ASTHMA

Relationship of asthma and rhinoconjunctivitis with obesity, exercise and Mediterranean diet in Spanish schoolchildren

Luis Garcia-Marcos¹, Izaskun Miner Canflanca², Jose Batlles Garrido³, Angel Lopez-Silvarrey Varela⁴, Gloria Garcia-Hernandez⁵, Francisco Guillen Grima⁶, Carlos Gonzalez-Diaz⁷, Ignacio Carvajal-Urueña⁸, Alberto Arnedo-Pena⁹, Rosa M Busquets-Monge¹⁰, Maria Morales Suarez-Varela¹¹, Alfredo Blanco-Quiros¹²

¹ Institute of Respiratory Health, University of Murcia, Spain
² Department of Paediatrics, Donostia Hospital, San Sebastián, Spain
³ Department of Paediatrics, Torrecárdenas Hospital, Almería, Spain
⁴ María José Jove Foundation, La Coruña, Spain
⁵ Paediatric Allergy and Pneumology Unit, 12 de Octubre Children’s Hospital, Madrid, Spain
⁶ Department of Health Sciences, Public University of Navarra, Spain
⁷ Department of Paediatrics, Basurto Hospital, Bilbao, Spain
⁸ Las Vegas Health Centre, Asturias, Spain
⁹ Department of Epidemiology, Regional Health Authority, Castellón, Spain
¹⁰ Department of Paediatrics, Hospital del Mar, Barcelona, Spain
¹¹ Public and Environmental Health Unit, Department of Preventive Medicine, University of Valencia, Spain
¹² Department of Paediatrics, University of Valladolid, Spain

Correspondence to:
Dr Luis Garcia-Marcos
Institute of Respiratory Health, University of Murcia, 30120 El Palmar, Murcia, Spain; lgmarcos{at}um.es

Background: Although several studies have investigated the influence of diet on asthma in schoolchildren, none of them has evaluated how obesity can modify this effect. A study was undertaken to evaluate the association of various foods and a Mediterranean diet with the prevalence of asthma and rhinoconjunctivitis, adjusting for obesity and exercise.

Methods: A cross-sectional study was performed in 20 106 schoolchildren aged 6–7 years from eight Spanish cities. Using the ISAAC phase III questionnaire, parents reported chest and nose symptoms, food intake, weight, height and other factors, including exercise. A Mediterranean diet score was developed. A distinction was made between current occasional asthma (COA) and current severe asthma (CSA).

Results: Independent of the amount of exercise, each Mediterranean score unit had a small but protective effect on CSA in girls (adjusted OR 0.90, 95% CI 0.82 to 0.98). Exercise was a protective factor for COA and rhinoconjunctivitis in girls and boys (the more exercise, the more protection). Obesity was a risk factor for CSA in girls (adjusted OR 2.35, 95% CI 1.51 to 3.64). Individually, a more frequent intake (1–2 times/week and 3 times/week vs never/occasionally) of seafood (adjusted ORs 0.63 (95% CI 0.44 to 0.91) and 0.53 (95% CI 0.35 to 0.80)) and cereals (adjusted OR 0.56 (95% CI 0.30 to 1.02) and 0.39 (95% CI 0.23 to 0.68)) were protective factors for CSA, while fast food was a risk factor (adjusted ORs 1.64 (95% CI 1.28 to 2.10) and 2.26 (95% CI 1.09 to 4.68)). Seafood (adjusted ORs 0.74 (95% CI 0.60 to 0.92) and 0.67 (95% CI 0.53 to 0.85)) and fruit (adjusted ORs 0.76 (95% CI 0.60 to 0.97) and 0.71 (95% CI 0.57 to 0.88)) were protective factors for rhinoconjunctivitis.

Conclusions: A Mediterranean diet has a potentially protective effect in girls aged 6–7 years with CSA. Obesity is a risk factor for this type of asthma only in girls.

Abbreviations: BMI, body mass index; COA, current occasional asthma; CSA, current severe asthma; ISAAC, International Study of Asthma and Allergies in Childhood

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