Research finds youth exposed to environmental tobacco smoke had significantly lower risks of wheezing when holding
Title of the article: Association between diet quality and adolescent wheezing: modification of the effect by exposure to environmental tobacco smoke (March 2022)
Journal: Annals of the American Thoracic Society
Authors: Sonali Bose, MD MPH, associate professor of medicine (pulmonology, critical care, and sleep medicine) and pediatrics at Icahn School of Medicine, Mount Sinai, New York; Elliot Eisenberg, MD, pulmonary and critical care fellow at the Icahn School of Medicine in Mount Sinai, New York; and other co-authors.
Bottom Line: More than four million teenagers in the United States have asthma, and many more young people who haven’t been officially diagnosed with this airway disease still suffer from wheezing. Adolescence includes a period of significant physiological changes, including accelerated growth towards peak lung function – a stage of life that can be particularly sensitive to environmental exposures, which can impact development and contribute to respiratory disease chronic in adulthood. Adolescence also represents a critical period for the formation of potentially permanent dietary patterns, as habits established during this period predict food preferences in adulthood.
This cross-sectional study of a nationally representative sample of adolescents found that youth with high exposure to environmental tobacco smoke who consumed a higher quality diet, such as the Mediterranean diet, and ate greater amounts of fruit , vegetables, omega-3 fatty acids and fiber – had significantly lower risks of wheezing than adolescents with the same exposure and lower quality diets including saturated fats and processed foods.
Why the research is interesting: Targeted public health interventions to improve access to and consumption of higher quality foods may represent a potential future strategy to reduce respiratory illnesses related to exposure to environmental tobacco smoke from cigarettes and cigars. The Mount Sinai researchers encourage further longitudinal, population-level studies devoted to understanding the role of diet in airway disorders in environmentally exposed adolescents.
How: The cross-sectional study of more than 7,000 non-smoking adolescents used National Health and Nutrition Survey data from 2003 to 2012. Researchers assessed diet quality using the Healthy Eating Index-2010 score, ranked in quintiles. A higher Healthy Eating Index-2010 score indicates better compliance with the USDA Food and Nutrition Services recommended dietary guidelines for Americans. Adolescent exposure to environmental tobacco smoke was measured using serum cotinine, a marker of nicotine intake, considering high (>2.99 ng/ml) or low (≤ 2.99ng/ml).
Researchers looked at results that included self-reported wheezing and coughing symptoms over the past 12 months, and looked at a subgroup who had tests showing how well their lungs were working. The researchers used logistic and linear regression models adjusted for survey design to assess associations between diet and 1) respiratory symptoms and 2) lung function, and assessed the interaction between the score of Healthy Eating Index-2010 and serum cotinine level.
Results: Although there was no significant association between diet quality and respiratory symptoms, there was a significant interaction between Healthy Eating Index-2010 score and cotinine serum on wheezing. Among those with elevated serum cotinine, adolescents with the healthiest diets are less likely to wheeze than those with the poorest diets.
In contrast, among adolescents with low serum cotinine, there were no significant differences in respiratory symptoms between those with the highest and lowest diet quality. Among the higher second-hand smoke exposure subgroup with detailed data on their respiratory and lung function, there was a trend for better lung function with improved diet quality, although this did not did not reach statistical significance.
Study Findings: Consumption of a higher quality diet was associated with a lower likelihood of wheezing in adolescents with substantial exposure to environmental tobacco smoke. Although additional longitudinal studies are needed to better understand the role of diet in airway disorders in people exposed to tobacco smoke, the researchers encourage consideration of public health interventions to improve the quality of feeding vulnerable populations exposed to the environment.
The Department of Population Health Science and Policy at Mount Sinai and the Institute for Translational Epidemiology contributed to this study, in addition to researchers from the Wexner Medical Center at Ohio State University and the University of Nebraska Medical Center.
Said Dr. Sonali Bose of Mount Sinai about the research: Although cross-cutting in its design, this work highlights the potential benefits of a healthy diet in mitigating the harmful effects of second-hand smoke exposure in adolescents. . For these vulnerable adolescents, for whom such passive environmental exposures may be unavoidable, we hope that future research will provide diet-based strategies that will allow them to protect their lung health.