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Tiyawisutsri T, Suwanpanyakul N, Kongkasri W, Thongsri K, Timothy Callaghan R, Singhato A. The Impact of Adequate Selenium Intake on Severity Symptoms and Quality of Life among People with Allergic Rhinitis. JNFS 2025; 10 (1) :155-162
URL: http://jnfs.ssu.ac.ir/article-1-1005-en.html
URL: http://jnfs.ssu.ac.ir/article-1-1005-en.html
Thanyapron Tiyawisutsri 
, Napassorn Suwanpanyakul , Weeraya Kongkasri , Kamonwan Thongsri , Roger Timothy Callaghan , Alongkote Singhato * 
, Napassorn Suwanpanyakul , Weeraya Kongkasri , Kamonwan Thongsri , Roger Timothy Callaghan , Alongkote Singhato *
Nutrition and Dietetics Division, Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
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The Impact of Adequate Selenium Intake on Severity Symptoms and Quality of Life among People with Allergic Rhinitis
Thanyapron Tiyawisutsri; BSc1, Napassorn Suwanpanyakul; BSc1, Weeraya Kongkasri; BSc1,
Kamonwan Thongsri; BSc1, Roger Timothy Callaghan; MD2 & Alongkote Singhato; PhD*1
Thanyapron Tiyawisutsri; BSc1, Napassorn Suwanpanyakul; BSc1, Weeraya Kongkasri; BSc1,
Kamonwan Thongsri; BSc1, Roger Timothy Callaghan; MD2 & Alongkote Singhato; PhD*1
1 Nutrition and Dietetics Division, Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand;
2 Department of Medicine, School of Medicine, Mae Fah Luang University, Chiang rai, Thailand.
2 Department of Medicine, School of Medicine, Mae Fah Luang University, Chiang rai, Thailand.
| ARTICLE INFO | ABSTRACT | |
| ORIGINAL ARTICLE | Background: Selenium (Se) deficiency leads to impairment of human immune function. Allergic Rhinitis (AR) is one of the most common immune-related diseases that affects the quality of life among patients. This study aims to investigate the effect of adequate Se intake on the severity of symptoms and quality of life among participants with AR. Methods: A total of 60 participants were recruited for the study and were divided into 2 groups; adequate Se intake (adSe) group and inadequate Se intake (InadSe) group based on nutritional suggestion calculated using a nutritional software package. All the participants were asked to complete the self-reported validated questionnaire on the severity of their symptoms and quality of life impairment for patients with AR. Results: The participants in InadSe group obtained significantly higher scores in almost all the aspects of the severity of symptoms and quality of life impairment compared with participants in adSe group (P<0.05). In addition, the amount of daily Se intake of the participants in this study was negatively correlated with the total scores of the questionnaires (P<0.05).Conclusions: The findings of this study indicated adequate Se intake, according to the recognized dietary guidelines, which tends to reduce the severity of symptoms and improve the quality of life among people with AR. | |
| Article history: Received: 23 Dec 2023 Revised: 22 Apr 2024 Accepted: 21 May 2024 |
||
| *Corresponding author: alongkote@go.buu.ac.th Nutrition and Dietetics Division, Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand. Postal code: 20131 Tel: +66 851797743 |
||
| Keywords: Food; Nutrition; Allergic rinitis; Selenium; Quality of life. |
Introduction
Selenium (Se) is an essential trace element regarding human physiological functions. Long-term inadequate Se intake can lead to the development of several complications affecting the quality of life (Arthur and Brown, 2001). Many countries have reported the prevalence of inadequate Se intake amongst their populations, for example Spain (13.9%) (Navia et al., 2014) and Ethiopia (36%) (Belay et al., 2020). In Thailand, there is a lack of reported data regarding Se status within Thai population. A study revealed that 56% of children with HIV infection in Thailand had a degree of Se deficiency (Bunupuradah et al., 2012). Se plays a critical role in human immunological functions (Filippini et al., 2023). Therefore, for people at risk of immune impairment, there needs to be a focus on adequate Se intake (Kamer et al., 2012).
Allergic rhinitis (AR) is a chronic immunology-related disease that affects the quality of life and causes distress to the affected patients (Ozdoganoglu et al., 2012). The reported global prevalence of AR is 10-60% (Savouré et al., 2022). In Thailand, the estimated prevalence of AR is 37% (Bunjean et al., 2012). Air pollution (i.e. particulate matter [PM2.5], vehicle and industrial emissions, etc.), wools, and pollens are examples of factors that stimulate severe symptoms of AR, such as sneezing, itchy nose, coryza or blocked nose, red and watery eyes, and cough (Mariani et al., 2021). Hence, adequate trace element intake among people with AR should be of concern, particularly Se, which could minimize the severity of symptoms of AR by suppressing cytokine production (ie, Tumor necrosis factor alpha [TNF-α], Interleukin-1 beta [IL-1β], etc.) and cleavage of free radicals, as detailed in vivo studies (Hoffmann and Berry, 2008, Liu et al., 2017). However, there is no established data on the effects of reduced Se intake below the nutritional standard (55 µg/day for adults) regarding the severity of symptoms and quality of life among people with AR. This study, therefore, aims to find out the impact of adequate Se intake on the severity of symptoms and the quality of life among people affected by AR in Thailand.
Materials and Methods
This cross-sectional study was conducted from April 1, 2023–November 30, 2023, involving people with AR living in Chonburi province, Thailand.
Questionnaires used in the study
Baseline questionnaire
This self-administered closed-ended questionnaire was developed to collect baseline and background data of the participants such as age, education level, sex, body mass index, and duration of diagnosed AR.
