PMC:4137988 / 10808-14323
Annnotations
2_test
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dietary patterns and asthma\n\nSystematic review\nTable 2 shows the main characteristics and results of the 12 studies in adults, published between 2006 and 2013. These papers included four cross-sectional studies,22–25 six cohort studies,26–31 one case-control study,20 and one RCT.21 Six of them were conducted in Europe,20,23–27 two in Australia,21,22 two in the USA,28,29 and two in Asia.30,31 Sample sizes ranged from 38 in the RCT to 156,035 in the cross-sectional studies. Two studies27,28 included female subjects only and one29 male subjects only, while the remaining examined both sexes, with one22 examining men and women separately.\nAll studies used food frequency questionnaires (FFQs) to measure dietary intakes, with the number of food items or groups ranging from 12 to over 200. Ten studies20,22–24,26–31 derived at least two dietary patterns a posteriori using PCA (n=9) or factor analysis (n=1). Two studies21,25 calculated a Mediterranean diet score defined a priori.\nAsthma outcomes evaluated in these studies included prevalence of ever or current asthma, asthma-related quality of life, asthma symptoms, lung function (forced expiratory volume in one second, forced vital capacity), frequency of asthma attacks, asthma control (Asthma Control Questionnaire alone or plus fractional exhaled nitric oxide), and asthma-related inflammatory markers. The findings were mixed. Among the 12 studies, six reported significant association between dietary patterns and ever asthma,22,31 forced expiratory volume in one second,24,26 frequency of asthma attacks,27 and risk of uncontrolled asthma.25 Although the asthma outcomes varied across these studies, potentially protective dietary patterns tended to include cheese/brown bread, nuts and wine, a prudent pattern diet (fruit, vegetables, oily fish, and wholemeal cereals), and the Mediterranean diet. At the same time, potentially risky dietary patterns tended to include meats/cheese, Chinese traditional pattern (rice and fresh vegetables), the Netherlands traditional diet (meat and potatoes), and Western pattern (pizza, salty pies, desserts, and cured meat). In contrast, one cross-sectional,23 one case-control,20 and three cohort studies28–30 reported no association. An RCT with 38 adults who had symptomatic asthma showed no effect of two Mediterranean diet interventions on asthma control, lung function, asthma-related quality of life, or inflammatory markers compared with no-intervention control.21\n\nResults of meta-analysis\nThe meta-analysis included three cohort studies,26,27,31 two cross-sectional studies,22,23 and one case-control study.20 Figures 2–4 show that there was no evidence of association between the prevalence of current or ever asthma and healthy (OR 1.01, 95% CI 0.78–1.31), unhealthy (OR 1.04, 95% CI 0.93–1.16), or neutral (OR 1.01, 95% CI 0.73–1.41) dietary patterns. The mixed model results show that the random effect estimates were zero, suggesting very small or negligible variance between versus within studies.\n\nPublication bias and heterogeneity\nFigure 5 shows funnel plots of studies examining the association between healthy, unhealthy, and neutral dietary patterns separately and the prevalence of current or ever asthma. The plots were roughly symmetrical, suggesting little evidence of publication bias, and almost all the studies lay within the diagonal lines indicating 95% CIs, suggesting negligible between-study heterogeneity, which is consistent with the model-based results described above."}