Introduction: Dietary intake of specific nutrients or food groups during pregnancy could play a role in the risk of asthma and atopy in offspring, but specific dietary patterns have not been implicated. The authors evaluated the impact of maternal (during pregnancy) and child adherence to a Mediterranean diet on asthma and atopy in childhood. Methods: Women presenting for antenatal care at all general practices in Menorca, a Mediterranean island in Spain, over a 12 month period starting in mid-1997 were recruited. 460 children were included in the analysis after 6.5 years of follow-up. Maternal dietary intake during pregnancy and children's dietary intake at age 6.5 years were assessed by food frequency questionnaires, and adherence to a Mediterranean diet was evaluated by a priori defined scores. During follow-up, parents completed questionnaires on the child's respiratory and allergic symptoms. Children underwent skin prick tests with six common aeroallergens. Results: The prevalence rates of persistent wheeze, atopic wheeze and atopy at age 6.5 years were 13.2%, 5.8% and 17.0%, respectively. One-third (36.1%) of mothers had a low quality Mediterranean diet during pregnancy according to the Mediterranean Diet Score, while the rest had a high score. A high Mediterranean Diet Score during pregnancy (at two levels, using ''low'' score as the reference) was found to be protective for persistent wheeze (OR 0.22; 95% CI 0.08 to 0.58), atopic wheeze (OR 0.30; 95% CI 0.10 to 0.90) and atopy (OR 0.55; 95% CI 0.31 to 0.97) at age 6.5 years after adjusting for potential confounders. Childhood adherence to a Mediterranean diet was negatively associated with persistent wheeze and atopy although the associations did not reach statistical significance. Conclusion: These results support a protective effect of a high level of adherence to a Mediterranean diet during pregnancy against asthma-like symptoms and atopy in childhood.

1Background Children born preterm or with a small-size-for-gestational-age are at increased 2

Epidemiological studies have shown inverse associations of asthma symptoms with fish, vegetable, and fruit intake. We evaluated the association between several dietary factors with wheeze and atopy among children in Menorca, a Spanish Mediterranean island. A cross-sectional analysis was performed on 460 children at age 6.5 yr. Parents completed a questionnaire on the child's respiratory and allergic symptoms, and a 96-item food frequency questionnaire. Children underwent skin prick tests with six common aeroallergens. The average daily intake was relatively high for fruits (177 g) and fish (54 g), and moderate for vegetables (59 g). A high consumption (>40 g/day) of fruity vegetables (tomatoes, eggplants, cucumber, green beans, zucchini) was found to have beneficial effect on current wheeze [odds ratio (OR), 0.38; 95% confidence interval (CI), 0.15-0.95, p < 0.05], and atopic wheeze with a significant decreasing trend when intake was increased (OR, 0.19; 95% CI, 0.04-0.95, p for trend = 0.04). No other fruits or vegetables were significantly associated with wheeze or atopy prevalence. An inverse association was found between a fish intake > or =60 g/day and atopy (OR, 0.43; 95% CI, 0.21-0.90, p < 0.05). The associations remained significant after adjustment for energy intake and maternal diet during pregnancy. Our results support a potential protective effect of fruity vegetables and fish intake during childhood on wheeze and atopy respectively.

Dose-response relationships between allergen exposure and sensitization or asthma may be allergen specific and nonlinear; a minimum threshold level is needed to induce sensitization, but no dose-response relationship exists above this level. The effect of a particular allergen seems to be similar on atopy and asthma inception.