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Purpose The impact of a healthy diet on asthma prevention and management, particularly among elderly women, remains poorly understood. We investigated whether a healthy diet would be associated with fewer asthma symptoms, and, among women with asthma, with reduced uncontrolled asthma and metabolic-related multimorbidity. Methods We included 12,991 elderly women (mean age = 63 years) from the Asthma-E3N study, a nested case–control study within the French E3N cohort. Negative binomial regressions were used to analyse associations between a healthy diet [evaluated by the Alternate Healthy Eating Index-2010 (AHEI-2010)] and a validated asthma symptom score, and logistic regressions to analyse associations between the AHEI-2010 with the asthma control test and multimorbidity profiles previously identified by clustering methods on medications used. Results After adjustment for potential confounders, a linear inverse association was found between the AHEI-2010 score and the asthma symptom score [mean score ratio (95% CI) = 0.82 (0.75–0.90) for the highest versus lowest quintile; p for trend p for trend = 0.05; n = 3474]. Conclusion Our results show that a healthy dietary intake could play an important role in the prevention and management of asthma over the life course.

We investigated the associations between maternal diet quality and allergic and respiratory diseases in children. Analyses were based on 1316 mother–child pairs from the EDEN mother–child cohort. Maternal diet quality during pregnancy was assessed through a food-based score (the Diet Quality), a nutrient-based score (the PANDiet), and the adherence to guidelines for main food groups. Clusters of allergic and respiratory multimorbidity clusters up to 8 years were identified using Latent Class Analysis. Associations were assessed by adjusted multinomial logistic regressions. Four clusters were identified for children: “asymptomatic” (67%, reference group), “asthma only” (14%), “allergies without asthma” (12%), “multi-allergic” (7%). These clusters were not associated with mother diet quality assessed by both scores. Children from mothers consuming legumes once a month or less were at higher risk of belonging to the “multi-allergic” cluster (odds ratio (OR) (95% confidence interval (95%CI)) = 1.60 (1.01;2.54)). No association was found with other food groups or other clusters. In our study, allergic and respiratory multimorbidity in children was described with four distinct clusters. Our results suggest an interest in legumes consumption in the prevention of allergic diseases but need to be confirmed in larger cohorts and randomized control trials.

Introduction Sleep troubles have been associated with respiratory and allergic health problems in children, however the time line of their association is overlooked. The current study examined the associations between: (1) sleep patterns at age 1 year and respiratory and allergic multi-trajectories between 1 and 5.5 years; (2) respiratory and allergic multi-trajectories between 1 and 5.5 years and sleep patterns at age 5.5 years in a French birth cohort. Methods Clusters of sleep characteristics at age 1 year (nocturnal sleep duration (NSD), day sleep duration (DSD), sleep onset difficulties (SOD), night awakenings (NA)) and at age 5.5 years (NSD, SOD, NA) and respiratory and allergic symptoms multi-trajectory groups between 1 and 5.5 years (wheezing, asthma medication, eczema, allergic conjunctivitis) were identified using unsupervised methods. Associations between sleep clusters at each age and multi-trajectory groups were assessed using multinomial regressions adjusted for potential confounding factors among 9,577 children. Results Two sleep clusters were identified at both age 1 and 5.5 years: C1a (79.9%, age 1 year) and C1b (83.1%, age 5.5 years) characterized by adequate sleep duration and good sleep quality; C2a (20.1%, age 1 year) and C2b (16.9%, age 5.5 years) characterized by shorter sleep duration and poorer sleep quality. Four multi-trajectory groups were also identified: G1 (no/few symptoms, 44.4%), G2 (persistent non-respiratory allergic symptoms, 23.1%), G3 (transient early respiratory symptoms, 25.2%), G4 (persistent respiratory and allergic symptoms, 7.3%). Belonging to cluster C2a was associated with an increased odds of belonging to G3 (adjusted odds ratio [95% interval confidence]; 1.14 [0.99-1.31]) and G4 (1.29 [1.05-1.59]). After accounting for sleep clusters at age 1 year, belonging to G4 was associated with an increased odds of belonging to cluster C2b (1.21 [0.98-1.5]). Conclusion Sleep disturbances at 1 year were associated with poorer respiratory and allergic health between 1 and 5.5 years and respiratory and allergic problems between age 1 and 5.5 years were associated with sleep troubles at 5.5 years suggesting bidirectionality. Further research is needed to explore potential coevolution of sleep and allergic and respiratory troubles during early childhood. Support (if any) ANR-21-CE36-0001-01

