Diet during pregnancy Diet during pregnancy

Diet during pregnancy Diet during pregnancy

Diet
Diet during
during pregnancy
pregnancy
and
and atopic
atopic disease
disease
1.
2.
3.
4.
Elimination diet
Probiotics
LCPUFA
Conclusions
Maternal
Maternal elimination
elimination diet
diet
during
?
during pregnancy
pregnancy?
NO
NO !!
•• Prescription
-risk woman
Prescriptionof
ofan
anantigen
antigenavoidance
avoidancediet
dietto
tohigh
high-risk
woman
during
duringpregnancy
pregnancyisisunlikely
unlikelyto
toreduce
reducesubstantially
substantiallyher
herrisk
risk
of
.
ofgiving
givingbirth
birthto
toan
anatopic
atopicchild
child.
•• Moreover
, such
Moreover,
suchaadiet
dietmay
mayhave
havean
anadverse
adverseeffect
effecton
on
maternal
maternaland/or
and/orfetal
fetalnutrition
nutrition
••
••
Kramer
KramerMS,
MS,Cochrane
CochraneLibrary
Library2002
2002
S.S.Salvatore,
Salvatore,K.
K.Keymolen,
Keymolen,B.
B.Hauser,
Hauser,Y.
Y.Vandenplas
Vandenplas
Intervention
spring
Interventionduring
duringpregnancy
pregnancyand
andallergic
allergicdisease
diseaseininthe
theoff
offspring
Paediatric
-66
PaediatricAllergy
Allergyand
andImmunology
Immunology2005;16:558
2005;16:558-66
Effects
Effectsof
ofearly
earlynutritional
nutritionalinterventions
interventionson
onthe
thedevelopment
developmentof
of
atopic
atopicdisease
diseasein
ininfants
infantsand
andchildren:
children:
the
, breastfeeding,
therole
roleof
ofmaternal
maternaldietary
dietaryrestriction
restriction,
breastfeeding,
timing
rmulas.
timingof
ofintroduction
introductionof
ofcomplementary
complementaryfoods,
foods,and
andhydrolyzed
hydrolyzedfo
formulas.
Greer
, AAP
; AAP
GreerFR
FR,
AAPCommittee
Committeeon
onNutrition
Nutrition;
AAPSection
Sectionon
onAllergy
Allergyand
andImmunology
Immunology
Pediatrics
. 2008;121:183
-91
Pediatrics.
2008;121:183-91
Current evidence does not
support a major role for
maternal dietary restrictions
during pregnancy or lactation.
Compliance
Compliance ??
??
The
Theimpact
impactof
ofgovernment
governmentadvice
adviceto
topregnant
pregnantmothers
mothersregarding
regarding
peanut
peanutavoidance
avoidanceon
onthe
theprevalence
prevalenceof
ofpeanut
peanutallergy
allergy
in
inUK
UKchildren
childrenat
atschool
schoolentry.
entry.
Hourihane
. JJAllergy
-202
HourihaneJO
JO.
AllergyClin
ClinImmunol
Immunol2007;119:1197
2007;119:1197-202
••Only
Only36/957
36/957mothers
mothers(3.8%)
(3.8%)followed
followedthe
theGovernment's
Government'sadvice
adviceby
bystopping
stopping
the
theconsumption
consumptionof
ofpeanuts
peanutswhile
whilepregnant.
pregnant.
••30
, 1.8%
30children
children(2.8%;
(2.8%;95%
95%CIs
CIs,
1.8%to
to3.8%):
3.8%):++SPT
SPT..
••20
, 1.1%
20children
children(1.8%;
(1.8%;95%
95%CIs
CIs,
1.1%to
to2.7%):
2.7%): peanut
peanutallergy.
allergy.
==highest
highestprevalence
prevalencefor
forpeanut
peanutallergy
allergyrecorded
recordedto
todate.
date.
