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Vol. 44. Issue 5.
Pages 400-409 (September - October 2016)
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Vol. 44. Issue 5.
Pages 400-409 (September - October 2016)
Original Article
DOI: 10.1016/j.aller.2015.12.002
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Effect of foods and Mediterranean diet during pregnancy and first years of life on wheezing, rhinitis and dermatitis in preschoolers
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J.A. Castro-Rodrigueza,b,
Corresponding author
jacastro17@hotmail.com

Corresponding author.
, M. Ramirez-Hernandezc, O. Padillab, R.M. Pacheco-Gonzalezd, V. Pérez-Fernándezd, L. Garcia-Marcosd
a Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
b Division of Public Health, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
c Allery Unit, Santa Lucia University Hospital, Cartagena, Spain
d Pediatric Allergy and Pulmonology Units, “Virgen de la Arrixaca” University Children's Hospital, University of Murcia and IMIB-Arrixaca Research Institute, Murcia, Spain
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Tables (6)
Table 1. Mediterranean diet score.a
Table 2. Sociodemographic and anthropometric characteristics (% or mean±SD) of population (n=1000).
Table 3a. Prevalence (%) of the intake of different foods by the mother during pregnancy and by children at S4, among children with or without current wheezing.
Table 3b. Prevalence (%) of the intake of different foods by the mother during pregnancy and by children at S4, among children with and without current rhinitis.
Table 3c. Prevalence (%) of the intake of different foods by the mother during pregnancy and by children at S4, among children with and without current dermatitis.
Table 4. Multivariate analysis for factors associated to current wheezing, rhinitis and dermatitis at survey 4.*
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Abstract
Background

There is a conflictive position if some foods and Mediterranean diet (MedDiet) consumed by the mother during pregnancy and by the child during the first years of life can be protective for current wheezing, rhinitis and dermatitis at preschool age.

Methods

Questionnaires of epidemiological factors and food intake by the mother during pregnancy and later by the child were filled in by parents in two surveys at two different time points (1.5 yrs and 4 yrs of life) in 1000 preschoolers.

Results

The prevalences of current wheezing, rhinitis and dermatitis were 18.8%, 10.4%, and 17.2%, respectively. After multiple logistic analysis children who were low fruit consumers (never/occasionally) and high fast-food consumers (≥3 times/week) had a higher risk for current wheezing; while intermediate consumption of meat (1 or 2 times/week) and low of pasta by mothers in pregnancy were protected. For current rhinitis, low fruit consumer children were at higher risk; while those consuming meat <3 times/week were protected. For current dermatitis, high fast food consumption by mothers in pregnancy; and low or high consumption of fruit, and high of potatoes in children were associated to higher prevalence. Children consuming fast food >1 times/week were protected for dermatitis. MedDiet adherence by mother and child did not remain a protective factor for any outcome.

Conclusion

Low consumption of fruits and high of meat by the child, and high consumption of potatoes and pasta by the mother had a negative effect on wheezing, rhinitis or dermatitis; while fast food consumption was inconsistent.

Keywords:
Asthma
Childhood
Dermatitis
Food during pregnancy
Mediterranean diet
Primary prevention
Rhinitis
Risk factors
Wheeze
Full Text
Introduction

It is well recognised that most allergic manifestations, e.g. asthma, rhinitis and dermatitis, usually appear during preschool age.1 Perinatal life is a critical period of the immune system development, and maternal diet during pregnancy has been proposed to influence foetal immune responses that might predispose to childhood allergic manifestations.2 Decreasing the intake of antioxidants (fruit and vegetables), increasing that of n-6 polyunsaturated fatty acid (PUFA) (in margarine or vegetable oil), and decreasing that of n-3 PUFA (oily fish) could have contributed to the recent increase in asthma and atopic diseases. Thus the role of diet during foetal (programming) and in early life (preschool) ages is an area for intense research.3

We previously showed that adherence to the Mediterranean diet [MedDiet] (in the univariate analysis) and to olive oil consumption (also after multivariate analysis) during pregnancy were protective factors for recurrent wheezing during the first year of life in Spanish infants.4 Another study from Spain and Greece showed that high meat intake and processed meat intake during pregnancy were associated with an increased risk of wheeze in the first year of life; whilst a high intake of dairy products, but not MedDiet, was significantly associated with a decreased risk of infant wheeze.5 However, a recent meta-analysis performed exclusively on maternal nutrition during pregnancy showed that MedDiet and higher maternal intake of vitamins D and E, zinc, copper, magnesium and vegetables during pregnancy are associated with a lower risk of wheeze and atopic diseases in childhood.6

On the other hand, we also reported previously that MedDiet adherence during preschool age was an independent protective factor for current wheezing in preschoolers, regardless of obesity and physical activity7; and for current severe asthma among girls at school-age (regardless of physical activity).8 Furthermore, a meta-analysis on adherence to MedDiet in children showed a trend that this type of diet is associated with lower occurrence of current wheeze, current severe wheeze, or asthma ever. For current and current severe wheeze, the significance of the association was mainly driven by the results in Mediterranean populations.9

However, few studies have looked into the interaction between maternal diet, especially MedDiet consumed by the mother during pregnancy and by the offspring during preschool age, on asthma, dermatitis and rhinitis in the offspring. The objective of the present study was to investigate if MedDiet adherence by the mother during pregnancy and by the child had an influence on asthma, rhinitis or dermatitis in the offspring during preschool age. We hypothesised that MedDiet consumed by the mother and by the child is a protective factor for asthma and allergic disease.