The 3-days food record questionnaire
The self-administered validated open-ended questionnaire (Yang et al., 2010) was developed to assign the participants to record their food intake randomly 3 days a week. The participants had to record their food menus and the number of ingredients that consumed on 2 weekdays and 1 weekend day. Then, registered dietitians calculated their daily energy consumption and Se intake using nutritional software program (INMUCAL-Nutrients version 4.0, developed by the Institute of Nutrition, Mahidol University, Thailand) after their questionnaires were submitted. The participants with an estimated average Se intake below 55 µg were allocated to the inadequate Se intake group, while participants with an estimated average Se intake above 55 µg were allocated to the adequate Se intake group (Barchielli et al., 2022).
Severity symptoms and quality of life questionnaire impairment
The validated self-respondence 5-level scale questionnaire, adapted from a previous study (Okubo et al., 2017), was used to ask the participants about their quality-of-life impairment, the severity of symptoms, and emotional status. Examples of questions on the severity of symptoms used in the questionnaire included “In the past 1-2 weeks, which level of coryza symptoms have you experienced” and “In the past 1-2 weeks, which level of sneezing symptoms have you experienced”. The rating scales and scoring method are 0=no symptoms, 1=mild, 2=moderate, 3=severe, and 4=extremely severe. The classification of severity scores was adapted from one study (Brown, 2019, Okuda, 2001). Average scores in ranges between 0.00-1.00 were considered mild, 1.01-2.00, moderate, 2.01-3.00, severe, and 3.01-4.00 was considered the most severe. Examples of questions on the quality-of-life impairment used in the questionnaire included “In the past 1-2 weeks, which level of AR symptoms reduced productivity at work/home” and “In the past 1-2 weeks, which level of AR symptoms led to limitation of outdoor life”. The rating scales and scoring method were 0=no, 1=Yes, slightly, 2=Yes, moderately, 3=Yes, severe, and 4=Yes, extremely severe. Again, average scores in the range between 0.00-1.00 was considered slight, 1.01-2.00 , moderate, 2.01-3.00 , severe, and 3.01-4.00 was considered very severe (Brown, 2019, Okuda, 2001).
All questionnaires were reviewed and proof-read by experts in dietetics and experts in immunological diseases. After revising the questionnaires, according to the experts’ comments, the questionnaires and study protocol were sent to the Burapha University Institutional Review Board (BUU-IRB) for ethical approval (approval no. IRB1-071/2566)
Participants
After enrollment, a total of 60 participants were recruited for the study. Participants were sampled by quota into the inadequate Se intake group (n=30) and adequate Se intake group (n=30) according to their average daily Se intake. The inclusion criteria included ages between 18-60, being diagnosed as having AR, and able to read and write Thai. The exclusion criteria included participants who suffered from communicable diseases and oral problems that affected chewing and swallowing, receiving dietary supplements or herbal supplements, those were pregnant or lactating, who had mental problems, and who could not complete any of the questionnaires, and could participate throughout the period of the study.
Study procedures
The public relation aspect of the study was performed via social media. Participants were invited to a room at the Faculty of Allied Health Sciences, Burapha University, Chonburi province, Thailand, and were asked to sign the informed consent before participating in the study. After that, baseline data were collected using the questionnaire. Next, participants were given knowledge of the Thai food exchange and were trained on how to count the portion sizes of food consumed in several food categories using the food models. Once completed, participants were assigned to record their food intake in the same week of the study, and fill in the 3-days food record questionnaire. Participants were asked to record their consumed food and the amount of each ingredient (portion size or gram estimation) over 2-week days and 1 weekend day. After that, the completed 3-day food record questionnaire was submitted to the dietitians by the following week. The 3-day average of energy intake and Se intake were calculated and the participants who had Se intake of below average, less than 55 µg per day, were allocated to the inadequate Se intake group (InadSe), while participants who had an average Se intake of 55 µg or above, were sampled into the adequate Se intake group (AdSe). Finally, all the participants were asked to complete severity symptoms and quality of life impairment questionnaire. Participants self-rated the scale in the questionnaire. The rated scores in the questionnaire were collected and the results were interpreted.
Data analysis
The percentage of sex and education level of the participants were recorded, and the data on BMI, energy intake (kcal), energy distribution, daily Se intake, and the scores of severity symptoms and quality of life impairment questionnaire were reported as mean±standard deviation (SD). The logistic regression analysis and independent t-test were used to compare the odd ratio, confident interval, and mean differences between groups, while percentages of data on sex and education level were reported and were tested for the percentage difference between the groups using Pearson’s chi square test. In addition, the Pearson correlation coefficient was used to investigate the correlation between the amount of Se intake and the scores relating to the severity of symptoms and quality of life impairment among the participants. Statistical analysis was performed using the statistical software package, Predictive Analytics Software Statistics (SPSS Inc, Chicago, Il), version 25.0. The significant difference was deemed at P-value<0.05.
Results
The percentage of female sex in the InadSe group was significantly higher than the AdSe group (P<0.05). Other background characteristics of the participants in this study revealed no significant differences. Regarding the daily Se intake, this was significantly higher in the AdSe group (134.08 ug/d) compared to the InadSe group (50.28 ug/d, P<0.05, Table 1).
