Study shows youth exposed to environmental factors are more likely than ever to become successful in life.

Paper Title: Association between Adolescent Wheezing and Diet Quality: Effect Modification by Environmental Tobacco Smoke Exposure (March 2022)

Journal: Annals of the American Thoracic Society

Authors: Sonali BoseMD MPH, Associate Professor in Medicine (Pulmonary and Critical Care Medicine and Sleep Medicine) at the Icahn school of Medicine at Mount Sinai, New York. Elliot EisenbergDr. Judith L. Sullivan, MD, Pulmonary & Critical Care Fellow at Icahn School of Medicine, Mount Sinai, New York; and coauthors.

Bottom Line: More than four million adolescents in the United States have asthma, and many more youth who have not received official diagnosis of this airway disease still experience wheezing. Adolescence includes a period of important physiologic changes, including accelerated growth towards peak lung function—a stage in life that may be particularly susceptible to environmental exposures, which may impact development and contribute to chronic respiratory disease in adulthood. Adolescence is also an important time to form potentially lifelong patterns of diet. Habits formed during this period can predict adult food preferences.

This cross-sectional study of a nationally representative sample of adolescents found that youth with substantial exposure to environmental tobacco smoke who consumed a higher quality diet—such as the Mediterranean diet and eating higher amounts of fruits, vegetables, omega-3 fatty acids, and fiber—experienced significantly lower odds of wheezing, compared to adolescents with the same exposure and a poorer quality diet including saturated fats and processed foods.

Why Research is Interesting: Targeted public health interventions that improve access to and consumption of higher quality foods could be a future strategy to reduce respiratory diseases caused by exposure to tobacco smoke from cigarettes or cigars. Mount Sinai researchers encourage the continuation of population-level longitudinal studies that aim to understand the role diet plays in airway disorders among adolescents exposed to environmental tobacco smoke.

How: Cross-sectional studies on more than 7,000 teens who were not smokers were done using data from the National Health and Nutrition Examination Survey (2003 to 2012). Researchers used the Healthy Eating Index 2010 score to assess diet quality. The score is divided into quintiles. A higher Healthy Eating Index score of 2010 indicates better compliance with dietary guidelines as recommended by USDA Food and Nutrition Services for Americans. The adolescents’ exposure to environmental tobacco smoke was measured using serum cotinine, a marker of nicotine intake, considering levels as high (>2.99 ng/ml) or low (≤2.99 ng/ml).

Researchers reviewed the results that included self-reported wheezing or cough symptoms over the past 12 month. They also examined a sub-group of people who had tests to determine how well their lungs function. The researchers used survey design adjusted logistic and linear regression models, which evaluated associations between diet and 1) symptoms and 2) lung function.

Results: While there was no correlation between diet quality, respiratory symptoms, there was a strong interaction between the Healthy Eating Index -2010 score and serum cozinine on wheezing. High serum cotinine diets are more likely to cause wheezing in adolescents than those who eat the least healthy diets.

However, there was no significant difference in respiratory symptoms among adolescents with low serum cholesterol. There was a trend toward better lung function and improved diet quality in the sub-group with heavier secondhand smoking exposure. However, it did not reach statistical significance.

Study the Conclusions: Consuming a higher quality diet was associated with lower wheezing odds in adolescents with substantial exposure to environmental tobacco smoke. While additional longitudinal studies are needed to better understand the role of diet in airways disorders among people exposed to tobacco smoke, researchers encourage consideration of public health interventions to improve diet quality in vulnerable, environmentally-exposed populations.

Mount Sinai’s Department of Population Health Science & Policy and Institute for Translational Epidemiology contributed to this study, in addition to researchers from Ohio State University Wexner Medical Center and the University of Nebraska Medical Center.

Said Mount Sinai’s Dr. Sonali Bose.Despite being cross-sectional, this study highlights the potential health benefits of a healthy diet to reduce the negative effects of secondhand smoking exposure among adolescents. We hope future research will provide diet-based strategies that can help vulnerable adolescents to protect their lungs.

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Mount Sinai Press Office: To request a complete copy of the paper, or to schedule an interview for one of the researchers, please call at [email protected]Or 347-346-33309. 

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