International audience; INTRODUCTION: The objectives of our study were to estimate the prevalence of asthma in adults in France and to study the effects of gender on the associations of asthma with the corpulence and socio-economic characteristics of individuals. METHODS: We estimated the prevalence of current asthma (asthma attack in the past 12 months or current treatment for asthma) from data collected at inclusion in the Constances cohort study in 2013-2014. Analyses were performed separately in men and women, using robust Poisson regression for multivariate analysis. RESULTS: Using data from 34,100 participants in the cohort (men: 47.7 %; mean age: 44.6 years), the prevalence of current asthma was estimated to be 5.8 % (5.1 % in men, 6.4 % in women). The risk of asthma was increased in women with high body mass index (BMI) or waist circumference. In men, only a high waist circumference was associated with an increased risk of asthma. An association with low socioeconomic status was observed only among women. CONCLUSION: The associations of asthma with corpulence and socioeconomic status differed between men and women. Additional analyses should provide a better understanding of the mechanisms responsible for these differences.; INTRODUCTION: Nos objectifs étaient d’estimer la prévalence de l’asthme chez l’adulte en France et d’étudier les effets du sexe dans les associations entre d’une part, l’asthme et d’autre part, la corpulence et le statut socio-économique des individus. MÉTHODES: Nous avons estimé la prévalence de l’asthme actuel (crise d’asthme dans les 12 derniers mois ou traitement actuel pour asthme) à partir des données d’inclusion dans la cohorte Constances en 2013-2014. Les analyses ont été effectuées séparément chez les hommes et chez les femmes, à l’aide de régression de Poisson à variance robuste pour l’analyse multivariée. RÉSULTATS: À partir des données de 34 100 participants de la cohorte (hommes : 47,7 % ; âge moyen : 44,6 ans), la prévalence de l’asthme actuel a été estimée à 5,8 % (hommes : 5,1 % ; femmes : 6,4 %). Le risque d’asthme était augmenté chez les femmes ayant un indice de masse corporelle (IMC) ou un tour de taille élevés. Chez les hommes, seul un tour de taille élevé était associé à un risque accru d’asthme. Une association avec un faible niveau socio-économique était observée uniquement chez les femmes. CONCLUSION: Les associations entre, d’une part, l’asthme et, d’autre part, l’obésité et le statut socio-économique différaient selon le sexe. Des analyses complémentaires des données de la cohorte devraient permettre de mieux en comprendre les différents mécanismes.

International audience; 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.

International audience; BACKGROUND: Associations of long-term exposure to air pollution and greenspace with health-related quality of life (HRQOL) are poorly studied and few studies have accounted for asthma-rhinitis status. OBJECTIVE: To assess the associations of air pollution and greenspace with HRQOL and whether asthma and/or rhinitis modify these associations. METHODS: The study was based on the participants in the second (2000-2002, n = 6542) and third (2011-2013, n = 3686) waves of the European Community Respiratory Health Survey (ECRHS) including 19 centres. The mean follow-up time was 11.3 years. HRQOL was assessed by the SF-36 Physical and Mental Component Summary scores (PCS and MCS). NO(2), PM(2.5) and PM(10) annual concentrations were estimated at the residential address from existing land-use regression models. Greenspace around the residential address was estimated by the (i) mean of the Normalized Difference Vegetation Index (NDVI) and by the (ii) presence of green spaces within a 300 m buffer. Associations of each exposure variable with PCS and MCS were assessed by mixed linear regression models, accounting for the multicentre design and repeated data, and adjusting for potential confounders. Analyses were stratified by asthma-rhinitis status. RESULTS: The mean (SD) age of the ECRHS-II and III participants was 43 (7.1) and 54 (7.2) years, respectively, and 48 % were men. Higher NO(2), PM(2.5) and PM(10) concentrations were associated with lower MCS (regression coefficients [95%CI] for one unit increase in the inter-quartile range of exposures were -0.69 [-1.23; -0.15], -1.79 [-2.88; -0.70], -1.80 [-2.98; -0.62] respectively). Higher NDVI and presence of forests were associated with higher MCS. No consistent associations were observed for PCS. Similar association patterns were observed regardless of asthma-rhinitis status. CONCLUSION: European adults who resided at places with higher air pollution and lower greenspace were more likely to have lower mental component of HRQOL. Asthma or rhinitis status did not modify these associations.

