Weight Status and Respiratory Health in Asthmatic Children

In this study,we explored the effect of adiposity as measured by BMI on lung function in 72 asthmatic school children (5–12 years) using baseline data from the Mediterranean diet enriched with fatty fish intervention study. Bronchial function was assessed using spirometry and fractional exhaled nitric oxide (FeNO). BMI categories were classified as normal and overweight/obese based on International Obesity Task Force cut-offs. Weak correlations were observed between BMI and FVC (p = 0.013) and FEV1 (p = 0.026). Median FeNO was lower in the overweight/obese as compared to normal weight group (p = 0.027). Linear regression showed an increment in FEF25–75% in the overweight/obese group as compared to normal weight after controlling for confounders namely age, height, sex, regular physical activity, medication and KIDMED score (p = 0.043; β = 11.65 units, 95% CI 0.36–22.94), although with no effect on FeNO. In conclusion, the findings of this study suggest that excess body weight could impact pulmonary dynamics in childhood asthma. © 2019, Springer Science+Business Media, LLC, part of Springer Nature

Weight status and respiratory health in asthmatic children

In this study,we explored the effect of adiposity as measured by BMI on lung function in 72 asthmatic school children (5–12 years) using baseline data from the Mediterranean diet enriched with fatty fish intervention study. Bronchial function was assessed using spirometry and fractional exhaled nitric oxide (FeNO). BMI categories were classified as normal and overweight/obese based on International Obesity Task Force cut-offs. Weak correlations were observed between BMI and FVC (p = 0.013) and FEV1 (p = 0.026). Median FeNO was lower in the overweight/obese as compared to normal weight group (p = 0.027). Linear regression showed an increment in FEF25–75% in the overweight/obese group as compared to normal weight after controlling for confounders namely age, height, sex, regular physical activity, medication and KIDMED score (p = 0.043; β = 11.65 units, 95% CI 0.36–22.94), although with no effect on FeNO. In conclusion, the findings of this study suggest that excess body weight could impact pulmonary dynamics in childhood asthma

Urinary organic acids as biomarkers in the assessment of pulmonary function in children with asthma

Childhood asthma prevalence continues to rise despite advancements in prevention and medical management strategies. The purpose of this study was to investigate correlations between urinary organic acids and pulmonary diagnostic tests, asthma control in Greek asthmatic children. We hypothesized that urinary organic acids are positively associated with poor pulmonary function in children with asthma. Seventy-two children, 5 to 12 years old with asthma were recruited from a pediatric asthma clinic in Athens, Greece. Pulmonary function was assessed using spirometry and exhaled nitric oxide analysis. Asthma control was measured qualitatively using the Asthma Control Questionnaire. Targeted metabolomic analysis of 34 urinary organic acids in children was conducted by gas chromatography–mass spectrometry. A statistically significant difference between girls and boys was found for asthma control score (P =.02), lactic acid (P =.03), but not for any other organic acids (P >.05). Statistically significant correlations were found between lactic acid and Forced Expiratory Volume in 1 second (FEV1) (P =.02), Forced Vital Capacity (FVC) (P =.03); 4- hydroxyphenylacetic acid and FEV1 (P =.01), FVC (P =.01); 5-hydroxyindoleacetic acid and FEV1/FVC (P =.03), eNO (P =.05); glycolic acid with Peak Expiratory Flow (PEF) (P =.03); and malic acid with asthma control (P =.02). In conclusion, metabolomics was used to determine correlations between urinary organic acids and conventional pulmonary diagnostic tests in Greek asthmatic children. Metabolomics could be a promising approach for asthma research and in detection of novel biomarkers for asthma monitoring and therapeutic targets for childhood asthma. This study contributes towards a better understanding of the biochemical pathways involved in asthma. © 2018 Elsevier Inc

Sufficient vitamin D status positively modified ventilatory function in asthmatic children following a Mediterranean diet enriched with fatty fish intervention study

