|Year : 2016 | Volume
| Issue : 2 | Page : 71-75
Effect of diet on the respiratory health of children in rural area of Delhi-NCR
Raj Kumar1, Kamal Singh2, Nitesh Gupta3
1 Department of Respiratory Allergy and Applied Immunology, National Centre of Respiratory Allergy, Asthma and Immunology, V P Chest Institute, University of Delhi, New Delhi, India
2 Department of Respiratory Allergy and Applied Immunology, V P Chest Institute, University of Delhi, New Delhi, India
3 Department of Pulmonary Medicine, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
|Date of Web Publication||5-Dec-2016|
Department of Respiratory Allergy and Applied Immunology, National Centre of Respiratory Allergy, Asthma and Immunology, V P Chest Institute, University of Delhi, New Delhi - 110 007
Source of Support: None, Conflict of Interest: None
Background: Asthma is one of the most common chronic diseases worldwide. For asthma and allergic disorders, diet has been recently established as a potential risk factor. Thus, a change in dietary habit may be postulated, as one of the unknown factors responsible for the rise in prevalence of asthma among children in rural India. Objectives: To assess the association of diet with asthma in Indian rural population. Materials and Methods: This study was a cross-sectional study of children aged <18 years residing in Khanpur Jupti village, Ghaziabad, Uttar Pradesh, during 2011-2015. A questionnaire-based survey was carried out for respiratory illness-related symptoms. It was developed on the basis of American Thoracic Society (ATS), British Medical Research Council, and the International Study of Asthma and Allergies in childhood questionnaires to detect the presence of symptoms suggestive of asthma. The age and sex, birth order, duration of breastfeeding, educational status, food habits (vegetarian and nonvegetarian), and major chronic chest symptoms (cough, sputum, shortness of breath, and wheezing) were included in the questionnaire-based survey. The diagnosis of asthma was made by the physician examining the children, based on the guidelines of ATS. Results: Of 187 houses which were surveyed, there were a total of 607 children (males n = 339 [55.84%] and females n = 268 [44.16%]). 17.1% (n = 104; males n = 59 [56.73%]) children were diagnosed as asthma. In the evaluation of dietary habits, children diagnosed with asthma had significantly higher consumption of nonvegetarian food (43.27% vs. 28.23; P < 0.05). However, age and gender distribution, educational status, birth order, and duration of breastfeeding did not show a significant difference between children diagnosed with asthma and without asthma. Conclusion: The study concluded that increased risk of asthma was associated with higher consumption of nonvegetarian food. Furthermore, breastfeeding did not have any protective effect on asthma.
Keywords: Asthma, children, diet
|How to cite this article:|
Kumar R, Singh K, Gupta N. Effect of diet on the respiratory health of children in rural area of Delhi-NCR. Indian J Allergy Asthma Immunol 2016;30:71-5
|How to cite this URL:|
Kumar R, Singh K, Gupta N. Effect of diet on the respiratory health of children in rural area of Delhi-NCR. Indian J Allergy Asthma Immunol [serial online] 2016 [cited 2018 Jun 19];30:71-5. Available from: http://www.ijaai.in/text.asp?2016/30/2/71/195233
| Introduction|| |
Asthma is one of the most common chronic diseases worldwide. The global prevalence of asthma, using a definition of clinical asthma or treated asthma, is estimated to be about 4.5% (95% confidence intervals, 4.4-4.6).  In studies from several single centers across India, the prevalence of asthma in children ranged from 2.3% to 11.9% and in adults it varied from 0.96% to 11.03%.  The rapid increase in asthma is possibly attributed to changing environmental/lifestyle rather than genetic influences. For asthma and allergic disorders, diet has been recently established as a potential risk factor. ,, Lifestyle factors (obesity, physical activity, and dietary habits) have also contributed to the development of asthma.  The incidence of wheezing in childhood and atopic asthma in later life has an inverse association with duration of exclusive breastfeeding.  However, infants fed with formula feed (cow's milk or soy protein) have been reported to have a higher incidence of wheezing illnesses in early childhood.  A history of perceived worsening of asthma in relation to dietary items is fairly common among Indian asthmatics ranging from 60% to 90%. Increased consumption of fast food, salted snacks, fried snacks, fats and oils nuts, dry fruits, carbonated drinks has been associated with asthma in the Indian adult population. ,,
Thus, a change in dietary habit may be postulated as one of the unknown factors responsible for the rise in prevalence of asthma among children in rural India. The present study was undertaken to assess the association of diet with asthma in Indian rural population.
| Materials and Methods|| |
This study was a cross-sectional study of children aged <18 years residing in Khanpurjupti village, Ghaziabad, Uttar Pradesh, during 2011-2015 after ethical clearance from the Institutional Ethics Committee. One hundred and eighty-seven houses with children aged <18 years from each socioeconomic class were selected for survey and health check-up.