International audience; While exposure to irritant and sprayed cleaning products at home is known to have a harmful role in asthma, the potential health effect of other categories or forms has not been investigated. We studied the associations of household use of cleaning products, including green, home-made products and disinfecting wipes, with asthma based on data from the large French populationbased Constances cohort. Participants completed standardized questionnaires on respiratory health and household use of cleaning products. Cross-sectional associations of cleaning products with current asthma, adjusted for gender, age, smoking status, BMI and educational level, were evaluated by logistic regressions. Analyses were conducted in 41,570 participants (mean age: 47 years, 56% women, weekly use of the six specific products/forms studied varied from 11% to 37%). Weekly use of irritants (OR=1.23[1.13-1.35]), scented (OR=1.15[1.06-1.26]), green (OR=1.09[1.00-1.20]) and homemade products (OR=1.19[1.06-1.34]), as well as sprays (OR=1.18[1.08-1.29]), disinfecting wipes (OR=1.21[1.09-1.34]) were significantly associated with asthma, with significant trends according to the frequency of use. When they were not co-used with irritants/sprays, associations were reduced and persisted only for disinfecting wipes. Weekly use of disinfecting wipes at home was associated with current asthma, but fewer risks were observed for the use of green and home-made products.

BackgroundScarce epidemiological studies have characterised allergic rhinitis (AR) and non-allergic rhinitis (NAR) in adults. In a population-based cohort, our aims were to 1) describe rhinitis, AR and NAR, and 2) explore how asthma and conjunctivitis may lead to the identification of novel rhinitis phenotypes.MethodsIn this cross-sectional analysis, current rhinitis was defined as present in the last 12 months using a questionnaire from the French CONSTANCES cohort. Participants with current rhinitis reporting nasal allergies were considered as AR, otherwise as NAR. We described AR and NAR phenotypes, and their phenotypes including co-occurrence with ever-asthma and ever-conjunctivitis.ResultsAmong the 20 772 participants included in this analysis (mean±sdage 52.6±12.6 years; 55.2% female), crude prevalences of AR and NAR were 28.0% and 10.9%. AR participants more frequently reported persistent rhinitis (31.6%versus25.1%) and moderate-to-severe rhinitis (40.1%versus24.2%) than NAR participants. Among AR or NAR participants, those with ever-asthma reported more moderate-to-severe rhinitis. Participants with AR, ever-asthma and ever-conjunctivitis had an earlier age of rhinitis onset, more severe rhinitis and higher eosinophil counts than participants in other groups. Results were replicated in another cohort.ConclusionsIn this large population-based cohort, 40% reported current rhinitis, with a lower prevalence of moderate-to-severe rhinitis than in clinical practice. For the first time in a general adult population, we showed that AR and NAR alone or in combination with asthma or in combination with asthma and conjunctivitis are different phenotypes. These results provide new insights on how best to manage rhinitis and its multimorbidities.

