In a recent article in BMC Pediatrics, researchers explored the relationship between energy intake from the diet and asthma risk in American children. Their findings suggest that calorie consumption has an L-shaped effect on asthma risk, meaning that as calorie intake increases, the risk of asthma decreases. However, the protective effect reaches a saturation point at around 56.4 kcal per kilogram of body weight per day, beyond which additional calorie intake no longer significantly reduces asthma risk.
Asthma, a chronic disease that affects the airways, is prevalent among children, with over 4.6 million out of 25 million Americans suffering from the condition. Asthma causes inflammation and narrowing of the airways, leading to breathing difficulties. As one of the most common childhood diseases, asthma places a significant burden on healthcare systems.
While diet has been suggested to play a role in the development and management of asthma, limited studies have investigated the direct impact of calorie intake on asthma risk. Previous research suggests that a Mediterranean diet, rich in healthy fats, fruits, vegetables, and fish, could reduce asthma risk, while Western diets high in processed foods may increase it.
The relationship between obesity and asthma has been well-documented, with excess body fat contributing to the severity of asthma symptoms due to the release of inflammatory molecules. However, how overall calorie intake affects asthma risk has remained unclear until now.
This study utilized data from the National Health and Nutrition Examination Survey (NHANES), a comprehensive national health survey that collects data through lab tests, physical exams, and interviews. The researchers analyzed data from 12,070 children under 18 years old, considering asthma diagnosis, dietary intake, and relevant health factors.
To evaluate calorie intake, the study relied on two 24-hour dietary recall surveys for each participant, classifying them into four quartiles based on their daily energy intake (measured in kcal per kilogram of body weight). The study then analyzed the relationship between calorie consumption and asthma prevalence, adjusting for potential confounders such as blood markers, nutritional intake, and demographic variables.
Asthma was reported in approximately 15.7% of the participants, with the highest prevalence observed in children with the lowest caloric intake. The study revealed that:
- Children in the lowest quartile (less than 33.98 kcal per kg) had the highest risk of asthma.
- Those in the second quartile (33.98 to 55.41 kcal per kg) had a 28% lower risk of asthma.
- The third quartile (55.41 to 81.6 kcal per kg) had a 37% lower risk.
- Children in the highest quartile (over 81.6 kcal per kg) had a 45% lower risk of asthma compared to the lowest quartile.
However, the protective association plateaued once energy intake reached approximately 56.4 kcal per kilogram per day. Beyond this threshold, further increases in calorie intake did not significantly reduce the risk of asthma. This finding suggests that while consuming more calories may reduce asthma risk up to a point, overconsumption offers no additional benefits.
The study found that children with lower calorie intake were also more likely to have deficiencies in essential nutrients, such as vitamin D and zinc, which play a crucial role in immune function and lung health. Moreover, the data showed that energy intake below the threshold was linked to higher levels of inflammation markers, suggesting an immune-related mechanism in the development of asthma.
Additionally, the study accounted for factors such as sex, ethnicity, age, and body mass index, and found no significant differences in the relationship between calorie intake and asthma risk based on these variables. Removing outliers with very high energy intake did not alter the study’s findings.
The research confirms that a higher caloric intake is linked to a reduced risk of asthma in children, but only up to a certain point. After exceeding 56.4 kcal per kilogram of body weight per day, additional calorie intake does not provide further protective effects. The researchers emphasized that the quality of the diet, not just calorie count, may also influence asthma risk, highlighting the importance of balanced nutrition.
Excessive intake of sugar and fat may lead to chronic inflammation and obesity, increasing asthma risk, while moderate energy intake could help regulate immune responses, preventing the development of asthma. The study also pointed out the need for further research to better understand how diet and energy intake interact with other factors, such as the gut microbiome, in asthma development.
While the study had a large sample size and robust analysis methods, it has some limitations. These include potential biases from self-reported dietary information and the cross-sectional nature of the study, which limits the ability to establish causality. Additionally, the study did not account for changes in energy requirements as children age.
Further studies are needed to confirm these findings and explore how specific dietary components, such as types of fats and sugars, may influence asthma development and management. Additionally, research into how the gut microbiome and immune system play a role in this process will be crucial for developing targeted prevention and treatment strategies for childhood asthma.
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