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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 30  |  Issue : 2  |  Page : 80-90

Dietary pattern and lifestyle factors in asthma control


1 Department of Respiratory Allergy and Applied Immunology, V P Chest Institute, University of Delhi, New Delhi, India
2 Department of Pulmonary Medicine, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
3 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

Date of Web Publication5-Dec-2016

Correspondence Address:
Raj Kumar
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
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-6691.195245

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  Abstract 

Background: The prevalence of asthma in adults varied from 0.96% to 11.03% while in children ranged from 2.3% to 11.9% in India. A number of factors including genetic predisposition, environment, and lifestyle factors including dietary habits influence the development and expression of asthma. The goal of asthma treatment is to achieve and maintain clinical control, which can be achieved in a majority of patients with pharmacologic intervention strategy. Objective: To assess the role of diet and lifestyle factors in asthma control in Indian population. Materials and Methods: Diagnosed asthma patients (aged 12-40 years) were enrolled from the outpatient clinics. All patients were followed up and reassessed after 4 weeks with asthma control test (ACT) and dietary and lifestyle questionnaire. The assessment of dietary pattern was performed by food frequency questionnaire (Nordic Nutrition Recommendations-Danish Physical Activity Questionnaire). The lifestyle factor included body mass index, smoking status, tobacco chewing, alcohol consumption, duration of travel (h/week), mental stress (visual analog scale: 0-10), sports activity - h/day, television (TV) watching/video games - h/day, duration of sleep - h/day. Results: Seventy-five asthma patients (43 males and 32 females) were divided into three groups according to ACT, 18 (24%) patients in poorly-controlled asthma, 35 (46.7%) in well-controlled asthma, and 22 (29.3%) patients with totally-controlled asthma. Increased consumption of vegetables and cereals in patients with total-controlled asthma while increased consumption of sugar, nonvegetarian, fast food, salted and fried snacks in patients with poorly-controlled asthma. Poorly-controlled asthma had the highest duration of watching TV and sleep and least duration of travel and sports, though the results failed to reach statistical significance. Conclusion: The dietary and lifestyle factors too contribute to degree of control of asthma in India.

Keywords: Asthma control, diet, lifestyle


How to cite this article:
Poongadan MN, Gupta N, Kumar R. Dietary pattern and lifestyle factors in asthma control. Indian J Allergy Asthma Immunol 2016;30:80-90

How to cite this URL:
Poongadan MN, Gupta N, Kumar R. Dietary pattern and lifestyle factors in asthma control. Indian J Allergy Asthma Immunol [serial online] 2016 [cited 2017 Apr 23];30:80-90. Available from: http://www.ijaai.in/text.asp?2016/30/2/80/195245


  Introduction Top


Asthma affects globally approximately 300 million individuals with a prevalence from 1% to 18% in different geographical regions. [1],[2] The prevalence of asthma in adults varied from 0.96% to 11.03% while in children ranged from 2.3% to 11.9% in India. [3] A number of factors including genetic predisposition, environment, and lifestyle factors including dietary habits influence the development and expression of asthma. [4] The goal of asthma treatment is to achieve and maintain clinical control, which can be achieved in a majority of patients with pharmacologic intervention strategy. [5] Patient's knowledge of the disease, avoidance of exacerbating factors, and adherence to treatment is associated with better control.

A positive correlation exists between consumption of diet rich in vegetable, fresh fruits along with lifestyle habits as periodical exercise and good asthma control. Furthermore, cigarette smoking, allergic rhinitis, gastroesophageal reflux disease, exposure to allergens are associated with poor asthma control. [6]

The most widely used method to assess the dietary pattern in asthma patients is food frequency questionnaire (FFQ). [7],[8] The relationship between diet and asthma control has been by and large been derived from western literature. This study was undertaken to assess the association of diet and asthma control in a demonstrative Indian population.


  Materials and Methods Top


Study design and demographics

The study is a prospective analysis of dietary pattern and asthma control performed for 1 year, between 2014 and 15.

Diagnosis and treatment of asthma

Diagnosed asthma patients (in agreement with Global Initiative For Asthma (GINA) guidelines) were enrolled from the outpatient clinics. [2] The study cohort consisted of 75 subjects (43 males and 32 females), aged between 12 and 40 years. The exclusion criteria were (1) inability to fill the questionnaire and (2) pregnant and lactating females. The asthma treatment was started in accordance with GINA guidelines. An asthma diary was provided to check the compliance to treatment. All 75 patients were followed up and reassessed after 4 weeks with asthma control test (ACT) and dietary and lifestyle questionnaire.

