New Opportunities to Mitigate the Burden of Disease Caused by Traffic Related Air Pollution: Antioxidant-Rich Diets and Supplements
Abstract
:1. Introduction
2. Materials and Methods
Were published peer-reviewed journal articles offering insight to the relationship between antioxidant-rich diet or antioxidant supplement interventions and the adverse health effects of TRAP, or markers thereof.Any design in human populations including cohort studies and clinical studies with controlled exposures.
Animal studiesCell culture studiesPapers without an English translationPapers where full text was not availablePapers with pollutants or exposures not relevant to traffic
3. Results
3.1. Overview of Results
3.2. Fruit and Vegetable Rich Diet
3.3. Mediterranean Diet
3.4. Fish Oil and Other Oil Supplements
3.5. Sulforaphane
3.6. Vitamin C and Vitamin E
4. Discussion
4.1. Summary and Key Findings
4.2. Comparison with Previous Studies
4.3. Limitations
4.4. Research Recommendations
4.5. Policy Recommendations
4.6. Practice Recommendations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
ADHD | Attention deficient hyperactivity disorder | HCs | Hydrocarbons |
aMED | Alternative Mediterranean diet | HRV | Heart rate variability |
BC | Black carbon | IHD | Ischemic heart disease |
CAP | Concentrated ambient particulate matter | LPO | Lipoperoxidation |
CO | Carbon monoxide | MDI | Mediterranean diet index |
COPD | Chronic obstructive pulmonary disease | NO2 | Nitrogen dioxide |
CVD | Cardiovascular disease | NOx | Nitrogen oxides |
DEP | Diesel exhaust particles | O3 | Ozone |
EC | Elemental carbon | ox-LDL | oxidized low-density lipoprotein |
ECAT | Elemental carbon attributable to traffic | PM | Particulate matter |
FDA | Food and Drug Administration | PM2.5 | Particulate matter with a diameter of 2.5 micrometers or smaller |
FEV1 | Forced expiratory volume in 1 second | PM10 | Particulate matter with a diameter of 10 micrometers or smaller |
FVC | Forced vital capacity | PUFA | Polyunsaturated fatty acids |
FVI | Fruit and vegetable intake | RCT | Randomized controlled trial |
GSH | Glutathione | ROS | Reactive oxygen species |
TSP | Total suspended particles | SO2 | Sulfur dioxide |
UFPs | Ultra fine particles | SO4 | Sulfate |
VOC | Volatile organic compounds | SOD | Superoxide dismutase |
TRAP | Traffic-related air pollution |
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Study Name and Reference | Study Design | Objective | Country of Origin | Population | Sample Size | Air Pollutants | Nutrient Intervention | Analysis Methods | Key Findings | Notes/Gaps |
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Fruit and Vegetable Rich Diet | ||||||||||
Guxens et al., 2012 [52] | Birth cohort study | Analyze the effect of antioxidants and detoxification factors on infant mental development that results from prenatal exposure to air pollution. | Spain | Infants (11 to 23 months of age at time of assessment) | 1889 | NO2 and benzene were measured with passive samplers distributed over the study areas and land use regression models were developed based on these measurements to predict average outdoor air pollution levels for the entire pregnancy at each residential address. | Mothers were given a validated food frequency questionnaire during their first trimester, focusing on fruit and vegetable intake. Information on maternal diet was obtained using a 101-item semi-quantitative validated food frequency questionnaire. Detailed information about child feeding through the second year of life was collected from mothers by interviewer-administered questionnaires. A single maternal fasting blood specimen was also drawn during pregnancy and levels of maternal plasma vitamin D were determined. | Multivariable linear regression models were performed to examine the relationship between log-transformed NO2 and benzene and infant mental development as continuous normal variables. A meta-analysis using random-effects models combining the estimates in each region of the association between each air pollutant and infant mental development was conducted. Effect modification of air pollution associations by levels of antioxidants and detoxification factors (fruits and vegetables, breast-feeding, circulating vitamin D), as well as by socioeconomic variables (parental social class and maternal education), was assessed using stratified analysis and interaction terms. The analysis adjusted for psychologist, child’s sex, child’s age at mental development assessment, maternal education, maternal age, maternal height and pre-pregnancy body mass index, maternal alcohol use during pregnancy, maternal large fatty and lean fish consumption at first trimester, season-specific maternal circulating vitamin D level at pregnancy, use of gas stove at home during pregnancy, and number of siblings at birth. | Mental development was assessed using the Bayley Scales of Infant Development. The Bayley Scales of Infant Development is composed of 163 items that assess age-appropriate mental development, performance abilities, memory, and early language skills. There was an inverse relationship between NO2 and benzene exposures and mental development, however, it was not statistically significant after adjusting for potential confounders. A statistically