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The effects of increasing fruit and vegetable intake in children with asthma: A randomized controlled trial
Bronwyn S Berthon1, Rebecca F McLoughlin1, Megan E Jensen2
1Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.
Insights
A high fruit and vegetable diet did not reduce asthma exacerbations in children over 6 months. However, it may improve lung function and offer protection against systemic inflammation, warranting further study.
Area of Science:
- Pediatric Allergy and Immunology
- Nutritional Science
- Respiratory Medicine
Background:
- A high fruit and vegetable (F&V) diet is linked to reduced asthma exacerbations in adults.
- This protective effect has not been previously studied in children with asthma.
Purpose of the Study:
- To determine if a 6-month high F&V diet intervention can reduce asthma exacerbations in children.
- To explore secondary effects on lung function, inflammation, and molecular markers.
Main Methods:
- A parallel-group, randomized controlled trial involving children aged 3-11 years with asthma and low F&V intake.
- Participants were assigned to either a high F&V diet or their usual diet for 6 months.
- Primary outcome was time to first asthma exacerbation; secondary outcomes included exacerbation rate, lung function, and biomarkers.
Main Results:
- The high F&V diet significantly increased F&V intake and plasma carotenoids compared to the control group.
- No significant difference was found in time to first exacerbation or exacerbation rate between groups.
- Airway reactance improved in the intervention group, with observed changes in gut microbiota, but no differences in systemic inflammation markers.
Conclusions:
- A 6-month high F&V diet did not significantly alter asthma exacerbations in children.
- The diet intervention showed potential for improving lung function and warrants further investigation for its role in pediatric asthma management.
- Further research is needed to confirm these findings and explore underlying mechanisms.
Background:
A high fruit and vegetable (F&V) diet reduces asthma exacerbations in adults; this has not been examined in children to date.
Objective:
To investigate the effect of a 6-month, high F&V diet on the time to first asthma exacerbation in children with asthma, in a parallel-group, randomized, controlled trial.
Methods:
Children (aged 3-11 years) with asthma, history of exacerbations and usual low F&V intake (≤3 serves/day) were randomized to the intervention (high F&V diet) or control group (usual diet) for 6 months. The primary outcome was time to first exacerbation requiring medical intervention. Secondary outcomes included exacerbation rate, lung function, plasma TNF-α, CRP, and IL-6, faecal microbiota and peripheral blood mononuclear cell (PBMC) histone deacetylase (HDAC) activity and G-protein coupled receptor (GPR) 41/43 and HDAC (1-11) expression.
Results:
67 children were randomized between September 2015 and July 2018. F&V intake (difference in change (∆): 3.5 serves/day, 95% CI: [2.6, 4.4] p < 0.001) and plasma total carotenoids (∆: 0.44 µg/ml [0.19, 0.70] p = 0.001) increased after 6 months (intervention vs control). Time to first exacerbation (HR: 0.81, 95% CI: [0.38, 1.69], p = 0.569; control vs. intervention) and exacerbation rate (IRR: 0.84, [0.47, 1.49], p = 0.553; control vs. intervention) were similar between groups. In per-protocol analysis, airway reactance z-scores increased in the intervention versus control group (X5 ∆: 0.76 [0.04, 1.48] p = 0.038, X20 ∆: 0.93 [0.23, 1.64] p = 0.009) and changes in faecal microbiota were observed though there was no difference between groups in systemic inflammation or molecular mechanisms. In the control group, CRP and HDAC enzyme activity increased, while GPR41 expression decreased. No adverse events attributable to the interventions were observed.
Conclusion & Clinical Relevance:
A high F&V diet did not affect asthma exacerbations over the 6-month intervention, though warrants further investigation as a strategy for improving lung function and protecting against systemic inflammation in children with asthma.
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