••ItItisisdifficult
ative) of
difficultto
toascertain
ascertainany
anyimpact
impact(either
(eitherpositive
positiveor
orneg
negative)
ofthe
the
United
llergy
UnitedKingdom
Kingdomgovernment
governmentadvice
adviceon
onthe
theprevalence
prevalenceof
ofpeanut
peanutaallergy
in
-5 years
inBritish
Britishchildren
childrenaged
aged44-5
yearsfrom
from2003
2003to
to2005.
2005.
Confounding
…
Confounding variables
variables…
Month
Monthof
ofbirth
birth––allergic
allergicdisease
disease//sensitization
sensitizationto
toaeroallergens
aeroallergens
755
755Japanese
Japanesechildren
children
Sensitisation
Sensitisation
••house
housedust
dustmites
mites
••Crytmeria
Crytmeriajaponica
japonicapollen
pollen
Jan
uary ––March
January
March
December
December––January
January
rest
restof
ofyear
year(<.01)
(<.01)
rest
restof
ofyear
year(<.05)
(<.05)
Asthma
, ififborn
Asthma,
bornin
in
November
-> 17.3
November––December
December::26
26%
%<<->
17.3%
%rest
restyear
year (<.05)
(<.05)
Allergic
, ififborn
Allergicrhinitis
rhinitis,
bornin
in
August
-> rest
August––October
October<<->
restof
ofyear
year(<.05)
(<.05)
Allergic
, ififborn
Allergicconjunctivitis
conjunctivitis,
bornin
in
December
-> 9.1
December––January
January(15.8%)
(15.8%)<<->
9.1%
%rest
restof
ofyear
year(<.01)
(<.01)
No
Norelation
relationeczema
eczema//season
seasonof
ofbirth
birth
1.
2.
3.
4.
Elimination diet
Probiotics
LCPUFA
Conclusions
Probiotics
Probiotics in
in human
human milk
milk
• Human milk contains Lactobacilli, Enterococci
• Strains are specific to mother-infant pairs
• Strains isolated from milk are identical to strains in infant
faeces, and different from strains isolated from areola
skin
Novak FR. Pediatr (Rio J). 2001;77:265-70
Martin R, J. Pediatr 2003; 143:754-8
Innate
Innaterecognition
recognitionof
ofbacteria
bacteriain
inhuman
humanmilk
milkisismediated
mediatedby
byaa
milk
-derived highly
D14
milk-derived
highlyexpressed
expressedpattern
patternrecognition
recognitionreceptor,
receptor,soluble
solubleCCD14
MO
. JJExp
-12
MOLabeta
Labeta.
ExpMed
Med2000;191:1807
2000;191:1807-12
breast milk of healthy women
is a source of commensal bacteria to the infant gut.
Cultivation-independent assessment of the bacterial diversity
of breast milk among healthy women.
Martín R. Res Microbiol. 2007;158:31-7
Diversity of the Lactobacillus group in breast milk and vagina
of healthy women and potential role in the colonization
of the infant gut.
Martín R. J Appl Microbiol. 2007;103:2638-44
Probiotics
-feeding might
Probioticsduring
duringpregnancy
pregnancyand
andbreast
breast-feeding
mightconfer
confer
immunomodulatory
.
immunomodulatoryprotection
protectionagainst
againstatopic
atopicdisease
diseasein
inthe
theinfant
infant.
S.S.Rautava
. JJAllergy
-21
Rautava.
