Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
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Relation of polyunsaturated fatty acid, n-3 fatty acid and n-6 fatty acid intakes and atopic dermatitis in the 9~ 11 year old children: KNHANES 2013 ~ 2015

9 ~ 11세 아동의 불포화지방산, n-3 지방산 및 n-6 지방산의 섭취와 아토피 피부염 과의 관련성 : 2013 ~ 2015년 국민건강영양조사

  • Kim, Ji-Myung (Food and Nutrition Major, Division of Food Science and Culinary Arts, Shinhan University)
  • 김지명 (신한대학교 식품조리과학부 식품영양전공)
  • Received : 2018.12.28
  • Accepted : 2019.02.12
  • Published : 2019.02.28
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Abstract

Purpose: This study was conducted to investigate the relationship between atopic dermatitis and dietary fat and fatty acid (FA) intakes in 9 ~ 11 year old children. Methods: We analyzed data from the combined 2013 ~ 2015 KNHANES (Korean National Health and Nutrition Examination Survey). Subjects were divided into two groups according to atopic dermatitis (AD); with AD and without AD. Data pertaining to macronutrients and FA intakes were obtained by a single 24-h dietary recall. Food sources were identified based on the amounts of total fat and FA consumption according to each food. The associations between each FA intake and atopic dermatitis were analyzed using simple and multiple logistic regression analyses. Age, sex, body mass index (BMI) and income levels were adjusted as covariates. Results: Of the participants, 17.69% suffered from atopic dermatitis. Children with AD had significantly lower fat percentages of total energy and higher carbohydrate percentages of total energy than normal children. Percentages of energy and intakes of polyunsaturated fatty acid (PUFA), n-3 FA and n-6 FA in children with AD were significantly lower than those in normal children. In the FA, linoleic acid, ${\gamma}$-linoleic acid and ${\alpha}$-linolenic acid levels of children with AD were significantly lower than those of normal children. However, the P/S ratio and n-6/n-3 ratio did not differ significantly between children with AD and normal children. Soybean oil was the main contributor to PUFA, n-3 FA and n-6 FA in both groups, while perilla seed oil and mackerel were the major food sources of n-3 FA in children with atopic dermatitis. Atopic dermatitis was significantly correlated with low-fat and high-carbohydrate diets. The adjusted odds ratios were 0.966, 0.776 and 0.963 for PUFA, n-3 FA, and n-6 FA intakes, respectively. Conclusion: The present study provides reliable evidence regarding the relationship between fat and FA intakes and AD in Korean children 9 ~ 11 years of age.