IntroductionObesity is a known risk factor for asthma. Although some evidence showed asthma causing obesity in children, the link between asthma and obesity has not been investigated in adults.MethodsWe used data from the European Community Respiratory Health Survey (ECRHS), a cohort study in 11 European countries and Australia in 3 waves between 1990 and 2014, at intervals of approximately 10 years. We considered two study periods: from ECRHS I (t) to ECRHS II (t+1), and from ECRHS II (t) to ECRHS III (t+1). We excluded obese (body mass index≥30 kg/m2) individuals at visitt. The relative risk (RR) of obesity att+1associated with asthma attwas estimated by multivariable modified Poisson regression (lag) with repeated measurements. Additionally, we examined the association of atopy and asthma medication on the development of obesity.ResultsWe included 7576 participants in the period ECRHS I-II (51.5% female, mean (SD) age of 34 (7) years) and 4976 in ECRHS II-III (51.3% female, 42 (8) years). 9% of participants became obese in ECRHS I-II and 15% in ECRHS II—III. The risk of developing obesity was higher among asthmatics than non-asthmatics (RR 1.22, 95% CI 1.07 to 1.38), and particularly higher among non-atopic than atopic (1.47; 1.17 to 1.86 vs 1.04; 0.86 to 1.27), those with longer disease duration (1.32; 1.10 to 1.59 in >20 years vs 1.12; 0.87 to 1.43 in ≤20 years) and those on oral corticosteroids (1.99; 1.26 to 3.15 vs 1.15; 1.03 to 1.28). Physical activity was not a mediator of this association.ConclusionThis is the first study showing that adult asthmatics have a higher risk of developing obesity than non-asthmatics, particularly those non-atopic, of longer disease duration or on oral corticosteroids.

The members of the ANSES expert assessment "Etat des connaissances relatif à l'impact sanitaire de l'exposition aux moisissures présentes dans l'air ambiant sur la population générale française et recommandations en matière de surveillance nationale?" are as follows: S. Achard (Paris University, Paris, France), V. Bex (SPSE, Paris, France), D. Caillaud (CHU Clermont-Ferrand, France), J. Dupont (Museum National d'Histoire Naturelle, Sorbonne Universit?s, Paris, France), E. Frealle (CHU Lille, France), B. Leynaert (INSERM, Paris, France), I. Thaon (CHU Nancy, France), M. Keirsbulck (ANSES, Paris, France), and C. Leger (ANSES, Paris, France). D. Caillaud and B. Leynaert were members, and M. Keirsbulck and C. Leger coordinated the ANSES expert assessment.; International audience; Background: Fungal spores are the predominant biological particulates in outdoor air. However, in contrast to pollens or outdoor air pollution, little is known about their respiratory health risks. Objectives: The objectives were to conduct the first review of epidemiological studies on the short- and long-term effects of outdoor mold exposure on respiratory health in children and adults. Methods: Health outcomes included asthma, lung function, and rhinitis. Cross-sectional and longitudinal epidemiological studies using quantitative measures of outdoor mold exposure (optical microscopy, culture-based methods) were selected, providing that important confounding factors including temporal trends or meteorological factors were accounted for. A systematic literature search was performed up to June 2020, leading to the selection of 37 publications. Results: Most studies were longitudinal and investigated short-term effects. There is evidence of an association between outdoor fungal exposure and an increase in asthma exacerbation among children for total spores, 2 phyla (ascomycetes, basidiomycetes), and 2 taxa (Cladosporium, Alternaria). A few studies also suggested an association for Coprinus, Ganoderma, Aspergillus-Penicillium, Botrytis, and Epicoccum in children, but this needs to be confirmed. Some studies reported mold associations with rhinitis, lung function, and among adults, but these were few in number or inconsistent. Discussion: Further ecological studies in different regions that measure exposure to all taxa over several years are required to better understand their impact on rhinitis, asthma exacerbations and lung function. Larger panel studies are necessary to identify threshold effects in susceptible individuals. Finally, further research should assess the long-term effects of outdoor mold.

