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Fatty acids in breast milk and development of atopic eczema and allergic sensitisation in infancy
Allergy
Abstract
One of the explanations for the increasing prevalence of atopic diseases is a relative low perinatal supply of n-3 fatty acids. However, this does not explain the protective effects of whole-fat dairy products or high levels of transfatty acids in breast milk, observed in some studies. We evaluated the role of perinatal supply of fatty acids in the early development of atopic eczema and allergic sensitisation.
Fatty acids, including n-3 long-chain polyunsaturated fatty acids (LCPs) as well as ruminant fatty acids (rumenic acid, cis-9,trans-11-C18:2 conjugated linoleic acid; and vaccenic acid, trans-11-C18:1), were determined in breast milk sampled at 1 month postpartum from 310 mother-infant pairs in the KOALA Birth Cohort Study, the Netherlands. Children were followed for atopic outcomes until 2 years of age.
Higher concentrations of n-3 LCPs as well as ruminant fatty acids were associated with lower risk of (1) parent-reported eczema, (2) atopic dermatitis (UK Working Party criteria), and (3) sensitisation at age 1 year (as revealed by specific serum IgE levels to cow's milk, hen's egg and/or peanut). In multivariable logistic regression analysis, the inverse associations between ruminant fatty acid concentrations in breast milk and atopic outcomes were found to be independent from n-3 LCPs.
The results confirm a protective role of preformed n-3 LCPs in the development of atopic disease. Moreover, this is the first study in humans confirming results from animal studies of protective effects of ruminant fatty acids against the development of atopic manifestations.
... 9 By contrast, fatty acids (FAs) have been proposed to have immunoregulatory properties, and they may be important in the etiology of allergic diseases. 11,12 Previous studies have reported that increased n-3 polyunsaturated fatty acid (PUFA) levels 13,14 and decreased n-6 PUFA levels are more likely to be associated with eczema in childhood. 13 First, we investigated whether maternal allergy influences sCD14 and FA composition during different lactation stages. ...
... 4,16 Among these, 43 children who dropped out during the 2-year follow-up period; 90 children who did not regularly return for follow-up or whose parents did not complete the questionnaires; 41 infants who had a gestational age <35 weeks, any perinatal insults, or major congenital anomalies; and 140 children whose mothers did not provide HM samples or who were only partially breastfed were excluded. Furthermore, at age 2 years, 40 children with allergic disorders other than AD (allergic rhinitis: 26 and asthma: 14) were excluded because the case numbers did not provide sufficient statistical power. Finally, 443 mother-child groups (445 children, two pairs of twins) were included. ...
... Although several observational studies have indicated that n-3 and n-6 PUFA may play a role in atopic eczema development in breastfed infants and toddlers, it is worth noting that in the most updated review article, 12 only three of nine studies found decreased n-3 PUFA levels, 13,14 and one of eight studies found that increased levels of n-6 PUFA were associated with an increased risk of eczema during childhood. 14 Thus, there is insufficient evidence showing that HM PUFA influences the risk of eczema during childhood. ...
Background
This study aimed to investigate whether maternal allergy is associated with soluble CD14 (sCD14) and fatty acid composition in different stages of lactation and the onset of atopic dermatitis (AD) in early childhood.
Methods
In total, 443 mother‐child groups (445 children) were enrolled in the Prediction of Allergies in Taiwanese Children birth cohort study. Colostrum and mature milk at 2 months postpartum (2‐month HM) were collected from lactating mothers. Information regarding parental allergy histories and physician‐diagnosed atopic diseases was obtained using age‐specific questionnaires (0‐2 years). We compared sCD14 levels and the composition of 30 fatty acids in the colostrum and 2‐month HM, respectively, between allergic and non‐allergic mothers and between children with and without AD by the age of 2 years.
Results
In total, 185 (41.8%) mothers presented with allergies, and 154 (34.6%) children had physician‐diagnosed AD by the age of 2 years. Both in the colostrum and 2‐month HM of 289 lactating mothers, sCD14 levels were significantly lower in allergic mothers whose children presented with AD compared with children who did not (P = 0.015 and 0.044, respectively). Among the children with AD who were born to non‐allergic mothers, sCD14 levels were lower. However, the result was not statistically significant (P = 0.376 and 0.264, respectively). Our data revealed the lack of associations between fatty acid composition and AD (P > 0.05).
Conclusion
Decreased sCD14 levels in the colostrum and 2‐month HM were associated with AD at 2 years of age, particularly among children born to mothers with allergies.
... Despite large variations in the levels of consumption of dairy fats and fatty acids by the mother (butter: from 4 to 20 g/d; milk and milk derivatives: from 550 g to 1100 g/d), results were inconclusive for an effect on the risk of allergy and atopic diseases in infants, whereas a protective effect was noted for cow's milk allergy (Tuokkola et al., 2016). The study of the consequences of dairy food products and dairy lipid consumption by the lactating woman have been exclusively focused on the incidence of atopic diseases (Thijs et al., 2011;Lumia et al., 2012) and one study has investigated the relation with the fatty acid concentration in human milk (Thijs et al., 2011). First, compared to a population of lactating women that rarely consumed dairy fats, the daily consumption of 4 dairy products þ butter reduced significantly the breast milk contents of LA and ALA, without modifying their relative proportion (LA/ALA ratio). ...
... Despite large variations in the levels of consumption of dairy fats and fatty acids by the mother (butter: from 4 to 20 g/d; milk and milk derivatives: from 550 g to 1100 g/d), results were inconclusive for an effect on the risk of allergy and atopic diseases in infants, whereas a protective effect was noted for cow's milk allergy (Tuokkola et al., 2016). The study of the consequences of dairy food products and dairy lipid consumption by the lactating woman have been exclusively focused on the incidence of atopic diseases (Thijs et al., 2011;Lumia et al., 2012) and one study has investigated the relation with the fatty acid concentration in human milk (Thijs et al., 2011). First, compared to a population of lactating women that rarely consumed dairy fats, the daily consumption of 4 dairy products þ butter reduced significantly the breast milk contents of LA and ALA, without modifying their relative proportion (LA/ALA ratio). ...
... It also significantly increased saturated fatty acid contents as well as levels of fatty acid markers of dairy fats (vaccenic and rumenic acids). Only the study of Thijs et al. (2011), conducted on 310 mother-infant pairs, has reported a significant protective effect of dairy food consumption since the concentration of vaccenic and rumenic acids in women's milk was negatively associated with the incidence of eczema and atopic dermatosis in 2-years-old infants. Moreover, a high breast milk content of long-chain n-3 PUFA was also predictive of a lower prevalence of these two diseases. ...
During the perinatal period, maternal dietary polyunsaturated fatty acids (PUFA) ensure optimal infant development. Observational studies on cognitive and visual development reported that a specific deficit intake in n-3 PUFA in pregnant women was associated with a reduction in visual acuity in 2-months-old infants. Moreover, a low docosahexaenoic acid (DHA) content associated with a high level of n-6 PUFA in breast milk was negatively associated with the degree of cognitive development in 6-years-old children. As regards to adipose tissue development, only observational human data agree with the hypothesis that excessive dietary intakes of n-6 PUFA compared with n-3 PUFA could promote the development of adipose tissue and obesity. With regard to immune system development, observational and clinical studies suggest that long-chain n-3 PUFA consumption during pregnancy may prevent the incidence of allergic diseases in children. Lastly, specific association between the maternal ingestion of food groups and the infant health has been studied mainly on allergic outcomes (fish, dairy products). Nutritional recommendations for PUFA intake in pregnant and lactating women were mainly based on brain development data, corresponding to breast milk levels of 10% of total fatty acids for linoleic acid, 1.5% for α-linolenic acid and 0.4% for DHA.
... In addition to these another paper was captured from journal alerts. Therefore this review contains 14 papers from 11 birth cohort studies (7)(8)(9)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), with three of these cohorts (MACS (7,9), PIAMA (19,20) and Swedish cohort (23,24) generating two publications each. Two papers were from case control studies (25) (26)and two were from cross sectional studies (27,28) . ...
... Three studies measured PUFA levels in both colostrum and breast milk (7,9,17,23). Of the remaining studies, PUFA was measured either in colostrum (16,22) or breast milk (8,14,15,18,19,21,(25)(26)(27)(28) Gas chromatography was used in all of the studies to quantify fatty acids from colostrum and breast milk. The concentration of fatty acids was expressed as lipid based (% of lipids) for 16 studies (7-9, 14, 16, 18-20, 22-28), while one reported results as wet based technology (% of total weight) (17). ...
... per inter-quartile range (IQR) increase (14,18,22). Some studies provided the mean (8,16,21) or median (25) fatty acid levels between affected and unaffected groups. ...
Introduction:
Dietary poly unsaturated fatty acids (PUFA) have immune regulatory properties. Breast milk is rich in PUFA, and it has been hypothesised that these PUFAs may be important in the aetiology of allergic diseases. Despite a growing body of evidence, the associations between breast milk PUFA and allergic disease have not previously been systematically reviewed.
Methods:
The search was performed in PubMed and EMBASE databases using breastfeeding, fatty acid and allergic disease terms. Two authors were involved in selecting papers for review according to the inclusion criteria and extracting information on study characteristics and measures of association. Only studies that reported numeric associations between concentration of breast-milk fatty acids and allergic disease outcomes were included.
Results:
A total of 18 papers met the inclusion criteria, reporting results from 15 study populations. The majority were cohort studies (n=11), with data from only two case control and two cross sectional studies. Sample size varied between 30 and 352 participants and follow-up time of the cohorts varied between three months and 14 years. Nine studies reported on eczema, seven on sensitisation and only five reported on asthma/wheeze. There was heterogeneity among studies in terms of presenting the association between PUFA and allergy, therefore estimates could not be pooled. Only a few studies observed associations between n-3 and n-6 PUFAs and allergic disease, and the magnitude of this effect varied greatly.
Conclusions:
There is insufficient evidence to suggest that colostrum or breast milk poly unsaturated fatty acids influence the risk of childhood allergic diseases. This article is protected by copyright. All rights reserved.
... Higher levels of the ruminal CLA isomer and its precursor TVA in breast milk correlate with lower rates of atopic manifestations in children. Perhaps this is because these natural TFAs modulate the immune function in the human body by reducing the production of pro-inflammatory mediators [20,21]. ...
... Although these differences were not statistically significant, the authors argue that the physiological importance of these apparently moderate differences should not be underestimated. In fact, in the studied cohort, an inverse correlation was already demonstrated between the levels of CLA in the milk of participants and the presence of a pathological condition in their children (atopic diseases and eczema) [20]. ...
Maternal diet plays a significant role in the fatty acid composition of breast milk. Dietary products such as milk and meat are the primary sources of natural TFAs for humans. These peculiar fatty acids hold nutritional significance as they not only lack the detrimental effects of industrially produced trans fats on the endothelium characteristic, but they also exhibit anti-inflammatory properties. The relationship between the presence of eight fatty acids in breast milk (including natural TFAs trans-vaccenic and conjugated linoleic acid) and the maternal diet has been explored, and their abundance has been compared to that of infant formulas. Two cohorts of lactating women, originating from a Spanish region, participated in this study; they adhered to the Southern European Atlantic diet or the Atlantic diet. While the consumption of conventional meat or dairy products does not seem to increase the abundance of TFAs in breast milk, trans-vaccenic and oleic acid are among the most distinctive features of breast milk fat in mothers consuming naturally improved dairy products with an improved fatty acid profile. The most significant differences between natural breastfeeding and formula feeding lie in natural TFAs, since formulas are notably deficient in natural TFAs while being overfortified in alpha-linolenic acid in comparison to breast milk. We suggest an improvement in the formulation of these products through using cow’s milk with an optimal fatty acid profile that better mimics the fatty acid composition found in human milk.
... These are considered key elements in inflammatory processes and, as such, have been linked to atopic conditions. 7 In light of this, observational studies showed that elevated concentrations of n-3 PUFAs in human milk might protect infants from developing AD, 8,9 suggesting antiinflammatory properties of these fatty acids. 10 N-6 PUFAs, on the contrary, are suggested to be pro-inflammatory, hence, increase the risk of AD. 11 In addition, females and males are reported to differ in immunological responses which result in differential susceptibility to inflammatory and autoimmune diseases. ...
... The human milk samples and information about breastfeeding practices were collected at approximately 6 weeks (Median [minmax]; (6 weeks [4][5][6][7][8][9][10]) and 6 months (26 weeks [23][24][25][26][27][28][29])) after delivery. Using a sterile collection jar, mothers manually expressed or pumped human milk after breakfast and before lunch, between 9 AM and 12 AM, at least 1 h after the last breastfeed. ...
Background
Polyunsaturated fatty acids (PUFAs) in human milk are essential in immune system maturation and might play a role in the development of allergic conditions, such as atopic dermatitis (AD) in infants. Immune system responses are modulated by sex, but data on the sex‐specific associations with PUFAs are limited. We therefore explored sex‐specific differences in human milk PUFAs and their association with AD up to 2 years.
Methods
PUFAs were measured in human milk samples from the Ulm SPATZ Health Study at 6 weeks (n = 512) and 6 months (n = 367). Associations with AD up to 2 years were evaluated using crude and multivariable logistic regression. Interactions between infant sex and PUFAs were explored by including the product term.