significant inverse relationship between pollutants and mental development was limited to infants with low maternal intake of fruits and vegetables during pregnancy. Inverse associations between pollutants and mental development in infants who were not breastfed and infants with low maternal vitamin D were also observed, however, these effect estimates, and interactions were not statistically significant. | Breast milk has long chains of polyunsaturated fatty acids and other micronutrients that reduce inflammation and oxidative stress. The main limitations reported by the authors were that noise annoyance during pregnancy was collected by a self-reported scale rather than by a direct measure of noise levels (and was used in sensitivity analysis). As such, residual confounding from noise may remain. Parental intelligence, an important determinant of infant mental development, was not evaluated although parental education and social class were but did not confound or modify the associations. Finally, not all children initially recruited at birth were included in the final analysis, and loss due to follow-up (25%) was related to lower social status, although this variable was adjusted for. |
Mediterranean Diet | ||||||||||
Lim et al., 2019 [46] | Prospective cohort study | Analyze the potential effect of a Mediterranean diet on the relationship between air pollutants and cardiovascular disease mortality risk. | United States | Adults (ages 50 to 71) | 548,845 | PM2.5, NO2 were modeled using a spatiotemporal prediction model and a recent model, which applied kriging models combining land-use regression methods with satellite data, respectively. | Mediterranean diet, which emphasizes consumption of plant-based food, olive oil and moderate alcohol intake. Alternative Mediterranean Diet score was used to assess dietary patterns. | Extended Cox proportional hazards models to estimate hazard ratios of mortality in relation to ambient air pollution levels. Fully adjusted multivariable models include the following covariates: age, sex, region, race or ethnic group, level of education, marital status, body mass index, alcohol use, smoking status, and household income. | Long-term exposure to PM2.5 had statistically significant associations with cardiovascular disease (CVD), ischemic heart disease (IHD) and cerebrovascular disease. Long term exposure to NO2 had statistically significant associations to cardiovascular disease and ischemic heart disease. Participants who had a higher alternative Mediterranean diet score had statistically significant lower rates of CVD and IHD mortality risk associated with long-term air pollution exposure. | The main limitations reported by the authors were the measures of diet were collected a baseline and the study could not account for changes in intake over time, personal covariates were only recorded at baseline and their changes could not be tracked over time, no information on residence location was available for participants that moved out of the region which could result in exposure misclassification, the cohort has a limited number of participants in races other than white and non-black Hispanic and therefore findings may not be generalized to the US population, Mediterranean dietary pattern may also reflect other overall healthy behaviors that were not fully adjusted for in this analysis. |
Romieu et al., 2009 [53] | Panel cohort study | Analyze the relationship between diet (fruits, vegetables and Mediterranean diet) and lung function (measured as Forced expiratory volume in 1 second (FEV1) and Forced vital capacity (FVC)) and airway inflammation (IL-8 levels in nasal lavage) after short-term exposure to air pollutants. | Mexico | Children (ages 6 to 14 years old) | 208 (158 asthmatics and 50 non-asthmatics) | PM2.5, NO2, and O3 were measured at 4 fixed site central monitors for all days of the study period (505 days). Readings from the closest monitoring station was assigned to the child’s geo-referenced residential address. No fixed site monitoring station was more than 5 km from a child’s home or school. | Dietary assessment to calculate fruit and vegetable intake (FVI) and a Mediterranean diet index (MDI) from mothers’ responses to a 108-item food frequency questionnaire administered at baseline to mothers. | Linear mixed effects models adjusted for gender, body mass index, previous day minimum temperature, corticoid use and chronological time. Other variables such as age, socioeconomic index, outdoor activities, atopic status, exposure to environmental tobacco smoke, use of anti-allergy medicine and season were not significant (p > 0.10) and did not alter the results by >1%. Interaction between air pollutant exposure and dietary intake was tested to assess any modifying effect of diet on adverse effect of air pollution on lung health. The effect of the nutritional indices was also assessed in children exposed to low and high levels of pollutants. | In asthmatic children, higher FVI scores were significantly associated with lower IL-8 levels in nasal lavage. In asthmatic children, children in the highest category of MDI had a higher FEV1 and FVC than children in the lowest category and this effect was statistically significant. In non-asthmatic healthy children, there were no statistically significant effects of diet. | The main limitations reported by the authors were the dietary intake food frequency questionnaire was provided by the child’s mother, some error in reporting dietary intake is unavoidable, small sample size, and non-asthmatic children are known to have higher levels of antioxidants in the serum which might have inherently influenced their susceptibility to pollutants. |