A questionnaire-based survey was carried out for respiratory illness-related symptoms. It was developed on the basis of the American Thoracic Society (ATS),  British Medical Research Council  and the International Study of Asthma and Allergies in Childhood  questionnaires to detect the presence of symptoms suggestive of asthma. The questionnaire was also translated in Hindi. The above-mentioned questionnaire comprised demographic details such as age and sex, birth order, duration of breastfeeding, educational status, food habits (vegetarian and nonvegetarian), and major chronic chest symptoms (cough, sputum, shortness of breath, and wheezing). The survey team did house visits, and the questionnaire was administered at the house itself. Examination of the child, their pulmonary function test or peak expiratory flow rate (PEFR), was conducted. The diagnosis of asthma was made by the physician examining the children, based on the guidelines of ATS.  Using an electronic portable spirometer, spirometry test of children was performed. Maximal expiratory flow-volume curves were obtained as per ATS 1995 recommendations.  In the children who could not perform spirometry, PEFR was obtained with a Wright's peak flow meter. The highest of the three recordings was noted.
The statistical analysis was performed with IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY. The groups were compared for all variables using the Student's t-test to compare equality for means and the Chi-square test to compare category value. The differences were considered to be statistically significant at the P < 0.05 (two-tailed test) level. Results are presented as percentage and mean ± standard deviation.
| Results|| |
There were 187 houses, which were surveyed, and they had a total of 607 children (males n = 339 [55.84%] and females n = 268 [44.16%]). Overall, a total of 17.1% (n = 104; males n = 59 [56.73%]) children were diagnosed as asthma. The various characteristics of children with asthma and without asthma were equated and are shown in [Table 1]. The age and gender distribution, educational status, birth order, and duration of breastfeeding did not show a significant difference between children diagnosed with asthma and without asthma. In the evaluation of dietary habits, children diagnosed with asthma had significantly higher consumption of nonvegetarian food (43.27% vs. 28.23; P < 0.05). Of total 187 children consuming nonvegetarian diet, 22.06% (n = 45) were diagnosed as having asthma in comparison to vegetarian subgroup (14.05%; n = 59) (P < 0.05). In addition, females suffering from asthma were significantly higher in nonvegetarian subgroup (25.61% vs. 12.9%; P < 0.05). The various characteristics of vegetarian and nonvegetarian children diagnosed with asthma are represented in [Table 2].
| Discussion|| |
Asthma is among the top twenty chronic conditions for global ranking of disability-adjusted life years (DALYs) in children; in the mid-childhood ages 5-14 years it is among the top ten causes. There are striking global variations in the prevalence of asthma symptoms (wheezing in the past 12 months) in children, with up to 13-fold differences between countries.  An estimated 1.9 DALYs are lost every year due to asthma per thousand children under 15 years of age in India.  There is a large variation in the prevalence of asthma in different parts of India. The Southern States show a higher prevalence (4.2-19.3%) compared with Northern (2.3-15.5%) and Western States (5.3-7.5%).  The prevalence in current study came out to be 17.1%.
The current study reported a higher prevalence of asthma in males compared to females that is in agreement with the literature.  In the evaluation by dietary consumption, nonvegetarian females had a higher prevalence of asthma than their vegetarian counterparts. No association was found between birth orders in this study, which was consistent with the literature. ,
The literature suggests a role of breastfeeding in protection against atopic dermatitis, wheeze in early childhood, and allergy to cow's milk. However, data about protection against asthma are inconsistent.  Exclusive breastfeeding for at least 3 months protects against asthma between 2 and 4 years of age, especially in children with family history of atopic diseases.  On the contrary, studies have reported no benefit of exclusive breastfeeding in children from nonatopic families or in decreasing the risk of asthma in children at 5 years of age.  A recent systematic review concluded breastfeeding protects against asthma until the age of 6 years, with a more pronounced effect in children <2 years of age.  The present study found no significant association between age of onset or severity of asthma and breastfeeding. Moreover, increased duration of breastfeeding did not alter this observation.