MethodsPopulation

This longitudinal prospective study started as a part of the International Study of Wheezing in Infants (EISL) study performed in Cartagena, Spain. Children have been followed up afterwards.10 Briefly, all primary care health centres monitoring children for nutrition, growth and development, and/or for vaccine administration from the health program in Cartagena were included as recruiting centres; and when the child attended to receive vaccination at 15 or 18 months of age (“survey 1.5”), parents or guardians were asked to complete the questionnaire, emphasising on nutritional aspects of the mother during pregnancy and respiratory/allergy symptoms in the offspring which occurred during the first 12 months. At age four years (“survey 4”) the participant families were contacted again to answer a similar questionnaire, emphasising nutrition and respiratory/allergy symptoms occurred in the offspring during the previous 12 months.

Questionnaires

At survey 1.5, a standardised and validated questionnaire,10 including questions on epidemiological risk/protective factors, was completed. The questions were: age; gender; race; type of delivery; number of siblings; birth weight and height (by parental report); low birth weight (<2000g or <2500g); exclusive breastfeeding for six months (without any formula feeding or infant food); air pollution (living near to factories or roads with heavy traffic); mould stains on the household walls; dogs and cats at home, during pregnancy and at present; maternal age and educational level; oral contraceptive used before pregnancy; paracetamol used during pregnancy; number of colds during the first year of life; maternal smoking during pregnancy; paternal current smoking; parental asthma, rhinitis and eczema.

At survey 4, the data collected included: kindergarten attendance; parental current tobacco smoking; dogs and cats at home; mould stains on the household walls; type of fuel used in heating and cooking systems; physical exercises (hours/week); TV-video play watching (hours/day); and height and weight (by parental report).

Definitions of outcome variables

Current wheezing was defined as a positive answer to the question: “Has your child had wheezing or whistling in the chest during the first 12 months of life?”. Current rhinitis was defined as a positive answer to the following question “Has your child had a problem with sneezing or a runny or blocked nose when he/she did not have a cold or the flu accompanied by itchy, watery eyes during the last 12 months?”. Current eczema was defined as a positive answer to the following question: “During the first 12 months of his/her life, has your child had an itchy rash which was coming and going in any part of his/her body except around the mouth and nose, and on the nappy area?”.

Questions were asked regarding the consumption of foods (never or occasionally, 1 or 2 times per week, and 3 or more times per week) by the mother during pregnancy at survey 1.5, and by the child at survey 4. The MedDiet score employed in the present study was previously developed by our group7,8 and is based on the score by Psaltopoulou et al.11: fruit, fish, vegetables, legumes, cereals, pasta, rice and potatoes are considered “pro- Mediterranean” foods and rated according to the frequency of their intake (0 points=never or occasionally, 1 point=1 or 2 times/week, or 2 points=≥3 times/week). Meat, milk and fast foods are considered “anti-Mediterranean” foods and are rated inversely (Table 1). We used MedDiet as quartiles of score and also as raw score. As in our three previous reports,4,7,8 olive oil was not included as part of the MedDiet score and was recorded apart. Therefore, a question about the type of oil used for cooking and dressing salads and vegetables was included; and a dichotomous variable: olive oil vs. others [margarine, butter or other oils] was built. Additionally, the frequency of industrial infant foods (e.g. yogurt, puddings, petit-suisse, commercial chips, jelly, chocolate, soft drinks and bottled/packed juices) consumed by the infants during their first year of life was recorded (as never, once per month, once per week and every day).

Table 1.

Mediterranean diet score.a

Food  Never or occasionally  1 or 2 times/week  ≥3 times/week 
  Points  Points  Points 
Fruit 
Fish 
Vegetables 
Legumes 
Cereals 
Pasta 
Rice 
Potatoes 
Meat 
Milk 
Fast foodb 
a

After adding up all the points, higher scores mean greater adherence to Mediterranean diet and lower scores mean less adherence.

b

Candies, industrial pastry, pre-cooked pizzas and fried food, together with hamburgers taken in fast food restaurants were considered generically as “fast food”.

The Ethics Committee of the University of Murcia approved the study, and full informed and signed consent was obtained from parents before completing the questionnaire.

Statistical analysis

Three different outcomes were considered: current wheezing, current rhinitis and current dermatitis at survey 4. The bivariate analysis was performed by means of the Fisher's exact test for categorical variables; the chi square test for trend for ordinal variables; and the Student t-test for independent samples for continuous variables. Odds ratios (OR) and 95% confidence intervals (95% CI) were also calculated. Multivariate logistic regression analysis models were built for each outcome. Adjusted OR (aOR) and 95% CI were calculated from the logistic regression models. Statistical analyses were performed using statistical software (SPSS® v.17, IBM, Armonk, NY, US).