Dietary pattern and lifestyle assessment

The assessment of dietary pattern was performed by FFQ (Nordic Nutrition Recommendations-Danish Physical Activity Questionnaire). The questionnaire required each subject to indicate in a pictorial-based questionnaire his/her self-estimated consumption frequency of each cereal food, fats and oils, sugars, milk and milk products, nonvegetarian food, pulses, vegetables, fruits, fast food, snacks, salted snacks, fried snacks, nuts, dry fruits, carbonated drinks, and fruit juices according to the following scale: "Never/occasionally eat," "1-2 times/week," "≥3 times/week."

The lifestyle factors that were assessed included:

  1. Body mass index (BMI)
  2. (a) Smoking status, (b) tobacco chewing, (c) alcohol consumption, (d) duration of travel (h/week), (e) mental stress (scale of 1-10, 1 = very low, 10 = very high)
  3. (a) Sports activity - h/day, (b) television (TV) watching/video games - h/day, (c) duration of sleep - h/day.


Asthma control test

All 75 patients were evaluated after 1 month of treatment using the ACT. The ACT is a patient-completed questionnaire of five items with five response options investigating limitations at work or school due to asthma, the presence of daytime or night-time symptoms, the use of rescue medications, and the subjective perception of the level of asthma control during the previous 4 weeks. Then they will be divided into three groups, total control (ACT = 25), well-controlled (ACT = 20-24), and poorly-controlled (ACT ≤19).

All subjects gave a written informed consent to take part in the study. The institutional ethical committee approved the study protocol.

Statistical analysis

Data analysis was performed using SPSS statistical package version 15.0 for Windows (SPSS, Chicago, IL, USA). It was examined for distribution and homogeneity of variances was checked before applying parametric tests. Quantitative variables were compared between three groups using ANOVA/Kruskal-Wallis test and between two groups using unpaired t-test/Mann-Whitney test. Qualitative variables were compared using Chi-square/Fisher's exact test. Statistical significance was set at the conventional 5% level (P < 0.05).


  Results Top


Seventy-five asthma patients (43 males and 32 females) had an age range from 6 to 40 years, the mean duration of symptoms of 10.06 ± 5.51 years and age of onset of symptoms of 12.63 ± 6.54 years. All the 75 patients were followed up after 1 month of treatment in accordance with GINA guidelines. They were divided into three groups according to ACT, 18 (24%) patients in poorly-controlled asthma, 35 (46.7%) in well-controlled asthma, and 22 (29.3%) patients with totally-controlled asthma [Figure 1]. The mean age in poorly-controlled asthma was 26.17 ± 7.71 years, 22.91 ± 8.73 years in well-controlled asthma and 18.91 ± 6.3 years in totally-controlled asthma (P < 0.05).
Figure 1: Asthma control test distribution among 75 subjects

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Dietary pattern and asthma control

The comparative analysis of the consumption of different food categories in accordance with ACT scores has been formulated in [Table 1]. On subgroup analysis, among cereals paratha consumption once or twice in a week was significantly higher in poorly-controlled group in comparison to other two groups. As a group, cereal consumption was more common in well-controlled group (6.57 ± 2.2) group and total control group (6.27 ± 2.47) as compared to poorly-controlled (6.17 ± 2.6) which was statistically not significant [Table 2]. Among fat and oil group, no food item had statistically significant relationship with asthma control [Table 3]. In the present study, among sugar, jam consumption three or more times in a week was significantly higher in poorly control group compared to well control group (P < 0.05) [Table 4].
Table 1: Summary between relationship of dietary pattern and level of asthma control

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Table 2: Frequency of consumption of cereals among different asthma control groups

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Table 3: Frequency of consumption of fats and oils among different asthma control groups

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Table 4: Frequency of consumption of sugars among different asthma control groups

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The milk and milk products consumption was higher in poorly-controlled group in comparison to other two groups, however, the difference was not statistically significant [Table 5]. The consumption of various nonvegetarian food and asthma control is depicted in [Table 6]. There was no significant relation between asthma control and consumption of different pulses [Table 7]. The consumption of different vegetables and fruits among the asthma control groups is depicted in [Table 8] and [Table 9]. Among fast food, consumption of ice cream, chocolates, and cake, never or occasionally in a week was significantly higher in totally-controlled group in comparison to other groups [Table 10]. The consumption frequency of beverages, snacks, and nuts has been described in [Table 11].
Table 5: Frequency of consumption of milk and milk products among different asthma control groups

