The Role of Nutritional Factors in Asthma: Challenges and Opportunities for Epidemiological Research

Annabelle Bédard, Zhen Li, Wassila Ait-Hadad, Carlos A Camargo Jr, Bénédicte Leynaert, Christophe Pison, Orianne Dumas, Raphaëlle Varraso, Annabelle Bédard, Zhen Li, Wassila Ait-Hadad, Carlos A Camargo Jr, Bénédicte Leynaert, Christophe Pison, Orianne Dumas, Raphaëlle Varraso

Abstract

The prevalence of asthma has nearly doubled over the last decades. Twentieth century changes in environmental and lifestyle factors, including changes in dietary habits, physical activity and the obesity epidemic, have been suggested to play a role in the increase of asthma prevalence and uncontrolled asthma worldwide. A large body of evidence has suggested that obesity is a likely risk factor for asthma, but mechanisms are still unclear. Regarding diet and physical activity, the literature remains inconclusive. Although the investigation of nutritional factors as a whole (i.e., the "diet, physical activity and body composition" triad) is highly relevant in terms of understanding underlying mechanisms, as well as designing effective public health interventions, their combined effects across the life course has not received a lot of attention. In this review, we discuss the state of the art regarding the role of nutritional factors in asthma, for each window of exposure. We focus on the methodological and conceptual challenges encountered in the investigation of the complex time-dependent interrelations between nutritional factors and asthma and its control, and their interaction with other determinants of asthma. Lastly, we provide guidance on how to address these challenges, as well as suggestions for future research.

Keywords: asthma; asthma control; body composition; diet; nutritional factors; physical activity.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 2
Figure 2
Issue of time-dependent confounding* in the interrelations between nutritional factors and asthma/asthma control. Covf: time-fixed covariates; Covt − 1: time-dependent covariates at time t − 1; * For simplicity, the interrelations between each nutritional factor are not represented in this figure (see Figure 1).
Figure 1
Figure 1
Issue of mediation* in the interrelations between nutritional factors and asthma/asthma control. IE1 = indirect effect of diet on asthma/asthma control mediated by body composition; IE2 = indirect effect of physical activity on asthma/asthma control mediated by body composition; DE1 = direct effect of diet on asthma/asthma control; DE2 = direct effect of physical activity on asthma/asthma control; * For simplicity, the time-dependent nature of the interrelations between nutritional factors and asthma, and their covariates, is not represented in this figure (see Figure 2).

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