Patients with concomitant features of asthma and chronic obstructive pulmonary disease (COPD) have a heavy disease burden. Using data collected prospectively in the European Community Respiratory Health Survey, we compared the risk factors, clinical history and lung function trajectories from early adulthood to late sixties of middle-aged subjects with asthma+COPD (n=179), past (n=263) or current (n=808) asthma alone, COPD alone (n=111) or none of these (n=3477). Interview data and pre-bronchodilator forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were obtained during three clinical examinations in 1991–1993, 1999–2002 and 2010–2013. Disease status was classified in 2010–2013, when the subjects were aged 40–68 years, according to the presence of fixed airflow obstruction (post-bronchodilator FEV1/FVC below the lower limit of normal), a lifetime history of asthma and cumulative exposure to tobacco or occupational inhalants. Previous lung function trajectories, clinical characteristics and risk factors of these phenotypes were estimated. Subjects with asthma+COPD reported maternal smoking (28.2%) and respiratory infections in childhood (19.1%) more frequently than subjects with COPD alone (20.9% and 14.0%, respectively). Subjects with asthma+COPD had an impairment of lung function at age 20 years that tracked over adulthood, and more than half of them had asthma onset in childhood. Subjects with COPD alone had the highest lifelong exposure to tobacco smoking and occupational inhalants, and they showed accelerated lung function decline during adult life. The coexistence between asthma and COPD seems to have its origins earlier in life compared to COPD alone. These findings suggest that prevention of this severe condition, which is typical at older ages, should start in childhood., The coexistence of asthma and COPD is generally diagnosed in older persons. Nonetheless, prevention of this condition should start in childhood. As a priority, maternal and personal smoking avoidance should be encouraged. https://bit.ly/3uQCmIX

Introduction: Although quality of life is impaired in subjects with various lung diseases, the associations with objective measures of lung function have been reported to be weak. Objectives: To describe the association between lung function decline and impaired self-reported health-status in a large adult general population sample followed for 10 years. Methods: Associations between changes in lung function and the SF-36 Health Survey was investigated in 3,843 participants in the European Community Respiratory Health Survey (ECRHS) with complete data in the second (2002, age range 30-55 years) and third follow-up (2012). We estimated the association between change of maximum forced expired volume in 1 second (FEV1) and forced vital capacity (FVC) and change in each of the eight SF-36 health scales adjusting for sex, age and lung function at baseline. Results: Mean yearly change in FEV1 were 48 (standard deviation (SD) 30) ml in males and 40(22) ml in women. Corresponding changes in FVC were 40(38) and 31(30) ml. Increasing decline in FEV1 and FVC were highly significantly associated with reduced scores in the four scales predominantly measuring physical health at follow-up, but not the mental scales. A yearly decline of 50 ml in FEV1 was associated with a reduced score of 0.25 SD in physical functioning, 0.12 in role limitations due to physical problems, 0.10 in bodily pain and 0.24 in general perception of health. Conclusion: In a general population followed for 10 years, we found marked effects of lung function decline on the physical scales of the SF-36, but not on the mental scales. This indicates SF-36 scales as sensitive self-reported measures of changes in lung health. *Shared last authorship

International audience

Introduction The study aim was to examine the association of snoring and nocturnal gastro-oesophageal reflux (nGOR) with respiratory symptoms and lung function, and if snoring and/or nGOR associated with a steeper decline in lung function. Methods Data from the third visit of the European Community Respiratory Health Survey (ECRHS) was used for cross-sectional analysis. Pre- and post-bronchodilator spirometry was performed, and information on sleep, nGOR and respiratory symptoms was collected (n=5715). Habitual snoring and nGOR were assessed by questionnaire reports. Pre-bronchodilator spirometry from ECRHS I, II and III (20 years follow-up) were used to analyse lung function changes by multivariate regression analysis. Results Snoring and nGOR were independently associated with a higher prevalence of wheeze, chest tightness, breathlessness, cough and phlegm. The prevalence of any respiratory symptom was 79% in subjects with both snoring and nGOR versus 56% in those with neither (p, Middle-aged adults with habitual snoring have a steeper decline in lung function over 10 years compared to controls. Habitual snorers with nocturnal gastro-oesophageal reflux have a higher prevalence of nocturnal respiratory symptoms than controls. http://ow.ly/YsiK30odcMY

