营养素和食物在哮喘与过敏症初级预防中的作用：系统综述与荟萃分析
2011/03/24
摘要
背景：流行病学研究显示，营养素（如硒、锌、维生素A、C、D、E）缺乏、低水果和低蔬菜饮食，与哮喘和过敏性疾病的发生具有一定相关性。
目的：研究有关营养素和食物摄取在调节儿童过敏症风险的证据。
方法：对11个数据库进行系统检索。对研究进行评价，并进行荟萃分析。
结果：共找到62个符合要求的研究，但无随机对照研究。其中队列研究21项，病例-对照研究15项，横断面研究26项。所有研究均具有中度至重度的风险偏倚。荟萃分析显示，与对照儿童相比，哮喘患儿的血清维生素A偏低（OR：0.25; 95% CI, 0.10-0.40）。此外，妊娠期，母亲饮食中维生素D和E含量较高，对于发生喘息性疾病具有保护作用（分别为OR, 0.56, 95% CI, 0.42-0.73和OR, 0.68, 95% CI, 0.52-0.88）。对地中海饮食的依从，对于持续喘息(OR, 0.22; 95% CI, 0.08-0.58)和特应性(OR, 0.55; 95% CI, 0.31-0.97)具有保护作用。有关水果、蔬菜的22个研究中，17个研究显示，水果、蔬菜的摄入，对哮喘和过敏症的发生也具有保护作用。但研究结果并不支持这些维生素或营养素对其他过敏性疾病的保护作用，以及不支持这些疾病受到维生素C和硒的保护。
结论：对于已有的流行病学证据较少，但支持维生素A、D、E和锌、水果、蔬菜及地中海饮食，有助于预防哮喘的发生。目前，尚需要进行更多的试验对这个结果进行证实。
（刘国梁 审校）
J Allergy Clin Immunol. 2010 Dec 23. [Epub ahead of print]
Nutrients and foods for the primary prevention of asthma and allergy: Systematic review and meta-analysis.
Nurmatov U, Devereux G, Sheikh A.
Allergy and Respiratory Research Group Centre for Population Health Sciences, University of Edinburgh, Medical School, Edinburgh, United Kingdom.
Abstract
BACKGROUND: Epidemiologic studies suggest that deficiencies of the nutrients selenium; zinc; vitamins A, C, D, and E; and low fruit and vegetable intake may be associated with the development of asthma and allergic disorders.
OBJECTIVES: To investigate the evidence that nutrient and food intake modifies the risk of children developing allergy.
METHODS: We systematically searched 11 databases. Studies were critically appraised, and meta-analyses were undertaken.
RESULTS: We identified 62 eligible reports. There were no randomized controlled trials. Studies used cohort (n = 21), case-control (n = 15), or cross-sectional (n = 26) designs. All studies were judged to be at moderate to substantial risk of bias. Meta-analysis revealed that serum vitamin A was lower in children with asthma compared with controls (odds ratio [OR], 0.25; 95% CI, 0.10-0.40). Meta-analyses also showed that high maternal dietary vitamin D and E intakes during pregnancy were protective for the development of wheezing outcomes (OR, 0.56, 95% CI, 0.42-0.73; and OR, 0.68, 95% CI, 0.52-0.88, respectively). Adherence to a Mediterranean diet was protective for persistent wheeze (OR, 0.22; 95% CI, 0.08-0.58) and atopy (OR, 0.55; 95% CI, 0.31-0.97). Seventeen of 22 fruit and vegetable studies reported beneficial associations with asthma and allergic outcomes. Results were not supportive for other allergic outcomes for these vitamins or nutrients, or for any outcomes in relation to vitamin C and selenium.
CONCLUSION: The available epidemiologic evidence is weak but nonetheless supportive with respect to vitamins A, D, and E; zinc; fruits and vegetables; and a Mediterranean diet for the prevention of asthma. Experimental studies of these exposures are now warranted.
