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  • 1. VITAMIN A, C, E AND DVITAMIN A, C, E AND D INSUFFICIENCYINSUFFICIENCY LINKED TOLINKED TO ASTHMA / WHEEZE ANDASTHMA / WHEEZE AND ASTHMA SEVERITYASTHMA SEVERITY
  • 2. DEFINITION OF ASTHMADEFINITION OF ASTHMA A chronic inflammatory disorder ofA chronic inflammatory disorder of the bronchial tubes (bronchi)the bronchial tubes (bronchi) makes them swell, narrowing themakes them swell, narrowing the airways.airways. Asthma involves only the bronchialAsthma involves only the bronchial tubes and does not affect the airtubes and does not affect the air sacs (alveoli) or the lung tissuesacs (alveoli) or the lung tissue (the parenchyma of the lung) itself.(the parenchyma of the lung) itself.
  • 3. DEFINITION OF ASTHMADEFINITION OF ASTHMA Airway narrowing in asthma is dueAirway narrowing in asthma is due to three major processes acting onto three major processes acting on the bronchi:the bronchi:  inflammationinflammation  spasmspasm  hyper reactivityhyper reactivity
  • 4. CAUSESCAUSES 1. Airborne allergens, such as pollen,1. Airborne allergens, such as pollen, animal dander, mold, cockroachesanimal dander, mold, cockroaches and dust mitesand dust mites 2. Respiratory infections, such as the2. Respiratory infections, such as the common coldcommon cold 3. Physical activity (exercise-induced3. Physical activity (exercise-induced asthma)asthma) 4. Cold air4. Cold air
  • 5. CAUSESCAUSES 5. Air pollutants and irritants such as5. Air pollutants and irritants such as smokesmoke 6. Certain medications, including6. Certain medications, including beta blockers, aspirin and other nobeta blockers, aspirin and other no steroidal anti-inflammatory drugssteroidal anti-inflammatory drugs 7. Strong emotions and stress7. Strong emotions and stress
  • 6. CAUSESCAUSES 8.8. Sulfites, preservatives added toSulfites, preservatives added to some perishable foodssome perishable foods 9.9. Gastro esophageal refluxGastro esophageal reflux diseasedisease 10.10. Allergic reactions to foods suchAllergic reactions to foods such as peanuts or shellfishas peanuts or shellfish
  • 7. RISK FACTORSRISK FACTORS 1. A family history of asthma1. A family history of asthma 2. Frequent respiratory infections as2. Frequent respiratory infections as a childa child 3. Exposure to secondhand smoke3. Exposure to secondhand smoke 4. Living in an urban area, especially4. Living in an urban area, especially if there's a lot of air pollutionif there's a lot of air pollution
  • 8. RISK FACTORSRISK FACTORS 5. Exposure to occupational triggers,5. Exposure to occupational triggers, such as chemicals used in farming,such as chemicals used in farming, hairdressing and manufacturinghairdressing and manufacturing 6. Low birth weight6. Low birth weight 7. Being overweight7. Being overweight 8. ????8. ????
  • 9. HYPOTHESISHYPOTHESIS  DIET LOW IN VITAMINS A, CDIET LOW IN VITAMINS A, C AND E LINKED TO ASTHMAAND E LINKED TO ASTHMA AND WHEEZEAND WHEEZE  VITAMIN D INSUFFICIENCYVITAMIN D INSUFFICIENCY IS LINKED TO ASTHMAIS LINKED TO ASTHMA SEVERITYSEVERITY
  • 10. The results of a systematic review andThe results of a systematic review and meta-analysis reported in the April 16meta-analysis reported in the April 16thth 2009 Online First issue of Thorax:2009 Online First issue of Thorax: RelativelyRelatively low dietary intakes oflow dietary intakes of vitamins A and Cvitamins A and C are associatedare associated with statistically significantwith statistically significant increased odds of asthma andincreased odds of asthma and wheezewheeze
  • 11. The American Journal of RespiratoryThe American Journal of Respiratory and Critical Care Medicine (May 1,and Critical Care Medicine (May 1, 2009):2009): Vitamin D insufficiency is linked toVitamin D insufficiency is linked to asthma severityasthma severity
  • 12. S. Allen, from the University ofS. Allen, from the University of Nottingham in Nottingham, UnitedNottingham in Nottingham, United Kingdom, and colleagues carried outKingdom, and colleagues carried out epidemiological studies:epidemiological studies: ““Dietary intake of vitamins A, C andDietary intake of vitamins A, C and E may be associated with theE may be associated with the occurrence of asthma”occurrence of asthma”
  • 13. The reviewers searched MEDLINE,The reviewers searched MEDLINE, EMBASE, CINAHL, CAB abstracts,EMBASE, CINAHL, CAB abstracts, and AMED up to November 2007and AMED up to November 2007 included 40 studies:included 40 studies: asthma, wheeze, or airwayasthma, wheeze, or airway responsiveness in association withresponsiveness in association with dietary intakes and serumdietary intakes and serum concentrations of vitamins A, C,concentrations of vitamins A, C, and Eand E..
