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

Leda Chatzi ¹, Gianna Apostolaki ¹, Ioannis Bibakis ², Isobel Skypala ³, Vasiliki Bibaki-Liakou ², Tzanakis Tzanakis ⁴, Manolis Kogevinas ⁵ and Paul Cullinan ^6*

¹ 1 Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
² Anti-tuberculosis Unit, Venezelion General Hospital, Heraklion, Crete, Greece
³ Royal Brompton Hospital, United Kingdom
⁴ Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
⁵ Centre for Research in Environmental Epidemiology, IMIM, Barcelona, Spain
⁶ Royal Brompton Hospital and National Heart and Lung Institute, London, United Kingdom

^* To whom correspondence should be addressed. E-mail: p.cullinan{at}imperial.ac.uk.

Accepted 11 January 2007

Abstract

Introduction: Atopy is not uncommon among children living in rural Crete; but wheeze and rhinitis are rare. We examined 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 the child's respiratory and allergic symptoms, and a 58-item food frequency questionnaire. Adherence to a Mediterranean diet was measured through a scale on 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. High consumption of nuts was found to be inversely associated with wheezing (OR, 0.46; 95% CI, 0.20-0.98), whereas margarine increased the risk of both wheeze (OR, 2.19; 95% CI, 1.01-4.82) and allergic rhinitis (OR, 2.10; 95% CI, 1.31-3.37). A high level of adherence to the Mediterranean diet was protective for allergic rhinitis (OR, 0.34; 95% CI, 0.18-0.64) while a more modest protection was observed for wheezing and atopy.

Conclusion: Our data 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.

Keywords: mediterranean diet, diet, fruit, rhinitis, wheeze

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