Department of Public Health, Postgraduate Program in Collective Health, Federal University of Maranhão (UFMA), São Luís, Brazil.
Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
Pediatr Allergy Immunol. 2020 Jul;31(5):480-488. doi: 10.1111/pai.13243. Epub 2020 Apr 6.
Studies on the exposure of children to sugar-sweetened beverages (SSBs) at an early age may contribute to better understand the common causes and the temporal order of the relationships between obesity and asthma in early childhood. The objective of this study was to estimate the association between SSB and child asthma traits in the 2nd year of life, modeling direct and indirect pathways mediated by the highest BMI-z of the child and allergic inflammation. Data from the BRISA cohort, São Luís-MA, Brazil (n = 1140), were obtained from the baseline and from the follow-up performed at the 2nd year of life. The main explanatory variable was the calories from added sugars in SSBs as a percentage of the total daily energy intake. The outcome child asthma traits was a latent variable deduced from four indicators: medical diagnosis of asthma, wheezing, emergency visit due to intense wheezing, and medical diagnosis of rhinitis. A high percentage of daily calories from sugars added to SSBs was directly associated with higher values of child asthma traits (standardized coefficient (SC = 0.073; P = .030)). High levels of eosinophils were also directly associated with child asthma traits (SC = 0.118; P = .049). No mediation pathways were observed via greater BMI-z or eosinophil counts. Therefore, early exposure of children to SSB may contribute to increased risk of childhood asthma, preceding the link between sugar consumption and overweight/obesity, not yet evident in children in the first 2 years of life.
研究儿童在早期接触含糖饮料（SSB）的情况，可能有助于更好地理解肥胖和哮喘在儿童早期的常见原因和时间顺序关系。本研究的目的是估计 SSB 与儿童在 2 岁时哮喘特征之间的关系，通过儿童最高 BMI-z 和过敏炎症来构建直接和间接途径。本研究数据来自巴西圣路易斯-马托格罗索州（n=1140）的 BRISA 队列，来自基线和 2 岁时的随访。主要解释变量是 SSB 中添加糖的卡路里占总日能量摄入量的百分比。儿童哮喘特征是从四个指标推断出来的潜在变量：哮喘的医学诊断、喘息、因剧烈喘息而急诊以及鼻炎的医学诊断。SSB 中添加糖的日卡路里百分比较高与儿童哮喘特征的较高值直接相关（标准化系数（SC）=0.073；P=0.030）。高水平的嗜酸性粒细胞也与儿童哮喘特征直接相关（SC=0.118；P=0.049）。未观察到通过更高的 BMI-z 或嗜酸性粒细胞计数的中介途径。因此，儿童早期接触 SSB 可能会增加儿童哮喘的风险，这先于糖消耗与超重/肥胖之间的联系，而这在 2 岁以下的儿童中尚未显现。