Results

During the study period 3564 children were registered born in the health district of Cartagena. After discarding those who were not of Spanish origin and those without correct contact data, 2396 families were invited to participate in the study, of whom 1694 completed survey 1.5 (70.7% participation rate). After excluding blank questionnaires or blank answers to the questions related to wheezing, rhinitis or dermatitis at survey 4, 1000 children had complete data for both surveys (1.5 and 4) and were analysed in the present report. The mean (SD) age was 16.9±2.7 months at survey 1.5 and 40.7±4.4 months at survey 4; 54.7% were males; and 98.2% had a complete immunisation schedule. At survey 4, the prevalence of current wheezing, rhinitis and dermatitis were respectively 18.8%, 10.4%, and 17.2%.

Current wheezing at survey 4

In terms of demographic and anthropometric characteristics the statistically significant differences between children with and without current wheezing were: length at birth; birth weight; number of colds during the first year of life; maternal tobacco smoking at survey 1.5; paternal rhinitis; mould stains on the household at survey 4; and age of wheezing onset (Table 2).

Table 2.

Sociodemographic and anthropometric characteristics (% or mean±SD) of population (n=1000).

  Current wheezingCurrent rhinitisCurrent dermatitis
  Yes  No  p value***  Yes  No  p value***  Yes  No  p value*** 
Age (yrs)  40.16±4.02  40.78±4.47  0.082  41.36±4.25  40.59±4.41  0.092  40.88±4.63  40.63±4.35  0.495 
Gender (males)  55.3  54.6  0.871  66.3  53.3  0.012  60.5  53.4  0.11 
Weight at birth (kg)  4.09±0.82  4.19±0.67  0.09  4.25±0.64  4.16±0.71  0.22  4.25±0.68  4.16±0.71  0.15 
Length at birth (cm)  49.29±3.02  49.86±2.72  0.014  49.77±2.74  49.75±2.79  0.927  50.05±2.58  49.68±2.83  0.114 
Delivery by C-section  29.4  26.0  0.40  30.3  26.2  0.40  29.0  26.2  0.5 
Birth weight <2500g  13.3  10.5  0.293  6.9  11.5  0.182  10.2  11.2  0.786 
Birth weight <2000g  5.5  1.8  0.008  2.0  2.6  1.00  1.8  2.7  0.785 
Exclusive breastfeeding  17.8  19.5  0.679  19.4  19.2  1.00  15.2  19.9  0.165 
Maternal age (yrs)  32.58±5.27  32.16±5.07  0.318  32.23±5.79  32.24±5.03  0.986  32.28±4.66  32.24±5.2  0.917 
Maternal studies      0.29      0.029      0.228 
Basic or none  8.6  10.5    9.8  10.2    13.3  9.4   
High school incomplete  8.1  12.4    10.8  11.6    8.4  12.2   
High school complete  55.9  50.5    63.7  50.1    51.5  51.5   
University  27.4  26.6    15.7  28.1    26.3  26.9   
Oral contraceptive used      0.558      0.467      0.246 
Never  56.5  61.2    68.2  59.4    56.4  61.1   
<1 yr  14.9  11.4    8.0  12.5    16.8  11.1   
1–3 yrs  18.6  18.5    15.9  18.8    16.8  18.9   
4–6 yrs  9.9  9.0    8.0  9.3    10.1  9.0   
Siblings (n)  0.78±0.88  0.74±0.99  0.646  0.59±0.72  0.77±1.0  0.09  0.68±0.78  0.76±1.0  0.323 
Paracetamol during preg      0.946      0.265      0.021 
Never or <1/m  82.6  83.4    79.2  83.7    85.4  82.6   
1–4 times/m  14.7  13.7    15.8  13.6    9.1  14.9   
>1time/week  2.7  2.9    5.0  2.7    5.5  2.4   
Pets during pregnancy  26.7  24.8  0.576  35.9  23.9  0.011  27.9  24.6  0.385 
Maternal smoking in preg  24.9  18.7  0.038*  22.1  19.6  0.518  22.2  19.4  0.40 