Results
No significant associations were observed with 6‐week data. At 6 months, the median relative proportion of docosahexaenoic acid (DHA) was significantly higher in milk for female than male infants (p = .001). Female infants whose milk was lower in quintile proportions of alpha‐linolenic acid (ALA) at 6 months had lower odds of AD compared to males [first vs. fifth quintile OR (95% confidence interval): 0.13 (0.02, 0.66), p = .02]. This interaction was not significant when correcting for multiple testing (α threshold: p = .004). No other statistically significant associations were observed.
Conclusion
Individual quintile PUFA proportions in human milk were not associated with AD, overall and in a sex‐specific manner. More comprehensive and statistically powered longitudinal studies are needed to determine whether potential sex differences in human milk, if any, could be of clinical relevance for infants including the investigation of mediating factors.
... 10 Inconsistent results are also reported for n-6 PUFAs (including CLA, DGLA, and ARA) and atopic conditions in children. 22,24,[36][37][38] In our study, we observed that higher CLA proportions were associated with higher odds of food sensitizations in girls, which contradicts previous findings from the Dutch KOALA birth cohort study, where CLA appeared to be protective-although sexstratified analyses were not performed. 37 There is a strong rationale for studying the ratio of total and in- proportions. ...
... 22,24,[36][37][38] In our study, we observed that higher CLA proportions were associated with higher odds of food sensitizations in girls, which contradicts previous findings from the Dutch KOALA birth cohort study, where CLA appeared to be protective-although sexstratified analyses were not performed. 37 There is a strong rationale for studying the ratio of total and in- proportions. ...
Background
Polyunsaturated fatty acids (PUFAs) may influence immune development. We examined the association of PUFAs in human milk with food sensitization and atopic dermatitis among breastfed infants.
Methods
In a selected subgroup of 1109 mother‐infant dyads from the CHILD Cohort Study, human milk was analyzed by gas‐liquid chromatography to quantify PUFAs including arachidonic acid (ARA) and docosahexaenoic acid (DHA). At 1 year of age, food sensitization was determined by skin‐prick testing for egg, peanut, cow's milk, and soybean, and atopic dermatitis was diagnosed by pediatricians. Logistic regression analyses controlled for breastfeeding exclusivity, family history of atopy, and other potential confounders.
Results
Overall, 184 infants (17%) were sensitized to one or more food allergens and 160 (14%) had atopic dermatitis. Sex‐specific associations were observed between these conditions and milk PUFAs. Girls receiving human milk with lower proportions of DHA had lower odds of food sensitization (aOR 0.35; 95% CI 0.12, 0.99 for lowest vs highest quintile), and a clear dose‐dependent association was observed for the ARA/DHA ratio (aOR 2.98; 95% CI 1.10, 8.06 for lowest vs highest quintile). These associations were not seen in boys. Similar sex‐specific tendencies were observed for atopic dermatitis.
Conclusions
Human milk PUFA proportions and their ratios are associated with infant atopic conditions in a sex‐specific manner. In female infants, a higher ratio of ARA/DHA may reduce the risk of food sensitization and atopic dermatitis. Further research is needed to determine the underlying mechanisms and clinical relevance of this sex‐specific association.
... Malgré de grandes variations observées dans les niveaux de consommation maternelle de matières grasses laitières (beurre: de 4 à 20 g/jour; lait et dérivés du lait: de 550 g à 1100 g/jour) et de plusieurs acides gras, les résultats n'amènent pas à des conclusions cohérentes pour le risque d'allergie et de maladies atopiques chez les enfants, bien qu'un effet protecteur soit noté pour l'allergie au lait de [40]. Les conséquences de la consommation des produits laitiers et/ou des matières grasses laitières par la femme allaitante sur la santé de l'enfant ont porté exclusivement sur l'incidence des maladies atopiques [41][42][43]. Dans ces études d'observation, les enquêtes alimentaires menées sont au mieux d'ordre semi-quantitatif, limitant grandement l'interprétation des données, et seule l'étude de Thijs et al. [41] rapporte les teneurs en acides gras du lait maternel. Dans cette dernière étude, un effet protecteur de la consommation des matières grasses laitières est proposé car il est observé que la teneur des acides gras marqueurs de leur consommation (acides vaccénique et ruménique) est liée négativement à l'incidence de l'eczéma et de la dermatite atopique chez l'enfant âgé de 2 ans. ...
... Les conséquences de la consommation des produits laitiers et/ou des matières grasses laitières par la femme allaitante sur la santé de l'enfant ont porté exclusivement sur l'incidence des maladies atopiques [41][42][43]. Dans ces études d'observation, les enquêtes alimentaires menées sont au mieux d'ordre semi-quantitatif, limitant grandement l'interprétation des données, et seule l'étude de Thijs et al. [41] rapporte les teneurs en acides gras du lait maternel. Dans cette dernière étude, un effet protecteur de la consommation des matières grasses laitières est proposé car il est observé que la teneur des acides gras marqueurs de leur consommation (acides vaccénique et ruménique) est liée négativement à l'incidence de l'eczéma et de la dermatite atopique chez l'enfant âgé de 2 ans. ...
Maternal dietary polyunsaturated fatty acids (PUFA) ensure optimal infant development. Observational studies reported in infants that a specific deficit in n-3 PUFA intake in pregnant women was associated with a reduction in their visual acuity, and a low docosahexaenoic acid (DHA) content associated with a high level of n-6 PUFA in breast milk was negatively associated with lower cognitive development. They agree with the hypothesis that unbalanced n-6/n-3 ratio could promote the development of adipose tissue and obesity. Moreover, they suggest that long-chain n-3 PUFA consumption during pregnancy may prevent the incidence of allergic diseases in children. Lastly, specific association between the maternal ingestion of food groups and the infant health has been studied mainly on allergic outcomes (fish, dairy products). Nutritional recommendations for PUFA intake in pregnant and lactating women were mainly based on brain development data, corresponding to breast milk levels of 10% of total fatty acids for linoleic acid, 1.5% for α-linolenic acid and 0.4% for DHA.
... However, rTFAs, like RA, and VA might be preventive. Increased concentration of both RA and VA in HM was correlated with a lower risk of eczema, atopic dermatitis, and allergic sensitization at one year of age, which was largely independent of HM n-3 LCPUFA values (164). Increased maternal VA-levels during pregnancy decreased the risk of atopic eczema in one-year-old children, but no other associations were found with other TFA values (165). ...
It is well known that long chain polyunsaturated fatty acids (LCPUFAs) play an important role in neurodevelopment in the perinatal life. The most important source of these fatty acids is the diet, however, they can also be formed in the human body from their shorter chain precursors, the essential fatty acids. Since the WHO recommends exclusive breastfeeding for the first six months after birth, the exclusive source of these fatty acids for breastfed infants is human milk, which can be influenced by the mother’s diet. Unsaturated fatty acids can have either cis or trans configuration double bond in their chain with distinct physiological effects. Cis isomeric unsaturated fatty acids have several beneficial effects, while trans isomers are mostly detrimental, because of their similar structure to saturated fatty acids. Trans fatty acids (TFAs) can be further subdivided into industrial (iTFA) and ruminant-derived trans fatty acids (rTFA). However, the physiological effects of these two TFA subgroups may differ. In adults, dietary intake of iTFA has been linked to atherosclerosis, insulin resistance, obesity, chronic inflammation, and increased development of certain cancers, among other diseases. However, iTFAs can have a negative impact on health not only in adulthood but in childhood too. Results from previous studies have shown that iTFAs have a significant negative effect on LCPUFA levels in the blood of newborns and infants. In addition, iTFAs can affect the growth and development of infants, and animal studies suggest that they might even have lasting negative effects later in life. Since the only source of TFAs in the human body is the diet, the TFA content of breast milk may determine the TFA supply of breastfed infants and thus affect the levels of LCPUFAs important for neurodevelopment and the health of infants. In this review, we aim to provide an overview of the TFA content in human milk available in the literature and their potential effects on infant health and development.
... at two years of age and risk of allergic sensitization at one year of age (OR = 0.17, 0.04-0.77). 28 Another study examined the relation between incidence of atopic disease and relative n-3 concentration in human milk (n = 263) Women with a prepregnancy BMI 1830 recruited before 15 wk gestation. ...
Polyunsaturated fatty acids are critically important for newborn nutrition and in the trajectory of growth and developmental processes throughout early life. This systematic review (PROSPERO ID: CRD42023400059) critically analyzes literature pertaining to how omega-3 and omega-6 fatty acids in human milk are related to health outcomes in early life. Literature selected for the review were published between 2005 and 2020 and included assessments in healthy term children between 0 and 5 years of age. The studies reported the relation between human milk fatty acids docosahexaenoic acid (C22:6 n -3, DHA), eicosapentaenoic acid (C20:5 n -3, EPA), alpha-linolenic acid (C18:3 n -3, ALA), arachidonic acid (C20:4 n -6, AA), and linoleic acid (C18:2 n -6, LA) with three domains of health outcomes: neurodevelopment, body composition, and allergy, skin & eczema. Results from the 21 studies consistently suggested better health outcomes across the three domains for infants consuming milk with higher concentrations of total n -3, DHA, EPA, and ALA. Negative health outcomes across the three domains were associated with higher levels of total n -6, AA, and LA in milk. N -3 and n -6 content of milk were related to neurodevelopmental, body composition, and allergy, skin & eczema outcomes with moderate certainty. Maternal diet impacting milk fatty acid content and fatty acid desaturase genotype modifying physiologic responses to fatty acid intake were prominent gaps identified in the review using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and GRADE approach. This research study can inform baby nutrition product development, and fatty acid intake recommendations or dietary interventions for mothers and children.
... Breastfeeding modulates the microbiota, which may induce regulatory T cells involved in in T helper (Th)1/Th2 balance and enhance systemic innate immunity 5,6 . In addition increased omega-3 essential polyunsaturated fatty acid and soluble CD14 concentrations in breast milk have been shown to associate with a lower risk of eczema development 7,8 . Those studies explain the protective effects of breastfeeding in infant's immunity. ...
Benefits of breastfeeding for both the mother and the child are well established, but a comprehensive and robust study to investigate the protective effect of breastfeeding and attenuated time effect stratified by cause of morbidity are lacking. This study is based on the nationwide birth cohort in Korea that includes data on all infants born from 2009 to 2015. Of 1,608,540 children, the median follow-up period was 8.41 years (interquartile range, 6.76-10.06). When compared to children with fully formula feeding, the hospital admission rate was 12% lower in those with partially breastfeeding and 15% lower in those with exclusive breastfeeding. The apparent protective effect of breastfeeding was reduced with increasing age. Our study provides potential evidence of the beneficial association of breastfeeding on subsequent hospital admissions. The protective effect declined over time as the children grew older. Encouraging any breastfeeding for at least the first 6 months among infants is an important public health strategy to improve overall child health.
... At that age, the immune system has had the opportunity to mature while being exposed to different concentrations of non-cholesterol sterols in breast milk [33]. The International Study of Asthma and Allergies in Childhood Questionnaire (ISAAC) was used to determine the presence of eczema and wheeze at 3, 7, 12 and 24 months postpartum, as described previously [34]. In short, if parents ever reported symptoms of eczema (itchy rash that was coming and going) or wheeze (wheezing or whistling in the chest) in this questionnaire, the child was defined as a case of eczema or wheeze, respectively. ...
This study aimed to explore associations between non-cholesterol sterol concentrations in breast milk and allergic outcomes in children aged two. Data from the KOALA Birth Cohort Study, the Netherlands, were used. Non-cholesterol sterols were analyzed by gas–liquid chromatography–mass spectrometry in breast milk sampled one-month postpartum (N = 311). Sterols were selected for each allergic outcome, i.e., eczema, wheeze, and allergic sensitization, prior to analyses. Associations between the selected sterols with allergic outcomes were analyzed using multiple logistic regression to calculate odds ratios (ORs). The odds of eczema in the first two years of life were lower with higher concentrations of cholestanol (OR (95%CI): 0.98 (0.95; 1.00), p = 0.04), lanosterol (0.97 (0.95; 1.00), p = 0.02), lathosterol (0.93 (0.87; 0.99), p = 0.02), and stigmasterol (0.51 (0.29; 0.91), p = 0.02) in breast milk sampled one-month postpartum. None of the sterols were associated with wheeze in the first two years of life. The odds of allergic sensitization at age two were lower with higher concentrations of campesterol in breast milk (OR (95%CI): 0.81 (0.70; 0.95), p = 0.01). In conclusion, our data suggest that exposure to higher non-cholesterol sterol concentrations in breast milk may indeed be associated with the prevention of allergic outcomes in the first two years of life.
... Opposingly, natural trans fatty acids are associated with health-related benefits [8]. Some researchers have observed that a higher level of natural trans fatty acids in human milk was related to a lower risk of atopic dermatitis, eczema and food allergies for the infant [9]. A possible explanation of this observation is that natural trans fatty acids, such as conjugated linoleic acid, modulate immune function in the human body by reducing the production of pro-inflammatory mediators (cytokines, prostaglandins, etc.) [10]. ...
The human milk fatty acid, including trans fatty acid, composition is predominantly affected by the maternal diet. The aim of this research was to determine the trans fatty acid level in human milk among lactating women in Latvia, and to evaluate how maternal dietary habits affect the trans fatty acid composition of human milk. In total, 70 lactating women participated in this cross-sectional study. A 72-hour food diary and food frequency questionnaire were used to evaluate maternal dietary habits. Different trans fatty acids in human milk samples were determined using gas chromatography (Agilent 6890N, Agilent Technologies Incorporated, the United States). Overall, the dietary intake of trans fatty acids among the participants was 0.54 ± 0.79 g per day. The total trans fatty acid level in the human milk samples was 2.30% ± 0.60%. The composition of trans fatty acids found in human milk was associated with maternal dietary habits. Higher elaidic acid, vaccenic acid and total trans fatty acid levels in human milk were found among participants with a higher milk and dairy product intake. Meat and meat product intake were associated with a higher vaccenic acid and total trans fatty acid levels in human milk. A moderate association was also established between maternal trans fatty acid intake and the total trans fatty acid level in human milk. The obtained correlations indicate that maternal dietary habits during lactation can impact the composition of trans fatty acids found in human milk.