AllergyClin
ClinImmunol
Immunol2002;109:119
2002;109:119-21
Lactobacillus
- placebo
Lactobacillusrhamnosus
rhamnosusstrain
strainGG
GG(ATCC
(ATCC53103)
53103)placebo
44weeks
weeksbefore
beforebirth
birth––during
duringbreast
breastfeeding
feeding(6
(6months
monthsafter
afterbirth)
birth)
L.GG
control
control
L.GG
Maternal
18/30
Maternalatopic
atopicdisease
disease
18/30(60%)
(60%) 24/32
24/32(75
(75%)
%)
Exclusive
3.2
3.2
Exclusivebreast
breastfeeding
feeding
3.2
3.2 months
months
Total
8.3
8.5
Totalbreast
breastfeeding
feeding
8.3
8.5 months
months
Anti-inflammatory transforming
-2 2885
1340
Anti
Anti-inflammatory
transforminggrowth
growthfactor
factor22TGF
TGF-2
2885
1340 pg/ml
pg/ml
At
At22years
years
eczema
4/27
eczema
4/27(15%)
(15%) 14/30
14/30(47%)
(47%)
GI
-symptoms
2/28
2/31
GI-symptoms
2/28(7%)
(7%)
2/31(6%)
(6%)
CMPA
6/29
CMPA
6/29(21%)
(21%) 3/31
3/31(10%)
(10%)
++-ve
-ve skin
6/26
skinprick
prick
6/26(23%)
(23%) 6/29
6/29(21%)
(21%)
serum
29
28
serumIgE
IgE
29
28 kU/l
kU/l
Spec
)
8/29
SpecIgE
IgEAb
Ab(>0.35
(>0.35kU/l
kU/l)
8/29(28%)
(28%) 11/30
11/30(37%)
(37%)
.018
.018
SS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
Probiotics
Probioticsand
andprevention
preventionof
ofatopic
atopicdisease:
disease:
44-year
-year follow
-up of
-controlled trial.
follow-up
ofaarandomised
randomisedplacebo
placebo-controlled
trial.
Kalliomaki
-71
KalliomakiM.
M.Lancet
Lancet2003;361:1869
2003;361:1869-71
••Perinatal
. rhamnosus
Perinataladministration
administrationof
ofLactob
Lactob.
rhamnosusstrain
strainGG
GG(ATCC
(ATCC53103)
53103)
reduces
-risk children
reducesincidence
incidenceof
ofatopic
atopiceczema
eczemain
inatat-risk
children
during
duringthe
thefirst
first22years
yearsof
oflife
life(infancy)
(infancy)
••??persistence
persistenceof
ofthe
thepotential
potentialto
toprevent
preventatopic
atopiceczema
eczemaatat44years
years
••questionnaire
questionnaire++clinical
clinicalexamination:
examination:atopic
atopiceczema
eczemain
in
14
14//53
53 Lactobacillus
Lactobacillus
25
-0.97)
25//54
54 placebo
placebo(relative
(relativerisk
risk0.57,
0.57,95%
95%CI
CI0.33
0.33-0.97)
••Skin
Skinprick
pricktest
testreactivity
reactivitywas
wasthe
thesame
samein
inboth
bothgroups
groups
10
10//50
50 Lactobacillus
Lactobacillus
99//50
50 placebo
placebo
preventive
preventiveeffect
effectof
ofLactob
LactobGG
GGon
onatopic
atopiceczema
eczemaextends
extendsbeyond
beyondinfancy
infancy
Probiotics
:
Probioticsduring
duringthe
thefirst
first77years
yearsof
oflife
life:
aacumulative
cumulativerisk
riskreduction
reductionof
ofeczema
eczemain
inaa
randomized,
-controlled trial.
randomized,placebo
placebo-controlled
trial.
Kalliom
äki M
. JJAllergy
-21
Kalliomäki
M.
AllergyClin
ClinImmunol
Immunol2007;119:1019
2007;119:1019-21
Randomized
, Double
-Blind, Placebo
-Controlled Trial
Randomized,
Double-Blind,
Placebo-Controlled
Trialof
ofProbiotics
Probioticsfor
for
Primary
: No
.
PrimaryPrevention
Prevention:
NoClinical
ClinicalEffects
Effectsof
ofLactobacillus
LactobacillusGG
GGSupplementation
Supplementation.
Kopp
. Pediatrics
-6
KoppMV
MV.