Allergic diseases usually begin early in life. The diet of the pregnant (and eventually breastfeeding) mother is the earliest probable nutritional influence. The consumption of diets by pregnant mother, which are rich in fruit and vegetables, such as the Mediterranean diet, have constantly been associated with a lower risk of allergic sensitization (which is defined as a positive skin prick test to allergens) and allergic rhinitis in children. Furthermore, a high maternal consumption of vegetable oils, margarine, and processed foods is associated with a higher risk of allergic sensitization.  The probable effect of several classes of dietary components is through influencing the development and homeostasis of the immune system, thus preventing or potentiating the development of allergy. Dietary components predominant either in a Western diet (such as saturated fatty acids and cholesterol) or in a Mediterranean diet (such as unsaturated fatty acids, vitamins, and fiber) has been shown to differentially regulate immune function and to exacerbate or protect against allergic diseases, respectively. Their complex mechanisms of action engage specific receptors.  In children residing in Sweden, Greece, and Mexico, a healthy dietary pattern by eating more vegetables and fruits in diet has been shown to be a protective factor for atopic diseases. ,, Agrawal et al. in a study on risk factors for asthma in adults, concluded consumption of a nonvegetarian diet, daily or even occasionally, were more likely to report asthma than those who were strictly vegetarian.  The finding of this study in which asthma was diagnosed significantly higher among nonvegetarians contributes to the growing evidence of protective effects of vegetarian diet in asthma. On the contrary, studies from Asia including India have reported increased asthma among the children , and adults  consuming vegetarian diet.
| Conclusion|| |
The study concluded that increased risk of asthma was associated with higher consumption of nonvegetarian food. Furthermore, breastfeeding did not have any protective effect on asthma. Future studies using epidemiological findings and clinical readings are needed to examine and explain dietary influences on asthma in children. Moreover, high prevalence of asthma in rural children, the findings in the present study, may be useful to help in reducing the burden of asthma through changes in dietary habits.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
The Global Asthma Report. International Union against Tuberculosis and Lung Disease, Paris, 2011. Available from: http://www
. globalasthmanetwork.org/publications/Global_Asthma_Report_2011.pdf. [Last accessed on 2016 Apr 10].
Agarwal R, Dhooria S, Aggarwal AN, Maturu VN, Sehgal IS, Muthu V, et al.
Guidelines for diagnosis and management of bronchial asthma: Joint ICS/NCCP (I) recommendations. Lung India 2015;32 Suppl 1:S3-42.
Devereux G, Seaton A. Diet as a risk factor for atopy and asthma. J Allergy Clin Immunol 2005;115:1109-17.
Romieu I, Trenga C. Diet and obstructive lung diseases. Epidemiol Rev 2001;23:268-87.
Tricon S, Willers S, Smit HA, Burney PG, Devereux G, Frew AJ, et al
. Nutrition and allergic disease. Clin Exp Allergy Rev. 2006;6:117-88. doi: 10.1111/j.1365-2222.2006.00114.x.
Silvers KM, Frampton CM, Wickens K, Pattemore PK, Ingham T, Fishwick D, et al.
Breastfeeding protects against current asthma up to 6 years of age. J Pediatr 2012;160:991-6.e1.
Friedman NJ, Zeiger RS. The role of breast-feeding in the development of allergies and asthma. J Allergy Clin Immunol 2005;115:1238-48.
Kumar R, Kumari D, Srivastava P, Khare V, Fakhr H, Arora N, et al.
Identification of IgE-mediated food allergy and allergens in older children and adults with asthma and allergic rhinitis. Indian J Chest Dis Allied Sci 2010;52:217-24.
Poongadan MN, Gupta N, Kumar R. Dietary pattern and asthma in India. Pneumonol Alergol Pol 2016;84:160-7.
Poongadan MN, Gupta N, Kumar R. Lifestyle factors and asthma in India - A case-control study. Pneumonol Alergol Pol 2016;84:104-8.
