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Relationship of asthma and rhinoconjunctivitis with obesity, exercise and Mediterranean diet in Spanish schoolchildren
  1. Luis Garcia-Marcos1,
  2. Izaskun Miner Canflanca2,
  3. Jose Batlles Garrido3,
  4. Angel Lopez-Silvarrey Varela4,
  5. Gloria Garcia-Hernandez5,
  6. Francisco Guillen Grima6,
  7. Carlos Gonzalez-Diaz7,
  8. Ignacio Carvajal-Urueña8,
  9. Alberto Arnedo-Pena9,
  10. Rosa M Busquets-Monge10,
  11. Maria Morales Suarez-Varela11,
  12. Alfredo Blanco-Quiros12
  1. 1Institute of Respiratory Health, University of Murcia, Spain
  2. 2Department of Paediatrics, Donostia Hospital, San Sebastián, Spain
  3. 3Department of Paediatrics, Torrecárdenas Hospital, Almería, Spain
  4. 4María José Jove Foundation, La Coruña, Spain
  5. 5Paediatric Allergy and Pneumology Unit, 12 de Octubre Children’s Hospital, Madrid, Spain
  6. 6Department of Health Sciences, Public University of Navarra, Spain
  7. 7Department of Paediatrics, Basurto Hospital, Bilbao, Spain
  8. 8Las Vegas Health Centre, Asturias, Spain
  9. 9Department of Epidemiology, Regional Health Authority, Castellón, Spain
  10. 10Department of Paediatrics, Hospital del Mar, Barcelona, Spain
  11. 11Public and Environmental Health Unit, Department of Preventive Medicine, University of Valencia, Spain
  12. 12Department of Paediatrics, University of Valladolid, Spain
  1. Correspondence to:
    Dr Luis Garcia-Marcos
    Institute of Respiratory Health, University of Murcia, 30120 El Palmar, Murcia, Spain; lgmarcos{at}


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.

  • 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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  • Published Online First 24 January 2007

  • Funding: “Instituto de Salud Carlos III, Red de Centros RCESP” (C03/09); Oscar Rava Foundation fund 2001, Barcelona; Health Department, Navarra Autonomic Government; Rotaria Luis Vives Fund 2002-2003, Valencia; Health Department, Murcia Autonomic Government; Maria José Jove Foundation, La Coruña; Health Department, Asturias Princedom; AstraZeneca Spain.

  • Competing interests: None.

  • The members of the International Study of Asthma and Allergies in Childhood (ISAAC) in Spain are: L García-Marcos (Coordinator), A Martínez Torres, J J Guillén Pérez, V Pérez Fernández (Cartagena, coordinating centre); J Batlles Garrido, T Rubí Ruiz, A Bonillo Perales, M M Sánchez Gutiérrez, B Chamizo Moreno, J Momblan de Cabo, R Jiménez Liria, J Aguirre Rodríguez, A Losilla Maldonado, M Torres Daza (Almería); I Carvajal Urueña, C Díaz Vázquez, C Díez Fernández, A García Merino, B Domínguez Aurrecoechea, M Marcilla Escotet, M O Díez Fernández, I Huerta González (Asturias); R M Busquets Monge, O Valls Combelles (Barcelona); C González Díaz, A González Hermosa, N Garcia Perez, M Ferrez Arriazu, M Villar Alvarez (Bilbao); A Arnedo-Pena, A Artero, J B Bellido, J B Campos, Mª L Museros, Mª R Pac, J Puig (Castellón); A López-Silvarrey Varela (La Coruña); G García Hernández, A Marínez Gimeno, C Luna Paredes, A L Moro Rodríguez, I González Gil (Madrid); F Guillén, I Aguinaga, B Marín, C Brun, J Hermoso, I Serrano, M Fernández, J de Irala, M A Martínez (Pamplona); E G Pérez-Yarza, P Gomez-Cabanillas, N García de Andoin, I Miner Canflanc (San Sebastián), M M Morales Suarez-Varela, A Llopis González, M C Jiménez López, M Gracia Antequera (Valencia); A Blanco Quirós, J Castrodeza Sanz, S Marín Urueña, E Burgueño Sánchez-Taiz (Valladolid).