Mould stains at S1.5  16.8  13.6  0.292  21.4  13.3  0.023*  17.0  13.6  0.277 
Pets at S1.5  31.0  29.9  0.791  39.8  29.0  0.031  35.5  29.1  0.059* 
Day care at S1.5  9.7  13.1  0.22  16.5  12.0  0.206  13.5  12.2  0.612 
Type of fuel at S1.5      0.384      0.625      0.432 
Electricity/central gas  96.3  94.5    97.8  94.5    92.9  95.2   
Gas stove  1.2  3.4    1.1  3.2    3.9  2.8   
Kerosene/wood/charcoal  2.5  2.2    1.1  2.1    3.2  2.0   
Colds during first yr. life  5.66±8.44  4.02±5.11  0.013  7.34±14.38  3.98±3.81  0.024  5.48±8.79  4.08±5.08  0.048 
Air Pollution at S1.5  25.3  21.8  0.33  27.2  21.9  0.21  23.4  22.2  0.76 
Paternal smoking at S1.5  46.8  39.3  0.036*  36.5  41.2  0.399  42.7  40.4  0.608 
Maternal smoking at S1.5  35.1  27.1  0.02*  29.8  28.5  0.819  29.2  28.4  0.853 
Paternal smoking at S4  43.1  37.3  0.084*  37.5  38.5  0.915  41.3  37.8  0.438 
Maternal smoking at S4  32.4  27.1  0.085*  31.7  27.7  0.42  29.7  27.8  0.642 
Mould stains at S4  10.6  4.7  0.003*  14.4  4.8  0.0004*  12.2  4.5  0.0003* 
Weight at S4  16.04±2.45  16.15±2.56  0.591  16.50±2.77  16.08±2.51  0.114  16.35±2.58  16.07±2.53  0.189 
Height at S4  99.24±4.11  100.6±32.0  0.553  100.3±5.3  100.4±30.5  0.966  100.1±4.8  100.4±31.7  0.902 
BMI at S4  16.27±2.17  16.29±2.35  0.901  16.42±2.65  16.27±2.28  0.536  16.32±2.27  16.28±2.33  0.863 
Wheezing onset at S4 (m)  10.52±9.36  7.98±5.83  0.002  9.23±8.9  8.78±7.03  0.689  9.52±9.05  8.68±6.84  0.401 
Kindergarten at S4 (m)  21.97±10.5  20.97±10.8  0.248  22.98±11.1  20.94±10.7  0.068  21.06±10.3  21.18±10.9  0.899 
Physical act. at S4 (h/w)  2.48±3.53  2.70±4.83  0.564  1.06±2.6  2.84±4.76  <0.0001  1.39±2.87  2.93±4.86  <0.0001 
TV-video at S4 (h/d)  1.09±0.81  1.11±0.83  0.717  1.22±1.04  1.10±0.79  0.242  1.18±0.98  1.09±0.79  0.28 
Paternal asthma  5.9  3.9  0.225  3.9  4.3  1.0  4.1  4.3  1.0 
Maternal asthma  6.4  5.4  0.595  12.5  4.8  0.003*  9.9  4.7  0.008* 
Paternal rhinitis  19.1  11.5  0.005*  19.8  12.1  0.026*  14.8  12.6  0.45 
Maternal rhinitis  15.2  13.2  0.476  22.5  12.6  0.006*  22.5  11.8  0.0003* 
Paternal dermatitis  3.3  4.9  0.436  8.7  4.1  0.039*  5.9  4.3  0.417 
Maternal dermatitis  7.1  7.6  1.0  10.7  7.2  0.233  10.6  6.9  0.07* 
MedDiet during preg      0.892      0.637      0.145 
1st quartile  27.0  27.4    23.3  27.8    28.3  27.2   
2nd quartile  39.7  40.3    41.1  40.1    36.8  40.8   
3rd quartile  17.8  15.5    20.0  15.5    21.7  14.8   
4th quartile  15.5  16.8    15.6  16.6    13.2  17.3   
MedDiet score during preg  12.6±1.99  12.6±2.1  0.965  12.71±2.07  12.58±2.08  0.584  12.59±1.99  12.6±2.01  0.97 
Olive oil during preg  86.8  87.4  0.806  83.2  87.8  0.205  87.5  87.3  1.0 
MedDiet at S4      0.531      0.02      0.001** 
1st quartile  39.6  41.2    35.3  41.6    29.2  43.4   
2nd quartile  26.2  21.9    16.7  23.4    26.3  21.9   
3rd quartile  21.4  21.1    22.5  21.0    25.1  20.2   
4th quartile  12.8  15.8    25.5  14.1    19.3  14.4   
MedDiet score at S4  12.75±1.74  12.86±1.76  0.44  13.12±1.89  12.81±1.74  0.096  13.12±1.83  12.78±1.74  0.022 
Olive oil at S4  89.4  89.5  1.0  88.5  89.6  0.735  89.0  89.6  0.786 

