The maternal nutritional index indicates the risk of allergic diseases in the offspring

November 02, 2022

4 minutes read

Disclosure:
Venter reports receiving grants from Food Allergy Research and Education, the National Peanut Board, and Reckitt Benckiser, and personal dues from Abbott Nutrition, Before Brands, Danone, Else Nutrition, Nestle Nutrition Institute, and Reckitt Benckiser. The relevant financial information of all other authors can be found in the study.


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According to a study conducted in The Journal of Allergy and Clinical Immunology: In Practice.

Using the index, doctors could potentially help women adjust their diet during pregnancy to reduce the risk of allergic outcomes, the researchers wrote.

Doctors can use the maternal nutritional index to estimate the risk of allergic disease in children. Source: Adobe Stock

“Current allergy prevention guidelines do not provide pregnant women with much information on allergy prevention in infants,” Carina Venter, PhD, RD, associate professor of pediatrics in the Department of Allergy and Immunology at Children’s Hospital Colorado and the University of Colorado Denver School of Medicine, Healio said.

Carina Venter

“All international food allergy guidelines only recommend not to avoid food allergens during pregnancy,” Venter continues.

According to the Global Initiative for Asthma, Venter said, correcting vitamin D deficiency in women who are pregnant or planning to become pregnant can reduce wheezing in their offspring.

Additionally, Venter says, the World Allergy Organization suggests that women who take a probiotic during pregnancy and breastfeeding can prevent eczema in their offspring, in addition to infants who take probiotics early in life.

Led by Venter, the European Academy of Allergy & Clinical Immunology Immunomodulation and Nutrition Group published three systematic reviews that further point to a lack of data providing pregnant women with nutritional information to prevent allergies in their offspring.

“With all of the above in mind, there is an urgent need to provide pregnant women with nutritional information to prevent allergies in children,” Venter said.

The researchers then developed the maternal nutritional index (MDI) to measure components associated with allergy prevention, such as yogurt and vegetables, and components associated with increased allergy, including red meat, rice and grains, fried potatoes, cold cereal and 100% fruit juice. Patients with higher scores have a more allergy-preventive diet than patients with lower scores.

Study design, results

The study examined 1,218 mother-to-child dyads of singleton pregnancies with available nutritional data who attended University of Colorado Hospital obstetric clinics between 2009 and 2014 to 4 years postpartum.

Researchers assessed these dyads via the MDI as well as the Healthy Eating Index (HEI), total dietary diversity (TDD), healthy dietary diversity (HDD), and unhealthy dietary diversity (UDD) for allergic outcomes in the children, including allergic rhinitis, atopy Dermatitis, asthma, wheezing and IgE-mediated food allergy.

Overall, 33% of the children had any allergy other than wheezing, 11% had allergic rhinitis, 26% had AD, 14% had asthma, 18% had wheezing, and 3% had an IgE-mediated food allergy.

Researchers found significant associations between increases in MDI scores and lower odds of allergic rhinitis (aOR = 0.82; 95% CI, 0.72-0.94), AD (aOR = 0.77; 95% CI, 0 .69-0.86), asthma (aOR = 0.84; 95% CI, 0.74-0.96) and wheezing (aOR = 0.8; 95% CI, 0.71-0.9), as well as for each allergy except wheezing (adjusted OR = 0.78; 95% CI, 0.7-0.87).

“All results were significant, except for food allergies, due to underperformance,” Venter said.

In addition, increases in maternal HEI scores were associated with significantly lower probabilities of allergies other than wheezing (aOR = 0.98; 95% CI, 0.97-0.99), allergic rhinitis (aOR = 0.98; 95% CI, 0 .96-0.99), AD (aOR = 0.98; 95% CI 0.97-0.995), asthma (aOR = 0.98; 95% CI 0.97-0.997), and wheezing (aOR = 0, 98, 95% CI 0.97-0.99).

There was also a significant association between increases in maternal HDD scores and lower probabilities of allergies other than wheezing (aOR = 0.91; 95% CI, 0.85-0.98), AD (aOR = 0.93, 95 % CI, 0.86-0.997), asthma (aOR = 0.88; 05% CI, 0.81-0.96), and wheezing (aOR = 0.9; 95% CI, 0.83-0.97 ).

Increases in maternal UDD scores were significantly associated with AD (aOR = 1.1; 95% CI, 1.02-1.19; P = 0.01), but not on other allergic consequences.

Overall, the MDI also had higher estimates of its area under the curve (AUC) for all allergic disease outcomes except food allergy compared to the other four measures of maternal nutrition.

According to the researchers, these differences between the AUC of the MDI and the others were statistically significant and the MDI offered the greatest diagnostic accuracy in predicting allergic outcomes in the children.

Specifically, the MDI had AUC values ​​of 0.68 for each allergy other than wheezing, 0.68 for allergic rhinitis, 0.66 for AD, 0.65 for asthma, 0.67 for wheezing, and 0.56 for food allergy.

Conclusion, next steps

“The most important aspect of the paper shows that when a nutritional index is developed to reduce a specific disease outcome – in this case allergic diseases – it performs better than other indices developed to reduce other diseases, e.g. like the Healthy Eating Index,” Venter said.

“Another important finding was that increased healthy dietary diversity (variety) was associated with fewer allergies in offspring, and increased unhealthy dietary diversity was associated with increased disease outcomes,” she continued.

This underscores the importance of a varied diet with an emphasis on healthy foods, Venter added.

“Our index simply states that increased intake of vegetables and yogurt and reduced, if not no, intake of fried, sugary, and low-fiber foods, and consumption of fruit instead of drinking fruit juice are associated with reduced allergy episodes in offspring.” .” She said.

These results were for asthma, wheezing, AD and allergic rhinitis at age 4, as shown in this study, and for food allergies at age 2, which the researchers found elsewhere but not in this study, Venter said.

The researchers also said that including information from other biomarkers such as sensitization status, maternal medical history, maternal and offspring genetics, and possibly maternal and offspring microbiome data could improve the diagnostic accuracy of the MDI scores. Other studies would also be welcome, Venter said.

“We really need to do RCTs [randomized controlled trials] to test whether our observational results are supported in an RCT setting,” she said.

Researchers concluded that the MDI’s superiority in predicting allergy outcomes makes it a potential tool to provide pregnant women with appropriate dietary advice so they can reduce the risk of allergic disease in their children.

References:

For more informations:

Carina Venter, PhD, RD, reachable at [email protected]

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