Points essentiels La prevalence de l’asthme a augmente de facon tres marquee depuis le debut des annees 1970, et seules des modifications de l’exposition a certains facteurs d’environnement, indissociables des modifications du mode de vie, peuvent expliquer une augmentation aussi rapide. L’exposition aux allergenes est un facteur de risque de sensibilisation allergique et la sensibilisation allergique un facteur de risque de l’asthme allergique. Toutefois, en dehors de l’exposition aux moisissures vis-a-vis de l’asthme de l’enfant, il est difficile d’etablir des liens de causalite entre l’exposition aux differents allergenes et le developpement de l’asthme. Un nouveau defi pour la recherche est d’analyser la multitude de donnees issues de la caracterisation metagenomique du microbiome environnemental et humain, pour comprendre le role des interactions entre virus, bacteries et allergenes dans le developpement de l’asthme. Il est admis que l’exposition prenatale et postnatale a la pollution de l’air et au tabagisme de la mere augmentent le risque de developper un asthme chez l’enfant. Chez l’adulte, les donnees sont plus rares et les resultats restent controverses quant au role de ces expositions sur l’incidence de l’asthme. Des recherches doivent etre developpees sur le role de l’exposition aux phenols, phtalates et composes perfluores, largement repandus dans notre environnement, et qui pourraient etre associes a l’asthme, notamment chez l’enfant. L’utilisation frequente des produits de nettoyage pour le menage a domicile, notamment sous forme de sprays ; — pratique tres repandue dans la population — est un facteur de risque du developpement de l’asthme de l’adulte, et peut etre aussi pour l’asthme de l’enfant expose a domicile. Les substances chimiques en cause restent mal connues. L’asthme professionnel est un phenotype specifique majeur de l’asthme de l’adulte. L’exposition professionnelle aux produits de nettoyage pourrait etre impliquee. Des relations ont ete montrees entre l’alimentation pendant la grossesse ou dans l’enfance et le risque de developper un asthme chez l’enfant, mais les donnees chez l’adulte sont insuffisantes. Au-dela des facteurs genetiques, la composition corporelle est influencee par les choix alimentaires et par le niveau d’activite physique. Des recherches doivent etre developpees pour clarifier le role des interrelations complexes entre ces facteurs nutritionnels dans le developpement de l’asthme. Le nouveau defi pour la recherche est de decrypter, par une approche holistique, le role de l’ensemble des facteurs d’environnement auxquels l’individu est expose depuis sa conception (« exposome ») dans le developpement de l’asthme.

Rationale The naturally occurring age-dependent decline in lung function accelerates after menopause, likely due to the change of the endocrine balance. Although increasing evidence shows suboptimal lung health in early life can increase adult susceptibility to insults, the potential effect of poor childhood lung function on menopause-dependent lung function decline has not yet been investigated. Objectives To study whether menopause-dependent lung function decline, assessed as forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), is determined by childhood lung function. Methods The Tasmanian Longitudinal Health Study, a cohort born in 1961, underwent spirometry at age seven. At ages 45 and 50 serum samples, spirometry and questionnaire data were collected (N = 506). We measured follicle stimulating and luteinizing hormones to determine menopausal status using latent profile analysis. The menopause-dependent lung function decline was investigated using linear mixed models, adjusted for anthropometrics, occupational level, smoking, asthma, asthma medication and study year, for the whole study population and stratified by tertiles of childhood lung function. Measurements and Main Results The overall menopause-dependent lung function decline was 19.3 mL/y (95%CI 2.2 to 36.3) for FVC and 9.1 mL/y (-2.8 to 21.0) for FEV1. This was most pronounced (pinteraction=0.03) among women within the lowest tertile of childhood lung function [FVC 22.2 mL/y (1.1 to 43.4); FEV1 13.9 mL/y (-1.5 to 29.4)]. Conclusions Lung function declines especially rapidly in postmenopausal women who had poor low lung function in childhood. This provides novel insights into respiratory health during reproductive aging and emphasizes the need for holistic public health strategies covering the whole lifespan.

International audience; 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 un-derlying 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.

International audience; Rationale: Few longitudinal studies have assessed the relationship between occupational exposures and lung-function decline in the general population with a sufficiently long follow-up.Objectives: To examine the potential association in two large cohorts: the ECRHS (European Community Respiratory Health Survey) and the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults).Methods: General-population samples of individuals aged 18 to 62 were randomly selected in 1991-1993 and followed up approximately 10 and 20 years later. Spirometry (without bronchodilation) was performed at each visit. Coded complete job histories during follow-up visits were linked to a job-exposure matrix, generating cumulative exposure estimates for 12 occupational exposures. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were jointly modeled in linear mixed-effects models, fitted in a Bayesian framework, taking into account age and smoking.Results: A total of 40,024 lung-function measurements from 17,833 study participants were analyzed. We found accelerated declines in FEV1 and the FEV1/FVC ratio for exposure to biological dust, mineral dust, and metals (FEV1 = -15.1 ml, -14.4 ml, and -18.7 ml, respectively; and FEV1/FVC ratio = -0.52%, -0.43%, and -0.36%, respectively; per 25 intensity-years of exposure). These declines were comparable in magnitude with those associated with long-term smoking. No effect modification by sex or smoking status was identified. Findings were similar between the ECRHS and the SAPALDIA cohorts.Conclusions: Our results greatly strengthen the evidence base implicating occupation, independent of smoking, as a risk factor for lung-function decline. This highlights the need to prevent or control these exposures in the workplace.