본 연구는 제6기 (2013 ~ 2015년) 국민건강영양조사 자료를 이용하여 만 9 ~ 11세의 학령기 아동 752명을 대상으로 아토피 피부염 유병에 따른 지방산 섭취상태 및 지방산 섭취가 아토피 피부염 위험에 미치는 영향을 분석하였다. 국내 만 9 ~ 11세 아동의 아토피 피부염 유병율은 17.69% 이었고, 아토피 피부염 아동의 연령이 10.20세로 정상 아동의 10.01세보다 유의적으로 높았다. 그러나, 체위상태를 살펴보았을 때, 아토피 피부염 아동의 신장, 체중, BMI 모두 정상 아동보다 유의적으로 낮게 나타났다. 월 가구 소득수준은 아토피 피부염 아동에서 중하> 상> 중상> 하의 순으로 나타난 반면, 정상 아동은 중상> 상> 중하> 하 순으로 차이를 보였다. 국내 9 ~ 11세의 아토피 피부염 아동은 정상 아동에 비해 탄수화물의 에너지섭취비율이 유의적으로 높고, 지질의 에너지섭취비율, 다가불포화지방산, n-3 지방산, n-6 지방산의 섭취상태가 유의적으로 낮았다. 또한, 리놀레산, 감마 리놀레산, 리놀렌산 섭취량도 아토피 피부염 아동에서 정상 아동에 비해 유의적으로 낮았다. 연령, 성별, 체질량지수 및 소득수준을 보정하였을 때에도 동일한 결과를 보였다. 그러나 P/S 비율 및 n-6/n-3 비율은 아토피 피부염 아동과 정상 아동 간에 유의적인 차이를 보이지 않았다. 9 ~ 11세 아동의 총 지방 및 단일불포화지방산 섭취에서 가장 기여도가 높은 식품은 돼지고기로 전체 섭취량의 12.97%, 17.47%였다. 포화지방산 섭취에 기여도가 가장 높은 식품은 우유로, 전체 섭취량의 18.24%였다. 콩기름은 다가불포화지방산, n-3 지방산 및 n-6 지방산 섭취에서 기여도가 가장 높은 식품으로, 전체 섭취량의 23.79%, 25.24%, 24.07%였다. 아토피 피부염 아동에서는 다가불포화지방산 및 n-6 지방산 급원식품으로 정상아동과 달리 닭고기가 상위 10개 식품에 포함되었고, 참기름의 섭취량이 높았다. n-3 지방산 급원식품으로 고등어 섭취량이 아토피 피부염 아동에서 높았다. 국내 9 ~ 11세 아동에서 지방산 섭취가 아토피 피부염 위험도에 미치는 영향은 보정 여부에 상관없이 탄수화물의 에너지섭취비율은 아토피 피부염 위험도를 유의적으로 높이는 반면, 지질의 에너지섭취비율, 다가불포화지방산, n-3 지방산, n-6 지방산의 섭취가 아토피 피부염 위험도를 유의적으로 낮추는 것으로 나타났다. 이상을 종합해 볼 때, 학령기 아동의 아토피 피부염 위험도에 탄수화물 및 지질의 에너지섭취비율, 불포화지방산, n-6 지방산 및 n-3 지방산의 섭취량 등이 영향을 미치는 것으로 보이나, 아토피 피부염 아동에서 보여 지는 고탄수화물 저 지질식은 증상 개선을 위한 식이조절의 결과일 수 있어, 결과해석에 주의가 필요하다. 식이 조절 시, 적절한 지방산 섭취비율의 균형을 고려하여 섭취하는 것이 도움이 될 것으로 사료되며, 이와 관련하여 아토피 피부염 개선을 위한 지방산의 적정 비율에 관한 추가 연구가 필요할 것으로 보인다.

