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The roles of the dietitian in an 18-week telephone and mobile application nutrition intervention for upper gastrointestinal cancer: a qualitative analysis.
Testa, S, Furness, K, Choi, T, Haines, T, Huggins, CE
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2023;31(4):245
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Patients with upper gastrointestinal (UGI) cancer (oesophagus, gastric, and pancreas) are vulnerable to malnutrition. Symptoms of the cancer and its treatment are barriers to usual eating patterns that contribute to unintentional weight loss. The aim of this study was to explore the patient-dietitian experience of an 18-week nutrition intervention (the TEND study) delivered using the telephone and a mobile application to people newly diagnosed with UGI cancer to elucidate the roles of the dietitian. This study was an analysis set within the TEND study (a three-arm randomised controlled trial exploring the impact of delivering an 18-week intensive nutrition intervention to patients newly diagnosed with UGI cancer). Participants were allocated to receive the intervention using either the telephone or a mobile application, myPace. Results showed that: - rapport can be built within the patient-dietitian relationship without face-to-face communication. - the roles of the dietitian were characterised by regular collaborative problem-solving to encourage empowerment, a reassuring care navigator (including anticipatory guidance), and rapport building via reliable psychosocial support. - that role limitations led to unmet needs as the dietitian was constrained by poorly managed cancer symptoms that negatively impacted oral intake and subsequently weight stability. Authors concluded that more research is needed to examine an advanced care role for dietitians in the management of nutrition impact symptoms.
Abstract
PURPOSE This study aimed to explore the patient-dietitian experience during an 18-week nutrition counselling intervention delivered using the telephone and a mobile application to people newly diagnosed with upper gastrointestinal (UGI) cancer to (1) elucidate the roles of the dietitian during intervention delivery and (2) explore unmet needs impacting nutritional intake. METHODS Qualitative case study methodology was followed, whereby the case was the 18-week nutrition counselling intervention. Dietary counselling conversations and post-intervention interviews were inductively coded from six case participants which included fifty-one telephone conversations (17 h), 244 written messages, and four interviews. Data were coded inductively, and themes constructed. The coding framework was subsequently applied to all post-study interviews (n = 20) to explore unmet needs. RESULTS Themes describing the roles of the dietitian were as follows: regular collaborative problem-solving to encourage empowerment, a reassuring care navigator including anticipatory guidance, and rapport building via psychosocial support. Psychosocial support included provision of empathy, reliable care provision, and delivery of positive perspective. Despite intensive counselling from the dietitian, nutrition impact symptom management was a core unmet need as it required intervention beyond the scope of practice for the dietitian. CONCLUSION Delivery of nutrition care via the telephone or an asynchronous mobile application to people with newly diagnosed UGI cancer required the dietitian to adopt a range of roles to influence nutritional intake: they empower people, act as care navigators, and provide psychosocial support. Limitations in dietitians' scope of practice identified unmet patient's needs in nutrition impact symptom management, which requires medication management. TRIAL REGISTRATION 27th January 2017 Australian and New Zealand Clinical Trial Registry (ACTRN12617000152325).
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Longitudinal Weight Gain and Related Risk Behaviors during the COVID-19 Pandemic in Adults in the US.
Bhutani, S, vanDellen, MR, Cooper, JA
Nutrients. 2021;13(2)
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The Covid-19 pandemic has altered health behaviours of many individuals resulting in weight gain. This cross-sectional study of 1779 individuals aimed to determine the long-term impact of Covid-19 on health behaviours and weight gain over 5 months. The results showed that most participants (40%) body weight increased alongside increased processed food intake and snacking. 33% of the individuals who gained weight continued to gain weight and 28% maintained their higher weight after lockdown measures were lifted. Take-away meals, processed food intake and stress levels remained high post-lockdown in those who gained weight. It was concluded that lockdown measures may have impacted daily life resulting in weight gain which may perpetuate long-term. This study could be used by healthcare professionals to understand that lockdown measures may have altered eating behaviours resulting in weight gain and that these may need to be uncovered to aid long-term weight loss.