Allergic rhinitis (AR) is a chronic immunology-related disease that affects the quality of life and causes distress to the affected patients (Ozdoganoglu et al., 2012). The reported global prevalence of AR is 10-60% (Savouré et al., 2022). In Thailand, the estimated prevalence of AR is 37% (Bunjean et al., 2012). Air pollution (i.e. particulate matter [PM2.5], vehicle and industrial emissions, etc.), wools, and pollens are examples of factors that stimulate severe symptoms of AR, such as sneezing, itchy nose, coryza or blocked nose, red and watery eyes, and cough (Mariani et al., 2021). Hence, adequate trace element intake among people with AR should be of concern, particularly Se, which could minimize the severity of symptoms of AR by suppressing cytokine production (ie, Tumor necrosis factor alpha [TNF-α], Interleukin-1 beta [IL-1β], etc.) and cleavage of free radicals, as detailed in vivo studies (Hoffmann and Berry, 2008, Liu et al., 2017). However, there is no established data on the effects of reduced Se intake below the nutritional standard (55 µg/day for adults) regarding the severity of symptoms and quality of life among people with AR. This study, therefore, aims to find out the impact of adequate Se intake on the severity of symptoms and the quality of life among people affected by AR in Thailand.
Materials and Methods
This cross-sectional study was conducted from April 1, 2023–November 30, 2023, involving people with AR living in Chonburi province, Thailand.
Questionnaires used in the study
Baseline questionnaire
This self-administered closed-ended questionnaire was developed to collect baseline and background data of the participants such as age, education level, sex, body mass index, and duration of diagnosed AR.
The 3-days food record questionnaire
The self-administered validated open-ended questionnaire (Yang et al., 2010) was developed to assign the participants to record their food intake randomly 3 days a week. The participants had to record their food menus and the number of ingredients that consumed on 2 weekdays and 1 weekend day. Then, registered dietitians calculated their daily energy consumption and Se intake using nutritional software program (INMUCAL-Nutrients version 4.0, developed by the Institute of Nutrition, Mahidol University, Thailand) after their questionnaires were submitted. The participants with an estimated average Se intake below 55 µg were allocated to the inadequate Se intake group, while participants with an estimated average Se intake above 55 µg were allocated to the adequate Se intake group (Barchielli et al., 2022).
Severity symptoms and quality of life questionnaire impairment
The validated self-respondence 5-level scale questionnaire, adapted from a previous study (Okubo et al., 2017), was used to ask the participants about their quality-of-life impairment, the severity of symptoms, and emotional status. Examples of questions on the severity of symptoms used in the questionnaire included “In the past 1-2 weeks, which level of coryza symptoms have you experienced” and “In the past 1-2 weeks, which level of sneezing symptoms have you experienced”. The rating scales and scoring method are 0=no symptoms, 1=mild, 2=moderate, 3=severe, and 4=extremely severe. The classification of severity scores was adapted from one study (Brown, 2019, Okuda, 2001). Average scores in ranges between 0.00-1.00 were considered mild, 1.01-2.00, moderate, 2.01-3.00, severe, and 3.01-4.00 was considered the most severe. Examples of questions on the quality-of-life impairment used in the questionnaire included “In the past 1-2 weeks, which level of AR symptoms reduced productivity at work/home” and “In the past 1-2 weeks, which level of AR symptoms led to limitation of outdoor life”. The rating scales and scoring method were 0=no, 1=Yes, slightly, 2=Yes, moderately, 3=Yes, severe, and 4=Yes, extremely severe. Again, average scores in the range between 0.00-1.00 was considered slight, 1.01-2.00 , moderate, 2.01-3.00 , severe, and 3.01-4.00 was considered very severe (Brown, 2019, Okuda, 2001).
All questionnaires were reviewed and proof-read by experts in dietetics and experts in immunological diseases. After revising the questionnaires, according to the experts’ comments, the questionnaires and study protocol were sent to the Burapha University Institutional Review Board (BUU-IRB) for ethical approval (approval no. IRB1-071/2566)
Participants
After enrollment, a total of 60 participants were recruited for the study. Participants were sampled by quota into the inadequate Se intake group (n=30) and adequate Se intake group (n=30) according to their average daily Se intake. The inclusion criteria included ages between 18-60, being diagnosed as having AR, and able to read and write Thai. The exclusion criteria included participants who suffered from communicable diseases and oral problems that affected chewing and swallowing, receiving dietary supplements or herbal supplements, those were pregnant or lactating, who had mental problems, and who could not complete any of the questionnaires, and could participate throughout the period of the study.
Study procedures
The public relation aspect of the study was performed via social media. Participants were invited to a room at the Faculty of Allied Health Sciences, Burapha University, Chonburi province, Thailand, and were asked to sign the informed consent before participating in the study. After that, baseline data were collected using the questionnaire. Next, participants were given knowledge of the Thai food exchange and were trained on how to count the portion sizes of food consumed in several food categories using the food models. Once completed, participants were assigned to record their food intake in the same week of the study, and fill in the 3-days food record questionnaire. Participants were asked to record their consumed food and the amount of each ingredient (portion size or gram estimation) over 2-week days and 1 weekend day. After that, the completed 3-day food record questionnaire was submitted to the dietitians by the following week. The 3-day average of energy intake and Se intake were calculated and the participants who had Se intake of below average, less than 55 µg per day, were allocated to the inadequate Se intake group (InadSe), while participants who had an average Se intake of 55 µg or above, were sampled into the adequate Se intake group (AdSe). Finally, all the participants were asked to complete severity symptoms and quality of life impairment questionnaire. Participants self-rated the scale in the questionnaire. The rated scores in the questionnaire were collected and the results were interpreted.
Data analysis
The percentage of sex and education level of the participants were recorded, and the data on BMI, energy intake (kcal), energy distribution, daily Se intake, and the scores of severity symptoms and quality of life impairment questionnaire were reported as mean±standard deviation (SD). The logistic regression analysis and independent t-test were used to compare the odd ratio, confident interval, and mean differences between groups, while percentages of data on sex and education level were reported and were tested for the percentage difference between the groups using Pearson’s chi square test. In addition, the Pearson correlation coefficient was used to investigate the correlation between the amount of Se intake and the scores relating to the severity of symptoms and quality of life impairment among the participants. Statistical analysis was performed using the statistical software package, Predictive Analytics Software Statistics (SPSS Inc, Chicago, Il), version 25.0. The significant difference was deemed at P-value<0.05.