Pediatrics2008
2008:121:e850
:121:e850-6
DBPCR
family with
1 member
DBPCRtrial,
trial,105
105pregnant
pregnantwomen
women((family
with>>1
memberwith
withAD)
AD)
44-6
-6 weeks
weeksbefore
beforedelivery
delivery––66months
monthspostnatal
postnatal
9
Lactobacillus
day
LactobacillusGG
GG53103;
53103;55xx10
109CFU
CFU2x/
2x/day
placebo
placebo
94
94families
families(89.5%)
(89.5%)completed
completedthe
thetrial
trial
Primary
: atopic
Primaryendpoint
endpoint:
atopicdermatitis
dermatitisatatthe
theage
ageof
of22years
years
Atopic
Atopicdermatitis
dermatitis
14/50
14/50(28%)
(28%)Lactobacillus
LactobacillusGG
GGgroup
group
12/44
12/44(27.3%)
(27.3%)placebo
placebogroup
group
Children
> 5)
Childrenwith
withrecurrent
recurrent((>
5)episodes
episodesof
ofwheezing
wheezingbronchitis
bronchitis
were
weremore
morefrequent
frequentin
inthe
theLactobacillus
LactobacillusGG
GGgroup
group(26%;
(26%;nn==13),
13),
as
ascompared
comparedwith
withthe
theplacebo
placebogroup
group(9.1%;
(9.1%;nn==4).
4).
No
Nodifference
differencein
inIGE
IGEor
orsensitisation
sensitisation
Impact
Impactof
ofmaternal
maternalatopy
atopyand
andprobiotic
probioticsupplementation
supplementationduring
duringpregnancy
pregnancy
on
-blind placebo
-controlled study.
oninfant
infantsensitization:
sensitization:aadouble
double-blind
placebo-controlled
study.
Huurre
. Clin
-8
HuurreAA.
ClinExp
ExpAllergy
Allergy2008;38:1342
2008;38:1342-8
171
-infant pairs
171mother
mother-infant
pairsPCDBR
PCDBRstudy
study
••Risk
Riskof
ofsensitization
sensitization in
ininfants
infantswith
withallergic
allergicmothers
mothers
breastfeeding
breastfeedingover
over66months
months[odds
[oddsratio
ratio(OR=4.83,
(OR=4.83,P=0.005)],
P=0.005)],
or
orexclusively
exclusivelybreastfeeding
breastfeedingover
over2.5
2.5months
months(OR=3.4,
(OR=3.4,P=0.018).
P=0.018).
compared
-allergic mothers
comparedto
tonon
non-allergic
mothers
••Probiotic
Probioticsupplementation
supplementationhad
hadaaprotective
protectiveeffect
effectagainst
againstsensitization
sensitization
in
tion
ininfants
infantswith
withaahigh
highhereditary
hereditaryrisk
riskdue
dueto
tomaternal
maternalsensitiza
sensitization
(OR=0.3,
(OR=0.3,P=0.023).
P=0.023).
••The
-β2 tended
Theconcentration
concentrationof
ofTGF
TGF-β2
tendedto
tobe
be in
inthe
thecolostrum
colostrum
of
ofthe
themothers
mothersin
inthe
theprobiotic
probioticgroup
groupcompared
comparedto
toplacebo
placebo
((probiotic/placebo
probiotic/placebo ratio=1.50,
ratio=1.50,P=0.073).
P=0.073).
Also
prob/plac ratio=1.56,
Alsoin
insubgroup
subgroupof
ofallergic
allergicmothers
mothers ((prob/plac
ratio=1.56,P=0.094)
P=0.094)
Probiotic supplementation during pregnancy
sensitisation infants at 12 months
Meta
-analysis of
Meta-analysis
ofclinical
clinicaltrials
trialsof
ofprobiotics
probioticsfor
for
prevention
preventionand
andtreatment
treatmentof
ofpediatric
pediatricatopic
atopicdermatitis
dermatitis
Lee
-121
LeeJ.J.JJAllergy
AllergyClin
ClinImmunol
Immunol2008;121:
2008;121:116
116-121
21
-13 y)
21trials
trials(n:
(n:1898,
1898,00-13
y)
66prevention
preventiontrials
trials
44treatment
treatmenttrials
trials
some
someefficacy
efficacy
no
noefficacy
efficacy
1.