Abstract
Cross-sectional analyses have shown increased obesogenic behaviors and a potential for weight gain during COVID-19 related peak-lockdown (March-May 2020), but longitudinal data are lacking. This study assessed longitudinal changes in body weight and lifestyle behaviors in the US adults during the pandemic. METHODS We used Qualtrics survey to collect self-reported data on body weight, dietary, physical activity, and psychological variables (n = 727) during the peak-lockdown (April/May) and at post-lockdown (September/October). Peak-lockdown weight data were categorized based on the magnitude of weight gained, maintained, or lost, and behavioral differences were examined between categories at two time points. RESULTS Body weight increased (+0.62 kg; p < 0.05) at the post-lockdown period. The body mass index also increased (26.38 ± 5.98 kg/m2 vs. 26.12 ± 5.81 kg/m2; p < 0.01) at the post-lockdown period vs. peak-lockdown period. Close to 40% of participants reported gaining either 1-4 lbs or >5 lbs of body weight during the peak-lockdown, while 18.2% lost weight. Weight-gainers engaged in riskier dietary behaviors such as frequent ultra-processed food intake (p < 0.01) and snacking (p < 0.001), were less active, and reported high stress and less craving control during peak-lockdown. Of those gaining >5 lbs, 33% continued to gain weight after the lockdown eased, while 28% maintain higher body weight. In weight-gainers, takeout meal frequency increased, and high ultra-processed food intake and stress, and low craving control continued to persist after the lockdown eased. CONCLUSION We show that the COVID-19 lockdown periods disrupted weight management among many Americans and that associated health effects are likely to persist.
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Pilot trial of a group cognitive behavioural therapy program for comorbid depression and obesity.
Lores, T, Musker, M, Collins, K, Burke, A, Perry, SW, Wong, ML, Licinio, J
BMC psychology. 2020;8(1):34
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Depression and obesity are significant global health concerns. Depression can significantly impact physical health and reduced immune function. The aim of this study was to examine the potential benefits of a novel group psychological intervention program. The study is a preliminary quasi-experimental (single-arm) before-after pilot trial of a newly developed group-based psychological intervention program for people with depression and comorbid obesity. The program consisted of 10 two-hour group sessions held weekly. A total of 24 participants were recruited to the program across two pilot groups. Results indicate that there was a significant reduction in participants’ depression and anxiety scores by program-end. Some evidence also shows improvements in weight-related negative cognitions. Authors conclude that the group therapy program therefore has considerable potential to be effective in helping people enjoy better mental health and improve health outcomes.
Abstract
BACKGROUND Depression and obesity are significant global health concerns that commonly occur together. An integrated group cognitive behavioural therapy program was therefore developed to simultaneously address comorbid depression and obesity. METHODS Twenty-four participants (63% women, mean age 46 years) who screened positively for depression with a body mass index ≥25 were recruited from a self-referred general population sample. The group therapy program (10 two-hour weekly sessions) was examined in a single-arm, before-after pilot trial, conducted in a behavioural health clinic in Adelaide, Australia. Primary outcomes included survey and assessment-based analyses of depression, anxiety, body image, self-esteem, and weight (kg), assessed at four time-points: baseline, post-intervention, three-months and 12-months post program. Eighteen participants (75%) completed the program and all assessments. RESULTS Significant improvements in depression, anxiety, self-esteem and body shape concern scores, several quality of life domains, eating behaviours and total physical activity (among others) - but not weight - were observed over the course of the trial. CONCLUSIONS Results from this pilot trial suggest that combining interventions for depression and obesity may be useful. Further development of the program, particularly regarding the potential for physical health benefits, and a randomised controlled trial, are warranted. TRIAL REGISTRATION Trial registration: ANZCTR, ACTRN12617001079336, 13 July 2017. Retrospectively registered after date of the first consent (6 July 2017), but before the date of the first intervention session (20 July 2017).