... Several studies were initiated to investigate health-related effects of organic food consumption during pregnancy, a period in which health expectations are particularly relevant, since they can long-term affect both mothers' and their offspring's health. Results suggest favourable impacts of organic food consumption on the prevalence of preeclampsia [22] and child hypospadias [23], as well as on the later development of child atopic sensitisation, allergies and eczemas [24][25][26]. Moreover, our previous work with data from the Dutch KOALA-study revealed that organic food consumption is associated with lower prevalence of maternal overweight and adiposity during pregnancy [27], which suggests a beneficial effect of food of organic production on GD development. ...
Purpose
To evaluate whether consumption of organic food and reduced intake of meat products in pregnancy are associated with lower prevalence of gestational diabetes (GD).
Methods
Women participating in the KOALA Birth Cohort Study with valid informed consent, a singleton pregnancy and information on their food intake were considered in this cross-sectional analysis. Participants with and without GD were compared with each other in terms of dietary characteristics ( n = 37 and n = 2766, respectively). Multivariable logistic regression (LR) was used to adjust for relevant covariates.
Results
Organic food consumption tended to be lower, although not significantly, in women with GD compared to women without GD, whereas consumption of meat was positively associated with GD prevalence. LR modelling showed that GD was significantly associated with higher consumption of meat and, in addition, also of cheese, after adjustment for other relevant covariates. GD was associated with some indicators of animal product intake, namely dietary animal to plant protein ratio and maternal plasma arachidonic acid (for the latter, data available for n = 16 and n = 1304, respectively). Food patterns of participants with GD were characterised by more meat products and less vegetarian products.
Conclusions
Due to the low number of participants with GD, results have to be interpreted cautiously. Consumption of organic food during pregnancy does not seem to be markedly associated with a lower GD prevalence; lower intake of meat and cheese, irrespective of its origin (organic or conventional), does. The latter supports previous studies suggesting a causal association between consumption of animal products and GD.
... In our study, we found no association of vitamin D intake to any of these allergies. Instead, a possible explanation for the beneficial effects of cow's milk relates to the fat composition of these products [25], which typically have high concentrations of saturated fats and ruminant trans fats. Based on intakes from the nutritional calculations, we found that saturated fat and trans fats were significantly associated with lower prevalence of both food allergy and atopic eczema. ...
Maternal diet during pregnancy and lactation may affect the propensity of the child to develop an allergy. The aim was to assess and compare the dietary intake of pregnant and lactating women, validate it with biomarkers, and to relate these data to physician-diagnosed allergy in the offspring at 12 months of age. Maternal diet during pregnancy and lactation was assessed by repeated semi-quantitative food frequency questionnaires in a prospective Swedish birth cohort (n = 508). Fatty acid proportions were measured in maternal breast milk and erythrocytes. Allergy was diagnosed at 12 months of age by a pediatrician specialized in allergy. An increased maternal intake of cow’s milk during lactation, confirmed with biomarkers (fatty acids C15:0 and C17:0) in the maternal blood and breast milk, was associated with a lower prevalence of physician-diagnosed food allergy by 12 months of age. Intake of fruit and berries during lactation was associated with a higher prevalence of atopic eczema at 12 months of age. Our results suggest that maternal diet modulates the infant’s immune system, thereby influencing subsequent allergy development.
... HM consists of many natural immunologic and antiinfective agents that have strong antimicrobial functions, which offer specific and nonspecific passive immunities [57]. Apart from that, the fatty acids including n-3 long-chain polyunsaturated fatty acids (LCPs) and ruminant fatty acids have an important role in the curative effect of HM [58]. Also, a group of inflammatory cytokines such as IL-Iβ as well as CD14 protein are shown to be associated with eczema [59]. ...
Methods:
The various datasets including Ovid, PubMed, Google Scholar, Science Direct, Magiran, Irandoc, SID, and IranMedex were searched from 1990 to 2018. From the 119 reviewed articles, 20 articles were selected to be included in the current article.
Results:
There is a consensus among the literature and ancient texts regarding the effectiveness of THM in curing the various types of skin damages, such as cord separation, atopic dermatitis, diaper dermatitis, conjunctivitis, scratches, insect bite, perineal ulcer, and nipple ulcer. However, the importance of its application has not been given much attention.
Conclusion:
According to the information obtained from the articles reviewed, the THM appears to be an effective, safe, and available treatment compared to conventional chemical treatments. This study suggests THM as an alternative remedy to minimize the frequent use of chemical-based treatments. More research may be beneficial to reach certainty in terms of curative properties of THM in similar or different injuries in different populations.
... Acetate and butyrate are also involved in the production of long-chain fatty acids (31). However, contrary to our findings, HM long-chain fatty acid levels do not appear to differ by atopic status (35)(36)(37). ...
Short chain fatty acids (SFCAs) are microbial metabolites produced in the gut upon fermentation of dietary fiber. These metabolites interact with the host immune system and can elicit epigenetic effects. There is evidence to suggest that SCFAs may play a role in the developmental programming of immune disorders and obesity, though evidence in humans remains sparse. Here we have quantified human milk (HM) SCFA levels in an international cohort of atopic and non-atopic mothers (n = 109). Our results demonstrate that human milk contains detectable levels of the SCFAs acetate, butyrate, and formate. Samples from atopic mothers had significantly lower concentrations of acetate and butyrate than those of non-atopic mothers. HM SCFA levels in atopic and non-atopic women also varied based on maternal country of residence (Australia, Japan, Norway, South Africa, USA). Reduced exposure to HM SCFA in early life may program atopy or overweight risk in breastfed infants.
... Interestingly, this study found that certain SNP haplotypes together with high dietary intake of DHA increased PUFA levels in human milk when compared with other haplotypes [110]. Higher concentrations of n 3 long-chain polyunsaturated fatty acids (LCPs), as well as ruminant fatty acids in human milk, showed a protective role in the development of atopic dermatitis (eczema) [111]. These findings highlight the importance of further characterization of genetic variations that affect human milk fatty acid composition that may affect the infant's nutritional status. ...
Human milk is considered the optimal nutrition for infants as it provides additional attributes other than nutritional support for the infant and contributes to the mother’s health as well. Although breastfeeding is the most natural modality to feed infants, nowadays, many mothers complain about breastfeeding difficulties. In addition to environmental factors that may influence lactation outcomes including maternal nutrition status, partner’s support, stress, and latching ability of the infant, intrinsic factors such as maternal genetics may also affect the quantitative production and qualitative content of human milk. These genetic factors, which may largely affect the infant’s growth and development, as well as the mother’s breastfeeding experience, are the subject of the present review. We specifically describe genetic variations that were shown to affect quantitative human milk supply and/or its qualitative content. We further discuss possible implications and methods for diagnosis as well as treatment modalities. Although cases of nutrient-deficient human milk are considered rare, in some ethnic groups, genetic variations that affect human milk content are more abundant, and they should receive greater attention for diagnosis and treatment when necessary. From a future perspective, early genetic diagnosis should be directed to target and treat breastfeeding difficulties in real time.
... The consumption of biodynamically manufactured dairy products lead to a higher fat quality of breast milk compared to the breast milk of women who consumed organic or conventional dairy products (Simões-Wüst et al. 2011). Newborn babies whose mothers mainly consumed biody-namically manufactured dairy products had a lower risk of contracting eczema ( Thijs et al. 2011). ...
Research into biodynamic food and farming has a long history within the biodynamic movement. Whilst the basic aim of this research has always been to provide knowledge for furthering the development of this farming approach, recently interest has increased in sharing research activities and results with the global scientific community. After commencing with an introduction to biodynamic agriculture, this review gives an overview of peer-reviewed publications on issues in biodynamic food and farming that have been published between 2006 and 2017. The time before this period is covered by the reviews of Leiber et al. (2006) and Turinek et al. (2009).
Overall, 86 articles were included into this review. The most recognized topics were soil quality and soil health in biodynamic vs. conventional and organic farming, effects of biodynamic preparations, food quality, and viticulture. The studies provide substantial evidence for positive effects of biodynamic management on agroecosystems and food quality:
1) Biodynamic management creates system effects on soils, where compost application plays a crucial role.
2) Biodynamic preparations create effects on food chemical composition and food quality.
3) Biodynamic production can improve the value of food with regard to nutritive properties, taste and human health and well-being.
4) Biodynamic management improves grape quality and plant traits compared to non-biodynamic management.
Until now, the effects of biodynamic management have usually been studied with classical analytical methods in natural and life sciences through disciplinary and reductionist study designs. An application of study designs or specific methods that are conducive for a more holistic analysis are rarely implemented. Thus, we identify the development of appropriate methods and study designs for a holistic examination as a major challenge of future research in biodynamic food and farming.
... A cohort study conducted with mothers and babies on the exclusive consumption of organic dairy products during pregnancy and infancy reported a 36% reduction in the risk of eczema in two-year-old children and a higher content of ruminant fatty acids in the breast milk of mothers. (Thijs et al., 2011). Another cohort study involving mothers and their offspring reported that frequent consumption of organic vegetables by pregnant women resulted in a reduced risk of pre-eclampsia (Torjusen et al., 2014). ...
... Cutoff point, sensitivity, and specificity of skin prick test in positive challenge test. Some studies, such as Jing et al. [33], and Thijs et al. [34], demonstrated a protective effect by introduction of CMP in the infant's diet with breast milk, as breast milk may help development of oral tolerance because of its immunologic factors. In this study, we found that the early introduction of cow milk and its products before 6 months of age increases the risk of developing CMPA, as of 57 infants of 100 infants of the suspected group, 58.82% (20 infants) of them were confirmed to have CMPA, and 41.17% (14 infants) of confirmed cases were exposed to cow milk and its products after 6 months of age. ...
Background Many research studies have been done to explore the prevalence of cow milk allergy.
Aim of the work The aim of this study is to determine the frequency of cow’s milk protein allergy (CMPA) among children of Damietta Governorate during the first 2 years of life.
Patients and methods A cross-sectional study with nonsystemic random sampling was conducted on 1000 children in the first 2 years of age, comprising 512 male and 488 female exposed to cow milk or its products either directly or indirectly, attending outpatient clinics of Al Azhar University Hospital in New Damietta. Each included infant was subjected to history taking and clinical examination, and suspected cases from history and examination were subjected to skin prick test, specific immunoglobulin E (IgE) for cow’s milk protein, oral food challenge, and food elimination tests.
Results In the present work, there was a male predominance among the suspected group (58.5% males and 41.5% females). We found that infants from urban regions were more affected than those from rural regions (61.76% of the confirmed cases were from urban areas and 38.24% from rural regions). We found that the risk of CMPA declined in exclusively breast-fed infants. The clinical manifestations in infants with suspected CMPA were variable, and the main presenting feature was gastrointestinal tract manifestations (84% of the cases) (P
... 1 In these individuals, allergy is related to the presence of antibodies specific for food antigens in the serum and is frequently associated with high serum immunoglobulin E (IgE) levels. 2 Its prevalence has increased in developed and developing countries, and it affects between 1.1 and 10.4% of children. 3,4 Diet can play a role in both the prevention and management of food allergy. ...
Background:
Food allergy is an abnormal immune response to antigens introduced into the body through food. Its prevalence has increased in developed and developing countries. Natural products are traditionally used to alleviate and treat diseases, and diet can play a role in both the prevention and management of food allergy. The effects of capsaicin as an anti-oxidant, anticarcinogenic, and anti-inflammatory in the energy expenditure and suppression of fat accumulation have been demonstrated. This study evaluated the effect of oral supplementation with capsaicin on a food allergy model.
Methods:
OVA-sensitized mice received ovalbumin solution, and they were fed with chow supplemented with capsaicin for 7 days. The control group received AIN-93 chow with no supplementation. IgE anti-ova, inflammatory infiltration, oxidative stress and metabolic analysis were performed.
Results:
The results showed that capsaicin supplementation is not able to reduce characteristic signs of food allergy, such as production of IgE and weight loss. However, macrophages infiltration and IL-33 in proximal jejunum was reduced in OVA capsaicin group. In addition, hepatic triglycerides and intestinal hydroperoxides were reduced in both capsaicin groups.
Conclusion:
Oral supplementation with capsaicin attenuated important factors associated to food allergy such as inflammation and oxidative stress, suggesting better prognosis and evolution of the disease.
... In addition, breast milk contains numerous components with immunomodulatory properties, such as immunoglobulins, lactoferrin, oligosaccharides, long-chain fatty acids, antioxidants and anti-inflammatory cytokines [1]. These bioactive components are potentially responsible for the allergy-protective effects associated with breastfeeding [2][3][4]. ...