Numbers were expressed as % or media±SD, when corresponded. Bold values mean “statistical significance”.

*

One-tail p value for Fisher's exact test.

**

p value for chi-square test for trend; MedDiet=Mediterranean diet; preg=pregnancy; m=month; w=week; d=day; S1.5=first survey; S4=second survey.

***

Two-tailed p value for independent samples t-test or for Fisher's exact test.

Among diet, MedDiet score adherence and olive oil consumption by the mother and by the child at survey 4 were not significantly different between children with and without current wheezing (Table 2). Also, when comparing separately each group of foods consumed by the mother and by the child, no significant differences were found. The only exception was the association between a higher prevalence of wheezing among those who never or occasionally took fruits and vegetables, and among those eating meat and fast food ≥3 times/week (Table 3a).

Table 3a.

Prevalence (%) of the intake of different foods by the mother during pregnancy and by children at S4, among children with or without current wheezing.

  WheezeNo wheeze
  Never or occasionally  1 or 2 times/week  ≥3 times/week  Never or occasionally  1 or 2 times/week  ≥3 times/week  p value* 
By the mother
Fruit  7.7  15.9  76.4  5.4  14.4  80.2  0.375 
Fish  9.7  64.9  25.4  9.1  67.0  23.9  0.841 
Vegetables  0.5  13.5  85.9  2.4  13.9  83.7  0.291 
Legumes  7.1  55.2  37.7  6.0  54.8  39.2  0.792 
Cereals  6.0  17.5  76.5  6.3  19.4  74.3  0.854 
Pasta  4.9  73.2  21.9  7.5  67.9  24.6  0.323 
Rice  8.7  72.8  18.5  8.3  72.9  18.9  0.98 
Potatoes  11.5  54.6  33.9  13.8  50.7  35.4  0.584 
Meat  3.3  29.9  66.8  2.2  34.8  63.0  0.298 
Milk  1.1  8.1  90.8  2.0  6.5  91.5  0.57 
Fast food  20.5  48.6  30.8  21.4  44.7  33.8  0.624 
By the child
Fruit  8.0  21.3  70.7  3.2  28.2  68.6  0.005 
Fish  2.1  59.0  38.8  1.4  59.5  39.2  0.703 
Vegetables  1.1  24.5  74.5  0.6  32.9  66.5  0.032 
Legumes  2.7  66.0  31.4  2.3  70.8  26.8  0.402 
Cereals  1.1  7.4  91.5  0.6  11.2  88.2  0.192 
Pasta  5.9  88.3  5.9  5.4  86.9  7.6  0.717 
Rice  6.9  88.8  4.3  8.0  85.6  6.4  0.494 
Potatoes  5.9  22.5  71.7  5.8  30.6  63.6  0.076 
Meat  1.1  33.0  66.0  1.0  41.9  57.1  0.021 
Milk  1.1  1.6  97.3  0.6  2.6  96.8  0.577 
Fast food  23.9  33.5  42.6  28.6  41.9  29.6  0.003 

Bold values mean “statistical significance”.

*

2-tail p value for Fisher's exact test.

Table 3b.

Prevalence (%) of the intake of different foods by the mother during pregnancy and by children at S4, among children with and without current rhinitis.

  RhinitisNo rhinitis
  Never or occasionally  1 or 2 times/week  ≥3 times/week  Never or occasionally  1 or 2 times/week  ≥3 times/week  p value* 
By the mother
Fruit  8.0  19.0  73.0  5.6  14.2  80.2  0.202 
Fish  5.9  68.6  25.5  9.7  66.3  24.0  0.491 
Vegetables  2.0  14.7  83.3  2.1  13.7  84.2  0.932 
Legumes  10.3  50.5  39.2  5.7  55.3  38.9  0.21 
Cereals  7.0  18.0  75.0  6.2  19.2  74.6  0.911 
Pasta  9.8  64.7  25.5  6.7  69.4  23.9  0.399 
Rice  6.9  69.3  23.8  8.5  73.3  18.2  0.392 
Potatoes  11.1  50.5  38.4  13.7  51.6  34.8  0.717 
Meat  2.0  33.7  64.4  2.4  33.9  63.7  1.0 
Milk  3.9  4.9  91.2  1.6  7.0  91.4  0.171 
Fast food  22.5  43.1  34.3  21.1  45.8  33.1  0.857 
By the child
Fruit  9.6  9.6  80.8  3.5  28.9  67.6  <0.0001 
Fish  4.8  48.1  47.1  1.1  60.7  38.2  0.003 
Vegetables  1.9  12.5  85.6  0.6  33.5  66  <0.0001 
Legumes  1.9  64.4  33.7  2.5  70.5  27.0  0.352 
Cereals  1.0  7.7  91.3  0.7  10.8  88.5  0.42 
Pasta  7.7  78.8  13.5  5.2  88.2  6.6  0.02 
Rice  6.7  85.6  7.7  7.9  86.3  5.8  0.652 
Potatoes  2.0  14.7  83.3  6.3  30.7  63.1  0.0001 
Meat  1.0  17.3  81.7  1.0  42.9  56.1  <0.0001 
Milk  2.9  0.0  97.1  0.4  2.7  96.9  0.01 
Fast food  15.4  47.1  37.5  29.1  39.5  31.4  0.008 

Bold values mean “statistical significance”.

*

2-tail p value for Fisher's exact test.

Table 3c.

Prevalence (%) of the intake of different foods by the mother during pregnancy and by children at S4, among children with and without current dermatitis.