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Body Composition Changes Following a Very-Low-Calorie Pre-Operative Diet in Patients Undergoing Bariatric Surgery.
Sivakumar, J, Chong, L, Ward, S, Sutherland, TR, Read, M, Hii, MW
Obesity surgery. 2020;30(1):119-126
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Surgery for the treatment of morbid obesity has become a very common intervention due to the increased prevalence of disease and relative ineffective comparative therapies. The aim of this study was to evaluate overall changes in body composition in bariatric surgery patients undergoing a very-low-calorie-diet (VLCD). The study is a prospective analysis on patients who underwent a 2-week period of VLCD prior to bariatric surgery. A total of 60 patients were enrolled. This study demonstrated that although VLCD appears to induce considerable weight loss in a short period of time, the majority of this is attributable to lean body mass (62.2%) rather than fat mass (37.6%). Another notable finding is that greater losses in weight occur largely at the expense of lean body mass rather than fat mass. Authors conclude that a 2-week VLCD is an effective tool for pre-operative weight reduction. However, a large amount of the total weight loss is attributed to a loss of lean body mass.
Abstract
BACKGROUND Fatty liver in obese patients increases the technical difficulty of bariatric surgery. Pre-operative weight loss with a very-low-calorie diet (VLCD) is commonly used to facilitate surgery. Few studies have quantified the systemic effect of rapid pre-operative weight loss on body composition. The objective of this study is to evaluate body composition changes in bariatric surgery patients undergoing a VLCD. METHODS Body composition assessments were performed between August 2017 and January 2019 using dual-energy X-ray absorptiometry immediately before and after a 2-week VLCD at St Vincent's Hospital Melbourne. Data collected prospectively pre- and post-VLCD included total body weight, excess body weight, body mass index (BMI), lean body mass (LBM), fat mass (FM) and bone mineral content (BMC). The pre- and post-operative results were compared. RESULTS Forty-four patients completed both the 2-week VLCD and body composition assessments. Following a 2-week VLCD, patients lost a mean of 4.5 kg (range - 0.3 to 9.5) in a total body weight and 8.8% (range - 0.9 to 17.1) of excess body weight, with a mean reduction in body mass index of 1.6 kg/m2 (range - 0.2 to 3.1). Loss of LBM was 2.8 kg and was significantly greater than loss of FM, 1.7 kg (p < 0.05). BMC changes were insignificant. CONCLUSION A VLCD is an effective tool for pre-operative weight reduction. In this cohort, a large amount of the total weight loss was attributed to a loss of lean body mass. The impact of significant lean body mass loss and its relationship to short- and long-term health outcomes warrants further assessment.
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An exercise-based educational and motivational intervention after surgery can improve behaviors, physical fitness and quality of life in bariatric patients.
Gallé, F, Marte, G, Cirella, A, Di Dio, M, Miele, A, Ricchiuti, R, Liguori, F, Maida, P, Liguori, G
PloS one. 2020;15(10):e0241336
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Bariatric surgery is currently the most effective method of weight loss for individuals with obesity. However sustained weight loss after surgery can be hindered by unhealthy behaviours that have sustained since before the procedure. Motivational, educational, diet and exercise programmes have been shown to help sustain weight loss following surgery. This non-randomised control trial over 12 months, aimed to assess the effects of a motivational, educational diet and exercise programme on fitness and quality of life in 82 individuals following bariatric surgery. The results showed that a diet and exercise programme improved quality of life and fitness. There was an increased daily intake of fruits and vegetables, eating behaviours were improved and there was a greater weight loss in those following the programme. It was concluded that the diet and exercise programme was responsible for behavioural changes that ensured better quality of life and sustained weight loss following surgery. Health care professionals could use this study to understand the need to recommend motivational and educationally based diet and exercise programme to patients following bariatric surgery.
