Cured meat intake is associated with worsening asthma symptoms
- Zhen Li1,2,3,
- Marta Rava1,4,
- Annabelle Bédard1,2,
- Orianne Dumas1,2,
- Judith Garcia-Aymerich5,6,7,
- Bénédicte Leynaert8,
- Christophe Pison9,10,11,
- Nicole Le Moual1,2,
- Isabelle Romieu12,
- Valérie Siroux13,14,15,
- Carlos A Camargo Jr16,
- Rachel Nadif1,2,
- Raphaëlle Varraso1,2
- 1INSERM, U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, Villejuif, France
- 2Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
- 3Univ Paris-Sud, Kremlin-Bicêtre, France
- 4Spanish National Cancer Research Centre (CNIO), Genetic & Molecular Epidemiology Group, Human Cancer Genetics Program, Madrid, Spain
- 5Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- 6Universitat Pompeu Fabra (UPF), Barcelona, Spain
- 7CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- 8INSERM UMR1152, Physiopathologie et épidémiologie des maladies respiratoires, équipe Epidémiologie, Paris, France
- 9Clinique Universitaire de Pneumologie, Pôle Thorax et Vaisseaux, CHU Grenoble, Grenoble, France
- 10INSERM U1055, Grenoble, France
- 11Université Alpes, Grenoble, France
- 12Instituto Nacional De Salud Publica, Mexico, currently at International Agency for Research on Cancer, Lyon, France
- 13INSERM IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Inserm, Grenoble, France
- 14IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Universite Grenoble Alpes, Grenoble, France
- 15CHU de Grenoble, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Grenoble, France
- 16Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Correspondence to Zhen Li, Inserm U1168, Hopital Paul Brousse, Batiment Leriche, 16, avenue Paul Vaillant Couturier, Villejuif 94807, France;
- Received 21 January 2016
- Revised 5 July 2016
- Accepted 11 July 2016
- Published Online First 20 December 2016
Background Cured meat intake—a recent carcinogenic factor—may increase the risk of COPD, but its association with asthma remains unknown. Though body mass index (BMI) is a likely risk factor for asthma, its role in the diet–asthma association as a mediator has never been studied. We investigated the association between cured meat intake and worsening asthma symptoms in adults, and the role of BMI as a potential mediator.
Methods Using data from the French prospective EGEA study (baseline: 2003–2007; follow-up: 2011–2013), we applied a mediation analysis in the counterfactual framework, a marginal structural model (MSM), to estimate the direct effect of baseline cured meat intake (<1, 1–3.9, ≥4 servings/week) on change in asthma symptom score (worsening or not), and the indirect effect mediated by BMI.
Results Among the 971 participants (mean age 43 years; 49% men; 42% with asthma), 20% reported worsening asthma symptoms during the mean follow-up time of 7 years. Using the MSM, we reported a positive direct effect of cured meat intake on worsening asthma symptoms (multivariable OR=1.76, 95% CI 1.01 to 3.06 for ≥4 vs <1 serving/week). We also reported an indirect effect mediated by BMI (OR=1.07; 95% CI 1.01 to 1.14), accounting for 14% of the total effect.
Conclusions Higher cured meat intake was associated with worsening asthma symptoms over time, through a direct effect and to a lesser extent an effect mediated by BMI. This research extends the effect of diet on asthma in adults.
RN and RV contributed equally.
Contributors ZL, RN and RV: designed and conducted the research; BL, NLM, CP, VS, RN and RV: provided essential reagents or provided essential materials; ZL, MR, AB, OD, JG-A, VS, CAC, RN and RV: analysed data or performed statistical analysis; ZL, RN and RV: wrote the manuscript and had primary responsibility for final content; all authors read, edited and approved the final manuscript.
Funding This research was funded in part by Merck Sharp & Dohme (MSD), the GA2LEN project, Global Allergy and Asthma European Network, and Conseil scientifique AGIR pour les maladies chroniques, National Hospital program of clinical research (PHRC-national).
Competing interests None declared.
Ethics approval Ethical approval was obtained from the relevant institutional review board committees (Cochin Port-Royal Hospital and Necker-Enfants Malades Hospital, Paris).
Provenance and peer review Not commissioned; externally peer reviewed.