The relationships between asthma and weight and asthma and nutrition is a fairly new topic that will need much more research. It is known that overweight children seem to be at a greater risk of developing asthma and also, that being overweight may aggravate the symptoms according to AND.  Many of the blog responses agreed that an experimental group should be included for weight reduction and/or weight control.

         As shown below by all of the blog responses, there are numerous possible groupings for the experimental groups.  Recent research has looked at antioxidative dietary constituents, sodium, potassium and magnesium and also omega-3 and omega 6 fatty acids and their role in asthma. Not surprisingly, almost everyone was in agreement that obtaining the antioxidants, vitamin D and fatty acids through foods was the best option for those with asthma.

Q1: Counsel on kid-friendly diet for asthma and weight loss. 

-Everyone agrees that adding in foods containing MUFAs and omega-3s (such as canola oil, olive oil, fish, almonds) to help control inflammation would be beneficial for the child’s asthma.
-Everyone also agrees they would individualize by assessing what the current usual diet is for the child and recommend the child utilize portion control and include more of the typical Mediterranean foods.

-Taylor takes a different approach and recommends a highly alkaline-forming diet (consisting of leafy greens and non-starchy vegetables, moderate amounts of fruits, legumes and whole grains) for reducing inflammation. Taylor also recommends the child steer clear of soda due to its acidic and pro-inflammatory character.
-Nate and Emily feel a typical healthy diet including lean sources of protein; fruit, veggies and whole grains would be adequate versus individualizing a weight loss diet for the child. Molly also suggests adding in variety of foods, especially fruits and vegetables.
-Amy also comments on the challenges of a kid-friendly, Mediterranean Diet because of textures and flavors and the general “pickiness” of children.
-Beth, Amy, Angela Courtney and Sarah agree they would recommend small changes in incorporating the Mediterranean diet into the child’s diet and that it is vital the mother eats what the child is eating.
-Emily stated she would explain the connection of asthma with obesity, hypertriglyceridemia, and insulin resistance and more importantly she would put priority on educating the child, feeling this would be most beneficial long-term.
-Sarah, Lynetta, Erin M and Joci mention they would not only educate but also supply materials and resources such as recipes and websites to visit.
-Erin, Carly and Courtney would emphasize lifestyle change for not only diet but also to include physical activity and recommend MyPlate. Courtney Erin M and Lynetta believe they would make healthy eating fun for the child by making it a game.
-Kaitlin, Angela, Erin M and Emily S agree that not only individualizing the diet of the child but of the family is important. Erin M would identify the stage of change the mother is in to get a feel for the recommendations she might suggest as to not overwhelm the mother or child.

Question 2: Would you recommend antioxidants, Vit D and PUFA/MUFAs?

-Everyone agrees they would recommend the child first begins by adding food sources of these nutrients because of their general benefits.
-Nate also recommends taking omega-3 and vitamin D for the general adult population because people generally do not consume enough as it is.
-Amy would explain the connection of asthma with these nutrients but explain how these benefits have not been proven yet.
-Molly, Lynetta, Amy, Erin, Erin M. and Alana says that she would leave it up to the parents on whether they wanted to spend their money on these supplements because it has not been proven yet but she would suggest the child see his or her pediatrician before adding these to the child’s diet. Nate, Angela, Emily S. and Sarah believe it is the RDs role to know about supplements and be the one to push them if the RD feels the client or patient would benefit from it.
-Alana, Lynetta and Molly agree that the recommendation and use of supplements should be only after there is evidence of a gap in the child’s diet. Emily, Courtney, Carly and Beth state that they would not have supplementation as her first plan of attack.
-Erin and Taylor bring up the importance of a food recall to evaluate if the child is meeting their needs with their current diet. She would also explain that food sources of these nutrients provide many more health benefits.
-Carly and Angela believe that Vitamin D supplementation during the winter months may be a good idea for the child and Angela emphasizes the importance of having the child get outside to get natural Vitamin D when possible.
-Joci and Kaitlin believe that supplementation would not be harmful to the child or adult and to go ahead and recommend supplements and foods containing these. They believe the best option would be to improve their diet with food first and supplementation second.
-Emily S. states she would not recommend these supplements because it could all be consumed through diet. 

Q3: Study on weight gain/loss vs dietary intake and how would you do the study?

There was definite consensus that a longitudinal study of those already diagnosed with ashtma would need to be used. Most people say more than 2 years would produce the best results. Nate feels that he would continue the study until the child reached 18 years old. Many agreed that physical activity and nutrition education would be beneficial. Courtney would choose to follow up every two years for ten years.

Intervention groups included:
 -High fruit and veg, high sat fat high omega fat and a weight gain diet from healthy fats.

 -Vitamin D supplementation, omega-3 supplementation, antioxidants in diet group, and a combination of all the previous 3 treatments would be the different groups
 -High antioxidants, omega 3 and 6, vitamin D supplementation, and lean protein.
 - Control, higher omega 3, high sat fat, and vit D supplementation.

 - control, high omega 3, high vitamin D, and 60 minutes of physical activity a day

 - one control, one group that just took supplements of antioxidants, omega-3s and vitamin D with no diet intervention, the third would be a diet intervention with no supplements, and the fourth would be both supplements and diet intervention.
- diets with high antioxidants, omega-3 & 6's, and Vitamin D. The most practical way to do this would be to provide the participants with daily supplements of the selected variable(s). Some participants would have all 3 supplements, while others may only have 1 or 2.
- Control group, Mediterranean style diet and encourage antioxidant rich F&V, omega-3 fats, and Vitamin D rich foods.
- Control group, nutrition education group, supplementation with Vitamin D and n-3, and physical activity

-1-a control group; 2- required to meet with a dietitian every two weeks and a diet that is high in omega 3s, vitamin D, and antioxidant foods; 3- Increased activity ( 30 min/day for at least 5 days a week).

 Amy, Erin and Alana would track weight monthly. Amy would also use a FFQ to assess diet quality and Alana, Erin and Emily feel lab values, such as blood lipids, vitamin D levels and antioxidant consumption would also need to be tracked.
Erin and Angela considered using supplements in an experimental group.

Alana, Carly Courtney, Beth and Sarah would include a physical activity component.
Emily would choose to do an observational study looking at BMI and its effect on asthma. Beth also would choose to track BMI for height and weight along with waist and hip measurements.

Kaitlin would not put anyone on a diet, she would instead choose to have them log what they normally eat and the severity of their symptoms. Angela would also choose to have them log their food and symptoms but she would have them be in control and experimental groups.
Emily S. would choose to do a study with obese children and do a weight loss program.
Lynetta would use four different schools to be her control and experimental groups.
Erin M would incorporate meeting with a dietitian into one of her experimental groups.

Taylor would have the kids eat all of their food that has been prepared in a test kitchen