Abstract
INTRODUCTION Unhealthy lifestyles may hinder bariatric surgery outcomes. This non-randomized controlled study aimed to evaluate the effects of an integrated post-operative exercise-based educational and motivational program in improving behaviors, quality of life, anthropometric features, cardiorespiratory and physical fitness in bariatric patients respect to the only surgical intervention. METHODS A group of adult sedentary bariatric patients chose to attend a 12-month exercise program integrated with diet education and motivational support, or to receive usual care. Dietary habits, binge eating disorder, physical activity, obesity-related quality of life, Body Mass Index, waist and hip circumference, VO2max, strength and flexibility were assessed at the start and at the end of the study in both groups. RESULTS On a total of 82 patients enrolled, follow-up measures were obtained from 28 (85.7% females, mean age 38.2±8.7) and 42 (71.4% females, mean age 40.2±9.5) patients included in the intervention and control group, respectively. All the behavioral and physical outcomes improved significantly in the participants to the intervention, while the control group showed lesser changes, especially regarding quality of life and physical fitness. CONCLUSIONS Notwithstanding the self-selection, these results suggest that a timely postoperative behavioral multidisciplinary program for bariatric patients may be effective in establishing healthy behaviors which can lead to better surgery outcomes.
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Early evidence of efficacy for orally administered SPM-enriched marine lipid fraction on quality of life and pain in a sample of adults with chronic pain.
Callan, N, Hanes, D, Bradley, R
Journal of translational medicine. 2020;18(1):401
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Alternatives for the management of chronic pain are needed due to the high side effect profiles, high incidence of developing tolerance, and high potential for addiction in the most common treatments which are currently used. Marine lipids (i.e. fish oil) are a well-known source of the long chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). EPA and DHA can be metabolised in the body into potent anti-inflammatory and pro-resolving mediators, which are integral parts of a fatty acid metabolite class known as specialized pro-resolving mediators (SPMs). The aim of this study was to collect preliminary data on the effects of SPM-enriched marine lipid supplementation on quality of life, pain, mood, and inflammation in adults with a history of chronic pain. This study is a single-arm, open-label clinical trial. Forty-four adults with moderate pain intensity for at least 3 months were recruited. Results show improved quality of life in an adult population with chronic pain after supplementation. Furthermore, there were also reductions in measures of pain intensity, pain interference, depression, and anxiety, as well as an increase in physical function. Authors conclude that orally administered supplements containing resolving precursors may improve the quality of life, reduce pain intensity and interference, and improve mood within 4 weeks of supplementation.
Abstract
BACKGROUND Marine lipids contain omega-3 fatty acids that can be metabolized into anti-inflammatory and pro-resolving mediators-namely 17-HDHA and 18-HEPE-which can serve as modulators of the pain experience. The purpose of this study was to determine the impact of 4 weeks of oral supplementation with a fractionated marine lipid concentration, standardized to 17-HDHA and 18-HEPE, on health-related quality of life and inflammation in adults with chronic pain. METHODS This study was a prospective, non-randomized, open-label clinical trial. Forty-four adults with ≥ moderate pain intensity for at least 3 months were recruited. The primary outcome was change in health-related quality of life (QOL) using the Patient Reported Outcomes Measurement Information System-43 Profile (PROMIS-43) and the American Chronic Pain Association (ACPA) QOL scale. Exploratory outcomes assessed safety and tolerability, changes in anxiety and depression, levels of pain intensity and interference, patient satisfaction, and impression of change. Changes in blood biomarkers of inflammation (hs-CRP and ESR) were also explored. RESULTS Outcome measures were collected at Baseline, Week 2, and Week 4 (primary endpoint). At Week 4, PROMIS-43 QOL subdomains changed with significance from baseline (p < 0.05), with borderline changes in the ACPA Quality of Life scale (p < 0.052). Exploratory analyses revealed significant changes (p < 0.05) in all measures of pain intensity, pain interference, depression, and anxiety. There were no statistically significant changes in either hs-CRP or ESR, which stayed within normal limits. CONCLUSION We conclude that oral supplementation with a fractionated marine lipid concentration standardized to 17-HDHA and 18-HEPE may improve quality of life, reduce pain intensity and interference, and improve mood within 4 weeks in adults with chronic pain. The consistency and magnitude of these results support the need for placebo-controlled clinical trials of marine lipid concentrations standardized to 17-HDHA and 18-HEPE. Trial registration ClinicalTrials.gov: Influence of an Omega-3 SPM Supplement on Quality of Life, NCT02683850. Registered 17 February 2016-retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02683850 .