Raw cow’s milk was previously shown to suppress allergic symptoms in a murine model for food allergy. In the present study, we investigated the contribution of fat content and heat-sensitive milk components to this allergy-protective effect. In addition, we determined the potency of alkaline phosphatase (ALP), a heat-sensitive raw milk component, to affect the allergic response. C3H/HeOuJ mice were treated with raw milk, pasteurized milk, skimmed raw milk, pasteurized milk spiked with ALP, or phosphate-buffered saline for eight days prior to sensitization and challenge with ovalbumin (OVA). Effects of these milk types on the allergic response were subsequently assessed. Similar to raw milk, skimmed raw milk suppressed food allergic symptoms, demonstrated by a reduced acute allergic skin response and low levels of OVA-specific IgE and Th2-related cytokines. This protective effect was accompanied by an induction of CD103+CD11b+ dendritic cells and TGF-β-producing regulatory T cells in the mesenteric lymph nodes. Pasteurized milk was not protective but adding ALP restored the allergy-protective effect. Not the fat content, but the heat-sensitive components are responsible for the allergy-protective effects of raw cow’s milk. Adding ALP to heat-treated milk might be an interesting alternative to raw cow’s milk consumption, as spiking pasteurized milk with ALP restored the protective effects.
... 25 Low levels of n-3 LC-PUFAs in breast milk have been shown to be a risk factor for AD. [43][44][45] Another study showed a protective effect of high concentrations of n-3 fatty acids and ruminant fatty acids in breast milk at 1 month on the development of AD. 46 In contrast, in a high-risk birth cohort, measurements of fatty acids in colostrum and breast milk at 3 months showed that high levels of n-3 LC-PUFA were associated with an increased risk of AD. 47 Similarly, a Swedish study reported higher mean concentrations of cord serum n-3 PUFA and n-6 PUFA in AD cases compared to non-allergic 13-year old children; however, non-allergic children had higher cord serum concentrations of saturated and mono-unsaturated fatty acids. 48 Finally, another study showed no association between levels of LC-PUFA in breast milk and allergic diseases, such as AD. ...
The prevalence of allergic diseases such as allergic rhinitis, asthma, food allergy, and atopic dermatitis has increased dramatically during the last decades, which is associated with altered environmental exposures and lifestyle practices. The purpose of this review was to highlight the potential role for dietary fatty acids, in the prevention and management of these disorders. In addition to their nutritive value, fatty acids have important immunoregulatory effects. Fatty acid‐associated biological mechanisms, human epidemiology, and intervention studies are summarized in this review. The influence of genetics and the microbiome on fatty acid metabolism is also discussed. Despite critical gaps in our current knowledge, it is increasingly apparent that dietary intake of fatty acids may influence the development of inflammatory and tolerogenic immune responses. However, the lack of standardized formats (ie, food versus supplement) and standardized doses, and frequently a lack of prestudy serum fatty acid level assessments in clinical studies significantly limit our ability to compare allergy outcomes across studies and to provide clear recommendations at this time. Future studies must address these limitations and individualized medical approaches should consider the inclusion of specific dietary factors for the prevention and management of asthma, food allergy, and atopic dermatitis.
... In addition, fatty acids, which are among the immunological components of the breast milk may play a role in food allergy. Thijs et al. [64] found an inverse association between omega-3 and rumenic fatty acid content of breast milk and the food sensitization in the first year of life. Besides, oligosaccharides in the breast milk may be protective against cow's milk allergy due to its positive effects on intestinal microbiome [48]. ...
Breast milk is the best source of nutrition that provides the energy and nu-trients needed for the ideal growth and development of newborns and infants. Besides, breast milk includes various bioactive compounds, which protectsinfants against infectious agents and antigens and contributes to immune maturation, organ development andmicrobial colonization. Breast milk is dynamic; the composition of the nutrients and the content of immunological active compounds may change in eachstage of lactation. During the early stages of lactation, biological and immunological active compounds provide additional support to the development of the neonatal immune system. After these stages, the composition of breast milk continues to provide appropriate energy and nutrients according to theinfant needs, in order to protect neonatal immune system and maintain the development and growth of in-fants. Immunological maturation during the fetallife and the first months of life is provided by immunoglobulins in breast milk, which are among the most important immune protective factors and transferred to infants throughbreastfeeding. Due to their biological characteristics, Secretory Immunoglo-bulin A (SIgA) antibodies are the most important antibodies in breast milk, which provide the first defense against the antigens in the intestines of in-fants. In addition to antibodies, enzymes, including active leukocytes, cyto-kines, oligosaccharides, lactoferrin, lysozyme andlactoperoxidase, as well as biological and immunological factors, such as hormones, growth factors, bio-active peptides, nucleotides and fatty acids are transferred to infants through breastfeeding.There is now a growing body of evidence suggesting that breastfeeding protects infants against many infections such as gastrointestinal system and respiratory tract infections, strengthens immune system and pro-vides protective effects against allergic and autoimmune diseases in later life.
(10) (PDF) Breast Milk: Its Role in Early Development of the Immune System and Long-Term Health. Available from: https://www.researchgate.net/publication/332363458_Breast_Milk_Its_Role_in_Early_Development_of_the_Immune_System_and_Long-Term_Health [accessed Apr 17 2019].
... The quality of fat in milk depends on the ingredients cows are fed-if it is only grass, without any industrial mixtures, the content of polyunsaturated omega-3 fatty acids is higher. A prospective study by KOALA showed that the higher concentration of these acids in the milk of breastfeeding mothers reduced the risk of eczema at 2 years of age and 1 year of allergy in children [25]. ...
Living on a farm and having contact with rural exposures have been proposed as one of the most promising ways to be protected against allergy and asthma development. There is a significant body of epidemiological evidence that consumption of raw milk in childhood and adulthood in farm but also nonfarm populations can be one of the most effective protective factors. The observation is even more intriguing when considering the fact that milk is one of the most common food allergens in childhood. The exact mechanisms underlying this association are still not well understood, but the role of raw milk ingredients such as proteins, fat and fatty acids, and bacterial components has been recently studied and its influence on the immune function has been documented. In this review, we present the current understanding of the protective effect of raw milk on allergies and asthma.
... Nevertheless, and often after correcting for several co-variables, studies show that consumption of organic food may have favourable impacts on some diseases and disorders. One group of such disorders includes atopic sensitization, allergies and eczemas (reviewed in [2]; see also [16,22]). Additional possible effects on health comprise lower prevalence of preeclampsia [24], and of hypospadias [1]. ...
Worldwide, traditional diets are being replaced by diets with high proportions of ultra-processed industrial foods, meat products and refined sugars, fats and oils. By contrast, the (slowly) growing consumption of unrefined organic food products and the more and more popular organic-type of diets are associated with lower consumption of these foods. In this comment, we argue that the growth of the organic food chain is already now contributing to the goal of improving public health in global terms as well as to the goal of reducing the environmental impact of agricultural production and food processing. Thus, consumption of organic food contributes to saving lives and enabling future human existence. As such, the organic food system deserves increased attention and stimulation by scientists and public agencies.
... 7 Breastmilk as a preventive factor for allergic diseases was still subject to considerable debate, 5,8,9 several studies reported that breastmilk consumption may prevent allergic diseases 10 while other studies reported otherwise. 11,12 Fatty acid contents within breastmilk was found to be an immunomodulator that may trigger an atopic dermatitis. Hoppu et al reported that breastmilk with high content of saturated fatty acid and low content of n-3 fatty acid may precipitate atopic dermatitis in infants. ...
... Some studies observed associations between n-3 and n-6 PUFAs and allergic disease [60], and the magnitude of this effect varied greatly. Otherwise it is known that breast milk contains different composition of PUFA, which could explain the variability of the results [61]. ...
... Ces apports pourraient modifier la composition lipidique du lait maternel (332) qui modifierait à son tour le bilan lipidique chez le nourrisson (332) et pourraient ainsi être en lien avec la sensibilisation allergénique dans les premiers mois de vie (333). La concentration en oméga-3 dans le lait maternel a été négativement (274,334) mais aussi positivement (335) associée à la sensibilisation chez l'enfant dans différentes cohortes de naissances. La concentration sérique en oméga-3 chez la femme enceinte allergique n'a pas été corrélée aux IgE totales chez l'enfant par ailleurs (164). ...
Contexte. Les premières années de vie apparaissent particulièrement propices au développement de la sensibilisation allergénique. Objectifs. Cette thèse vise à : i) décrire les profils de sensibilisation allergénique chez le nourrisson et l’enfant, ii) étudier l’association entre ces profils et la morbidité allergique et iii) identifier les facteurs de risque de cette sensibilisation. Méthodes. Dans le cadre du suivi de la cohorte prospective de naissances en population générale Pollution and Asthma Risk: an Infant Study (PARIS), la sensibilisation allergénique a été évaluée chez 1 860 nourrissons à 18 mois et 1 007 enfants à 8/9 ans par dosage des IgE spécifiques dirigées contre 16 et 19 allergènes, respectivement. Les informations concernant la santé et le cadre de vie des enfants ont été recueillies par questionnaires standardisés répétés. Des profils de sensibilisation et des profils de morbidité ont été identifiés par classification non supervisée et mis en relation par régression logistique multinomiale. Enfin, les facteurs associés à la sensibilisation allergénique chez le nourrisson ont été étudiés par régression logistique multivariée. Résultats. Dès 18 mois, 13,8% des enfants étaient sensibilisés et 6,2%, multi-sensibilisés. À 8/9 ans, ces prévalences étaient de 34,5% et 19,8%, respectivement. Les profils de sensibilisation identifiés chez le nourrisson (3) et dans l’enfance (5) différaient au regard de la morbidité allergique. L’analyse étiologique a permis de préciser le rôle des expositions précoces aux allergènes et aux microorganismes sur la sensibilisation allergénique. Conclusion. Cette thèse contribue à une meilleure compréhension de l’histoire naturelle de la sensibilisation allergénique, et ce, dès les premières années de vie. Cette connaissance est essentielle à la prévention des maladies allergiques qui en découlent.
... Wijga et al. [15] showed that a higher concentration of trans FA in breastmilk is associated with lower risk of atopic symptoms. Thijs et al. [16] confirmed these observations in children, by showing a protective association (with a plausible cause-effect relationship) of these FAs on the development of atopic manifestations. Chisaguano et al. [14] showed that higher maternal VA concentrations at week 12 of gestation were associated with a decreased risk of atopic eczema in one-year-old infants. ...
The quantity and quality of dietary lipids in infant formulae have a significant impact on health outcomes, especially when fat storing and/or absorption are limited (e.g., preterm birth and short bowel disease) or when fat byproducts may help to prevent some pathologies (e.g., atopy). The lipid composition of infant formulae varies according to the different fat sources used, and the potential biological effects are related to the variety of saturated and unsaturated fatty acids. For example, since lipids are the main source of energy when the normal absorptive capacity of the digestive tract is compromised, medium-chain saturated fatty acids might cover this requirement. Instead, ruminant-derived trans fatty acids and metabolites of n-3 long-chain polyunsaturated fatty acids with their anti-inflammatory properties can modulate immune function. Furthermore, dietary fats may influence the nutrient profile of formulae, improving the acceptance of these products and the compliance with dietary schedules.
... Moreover, the samples from the affected horse and its matched healthy control were collected at the same time. Therefore, it is unlikely that nutritional factors had markedly impacted on these results, although the composition of serum lipids (Subbaiah & Liu 1996, Vesper et al. 1999, O'Connor et al. 2007, Fuchs et al. 2009, Paassilta et al. 2014) and even of milk lipids (Laitinen et al. 2006, Thijs et al. 2011, Kuhnt et al. 2015 is strongly dependent on the type of diet, and certain diets may per se decrease the risk for allergies (Magnusson et al. 2015). It has been suggested that PC is consumed as a source of arachidonic acid that is further converted to leukotrienes in cells assembling in allergic responses (Metcalfe et al. 2016). ...
The aims of this study were to examine clinical features of summer eczema in native Finnhorses, to assess efficacy of autoserum therapy and to delineate phospholipids in the serum and autoserum preparations and to evaluate their association with the clinical course of summer eczema.
... We identified 4,277 potentially relevant citations, and 119 full citations were retrieved. Overall, 26 unique citations were deemed eligible for systematic review, and 19 provided sufficient data for meta-analysis (Chisaguano et al. 2014;Dirix et al. 2011;Jonsson et al. 2016;Lowe et al. 2008;Lumia et al. 2014;Lumia et al. 2011;Miyake et al. 2013;Miyake et al. 2009;Montes et al. 2013;Morales et al. 2012;Newson et al. 2004;Notenboom et al. 2011;Nwaru et al. 2012;Nwaru et al. 2011;Nwaru et al. 2010;Pike et al. 2012;Rosenlund et al. 2016;Rucci et al. 2016;Saito et al. 2010;Soto-Ramirez et al. 2012;Standl et al. 2014;Thijs et al. 2011;van Elten et al. 2015;Waidyatillake et al. 2017;Wijga et al. 2006;Yu et al. 2015) (Figure 1). ...
Early life nutritional exposures could modify the gene expression and susceptibility of allergic diseases (AD). This systematic review aimed to evaluate whether early life (the first 1,000 days) natural exposure to polyunsaturated fatty acids (PUFA) and ruminant trans fatty acids (R-TFA) could affect the AD risk. We searched PubMed, EMBASE, PsycINFO, Scopus, the Cochrane Library, and ClinicalTrials.gov from inception through September 10, 2017 for observational studies. The quality of studies was examined by the Newcastle-Ottawa Scale, and the best evidence synthesis (BES) was applied. We included 26 observational studies, and 8 of them showed high quality. BES showed a moderate evidence for the protective effect of vaccenic acid (VA) on eczema, while insufficient or no evidence was found in other associations. Meta-analysis showed that higher n-6/n-3 ratio and linoleic acid were associated with higher risk of eczema (pooled odds ratio [OR] = 1.06, 95% confidence intervals [CI]: 1.00-1.13; 1.08, 95% CI: 1.02-1.15). However, VA was inversely associated with eczema pooled OR = 0.43, 95% CI: 0.26-0.72). Early life natural exposure to VA showed evident benefit on decreasing the risk of eczema, while PUFA and other R-TFA showed limited effects on AD. More robust studies especially for R-TFA are required.