  DermatitisNo dermatitis
  Never or occasionally  1 or 2 times/week  ≥3 times/week  Never or occasionally  1 or 2 times/week  ≥3 times/week  p value* 
By the mother
Fruit  4.2  13.3  82.5  6.2  15.0  78.8  0.54 
Fish  7.2  66.5  26.3  9.7  66.7  23.6  0.527 
Vegetables  3.0  14.3  82.7  1.9  13.8  84.4  0.559 
Legumes  6.1  56.4  37.4  6.2  54.5  39.3  0.894 
Cereals  6.7  17.2  76.1  6.2  19.4  74.4  0.81 
Pasta  6.1  65.5  28.5  7.3  69.6  23.2  0.353 
Rice  10.4  68.9  20.7  7.9  73.6  18.4  0.387 
Potatoes  12.9  50.9  36.2  13.4  51.6  35.0  0.963 
Meat  2.4  31.1  66.3  2.4  34.5  63.2  0.737 
Milk  1.2  4.2  94.6  2.0  7.3  90.7  0.311 
Fast food  15.0  43.7  41.3  22.6  45.8  31.6  0.02 
By the child
Fruit  8.7  9.9  81.4  3.1  30.5  66.3  <0.0001 
Fish  3.5  52.3  44.2  1.1  60.8  38.1  0.016 
Vegetables  0.6  16.9  82.6  0.7  34.3  64.9  <0.0001 
Legumes  1.7  68.0  30.2  2.5  70.4  27.1  0.663 
Cereals  1.2  7.0  91.9  0.6  11.2  88.1  0.141 
Pasta  8.1  84.9  7.0  5.0  87.7  7.4  0.257 
Rice  8.1  86.6  5.2  7.7  86.1  6.2  0.901 
Potatoes  5.3  14.6  80.1  5.9  32.1  62.0  <0.0001 
Meat  1.7  25.0  73.3  0.8  43.4  55.7  <0.0001 
Milk  2.9  0.6  96.5  0.2  2.8  97.0  0.001 
Fast food  23.8  44.2  32.0  28.5  39.4  32.0  0.382 

Bold values mean “statistical significance”.

*

2-tail p value for Fisher's exact test.

In the multiple logistic regression analysis parental rhinitis; birth weight below 2kg; maternal tobacco during pregnancy; mould stains in household walls at survey 4; having fruit never or occasionally; and consuming ≥3 times/week fast food by the child remained as independent risk factors associated to current wheezing. While consumption by the mother during pregnancy of meat 1 or 2 times/week, and never or occasionally pasta, remained as independent protective factors for current wheezing in the offspring, (Table 4).

Table 4.

Multivariate analysis for factors associated to current wheezing, rhinitis and dermatitis at survey 4.*

  p value  OR  95%CI 
Current wheezing
Paternal rhinitis  0.008  1.87  1.18–2.96 
Birth weight <2kg  0.002  4.22  1.71–10.44 
Smoking during pregnancy  0.029  1.58  1.05–2.4 
Mould stain at S4  0.003  2.56  1.39–4.74 
Pasta by mother (never or occasionally)b  0.049  0.43  0.19–0.998 
Pasta by mother (≥3 times/w)  0.102  0.70  0.46–1.07 
Meat by mother (≥3 times/w)a  0.141  0.47  0.18–1.28 
Meat by mother (1 or 2 times/w)  0.039  0.34  0.12–0.95 
Fruits by child (never or occasionally)b  0.023  2.60  1.14–5.92 
Fruits by child (≥3 times/w)  0.714  1.09  0.69–1.74 
Fast food by child (≥3 times/w)b  0.033  1.55  1.04–2.31 
Fast food by child (never or occasionally)  0.679  1.11  0.68–1.8 
Rhinitis
Pets during pregnancy  0.007  1.88  1.19–2.98 
Maternal rhinitis  0.014  1.96  1.15–3.36 
Maternal education level (basic or none)u  0.065  2.24  0.95–5.28 
Maternal education level (high school incomplete)  0.201  1.74  0.74–4.08 
Maternal education level (high school complete)  0.004  2.38  1.32–4.27 
Female gender  0.026  0.60  0.38–0.94 
Weight at S4 (per kg increase)  0.037  1.09  1.005–1.19 
Mould stains at S4  0.014  2.30  1.18–4.49 
Fruits by child (never or occasionally)b  0.009  4.33  1.45–12.92 
Fruits by child (≥3 times/w)  0.22  1.65  0.74–3.69 
Meat by child (<3 times/w)c,n  0.004  0.39  0.21–0.74 
Dermatitis
Maternal rhinitis  0.001  2.12  1.37–3.30 
Mould stains at S4  0.008  2.21  1.23–3.97 
Fast food by mother (≥3 times/w)a  0.005  2.10  1.25–3.53 
Fast food by mother (1 or 2 times/w)  0.056  1.64  0.99–2.73 
Fruits by child (never or occasionally)b  <0.0001  9.48  3.77–23.86 
Fruits by child (≥3 times/w)  0.001  3.23  1.63–6.41 
Potatoes by child (never or occasionally)b  0.109  2.21  0.84–5.81 
Potatoes by child (≥3 times/w)  0.016  2.20  1.16–4.17 
Fast food by child (≥3 times/w)a  0.002  0.40  0.23–0.72 
Fast food by child (1 or 2 times/w)  0.038  0.56  0.33–0.97 

Bold values mean “statistical significance”.

*

The reference categories are:

a

never or occasionally;

b

1 or 2 times/w;

c

≥3 times/w;

u

College.

n

The levels never or occasionally and 1 or 2 times/w were collapsed as <3 times/w.

Current rhinitis at survey 4

There were significant associations with current rhinitis with the following factors in the univariate analyses (Table 2): male gender; maternal asthma; paternal rhinitis; maternal rhinitis; paternal dermatitis; dog/cat ownership at birth; dog/cat ownership at survey 1.5; mould stains on the household at survey 1.5 and at survey 4. Furthermore, as compared to those without current rhinitis, children with current rhinitis had a lower proportion of mothers with university degrees; a higher number of colds during the first year of life; and lower physical activity (Table 2).

