally impede the ability of intubated patients to be weaned from their ventilators. This experience does not necessarily relate to asthma prevalence, but it is pertinent to respiratory quotients and functions within the critical care setting and needs to be considered in that area of practice.
I think that my recommendations for these patients would be similar to those for individuals seeking information for general health and wellness: a mostly plant-based diet rich in a variety of fruit and vegetables, with the inclusion of fish, poultry, cheese and eggs in moderation. This dietary approach has been studied and proven to provide nutrients necessary to support gut health, inflammation and the prevention of chronic disease.
The most obvious next step in my opinion would be to design and conduct high quality randomized, placebo-controlled clinical trials with human subjects, assessing the impact of macronutrient intakes with asthma prevalence. I do believe that these types of studies should be carried out in different parts of the world to be able to associate socioeconomic status and perhaps even gross domestic product.
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