Korean J Community Nutr.  2013 Oct;18(5):515-524. 10.5720/kjcn.2013.18.5.515.

Effects of Nutrition Education Promoting Vegetable, Fruit, and Fish Intake on the Severity of Atopic Dermatitis in Children: Results from a One-year Follow Up Study

Affiliations
  • 1Department of Foods and Nutrition, Kookmin University, Seoul, Korea. schung@kookmin.ac.kr
  • 2Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

Atopic dermatitis (AD) is believed to be associated with the intake of antioxidant nutrients and fatty acids due to its immunological dysfunction. The purpose of this study was to examine the effects of nutrition education promoting vegetable, fruit, and fish intake on the severity of AD in children. Children with AD aged 6 months to 5 years were randomly assigned into education and control groups, and followed for 1 year. Seventy-six children completed the study (38 for control, 38 for education). The education group received education promoting the intakes of antioxidant-rich foods (vegetables, fruits) and n-3 fatty acid foods (fish). A 24-hour food recall was collected for the diet information. After education, all vegetables (p < 0.001), fruits (p < 0.01), and fish (p < 0.05) intakes per 1000 kcal increased significantly in the education group, whereas only vegetable intake increased in the control group (p < 0.001). The SCORAD index, the severity of atopic dermatitis, decreased significantly in the education group (p < 0.05). Increased consumption of dietary vitamin E was significantly associated with reduction in the SCORAD index, after adjusting for age and gender (p < 0.05). A nutritional education program to increase vegetable, fruit, and fish intake may be effective in reducing the severity of AD, and vitamin E intake may be associated with the decreased severity of AD. More controlled studies on the relationship between these intakes and severity of AD, with intensive diet and/or supplement intervention programs, are needed to obtain conclusive results.

Keyword

atopic dermatitis; children; severity; fruit and vegetable; vitamin E

MeSH Terms

Child*
Dermatitis, Atopic*
Diet
Education*
Fatty Acids
Follow-Up Studies*
Fruit*
Humans
Vegetables*
Vitamin E
Vitamins
Fatty Acids
Vitamin E
Vitamins