MedDiet score adherence by the mother and olive oil consumption by the mother and by the child were not significantly different between children with and with current rhinitis (Table 2). However, children without current rhinitis had significantly lower MedDiet adherence at survey 4 (using quartiles of MedDiet) (Table 2). Separately considering each group of foods consumed by the mother and by the child at survey 4, when comparing children with and without rhinitis, those with current rhinitis had a significantly higher proportion of high consumption (≥3 times/week) of fruits, fish, vegetables, pasta, potatoes and meat; a higher proportion of low consumption (never or occasionally) of milk by the child; and a lower proportion of fast food consumption by the child (Table 3b).

In the multiple logistic regression analysis, pets at birth; maternal rhinitis; higher maternal education level; increased weight; and mould stains at survey 4 remained independent risk factors associated to current rhinitis; as did low consumption (never or occasionally) of fruits by the child. Female gender and consuming meat<than 3 times/week by the child were protective factors (Table 4).

Current dermatitis at survey 4

There was a higher proportion of maternal asthma, maternal rhinitis, mould stains on the household at survey 4 among children with current dermatitis than without it (Table 2). Moreover, mothers of children with current dermatitis had a significantly higher frequency (>once per week) of paracetamol use during pregnancy; and children had more colds during the first year of life, and exercised less than those without dermatitis (Table 2).

MedDiet score adherence consumption by the mother during pregnancy; and olive oil consumption by the mother and by the child at survey 4 were not significantly different between children with current dermatitis than those without (Table 2). However, children with current dermatitis had higher MedDiet consumption (in quartiles and score) by child (Table 2). Comparing separately each group of foods consumed by the mother and by the child at survey 4, children with current dermatitis had a higher proportion of consumption of ≥3 times/week of fruits, fish, vegetables, potatoes and meat than those without dermatitis. Additionally, those without dermatitis had a lower proportion of never or occasional consumption of milk.

In the multiple logistic regression analysis, maternal rhinitis; mould stains at survey 4; ≥3 times/week fast food consumption by the mother; never or occasionally and ≥3 times/week fruits consumption by the child; and ≥3 times/week potatoes consumption by the child remained associated to higher risk of current dermatitis. Curiously, 1 or 2 times/week or ≥3 times/week fast food consumption by the child were a protective factor for dermatitis.

Discussion

The present study showed that children never or occasionally consuming fruit and having fast food ≥3 times/week had a higher risk for current wheezing; while maternal consumption during pregnancy of meat 1 or 2 times/week, and pasta never or occasionally remained as protective factors. For current rhinitis, children never or occasionally consuming fruits were at higher risk; while consuming meat <3 times/week was protective. Finally, for current dermatitis, maternal consumption of fast food ≥3 times/week, and children consumption of fruits never/occasionally or ≥3 times/week, and potatoes ≥3 times/week was associated to higher risk. Curiously, children consuming fast food 1 or 2 times/week or ≥3 times/week had a lower prevalence of the condition. MedDiet did not remain as a protective factor for wheeze, dermatitis or rhinitis.

A recent meta-analysis6 (N=32 studies, 29 cohorts) found a protective effect of maternal dietary intake of three vitamins/nutrients (vitamin D, vitamin E, and zinc) against wheeze during childhood. However, none of these nutrients were consistently associated with asthma or with other atopic conditions, and thus there is inconclusive evidence for either a true cause–effect relationship or the mechanisms underlying our findings. Higher maternal intake of magnesium and vegetables was associated with a lower risk of eczema; higher copper consumption was associated with a lower risk of food allergy; and MedDiet was associated with lower risk of positive skin prick test.

Furthermore, another meta-analysis12 showed that serum vitamin A was lower in children with asthma as compared with controls. High maternal dietary vitamin D and E intakes during pregnancy were protective for the development of wheezing. Adherence to a MedDiet was protective for persistent wheeze and atopy. Seventeen of 22 fruit and vegetable studies report a beneficial association with asthma and allergic condition. Vitamin C and selenium were not related with this wheeze/asthma and atopy.

There are several variants of the MedDiet, but some common components are: high monounsaturated/saturated fat ratio; high consumption of vegetables, fruit, legumes, and grains and moderate consumption of milk and dairy products.13 Thus MedDiet is a diet rich in both antioxidants and cis monounsaturated fatty acids. A recent meta-analysis showed that MedDiet consumed by the mother was a protective factor for atopic diseases in the offspring.6 Also a meta-analysis on the adherence to MedDiet in children (N=8 studies, 39804 children aged 3–18 yrs) showed a trend to be associated with lower occurrence of current wheeze, current severe wheeze, or ever asthma.9 However, in the present study, MedDiet consumption by the mother during pregnancy or by the child during the previous year was not a protective factor for current wheezing, rhinitis, or dermatitis in preschoolers.