Asthma in children is the most prevalent allergic disease worldwide that has become a major public health priority. The objective of this study was to examine the relationship between baseline serum vitamin D status, spirometry, and fractional exhaled nitric oxide levels (FeNO) in 64 Greek children with ‘mild asthma’ aged 5 to 12 years (51.6% male) in a dietary intervention study. We hypothesized that baseline serum vitamin D levels modify the beneficial response of fatty fish intake on pulmonary function in asthmatic children following a Mediterranean diet. The intervention group consumed 2 fatty fish meals/week (≥150 g cooked filleted fish/meal) as part of the Mediterranean diet for six months, and the control group consumed their usual diet. Baseline serum 25(OH)D was determined using enzyme-linked immunoassay and defined as sufficient levels of 25(OH)D ≥25 ng/mL. Only 36% of children were graded as sufficient in 25(OH)D levels on entry into the study with a higher proportion of girls insufficient than boys (61% vs 39% respectively). Participants with sufficient levels of serum 25(OH)D at baseline, consuming the intervention diet increased FEV1/FVC by 4.89 units (β = 4.89; 95%CI: 1.19-8.61; p = 0.013) and FEF25-75% by 12.83 units (β = 12.83; 95%CI: 4.27-21.40; p = 0.006) compared to controls. No significant differences in pulmonary function or FeNO were observed for those with insufficient levels of 25(OH) D in the intervention or control groups. In conclusion, sufficient serum vitamin D levels enhanced ventilatory function in response to a dietary intervention in asthmatic children

Potential role of folate status on pulmonary function in pediatric asthma

Objective: The aim of this study was to explore the relationship between plasma folate status and measures of airway disease (as reflected by spirometry) in children with asthma on a traditional Mediterranean diet. We hypothesized that folate deficiency is associated with lung function impairment in this group of children. Methods: This cross-sectional study included 64 children with mild asthma (52% boys, mean age 8 ± 2 y) residing in Athens, Greece. Clinical assessments included spirometry and fractional exhaled nitric oxide (FeNO). Plasma 5-methyltetrahydrofolate (5-MTHF) was analyzed using high performance-liquid chromatography assay and examined in participants using quartiles (Q1–Q4). Results: Of the 64 children, 45.3% were folate deficient (5-MTHF <10 nmol/L). A positive relationship was observed between 5-MTHF and forced vital capacity (FVC; β = 0.79, 95% confidence interval (CI), 0.14–1.44; adjusted P = 0.019), forced expiratory volume in 1s (FEV1) (β = 0.78; 95% CI, 0.01–1.55; adjusted P = 0.046), and peak expiratory flow (PEF; β = 1.64; 95% CI, 0.14–3.15; adjusted P = 0.033) in girls only, adjusting for body mass index and regular exercise. Girls with low plasma folate concentrations (Q1), compared with girls with high concentrations (Q4) had 8.64% lower FVC (β = –8.64; 95% CI, –16.18 to –1.09; adjusted P = 0.027), 10.35% FEV1 (β = –10.35; 95% CI, –18.82 to –1.89; adjusted P = 0.019), and 18.72% PEF (β = –18.72; 95% CI, –36.30 to –1.14; adjusted P = 0.038). Conclusion: The findings of this study highlighted the potential negative effects of folate deficiency on pulmonary function in girls with asthma, the importance of monitoring folate status in children with asthma, and early prevention strategies. © 2021 Elsevier Inc

Sufficient vitamin D status positively modified ventilatory function in asthmatic children following a Mediterranean diet enriched with fatty fish intervention study