Ferris BG. Epidemiology standardization project (American Thoracic Society). Am Rev Respir Dis 1978;118 (6 Pt 2):1-120.
Medical Research Council. Standardized questionnaires on respiratory symptoms. Br Med J 1960;2:1665.
Keil U, Weiland SK, Duhme H, Chambless L. The International Study of Asthma and Allergies in Childhood (ISAAC): Objectives and methods; results from German ISAAC centres concerning traffic density and wheezing and allergic rhinitis. Toxicol Lett 1996;86:99-103.
Standardization of spirometry, 1994 update. American Thoracic Society. Am J Respir Crit Care Med 1995;152:1107-36.
Asher I, Pearce N. Global burden of asthma among children. Int J Tuberc Lung Dis 2014;18:1269-78.
Jain A, Vinod Bhat H, Acharya D. Prevalence of bronchial asthma in rural Indian children: A cross sectional study from South India. Indian J Pediatr 2010;77:31-5.
Qureshi UA, Bilques S, Ul Haq I, Khan MS, Qurieshi MA, Qureshi UA. Epidemiology of bronchial asthma in school children (10-16 years) in Srinagar. Lung India 2016;33:167-73.
George CE, Chopra H, Garg SK, Bano T, Jain S, Kumar A. Early childhood determinants of bronchial asthma: A cross-sectional study from Western Uttar Pradesh. Int J Contemp Pediatr 2014;1:160-3.
Gdalevich M, Mimouni D, Mimouni M. Breast-feeding and the risk of bronchial asthma in childhood: A systematic review with meta-analysis of prospective studies. J Pediatr 2001;139:261-6.
Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev 2012;8:CD003517.
Brew BK, Allen CW, Toelle BG, Marks GB. Systematic review and meta-analysis investigating breast feeding and childhood wheezing illness. Paediatr Perinat Epidemiol 2011;25:507-18.
Dogaru CM, Nyffenegger D, Pescatore AM, Spycher BD, Kuehni CE. Breastfeeding and childhood asthma: Systematic review and meta-analysis. Am J Epidemiol 2014;179:1153-67.
Netting MJ, Middleton PF, Makrides M. Does maternal diet during pregnancy and lactation affect outcomes in offspring? A systematic review of food-based approaches. Nutrition 2014;30:1225-41.
Nurmatov U, Devereux G, Sheikh A. Nutrients and foods for the primary prevention of asthma and allergy: Systematic review and meta-analysis. J Allergy Clin Immunol 2011;127:724-33.e1-30.
de Batlle J, Garcia-Aymerich J, Barraza-Villarreal A, Antó JM, Romieu I. Mediterranean diet is associated with reduced asthma and rhinitis in Mexican children. Allergy 2008;63:1310-6.
Nagel G, Weinmayr G, Kleiner A, Garcia-Marcos L, Strachan DP; ISAAC Phase Two Study Group. Effect of diet on asthma and allergic sensitisation in the International Study on Allergies and Asthma in Childhood (ISAAC) phase two. Thorax 2010;65:516-22.
Arvaniti F, Priftis KN, Papadimitriou A, Papadopoulos M, Roma E, Kapsokefalou M, et al.
Adherence to the Mediterranean type of diet is associated with lower prevalence of asthma symptoms, among 10-12 years old children: The PANACEA study. Pediatr Allergy Immunol 2011;22:283-9.
Agrawal S, Pearce N, Ebrahim S. Prevalence and risk factors for self-reported asthma in an adult Indian population: A cross-sectional survey. Int J Tuberc Lung Dis 2013;17:275-82.
Koolwal A, Kapoor H, Sehajpal R, Koolwal S. Diet and asthma: An observational study. Indian J Allergy Asthma Immunol 2014;28:93-7.
Huang SL, Lin KC, Pan WH. Dietary factors associated with physician-diagnosed asthma and allergic rhinitis in teenagers: Analyses of the first Nutrition and Health Survey in Taiwan. Clin Exp Allergy 2001;31:259-64.
Shi Z, Yuan B, Wittert GA, Pan X, Dai Y, Adams R, et al.
Monosodium glutamate intake, dietary patterns and asthma in Chinese adults. PLoS One 2012;7:e51567.
[Table 1], [Table 2]