The potential explanations of this negative result about MedDiet as a protective factor for wheezing and allergic diseases could be that other factors blunt its effect. Indeed, in our study other factors remain as a risk for wheezing (e.g. parental rhinitis, birth weight below 2kg, maternal tobacco use during pregnancy, mould stains at survey 4), for rhinitis (e.g. pets at birth, maternal rhinitis, higher maternal education level, increased weight and mould stains at survey 4) and for dermatitis (e.g. maternal rhinitis, mould stains at survey 4). All of these are well recognised risk factors for those diseases.14

There are some potential limitations in the present study. Firstly, an information bias on food intake could be present. However, it has been shown that parents are reliable when reporting food intake of their children, especially with fruit and vegetables.15 Additionally and unfortunately, our food questionnaires did not allow to correct for the energy intake; nevertheless most studies on diet and asthma in children do not correct for this parameter either.16 Secondly, a bias on reported height and weight could also be present; however, a prior study carried out in the same area showed that height and weight reported by parents are reliable for epidemiological studies.17 Finally, as in all cross-sectional studies, this one cannot show the association over time, and recall bias may be present. Thus, prospective studies on the relationship between asthma and diet should be carried out, especially during foetal and early life,3,16 to understand the potential of food for preventing asthma and allergic diseases.

In conclusion, our results suggest that low consumption of fruits and high of meat by the child, and high consumption of potatoes and pasta by the mother had a negative effect on wheezing, rhinitis or dermatitis; while fast food consumption by mother and child were inconsistent.

Ethical disclosuresPatients’ data protection

The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.

Right to privacy and informed consent

The authors have obtained the informed consent of the patients and/or subjects mentioned in the article. The author for correspondence is in possession of this document.

Protection of human subjects and animals in research

The authors declare that no experiments were performed on humans or animals for this investigation.

Conflict of interest

The authors declare no conflict of interest.

Acknowledgment

We thank Anthony Carlson for his editorial assistance.

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References
[1]
J. Bousquet, J.E. Gern, F.D. Martinez, J.M. Anto, C.C. Johnson, P.G. Holt, et al.
Birth cohorts in asthma and allergic diseases: report of a NIAID/NHLBI/MeDALL joint workshop.
J Allergy Clin Immunol, 133 (2014), pp. 1535-1546
[2]
K. Allan, G. Devereux.
Diet and asthma: nutrition implications from prevention to treatment.
J Am Diet Assoc, 111 (2011), pp. 258-268
[3]
G. Devereux, A. Seaton.
Diet as a risk factor for atopy and asthma.
J Allergy Clin Immunol, 115 (2005), pp. 1109-1117
[4]
J.A. Castro-Rodriguez, L. Garcia-Marcos, M. Sanchez-Solis, V. Pérez-Fernández, A. Martinez-Torres, J. Mallol.
Olive oil during pregnancy is associated with reduced wheezing during the first year of life of the offspring.
Pediatr Pulmonol, 45 (2010), pp. 395-402
[5]
L. Chatzi, R. Garcia, T. Roumeliotaki, M. Basterrechea, H. Begiristain, C. Iñiguez, et al.
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
[6]
A.A. Beckhaus, L. Garcia-Marcos, E. Forno, R.M. Pacheco-Gonzalez, J.C. Celedón, J.A. Castro-Rodriguez.
Maternal nutrition during pregnancy and risk of asthma, wheeze, and atopic diseases during childhood: a systematic review and meta-analysis.
Allergy, 70 (2015), pp. 1588-1604
[7]
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
[8]
L. Garcia-Marcos, I.M. Canflanca, J.B. Garrido, A.L. Varela, G. Garcia-Hernandez, F. Guillen Grima, et al.
Relationship of asthma and rhinoconjunctivitis with obesity, exercise and Mediterranean diet in Spanish schoolchildren.
Thorax, 62 (2007), pp. 503-508
[9]
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
[10]
J. Mallol, L. García-Marcos, D. Solé, P. Brand, EISL Study Group.
International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources.
Thorax, 65 (2010), pp. 1004-1009
[11]
T. Psaltopoulou, A. Naska, P. Orfanos, D. Trichopoulos, T. Mountokalakis, A. Trichopoulou.
Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study.
Am J Clin Nutr, 80 (2004), pp. 1012-1018
[12]
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
[13]
A. Trichopoulou, P. Lagiou.
Healthy traditional Mediterranean diet: an expression of culture, history, and lifestyle.
Nutr Rev, 55 (1997), pp. 383-389
[14]
S. Hofmaier.
Allergic airway diseases in childhood: an update.
Pediatr Allergy Immunol, 25 (2014), pp. 810-816
[15]
T. Byers, F. Trieber, E. Gunter, R. Coates, A. Sowell, S. Leonard, et al.
The accuracy of parental reports of their children's intake of fruits and vegetables: validation of a food frequency questionnaire with serum levels of carotenoids and vitamins C, A, and E.
Epidemiology, 4 (1993), pp. 350-355
[16]
T.M. McKeever.
Diet and asthma.
AM J Respir Crit Care Med, 170 (2004), pp. 725-729
[17]
L. Garcia-Marcos, J. Valverde-Molina, M. Sanchez-Solis, M.J. Soriano-Perez, A. Baeza-Alcaraz, A. Martinez-Torres, et al.
Validity of parent-reported height and weight for defining obesity among asthmatic and non-asthmatic schoolchildren.
Int Arch Allergy Immunol, 139 (2006), pp. 139-145
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