Asthma in children is the most prevalent allergic disease worldwide that has become a major public health priority. The objective of this study was to examine the relationship between baseline serum vitamin D status, spirometry, and fractional exhaled nitric oxide levels (FeNO) in 64 Greek children with ‘mild asthma’ aged 5 to 12 years (51.6% male) in a dietary intervention study. We hypothesized that baseline serum vitamin D levels modify the beneficial response of fatty fish intake on pulmonary function in asthmatic children following a Mediterranean diet. The intervention group consumed 2 fatty fish meals/week (≥150 g cooked filleted fish/meal) as part of the Mediterranean diet for six months, and the control group consumed their usual diet. Baseline serum 25(OH)D was determined using enzyme-linked immunoassay and defined as sufficient levels of 25(OH)D ≥25 ng/mL. Only 36% of children were graded as sufficient in 25(OH)D levels on entry into the study with a higher proportion of girls insufficient than boys (61% vs 39% respectively). Participants with sufficient levels of serum 25(OH)D at baseline, consuming the intervention diet increased FEV1/FVC by 4.89 units (β = 4.89; 95%CI: 1.19-8.61; p = 0.013) and FEF25-75% by 12.83 units (β = 12.83; 95%CI: 4.27-21.40; p = 0.006) compared to controls. No significant differences in pulmonary function or FeNO were observed for those with insufficient levels of 25(OH) D in the intervention or control groups. In conclusion, sufficient serum vitamin D levels enhanced ventilatory function in response to a dietary intervention in asthmatic children. © 202

Efficacy of a Mediterranean diet supplemented with fatty fish in ameliorating inflammation in paediatric asthma: a randomised controlled trial

Background: Childhood asthma is the most common respiratory disorder worldwide, being associated with increased morbidity and a decreased quality of life. Omega-3 fatty acids have anti-inflammatory and immunomodulating properties; however, their efficacy in asthma is controversial. The present study aimed to examine the efficacy of a Mediterranean diet supplemented with a high omega-3 ‘fatty’ fish intake in Greek asthmatic children. Methods: A single-centred, 6-month, parallel randomised controlled trial compared the consumption of a Mediterranean diet supplemented with two meals of 150 g of cooked fatty fish weekly (intervention) with the usual diet (control) with respect to pulmonary function in children (aged 5–12 years) with mild asthma. Pulmonary function was assessed using spirometry and bronchial inflammation by fractional exhaled nitric oxide analysis. Results: Sixty-four children (52% male, 48% female) successfully completed the trial. Fatty fish intake increased in the intervention group from 17 g day −1 at baseline to 46 g day −1 at 6 months (P < 0.001). In the unadjusted analysis, the effect of the intervention was of borderline significance (P = 0.06, β = −11.93; 95% confidence interval = −24.32 to 0.46). However, after adjusting for age, sex, body mass index and regular physical activity, a significant effect was observed (P = 0.04, β = −14.15 ppb; 95% confidence interval = −27.39 to −0.91). No difference was observed for spirometry, asthma control and quality of life scores. Conclusions: A Mediterranean diet supplemented with two fatty fish meals per week might be a potential strategy for reducing airway inflammation in childhood asthma. Future robust clinical trials are warranted to replicate and corroborate these findings. © 2018 The British Dietetic Association Ltd

Application of metabolomics in pediatric asthma: Prediction, diagnosis and personalized treatment

Asthma in children remains a significant public health challenge affecting 5–20% of children in Europe and is associated with increased morbidity and societal healthcare costs. The high varia-tion in asthma incidence among countries may be attributed to differences in genetic susceptibility and environmental factors. This respiratory disorder is described as a heterogeneous syndrome of multiple clinical manifestations (phenotypes) with varying degrees of severity and airway hyper-responsiveness, which is based on patient symptoms, lung function and response to pharmacotherapy. However, an accurate diagnosis is often difficult due to diversities in clinical presentation. Therefore, identifying early diagnostic biomarkers and improving the monitoring of airway dysfunction and inflammatory through non-invasive methods are key goals in successful pediatric asthma manage-ment. Given that asthma is caused by the interaction between genes and environmental factors, an emerging approach, metabolomics—the systematic analysis of small molecules—can provide more insight into asthma pathophysiological mechanisms, enable the identification of early biomarkers and targeted personalized therapies, thus reducing disease burden and societal cost. The purpose of this review is to present evidence on the utility of metabolomics in pediatric asthma through the analysis of intermediate metabolites of biochemical pathways that involve carbohydrates, amino acids, lipids, organic acids and nucleotides and discuss their potential application in clinical practice. Also, current challenges on the integration of metabolomics in pediatric asthma management and needed next steps are critically discussed. © 2021 by the authors. Licensee MDPI, Basel, Switzerland