Reference

1. Alm B, Aberg N, Erdes L, Möllborg P, Pettersson R, Norvenius SG, Goksör E, Wennergren G. Early introduction of fish decreases the risk of eczema in infants. Arch Dis Child. 2009; 94(1):11–15.
2. Arslanoglu S, Moro GE, Schmitt J, Tandoi L, Rizzardi S, Boehm G. Early dietary intervention with a mixture of prebiotic oligosaccharides reduces the incidence of allergic manifestations and infections during the first two years of life. J Nutr. 2008; 138(6):1091–1095.
3. Boguniewicz M, Leung DY. Atopic dermatitis: a disease ofaltered skin barrier and immune dysregulation. Immunol Rev. 2011; 242:233–246.
4. Chatzi L, Apostolaki G, Bibakis I, Skypala I, Bibaki-Liakou V, Tzanakis N, Kogevinas M, Cullinan P. Protective effect of fruits, vegetables and the Mediterranean diet on asthma and allergies among children in Crete. Thorax. 2007; 62(8):677–683.
5. Devereux G, Seaton A. Diet as a risk factor for atopy and asthma. J Allergy Clin Immunol. 2005; 115(6):1109–1117.
6. Devereux G, Turner SW, Craig LC, McNeill G, Martindale S, Harbour PJ, Helms PJ, Seaton A. Low maternal vitamin E intake during pregnancy is associated with asthma in 5-year-old children. Am J Respir Crit Care Med. 2006; 174(5):499–507.
7. Eriksen BB, Kåre DL. Open trial of supplements of omega 3 and 6 fatty acids, vitamins and minerals in atopic dermatitis. J Dermatolog Treat. 2006; 17(2):82–85.
8. Fitzsimon N, Fallon U, O'Mahony D, Loftus BG, Bury G, Murphy AW, Kelleher CC. Mother's dietary patterns during pregnancy and risk of asthma symptoms in children at 3 years. Ir Med J. 2007; 100(8):suppl 27–suppl 32.
9. Fogarty A, Lewis S, Weiss S, Britton J. Dietary vitamin E, IgE concentrations, and atopy. Lancet. 2000; 356(9241):1573–1574.
10. Kremmyda LS, Vlachava M, Noakes PS, Diaper ND, Miles EA, Calder PC. Atopy risk in infants and children in relation to early exposure to fish, oily fish, or long-chain omega-3 fattyacids: a systematic review. Clin Rev Allergy Immunol. 2011; 41(1):36–66.
11. Kull I, Bergström A, Lilja G, Pershagen G, Wickman M. Fish consumption during the first year of life and development of allergic diseases during childhood. Allergy. 2006; 61(8):1009–1015.
12. Kunz B. Clinical validation and guidelines for the SCORAD Index: consensus report of the European task force on atopic dermatitis. Dermatology. 1997; 195:10–19.
13. Hijazi N, Abalkhail B, Seaton A. Diet and childhood asthma in a society in transition: a study in urban and rural Saudi Arabia. Thorax. 2000; 55(9):775–779.
14. Javanbakht MH, Keshavarz SA, Djalali M, Siassi F, Eshraghian MR, Firooz A, Seirafi H, Ehsani AH, Chamari M, Mirshafiey A. Randomized controlled trial using vitamins E and D supplementation in atopic dermatitis. J Dermatolog Treat. 2011; 22(3):144–150.
15. Korean Nutrition Society. Dietary reference intakes for Koreans.
16. Lee JH, Kim EH, Cho JB, Kim HY, Suh JM, Ahn KM, Cheong HK, Lee SI. Comparison of prevalence and risk factors of atopic dermatitis by physical examination and questionnaire survey in elementary school children. Pediatr Allergy Respir Dis. 2011; 21(3):186–196.
17. Lee JS, Jo S, Lee H, Kang A, Chung SJ. Associated factors of severity of atopic dermatitis in children. Korean J Community Nutr. 2010; 15(6):776–782.
18. Lee S, Ahn K, Paik HY, Chung SJ. Serum immunoglobulin E (IgE) levels and dietary intake of Korean infants and young children with atopic dermatitis. Nutr Res Pract. 2012; 6(5):429–435.
19. Li-Weber M, Giaisi M, Treiber MK, Krammer PH. Vitamin E inhibits IL-4 gene expression in peripheral blood T cells. Eur J Immunol. 2002; 32(9):2401–2408.
20. Malmberg KJ, Lenkei R, Petersson M, Ohlum T, Ichihara F, Glimelius B, Frödin JE, Masucci G, Kiessling R. A short-term dietary supplementation of high doses of vitamin E increases T helper 1 cytokine production in patients with advanced colorectal cancer. Clin Cancer Res. 2002; 8(6):1772–1778.
21. Martindale S, McNeill G, Devereux G, Campbell D, Russell G, Seaton A. Antioxidant intake in pregnancy in relation to wheeze and eczema in the first two years of life. Am J Respir Crit Care Med. 2005; 171(2):121–128.
22. Mayser P, Mayer K, Mahloudjian M, Benzing S, Krämer HJ, Schill WB, Seeger W, Grimminger F. A double-blind, randomized, placebo-controlled trial of n-3 versus n-6 fatty acid-based lipid infusion in atopic dermatitis. JPEN J Parenter Enteral Nutr. 2002; 26(3):151–158.
23. Njå F, Nystad W, Lødrup Carlsen KC, Hetlevik O, Carlsen KH. Effects of early intake of fruit or vegetables in relation to later asthma and allergic sensitization in school-age children. Acta Paediatr. 2005; 94(2):147–154.
24. Oh JW, Kim KE, Pyun BY, Lee HR, Choung JT, Hong SJ, Park KS, Lee SY, Song SW, Kim CH, Ahn KM, Nam SY, Shon MH, Kim WK, Lee MH, Kwon BC, Choi SY, Lee SY, Lee HB, Lee SI, Lee JS. Nationwide study for epidemiological change of atopic dermatitis in school aged children between 1995 and 2000 and kindergarten aged children in 2003 in Korea. Pediatr Allergy Respir Dis. 2003; 13(4):227–237.
25. Oh SY, Chung J, Kim MK, Kwon SO, Cho BH. Antioxidant nutrient intakes and corresponding biomarkers associated with the risk of atopic dermatitis in young children. Eur J Clin Nutr. 2010; 64(3):245–252.
26. Seaton A, Godden DJ, Brown K. Increase in asthma: a more toxic environment or a more susceptible population? Thorax. 1994; 49(2):171–174.
27. Senkal M, Geier B, Hannemann M, Deska T, Linseisen J, Wolfram G, Adolph M. Supplementation of omega-3 fatty acids in parenteral nutrition beneficially alters phospholipid fatty acid pattern. JPEN J Parenter Enteral Nutr. 2007; 31(1):12–17.
28. Tamay Z, Akcay A, Ones U, Guler N, Kilic G, Zencir M. Prevalence and risk factors for allergic rhinitis in primary school children. Int J Pediatr Otorhinolaryngol. 2007; 71(3):463–471.
29. The Korean Nutrition Society. Dietary reference intakes for Koreans, first revision. Seoul: The Korean Nutrition Society;2010.
30. Tsoureli-Nikita E, Hercogova J, Lotti T, Menchini G. Evaluation of dietary intake of vitamin E in the treatment of atopic dermatitis: a study of the clinical course and evaluation ofthe immunoglobulin E serum levels. Int J Dermatol. 2002; 41(3):146–150.
31. Wong GW, Ko FW, Hui DS, Fok TF, Carr D, von Mutius E, Zhong NS, Chen YZ, Lai CK. Factors associated with difference in prevalence of asthma in children from three cities in China: multicentre epidemiological survey. BMJ. 2004; 329(7464):486.
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