... Thus, in the Koala birth cohort of 2700 mothers and babies from the Netherlands [39], exclusive consumption of organic dairy products during pregnancy and during infancy was associated with a 36% reduction in the risk of eczema at age 2 years. In this cohort, the preference of organic food was associated with a higher content of ruminant fatty acids in breast milk [40], which in turn was associated with a lower odds ratio for parent-reported eczema until age 2y [45]. ...
This review summarises existing evidence on the impact of organic food on human health. It compares organic vs. conventional food production with respect to parameters important to human health and discusses the potential impact of organic management practices with an emphasis on EU conditions. Organic food consumption may reduce the risk of allergic disease and of overweight and obesity, but the evidence is not conclusive due to likely residual confounding, as consumers of organic food tend to have healthier lifestyles overall. However, animal experiments suggest that identically composed feed from organic or conventional production impacts in different ways on growth and development. In organic agriculture, the use of pesticides is restricted, while residues in conventional fruits and vegetables constitute the main source of human pesticide exposures. Epidemiological studies have reported adverse effects of certain pesticides on children’s cognitive development at current levels of exposure, but these data have so far not been applied in formal risk assessments of individual pesticides. Differences in the composition between organic and conventional crops are limited, such as a modestly higher content of phenolic compounds in organic fruit and vegetables, and likely also a lower content of cadmium in organic cereal crops. Organic dairy products, and perhaps also meats, have a higher content of omega-3 fatty acids compared to conventional products. However, these differences are likely of marginal nutritional significance. Of greater concern is the prevalent use of antibiotics in conventional animal production as a key driver of antibiotic resistance in society; antibiotic use is less intensive in organic production. Overall, this review emphasises several documented and likely human health benefits associated with organic food production, and application of such production methods is likely to be beneficial within conventional agriculture, e.g., in integrated pest management.
... Essentially, all dietary antigens are proteins, and therefore highly digestible diets are recommended for food allergic individuals to reduce the number of intact antigens reaching the Peyer's patches. Solid foods associated with lowered allergy prevalence include fruit and vegetables, vitamins, polyunsaturated fatty acids, and (raw) cow's milk, but the processing of foods can possibly also affect allergy development [10,[42][43][44][45][46][47][48][49][50]. These food components, as well as the effects of food processing, are also addressed in the papers by ...
The development of IgE-mediated allergic diseases is influenced by many factors, including genetic and environmental factors such as pollution and farming, but also by nutrition. In the last decade, substantial progress has been made in our understanding of the impact that nutrition can have on allergic diseases. Many studies have addressed the effect of breastfeeding, pre-, pro- and synbiotics, vitamins and minerals, fiber, fruit and vegetables, cow’s milk, and n-3 fatty acids, on the development of allergies. In addition, nutrition can also have indirect effects on allergic sensitization. This includes the diet of pregnant and breastfeeding women, which influences intrauterine development, as well as breastmilk composition. These include the diet of pregnant and breastfeeding women that influences intrauterine development as well as breastmilk composition, effects of food processing that may enhance allergenicity of foods, and effects via modulation of the intestinal microbiota and their metabolites. This editorial review provides a brief overview of recent developments related to nutrition and the development and management of allergic diseases.
... breast-fed children (5) . Moreover, 2-year-old children consuming milk products almost exclusively from organic origin had a significantly lower risk to develop eczema compared with children consuming conventional milk products (6) . ...
Objective
To investigate the associations of organic food consumption with maternal pre-pregnancy BMI, hypertension and diabetes in pregnancy, and several blood biomarkers of pregnant women.
Design
Prospective cohort study.
Setting
Pregnant women were recruited at midwives’ practices and through channels related to consumption of food from organic origin.
Subjects
Pregnant women who filled in FFQ and donated a blood sample ( n 1339). Participant groups were defined based on the share of consumed organic products; to discriminate between effects of food origin and food patterns, healthy diet indicators were considered in some statistical models.
Results
Consumption of organic food was associated with a more favourable pre-pregnancy BMI and lower prevalence of gestational diabetes. Compared with participants consuming no organic food (reference group), a marker of dairy products intake (pentadecanoic acid) and trans -fatty acids from natural origin (vaccenic and rumenic acids) were higher among participants consuming organic food (organic groups), whereas elaidic acid, a marker of the intake of trans -fatty acids found in industrially hydrogenated fats, was lower. Plasma levels of homocysteine and 25-hydroxyvitamin D were lower in the organic groups than in the reference group. Differences in pentadecanoic acid, vaccenic acid and vitamin D retained statistical significance when correcting for indicators of the healthy diet pattern associated with the consumption of organic food.
Conclusions
Consumption of organic food during pregnancy is associated with several health-related characteristics and blood biomarkers. Part of the observed associations is explained by food patterns accompanying the consumption of organic food.
... 4,5 Indeed, studies investigating the effect of breastmilk fatty acids on development of atopic eczema or atopic sensitization imply they may play a mediating role in allergic disease. [6][7][8] However, similar studies investigating their potential association with long-term health consequences, including wheeze and asthma in later childhood, are scarce. ...
BACKGROUND: Previous observational studies have implied breast milk fatty acid composition may play a role in development of atopic eczema or atopic sensitization in breastfed infants and toddlers. However, studies investigating associations with wheeze and asthma in later childhood are scarce and did not account for inherent correlation of compositional data. Our aim was to explore the association of maternal milk fatty acid composition with childhood wheezing phenotypes and asthma up to age 13 years using a new statistical approach.
METHODS: Breast milk was collected 6 weeks and 6 months post-delivery in the Ulm Birth Cohort Study (n=720 and n=454, respectively). Concentrations of 28 fatty acids were measured by high-resolution capillary gas-liquid chromatography. To control for constant sum constraint, concentration data were transformed using the centered log ratio method. Compositional biplots and correlation matrices were used to group centered log ratio transformed fatty acids. Adjusted risk ratios with parent-reported wheezing phenotypes and doctor-diagnosed asthma were computed using a modified Poisson regression.
RESULTS: We observed no straightforward evidence of associations between overall breast milk fatty acid composition and specific wheeze phenotypes or doctor-diagnosed asthma.
CONCLUSION: Using appropriate statistical methodology, we report null associations. These findings may partly be attributable to several cohort-specific factors associated with breastfeeding and breast milk collection. Further studies could improve on ours by analyzing samples of breast milk and formula and by including all children for whom these are exclusively or together the major source of fatty acids in the first months of life. This article is protected by copyright. All rights reserved.
The role of nutrition is increasingly recognized in the management of chronic immune diseases. However, the role of an immune‐supportive diet as adjuvant therapy in the management of allergic disease has not been similarly explored. This review assesses the existing evidence for a relationship between nutrition, immune function, and allergic disease from a clinical perspective. In addition, the authors propose an immune‐supportive diet to enhance dietary interventions and complementing other therapeutic options for allergic disease from early life to adulthood. A narrative review of the literature was conducted, to determine the evidence of the relationship between nutrition and immune function, overall health, epithelial barrier function, and gut microbiome, particularly in relation to allergy. Studies on food supplements were excluded. The evidence was assessed and utilized to develop a sustainable immune‐supportive diet to complement other therapies in allergic disease. The proposed diet consists of a highly diverse range of fresh, whole, and minimally processed plant‐based and fermented foods supplemented with moderate amounts of nuts, omega‐3‐rich foods and animal‐based products in proportional amounts of the EAT‐Lancet diet, such as (fatty) fish, (fermented) milk products which may be full‐fat and eggs, lean meat or poultry, which may be free‐range or organic.
Fatty acids (FAs) are key determinants of the nutritional quality of human milk lipids. While milk fat concentration is highly variable even within milk produced by an individual woman, the relative FA composition is reasonably stable over time. These stable FA patterns result in large part from the utilization of maternal adipose tissue depots and other long-term storage pools as sources of milk FA, in addition to current dietary intake. Moreover, short-term fluctuations of the FA composition due to changing dietary intake are attenuated, whereas the effects of dietary changes or supplements show their full effects only after a considerable time delay.
All milk FAs are subject to dietary influences, but the strongest effects of diet are seen in ω-3 long-chain polyunsaturated FA (LC-PUFA) percentage contributions. This is largely because their absolute amounts in milk are relatively small, and diet is their most important source. In contrast, for milk ω-6 LC-PUFA endogenous conversion from precursor FA is of considerable importance.
In addition to maternal diet, duration of gestation, stage of lactation, maternal body mass index, and further factors influence milk FA composition, but the magnitude of these effects and interactions with further factors is uncertain as studies yield ambiguous results.
There are several groups of FA, such as trans isomeric and branched-chain FA, which provide only small portions to total milk fat, but there are indications that they may influence infant health, which makes it worthwhile to investigate how they are influenced by diet and other factors.
Virtually all living cells produce and secrete extracellular vesicles into the extracellular space. Among the various classes of extracellular vesicles, exosomes (~100 nm diameter) are of particular interest because of their unique role in cell-to-cell communication. This type of communication is facilitated by the transfer of regulatory cargos such as microRNAs from donor cells to adjacent or distant recipient cells. Evidence suggests that exosomes and their microRNA cargos are derived not only from endogenous synthesis but may also be absorbed in the gastrointestinal tract from milk, and microRNAs in milk exosomes alter gene expression in recipient cells. Studies of exosomes and microRNA cargos in human milk and infant nutrition are just beginning to emerge. Preliminary evidence, discussed in this chapter, suggests that exosomes found in milk and consumed from the diet accumulate primarily in the brain and liver in mice and change microbial communities in the murine rectum. In addition, consumption of a diet depleted of milk-borne exosomes and their microRNA cargos causes a loss in spatial learning and memory, alters purine metabolism, and might impair immune function compared with exosomes and microRNA-sufficient controls in murine models. Much remains to be discovered about milk-borne exosomes and their biological functions.
Background: Vitamin B12 is essential for many metabolic reactions in humans and deficiency results in impaired neurologic functions and disruption in hematopoiesis. Infants are particularly prone to vitamin B12 deficiency due to depleted maternal stores during pregnancy and low vitamin B12 concentrations in the breastmilk. Megaloblastic anemia is a common complication of vitamin B12 deficiency, however hematologic changes are not clearly defined in infants. Our aim was to identify hematologic changes in infants associated with vitamin B12 deficiency.
Method: We retrieved laboratory results including complete blood cell count concomitant with serum B12 and ferritin measurements of infants younger that 1 year of age. The vitamin B12 deficiency was defined as levels below serum concentration of 203 pg/ml. Neutropenia was defined as absolute neutrophil count of ≤ 1000 for infants ≤6 months of age and ≤ 1500 for infants >6 months of age. Continuous variables were expressed as median and interquartile range) and compared by Mann Whitney U test. Associations were analyzed by Spearman correlation and linear regression. Statistical analysis was performed using SPSS 20.0. The study was approved by the ethical committee of the University.
Results: Results of 864 infants were analyzed after exclusion of infants with missing data. Median age of the infants was 6 months (interquartile range: 5-6 months). Vitamin B12 deficiency was detected in 480 infants (55.6%). Serum vitamin B12 concentration showed a weak positive correlation with increasing age (rs=0.09, p=0.006). Vitamin B12 deficient patients had significantly lower white blood cell (WBC) count (9,400/μL, 7,800-11,100 /μL vs 9,900/μL, 8,300-12,175/μL, p=0.001) and absolute neutrophil count (ANC) (2,200/μL, 1,600-3,100 /μL vs 2,500/μL, 1,800-3,500/μL, p=0.001) compared to the vitamin B12 sufficient patients. Vitamin B12 levels were weakly and positively correlated with ANC (rs=0.11, p<0.001), WBC count (rs=0.11, p=0.001), ferritin (rs=0.08, p=0.01) and mean corpuscular volume (MCV) (rs=0.07, p=0.02). In a multiple regression model assessing the ability of hematologic parameters (WBC count, ANC, absolute lymphocyte count, hemoglobin concentration, MCV, and platelet count) to predict vitamin B12 levels, none of the variables were able to predict vitamin B12 levels in infants. In another model assessing the ability of neutrophil count to predict vitamin B12 level after controlling for age, ANC was a statistically significant predictor of vitamin B12 level (beta: 0.11, p: 0.01). However there were no statistical difference between vitamin B12 levels of neutropenic patients (n=66, 178.50 pg/ml, IQR:127.75- 247.75 pg/ml) and patients with normal neutrophil count (n=798, 189.0 pg/ml, IQR:132.0-316.0 pg/ml).
Conclusion: Although hematologic abnormalities characterized by megaloblastic anemia is expected to be seen in vitamin B12 deficiency, complete blood cell counts of infants with vitamin B12 deficiency may not reveal any signs of it, except for neutrophil count corrected for age. Given the common prevalence of vitamin B12 deficiency in infants and considering the severe sequela associated with neurological impairments in developing infant, clinicians should consider to monitor vitamin B12 levels during anemia screening in well child visits, since complete blood cell count may not indicate clues for vitamin B12 deficiency. Besides, low neutrophil counts in infants should drive the clinicians to check for vitamin B12 deficiency.
