Maternal iron status during pregnancy and respiratory and atopic outcomes in the offspring: a Mendelian randomisation study.

INTRODUCTION: Limited evidence from birth cohort studies suggests that lower prenatal iron status may be a risk factor for childhood respiratory and atopic outcomes, but these observational findings may be confounded. Mendelian randomisation (MR) can potentially provide unconfounded estimates of causal effects by using common genetic variants as instrumental variables. We aimed to study the relationship between prenatal iron status and respiratory and atopic outcomes in the offspring using MR. METHODS: In the Avon Longitudinal Study of Parents and Children birth cohort, we constructed four maternal genotypic risk scores by summing the total number of risk alleles (associated with lower iron status) across single nucleotide polymorphisms known to be associated with at least one of four iron biomarkers (serum iron, ferritin, transferrin and transferrin saturation). We used MR to study their associations with respiratory and atopic outcomes in children aged 7-9 years (n=6002). RESULTS: When analyses were restricted to mothers without iron supplementation during late pregnancy, negative associations were found between the maternal transferrin saturation score and childhood forced expiratory volume in 1 s and forced vital capacity (difference in age, height and gender-adjusted SD units per SD increase in genotypic score: -0.05 (-0.09, -0.01) p=0.03, and -0.04 (-0.08, 0.00) p=0.04, respectively). CONCLUSION: Using MR we have found weak evidence suggesting that low maternal iron status during pregnancy may cause impaired childhood lung function

Maternal intake of sugar during pregnancy and childhood respiratory and atopic outcomes.

The possible role of maternal consumption of free sugar during pregnancy in the inception of respiratory and atopic diseases has not been studied. We aimed to study the relationship between maternal intake of free sugar during pregnancy and respiratory and atopic outcomes in the offspring in a population-based birth cohort, the Avon Longitudinal Study of Parents and Children.We analysed associations between maternal intake of free sugar in pregnancy (estimated by a food frequency questionnaire), and current doctor-diagnosed asthma, wheezing, hay fever, eczema, atopy, serum total IgE and lung function in children aged 7-9 years (n=8956 with information on maternal diet in pregnancy and at least one outcome of interest).After controlling for potential confounders, maternal intake of free sugar was positively associated with atopy (OR for highest versus lowest quintile of sugar intake 1.38, 95% CI 1.06-1.78; per quintile p-trend=0.006) and atopic asthma (OR 2.01, 95% CI 1.23-3.29; per quintile p-trend=0.004). These associations were not confounded by intake of sugar in early childhood, which was unrelated to these outcomes.Our results suggest that a higher maternal intake of free sugar during pregnancy is associated with an increased risk of atopy and atopic asthma in the offspring, independently of sugar intake in early childhood.The UK Medical Research Council, the Wellcome Trust (Grant 102215/2/13/2) and the University of Bristol currently provide core support for the Avon Longitudinal Study of Parents and Children. A. Bédard is funded by a European Respiratory Society Long-Term Research Fellowship (LTRF 2015-5838). K. Northstone is supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Foundation Trust. Funding information for this article has been deposited with the Crossref Funder Registr

Validity, reliability, and responsiveness of daily monitoring visual analog scales in MASK‐air®

Background: MASK-air® is an app that supports allergic rhinitis patients in disease control. Users register daily allergy symptoms and their impact on activities using visual analog scales (VASs). We aimed to assess the concurrent validity, reliability, and responsiveness of these daily VASs. Methods: Daily monitoring VAS data were assessed in MASK-air® users with allergic rhinitis. Concurrent validity was assessed by correlating daily VAS values with those of the EuroQol-5 Dimensions (EQ-5D) VAS, the Control of Allergic Rhinitis and Asthma Test (CARAT) score, and the Work Productivity and Activity Impairment Allergic Specific (WPAI-AS) Questionnaire (work and activity impairment scores). Intra-rater reliability was assessed in users providing multiple daily VASs within the same day. Test–retest reliability was tested in clinically stable users, as defined by the EQ-5D VAS, CARAT, or “VAS Work” (i.e., VAS assessing the impact of allergy on work). Responsiveness was determined in users with two consecutive measurements of EQ-5D-VAS or “VAS Work” indicating clinical change. Results: A total of 17,780 MASK-air® users, with 317,176 VAS days, were assessed. Concurrent validity was moderate–high (Spearman correlation coefficient range: 0.437–0.716). Intra-rater reliability intraclass correlation coefficients (ICCs) ranged between 0.870 (VAS assessing global allergy symptoms) and 0.937 (VAS assessing allergy symptoms on sleep). Test–retest reliability ICCs ranged between 0.604 and 0.878—“VAS Work” and “VAS asthma” presented the highest ICCs. Moderate/large responsiveness effect sizes were observed—the sleep VAS was associated with lower responsiveness, while the global allergy symptoms VAS demonstrated higher responsiveness. Conclusion: In MASK-air®, daily monitoring VASs have high intra-rater reliability and moderate–high validity, reliability, and responsiveness, pointing to a reliable measure of symptom loads