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Table 6: Frequency of consumption of nonvegetarian food among different asthma control groups

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Table 7: Frequency of consumption of pulses among different asthma control groups

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Table 8: Frequency of consumption of vegetables among different asthma control groups

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Table 9: Frequency of consumption fruits among different asthma control groups

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Table 10: Frequency of consumption of fast foods among different asthma control groups

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Table 11: Frequency of consumption of other food items among different asthma control groups

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The overall summary of food items with frequent intake in poorly-controlled asthma and well- and totally-controlled asthma has been depicted in [Table 12].
Table 12: List food items with significant difference in intake with asthma control

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Relationship between lifestyle and levels of asthma control

The BMI was more in poorly-controlled group (24.17 ± 2.89) compared to well-controlled group (23.04 ± 3.98) and totally-controlled group (21.81 ± 3.08) [Figure 2]. The relationship was statistically significant (P = 0.009).
Figure 2: Relationship between body mass index and asthma control

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The relationship between different lifestyle factors and their outcome among the asthma control groups is described in [Table 13]. Poorly-controlled asthma had the highest duration of watching TV and sleep and least duration of travel and sports, though the results failed to reach statistical significance. Furthermore, the mental stress was observed to be highest in poorly-controlled group.
Table 13: Relationship between hours of sports, television watching, and sleep with asthma control

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  Discussion Top


The goal of asthma treatment is to achieve and maintain clinical control, which can be achieved in a majority of patients with pharmacologic intervention strategy. [5] However, asthma control still remains difficult to attain in all patients. [9] There are only few studies related to asthma control and diet. The remarkable variation in asthma prevalence between countries or geographically adjacent areas suggests that environmental factors play a determinant role both in asthma prevalence and severity. The marked changes in dietary patterns in recent decades may explain some of the variation. [10] Interventions with supplementation of a single nutrient have been disappointing, [11],[12],[13] and it may be important to consider the diet as a whole to understand the possible synergistic effects of various food components. Several studies have shown that asthma outcomes were negatively associated with citrus fruits, apples, pears, tomato, carrots, leafy vegetables, butter, whole milk and nonpasteurized farm milk, and positively associated with fast foods. [14],[15],[16],[17],[18],[19] These previous studies elucidated the relationship between asthma incidence and diet. On the contrary, the current study evaluated the relationship between asthma control and diet. Iikura et al. [6] in their study in Japanese population concluded raw vegetable intake (>5 units/week) was significantly associated with good asthma control by bivariate analysis. The present study too revealed increased consumption of vegetables and cereals in patients with total-controlled asthma in comparison to partially and poorly-controlled asthma. In addition, the study also revealed increased consumption of sugar, nonvegetarian, fast food, salted, and fried snacks in patients with poorly-controlled asthma.

Their evidence of association of lifestyle factors with asthma is present in abundance; however, an association of lifestyle factors with asthma control is sparse. The present study evaluated the asthma control and lifestyle factors in 75 subjects. The poorly-controlled asthma group had significantly higher BMI compared to well- and totally-controlled group. The results were in line with a study conducted by Biring et al. stating association of higher BMI with poor asthma control. [20] Literature suggests an association of cigarette smoking with poor asthma control. [21],[22],[23] However, Iikura et al. reported direct tobacco smoking status and alcohol drinking were not associated with asthma control. [6] In the present study, smoking was higher in the well-controlled group and alcohol intake in poorly-controlled group.

Lucas and Platts-Mills asserted the importance of physical activity in decreasing asthma prevalence. [24] However, Westermann reported no relationship between asthma control and periodic exercise. [25] Iikura et al. observed patients with more than 3 metabolic equivalents of tasks - hours/week exercise had good asthma control. [6] In the present study, the poorly-controlled asthma group had the least duration of sports and travel. Furthermore, poorly-controlled asthmatics spend the highest duration of time in watching TV and sleep. These factors could have been accredited to disease itself or due to the adoption of a sedentary lifestyle in asthma patients.


  Conclusion Top


To the best of our knowledge, the present study is among few to evaluate the importance of diet and lifestyle factors in control of asthma in India. The present study can form basis to further longitudinal studies that would allow better information regarding the complexity of role of diet and lifestyle factors in asthma control.

The small number of subjects enrolled limits the work hence interpretations should be made with prudence. The broader age group and cultural diversity may have led to a degree of difference in lifestyle preferences, thus influencing the results. Hence, a further large-scale population-based study is required for assessing the effect of dietary and lifestyle pattern affecting asthma control in Indian population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13]



 

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