Breast milk is a living source of nutrition for babies and is currently recommended by the American Academy of Pediatrics as well as the American Academy of Allergy, Asthma and Immunology. Breast milk complements a baby’s immune system, supplementing undeveloped defenses with immune factors while also creating the foundation for both the innate and adaptive immune systems. Such immune development includes tolerance of the environment and, in the case of food allergy, formation of an IgE antibody response. Breast milk was thought to be protective against food allergy, and recent research with mice strengthens this paradigm. This chapter reviews the immature immune system, the immunology and nutrition of breast milk, the literature exploring breast milk and food allergy, and the current recommendations regarding breast milk and the prevention of food allergy.
Background:
The increasing incidence of food allergy (FA) can be attributed to interactions between genes and the environment, but these interactions are not yet fully clear.
Objective:
We aimed to evaluate the interaction between infant genetic variations and maternal dietary patterns to identify risk factors in the development of FA.
Methods:
We used the Cohort for Childhood Origin of Asthma and allergic diseases birth cohort of 1628 infants, born between 2007 and 2015. Maternal dietary intakes were assessed at 26 weeks of pregnancy using a food frequency questionnaire and grouped according to 5 dietary patterns. Infant cord blood samples were genotyped at 12 loci.
Results:
Among 1628 infants, 147 (9.0%) were diagnosed with FA based on history. A maternal confectionery diet characterized by a higher intake of baked and sugary products during pregnancy was associated with a higher prevalence of FA (adjusted odds ratio [OR] = 1.517, P = .02); this dietary pattern tended to be higher in trans fat (r = 0.498, P < .001). Development of FA was associated with longer periods of breastfeeding (adjusted OR = 1.792, P = .03), and this dietary pattern was more significantly related to the development of FA in infants with the homozygous TT genotype of CD14 (rs2569190) and more than 1 copy of GSTM1 and GSTT1.
Conclusions:
A maternal confectionery diet during pregnancy that majorly consists of baked and sugary products, combined with a longer ensuing period of breastfeeding, may lead to the development of FA, suggesting a harmful effect of trans fats in the infant. Polymorphisms in CD14 and GST in the infant influence FA susceptibility.
Much progress has happened in understanding developmental vulnerability to preventable environmental hazards. Along with the improved insight, the perspective has widened, and developmental toxicity now involves latent effects that can result in delayed adverse effects in adults or at old age and additional effects transgenerationally transferred to future generations. Although epidemiology and toxicology to an increasing degree are exploring the adverse effects from developmental exposures in humans, the improved documentation has resulted in little progress in protection, and few environmental chemicals are currently regulated to protect against developmental toxicity, whether it be neurotoxicity, endocrine disruption or other adverse outcomes. The desire to obtain a high degree of certainty and verification of the evidence used for decision‐making must be weighed against the costs and necessary duration of research, as well as the long‐term costs to human health because of delayed protection of vulnerable early‐life stages of human development and, possibly, future generations. Although two‐generation toxicology tests may be useful for initial test purposes, other rapidly emerging tools need to be seriously considered from computational chemistry and metabolomics to CLARITY‐BPA‐ type designs, big data and population record linkage approaches that will allow efficient generation of new insight, while epigenetic mechanisms may necessitate a set of additional regulatory tests to reveal such effects. As reflected by the Prenatal Programming and Toxicity (PPTOX) VI conference, the current scientific understanding and the time scales involved require an intensified approach to protect against preventable adverse health effects that can harm the next generation and generations to come. While further research is needed, the main emphasis should be on research translation and timely public health intervention to void serious, irreversible and perhaps transgenerational harm.
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Umweltfaktoren, frühkindliche Sensibilisierung oder genetische Disposition — die Theorien zur Entstehung von Allergien sind vielfältig. Auch deswegen sollte Allergieprävention nicht bloß auf Vermeidungsansätzen basieren.
Introduction
Eczema is a common childhood ailment responsible for a considerable disease burden. Both timing of introduction to solid food and allergenic food are believed to be related to childhood eczema. Despite the growing body of evidence, the relationship between timing of any solid food introduction (allergenic and/or non-allergenic) and development of eczema has not previously been systematically reviewed.
Methods
PubMed and EMBASE databases were searched using food and eczema terms. Two authors selected papers according to the inclusion criteria and extracted information on study characteristics and measures of association. Meta-analyses were performed after grouping studies according to the age and type of exposure.
Results
A total of 17 papers met the inclusion criteria, reporting results from 16 study populations. Of these, 11 were cohort studies, two case controls, one cross sectional study and, 2 randomised controlled trials. Limited meta-analyses were performed due to heterogeneity between studies. Timing of solid food introduction was not associated with eczema. One randomized controlled trial provided weak evidence of an association between early allergenic (around 4 months) food introduction and reduced risk of eczema.
Conclusions
The available evidence is currently insufficient to determine whether the timing of introduction of any solid food influences the risk of eczema.
Atopic disease has been on the rise in the United States and worldwide. Speculation is that the immune system plays a role in its development in utero. The purpose of this review is to evaluate the strength of available evidence supporting or refuting the impact of maternal long-chain omega-3 status on atopy development in offspring. After reviewing 21 primary articles, the evidence shows a potential for omega-3 fatty acids to influence immune system development in utero and subsequent atopy in offspring. More randomized controlled trials are needed to confirm these findings, with attention to the confounding variables.
Associations between maternal vitamin E, vitamin D and zinc intakes during pregnancy and asthma, wheeze and eczema in 5-year-old children have previously been reported. A study was undertaken to investigate whether maternal intake of specific foods during pregnancy is associated with asthma and allergic outcomes in the same children.
A longitudinal birth cohort study was conducted in 1,924 children born to women recruited during pregnancy. Maternal diet during pregnancy was assessed by food frequency questionnaire (FFQ). Cohort children were followed up at 5 years by symptom questionnaire and FFQ. Food groups of interest were fruit, vegetables, fruit juice, whole grain products, fish, dairy products and fat spreads. Trends across outcome groups defined by level of food intake are presented.
1,253 children participated at 5 years and maternal FFQ data were available for 1,212. No consistent associations were found between childhood outcomes and maternal intake of the analysed foods except for apples and fish. Maternal apple intake was beneficially associated with ever wheeze (OR highest vs lowest tertile 0.63, 95% CI 0.42 to 0.95), ever asthma (OR 0.54, 95% CI 0.32 to 0.92) and doctor-confirmed asthma (OR 0.47, 95% CI 0.27 to 0.82) in the children. Maternal fish consumption was beneficially associated with doctor-confirmed eczema (OR >or=1/week vs never 0.57, 95% CI 0.35 to 0.92).
There was no evidence for associations between maternal intake of most foods during pregnancy and asthma, respiratory and allergic outcomes in 5-year-old children, except for apples and fish. Consumption of apples and fish during pregnancy may have a protective effect against the development of childhood asthma and allergic disease.
Conjugated linoleic acid (CLA), which is present in milk products and meat from ruminants, appears to have anticarcinogenic activity against breast cancer in animal and in vitro experiments. To date, few epidemiologic data are available in humans.
This study evaluated the relation between intakes of CLA and other fatty acids and breast cancer incidence in the Netherlands Cohort Study.
Intake data derived from a validated 150-item food-frequency questionnaire were linked to an existing database with analytic data on specific fatty acids in European foods (the TRANSFAIR study). With 6.3 y of follow-up and 941 incident cases of breast cancer, multivariate rate ratios and 95% CIs were calculated for energy-adjusted intakes of fatty acids and CLA-containing food groups (eg, butter, cheese, milk, other milk products, and meat).
CLA intake showed a weak, positive relation with breast cancer incidence (rate ratio for highest compared with lowest quintile: 1.24, 95% CI: 0.91, 1.69; P for trend = 0.02). Statistically significant positive associations were found with total trans fatty acids and (borderline) with saturated fatty acids. Significant inverse associations were found with monounsaturated and cis unsaturated fatty acids, whereas total fat and energy intake of CLA-containing food groups were not related to breast cancer incidence.
The suggested anticarcinogenic property of CLA in animal and tissue culture models could not be confirmed in this epidemiologic study in humans.
Environment and lifestyle contribute to the development of asthma in children. Understanding the relevant factors in this relationship may provide methods of prevention. The role of diet in the development of asthma in pre-school children was investigated.
Data from 2978 children participating in a prospective birth cohort study were used. Food frequency data were collected at the age of 2 years and related to asthma symptoms reported at the age of 3 years.
The prevalence of recent asthma at age 3 was lower in children who consumed (at age 2) full cream milk daily (3.4%) than in those who did not (5.6%) and in those who consumed butter daily (1.5%) than in those who did not (5.1%). The prevalence of recent wheeze was lower in children who consumed milk products daily (13.7%) than in those who did not (18.4%) and in children who consumed butter daily (7.7%) than in those who did not (15.4%). These effects remained in a logistic regression model including different foods and confounders (adjusted odds ratio (CI) for recent asthma: full cream milk daily v rarely 0.59 (0.40 to 0.88), butter daily v rarely 0.28 (0.09 to 0.88)). Daily consumption of brown bread was also associated with lower rates of asthma and wheeze, whereas no associations were observed with the consumption of fruits, vegetables, margarine, and fish.
In pre-school children, frequent consumption of products containing milk fat is associated with a reduced risk of asthma symptoms.
The uniqueness of ruminant milk lipids is based on their high concentration of CLA. Maximal CLA concentrations in milk lipids require optimal conditions of ruminal fermentation and substrate availability, conditions like those present in pasture-fed cows. Our previous work showed that farm management (indoor feeding vs. pasture feeding) markedly influenced the CLA concentration. In this study, the objective was to evaluate the influence of the farm management system as dependent on different locations. Milk samples from different locations (Thuringia and the Alps, representing diverse altitudes) were collected during the summer months and analyzed for FA profile and CLA isomer distribution. The proportion of PUFA and total CLA in milk fat was significantly lower in milk from indoor cows compared with the pasture cows in the Alps. The trans-11 18:1 in milk fat of Alpine cows was elevated, in contrast to lower values for trans-10 18:1. Milk from cows grazing pasture in the Alps was higher in EPA and lower in arachidonic acid than milk from indoor-fed cows. The proportion of cis,trans/trans,cis isomers of CLA was 10 times higher from the indoor cows than from the Alpine cows. In addition to the major isomer cis-9,trans-11, this difference also occurred for the trans-11,cis-13 isomer, which represented more than a fourth of the total CLA present in milk fat. This is the first report showing a special isomer distribution in the milk fat of cows living under very natural conditions. We hypothesize that the CLA isomer trans-11,cis-13 is formed in large quantity as a result of grazing mountain pasture, which is rich in alpha-linolenic acid.
Some aspects of diet are relatively newly recognized potential risk factors for asthma, but the evidence to date is conflicting.
The goal was to determine whether the food and nutrient intakes of adults with asthma differ from those of adults without asthma.
This was a community-based, cross-sectional study of 1601 young adults ( +/- SD age: 34.6 +/- 7.1 y) who were initially recruited by random selection from the federal electoral rolls in Melbourne in 1999. Subjects completed a detailed respiratory questionnaire, a validated semiquantitative food-frequency questionnaire, skin-prick testing, and lung function tests, including a methacholine challenge test for bronchial hyperreactivity (BHR). A total of 25 nutrients and 47 food groups were analyzed by using multiple logistic regression with alternate definitions of asthma and atopy as the outcomes.
Whole milk appeared to protect against current asthma (odds ratio: 0.66; 95% CI: 0.46, 0.97), doctor-diagnosed asthma (0.73; 0.54, 0.99), BHR (0.68; 0.48, 0.92), and atopy (0.71; 0.54, 0.94). Conversely, soy beverage was associated with an increased risk of current asthma (2.05; 1.19, 3.53), doctor-diagnosed asthma (1.69; 1.04, 2.77), and BHR (1.65; 1.00, 2.71). Apples and pears appeared to protect against current asthma (0.83; 0.71, 0.98), asthma (0.88; 0.78, 1.00), and BHR (0.88; 0.77, 1.00).
The consumption of dairy products, soy beverages, and apples and pears, but not of nutrients per se, was associated with a range of asthma definitions. Dietary modification after diagnosis is one possible explanation for this finding. Intervention studies using whole foods are required to ascertain whether such modifications of food intake could be beneficial in the prevention or amelioration of asthma.
Asthma is a leading cause of morbidity for children and is a major public health problem in Australia. Ecological and temporal data suggest that dietary factors may have a role in recent increases in the prevalence of asthma.
The aim of conducting this study was to investigate whether childhood asthma was associated with the ratio of omega 6 (n-6) to omega 3 (n-3) fatty acids in the diet (n-6:n-3).
The Western Australian Pregnancy Cohort Study is a prospective birth cohort of 2602 children. Using a nested case-control cross-sectional study design within this cohort, a group of children were identified as cases with current asthma at 6 or at 8 years of age or as controls with no asthma at 6 or at 8 years. Dietary details including n-6 and n-3 fatty acid intake data were collected by parent response to a questionnaire when the children were 8 years old. Logistical regression was used to compare quartiles of n-6:n-3 intake in cases and controls. Adjustment was made for covariates: gender, gestational age, breastfeeding, older siblings, maternal smoking during pregnancy, maternal age, maternal asthma, child's current age in months, body mass index, total energy intake, and antioxidant intake (vitamins A, C, E, and zinc).