The ARIA-MASK-air® approach

Funding Information: The authors thank Ms Véronique Pretschner for submitting the paper. MASK‐air has been supported by Charité Universitätsmedizin Berlin, EU grants (EU Structural and Development Funds Languedoc Roussillon and Region PACA; POLLAR: EIT Health; Twinning: EIP on AHA; Twinning DHE: H2020; Catalyse: Horizon Europe) and educational grants from Mylan‐Viatris, ALK, GSK, Novartis, Stallergènes‐Greer and Uriach. None for the study. ® Publisher Copyright: © 2023 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.MASK-air®, a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK-air® is a Good Practice of DG Santé on digitally-enabled, patient-centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co-operation and Development). MASK-air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK-air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as-needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom-medication score (ARIA-EAACI-CSMS) has been validated for clinical practice and trials. The implications of the novel MASK-air® results should lead to change management in rhinitis and asthma.publishersversionpublishe

Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air (R) App

Background In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently. Methods All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated. Results A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures. Conclusions VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.Peer reviewe

Validity, reliability, and responsiveness of daily monitoring visual analog scales in MASK-air (R)

Background MASK-air (R) is an app that supports allergic rhinitis patients in disease control. Users register daily allergy symptoms and their impact on activities using visual analog scales (VASs). We aimed to assess the concurrent validity, reliability, and responsiveness of these daily VASs. Methods Daily monitoring VAS data were assessed in MASK-air (R) users with allergic rhinitis. Concurrent validity was assessed by correlating daily VAS values with those of the EuroQol-5 Dimensions (EQ-5D) VAS, the Control of Allergic Rhinitis and Asthma Test (CARAT) score, and the Work Productivity and Activity Impairment Allergic Specific (WPAI-AS) Questionnaire (work and activity impairment scores). Intra-rater reliability was assessed in users providing multiple daily VASs within the same day. Test-retest reliability was tested in clinically stable users, as defined by the EQ-5D VAS, CARAT, or "VAS Work" (i.e., VAS assessing the impact of allergy on work). Responsiveness was determined in users with two consecutive measurements of EQ-5D-VAS or "VAS Work" indicating clinical change. Results A total of 17,780 MASK-air (R) users, with 317,176 VAS days, were assessed. Concurrent validity was moderate-high (Spearman correlation coefficient range: 0.437-0.716). Intra-rater reliability intraclass correlation coefficients (ICCs) ranged between 0.870 (VAS assessing global allergy symptoms) and 0.937 (VAS assessing allergy symptoms on sleep). Test-retest reliability ICCs ranged between 0.604 and 0.878-"VAS Work" and "VAS asthma" presented the highest ICCs. Moderate/large responsiveness effect sizes were observed-the sleep VAS was associated with lower responsiveness, while the global allergy symptoms VAS demonstrated higher responsiveness. Conclusion In MASK-air (R), daily monitoring VASs have high intra-rater reliability and moderate-high validity, reliability, and responsiveness, pointing to a reliable measure of symptom loads.</p

ARIA digital anamorphosis: Digital transformation of health and care in airway diseases from research to practice

Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed

FACTEURS NUTRITIONNELS DANS L‘ASTHME

The general aim of the thesis was to assess the complex role of nutritional factors in asthma, with a first part focused on diet, and a second part focused on obesity.Diet – The objective was to compare dietary patterns based on principal component analysis (PCA) to patterns based on confirmatory factor analysis (CFA). The analysis was performed among 30,589 women from the E3N study (epidemiological cohort study among women of the Mutuelle Générale de l’Education Nationale). Whether PCA or CFA was used, 3 patterns were derived. For each pattern, we reported different correlations between food groups and dietary patterns when using PCA or CFA, leading to different associations between dietary patterns with socio-economic characteristics and adult-onset asthma.Obesity – The first objective was to assess the joint and independent, time-dependent, roles of physical activity and obesity on asthma using marginal structural models. Among 15,352 women from E3N, analyses showed that obesity was related causally to current asthma with symptoms independently of physical activity, whereas no association was reported for physical activity. The second objective was to assess the modifying role of overweight in the association between domestic exposure to cleaning sprays and current asthma. Among 304 women from E3N, analysis showed that among women without anti-inflammatory therapy, the effect of spray use on asthma was higher in overweight women.CFA should be considered for the assessment of dietary patterns in nutritional epidemiology. Obesity may lead to asthma independently of physical activity, and may increase the deleterious effect of other environmental factors of asthma.L’objectif principal de la thèse était de comprendre le rôle complexe des facteurs nutritionnels dans l’asthme, avec une première partie portant sur l’alimentation et une seconde sur l’obésité.Alimentation – L’objectif était de comparer les typologies alimentaires obtenues par une analyse en composantes principales (ACP) à celles identifiées par une analyse factorielle confirmatoire (AFC) grâce aux données de l’étude E3N (étude épidémiologique auprès des femmes de la MGEN, 30589 femmes). En utilisant les ACP et les AFC, 3 typologies alimentaires ont été identifiées. Selon la méthode, des corrélations différentes étaient observées entre les typologies alimentaires et les groupes d’aliments, conduisant à des associations différentes avec les caractéristiques socio-économiques et l’incidence de l’asthme chez l’adulte.Obésité – Le premier objectif était de comprendre les rôles conjoints et indépendants, dépendants du temps, de l’activité physique et l’obésité sur l’asthme en utilisant des modèles marginaux structuraux chez 15352 femmes d’E3N. L’obésité était liée de façon causale à l’asthme actuel avec symptômes, indépendamment de l’activité physique. Le second objectif était de considérer le rôle modificateur du surpoids dans l’association entre l’exposition domestique aux sprays de nettoyage et l’asthme chez 304 femmes d’E3N. Parmi les femmes sans traitement anti-inflammatoire, le rôle délétère de l’utilisation de sprays sur l’asthme était plus fort chez les femmes en surpoids.L’AFC devrait être utilisée pour l’identification des typologies alimentaires en épidémiologie nutritionnelle. L’obésité pourrait causer de l’asthme indépendamment de l’activité physique, et pourrait augmenter l’effet délétère d’autres facteurs environnementaux de l’asthme

Nutritional factors in asthma = Facteurs nutritionels dans l'asthme

The general aim of the thesis was to assess the role of nutritional factors in asthma in the French E3N study. The first objective was to compare principal component (PCA) with confirmatory factor analysis (CFA) to identify dietary patterns. In comparison with PCA patterns, CFA patterns were more relevant in terms of correlations with food groups and socio-economic characteristics, and associations with adult-onset asthma. The second objective was to assess the joint roles of physical activity and obesity on asthma using marginal structural models. Analyses showed that obesity was related causally to current asthma with symptoms independently of physical activity, whereas no association was reported for physical activity. The third objective was to assess the modifying role of overweight in the association between domestic cleaning spray use and current asthma. Analyses showed that among women without anti-inflammatory therapy, the effect of spray use on asthma was higher in overweight women.L’objectiu general de la tesi fou avaluar el paper dels factors nutricionals en l’asma. El primer objectiu fou comparar l’anàlisi de components principals (PCA) amb l’anàlisi factorial confirmatori (CFA) per identificar patrons de dieta. Comparat amb els patrons obtinguts amb PCA, els patrons obtinguts amb CFA mostraven major correlació amb grups d’aliments i característiques sociodemogràfiques, i aconseguien millor predicció de la incidència d’asma. El segon objectiu fou avaluar l’efecte conjunt de l’activitat física i l’obesitat en l’asma, utilitzant models marginals estructurals. Els resultats mostraren que l’obesitat es relaciona causalment amb els símptomes d’asma independentment de l’activitat física, mentre que no es va trobar cap efecte de l’activitat física. El tercer objectiu fou estudiar el paper modificador del sobrepès en l’associació entre l’ús de pulveritzadors de neteja domèstica i la presència d’asma. Les anàlisis mostraren que l’efecte de l’ús dels pulveritzadors era més gran en dones amb sobrepès i tractament antiinflamator

Potential confounders in the asthma-diet association: how causal approach could help?

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