While peanut butter exposure aids children from an early age, fish oil could improve asthma rates.
Modern research is turning disease etiology on its head.
In 30-plus years of research, Hans Bisgaard, MD, professor of Pediatrics at the University of Copenhagen and founder of the Copenhagen Prospective Studies on Asthma in Childhood, has seen his most rewarding results only in the past few years.
In a presentation at the 2018 American Academy of Allergy, Asthma & Immunnology (AAAAI) and World Allergy Joint Congress in Orlando, FL, Bisgaard explained how prenatal fish oil supplementation analysis has dramatically provided recent evidence that asthma and general disease begins in the womb.
Bisgaard presented his studies, which examined the effects of administering 4 grams of long-chain polyunsaturated fatty acids (PUFA) compared to olive oil to children (n=700 unselected) from 24 weeks of age with follow up visits every 6 months, and a 96% follow-up to the age of 3 years old.
Most striking, there was a 2-fold reduction in wheezing or asthma in individuals starting with exceptionally low PUFA levels or the AA/AG FADS (fatty acid desaturase) genotype. No adverse events were reported and secondary endpoints were particularly significant and impressive as well. The cognitive IQ of 2.5 year-old boys was raised to be equivalent with girls by supplementation with 4g of PUFAs. There was also a 25% reduction in risk of lower respiratory infections.
Bisgaard, who had no conflicts of interest in the study, stated that it is a “serious decision to say no to the recommendation of administering 4 grams of fish oil to the developing child.”
He pointed out that the average PUFA intake in the United States corresponds to the lowest quartile in Denmark. The highest intakes of fish are in Japan followed by Norway, Spain, and Iceland. He would expect huge benefits for the United State if fish oil was commonly consumed.
Ultimately, the number needed to treat in order for 1 child to derive benefit in the reduction of asthma/wheezing risk from PUFA is 12. In the high-risk population, only 6 children would need to be treated to prevent asthma or wheezing.
A session attendant pointed out that American salmon are typically raised on corn, which provides omega-6 fatty acids and this is affordable at $5 per lb, while Norwegian salmon is $20 per lb. However, Bisgaard answered that 4 grams from a fish oil pill can be purchased for less than $1 daily, making it the most affordable value.
In an accompanying session to Bisgaard’s presentation, prenatal diet, as it influences potential food allergy in the developing child, was discussed at length.
Pediatricians commonly field questions on what should and should not be eaten while pregnant, particularly as related to allergies.
Supinda Bunyavanich, MD, a practicing Allergist/Immunologist in the Department of Genetics and Genomic Sciences at the Icahn School of Medicine at Mount Sinai, has examined this in great detail.
One of the most exciting discoveries is the discovery that consumption of peanuts early in life can reduce the likelihood for peanut allergy. Peanut allergy prevalence has doubled in the United States in the past 10 years.
Clinical trials have revealed that early consumption of peanuts by infants (4-11 months until 60-month endpoint) can reduce the likelihood for developing a peanut allergy by 81% in a high-risk cohort (n=628). Initial examinations of maternal peanut consumption were negative, but more recent studies reveal that maternal peanut consumption in the first trimester can actually also reduce the occurrence of peanut allergy by 47%.
Bunyavanich also described clinical studies that clearly show maternal high sugar diets increase the risk for the development of asthma and atopy. Ultimately, the guidelines for pregnant women will continue to be modified with time.
In a separate interview with MD Magazine, Bunyavanich said she considers the dietary implications pregnant women face to be more an opportunity than a burden.
“There’s been observational studies done that show data pulling both ways — that some foods are helpful and some foods are not helpful, and some have no impact” Bunyavanich said. “The current recommendations are that expected moms should not avoid or restrict any foods.”
That lack of restriction should be considered freeing to pregnant women, Bunyavanich said.