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Exposure to Different Amounts of Dietary Gluten in Patients with Non-Celiac Gluten Sensitivity (NCGS): An Exploratory Study.
Roncoroni, L, Bascuñán, KA, Vecchi, M, Doneda, L, Bardella, MT, Lombardo, V, Scricciolo, A, Branchi, F, Elli, L
Nutrients. 2019;11(1)
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Non-coeliac gluten sensitivity (NCGS) is characterised by adverse gastrointestinal symptoms related to ingestion of gluten-containing foods and amelioration of symptoms when gluten is removed from the diet. It is currently unclear whether gluten sensitivity is a permanent condition. The aim of this exploratory study was to evaluate the effects of gluten re-introduction in 22 NCGS patients who have been on a strict gluten-free diet for three weeks. Working with a qualified nutritionist, participants began incrementally introducing gluten each week for three weeks. Gastrointestinal symptoms and quality of life were assessed at baseline and post-intervention. When adverse symptomology was reported, participants returned to the gluten-level before symptoms started. This study found mixed results with gluten reintroduction. Of the 22 participants, 8 were able to return to a normal gluten-containing diet, and the remaining participants had differing levels of tolerance for gluten consumption. Based on these results, the authors conclude further controlled studies are required to assess the clinical response of reintroducing dietary gluten in patients with NCGS.
Abstract
It is unclear whether patients with non-celiac gluten sensitivity (NCGS) can tolerate gluten. We have evaluated the changes of both gastrointestinal symptoms and quality of life for NCGS patients after the re-introduction of dietary gluten. Twenty-two NCGS patients reporting functional gastroenterological symptoms and on gluten-free diet (GFD) for the previous three weeks were exposed to incremental gluten-containing diets. Three groups were compared at baseline (immediately after 3-weeks on GFD) and immediately after the return of symptomatology: (i) a group tolerating a low-gluten diet (3.5 g gluten/day, week 1, n = 8), (ii) a group tolerating a mid-gluten diet (8 g gluten/day, week 2, n = 6), and (iii) a group tolerating a high-gluten diet (13 g gluten/day, week 3, n = 8). Their gastrointestinal symptoms and quality of life were assessed at baseline and post-intervention. The most common symptoms were: constipation (46%), abdominal pain (50%) and dyspepsia (38%). A decrease in several short form health survey (SF-36) sub-scores (all p < 0.03) after gluten re-introduction was only observed in the group tolerating the low-gluten diet; the same group showed a lower post-intervention role-emotional SF-36 score (p = 0.01). Most gastrointestinal symptoms remained similar after gluten re-introduction. However, a decrease in the general perception of well-being was only found after gluten re-introduction in the group tolerating a low-gluten diet (p = 0.01); the same was true when comparing the post-intervention general well-being perception among the three groups (p = 0.050). In conclusion, dissimilar responses from patients with NCGS were observed after the re-introduction of gluten, with gluten at a low dosage affecting the quality of life and general well-being of a group of patients, whereas others tolerate even higher doses of dietary gluten.
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The effects of short-term fasting on quality of life and tolerance to chemotherapy in patients with breast and ovarian cancer: a randomized cross-over pilot study.
