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Dietary Patterns and Asthma Endotypes in Puerto Rican Youth
Allen Joe1, Franziska J Rosser1, Kristina Gaietto1
1Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
Background:
Diet may influence the pathogenesis of asthma, a heterogeneous syndrome comprising unique mechanisms or endotypes. Little is known about the relation between diet and asthma endotypes in children and adolescents.
Research Question:
Are dietary patterns associated with T-helper 17 (T17)-high asthma?
Study Design And Methods:
Cross-sectional (n = 465) and longitudinal (n = 358) analyses of dietary patterns and asthma endotypes in Puerto Rican populations with (cases) and without (control patients) asthma who completed a baseline study visit at 6 to 14 years of age and a second visit at 9 to 20 years of age, with a mean interval of 5.3 years between visits. A dietary score, ranging from -2 (unhealthiest diet) to 2 (healthiest diet) was developed using data from a food frequency questionnaire. An unhealthy diet was defined as a nonpositive dietary score (-2 to 0). Based on nasal epithelial expression of 8 signature genes for T-helper 2 (T2) and T17 immunity, 3 asthma endotypes were identified at the second visit: T2-high, T17-high, and T2-low/T17-low. Multinomial regression was used for the multivariable analysis of dietary patterns and asthma endotypes.
Results:
In a cross-sectional analysis including 465 participants at the second visit, with control patients as the reference group, each 1-point increment in dietary score was associated with decreased odds of T17-high asthma (OR, 0.72; 95% CI, 0.55-0.95; P = .02), whereas an unhealthy diet was associated with increased odds of T17-high asthma (OR, 2.31; 95% CI, 1.31-4.08; P < .01). In a prospective analysis including 356 youths who completed both visits, an unhealthy diet at both visits was associated with increased odds of T17-high (OR, 4.30; 95% CI, 1.77-10.47; P < .01) and T2-low/T17-low asthma (OR, 2.48; 95% CI, 0.99-6.20; P = .05).
Interpretation:
Our results show that in a study of Puerto Rican youths, an unhealthy diet was associated with T17-high asthma in cross-sectional and prospective analyses, suggesting that T17 pathways may potentially mediate dietary effects on asthma.
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