ASTHMA

Protective effect of fruits, vegetables and the Mediterranean diet on asthma and allergies among children in Crete

Leda Chatzi¹, Gianna Apostolaki¹, Ioannis Bibakis², Isabel Skypala³, Vasilki Bibaki-Liakou², Nikolaos Tzanakis¹, Manolis Kogevinas^1,4 and Paul Cullinan³

¹ Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
² Anti-Tuberculosis Unit, Venezelio General Hospital, Heraklion, Crete, Greece
³ Royal Brompton Hospital and National Heart and Lung Institute, London, UK
⁴ Centre for Research in Environmental Epidemiology, IMIM, Barcelona, Spain

Correspondence to:
Correspondence to:
Dr P Cullinan
Department of Occupational and Environmental Medicine, Royal Brompton Hospital and National Heart and Lung Institute, London SW3 6LR, UK; p.cullinan{at}imperial.ac.uk

Background: Atopy is not uncommon among children living in rural Crete, but wheeze and rhinitis are rare. A study was undertaken to examine whether this discrepancy could be attributed to a high consumption of fresh fruit and vegetables or adherence to a traditional Mediterranean diet.

Methods: A cross-sectional survey was performed in 690 children aged 7–18 years in rural Crete. Parents completed a questionnaire on their child’s respiratory and allergic symptoms and a 58-item food frequency questionnaire. Adherence to a Mediterranean diet was measured using a scale with 12 dietary items. Children underwent skin prick tests with 10 common aeroallergens.

Results: 80% of children ate fresh fruit (and 68% vegetables) at least twice a day. The intake of grapes, oranges, apples, and fresh tomatoes—the main local products in Crete—had no association with atopy but was protective for wheezing and rhinitis. A high consumption of nuts was found to be inversely associated with wheezing (OR 0.46; 95% CI 0.20 to 0.98), whereas margarine increased the risk of both wheeze (OR 2.19; 95% CI 1.01 to 4.82) and allergic rhinitis (OR 2.10; 95% CI 1.31 to 3.37). A high level of adherence to the Mediterranean diet was protective for allergic rhinitis (OR 0.34; 95% CI 0.18 to 0.64) while a more modest protection was observed for wheezing and atopy.

Conclusion: The results of this study suggest a beneficial effect of commonly consumed fruits, vegetables and nuts, and of a high adherence to a traditional Mediterranean diet during childhood on symptoms of asthma and rhinitis. Diet may explain the relative lack of allergic symptoms in this population.

Abbreviations: BMI, body mass index; FEV₁, forced expiratory volume in 1 s

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