Fish Oil and Other Oil Supplements | ||||||||||
Romieu et al., 2005 [54] | Randomized double blinded trial | Analyze the effect of fish oil versus soy oil supplements on the relationship between particulate matter with a diameter of 2.5 micrometers or smaller (PM2.5) exposure and heart rate variability. | Mexico | Adults (nursing home residents, older than 60 years) | 50 | Daily 24-h measurements of PM2.5 measured by using Mini-Vol portable air samplers for indoors of the nursing home, and outdoors at the nursing home site conducted on the roof of the nursing home during the follow-up period. | Randomization to either 2 g/d of fish oil versus 2 g/d of soy oil as the control. Measurements at 1-mo pre-supplementation and 5-mo post-supplementation. | Random-effect regression models adjusted for age, sex, heart rate, body mass index, hypertension. Subsequent models were also adjusted for systolic or diastolic blood pressure and day of the week. Analysis was stratified by hypertension diagnosis. | Reduction in heart rate variability with same day exposures to indoor PM2.5 during the pre-supplementation phase. Participants given soybean oil supplements experienced marginal and non-significant protection from the effects of PM2.5 on heart rate variability. Supplementation with 2 g/d of fish oil prevented heart rate variability effects related to PM2.5 exposure in the study population. | The main limitations reported by the authors were the small sample size, the use of short-term heart rate variability recordings which might have hindered the possibility of performing an adequate assessment on very low frequencies, and the fact that the pre-supplementation phase was limited to 1 month (and consequently the confidence limit around the point estimate for the effect of PM2.5 on heart rate variability during this phase was greater) |
Romieu et al., 2008 [55] | Randomized, double blinded, controlled trial | Analyze the effect of n-3-polyunsaturated fatty acid (PUFA) supplements (in fish oil) on protection from cardiac alterations linked to PM2.5 exposure. | Mexico | Adults (nursing home residents, older than 60 years) | 52 | Daily 24-h measurements of PM2.5 measured by mini-vol portable air samplers (indoor and ambient levels) located in the living room of the nursing home during the follow-up period. O3 was monitored by an automated stationary monitoring site located 3 km upwind from the study site. | Randomization of either fish oil (n-3-PUFA) or soy oil supplements (both 2 g/d capsules). Measurements during a pre-supplementation phase of 3 months and a supplementation phase of 4 months. | Linear mixed models which account for repeated measurements within the same individual and allow for variation of effect among individuals were used to determine the effect of PM2.5 exposure on biomarkers of in the fish and soy oil supplementation groups. Adjusted for time. Average PM2.5 levels were broadly the same between the two treatment periods. | Participants who took the supplementation had greater Cu/Zn superoxide dismutase (SOD) activity, and increased levels of reduced glutathione (GSH) in plasma. The fish oil group experienced statistically significant decreased levels of lipoperoxidation (LPO) products in response to PM2.5. These effects were particularly pronounced in the fish oil group compared to the soy oil group. | The main limitations reported by the authors were that exposure assessments were limited to a stationary 24-h gravimetric analysis of PM2.5, the small sample size limited the exploration of interactions among supplementation groups and PM2.5, and a larger sample size is required to analyze the lack of significance in the soy oil group. |
Lin et al., 2019 [56] | Randomized, double blinded, placebo-controlled trial | Analyze the extent to which fish oil supplements can protect cardiovascular health against PM2.5 exposure. | China | Adults (healthy college students between the ages of 20 and 25 years old) | 65 | PM2.5 was measured from fixed sites on campus in real time. | Randomly assigned to either a placebo (sunflower seed oil) or fish oil supplementation (2.5 g per day) for 5 months with 4 rounds of follow up visits with an interval of 2 weeks in the last 2 months of the intervention. | Linear mixed effects models to evaluate PM2.5 in relation to cardiovascular health outcomes adjusted for age, sex, body mass index, 3-day average temperature and 3-day average relative humidity. | The placebo group had statistically significantly higher levels of biomarkers of oxidative stress (higher levels of oxidized low-density lipoprotein (ox-LDL) and lower activities of antioxidant capacity), coagulation, endothelial dysfunction (higher levels of endothelin-1 and E-selectin, and lower levels of concentration of serum eNOS protein), neuroendocrine disturbance and blood inflammation than the fish oil group. | The main limitations reported by the authors were that PM2.5 exposures were from fixed monitoring sites rather than personal monitors; healthy college age students may be less susceptible to the adverse effects of PM2.5 and the benefits of supplementation. Another limitation is cannot exclude the potential confounding effects of daily dietary intakes of omega-3 fatty acids and other nutrients. |
