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2016 FI

1.439
© Thomson Reuters, Journal Citation Reports, 2016

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Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME Cancerlit, Bibliomed, CabHealth, Scisearch, HealthStar, Scopus, Prous, Science Intergews, Science Citation Index Expanded.

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  • Impact Factor: 1.439 (2016)
  • SCImago Journal Rank (SJR):0,38
  • Source Normalized Impact per Paper (SNIP):0,591

© Thomson Reuters, Journal Citation Reports, 2016

Allergol Immunopathol (Madr) 2016;44:97-8 - DOI: 10.1016/j.aller.2016.02.001
Editorial
Mediterranean diet as a protection against asthma: Still another brick in building a causative association
L. Garcia-Marcosa,b
a Respiratory and Allergy Units, Arrixaca Children's University Hospital, University of Murcia, Spain
b IMIB Bioresearch Institute, Spain

The association between Mediterranean diet consumption and a lower prevalence of asthma was described for the first time by our group and by a Greek one. In fact, the results of both studies were published in the same issue of Thorax in 2007.1,2 Both studies were epidemiological and cross-sectional, and thus with obvious limitations. The results of those two seminal papers were replicated in other epidemiological cohorts in the following years with most of them pointing to the same direction: Mediterranean diet was a protective factor for asthma.3–8 A new step was taken when some evidence was found that this diet taken in pregnancy protected of asthma symptoms in school-children.9 Yet a further stage was achieved when a Mexican group found that Mediterranean diet was associated to better lung function (higher FEV1) and lower inflammatory response (lower IL-8 in nasal lavage) in a group of asthmatic children.10 The results of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two, including more than 50,000 children from a wide range of countries, but mostly from Europe, found even more evidence that the diet in question was associated to lower prevalence of asthma symptoms in school children 8–12 of age.11 Mediterranean diet has also been associated with lower prevalence of eczema in ISAAC Phase Three in Spain12 and was a included as an important item in a prediction model for wheezing in the first year of life.13

Although some researchers could not to find an association between diet in children and asthma14 and between maternal diet during pregnancy and recurrent wheezing15 or asthma in children,16 none of those studies was specifically designed for that purpose.

Two recent meta-analyses arrived at the same conclusion of Mediterranean diet associated to less asthma prevalence17,18; and the first one also found that the effect was not comparable everywhere and that it was mainly driven by cohorts based in Mediterranean areas.

The paper by Calatayud-Sáez et al.,19 included in the present issue of A&I adds important evidence that Mediterranean diet may help to control asthmatic children. About one hundred families of asthmatic children 1–5 years of age were enrolled in the one year program “Learning to Eat from the Mediterranean”. Children as a group modified substantially their diet after the program, and this accompanied by an overall improvement of their asthma control as measured by the need of medication, number of asthma attacks and emergency department visits. The change in BMI before and after the program was not significant although lean mass was higher significantly increased.

In summary, epidemiological evidence points out that Mediterranean diet might be a protector factor for asthma, although more and specific studies are needed to better establish whether this association is causative. Of especial importance are studies which include the diet of mother in pregnancy both in general and in high-risk populations. Therefore, ongoing trials such as the one recently reported by Sewell et al.20 in a high risk population and the starting pregnancy cohort “Nutrition in Early Life and Asthma” (NELA)21 in the general population may contribute to clarify the issue of Mediterranean diet as a primary prevention intervention. Other stages of prevention should also been looked for, as in the paper published in the present issue of A&I. With new knowledge coming from such studies we will be able to disentangle whether Mediterranean diet is in itself (and by what mechanisms) a protective factor for asthma everywhere, or just in some type of environments,22,23 or just a marker of a specific lifestyle which promotes healthier habits. These may include the intake of certain nutrients/foods which have already been related to lower24 or the avoiding of others which have been shown to be related to higher asthma prevalence25; or the maintenance of BMI in the healthy range,26 among other factors.