Results
The percentage of female sex in the InadSe group was significantly higher than the AdSe group (P<0.05). Other background characteristics of the participants in this study revealed no significant differences. Regarding the daily Se intake, this was significantly higher in the AdSe group (134.08 ug/d) compared to the InadSe group (50.28 ug/d, P<0.05, Table 1).
| Table 1. Background characteristics of the participants in this study | |||
| Characteristics | AdSe group (n=30) | InadSe group (n=30) | P-valuea |
| Sex Male Female |
15 (50.00)b 15 (50.00) |
5 (16.66) 25 (83.34) |
<0.05 |
| Education level Secondary school degree High school diploma Bachelor’s degree Master’s degree |
0 (0.00) 4 (13.33) 26 (86.67) 0 (0.00) |
2 (6.67) 6 (20.00) 20 (66.67) 2 (6.67) |
0.15 |
| Age (y) | 29.30 ± 10.14c | 28.70 ± 8.64 | 0.86 |
| Body mass index (kg/m2) | 23.34 ± 5.53 | 21.40 ± 3.56 | 0.11 |
| Length of AR diagnosed (y) | 7.60 ± 6.54 | 8.86 ± 7.62 | 0.49 |
| Daily Se intake (µg) | 134.08 ± 45.51 | 50.28 ± 5.43 | <0.05 |
| a: Obtained by Chi-square test for qualitative variables and independent two sample test for quantitative variables; b: n (%); c: Mean±SD; AdSe: adequate Se intake group; InadSe: Inadequate Se intake group. | |||
There were significantly higher scores in almost all aspects of severity symptoms in the InadSe group compared to the AdSe group, such as sneezing, blocked nose, itchy nose, itchy eyes, and watery eyes (P<0.05). Furthermore, the sum of the total score from part 1 questionnaire on the severity symptoms of participants in the InadSe group (11.43 points) was significantly higher than those of the AdSe group (6.83 points) at P<0.05. From the past 2 questionnaires on quality-of-life impairment, almost all aspects of sub-questions scores regarding quality-of-life impairment were significantly higher in the InadSe group compared with AdSe group (P<0.05) except for hesitation in visiting friends or relatives, frustration, and irritability. In addition, the sum of the total score on the quality-of-life impairment of participants in InadSe group (25.26 points) was significantly higher than the AdSe group (12.66 points) at P<0.05. As to the question on the general state (including symptoms, life, and emotion) in the past 1-2 weeks, the participants in the InadSe group obtained significantly higher scores (2.43 points) compared with participants in the AdSe group (1.33 points) in P<0.05. Moreover, the sum of the total score from all 3 parts of the questionnaire revealed that participants in the InadSe group obtained 39.13 points (from the total score of 96 points), which was significantly higher than the participants in the AdSe group (20.83 points) at P<0.05, Table 2).
In addition, Figure 1 shows the significant negative correlation between the amount of daily Se intake and the total score on the severity of symptoms and quality of life impairment questionnaire regarding the participants in this study (P<0.05).
As to the dietary habits of the participants, the results revealed there were no significant differences in kcal intake and %kcal from carbohydrates and fat between the 2 groups of the participants, the exception being that %kcal from fat and %kcal from protein consumed by the participants in AdSe group were significantly higher than the participants in InadSe group for protein (P<0.05) and significantly higher than the participants in InadSe group for fat (P<0.05, Table 3).
Discussion
Selenium is an essential trace element in human physiology, especially the immune system. The findings of this study revealed that the participants in InadSe group ingested less than the suggested amount of daily Se, recognized as 55 ug/d for adults (Wang et al., 2023). However, most of the participants in InadSe group were females who are often more concerned about their dietary habits (Alhazmi and Aziz, 2020, Alkazemi, 2018). Regarding the severity of symptoms, participants in AdSe group showed less severe symptoms relating to AR when compared with InadSe group. The results could be explained by the effectiveness of Se in promoting anti-inflammatory functions. Previous studies pointed out that Se combined with vitamin E is beneficial in suppressing immune signaling and lowering inflammatory cytokines such as nuclear factor erythroid 2-related factor 2 (Nrf2), TNF-alpha, interleukin (IL)-6, IL-8, and IL-10, which can alleviate AR symptoms (Ansar, 2016, Jiang et al., 2021). The organic form of Se, Se combined with protein, is more efficiently used in the human body compared with the inorganic form. Selenomethionine and Selenocystein are examples of common organic forms of Se found in natural meat and fish (Sele et al., 2018, Singhato et al., 2023, Singhato et al., 2022) that the human body can utilize to metabolize glutathione peroxidase (GPX), 15 kDa selenoprotein F (SELENOF), selenoproteins K and S, and thioredoxin reductases, all of which reduce oxidative stress and improve mitochondrial functions in endoplasmic reticulum of the cells (Genchi et al., 2023, Kieliszek, 2019). Therefore, the participants in AdSe group potentially received these benefits from the adequate amount of daily Se intake to reduce the severity of their symptoms. The quality-of-life impairment scores of the participants in AdSe group were also lower than InadSe group. These results were in line with previous studies that indicated minimizing of the severity of symptoms of patients' underlying diseases, especially allergic rhinitis, with and without comorbid asthma, is related to increased physical activity of the participants, allowing them to have a better quality of life when compared to participants suffering from severe symptoms (Moitra et al., 2023)
Interestingly, the differences in dietary intake of the participants revealed that not only was %kcal from protein in the AdSe group higher than InadSe group, but also the %kcal from fat in the AdSe group was lower than InadSe group. This could be the reason for the difference in the amount of daily Se intake between the 2 groups because the food sources rich in Se included meat, eggs, fish (both freshwater and marine fish), and poultry (Bakaloudi et al., 2021, Hu et al., 2021). Therefore, people who are at risk of inadequate Se intake have reduced protein intake, as noted in vegetarians, those suffering from oral problems, and gastrointestinal system dysfunction (Corsello et al., 2020, Jayasinghe et al., 2022, Zhang et al., 2019).
