Asthma and lower airway disease
The protective effect of farm milk consumption on childhood asthma and atopy: The GABRIELA study

https://doi.org/10.1016/j.jaci.2011.07.048Get rights and content

Background

Farm milk consumption has been identified as an exposure that might contribute to the protective effect of farm life on childhood asthma and allergies. The mechanism of action and the role of particular constituents of farm milk, however, are not yet clear.

Objective

We sought to investigate the farm milk effect and determine responsible milk constituents.

Methods

In rural regions of Germany, Austria, and Switzerland, a comprehensive questionnaire about farm milk consumption and other farm-related exposures was completed by parents of 8334 school-aged children, and 7606 of them provided serum samples to assess specific IgE levels. In 800 cow's milk samples collected at the participants' homes, viable bacterial counts, whey protein levels, and total fat content were analyzed. Asthma, atopy, and hay fever were associated to reported milk consumption and for the first time to objectively measured milk constituents by using multiple regression analyses.

Results

Reported raw milk consumption was inversely associated to asthma (adjusted odds ratio [aOR], 0.59; 95% CI, 0.46-0.74), atopy (aOR, 0.74; 95% CI, 0.61-0.90), and hay fever (aOR, 0.51; 95% CI, 0.37-0.69) independent of other farm exposures. Boiled farm milk did not show a protective effect. Total viable bacterial counts and total fat content of milk were not significantly related to asthma or atopy. Increased levels of the whey proteins BSA (aOR for highest vs lowest levels and asthma, 0.53; 95% CI, 0.30-0.97), α-lactalbumin (aOR for interquartile range and asthma, 0.71; 95% CI, 0.52-0.97), and β-lactoglobulin (aOR for interquartile range and asthma, 0.62; 95% CI, 0.39-0.97), however, were inversely associated with asthma but not with atopy.

Conclusions

The findings suggest that the protective effect of raw milk consumption on asthma might be associated with the whey protein fraction of milk.

Section snippets

Study population and study design

The GABRIEL Advanced studies were conducted in 5 rural areas of southern Germany, Switzerland, Austria, and Poland. Because of differences in study design, the Polish data will be reported separately. In phase I a short recruitment questionnaire was distributed through elementary schools to parents of all 6- to 12-year-old school children in the selected study areas. Three strata were defined as follows: (1) farm children (ie, children living on a farm run by the family); (2) exposed nonfarm

Results

The distribution of milk consumption stratified by farm and nonfarm children is shown in Table II (the prevalence of health outcomes is shown in Table E1 in this article's Online Repository at www.jacionline.org). Among nonfarm children, 71.2% reported exclusive shop milk consumption, whereas 45.0% of the farm children indicated exclusive farm milk consumption. Consumption of both farm and shop milk (mixed milk exposure) was more or less comparable between farm and nonfarm children,

Discussion

The results of this large epidemiologic study add to the increasing body of evidence identifying consumption of farm milk (early in life) to be associated with a reduced risk of childhood asthma and allergies independently of concomitant farm exposures.7, 8, 9, 10 The results indicate that the effect is due to the consumption of unheated farm milk. For the first time, associations between objectively measured milk constituents and asthma and atopy could be demonstrated. Neither total viable

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      Furthermore, various authors have reported that the guts of infants raised on farms contain higher amounts of specific bacteria reducing inflammatory processes.11,14,15,36,37 Therefore, dietary choices such as the consumption of unprocessed cow’s milk may contribute to the farm effect.38 Additionally, exposure to a highly diverse microbial environment on farms may influence the microbiome of the upper airways11 and the gut.12,14

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    Supported by a European Union Research grant under the FP6-LifeSCIHEALTH Integrated Program LSH-2004-1.2.5-1 (contract no. 018996).

    Disclosure of potential conflict of interest: J. Weber, B. Sozanska, H. Danielewicz, A Boznanski, A. Dębińska, M. Depner, A. Kosmęda, and C. Strunz-Lehner have received research support from the European Commission. D. Heederik and I. M. Wouters have received research support from the European Union. E. von Mutius is a consultant for Novartis, GlaxoSmithKline, ALK-Abelló, and Protectimmun; has received a speaker's fee from InfectoPharm; has received research support from Airsonett AB; is a member of the Expert Panel for UK Research Excellence Framework; and is an Associate Editor for the Journal of Allergy and Clinical Immunology. M. Ege has received research support from the European Commission and the Deutsche Forschungsgemeinschaft (DFG). M. Kabesch has financial interests in Roxall, GlaxoSmithKline, Novartis, Sanofi-Aventis, Allergopharma, and AstraZeneca GmbH and has received research support from DFG, BMBF, and the European Union. The rest of the authors have declared that they have no conflict of interest.

    The members of the GABRIELA study group are shown in Appendix 1.

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