Bauersfeld, SP, Kessler, CS, Wischnewsky, M, Jaensch, A, Steckhan, N, Stange, R, Kunz, B, Brückner, B, Sehouli, J, Michalsen, A
BMC cancer. 2018;18(1):476
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Short-term fasting (STF) has been shown to protect healthy cells against the adverse effects of chemotherapy while making tumor cells more vulnerable to it. The present randomised pilot cross-over study was designed to assess the effect of a 60 hour STF on quality of life (QOL), well-being and fatigue in patients with gynaecological cancer undergoing chemotherapy. Group A was randomised to a STF during the first three of six scheduled chemotherapies (36 h before to 24 h after the chemotherapy) followed by non-calorie restricted nutrition during the following three chemotherapies. During the fasting period subjects received unrestricted amounts of water, herbal tea, 2x100cl vegetable juice and small standardized quantities of light vegetable broth with a maximum total daily energy intake of 350 kcal. Group B was allocated to a vice versa sequence of nutrition. All measurements were performed at baseline and eight days after each chemotherapy cycle. A variety of questionnaires were used for assessment of QOL, general well-being and fatigue. 34 patients with breast or ovarian cancer completed the study. Fasting was safe and all reported side effects were of low grade. STF led to a better tolerance to chemotherapy with less compromised QOL and reduced fatigue within the 8 days after chemotherapy. At the final consultation the majority of patients reported better tolerance to chemotherapy with STF. The authors conclude that STF during chemotherapy is feasible and has beneficial effects on QOL, well-being and fatigue.
Abstract
BACKGROUND This pilot trial aimed to study the feasibility and effects on quality of life (QOL) and well-being of short-term fasting (STF) during chemotherapy in patients with gynecological cancer. METHODS In an individually-randomized cross-over trial patients with gynecological cancer, 4 to 6 planned chemotherapy cycles were included. Thirty-four patients were randomized to STF in the first half of chemotherapies followed by normocaloric diet (group A;n = 18) or vice versa (group B;n = 16). Fasting started 36 h before and ended 24 h after chemotherapy (60 h-fasting period). QOL was assessed by the FACIT-measurement system. RESULTS The chemotherapy-induced reduction of QOL was less than the Minimally Important Difference (MID; FACT-G = 5) with STF but greater than the MID for non-fasted periods. The mean chemotherapy-induced deterioration of total FACIT-F was 10.4 ± 5.3 for fasted and 27.0 ± 6.3 for non-fasted cycles in group A and 14.1 ± 5.6 for non-fasted and 11.0 ± 5.6 for fasted cycles in group B. There were no serious adverse effects. CONCLUSION STF during chemotherapy is well tolerated and appears to improve QOL and fatigue during chemotherapy. Larger studies should prove the effect of STF as an adjunct to chemotherapy. TRIAL REGISTRATION This trial was registered at clinicaltrials.gov: NCT01954836 .
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Dietary Intake after Weight Loss and the Risk of Weight Regain: Macronutrient Composition and Inflammatory Properties of the Diet.
Muhammad, HFL, Vink, RG, Roumans, NJT, Arkenbosch, LAJ, Mariman, EC, van Baak, MA
Nutrients. 2017;9(11)
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In 2015, 107.7 million children and 603.7 million adults worldwide were obese. Effective actions to prevent the increasing rate of obesity and to treat those who are already obese are required. The aim of the study is to investigate the influence of macronutrients composition and inflammatory properties of the diet on weight regain during a weight maintenance period after weight loss of overweight and obese individuals. The study enrolled 57 Caucasian adult participants (27 males and 30 females) who had a body mass index more than 28kg/m2. The dietary intervention program consisted of three periods i.e. weight loss period, weight stable period and follow-up period. The study shows that the macronutrient composition of the weight maintenance diet was not associated with weight regain. However, the dietary inflammatory index was positively correlated with weight regain. In fact, intake of micronutrients with anti-inflammatory properties was found to be negatively correlated with weight regain. Authors conclude that the inflammatory properties of the diet during the weight maintenance period play a role in weight regain after a diet-induced weight loss program in overweight and obese adults.