2.
3.
4.
Elimination diet
Probiotics
LCPUFA
Conclusions
Abnormal
Abnormalfatty
fattyacid
acidcomposition
compositionin
inumbilical
umbilicalcord
cordblood
bloodof
ofinfants
infants
at
athigh
highrisk
riskof
ofatopic
atopicdisease
disease
Beck
-84
BeckM.
M.Acta
ActaPaediatr
Paediatr2000;89:279
2000;89:279-84
Breast
Breastmilk
milkfrom
frommothers
mothersof
ofchildren
childrenwith
withnewly
newlydeveloped
developed
atopic
atopiceczema
eczemahas
haslow
lowlevels
levelsof
ofLCPUFAs
LCPUFAs
Businco
-9
BusincoL,
L,JJAllergy
AllergyClin
ClinImmunol
Immunol1993;91:1134
1993;91:1134-9
House
-3 fatty
Housedust
dustmite
miteavoidance
avoidanceand
andomega
omega-3
fattyacids
acids
protect
protectfor
forwheezing
wheezingatat18
18months
months
Mihrshahi
-8
MihrshahiS.S.JJAllergy
AllergyClin
ClinImmunol
Immunol2003;111:162
2003;111:162-8
616
616pregant
pregantwomen
women house
housedust
dustmite
miteavoidance
avoidance
++omega
-3 rich
omega-3
richfat
fatsources
sources//normal
normalfood
food
Omega
-3 rich
Omega-3
richfat
fatsources
sourcesresult
resultin
in
9.8
9.8%
%absolute
absolutereduction
reduction(95
(95%
%CI
CI1.5
1.5––18.1)
18.1)p=0.02
p=0.02
of
any wheeze
”
of““any
wheeze”
7.8
7.8%
%absolute
absolutereduction
reduction(95%
(95%CI
CI0.5
0.5––15.1)
15.1)p=0.04
p=0.04
prevalence
wheeze 11week
”
prevalenceof
of““wheeze
week”
No
, atopy
, asthma
Noeffect
effecton
onserum
serumIgE
IgE,
atopy,
asthma(diagnosis
(diagnosisdoctor)
doctor)
Fish
-specific
Fishoil
oilsupplementation
supplementationin
inpregnancy
pregnancymodifies
modifiesneonatal
neonatalallergen
allergen-specific
immune
f atopy
:
immuneresponses
responsesand
andclinical
clinicaloutcomes
outcomesin
ininfants
infantsatathigh
highrisk
riskoof
atopy:
aarandomized,
randomized,controlled
controlledtrial
trial(1)
(1)
Dunstan
-84
DunstanJA.
JA.JJAllergy
AllergyClin
ClinImmunol
Immunol2003;112:1178
2003;112:1178-84
Objective:
Objective:
maternal
-3 PUFAs
maternaldietary
dietarysupplementation
supplementationwith
withωω-3
PUFAsduring
duringpregnancy
pregnancy
modifies
modifiesimmune
immuneresponses
responsesin
ininfants
infants
Methods:
Methods:
randomized,
randomized,controlled
controlledtrial
trial
98
, pregnant
-3 PUFAs
98atopic
atopic,
pregnantwomen
women:: fish
fishoil
oil(3.7
(3.7ggωω-3
PUFAsper
perday)
day)
placebo
placebo
from
from20
20weeks'
weeks'gestation
gestationuntil
untildelivery
delivery
Neonatal
rth
NeonatalPUFA
PUFAlevels
levelsand
andimmunologic
immunologicresponse
responseto
toallergens
allergensatatbi
birth
Results:
Results:
Fish
-specific
Fishoil
oilsupplementation
supplementationin
inpregnancy
pregnancymodifies
modifiesneonatal
neonatalallergen
allergen-specific
immune
f atopy
:
immuneresponses
responsesand
andclinical
clinicaloutcomes
outcomesin
ininfants
infantsatathigh
highrisk
riskoof
atopy:
aarandomized,
randomized,controlled
controlledtrial
trial(2)
(2)
Dunstan
-84
DunstanJA.