J Allergy Clin Immunol. 2010 Dec 23. [Epub ahead of print]
背景：流行病学研究显示，营养素（如硒、锌、维生素A、C、D、E）缺乏、低水果和低蔬菜饮食，与哮喘和过敏性疾病的发生具有一定相关性。
目的：研究有关营养素和食物摄取在调节儿童过敏症风险的证据。
方法：对11个数据库进行系统检索。对研究进行评价，并进行荟萃分析。
结果：共找到62个符合要求的研究，但无随机对照研究。其中队列研究21项，病例-对照研究15项，横断面研究26项。所有研究均具有中度至重度的风险偏倚。荟萃分析显示，与对照儿童相比，哮喘患儿的血清维生素A偏低（OR：0.25; 95% CI, 0.10-0.40）。此外，妊娠期，母亲饮食中维生素D和E含量较高，对于发生喘息性疾病具有保护作用（分别为OR, 0.56, 95% CI, 0.42-0.73和OR, 0.68, 95% CI, 0.52-0.88）。对地中海饮食的依从，对于持续喘息(OR, 0.22; 95% CI, 0.08-0.58)和特应性(OR, 0.55; 95% CI, 0.31-0.97)具有保护作用。有关水果、蔬菜的22个研究中，17个研究显示，水果、蔬菜的摄入，对哮喘和过敏症的发生也具有保护作用。但研究结果并不支持这些维生素或营养素对其他过敏性疾病的保护作用，以及不支持这些疾病受到维生素C和硒的保护。
结论：对于已有的流行病学证据较少，但支持维生素A、D、E和锌、水果、蔬菜及地中海饮食，有助于预防哮喘的发生。目前，尚需要进行更多的试验对这个结果进行证实。
（刘国梁 审校）
J Allergy Clin Immunol. 2010 Dec 23. [Epub ahead of print]
Nutrients and foods for the primary prevention of asthma and allergy: Systematic review and meta-analysis.
Nurmatov U, Devereux G, Sheikh A.
Allergy and Respiratory Research Group Centre for Population Health Sciences, University of Edinburgh, Medical School, Edinburgh, United Kingdom.
Abstract
BACKGROUND: Epidemiologic studies suggest that deficiencies of the nutrients selenium; zinc; vitamins A, C, D, and E; and low fruit and vegetable intake may be associated with the development of asthma and allergic disorders.
OBJECTIVES: To investigate the evidence that nutrient and food intake modifies the risk of children developing allergy.
METHODS: We systematically searched 11 databases. Studies were critically appraised, and meta-analyses were undertaken.
RESULTS: We identified 62 eligible reports. There were no randomized controlled trials. Studies used cohort (n = 21), case-control (n = 15), or cross-sectional (n = 26) designs. All studies were judged to be at moderate to substantial risk of bias. Meta-analysis revealed that serum vitamin A was lower in children with asthma compared with controls (odds ratio [OR], 0.25; 95% CI, 0.10-0.40). Meta-analyses also showed that high maternal dietary vitamin D and E intakes during pregnancy were protective for the development of wheezing outcomes (OR, 0.56, 95% CI, 0.42-0.73; and OR, 0.68, 95% CI, 0.52-0.88, respectively). Adherence to a Mediterranean diet was protective for persistent wheeze (OR, 0.22; 95% CI, 0.08-0.58) and atopy (OR, 0.55; 95% CI, 0.31-0.97). Seventeen of 22 fruit and vegetable studies reported beneficial associations with asthma and allergic outcomes. Results were not supportive for other allergic outcomes for these vitamins or nutrients, or for any outcomes in relation to vitamin C and selenium.
CONCLUSION: The available epidemiologic evidence is weak but nonetheless supportive with respect to vitamins A, D, and E; zinc; fruits and vegetables; and a Mediterranean diet for the prevention of asthma. Experimental studies of these exposures are now warranted.
J Allergy Clin Immunol. 2010 Dec 23. [Epub ahead of print]
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产前和婴儿期对乙酰氨基酚暴露、抗氧化基因多态性和儿童哮喘
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老年哮喘患者FoxP3、GATA-3和T-bet的表达