References
1
L. Garcia-Marcos,I.M. Canflanca,J.B. Garrido,A.L. Varela,G. Garcia-Hernandez,G.F. Guillen
Relationship of asthma and rhinoconjunctivitis with obesity, exercise and Mediterranean diet in Spanish schoolchildren
2
L. Chatzi,G. Apostolaki,I. Bibakis,I. Skypala,V. Bibaki-Liakou,N. Tzanakis
Protective effect of fruits, vegetables and the Mediterranean diet on asthma and allergies among children in Crete
3
L. Chatzi,M. Torrent,I. Romieu,R. Garcia-Esteban,C. Ferrer,J. Vioque
Diet, wheeze, and atopy in school children in Menorca, Spain
Pediatr Allergy Immunol, 18 (2007), pp. 480-485 http://dx.doi.org/10.1111/j.1399-3038.2007.00596.x
4
R. Barros,A. Moreira,J. Fonseca,J.F. de Oliveira,L. Delgado,M.G. Castel-Branco
Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma control
5
J.A. Castro-Rodriguez,L. Garcia-Marcos,J.D. Alfonseda Rojas,J. Valverde-Molina,M. Sanchez-Solis
Mediterranean diet as a protective factor for wheezing in preschool children
J Pediatr, 152 (2008), pp. 823-828 http://dx.doi.org/10.1016/j.jpeds.2008.01.003
6
J. De Batlle,J. Garcia-Aymerich,A. Barraza-Villarreal,J.M. Anto,I. Romieu
Mediterranean diet is associated with reduced asthma and rhinitis in Mexican children
7
D. Grigoropoulou,K.N. Priftis,M. Yannakoulia,A. Papadimitriou,M.B. Anthracopoulos,K. Yfanti
Urban environment adherence to the Mediterranean diet and prevalence of asthma symptoms among 10- to 12-year-old children: The Physical Activity, Nutrition, and Allergies in Children Examined in Athens study
Allergy Asthma Proc, 32 (2011), pp. 351-358 http://dx.doi.org/10.2500/aap.2011.32.3463
8
J.L. Rice,K.M. Romero,R.M. Galvez Davila,C.T. Meza,A. Bilderback,D.L. Williams
Association between adherence to the Mediterranean diet and asthma in peruvian children
9
L. Chatzi,M. Torrent,I. Romieu,R. Garcia-Esteban,C. Ferrer,J. Vioque
Mediterranean diet in pregnancy is protective for wheeze and atopy in childhood
10
I. Romieu,A. Barraza-Villarreal,C. Escamilla-Nunez,J.L. Texcalac-Sangrador,L. Hernandez-Cadena,D. Diaz-Sanchez
Dietary intake, lung function and airway inflammation in Mexico City school children exposed to air pollutants
Respir Res, 10 (2009), pp. 122-130 http://dx.doi.org/10.1186/1465-9921-10-122
11
G. Nagel,G. Weinmayr,A. Kleiner,L. Garcia-Marcos,D.P. Strachan
Effect of diet on asthma and allergic sensitisation in the International Study on Allergies and Asthma in Childhood (ISAAC) Phase Two
12
M.M. Suarez-Varela,L.G. Alvarez,M.D. Kogan,J.C. Ferreira,G.A. Martinez,I. Aguinaga Ontoso
Diet and prevalence of atopic eczema in 6 to 7-year-old schoolchildren in Spain: ISAAC phase III
J Investig Allergol Clin Immunol, 20 (2010), pp. 469-475
13
J. Pellegrini-Belinchon,F. Lorente-Toledano,P. Galindo-Villardon,I. Gonzalez-Carvajal,J. Martin-Martin,J. Mallol
Factors associated to recurrent wheezing in infants under one year of age in the province of Salamanca, Spain: Is intervention possible?. A predictive model
Allergol Immunopathol (Madr), (2016), http://dx.doi.org/10.1016/j.aller.2015.09.001
14
F.J. Gonzalez Barcala,S. Pertega,L. Bamonde,L. Garnelo,C.T. Perez,M. Sampedro
Mediterranean diet and asthma in Spanish schoolchildren