The limitations of this study included not investigating the biomarkers of Se status in the body, such as serum Se, selenoprotein P, and GPX (Müller et al., 2020). Hence, future study is suggested to determine these Se biomarkers in the body as well as long-term monitoring of health outcomes and the quality of life among larger groups of participants. In conclusion, adequate Se intake, according to the recognized dietary guideline, is effective and can be correlated to a reduction of the severity of symptoms and improvement of quality of life among participants.
Conclusions
This study revealed the importance of adequate Se intake in people suffering from AR, that can minimize their symptoms and improve their quality of life. In conclusion, participants with adequate Se intake, according to the RDA, had less severe symptoms and a better quality of life compared with the participants with inadequate Se intake.
In addition, Figure 1 shows the significant negative correlation between the amount of daily Se intake and the total score on the severity of symptoms and quality of life impairment questionnaire regarding the participants in this study (P<0.05).
As to the dietary habits of the participants, the results revealed there were no significant differences in kcal intake and %kcal from carbohydrates and fat between the 2 groups of the participants, the exception being that %kcal from fat and %kcal from protein consumed by the participants in AdSe group were significantly higher than the participants in InadSe group for protein (P<0.05) and significantly higher than the participants in InadSe group for fat (P<0.05, Table 3).
Discussion
Selenium is an essential trace element in human physiology, especially the immune system. The findings of this study revealed that the participants in InadSe group ingested less than the suggested amount of daily Se, recognized as 55 ug/d for adults (Wang et al., 2023). However, most of the participants in InadSe group were females who are often more concerned about their dietary habits (Alhazmi and Aziz, 2020, Alkazemi, 2018). Regarding the severity of symptoms, participants in AdSe group showed less severe symptoms relating to AR when compared with InadSe group. The results could be explained by the effectiveness of Se in promoting anti-inflammatory functions. Previous studies pointed out that Se combined with vitamin E is beneficial in suppressing immune signaling and lowering inflammatory cytokines such as nuclear factor erythroid 2-related factor 2 (Nrf2), TNF-alpha, interleukin (IL)-6, IL-8, and IL-10, which can alleviate AR symptoms (Ansar, 2016, Jiang et al., 2021). The organic form of Se, Se combined with protein, is more efficiently used in the human body compared with the inorganic form. Selenomethionine and Selenocystein are examples of common organic forms of Se found in natural meat and fish (Sele et al., 2018, Singhato et al., 2023, Singhato et al., 2022) that the human body can utilize to metabolize glutathione peroxidase (GPX), 15 kDa selenoprotein F (SELENOF), selenoproteins K and S, and thioredoxin reductases, all of which reduce oxidative stress and improve mitochondrial functions in endoplasmic reticulum of the cells (Genchi et al., 2023, Kieliszek, 2019). Therefore, the participants in AdSe group potentially received these benefits from the adequate amount of daily Se intake to reduce the severity of their symptoms. The quality-of-life impairment scores of the participants in AdSe group were also lower than InadSe group. These results were in line with previous studies that indicated minimizing of the severity of symptoms of patients' underlying diseases, especially allergic rhinitis, with and without comorbid asthma, is related to increased physical activity of the participants, allowing them to have a better quality of life when compared to participants suffering from severe symptoms (Moitra et al., 2023)
Interestingly, the differences in dietary intake of the participants revealed that not only was %kcal from protein in the AdSe group higher than InadSe group, but also the %kcal from fat in the AdSe group was lower than InadSe group. This could be the reason for the difference in the amount of daily Se intake between the 2 groups because the food sources rich in Se included meat, eggs, fish (both freshwater and marine fish), and poultry (Bakaloudi et al., 2021, Hu et al., 2021). Therefore, people who are at risk of inadequate Se intake have reduced protein intake, as noted in vegetarians, those suffering from oral problems, and gastrointestinal system dysfunction (Corsello et al., 2020, Jayasinghe et al., 2022, Zhang et al., 2019).
The limitations of this study included not investigating the biomarkers of Se status in the body, such as serum Se, selenoprotein P, and GPX (Müller et al., 2020). Hence, future study is suggested to determine these Se biomarkers in the body as well as long-term monitoring of health outcomes and the quality of life among larger groups of participants. In conclusion, adequate Se intake, according to the recognized dietary guideline, is effective and can be correlated to a reduction of the severity of symptoms and improvement of quality of life among participants.
Conclusions
This study revealed the importance of adequate Se intake in people suffering from AR, that can minimize their symptoms and improve their quality of life. In conclusion, participants with adequate Se intake, according to the RDA, had less severe symptoms and a better quality of life compared with the participants with inadequate Se intake.
