Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, the Ohio State University Wexner Medical Center, Columbus, Ohio.
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and.
Ann Am Thorac Soc. 2022 Aug;19(8):1328-1337. doi: 10.1513/AnnalsATS.202107-837OC.
Protective effects of a high-quality diet on respiratory health, particularly among youths exposed to environmental tobacco smoke (ETS), are unknown. To assess if a higher-quality diet is associated with improved respiratory symptoms and lung function among adolescents and if these associations are modified by ETS exposure. This was a cross-sectional study on 7,026 nonsmoking adolescents of the 2003-2012 National Health and Nutrition Examination Survey. Diet quality was assessed using the Healthy Eating Index-2010 score (HEI-2010), categorized into quintiles. ETS exposure was measured using serum cotinine, dichotomized as high (>2.99 ng/ml) or low (⩽2.99 ng/ml). Outcomes included the presence of wheezing and cough symptoms in the past 12 months and, in a subgroup, spirometric lung function. Survey design-adjusted logistic and linear models evaluated associations between diet and ) respiratory symptoms, and ) lung function, respectively, and assessed the interaction between HEI-2010 and serum cotinine. Although there were no significant associations between diet quality and respiratory symptoms, there was a significant interaction between HEI-2010 and serum cotinine on wheezing ( = 0.011). In models stratified by serum cotinine, adolescents with high serum cotinine and the healthiest diet (fifth quintile HEI-2010) experienced lower wheezing odds (odds ratio, 0.10; 95% confidence interval, 0.02-0.61) than those with the poorest diet (first quintile HEI-2010). In contrast, among adolescents with low serum cotinine, there were no significant differences in any respiratory symptoms between those with the highest compared with the lowest diet quality. Of the subgroup with spirometry data ( = 3,166), there was a trend toward better lung function with improving diet quality, although this did not achieve statistical significance. There was no effect modification by ETS exposure on the relationship between diet quality and lung function. Consuming a higher-quality diet was associated with lower wheezing odds in adolescents with substantial ETS exposure. Although longitudinal studies are needed, public health interventions to improve diet quality in vulnerable, environmentally exposed populations merit consideration.
高优质饮食对呼吸系统健康的保护作用，特别是在接触环境烟草烟雾（ETS）的青少年中，目前尚不清楚。本研究旨在评估更高质量的饮食是否与青少年呼吸症状和肺功能的改善有关，以及这些关联是否受 ETS 暴露的影响。这是一项 2003-2012 年全国健康与营养调查的 7026 名不吸烟青少年的横断面研究。饮食质量使用健康饮食指数-2010 评分（HEI-2010）进行评估，分为五分位数。ETS 暴露使用血清可替宁测量，分为高低两种。结果包括过去 12 个月内是否出现喘息和咳嗽症状，以及在亚组中是否存在肺功能的肺活量测定。使用调查设计调整的逻辑和线性模型分别评估了饮食与)呼吸症状和)肺功能之间的关联，并评估了 HEI-2010 和血清可替宁之间的相互作用。虽然饮食质量与呼吸症状之间没有显著关联，但 HEI-2010 和血清可替宁之间存在显著的相互作用，与喘息有关（ = 0.011）。在按血清可替宁分层的模型中，血清可替宁水平较高且饮食最健康（第五五分位 HEI-2010）的青少年喘息的可能性较低（比值比，0.10；95%置信区间，0.02-0.61）比饮食最差（第一五分位 HEI-2010）的青少年低。相比之下，在血清可替宁水平较低的青少年中，最高与最低饮食质量之间的任何呼吸症状差异均无统计学意义。在有肺活量测定数据的亚组（ = 3166）中，尽管未达到统计学意义，但随着饮食质量的改善，肺功能呈改善趋势。ETS 暴露对饮食质量与肺功能之间的关系没有影响。在大量接触 ETS 的青少年中，较高质量的饮食与较低的喘息几率有关。尽管需要进行纵向研究，但在脆弱的、环境暴露的人群中改善饮食质量的公共卫生干预措施值得考虑。