Pediatr Allergy Immunol, 21 (2010), pp. 1021-1027 http://dx.doi.org/10.1111/j.1399-3038.2010.01080.x
15
N.E. Lange,S.L. Rifas-Shiman,C.A. Camargo Jr.,D.R. Gold,M.W. Gillman,A.A. Litonjua
Maternal dietary pattern during pregnancy is not associated with recurrent wheeze in children
J Allergy Clin Immunol, 126 (2010), pp. 250-255 http://dx.doi.org/10.1016/j.jaci.2010.05.009
16
L. Chatzi,R. Garcia,T. Roumeliotaki,M. Basterrechea,H. Begiristain,C. Iniguez
Mediterranean diet adherence during pregnancy and risk of wheeze and eczema in the first year of life: INMA (Spain) and RHEA (Greece) mother–child cohort studies
Br J Nutr, 110 (2013), pp. 2058-2068 http://dx.doi.org/10.1017/S0007114513001426
17
L. Garcia-Marcos,J.A. Castro-Rodriguez,G. Weinmayr,D.B. Panagiotakos,K.N. Priftis,G. Nagel
Influence of Mediterranean diet on asthma in children: a systematic review and meta-analysis
Pediatr Allergy Immunol, 24 (2013), pp. 330-338 http://dx.doi.org/10.1111/pai.12071
18
N. Lv,L. Xiao,J. Ma
Dietary pattern and asthma: a systematic review and meta-analysis
J Asthma Allergy, 7 (2014), pp. 105-121 http://dx.doi.org/10.2147/JAA.S49960
19
F.M. Calatayud-Saez,D.P. Calatayud Moscoso,J.G. Gallego Fernandez-Pacheco,C. Gonzalez-Martin,L.F. Alguacil Merino
Mediterranean diet and childhood asthma
Allergol Immunopathol (Madr), 44 (2016), pp. 99-105
20
D.A. Sewell,V.S. Hammersley,G. Devereux,A. Robertson,A. Stoddart,C. Weir
Investigating the effectiveness of the Mediterranean diet in pregnant women for the primary prevention of asthma and allergy in high-risk infants: protocol for a pilot randomised controlled trial
21
http://www.nela.imib.es. Accessed February 19th, 2016.
22
F. Arvaniti,K.N. Priftis,A. Papadimitriou,P. Yiallouros,M. Kapsokefalou,M.B. Anthracopoulos
Salty-snack eating, television or video-game viewing, and asthma symptoms among 10- to 12-year-old children: the PANACEA study
J Am Diet Assoc, 111 (2011), pp. 251-257 http://dx.doi.org/10.1016/j.jada.2010.10.051
23
G. Alphantonogeorgos,D.B. Panagiotakos,D. Grigoropoulou,K. Yfanti,C. Papoutsakis,A. Papadimitriou
Investigating the associations between Mediterranean diet, physical activity and living environment with childhood asthma using path analysis
Endocr Metab Immune Disord Drug Targets, 14 (2014), pp. 226-233
24
U. Nurmatov,G. Devereux,A. Sheikh
Nutrients and foods for the primary prevention of asthma and allergy: systematic review and meta-analysis
J Allergy Clin Immunol, 127 (2011), pp. 724-733 http://dx.doi.org/10.1016/j.jaci.2010.11.001
25
P. Ellwood,M.I. Asher,L. Garcia-Marcos,H. Williams,U. Keil,C. Robertson
Do fast foods cause asthma, rhinoconjunctivitis and eczema?. Global findings from the International Study of Asthma and Allergies in Childhood (ISAAC) phase three
26
N. Roswall,L. Angquist,T.S. Ahluwalia,D. Romaguera,S.C. Larsen,J.N. Ostergaard
Association between Mediterranean and Nordic diet scores and changes in weight and waist circumference: influence of FTO and TCF7L2 loci
Am J Clin Nutr, 100 (2014), pp. 1188-1197 http://dx.doi.org/10.3945/ajcn.114.089706
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