| Table 2. Severity symptoms and quality of life impairment scores. | |||||
| Variable | AdSe group (n=30) |
InadSe group (n=30) | Odd ratio | 95% CI | P-valuea |
| Severity symptoms | |||||
| Coryza Sneezing Blocked nose Itchy nose Itchy eyes Watery eyes Total scores |
1.36(0.96)b 1.36(0.92) 1.53(1.00) 1.06(0.90) 0.80(1.06) 0.70(0.87) 6.83(4.06) |
1.83(1.05) 2.10(1.05) 2.13(1.07) 2.00(1.01) 1.66(1.02) 1.70(1.05) 11.43(3.90) |
0.71 1.41 0.64 1.25 3.20 2.40 1.31 |
(0.12, 3.99) (0.12, 15.78) (0.08, 4.88) (0.23, 6.65) (0.75, 13.65) (0.55, 10.32) (1.13, 1.52) |
0.07 <0.05 0.03 <0.05 <0.05 <0.05 <0.05 |
| Quality of life impairment | |||||
| Reduced productivity at work/home Poor mental concentration Reduce thinking power Impaired reading Book/newspaper Reduced memory loss Limitation of outdoor life Limitation of going out Hesitation to visit friends or relatives Reduced contact with friends or others by telephone or conversation Not an easy person to be around Impaired sleeping Tiredness Fatigue Frustration Imitability Depression Unhappiness Total score |
0.73(0.82) 0.86(0.93) 0.60(0.81) 0.53(0.81) 0.40(0.67) 0.93(1.08) 0.90(1.02) 1.10(1.12) 0.73(0.86) 0.23(0.43) 1.26(1.22) 1.23(1.19) 1.20(1.18) 0.93(1.01) 0.33(0.60) 0.26(0.44) 0.36(0.71) 12.66(10.46 |
1.63(1.03) 1.66(0.95) 1.40(1.16) 1.73(1.04) 1.50(1.10) 1.73(0.90) 1.63(1.06) 1.00(0.94) 1.46(0.81) 1.56(1.16) 2.13 (1.40) 2.16(0.91) 1.83(1.23) 1.36(1.03) 0.53(0.68) 0.80(0.88) 1.10(0.92) 25.26(9.28) |
2.86 3.50 0.75 4.75 2.18 9.62 1.45 1.95 4.16 2.05 0.91 8.09 1.04 2.88 2.15 2.53 9.37 1.12 |
(0.69, 11.82) (0.76, 16.11) (0.18, 3.10) (1.05, 21.36) (0.51, 9.22) (1.69, 54.78) (0.33, 6.34) (0.57, 6.58) (1.00, 17.30) (0.50, 8.34) (0.16, 5.04) (1.69, 38.59) (0.21, 5.09) (0.79, 10.57) (0.65, 7.11) (0.82, 7.83) (2.10, 41.62) (1.05, 1.19) |
<0.05 <0.05 <0.05 <0.05 <0.05 <0.05 <0.05 0.71 <0.05 <0.05 <0.05 <0.05 0.04 0.10 0.23 <0.05 <0.05 <0.05 |
| General state (including symptoms, life and emotion) in the past 1-2 weeks | 1.33(0.75) |
2.43(0.93) |
4.54 |
(2.02, 10.18) |
<0.05 |
| Overall scores from 3 parts | 20.83(13.05) | 39.13(12.51) | 1.10 | (1.05, 1.15) | <0.05 |
| a: Obtained by independent two sample test; b: Mean (SD); AdSe: adequate Se intake group; InadSe: Inadequate Se intake group; Total score in each sub-question = 4.0; Total score of part 1 = 24; Total score of part 2 = 68; Total score from all the 3 parts = 96. | |||||
| Table 3. Dietary intake of the participants. | |||
| Variable | AdSe group (n=30) | InadSe group (n=30) | p valuea |
| Total energy in kcal | 2,079 .13(331.56)b | 1,976.93(337.37) | 0.24 |
| %kcal from carbohydrate | 57.43(5.49) | 56.06(6.05) | 0.36 |
| %kcal from protein | 16.46(4.93) | 11.83(3.86) | <0.05 |
| %kcal from fat | 26.10 (6.42) | 32.10 (6.83) | <0.05 |
| a: Obtained by independent two sample test; b: Mean (SD); AdSe: adequate Se intake group; InadSe: Inadequate Se intake group. | |||
Acknowledgments
Authors would like to thank all the participants in this study
Authors’ contributions
T Tiyawisutsri, N Suwanpanyakul, W Kongkasri, and K Thongsri collected the data. A Singhato conceptualized the study design and wrote the manuscript, and R Timothy Callaghan proof read the English writing of the manuscript.
Conflict of Interest
The authors declared no conflict of interests.
Funding
This study was funded by Thai Dietetics Association of Thailand (TDA Young Researcher Award 2023).
References
Alhazmi A & Aziz F 2020. Dietary Assessment and Its Awareness in Female Students from Different Health Departments: Unhealthy Diet with Normal Bmi. Journal of public health research. 9 (3): jphr.2020.1799.
Alkazemi D 2018. Gender differences in weight status, dietary habits, and health attitudes among college students in Kuwait: A cross-sectional study. Nutrition and health. 25 (2): 75-84.
Ansar S 2016. Effect of Selenium on the Levels of Cytokines and Trace Elements in Toxin-Mediated Oxidative Stress in Male Rats. Biological trace element research. 169 (1): 129-133.
Arthur JR & Brown KM 2001. Selenium, selenoproteins and human health: a review. Public health nutrition. 4 (2b): 593-599.
Bakaloudi DR, et al. 2021. Intake and adequacy of the vegan diet. A systematic review of the evidence. Clinical nutrition. 40 (5): 3503-3521.
Barchielli G, Capperucci A & Tanini D 2022. The Role of Selenium in Pathologies: An Updated Review. Antioxidants 11 (2): 251.
Belay A, et al. 2020. Selenium Deficiency Is Widespread and Spatially Dependent in Ethiopia. Nutrients. 12 (6).
Brown T 2019. Diagnosis and Management of Allergic Rhinitis in Children. Pediatr Ann. 48 (12): e485-e488.
Bunjean K, et al. 2012. Prevalence of allergic rhinitis and types of sensitized allergen in adult at Wat Intaram community, Hua Raeu, Phra Nakhon Si Ayutthaya District, Phra Nakhon Si Ayutthaya Province, Thailand. Journal of the medical association of Thailand 95 (Suppl 5): S63-68.