Tong et al., 2012 [57] | Randomized, double blinded controlled trial. Controlled exposure to pollutant. | Analyze the extent to which fish oil supplements can mitigate the adverse cardiac effects of exposure to CAP (concentrated ambient PM) and ultrafine particulate matter. | United States | Adults (ages 50 to 72 years old) | 29 | Controlled exposure to CAP for two hours (mean: 278 ± 19 µg/m3, by drawing ambient air from above the roof and passing it through a 2-stage aerosol Harvard concentrator that produces up to a 30-fold increase in particle number and mass) | Randomly assigned to either a fish oil supplementation or an olive oil supplementation (both 3 g/d) for 4 weeks before sequential chamber exposure to filtered air or CAP for 2 h | Two-factor (supplement and PM (particulate matter) concentration) mixed effects model with a subject specific random intercept. Changes in HRV, cardiac repolarization, and blood parameters were assessed at two time points: immediately and approximately 20 h after exposure to CAP and filtered air | Participants taking the fish oil supplement were protected from cardiac electrophysiological and lipid changes after exposure to inhaled CAP while the olive oil group was not. Fish oil supplementation attenuated CAP-induced reductions in high-frequency/low-frequency ratio and normalized low-frequency HRV. Olive oil supplementation group experienced very low-density lipoprotein and triglyceride concentrations. | Olive oil did not provide protection in this study despite the fact it is an important part of the Mediterranean diet. The main limitations reported by the authors were the small number of participants whose results may not be applicable to the population as a whole. Another limitation is related to the fact that the exposure to air and CAP was not randomized. |
Tong et al., 2015 [58] | Randomized, double blinded, controlled trial, with controlled exposure to pollutants | Analyze the effect of olive oil and fish oil in mitigating endothelial dysfunction (a mechanism of cardiovascular diseases) and disruption of homeostasis induced by PM exposures. | United States | Adults (ages 50 to 72) | 42 | 2 h exposure to CAP or filtered air (mean: 253 ± 16 µg/m3, by drawing ambient air from above the roof and passing it through a 2-stage aerosol Harvard concentrator that produces up to a 30-fold increase in particle number and mass) | Randomization of either 3 g/d of olive oil or 3 g/d of marine derived n-3-fatty acid fish oil or placebo for 28 days (4 weeks), prior to CAP exposure. | Two-factor (supplement and CAP concentration) mixed effects model with a participant specific random intercept. To examine the influence of sex on CAP response and outcomes, sensitivity analysis was conducted by adjusting for sex as a confounder and by restricting analyses to women only. | CAP induced vascular endothelial dysfunction, which was assessed by flow mediated dilation, in middle-aged volunteers who did not receive dietary supplementation. Participants given olive oil (but not fish oil) supplements further experienced a statistically significant reduction in flow mediated dilation and increases in fibrinolysis blood markers in response to the CAP exposure. | Olive oil is a principal component of the Mediterranean diet. Olive oil contains oleic acid which has antioxidant and anti-inflammatory properties. Olive oil should be further investigated as a possible intervention to protect against adverse vascular effects from air pollution exposure. The main limitations reported by the authors were the small number of participants potentially making the results not applicable to the population as a whole. The modest sample size and number of secondary end points measured might have affected the statistical significance of the findings. Another limitation is related to the fact that the exposure to air and CAP was not randomized. |
Sulforaphane | ||||||||||
Heber et al., 2014 [59] | Randomized, single blinded, placebo-controlled trial. Controlled exposure to pollutant | Analyze the effect of standardized broccoli sprout extract (contains sulforaphane) on the nasal inflammatory response in human subjects after the exposure to 300 µg of DEP. | United States | Healthy adults over the age of 18 and who tested positive for cat allergens via skin prick test | 29 | Diesel exhaust particles (DEP) administered from a dilution tunnel constant volume sampler. 300 µg in an aqueous suspension (stated as ‘equivalent to daily PM exposure levels on a Los Angeles freeway’.) | Standardized dose of 100 micromolar sulforaphane in mango juice administered daily for 4 days prior to DEP exposure. | For data following a normal distribution, mixed model analysis of variance was used for analysis. The model accounted for the fact that subjects were being compared to themselves. For data that did not follow a normal distribution, medians were reported in addition to means, and non-parametric Wilcoxon signed rank methods were used to compute p-values. | White blood cells in nasal lavage increased after exposure to DEP. When participants consumed the broccoli sprout extract for four days, their white blood cell count in nasal lavage was decreased by 54%. | Small sample size for the study. White blood cell counts in nasal lavage served as a biomarker for inflammatory responses. The main limitations reported by the authors were that the presence of GSTM1 or GSTP1 Ile/Ile105 polymorphisms did not significantly affect the DEP-induced pro-inflammatory effects although there may have been a modulating effect which was not captured due to the small sample study size. |