JA.JJAllergy
AllergyClin
ClinImmunol
Immunol2003;112:1178
2003;112:1178-84
Results
: 83/98
Results:
83/98women
womencompleted
completedthe
thestudy
study
nn-3
-3 PUFAs
- SD)
PUFAs(mean
(mean+/
+/SD)(%
(%total
totalfatty
fattyacids)
acids)
Fish
control
Fishoil
oilsuppl
suppl
control
nn==40
nn==43
40
43
neonatal
- 1.85%
- 1.22%
neonatalerythrocyte
erythrocytemembranes
membranes 17.75%
17.75%+/
+/1.85% 13.69%
13.69%+/
+/1.22%(<.001)
(<.001)
All
-5, IL
-13, IL
-10, and
-gamma)
Allneonatal
neonatalcytokine
cytokine(IL
(IL-5,
IL-13,
IL-10,
andIFN
IFN-gamma)
responses
responses(to
(toall
allallergens)
allergens)
tended
tendedto
tobe
belower
lowerin
inthe
thefish
fishoil
oilgroup
group
(statistically
-10 in
(statisticallysignificant
significantonly
onlyfor
forIL
IL-10
inresponse
responseto
tocat)
cat)
Fish
-specific
Fishoil
oilsupplementation
supplementationin
inpregnancy
pregnancymodifies
modifiesneonatal
neonatalallergen
allergen-specific
immune
f atopy
:
immuneresponses
responsesand
andclinical
clinicaloutcomes
outcomesin
ininfants
infantsatathigh
highrisk
riskoof
atopy:
aarandomized,
randomized,controlled
controlledtrial
trial(3)
(3)
Dunstan
-84
DunstanJA.
JA.JJAllergy
AllergyClin
ClinImmunol
Immunol2003;112:1178
2003;112:1178-84
Although
,
Althoughthis
thisstudy
studywas
wasnot
notdesigned
designedto
toexamine
examineclinical
clinicaleffects
effects,
we
wenoted
notedthat
thatinfants
infantsin
inthe
thefish
fishoil
oilgroup
groupwere
were
33times
timesless
lesslikely
likelyto
tohave
haveaapositive
positiveskin
skinprick
pricktest
test
to
toegg
eggatat11year
yearof
ofage
age
(odds
5).
(oddsratio,
ratio,0.34;
0.34;95%
95%confidence
confidenceinterval,
interval,0.11
0.11to
to1.02;
1.02;PP=.05
=.055).
Although
Althoughthere
therewas
wasno
nodifference
differencein
inthe
thefrequency
frequency
of
ofatopic
atopicdermatitis
dermatitisatat11year
yearof
ofage,
age,
infants
infantsin
inthe
thefish
fishoil
oilgroup
groupalso
alsohad
hadsignificantly
significantlyless
lesssevere
severedisease
disease
(odds
5)
(oddsratio,
ratio,0.09;
0.09;95%
95%confidence
confidenceinterval,
interval,0.01
0.01to
to0.94;
0.94;PP=.04
=.045)
Comparison
-like receptor
- and
-/Th-2 related
Comparisonof
ofToll
Toll-like
receptorandTh1
Th1-/Th-2
relatedmRNA
mRNAlevels
levels
in
inSpanish
Spanishversus
versusGerman
Germanpregnant
pregnantwomen
womenand
andneonates
neonates
D.
. JPGN
D.Hartl
Hartl.