Bunupuradah T, Pinyakorn S & Puthanakit T 2012. Prevalence of selenium deficiency in Thai HIV-infected children without severe HIV symptoms. European journal of clinical nutrition. 66 (11): 1278-1278.
Corsello A, Pugliese D, Gasbarrini A & Armuzzi A 2020. Diet and Nutrients in Gastrointestinal Chronic Diseases. In Nutrients, p. 2693.
Filippini T, Fairweather-Tait S & Vinceti M 2023. Selenium and immune function: a systematic review and meta-analysis of experimental human studies. American journal of clinical nutrition. 117 (1): 93-110.
Genchi G, Lauria G, Catalano A, Sinicropi MS & Carocci A 2023. Biological Activity of Selenium and Its Impact on Human Health. In International journal of molecular sciences, p. 2633.
Hoffmann PR & Berry MJ 2008. The influence of selenium on immune responses. Molecular nutrition & food research. 52 (11): 1273-1280.
Hu W, Zhao C, Hu H & Yin S 2021. Food Sources of Selenium and Its Relationship with Chronic Diseases. Nutrients. 13 (5): 1739.
Jayasinghe TN, Harrass S, Erdrich S, King S & Eberhard J 2022. Protein Intake and Oral Health in Older Adults & mdash; A Narrative Review. In Nutrients, p. 4478.
Jiang J, Mehrabi Nasab E, Athari SM & Athari SS 2021. Effects of vitamin E and selenium on allergic rhinitis and asthma pathophysiology. Respiratory physiology & neurobiology. 286: 103614.
Kamer B, et al. 2012. Role of selenium and zinc in the pathogenesis of food allergy in infants and young children. Archives of medical science. 8 (6): 1083-1088.
Kieliszek M 2019. Selenium⁻Fascinating Microelement, Properties and Sources in Food. Molecules. 24 (7): 1298.
Liu J, et al. 2017. Investigation of selenium pretreatment in the attenuation of lung injury in rats induced by fine particulate matters. Environmental science and pollution research. 24 (4): 4008-4017.
Mariani J, et al. 2021. Particulate Matter Exposure and Allergic Rhinitis: The Role of Plasmatic Extracellular Vesicles and Bacterial Nasal Microbiome. International journal of environmental research and public health. 18 (20): 10689.
Moitra S, et al. 2023. Symptom control and health-related quality of life in allergic rhinitis with and without comorbid asthma: A multicentre European study. Clinical and translational allergy. 13 (2): e12209.
Müller SM, et al. 2020. Functional Biomarkers for the Selenium Status in a Human Nutritional Intervention Study. Nutrients. 12 (3): 676.
Navia B, et al. 2014. Selenium status in a group of schoolchildren from the region of Madrid, Spain. Journal of human nutrition and dietetics. 27 239-246.
Okubo K, et al. 2017. Japanese guidelines for allergic rhinitis 2017. Allergology international. 66 (2): 205-219.
Okuda M 2001. Grading the severity of allergic rhinitis for treatment strategy and drug study purposes. Current allergy and asthma reports. 1 (3): 235-241.
Ozdoganoglu T, Songu M & Inancli HM 2012. Quality of life in allergic rhinitis. Therapeutic advances in respiratory disease. 6 (1): 25-39.
Savouré M, et al. 2022. Worldwide prevalence of rhinitis in adults: A review of definitions and temporal evolution. Clinical and translational allergy. 12 (3): e12130.
Sele V, Ørnsrud R, Sloth JJ, Berntssen MHG & Amlund H 2018. Selenium and selenium species in feeds and muscle tissue of Atlantic salmon. Journal of trace elements in medicine and biology. 47: 124-133.
Singhato A, et al. 2023. Speciation of selenium in fresh and cooked commonly consumed fish in Thailand. Journal of food composition and analysis. 120: 105303.
Singhato A, et al. 2022. Effect of Different Cooking Methods on Selenium Content of Fish Commonly Consumed in Thailand. Foods. 11 (12): 1808.
Wang P, et al. 2023. Selenium intake and multiple health-related outcomes: an umbrella review of meta-analyses. Frontiers in nutrition. 10: 1263853.
Yang YJ, et al. 2010. Relative validities of 3-day food records and the food frequency questionnaire. Nutrition research and practice. 4 (2): 142-148.
Zhang L, et al. 2019. Effects of selenium deficiency and low protein intake on the apoptosis through a mitochondria-dependent pathway. Journal of trace elements in medicine and biology. 56: 21-30.
Authors would like to thank all the participants in this study
Authors’ contributions
T Tiyawisutsri, N Suwanpanyakul, W Kongkasri, and K Thongsri collected the data. A Singhato conceptualized the study design and wrote the manuscript, and R Timothy Callaghan proof read the English writing of the manuscript.
Conflict of Interest
The authors declared no conflict of interests.
Funding
This study was funded by Thai Dietetics Association of Thailand (TDA Young Researcher Award 2023).
References
Alhazmi A & Aziz F 2020. Dietary Assessment and Its Awareness in Female Students from Different Health Departments: Unhealthy Diet with Normal Bmi. Journal of public health research. 9 (3): jphr.2020.1799.
Alkazemi D 2018. Gender differences in weight status, dietary habits, and health attitudes among college students in Kuwait: A cross-sectional study. Nutrition and health. 25 (2): 75-84.
Ansar S 2016. Effect of Selenium on the Levels of Cytokines and Trace Elements in Toxin-Mediated Oxidative Stress in Male Rats. Biological trace element research. 169 (1): 129-133.
