The effects of increasing fruit and vegetable intake in children with asthma: A randomized controlled trial. Issue 9 (14th July 2021)

• Record Type: Journal Article
• Authors: Berthon, Bronwyn S.; McLoughlin, Rebecca F.; Jensen, Megan E.; Hosseini, Banafshe; Williams, Evan J.; Baines, Katherine J.; Taylor, Steven L.; Rogers, Geraint B.; Ivey, Kerry L.; Morten, Matthew; Da Silva Sena, Carla R.; Collison, Adam M.; Starkey, Malcolm R.; Mattes, Joerg; Wark, Peter A. B.; Wood, Lisa G.
• Is Part Of: Clinical & experimental allergy. Volume 51:Issue 9(2021)
• Page Start: 1144
• Page End: 1156
• Publication Date: 2021-07-14
• Subjects: antioxidants -- asthma -- dietary fibre -- fruit and vegetables -- paediatrics; Allergy -- Periodicals; Immunology -- Periodicals; 616.97
• DOI: 10.1111/cea.13979
• Languages: English
• ISSNs: 0954-7894

Abstract

Abstract: 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 ( X 5 ∆: 0.76 [0.04, 1.48] p = 0.038, X 20 ∆: 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. Abstract : In a 6‐month RCT in asthmatic children, a high fruit and vegetable (F&V) diet more than doubled fruit and vegetable intake and increased plasma carotenoids, compared to the low F&V control group. The high F&V diet did not affect asthma exacerbations; however, changes in gut microbiome and improvements in lung function were observed. In the low F&V group, changes in gut microbiome, increased plasma CRP, increased HDAC activity and decreased GPR41 gene expression in PBMCs were observed.