The Effects of a Healthy Diet on Asthma and Wheezing in Children and Adolescents: A Systematic Review and Meta-Analysis

Jin Zhang; Mengyang He; Qiduo Yu; Fei Xiao; Yongming Zhang; Chaoyang Liang

doi:10.2147/JAA.S423884

The Effects of a Healthy Diet on Asthma and Wheezing in Children and Adolescents: A Systematic Review and Meta-Analysis

J Asthma Allergy. 2023 Sep 25:16:1007-1024. doi: 10.2147/JAA.S423884. eCollection 2023.

Authors

Jin Zhang¹, Mengyang He², Qiduo Yu¹, Fei Xiao¹, Yongming Zhang³, Chaoyang Liang¹

Affiliations

¹ Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People's Republic of China.
² Graduate School, Beijing University of Chinese Medicine, Beijing, People's Republic of China.
³ Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China.

Abstract

Background: Asthma is a public health problem requiring focused attention. This study aimed to systematically evaluate the association between dietary structure and asthma or wheezing in children.

Methods: The study protocol of this meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration code CRD42023390191. A total of 8397 articles were retrieved, searching PubMed, Medline, Embase, Web of Science, and Scopus databases as of November 21, 2022. Two independent authors were responsible for independently conducting the literature screening process. Effect-size estimates were expressed as odds ratio (OR) in cross-sectional studies and risk ratio (RR) in cohort studies with a 95% confidence interval (CI). Summary effect estimates were evaluated with random-effect models. Meanwhile, subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity and the robustness of the pooled estimation.

Results: A total of 65 studies, including 567,426 subjects had been analyzed. Overall analyses of cross-sectional studies revealed that a healthy diet was protective against asthma (adjusted OR=0.85, 95% CI: 0.80-0.89, P <0.001, I²=69.8%, Tau²=0.026) and wheezing (adjusted OR=0.85, 95% CI: 0.81-0.89, P <0.001, I²=66.8%, Tau²=0.015) in children and adolescents. Conversely, unhealthy diets can exacerbate asthma (adjusted OR=1.28, 95% CI: 1.20-1.36, P <0.001, I²=64.9%, Tau²=0.019) and wheeze (adjusted OR=1.09, 95% CI: 1.02-1.16, P =0.006, I²=75.2%, Tau²=0.023) in children and adolescents. The same trend was found in cohort studies (adjusted RR=0.72, 95% CI: 0.58-0.90, P =0.003, I²=83.5%, Tau²=0.105). A clear trend was observed between high-frequency healthy diets (OR=0.80; 95% CI: 0.71-0.89; P <0.001) is more protective against asthma than low-frequency healthy diets (OR=0.81; 95% CI: 0.70-0.94; P =0.007).

Conclusion: Our findings highlight the protective effects of a healthy diet on asthma and wheezing in children, including fruit, seafood, cereals, and the Mediterranean diet.

Keywords: asthma; children; dietary habits; meta-analysis; wheezing.

Publication types

Review

Grants and funding

This study was supported by both National High Level Hospital Clinical Research Funding (NO.2022-NHLHCRF-YS-04) and the Project of Disciplines Construction of State Key Clinical Department [grant (2011)873].