Abstract
Weight regain after successful weight loss is a big problem in obesity management. This study aimed to investigate whether weight regain after a weight loss period is correlated with the macronutrient composition and/or the inflammatory index of the diet during that period. Sixty one overweight and obese adults participated in this experimental study. Subjects lost approximately 10% of their initial weight by means of very low-calorie diet for five weeks, or a low calorie diet for 12 weeks. After that, subjects in both groups followed a strict weight maintenance diet based on individual needs for four weeks, which was followed by a nine-month weight maintenance period without dietary counseling. Anthropometrics and dietary intake data were recorded before weight loss (baseline) and during the weight maintenance period. On average, participants regained approximately half of their lost weight. We found no evidence that macronutrient composition during the weight maintenance period was associated with weight regain. The dietary inflammatory index (r = 0.304, p = 0.032) was positively correlated with weight regain and remained significant after correction for physical activity (r = 0.287, p = 0.045). Our data suggest that the inflammatory properties of diet play a role in weight regain after weight loss in overweight and obese adults.
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Fish consumption during the first year of life and development of allergic diseases during childhood.
Kull, I, Bergström, A, Lilja, G, Pershagen, G, Wickman, M
Allergy. 2006;61(8):1009-15
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This study aimed to investigate the association of eating fish in the first year of human life, and the development of allergic diseases by the age of four. A group of 4089 new born babies was followed for a period of four years, and information about fish consumption and time of introduction was collected via a simple parental questionnaire when the infants were 2 months, 1, 2 and 4 years old. Five predefined categories – never, once a month, 2-3 times a month, once a week and more than once a week – were used to identify how much fish was eaten. There was a 90% response rate at 4 years. Clinical investigations of 2614 children aged four were undertaken, including blood sampling to analyse IgE responses to common foods and allergens, such as cat, dog, horse, birch, milk, egg, fish, soy, peanut and wheat. It was found that those children who ate fish in the first year of their life had a reduced risk of developing an allergic disease at age 4 (asthma, eczema, allergic rhinitis or sensitisation) when compared with those children who began to eat fish at 9 months or older. In addition, a reduced risk was seen when children ate fish more than twice a month compared with those who ate fish less than once a month, and this was more noticeable when measured as persistent allergic disease (those children who had allergic responses at 2 years and 4 years). In this study, there was no clear difference in risk between children with or without parental allergic diseases. However, reduced risk of sensitisation, alongside regular fish in the diet, was only seen in children without parental allergic disease. Risk reduction was most noticeable for allergic rhinitis. The authors conclude that eating fish early and regularly in life was associated with a reduced risk of developing allergic disease, in particular eczema and allergic rhinitis.
Abstract
BACKGROUND Fish consumption during infancy has been regarded as a risk factor for allergic disease but later evidence suggests a protective role. However, methodological limitations in the studies make conclusions uncertain. The aim of this study was to assess the association between fish consumption during the first year of life and development of allergic diseases by age 4. METHODS A prospective birth cohort of 4089 new-born infants was followed for 4 years using parental questionnaires at ages 2 months, 1, 2 and 4 years to collect information on exposure and health effects. The response rate at 4 years was 90%. A clinical investigation was performed at age 4 years, which included blood sampling for analysis of specific IgE to common food and airborne allergens. RESULTS Parental allergic disease and onset of eczema or wheeze during the first year of life delayed introduction of fish in the child's diet. After exclusion of such children to avoid disease-related modification of exposure, regular fish consumption during the first year of life was associated with a reduced risk for allergic disease by age 4, OR(adj) 0.76 (95% CI 0.61-0.94) and sensitization, OR(adj) 0.76 (0.58-1.0). The reduced risk appeared most pronounced for multiple disease, OR(adj) 0.56 (0.35-0.89). IgE-sensitization to fish was only present among 18 of the 2614 children. CONCLUSION Regular fish consumption before age 1 appears to be associated with a reduced risk of allergic disease and sensitization to food and inhalant allergens during the first 4 years of life.