JPGN2004;39(Suppl1):S13
2004;39(Suppl1):S13
Toll
-like receptors
Toll-like
receptorsbind
bindmicrobial
microbialcompounds
compounds
thereby
therebytriggering
triggeringinnate
innateimmune
immuneresponse
response
••Toll
-like receptor
Toll-like
receptor(TLR)
(TLR)22//44 Spanish
Spanish>>
>>German
Germanwomen
womenand
andneonates
neonates
••Spanish
-4 (Th
-2)
Spanishwomen
womenlower
lowerIL
IL-4
(Th-2)
••Correlation
Correlationbetween
betweenTLR2
TLR2and
andTLR4
TLR4between
betweenmothers/neonates
mothers/neonates
••Difference
)
Differencedue
dueto
todifferent
differentmicrobial
microbialexposure
exposurein
inboth
bothcities
cities(Granada
(Granada/ /Munchen
Munchen)
••??Role
Roleof
ofdifferent
differentdietary
dietaryintake
intake(low
(low//high
highfish
fishintake)
intake)
In
InSpanish
Spanishwomen
women
more
morebifidobacteria
bifidobacteria
less
than
lessallergy
allergy
thanin
inGerman
Germanwomen
women
Maternal
Maternaldiet
dietduring
duringpregnancy
pregnancyin
inrelation
relationto
to
eczema
.
eczemaand
andallergic
allergicsensitization
sensitizationin
inthe
theoffspring
offspringat
at22yyof
ofage
age.
Sausenthaler
. Am
-7
SausenthalerSS.
AmJJClin
ClinNutr
Nutr2007;85:530
2007;85:530-7
During
Duringlast
last44weeks
weekspregnancy
pregnancy
High
OR
95%
Highintake
intakeof
of
OR
95%CI
CI
margarine
1.49
margarine
1.49 1.08
1.08--2.04
2.04
vegetable
1.48
vegetableoils
oils
1.48 1.14
1.14--1.91
1.91
positively
positivelyassociated
associatedwith
witheczema
eczemain
inchildren
childrenatat22years
years
fish
0.75
fish
0.75 0.57
0.57––0.98
0.98
negatively
negativelyassociated
associatedwith
witheczema
eczemain
inchildren
childrenatat22years
years
celery
1.85
celery
1.85 1.18
1.18––2.89
2.89
citrus
1.73
citrusfruit
fruit
1.73 1.18
1.18––2.53
2.53
increased
increasedrisk
riskfor
forsensitization
sensitizationfood
foodallergens
allergens
deep
-frying vegetable
deep-frying
vegetablefat
fat 1.61
1.61 1.02
1.02––2.54
2.54
raw
2.16
rawsweet
sweetpepper
pepper
2.16 1.20
1.20––3.90
3.90
citrus
1.72
citrusfruit
fruit
1.72 1.02
1.02––2.92
2.92
increased
increasedrisk
riskfor
forsensitization
sensitizationinhalent
inhalentallergens
allergens
Maternal
Maternaldiet
dietduring
duringpregnancy
pregnancyin
inrelation
relationto
to
eczema
.
eczemaand
andallergic
allergicsensitization
sensitizationin
inthe
theoffspring
offspringat
at22yyof
ofage
age.
Sausenthaler
. Am
-7
SausenthalerSS.
AmJJClin
ClinNutr
Nutr2007;85:530
2007;85:530-7
Intake
Intake during
during pregnancy
pregnancy
food
-6 PUFA
food rich
rich in
in ω
ω-6
PUFA may
may
food
-3 PUFA
food rich
rich in
in ωω-3
PUFA may
may
the
the risk
risk of
of allergic
allergic disease
disease in
in the
the offspring
offspring..
Maternal
Maternalfish
fishintake
intakeduring
duringpregnancy
pregnancyand
andatopy
atopyand
andasthma
asthmain
ininfancy.
infancy.
Romieu
. Clin
-25
RomieuII.
