Asthma Clinical Trial
Official title:
Maternal Fatty Acids, Child Obesity, and Asthma Immunity
To study pre- and post-natal influences on the development of childhood asthma-related immune responses.
BACKGROUND:
Since most cases of asthma occur in the first few years of life, examining its pre- and
early postnatal determinants is crucial. This study focuses on determinants of the
developing immune system. T helper cells are of two types. Th1 cells participate in
cell-mediated immunity essential for controlling intracellular infectious agents such as
bacterial and viruses. Th2 cells are essential for antibody-mediated immunity to control
extracellular infectious agents. The Th2 pattern, characterized by higher levels of IgE,
increased production of proinflammatory cytokines such as interleukin-4 (IL-4) or IL-13, and
decreased production of interferon-gamma (IFN-gamma), predominates prenatally. If it is not
balanced by a Thl pattern after birth, e.g., increased IFN-7 production, risk of asthma
likely increases. Early childhood immune mechanisms associated with risk of asthma may also
involve non-IgE/Th2 pathways, with increased production of IL-6 or TNF-alpha. Preliminary
studies have linked asthma at various ages with reduced ratio of n-3 to n-6 polyunsaturated
fatty acids, increased birth weight, and overweight. Preliminary data have also linked these
dietary and weight variables to systemic production of IgE and both Th2 and non-Th2
proinflammatory cytokines. Thus allergy and inflammation may be pathways through which pre-
and early postnatal dietary factors influence development of asthma. However, there are
virtually no prospective human data linking maternal diet or fetal/early childhood growth
with the asthma-related immune response in childhood.
The study takes advantage of the resources of Project Viva, an ongoing NIH-funded
prospective cohort study of pregnant women and their offspring in eastern Massachusetts.
Project Viva already includes detailed dietary data on mother and infant, maternal and cord
blood samples, and data on anthropometric, social, environmental, demographic, economic,
psychological, and lifestyle variables. Relevant covariates are included, such as presence
and severity of atopic diseases in the parents, parental smoking, infant respiratory
infections, and infant environment.
DESIGN NARRATIVE:
The study examines associations of maternal gestational n-3 and n-6 fatty acid intake, fatty
acid levels in umbilical cord blood, fetal growth, and early childhood overweight with
markers of allergy and inflammation at the age of 3 years. These markers include
allergy-specific and total plasma IgE levels and levels of proinflammatory cytokines from
antigen- and mitogen-stimulated lymphocytes. This study takes advantage of the resources of
Project Viva, an ongoing NIH-funded prospective cohort study of pregnant women and their
offspring. Project Viva already includes detailed dietary data on mother and infant,
maternal and cord blood samples, and data on anthropometric, social, environmental,
demographic, economic, psychological, and lifestyle variables. This study supports several
elements not otherwise funded, including adding measurement of immune outcomes at age 3
years in a subset of 370 cohort participants. Given the existing infrastructure of Project
Viva, the study provides a relatively economical way to address scientific questions of
major public health importance.
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