Keywords

References

  1. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2015: Korea National Health and Nutrition Examination Survey (KNHANES VI-3). Sejong: Korea Centers for Disease Control and Prevention; 2016.
  2. Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr 1999; 70(3 Suppl): 560S-569S. https://doi.org/10.1093/ajcn/70.3.560s
  3. Devereux G, Seaton A. Diet as a risk factor for atopy and asthma. J Allergy Clin Immunol 2005; 115(6): 1109-1117. https://doi.org/10.1016/j.jaci.2004.12.1139
  4. Trak-Fellermeier MA, Brasche S, Winkler G, Koletzko B, Heinrich J. Food and fatty acid intake and atopic disease in adults. Eur Respir J 2004; 23(4): 575-582. https://doi.org/10.1183/09031936.04.00074404
  5. Chung YM, Kim S, Kim NI, Lee EY, Choue R. Study of dietary fatty acids, blood fatty acid composition, and immune parameters in atopic dermatitis patients. J Nutr Health 2005; 38(7): 521-532.
  6. Chung BY, Park SY, Jung MJ, Kim HO, Park CW. Effect of evening primrose oil on Korean patients with mild atopic dermatitis: a randomized, double-blinded, placebo-controlled clinical study. Ann Dermatol 2018; 30(4): 409-416. https://doi.org/10.5021/ad.2018.30.4.409
  7. Reese I, Werfel T. Do long-chain omega-3 fatty acids protect from atopic dermatitis? J Dtsch Dermatol Ges 2015; 13(9): 879-885.
  8. Miles EA, Calder PC. Can early omega-3 fatty acid exposure reduce risk of childhood allergic disease? Nutrients 2017; 9(7): 784-799. https://doi.org/10.3390/nu9070784
  9. Biagi PL, Hrelia S, Celadon M, Turchetto E, Masi M, Ricci G, et al. Erythrocyte membrane fatty acid composition in children with atopic dermatitis compared to age-matched controls. Acta Paediatr 1993; 82(9): 789-790. https://doi.org/10.1111/j.1651-2227.1993.tb12559.x
  10. Calder PC. Dietary modification of inflammation with lipids. Proc Nutr Soc 2002; 61(3): 345-358. https://doi.org/10.1079/PNS2002166
  11. Lee KH, Kim KW, Lee YK, Lee SM, Son SM. Nutrition education and counseling. 3rd ed. Seoul: Lifescience Co.; 2010.
  12. Lee JH, Han KD, Kim KM, Park YG, Lee JY, Park YM. Prevalence of atopic dermatitis in Korean children based on data from the 2008-2011 Korean National Health and Nutrition Examination Survey. Allergy Asthma Immunol Res 2016; 8(1): 79-83. https://doi.org/10.4168/aair.2016.8.1.79
  13. Ko Y, Lee YY, Chae I, Lee Y, Jekal Y, Park HK. Study on snack intakes in obese elementary students in Jeju city. J Nutr Health 2017; 50(1): 85-97. https://doi.org/10.4163/jnh.2017.50.1.85
  14. Her ES. Association of interpersonal relationships with preference and intake frequency of snack with a focus on obesity index and snack preparations in upper grade elementary school students. Korean J Food Nutr 2015; 28(2): 178-188. https://doi.org/10.9799/ksfan.2015.28.2.178
  15. Lee H, Ahn K, Han Y, Chung SJ. Comparison of maternal food intakes during pregnancy in children with and without atopic dermatitis. J Korean Diet Assoc 2012; 18(2): 141-154. https://doi.org/10.14373/JKDA.2012.18.2.141
  16. Hwang I, Cha A, Lee H, Yoon H, Yoon T, Cho B, et al. N-3 polyunsaturated fatty acids and atopy in Korean preschoolers. Lipids 2007; 42(4): 345-349. https://doi.org/10.1007/s11745-007-3033-9
  17. Park S, Choi HS, Bae JH. Instant noodles, processed food intake, and dietary pattern are associated with atopic dermatitis in an adult population (KNHANES 2009-2011). Asia Pac J Clin Nutr 2016; 25(3): 602-613.
  18. Yi Y, Kim J. Factors affecting asthma and atopic dermatitis in Korean children: a population-based cross-sectional survey. Child Health Nurs Res 2015; 21(1): 20-27. https://doi.org/10.4094/chnr.2015.21.1.20
  19. Park YM. Epidemiologic study and risk factors of atopic dermatitis. Pediatr Allergy Respir Dis 2011; 21(2): 74-77. https://doi.org/10.7581/pard.2011.21.2.74
  20. Lee JH. Study on food-intake and atopic dermatitis among adolescents: findings from the Korean youth risk behavior web-based survey. J Korean Diet Assoc 2016; 22(2): 79-87. https://doi.org/10.14373/JKDA.2016.22.2.79
