The prevalence of asthma has nearly doubled over the last decades. Twentieth century changes in environmental and lifestyle factors, including changes in dietary habits, physical activity and the obesity epidemic, have been suggested to play a role in the increase of asthma prevalence and uncontrolled asthma worldwide. A large body of evidence has suggested that obesity is a likely risk factor for asthma, but mechanisms are still unclear. Regarding diet and physical activity, the literature remains inconclusive. Although the investigation of nutritional factors as a whole (i.e., the “diet, physical activity and body composition” triad) is highly relevant in terms of understanding underlying mechanisms, as well as designing effective public health interventions, their combined effects across the life course has not received a lot of attention. In this review, we discuss the state of the art regarding the role of nutritional factors in asthma, for each window of exposure. We focus on the methodological and conceptual challenges encountered in the investigation of the complex time-dependent interrelations between nutritional factors and asthma and its control, and their interaction with other determinants of asthma. Lastly, we provide guidance on how to address these challenges, as well as suggestions for future research.

We aimed to test the hypothesis that adherence to a healthful plant-based diet (hPDI) is associated with a subsequent decrease in the incidence of asthma symptoms, with an opposite association with adherence to an unhealthful plant-based diet (uPDI). In addition, we evaluated a potential mediating role of body mass index (BMI) and the modifying effect of smoking. Among 5700 elderly women from the French Asthma-E3N study with dietary data in 1993 and 2005, we assessed the incidence of asthma symptoms in 2018 among women with no asthma symptoms in 2011. BMI was evaluated in 2008. Mediation analyses in the counterfactual framework were used to disentangle total, direct, and indirect effects mediated by BMI. We found that both healthful and unhealthful plant-based diets were associated with a lower incidence of asthma symptoms over time, mediated by BMI (OR (95%CI) for the indirect effect: 0.94 (0.89–1.00) for hPDI and 0.92 (0.70–1.00) for uPDI)). Associations with both healthful and unhealthful PDIs were mediated by changes in BMI by 33% and 89%, respectively. Plant-based diets (healthful and unhealthful) were associated with subsequently reduced incidences of asthma symptoms over time, partly or almost totally mediated by BMI according to their nutritional quality.

Background: A healthy diet has been associated with a lower risk of asthma, although the impact of the nutritional quality of the diet on asthma risk, particularly amongst the elderly, remains poorly unclear. Objectives: To study associations between the asthma symptom score and the Alternate Healthy Eating Index 2010 (AHEI-2010) which evaluates the nutritional quality of diet, the plant-based diet index (PDI) which prioritizes plant food vs. animal food consumption, and the healthful PDI (hPDI) which additionally emphasizes intake of healthy plant foods. Methods: We included 13,219 women (mean age 70 years) from the Asthma-E3N (nested case-control study on asthma) who completed standardized questionnaires on asthma and diet. Associations between tertiles of dietary scores and the asthma symptom score were evaluated by negative binomial regression adjusted for age, smoking, energy intake, physical activity, education, marital status, having farmer parents, and ever asthma. Results: 39.4% of women reported at least one asthma symptom. After adjustment, women with higher AHEI-2010 reported lower asthma symptom score, with mean score ratios (MSRs) (95% CI) = 0.90 (0.84-0.96) for tertile 2 (T2) and 0.91 (0.85-0.97) for tertile 3 (T3), as compared to the first tertile (p trend=0.005). Adherence to PDI was also inversely associated with asthma symptom score: MSRs T2=0.94 (0.87-1.00) and T3=0.90 (0.84-0.97), (p trend=0.005). Similar associations were reported for hDPI: MSRs T2=0.93 (0.87-1.00) and T3=0.89 (0.82-0.96), (p trend=0.002). Conclusions: Healthier diet behaviors and higher consumptions of plant foods were associated with fewer asthma symptoms. Our results could lead to dietary advice for prevention of asthma in elderly.