ClinExp
ExpAllergy
Allergy2007;37:518
2007;37:518-25
Cohort of women (n=462) enrolled during pregnancy - offspring followed up to 6 years
• 34 % infants: eczema at age 1 year 14.3% atopic [SPT + at 6 years]
5.7% atopic wheeze at 6 years
• After adjusting for confounding factors, fish intake during pregnancy
was protective against the
- risk of eczema at age 1 year
OR=0.73; 95% CI 0.55-0.98
- + SPT house dust mite (6 yrs)
OR=0.68; 95% CI 0.46-1.01
- atopic wheeze (6 yrs)
OR=0.55; 95% CI 0.31-0.96
!
• For
• ….
in fish intake from 1 x to 2.5 x per week,
the risk of eczema at age 1 year decreased by 37%,
and the risk of positive SPT at age 6 years by 35%.
Maternal
Maternalfish
fishintake
intakeduring
duringpregnancy
pregnancyand
andatopy
atopyand
andasthma
asthmain
ininfancy.
infancy.
Romieu
. Clin
-25
RomieuII.
ClinExp
ExpAllergy
Allergy2007;37:518
2007;37:518-25
….
• Stratification by breastfeeding showed that fish intake was
significantly related to a decrease risk in persistent wheeze
among non-breastfed children (P for interaction<0.05).
• No protective effect was observed among breastfed children.
!
Mediterranean
Mediterraneandiet
dietin
inpregnancy
pregnancyisisprotective
protectivefor
forwheeze
wheezeand
andatopy
atopyin
inchildhood.
childhood.
Chatzi
. Thorax.
-13
ChatziLL.
Thorax.2008;63:507
2008;63:507-13
460
460children
childrenfrom
fromMenorca
Menorcaage
age6.5
6.5years
years(prospective
(prospectivetrial)
trial)
••Prevalence
Prevalencerates
ratesatat6.5
6.5years
yearsof
of
persistent
13.2
persistentwheeze
wheeze
13.2%
%
atopic
5.8
atopicwheeze
wheeze
5.8%
%
atopy
17.0
atopy
17.0%
%
rd
••1/3
(36.1%)of
ofmothers
mothershad
hadaalow
lowquality
qualityMediterranean
Mediterraneandiet
diet
1/3rd(36.1%)
during
duringpregnancy
pregnancyaccording
accordingto
tothe
theMediterranean
MediterraneanDiet
DietScore,
Score,
while
whilethe
therest
resthad
hadaahigh
highscore.
score.
……
..
……..
Mediterranean
Mediterraneandiet
dietin
inpregnancy
pregnancyisisprotective
protectivefor
forwheeze
wheezeand
andatopy
atopyin
inchildhood.
childhood.
Chatzi
. Thorax.
-13
ChatziLL.
Thorax.2008;63:507
2008;63:507-13
……
..
……..
••AA““high”
high” Mediterranean
MediterraneanDiet
DietScore
Scoreduring
duringpregnancy
pregnancy::
protective
protectivefor
for
••persistent
persistentwheeze
wheeze(OR
(OR0.22;
0.22;95%
95%CI
CI0.08
0.08to
to0.58)
0.58)
••atopic
atopicwheeze
wheeze(OR
(OR0.30;
0.30;95%
95%CI
CI0.10
0.10to
to0.90)
0.90)
••atopy
atopy(OR
(OR0.55;
0.55;95%
95%CI
CI0.31
0.31to
to0.97)
0.97)
after
afteradjusting
adjustingfor
forpotential
potentialconfounders.
confounders.
!
••Childhood
Childhoodadherence
adherenceto
toaaMediterranean
Mediterraneandiet
dietwas
was
negatively
negativelyassociated
associatedwith
withpersistent
persistentwheeze
wheezeand
andatopy
atopy
although
.
althoughthe
theassociations
associationsdid
didnot
notreach
reachstatistical
statisticalsignificance
significance.
1.
2.
3.
4.
Elimination diet
Probiotics
LCPUFA
Conclusions
Conclusion
Conclusion
• No
data to recommend elimination diet
during pregnancy
• ? Harmfull
• Probiotic supplementation
• only evaluated strains
• conflicting data
• Meditarrean diet:
• food rich in ω-3 PUFA
may atopic disease