  21. Kristmundsdottir F, David TJ. Growth impairment in children with atopic eczema. J R Soc Med 1987; 80(1): 9-12. https://doi.org/10.1177/014107688708000106
  22. Palit A, Handa S, Bhalla AK, Kumar B. A mixed longitudinal study of physical growth in children with atopic dermatitis. Indian J Dermatol Venereol Leprol 2007; 73(3): 171-175. https://doi.org/10.4103/0378-6323.32740
  23. Voss LD, Mulligan J. Short normal stature - nature or nurture. Pediatr Res 1993; 33: S57.
  24. Wahlgren CF. Pathophysiology of itching in urticaria and atopic dermatitis. Allergy 1992; 47(2 Pt 1): 65-75. https://doi.org/10.1111/j.1398-9995.1992.tb05091.x
  25. Baum WF, Schneyer U, Lantzsch AM, Kloditz E. Delay of growth and development in children with bronchial asthma, atopic dermatitis and allergic rhinitis. Exp Clin Endocrinol Diabetes 2002; 110(2): 53-59. https://doi.org/10.1055/s-2002-23486
  26. Sicherer SH, Sampson HA. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol 1999; 104(3 Pt 2): S114-S122. https://doi.org/10.1016/S0091-6749(99)70053-9
  27. Jeong SJ. The importance of nutritional assessment and dietary counseling in infants and young children with common illnesses. Korean J Pediatr Gastroenterol Nutr 2011; 14(1): 33-44. https://doi.org/10.5223/kjpgn.2011.14.1.33
  28. Suarez-Varela MM, Alvarez LG, Kogan MD, Ferreira JC, Martinez Gimeno A, Aguinaga Ontoso I, et al. Diet and prevalence of atopic eczema in 6 to 7-year-old schoolchildren in Spain: ISAAC phase III. J Investig Allergol Clin Immunol 2010; 20(6): 469-475.
  29. Ministry of Health and Welfare; The Korean Nutrition Society. Dietary reference intakes for Koreans 2015. Sejong: Ministry of Health and Welfare; 2015.
  30. Kim SY, Sim S, Park B, Kim JH, Choi HG. High-fat and low-carbohydrate diets are associated with allergic rhinitis but not asthma or atopic dermatitis in children. PLoS One 2016; 11(2): e0150202. https://doi.org/10.1371/journal.pone.0150202
  31. Nosrati A, Afifi L, Danesh MJ, Lee K, Yan D, Beroukhim K, et al. Dietary modifications in atopic dermatitis: patient-reported outcomes. J Dermatolog Treat 2017; 28(6): 523-538. https://doi.org/10.1080/09546634.2016.1278071
  32. Schafer T, Ruhdorfer S, Weigl L, Wessner D, Heinrich J, Doring A, et al. Intake of unsaturated fatty acids and HDL cholesterol levels are associated with manifestations of atopy in adults. Clin Exp Allergy 2003; 33(10): 1360-1367. https://doi.org/10.1046/j.1365-2222.2003.01780.x
  33. Brown WR, Hansen AE. Arachidonic and linolic acid of the serum in normal and eczematous human subjects. Proc Soc Exp Biol Med 1937; 36(2): 113-117. https://doi.org/10.3181/00379727-36-9136
  34. Solvoll K, Soyland E, Sandstad B, Drevon CA. Dietary habits among patients with atopic dermatitis. Eur J Clin Nutr 2000; 54(2): 93-97. https://doi.org/10.1038/sj.ejcn.1600901
  35. Baek Y, Shim JE, Song S. Dietary intake of fat and fatty acids by 1-5-year-old children in Korea: a cross-sectional study based on data from the sixth Korea National Health and Nutrition Examination Survey. Nutr Res Pract 2018; 12(4): 324-335. https://doi.org/10.4162/nrp.2018.12.4.324
  36. Horrobin DF. Low prevalences of coronary heart disease (CHD), psoriasis, asthma and rheumatoid arthritis in Eskimos: are they caused by high dietary intake of eicosapentaenoic acid (EPA), a genetic variation of essential fatty acid (EFA) metabolism or a combination of both? Med Hypotheses 1987; 22(4): 421-428. https://doi.org/10.1016/0306-9877(87)90037-5
  37. Hodge L, Salome CM, Peat JK, Haby MM, Xuan W, Woolcock AJ. Consumption of oily fish and childhood asthma risk. Med J Aust 1996; 164(3): 137-140. https://doi.org/10.5694/j.1326-5377.1996.tb122010.x
  38. Meydani SN. Effect of (n-3) polyunsaturated fatty acids on cytokine production and their biologic function. Nutrition 1996; 12(1 Suppl): S8-S14.
  39. Kim BS, Kim YY, Park JH, Kim NI, Choue RW. Effects of medical nutrition therapy on dietary quality, plasma fatty acid composition and immune parameters in atopic dermatitis patients. Korean J Community Nutr 2008; 13(1): 80-90.

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