Cross-sectional and longitudinal observational studies have shown that higher levels of testosterone are associated with better lung function in men and a small attenuation of lung function decline in women. We used multivariable Mendelian randomization (MVMR), which is not affected by classical confounding, to assess the independent causal effect of total testosterone (TT) and sex hormone-binding globulin (SHBG) on lung function (FVC and FEV1/FVC) in men and women. To select SNPs associated with TT and SHBG for MR, we performed genome-wide association studies and replicated results in independent UK Biobank samples (N=323,144/161,572). SNPs were considered replicated with same direction of effect and p-value For TT, we replicated 63 SNP in females and 92 SNPs in males, and 308 SNPs were associated with SHBG in both sexes. In women, the MVMR analyses suggest that a natural log increase in TT is associated with a 33.9 mL increase in FVC independently of SHBG (figure 1A). Stratified analyses showed a beneficial effect of SHBG on FVC in physically active and post-menopausal women. In males, the MVMR analyses suggest that a log increase in SHBG is associated with 0.62% lower FEV1/FVC and 54.6 mL higher FVC independently of TT (figure 1A/B). However, no associations were found with TT in males in the main analysis nor subgroup analyses. For all analyses there was an indication of high heterogeneity (Q statistic p-value Our MR analyses show that higher hormone levels are associated with better lung function, with higher TT levels being beneficial for FVC in women and higher SHBG levels being beneficial for FVC in males.

International audience; BACKGROUND: Solar ultraviolet radiation (UVR) affects the body through pathways that exhibit positive as well as negative health effects such as immunoregulation and vitamin D production. Different vitamin D metabolites are associated with higher or lower concentrations of estrogens and may thus alter the female sex hormone balance. OBJECTIVE: To study whether exposure to UVR, as a modifiable lifestyle factor, is associated with levels of sex hormones (17β-estradiol, estrone, estrone 3-sulfate, testosterone, dehydroepiandrosterone sulfate), gonadotropins (follicle stimulating hormone, luteinizing hormone) as well as sex hormone binding globulin in postmenopausal women, and thus investigate whether managing UVR exposure can influence the hormone balance, with potential benefits for the biological aging process.METHODS: The study included 580 postmenopausal women from six European countries, participating in the European Community Respiratory Health Survey (2010-2014). Average UVR exposure during the month before blood sampling was estimated based on personal sun behavior and ambient levels. Hormone concentrations were measured in serum using state-of-the-art methods. Subsequently we applied linear mixed-effects models, including center as random intercept, hormone concentrations (one at a time) as outcome and UVR, age, skin type, body mass index, vitamin D from dietary sources, smoking, age at completed full-time education and season of blood sampling as fixed-effect predictors.RESULTS: One interquartile range increase in UVR exposure was associated with decreased levels of 17β-estradiol (-15.6 pmol/L, 95 % Confidence Interval (CI): -27.69, -3.51) and estrone (-13.36 pmol/L, 95 % CI: -26.04, -0.68) and increased levels of follicle stimulating hormone (9.34IU/L, 95 % CI: 2.91, 15.77) and luteinizing hormone (13.86 IU/daL, 95 % CI: 2.48, 25.25).CONCLUSIONS: Exposure to UVR is associated with decreased estrogens and increased gonadotropins in postmenopausal women, a status associated with osteoporosis, lung function decline and other adverse health effects. This study indicates that managing UVR exposure has potential to influence the hormone balance and counteract adverse health conditions after menopause.

International audience