A response rate of 83% was achieved by providing complete data from 335 children [49% cases with current asthma (n = 166), 51% controls (n = 169)]. Following adjustment for covariates the association between the ratio of n-6:n-3 fatty acids and risk for current asthma was statistically significant (p = 0.022).
We found evidence for a modulatory effect of the dietary n-6:n-3 fatty acid ratio on the presence of asthma in children. Our results provide evidence that promotion of a diet with increased n-3 fatty acids and reduced n-6 fatty acids to protect children against symptoms of asthma is warranted.
Conjugated linoleic acid (CLA) is a collective term for a mixture of positional and geometric isomers of conjugated dienoic derivatives of linoleic acid. CLA has received considerable attention as a result of animal experiments that report anti-carcinogenic, anti-atherogenic and anti-diabetic properties, and modulation of body composition and immune function. Several studies of CLA supplementation in human subjects have now been published, but in contrast to animal studies there has been marked variation between reports on the health-related outcomes. The consensus from seventeen published studies in human subjects is that CLA does not affect body weight or body composition. Some detrimental effects of the trans-10,cis-12 CLA isomer have also been reported in terms of altered blood lipid composition and impaired insulin sensitivity. Finally, CLA has only limited effects on immune functions in man. However, there have been reports of some interesting isomer-specific effects of CLA on the blood lipid profile, but not on immune function. These isomer-specific effects need further investigation. Until more is known, CLA supplementation in man should be considered with caution.
We studied the incorporation of the trans-11 vaccenic-1-(13)C acid ((13)C-VA) into milk and endogenous synthesis of cis-9, trans-11 conjugated linoleic acid (CLA) in lactating women. Subjects (n = 4) were 247 +/- 30 d postpartum, weighed 70.8 +/- 3.7 kg, breast-fed at least 6 times/d and consumed self-selected diets. After an overnight fast, they consumed the (13)C-VA (2.5 mg/kg body wt). Milk samples were obtained by complete breast expression at 0, 2, 4, 8, 12, 18, 24, and 48 h post-(13)C-VA ingestion. Lipid was extracted using chloroform:methanol. Fatty acids were methylated and converted to dimethyl disulfide and Diels-Alder derivatives before analysis by gas chromatography mass spectrometry. The mean (13)C-enrichment of milk VA was 3.1% at 8 h and reached maximal enrichment of 7.6% at 18 h. The (13)C enrichment of milk cis-9, trans-11 CLA reached a maximum of 0.4% at 18 h, confirming its conversion of VA to the Delta9-desaturase enzyme product. In the subjects examined, a portion (<10%) of the cis-9, trans-11 CLA present in milk was endogenously synthesized from VA.
CLA intake in exclusively breast-fed infants is close to levels found to have physiological effects in animals. However, in the majority of studies mixtures of CLA isomers have been used and the independent effects of the major CLA isomer in human milk, cis-9,trans-11 CLA, at the intake level in exclusively breast-fed infants have hardly been studied. We therefore studied the effects of cis-9,trans-11 CLA on plasma lipids and glucose, immune function, and bone metabolism in growing rats. Thirty male Sprague-Dawley rats (n = 10/group) were fed either 20 mg/kg/d cis-9,trans-11 CLA and 20 mg/kg/d sunflower oil (CLA20), 40 mg/kg/d cis-9,trans-11 CLA (CLA40), or 40 mg/kg/d sunflower oil (placebo) for 8 wk. No significant differences between groups were found in plasma lipids, glucose, insulin, C-reactive protein, or lipid peroxidation. Liver fat content was lowest in the CLA20 group. In vitro interleukin 2 (IL-2) production increased, and tumor necrosis factor alpha, IL-1beta, prostaglandin E2, and leukotriene B4 production decreased in the CLA20 group. No differences between groups were detected in IL-4, IL-6, or interferon gamma production, plasma osteocalcin, insulin-like growth factor, or urinary deoxypyridinoline crosslinks. Plasma tartrate-resistant acid phosphatase 5b activity was significantly increased in the CLA40 group. The results indicate anti-inflammatory effects and enhanced T-cell function for the CLA20 group. No adverse effects were seen in the CLA20 group, whereas indications of increased bone resorption rate were observed in the CLA40 group.
The aim of the present study was to find out whether the incorporation of organic dairy and meat products in the maternal diet affects the contents of the conjugated linoleic acid isomers (CLA) and trans-vaccenic acid (TVA) in human breast milk. To this purpose, milk samples from 312 breastfeeding mothers participating in the KOALA Birth Cohort Study have been analysed. The participants had documented varying lifestyles in relation to the use of conventional or organic products. Breast milk samples were collected 1 month postpartum and analysed for fatty acid composition. The content of rumenic acid (the main CLA) increased in a statistically significant way while going from a conventional diet (no organic dairy/meat products, 0.25 weight % (wt%), n 186) to a moderately organic diet (50-90 % organic dairy/meat, 0.29 wt%, n 33, P = 0.02) and to a strict organic diet (>90 % organic dairy/meat, 0.34 wt%, n 37, P </= 0.001). The levels of TVA were augmented among the participants with a moderately organic diet (0.54 wt%) and those with a strict organic diet (0.59 wt%, P </= 0.001), in comparison with the conventional group (0.48 wt%). After adjusting for covariables (recruitment group, maternal age, maternal education, use of supplements and season), statistical significance was retained in the group of the strict organic dairy users (P < 0.001 for rumenic acid). Hence, the levels of CLA and TVA in human milk can be modulated if breastfeeding mothers replace conventional dairy and/or meat products by organic ones. A potential contribution of CLA and TVA to health improvement is briefly discussed.
Atopy is not uncommon among children living in rural Crete, but wheeze and rhinitis are rare. A study was undertaken to examine whether this discrepancy could be attributed to a high consumption of fresh fruit and vegetables or adherence to a traditional Mediterranean diet.
A cross-sectional survey was performed in 690 children aged 7-18 years in rural Crete. Parents completed a questionnaire on their child's respiratory and allergic symptoms and a 58-item food frequency questionnaire. Adherence to a Mediterranean diet was measured using a scale with 12 dietary items. Children underwent skin prick tests with 10 common aeroallergens.
80% of children ate fresh fruit (and 68% vegetables) at least twice a day. The intake of grapes, oranges, apples, and fresh tomatoes-the main local products in Crete-had no association with atopy but was protective for wheezing and rhinitis. A high consumption of nuts was found to be inversely associated with wheezing (OR 0.46; 95% CI 0.20 to 0.98), whereas margarine increased the risk of both wheeze (OR 2.19; 95% CI 1.01 to 4.82) and allergic rhinitis (OR 2.10; 95% CI 1.31 to 3.37). A high level of adherence to the Mediterranean diet was protective for allergic rhinitis (OR 0.34; 95% CI 0.18 to 0.64) while a more modest protection was observed for wheezing and atopy.
The results of this study suggest a beneficial effect of commonly consumed fruits, vegetables and nuts, and of a high adherence to a traditional Mediterranean diet during childhood on symptoms of asthma and rhinitis. Diet may explain the relative lack of allergic symptoms in this population.
Dietary fat intake in pregnancy and lactation affects pregnancy outcomes and child growth, development and health. The European Commission charged the research project PERILIP, jointly with the Early Nutrition Programming Project, to develop recommendations on dietary fat intake in pregnancy and lactation. Literature reviews were performed and a consensus conference held with international experts in the field, including representatives of international scientific associations. The adopted conclusions include: dietary fat intake in pregnancy and lactation (energy%) should be as recommended for the general population; pregnant and lactating women should aim to achieve an average dietary intake of at least 200 mg DHA/d; intakes of up to 1 g/d DHA or 2.7 g/d n-3 long-chain PUFA have been used in randomized clinical trials without significant adverse effects; women of childbearing age should aim to consume one to two portions of sea fish per week, including oily fish; intake of the DHA precursor, alpha-linolenic acid, is far less effective with regard to DHA deposition in fetal brain than preformed DHA; intake of fish or other sources of long-chain n-3 fatty acids results in a slightly longer pregnancy duration; dietary inadequacies should be screened for during pregnancy and individual counselling be offered if needed.
We prospectively investigated whether organic food consumption by infants was associated with developing atopic manifestations in the first 2 years of life. The KOALA Birth Cohort Study in the Netherlands (n 2764) measured organic food consumption, eczema and wheeze in infants until age 2 years using repeated questionnaires. Diet was defined as conventional ( 90 % organic). Venous blood samples taken from 815 infants at 2 years of age were analysed for total and specific IgE. Multivariate logistic regression models were fitted to control for potential confounding factors. Eczema was present in 32 % of infants, recurrent wheeze in 11 % and prolonged wheezing in 5 %. At 2 years of age, 27 % of children were sensitised against at least one allergen. Of all the children, 10 % had consumed a moderately organic diet and 6 % a strictly organic diet. Consumption of organic dairy products was associated with lower eczema risk (OR 0.64 (95 % CI 0.44, 0.93)), but there was no association of organic meat, fruit, vegetables or eggs, or the proportion of organic products within the total diet with the development of eczema, wheeze or atopic sensitisation. Further studies to substantiate these results are warranted.
Milk consumption from early childhood on has been found to be inversely correlated with allergic sensitization and the onset of bronchial asthma. We tested whether cis-9,trans-11-conjugated linoleic acid (c9,t11-CLA), naturally occurring in milk fat, may prevent allergic sensitization and inhibit airway inflammation in a murine asthma model. BALB/c mice were fed a diet enriched in 1 wt% of c9,t11-CLA or a control diet 7 d prior to and for 32 d during sensitization [d 1 and 14, 100 mg/L ovalbumin (OVA) in adjuvant vs. PBS] and airway challenges (d 28-30, 1% OVA in PBS vs. PBS). Subgroups of mice were coadministered 20 micromol/L of the selective PPARgamma antagonist GW9662 during each OVA challenge. C9,t11-CLA feeding resulted in significantly reduced IgE production and allergen-induced in vivo airway hyperresponsiveness. Further, less mucous plugging of segmental bronchi and significantly reduced interleukin-5 and eosinophils were determined in bronchoalveolar lavage fluids of c9,t11-CLA-fed mice. C9,t11-CLA feeding prevented the downregulation of PPARgamma mRNA in the lung tissues observed after allergen sensitization and airway challenges in control mice. The inhibitory effects of c9,t11-CLA on airway inflammation were partially prevented by coadministration of GW9962. Further, c9,t11-CLA feeding resulted in a significantly lower concentration of the eicosanoid precursor, arachidonic acid, in tissue lipids. These findings demonstrate that dietary c9,t11-CLA can reduce allergic airway inflammation, most likely via a PPARgamma-related mechanism and by reducing eicosanoid precursors. They give new insights into the fatty acid-mediated mechanism of immunomodulation and may represent a step toward an attractive novel strategy in the dietary prevention and treatment of allergic asthma.
Background: Conjugated linoleic acid (CLA), which is present in milk products and meat from ruminants, appears to have anticarcinogenic activity against breast cancer in animal and in vitro experiments. To date, few epidemiologic data are available in humans. Objective: This study evaluated the relation between intakes of CLA and other fatty acids and breast cancer incidence in the Netherlands Cohort Study. Design: Intake data derived from a validated 150-item food-frequency questionnaire were linked to an existing database with analytic data on specific fatty acids in European foods (the TRANSFAIR study). With 6.3 y of follow-up and 941 incident cases of breast cancer, multivariate rate ratios and 95% CIs were calculated for energy-adjusted intakes of fatty acids and CLA-containing food groups (eg, butter, cheese, milk, other milk products, and meat). Results: CLA intake showed a weak, positive relation with breast cancer incidence (rate ratio for highest compared with lowest quintile: 1.24, 95% CI: 0.91, 1.69; P for trend = 0.02). Statistically significant positive associations were found with total trans fatty acids and (borderline) with saturated fatty acids. Significant inverse associations were found with monounsaturated and cis unsaturated fatty acids, whereas total fat and energy intake of CLA-containing food groups were not related to breast cancer incidence. Conclusion: The suggested anticarcinogenic property of CLA in animal and tissue culture models could not be confirmed in this epidemiologic study in humans.
In this chapter, the standard logistic model is extended to handle outcome variables that have more than two categories. Polytomous logistic regression is used when the categories of the outcome variable are nominal, that is, they do not have any natural order. When the categories of the outcome variable do have a natural order, ordinal logistic regression may also be appropriate.
There have been few studies of the population prevalence of allergic rhinitis and atopic eczema, and although hundreds of asthma-prevalence studies have been done in various parts of the world, they have seldom used standard approaches. An exception is the European Community Respiratory Health Survey (ECRHS), 1–3 which involved surveys of asthma and allergic-rhinitis prevalence in adults aged 20–44 years in 48 centres in 22 countries, although only nine centres in six countries were outside of western Europe. The ECRHS suggested that there were regional risk factors for asthma and allergic rhinitis in western Europe, but it did not comprehensively assess the global patterns. For children, the largest standard studies of the prevalences of asthma, allergic rhinitis, or atopic eczema have involved at most four countries. 4–6 Thus, in some respects, the epidemiology of asthma and other allergic disorders is currently similar to that of cancer epidemiology in the 1950s and 1960s, when the international patterns of the incidence of cancer were studied. 7 These studies revealed striking international differences that gave rise to many new hypotheses, tested in further epidemiological studies that identified previously unknown risk factors for cancer. These risk factors may not have been in the hypotheses investigated if the initial international comparisons had been confined to few western countries. More specifically, Rose 8,9 has noted that whole populations may be exposed to risk factors for disease (eg, high exposure to house-dust-mite allergen) and the patterns may be apparent only when comparisons are made between, rather than within, populations. Therefore, we carried out systematic, standardised, international comparisons of the prevalence of asthma and allergies to generate new hypotheses and to investigate existing hypotheses in the International Study of Asthma and Allergies in Childhood (ISAAC). The detailed findings for the prevalence and severity of the symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in children aged 6–7 years and 13–14 years will be reported elsewhere. Here, we give an overview of the findings for children aged 13–14 years (the age-group that was studied by all participating centres), assess the relationship between the findings for the three disorders, and discuss the potential for future ecological and case-control studies. Methods Phase one of the ISAAC programme 10 used a simple standard approach at minimum cost in as wide a range of centres and countries as possible, based on school populations to ensure Summary Background Systematic international comparisons of the prevalences of asthma and other allergic disorders in children are needed for better understanding of their global epidemiology, to generate new hypotheses, and to assess existing hypotheses of possible causes. We investigated worldwide prevalence of asthma, allergic rhinoconjunctivitis, and atopic.