  • 14.  Compared with people withoutCompared with people without asthma, those withasthma, those with asthma hadasthma had significantly lower dietary vitamin Asignificantly lower dietary vitamin A intakeintake (mean difference, –182 µg/day; 95% CI, –288 to –75 µg/day; 3(mean difference, –182 µg/day; 95% CI, –288 to –75 µg/day; 3 studies).studies).  In addition, people withIn addition, people with severesevere asthma had significantly lowerasthma had significantly lower dietary vitamin A intakedietary vitamin A intake vs. thosevs. those with mild asthmawith mild asthma (mean difference, –344 µg/day; 2 studies).(mean difference, –344 µg/day; 2 studies).
  • 15.  The odds of asthma were alsoThe odds of asthma were also increased inincreased in patients withpatients with lowerlower quantize dietaryquantize dietary intakesintakes and inand in those withthose with lower serumlower serum levels oflevels of vitamin C.vitamin C. (OR, 1.12; 95% CI, 1.04 - 1.21; 9 studies)(OR, 1.12; 95% CI, 1.04 - 1.21; 9 studies)
  • 16.  Vitamin E intakeVitamin E intake was generallywas generally not associated with asthma statusnot associated with asthma status..  ButBut it wasit was significantly lowersignificantly lower inin patients withpatients with severe asthmasevere asthma vs.vs. those with mild asthmathose with mild asthma (mean difference, –1.20 µg/day; 95% CI, –2.3 to –0.1 µg/day;(mean difference, –1.20 µg/day; 95% CI, –2.3 to –0.1 µg/day; 2 studies).2 studies).
  • 17. The study authors write:The study authors write: "Relatively low dietary intakes of"Relatively low dietary intakes of vitamins A and C are associatedvitamins A and C are associated with statistically significantwith statistically significant increased odds of asthma andincreased odds of asthma and wheeze,wheeze, andand Vitamin E intake doesVitamin E intake does not appear to be related to asthmanot appear to be related to asthma status."status."
  • 18. Erick Forno, from Brigham andErick Forno, from Brigham and Women's Hospital in Boston,Women's Hospital in Boston, Massachusetts, and colleagues:Massachusetts, and colleagues: "Maternal vitamin D intake during"Maternal vitamin D intake during pregnancy has been inverselypregnancy has been inversely associated with asthma symptomsassociated with asthma symptoms in early childhood,"in early childhood,"
  • 19. The study carried out in 616 CostaThe study carried out in 616 Costa Rican children aged 6 to 14 yearsRican children aged 6 to 14 years to evaluate the associationto evaluate the association between measured levels of 25between measured levels of 25 hydroxyvitamin D and markers ofhydroxyvitamin D and markers of asthma severity and allergyasthma severity and allergy
  • 20.  Levels of vitamin D were insufficientLevels of vitamin D were insufficient (< 30 ng/mL) in 175 (28%) of 616(< 30 ng/mL) in 175 (28%) of 616 children with asthma.children with asthma.  Vitamin D levelsVitamin D levels were significantlywere significantly andand inverselyinversely associated with totalassociated with total immunoglobulin E (IgE) andimmunoglobulin E (IgE) and eosinophileosinophil count, based oncount, based on multivariate linear regressionmultivariate linear regression models.models.
  • 21. Increase in vitamin D levels wasIncrease in vitamin D levels was associated with:associated with:  Lower odds of any hospitalizationLower odds of any hospitalization in the previous yearin the previous year (OR, 0.05; 95% confidence interval [CI], 0.004 - 0.71; P = .03),(OR, 0.05; 95% confidence interval [CI], 0.004 - 0.71; P = .03),  Lower use of anti-inflammatoryLower use of anti-inflammatory medications in the previous yearmedications in the previous year (OR, 0.18; 95% CI, 0.05 - 0.67; P = .01),(OR, 0.18; 95% CI, 0.05 - 0.67; P = .01),  increased airway responsivenessincreased airway responsiveness (OR, 0.15; 95% CI, 0.024 - 0.97;(OR, 0.15; 95% CI, 0.024 - 0.97; PP = .05),= .05),
  • 22. The study authors write:The study authors write: ““ Vitamin D insufficiency is relativelyVitamin D insufficiency is relatively frequent in an equatorialfrequent in an equatorial population of children with asthma.population of children with asthma. Lower vitamin D levels areLower vitamin D levels are associated with increased markersassociated with increased markers of allergy and asthma severity."of allergy and asthma severity."
  • 23. LimitationsLimitations of this study include:of this study include: • lack of a control group,lack of a control group, • cross-sectional design,cross-sectional design, • possible residual confounding bypossible residual confounding by socioeconomic status.socioeconomic status. Authors conclude:Authors conclude: should include in vitro and animalshould include in vitro and animal studies to further elucidate thestudies to further elucidate the mechanisms for the role of vitamin Dmechanisms for the role of vitamin D
  • 24. CONCLUSION:CONCLUSION: 1.1. Lower dietary intakes of vitamins ALower dietary intakes of vitamins A and C, but not vitamin E, wereand C, but not vitamin E, were associated with increased odds ofassociated with increased odds of asthma.asthma. 2.2. Vitamin E was significantly lower inVitamin E was significantly lower in patients with severe asthmapatients with severe asthma 3.3. Lower vitamin D level was associatedLower vitamin D level was associated with increased markers of allergy andwith increased markers of allergy and asthma severity uncertainly.asthma severity uncertainly.
  • 25. Thanks for yourThanks for your attentionsattentions

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