Egner et al., 2014 [60] | Randomized, placebo-controlled trial | Analyze the extent to which daily consumption of the broccoli sprout beverage could detoxify the air pollutants and whether daily doses in a 12-week time frame would make a sustainable difference. | China | Adults (ages 21 to 65 years) | 267 | 24-h averaged concentrations of PM10 levels provided by Qidong Environmental Monitoring Station and Shanghai Environmental Monitoring Center, Shanghai Environmental Protection Bureau were recorded during the 84-day study period. | Randomization of a placebo beverage or a broccoli sprout beverage daily for 84 consecutive days (12 weeks). | For the baseline comparison of the treatment and placebo arms, a two-sample t-test of geometric means for each biomarker was conducted. To describe the acute and persistent effects of treatment, separate log linear mixed effects models for each biomarker were fitted. | Participants who received the broccoli sprout beverage had a significantly higher excretion of S-phenyl mercapturic acid (SPMA) and hydroxypropyl mercapturic acid (3-HPMA) both of which are formed in the metabolism of benzene. Increased level of excretion of SPMA and 3-HPMA indicate that the broccoli sprout beverage enhanced the detoxification of pollutants. | SPMA and 3-HPMA are levels of mercapturic acids formed in the metabolism of benzene. The main limitations reported by the authors were modest number of participants (267), 0.3% of the urine samples were not collected, 0.2% of the blood samples were not collected, and participants were under no dietary restrictions during the trial. Other aspects of the participants’ diets were not controlled for. |
Vitamin C and E | ||||||||||
Sienra-Monge et al., 2004 [61] | Randomized, double blinded, placebo control | Analyze the effect of antioxidant supplements on the nasal inflammatory response that is caused by ozone exposure in atopic asthmatic children. | Mexico | Children with asthma (between the ages of 7 and 11 years old) | 117 | 8-h moving averages of O3 and PM10 levels obtained from the Mexican government’s air monitoring station, no further than 5 km away from child’s home were recorded during the study period (17 May 1999 to 19 April 2000). | Randomization of either a daily supplement (50 mg vitamin E and 250 mg vitamin C) or a placebo with measurements of nasal lavages taken 3 times during a 4 month follow up and analyzed form content of interleukin-6, IL-8, uric acid and glutathione. | Mixed effect models were used to analyze longitudinal data adjusted for age, exposure to environmental tobacco smoke, atopy, temperature, relative humidity, asthma severity, week of the study, total protein, use of corticoids and uric acid levels in nasal lavage. Regression coefficients were compared using a t-test to estimate the effect of the supplementation. | After ozone exposure, children who received the placebo had statistically significant increases in interleukin-6 (IL-6) in nasal lavage while children receiving the supplement did not. Results were similar for interleukin-8 but were not significant. Uric acid decreased slightly in the placebo group. | IL-8 is a mediator of inflammation. Antioxidant supplements, such as vitamin C and E, could decrease the nasal inflammatory response to air pollutants. The main limitations reported by the authors were the exposure assessment being based on a monitoring network and not a personal measurement which could lead to misclassification of exposure, and the fact that the authors did not account for information of allergens indoors and outdoors. |
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Barthelemy, J.; Sanchez, K.; Miller, M.R.; Khreis, H. New Opportunities to Mitigate the Burden of Disease Caused by Traffic Related Air Pollution: Antioxidant-Rich Diets and Supplements. Int. J. Environ. Res. Public Health 2020, 17, 630. https://doi.org/10.3390/ijerph17020630
Barthelemy J, Sanchez K, Miller MR, Khreis H. New Opportunities to Mitigate the Burden of Disease Caused by Traffic Related Air Pollution: Antioxidant-Rich Diets and Supplements. International Journal of Environmental Research and Public Health. 2020; 17(2):630. https://doi.org/10.3390/ijerph17020630
Chicago/Turabian StyleBarthelemy, Jillian, Kristen Sanchez, Mark R. Miller, and Haneen Khreis. 2020. "New Opportunities to Mitigate the Burden of Disease Caused by Traffic Related Air Pollution: Antioxidant-Rich Diets and Supplements" International Journal of Environmental Research and Public Health 17, no. 2: 630. https://doi.org/10.3390/ijerph17020630