Asthma is a leading cause of morbidity for children and is a major public health problem in Australia. Ecological and temporal data suggest that dietary factors may have a role in recent increases in the prevalence of asthma. Aim: The aim of conducting this study was to investigate whether childhood asthma was associated with the ratio of omega 6 (n‐6) to omega 3 (n‐3) fatty acids in the diet (n‐6:n‐3). Method: The Western Australian Pregnancy Cohort Study is a prospective birth cohort of 2602 children. Using a nested case‐control cross‐sectional study design within this cohort, a group of children were identified as cases with current asthma at 6 or at 8 years of age or as controls with no asthma at 6 or at 8 years. Dietary details including n‐6 and n‐3 fatty acid intake data were collected by parent response to a questionnaire when the children were 8 years old. Logistical regression was used to compare quartiles of n‐6:n‐3 intake in cases and controls. Adjustment was made for covariates: gender, gestational age, breastfeeding, older siblings, maternal smoking during pregnancy, maternal age, maternal asthma, child's current age in months, body mass index, total energy intake, and antioxidant intake (vitamins A, C, E, and zinc). Results: A response rate of 83% was achieved by providing complete data from 335 children [49% cases with current asthma (n = 166), 51% controls (n = 169)]. Following adjustment for covariates the association between the ratio of n‐6:n‐3 fatty acids and risk for current asthma was statistically significant (p = 0.022). Conclusion: We found evidence for a modulatory effect of the dietary n‐6:n‐3 fatty acid ratio on the presence of asthma in children. Our results provide evidence that promotion of a diet with increased n‐3 fatty acids and reduced n‐6 fatty acids to protect children against symptoms of asthma is warranted.
Background
Systematic international comparisons of the prevalences of asthma and other allergic disorders in children are needed for better understanding of their global epidemiology, to generate new hypotheses, and to assess existing hypotheses of possible causes. We investigated worldwide prevalence of asthma, allergic rhinoconjunctivitis, and atopic.
Methods
We studied 463 801 children aged 13–14 years in 155 collaborating centres in 56 countries. Children self-reported, through one-page questionnaires, symptoms of these three atopic disorders. In 99 centres in 42 countries, a video asthma questionnaire was also used for 304 796 children.
Findings
We found differences of between 20-fold and 60-fold between centres in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema, with four-fold to 12-fold variations between the 10th and 90th percentiles for the different disorders. For asthma symptoms, the highest 12-month prevalences were from centres in the UK, Australia, New Zealand, and Republic of Ireland, followed by most centres in North, Central, and South America; the lowest prevalences were from centres in several Eastern European countries, Indonesia, Greece, China, Taiwan, Uzbekistan, India, and Ethiopia. For allergic rhinoconjunctivitis, the centres with the highest prevalences were scattered across the world. The centres with the lowest prevalences were similar to those for asthma symptoms. For atopic eczema, the highest prevalences came from scattered centres, including some from Scandinavia and Africa that were not among centres with the highest asthma prevalences; the lowest prevalence rates of atopic eczema were similar in centres, as for asthma symptoms.
Interpretation
The variation in the prevalences of asthma, allergic rhinoconjunctivitis, and atopic-eczema symptoms is striking between different centres throughout the world. These findings will form the basis of further studies to investigate factors that potentially lead to these international patterns.
CLA intake in exclusively breast-fed infants is close to levels found to have physiological effects in animals. However, in
the majority of studies mixtures of CLA isomers have been used and the independent effects of the major CLA isomer in human
milk, cis-9, trans-11 CLA, at the intake level in exclusively breast-fed infants have hardly been studied. We therefore studied the effects
of cis-9, trans-11 CLA on plasma lipids and glucose, immune function, and bone metabolism in growing rats. Thirty male Sprague-Dawley rats
(n=10/group) were fed either 20 mg/kg/d cis-9, trans-11 CLA and 20 mg/kg/d sunflower oil (CLA20), 40 mg/kg/d cis-9, trans-11 CLA (CLA40), or 40 mg/kg/d sunflower oil (placebo) for 8 wk. No significant differences between groups were found in plasma
lipids, glucose, insulin, C-reactive protein, or lipid peroxidation. Liver fat content was lowest in the CLA20 group. In vitro interleukin 2 (IL-2) production increased, and tumor necrosis factor alpha, IL-1β, prostaglandin E2, and leukotriene B4 production decreased in the CLA20 group. No differences between groups were detected in IL-4, IL-6, or interferon gamma production,
plasma osteocalcin, insulin-like growth factor, or urinary deoxypyridino line crosslinks. Plasma tartrate-resistant acid phosphatase
5b activity was significantly increased in the CLA40 group. The results indicate anti-inflammatory effects and enhanced T-cell
function for the CLA20 group. No adverse effects were seen in the CLA20 group, whereas indications of increased bone resorption
rate were observed in the CLA40 group.
SummaryA working party of 13 dermatologists, two family practitioners and a paediatrician was assembled, with the aim of developing a minimum list of reliable discriminators for atopic dermatitis. Each physician was asked to select 10 consecutive new cases of unequivocal mild to moderate atopic dermatitis and 10 controls with other inflammatory dermatoses. Each subject was examined by two independent observers, who were blind to the clinical diagnosis and study aim, with regard to 31 clinically useful diagnostic features for atopic dermatitis. Two hundred and twenty-four patients were studied (120 cases and 102 controls). Using the key physician's clinical diagnosis as a gold standard, the sensitivity and specificity of each of the 31 diagnostic criteria were tested. Using multiple logistic regression techniques, a minimum set of diagnostic criteria for atopic dermatitis was derived. These were: history of flexural involvement, history of a dry skin, onset under the age of 2, personal history of asthma, history of a pruritic skin condition, and visible flexural dermatitis. Adjustment for age, sex, region, social class and ethnic group did not alter the choice of final criteria. The discriminatory value of these criteria was also satisfactory when tested against a further sample of 150 patients drawn from the community, who did not have skin disease.
By means of a previously developed basophil staining and fixation technique, it was possible to identify human basophilic granulocytes in leukocyte suspensions, which had been subjected to an immunofluorescence technique with anti-IgE. Using fluoresceinated anti-IgE, the fluorescence intensity of the basophils was measured by means of microfluorometry as a reflection of the IgE-load per cell. The reproducibility of this technique and the influence of the incubation time were studied. The mean fluorescence intensity of the basophil varied considerably in six donors, but the cells of two atopic patients showed the highest intensity. IgE was eluted from the cells at pH 2.5 and measured in the supernatant. A correlation was found between the amount of eluted IgE per basophil and the mean fluorescence intensity of the basophils. The number of IgE molecules per basophil was found to be in the range of 15,000--500,000.
To help shed some light on the 50-year-old controversy concerning the possible protective effect of breast feeding on subsequent atopic disease, I developed 12 standards pertaining to both biologic and methodologic aspects of exposure (infant feeding), outcome (atopic conditions), and statistical analysis for studies of atopic eczema, asthma, allergic rhinitis, cow milk allergy, and other food allergy. Among the published studies on atopic eczema, the nine claiming a protective benefit of breast feeding performed less well than the 12 not making such a claim on "methodologic" standards relating to strict diagnostic criteria and blind ascertainment of outcome. The positive studies were somewhat stronger, however, on the "biologic" standards bearing on sufficient duration and exclusivity of breast feeding and on separate analysis of children at high risk. For the other atopic conditions, there were no important differences between positive and negative studies. In few negative or positive studies was there adequate control for confounding variables or examination of potential benefits relating to the severity or age at onset of atopic disease. To avoid another 50 years of unresolved controversy, future studies should improve both the biologic and methodologic aspects of their design and analysis.
IgE in some human sera reacted with an antigen present in a large number of unrelated foods: potato, spinach, wheat, buckwheat, peanut, honey and others. The antigen, which was periodate-sensitive and heat-stable, was also found in pollen. Even more surprisingly, these antibodies often reacted in vitro with bee and vespid venom and were sometimes apparently induced by Hymenoptera stings.
The last two decades have seen an increase in the prevalence of asthma, eczema, and allergic rhinitis in developed countries. This increase has been paralleled by a fall in the consumption of saturated fat and an increase in the amount of polyunsaturated fat in the diet. This is due to a reduction in the consumption of animal fat and an increase in the use of margarine and vegetable oils containing omega-6 polyunsaturated fatty acids (PUFAs), such as linoleic acid. There is also evidence for a decrease in the consumption of oily fish which contain omega-3 PUFAs, such as eicosapentaenoic acid. In a number of countries, there are social class and regional differences in the prevalence of allergic disease, which are associated with differences in the consumption of PUFAs. Linoleic acid is a precursor of arachidonic acid, which can be converted to prostaglandin E2 (PGE2), whereas eicosapentaenoic acid inhibits the formation of PGE2. PGE2 acts on T-lymphocytes to reduce the formation of interferon-gamma (IFN-gamma) without affecting the formation of interleukin-4 (IL-4). This may lead to the development of allergic sensitization, since IL-4 promotes the synthesis of immunoglobulin E (IgE), whereas IFN-gamma has the opposite effect. Changes in the diet may explain the increase in the prevalence of asthma, eczema and allergic rhinitis. The effects of diet may be mediated through an increase in the synthesis of prostaglandin E2 which in turn can promote the formation of immunoglobulin E.
Dietary fat consumption is hypothesized to influence atopy development by modulation of IgE production. The aim of our study was to assess whether margarine consumption is associated with allergic sensitization and diseases in children. Data of a cross-sectional health survey in 1998-1999 comprising 2,348 children age 5 to 14 yr were analyzed. Information on type of fat used as spread during the past 12 mo, children's health, and sociodemographic factors were gathered by questionnaire. Allergic sensitization to common aeroallergens was assessed by specific serum IgE. Compared with butter consumption, margarine consumption was associated with allergic sensitization (adjusted odds ratio 1.30 [95% confidence interval: 1.01 to 1.67]) and with rhinitis symptoms during the past 12 mo (1.41 [1.01 to 1.97]). Sex-stratified analysis showed that these associations were limited to boys (boys: sensitization 1.57 [1.12 to 2.20], rhinitis symptoms 1.76 [1.12 to 2.78]; girls: sensitization 0.99 [0.67 to 1.46], rhinitis symptoms 1.03 [0.63 to 1.70]). No statistically significant relation was observed between exclusive margarine consumption and ever physician-diagnosed hay fever or asthma in all children. In conclusion, the sex difference in the association of margarine consumption with allergic sensitization was in accordance with the higher IgE concentrations and atopy prevalence in boys compared with girls. Increased intake of certain polyunsaturated fatty acids might further stimulate IgE production in boys.
The reasons behind the reported increase in the occurrence of childhood atopic sensitization rates are unclear. We wanted to evaluate the association between dietary fats, serum fatty acids, and the occurrence and development of atopic diseases.
From a longitudinal database of a population-based sample, 231 sex- and age-matched pairs in 1980 and 154 pairs in 1986 were chosen, between whom we compared the dietary data, serum fatty acid composition, and occurrence of atopic diseases. The same variables were also compared between those who developed atopic disease later and those who did not during the 9-year follow-up.
Examination of the dietary data in 1980 for those who had developed atopic disease compared with those who had remained healthy showed that the atopic children had used less butter before the expression of atopy. According to the cross-sectional data, the children with atopic disease consumed more margarine (mean 8.6 vs 7.3 [P = 0.04]), and less butter (mean 9.4 vs 11.6 g/1000 kcal [P = 0.002]), than the nonatopic children in 1980. Differences supporting these dietary findings were similarly found in the serum fatty acid data.
The diet of the atopic children differed from that of the nonatopic children in the consumption of polyunsaturated fat.
Serologic IgE testing is generally performed using serum, obtained by venepuncture. We tested whether paper-absorbed and eluted capillary blood, obtained by a less invasive method (finger prick) could be used for allergy testing in young children. This was performed by comparative IgE testing, using paper-absorbed blood/serum and serum. Practical applicability of the procedure was tested by assaying paper-absorbed and eluted blood, obtained from 640 children with complaints of prolonged coughing, for IgE to airborne allergens. We found that IgE testing, using paper-absorbed/eluted material and serum yields virtually identical results (mean ratio for positive samples: 1.01, 95% confidence interval: 0.58-1.75). Blood spot testing revealed that sensitization to inhalant allergens is not uncommon in preschool children (13% positive radioallergosorbent test [RAST] tests), which means that this procedure is a useful method for assaying allergic sensitization in children.