Original article
Mediterranean Diet as a Protective Factor for Wheezing in Preschool Children

https://doi.org/10.1016/j.jpeds.2008.01.003Get rights and content

Objective

To test the hypothesis that the Mediterranean diet can be a protective factor for current wheezing in preschoolers.

Study design

Questionnaires were completed by parents of 1784 preschoolers (mean age, 4.08 ± 0.8 years). Children were stratified according to whether they experienced wheezing (20.0%) or not in the previous year. A Mediterranean diet score was built according to the intake frequency of several foods.

Results

Age, birth by cesarean section, low birth weight, exposure to livestock during pregnancy, antibiotic use in the first year of life, acetaminophen consumption in the previous 12 months, rhinoconjunctivitis, eczema, parental asthma and tobacco consumption, maternal educational level, maternal age, physical activity, cat at home, and Mediterranean diet were associated with current wheezing but not with obesity. In the multivariate analysis, eczema, rhinoconjunctivitis, paternal asthma, and acetaminophen consumption remained risk factors for current wheezing (adjusted odds ratio [aOR] = 2.35 [95% confidence interval (CI) = 1.2 to 4.8], 2.78 [95% CI =1.3 to 6.1], 3.89 [95% CI = 1.4 to 10.7], and 2.38 [95% CI = 1.2 to 4.6], respectively). Conversely, Mediterranean diet and older age remained protective factors (aOR = 0.54 [95% CI = 0.3 to 0.9] and 0.67 [95% CI = 0.5 to 0.9], respectively).

Conclusions

The Mediterranean diet is an independent protective factor for current wheezing in preschoolers, irrespective of obesity and physical activity.

Section snippets

Methods

The study population comprised preschool-age children from the 3 major cities—Murcia, Cartagena, and Lorcain—in the province of Murcia in southeastern Spain. Because most preschool-age children attend school/kindergarten, all parents of children in a random sample of all primary schools (having preschool education) in each city were invited to participate. The number of schools included in the sample was that which allowed a sampling frame of 1000 children per city. All classes of the 2 grades

Statistical Analysis

Statistical analyses of the differences between the current wheezing and non–current wheezing groups were performed using the χ2 test for categorical variables, Student's t-test for continuous variables, and the Mann-Whitney U-test for ordinal variables. Odds ratios (ORs) and 95% confidence intervals (CIs) also were calculated. A multivariate logistic regression model was built using the presence of current wheezing as the dependent variable and those factors that were statistically significant

Results

Of the 2922 children invited to participate in the study, 1784 children completed the questionnaire (a 61% participation rate), and 1757 children (mean age, 4.08 ± 0.8 years; 48.8% male) answered the question regarding current wheezing status. In this group, the prevalence of current wheezing was 20.0% (n = 351). There were no significant sex differences between wheezing and nonwheezing children; however, there were slightly more Caucasians among the nonwheezing children. Children in the

Discussion

The present cross-sectional study suggests that the Mediterranean diet may be a protective factor for current wheezing in preschool-age children, independent of obesity and physical activity. This finding is in agreement with a recent study reported by our group in which Mediterranean diet was found to be a protective factor, and obesity a risk factor, for clinically significant asthma in 6- to 7-year-old Spanish females.18 In the present study, current wheezing was not associated with obesity

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