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Effect of diet on asthma and allergic sensitisation in the International Study on Allergies and Asthma in Childhood (ISAAC) Phase Two
  1. Gabriele Nagel1,
  2. Gudrun Weinmayr1,
  3. Andrea Kleiner1,
  4. Luis Garcia-Marcos2,
  5. David P Strachan3,
  6. the ISAAC Phase Two Study Group
  1. 1Institute of Epidemiology, Ulm University, Germany
  2. 2Pediatric Respiratory and Allergy Units, “Arrixaca” University Children's Hospital, University of Murcia and CIBER of Epidemiology and Public Health (CIBERSP), Murcia, Spain
  3. 3Division of Community Health Sciences, St George's Hospital, University of London, London, UK
  1. Correspondence to Dr Gabriele Nagel, Institute of Epidemiology, Ulm University, Helmholtzstr. 22, Ulm 89081, Germany; gabriele.nagel{at}


Background The increasing prevalence of asthma and allergy might be related to diet, particularly in Western countries. A study was undertaken to assess the association between dietary factors, asthma and allergy in a large international study including objective measurements of atopy.

Methods Between 1995 and 2005, cross-sectional studies were performed in 29 centres in 20 countries. Parental questionnaires were used to collect information on allergic diseases and exposure factors and data from 50 004 randomly selected schoolchildren (8–12 years, 29 579 with skin prick testing) were analysed. Random effect models for meta-analysis were applied to calculate combined ORs.

Results Fruit intake was associated with a low prevalence of current wheeze in affluent (ORadj 0.86, 95% CI 0.73 to 1.02) and non-affluent countries (ORadj 0.71, 95% CI 0.57 to 0.88). Consumption of fish in affluent countries (ORadj 0.85, 95% CI 0.74 to 0.97) and of cooked green vegetables in non-affluent countries (ORadj 0.78, 95% CI 0.65 to 0.95) was associated with a lower prevalence of current wheeze. Overall, more frequent consumption of fruit, vegetables and fish was associated with a lower lifetime prevalence of asthma, whereas high burger consumption was associated with higher lifetime asthma prevalence. None of the food items was associated with allergic sensitisation. Except for fruit juice and fruit consumption, no associations were found with atopic wheeze. Food selection according to the ‘Mediterranean diet’ was associated with a lower prevalence of current wheeze and asthma ever (ptrend=0.03).

Conclusion Diet is associated with wheeze and asthma but not with allergic sensitisation in children. These results provide further evidence that adherence to the ‘Mediterranean diet’ may provide some protection against wheeze and asthma in childhood.

  • Diet
  • asthma
  • atopy
  • BHR
  • Mediterranean diet
  • asthma epidemiology
  • oxidative stress
  • paediatric asthma

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  • The ISAAC Phase Two Study group consists of: The ISAAC Phase Two Coordinating and Data Centre: S K Weiland† (Director), G Büchele, C Dentler, A Kleiner, P Rzehak, G Weinmayr (Institute of Epidemiology, Ulm University, Ulm, Germany).

    Principal investigators: A Priftanji, A Shkurti, J Simenati, E Grabocka, K Shyti, S Agolli, A Gurakuqi (Tirana, Albania); R T Stein, M Urrutia de Pereira, M H Jones, P M Pitrez (Uruguaiana, Brazil); P J Cooper, M Chico (Pichincha Province, Ecuador); Y Z Chen (Beijing, China); N S Zhong (Guangzhou, China); C K W Lai (National Coordinator), G W K Wong (Hong Kong, China); M-A Riikjärv, T Annus (Tallinn, Estonia); I Annesi-Maesano (Créteil, France); M Gotua, M Rukhadze, T Abramidze, I Kvachadze, L Karsanidze, M Kiladze, N Dolidze (Tbilisi, Georgia); W Leupold, U Keil, E von Mutius, S K Weiland† (Dresden, Germany); E von Mutius, U Keil, S K Weiland† (Munich, Germany); P Arthur†, E Addo-Yobo (Kintampo, Ghana); C Gratziou (National Coordinator), K Priftis, A Papadopoulou, C Katsardis (Athens, Greece); J Tsanakas, E Hatziagorou, F Kirvassilis (Thessaloniki, Greece); M Clausen (Reykjavik, Iceland); J R Shah, R S Mathur, R P Khubchandani, S Mantri (Mumbai, India); F Forastiere, R Di Domenicantonio, M De Sario, S Sammarro, R Pistelli, M G Serra, G Corbo, C A Perucci (Rome, Italy); V Svabe, D Sebre, G Casno, I Novikova, L Bagrade (Riga, Latvia); B Brunekreef, D Schram, G Doekes, P H N Jansen-van Vliet, N A H Janssen, F J H Aarts, G de Meer (Utrecht, The Netherlands); J Crane, K Wickens, D Barry (Hawkes Bay, New Zealand); W Nystad, R Bolle, E Lund (Tromsø, Norway); J Batlles Garrido, T Rubi Ruiz, A Bonillo Perales, Y Gonzalez Jiménez, J Aguirre Rodriguez, J Momblan de Cabo, A Losilla Maldonado, M Daza Torres (Almeria, Spain); L García-Marcos (National Coordinator), A Martinez Torres, J J Guillén Pérez, A Piñana López, S Castejon Robles (Cartagena, Spain); G García Hernandez, A Martinez Gimeno, A L Moro Rodríguez, C Luna Paredes, I Gonzalez Gil (Madrid, Spain); M M Morales Suarez-Varela, A Llopis González, A Escribano Montaner, M Tallon Guerola (Valencia, Spain); L Bråbäck (National Coordinator), M Kjellman, L Nilsson, X-M Mai (Linköping, Sweden); L Bråbäck, A Sandin (Östersund, Sweden); Y Saraçlar, S Kuyucu, A Tuncer, C Saçkesen, V Sumbulǒglu, P Geyik, C Kocabas, (Ankara, Turkey); D P Strachan, B Kaur (West Sussex, UK); N El-Sharif, B Nemery, F Barghuthy, S Abu Huij, M Qlebo (Ramallah, West Bank).

    ISAAC Steering Committee: N Aït-Khaled (Paris, France); H R Anderson and D P Strachan* (London, UK); C Flohr* and H Williams (Nottingham, UK); F Forastiere* (Rome, Italy); I Asher, P Ellwood, A Stewart and E Mitchell (Auckland, New Zealand); J Crane, N Pearce and R Beasley (Wellington, New Zealand); B Björkstén (Stockholm, Sweden); B Brunekreef* (Utrecht, The Netherlands); S Foliaki (Nuku'alofa, Kingdom of Tonga); L García-Marcos (Murcia, Spain); U Keil (Münster, Germany), E von Mutius* (Munich, Germany); S K Weiland*†, G Weinmayr* (Ulm, Germany); C K W Lai and G W K Wong (Hong Kong, China); J Mallol (Santiago, Chile); S Montefort (Naxxar, Malta); J Odhiambo (Nairobi, Kenya); C Robertson (Parkville, Australia).

    *Also members of the ISAAC Phase Two Steering Group. †Deceased.

  • Funding The coordination and central laboratory analyses of the European centres were funded by the Fifth Framework Programme of the European Commission (QLK4-CT-1999-01288). The agencies funding the field work are listed elsewhere.15

  • Competing interests None.

  • Ethics approval This study was conducted with local ethical committee approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.