Arthur JR & Brown KM 2001. Selenium, selenoproteins and human health: a review. Public health nutrition. 4 (2b): 593-599.
Bakaloudi DR, et al. 2021. Intake and adequacy of the vegan diet. A systematic review of the evidence. Clinical nutrition. 40 (5): 3503-3521.
Barchielli G, Capperucci A & Tanini D 2022. The Role of Selenium in Pathologies: An Updated Review. Antioxidants 11 (2): 251.
Belay A, et al. 2020. Selenium Deficiency Is Widespread and Spatially Dependent in Ethiopia. Nutrients. 12 (6).
Brown T 2019. Diagnosis and Management of Allergic Rhinitis in Children. Pediatr Ann. 48 (12): e485-e488.
Bunjean K, et al. 2012. Prevalence of allergic rhinitis and types of sensitized allergen in adult at Wat Intaram community, Hua Raeu, Phra Nakhon Si Ayutthaya District, Phra Nakhon Si Ayutthaya Province, Thailand. Journal of the medical association of Thailand 95 (Suppl 5): S63-68.
Bunupuradah T, Pinyakorn S & Puthanakit T 2012. Prevalence of selenium deficiency in Thai HIV-infected children without severe HIV symptoms. European journal of clinical nutrition. 66 (11): 1278-1278.
Corsello A, Pugliese D, Gasbarrini A & Armuzzi A 2020. Diet and Nutrients in Gastrointestinal Chronic Diseases. In Nutrients, p. 2693.
Filippini T, Fairweather-Tait S & Vinceti M 2023. Selenium and immune function: a systematic review and meta-analysis of experimental human studies. American journal of clinical nutrition. 117 (1): 93-110.
Genchi G, Lauria G, Catalano A, Sinicropi MS & Carocci A 2023. Biological Activity of Selenium and Its Impact on Human Health. In International journal of molecular sciences, p. 2633.
Hoffmann PR & Berry MJ 2008. The influence of selenium on immune responses. Molecular nutrition & food research. 52 (11): 1273-1280.
Hu W, Zhao C, Hu H & Yin S 2021. Food Sources of Selenium and Its Relationship with Chronic Diseases. Nutrients. 13 (5): 1739.
Jayasinghe TN, Harrass S, Erdrich S, King S & Eberhard J 2022. Protein Intake and Oral Health in Older Adults & mdash; A Narrative Review. In Nutrients, p. 4478.
Jiang J, Mehrabi Nasab E, Athari SM & Athari SS 2021. Effects of vitamin E and selenium on allergic rhinitis and asthma pathophysiology. Respiratory physiology & neurobiology. 286: 103614.
Kamer B, et al. 2012. Role of selenium and zinc in the pathogenesis of food allergy in infants and young children. Archives of medical science. 8 (6): 1083-1088.
Kieliszek M 2019. Selenium⁻Fascinating Microelement, Properties and Sources in Food. Molecules. 24 (7): 1298.
Liu J, et al. 2017. Investigation of selenium pretreatment in the attenuation of lung injury in rats induced by fine particulate matters. Environmental science and pollution research. 24 (4): 4008-4017.
Mariani J, et al. 2021. Particulate Matter Exposure and Allergic Rhinitis: The Role of Plasmatic Extracellular Vesicles and Bacterial Nasal Microbiome. International journal of environmental research and public health. 18 (20): 10689.
Moitra S, et al. 2023. Symptom control and health-related quality of life in allergic rhinitis with and without comorbid asthma: A multicentre European study. Clinical and translational allergy. 13 (2): e12209.
Müller SM, et al. 2020. Functional Biomarkers for the Selenium Status in a Human Nutritional Intervention Study. Nutrients. 12 (3): 676.
Navia B, et al. 2014. Selenium status in a group of schoolchildren from the region of Madrid, Spain. Journal of human nutrition and dietetics. 27 239-246.
Okubo K, et al. 2017. Japanese guidelines for allergic rhinitis 2017. Allergology international. 66 (2): 205-219.
Okuda M 2001. Grading the severity of allergic rhinitis for treatment strategy and drug study purposes. Current allergy and asthma reports. 1 (3): 235-241.
Ozdoganoglu T, Songu M & Inancli HM 2012. Quality of life in allergic rhinitis. Therapeutic advances in respiratory disease. 6 (1): 25-39.
Savouré M, et al. 2022. Worldwide prevalence of rhinitis in adults: A review of definitions and temporal evolution. Clinical and translational allergy. 12 (3): e12130.
Sele V, Ørnsrud R, Sloth JJ, Berntssen MHG & Amlund H 2018. Selenium and selenium species in feeds and muscle tissue of Atlantic salmon. Journal of trace elements in medicine and biology. 47: 124-133.
Singhato A, et al. 2023. Speciation of selenium in fresh and cooked commonly consumed fish in Thailand. Journal of food composition and analysis. 120: 105303.
Singhato A, et al. 2022. Effect of Different Cooking Methods on Selenium Content of Fish Commonly Consumed in Thailand. Foods. 11 (12): 1808.
Wang P, et al. 2023. Selenium intake and multiple health-related outcomes: an umbrella review of meta-analyses. Frontiers in nutrition. 10: 1263853.
Yang YJ, et al. 2010. Relative validities of 3-day food records and the food frequency questionnaire. Nutrition research and practice. 4 (2): 142-148.
Zhang L, et al. 2019. Effects of selenium deficiency and low protein intake on the apoptosis through a mitochondria-dependent pathway. Journal of trace elements in medicine and biology. 56: 21-30.
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Received: 2023/12/23 | Published: 2025/02/4 | ePublished: 2025/02/4
Received: 2023/12/23 | Published: 2025/02/4 | ePublished: 2025/02/4
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