Skip to main content
Thorax logoLink to Thorax
. 2003 Mar;58(3):231–236. doi: 10.1136/thorax.58.3.231

Nutrition and respiratory health in children in six Central and Eastern European countries

T Antova 1, S Pattenden 1, B Nikiforov 1, G Leonardi 1, B Boeva 1, T Fletcher 1, P Rudnai 1, H Slachtova 1, C Tabak 1, R Zlotkowska 1, D Houthuijs 1, B Brunekreef 1, J Holikova 1
PMCID: PMC1746605  PMID: 12612301

Abstract

Method: A total of 20 271 children aged 7–11 were surveyed in six European countries. Respiratory health and food intake were assessed using questionnaires. Associations between four symptoms and nutritional factors were evaluated using logistic regression, controlling for area plus other potential confounders.

Results: All symptoms showed initial associations with nutritional factors. Low consumption of fish and of summer and winter fruit were the most consistent predictors. In a fully adjusted model low fish intake remained a significant independent predictor of persistent cough (OR=1.18; 95% CI 1.04 to 1.34), wheeze ever (OR=1.14; 95% CI 1.03 to 1.25) and current wheeze (OR=1.21; 95% CI 1.06 to 1.39) and a weaker predictor of winter cough (OR=1.10; 95% CI 0.99 to 1.23). Low summer fruit intake was a predictor of winter cough (OR=1.40; 95% CI 1.10 to 1.79) and persistent cough (OR=1.35; 95% CI 1.01 to 1.82). Low winter fruit intake was associated with winter cough (OR=1.28; 95% CI 1.09 to 1.51). Associations between symptoms and vegetable intake were inconsistent. Low summer intake was significantly associated with winter cough (OR=1.23; 95% CI 1.03 to 1.47) but, overall, winter intake had inverse associations with both coughs. Associations between winter vegetable intake and wheeze varied considerably between countries.

Conclusion: A number of associations were found between respiratory symptoms and low intake of fish, fruit and vegetables in children. Low fish intake was the most consistent predictor of poor respiratory health. Fruit and vegetable intake showed stronger associations with cough than with wheeze.

Full Text

The Full Text of this article is available as a PDF (124.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Asher M. I., Keil U., Anderson H. R., Beasley R., Crane J., Martinez F., Mitchell E. A., Pearce N., Sibbald B., Stewart A. W. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J. 1995 Mar;8(3):483–491. doi: 10.1183/09031936.95.08030483. [DOI] [PubMed] [Google Scholar]
  2. Black P. N., Sharpe S. Dietary fat and asthma: is there a connection? Eur Respir J. 1997 Jan;10(1):6–12. doi: 10.1183/09031936.97.10010006. [DOI] [PubMed] [Google Scholar]
  3. Butland B. K., Strachan D. P., Anderson H. R. Fresh fruit intake and asthma symptoms in young British adults: confounding or effect modification by smoking? Eur Respir J. 1999 Apr;13(4):744–750. doi: 10.1034/j.1399-3003.1999.13d08.x. [DOI] [PubMed] [Google Scholar]
  4. Byers T., Trieber F., Gunter E., Coates R., Sowell A., Leonard S., Mokdad A., Jewell S., Miller D., Serdula M. The accuracy of parental reports of their children's intake of fruits and vegetables: validation of a food frequency questionnaire with serum levels of carotenoids and vitamins C, A, and E. Epidemiology. 1993 Jul;4(4):350–355. [PubMed] [Google Scholar]
  5. Carey I. M., Strachan D. P., Cook D. G. Effects of changes in fresh fruit consumption on ventilatory function in healthy British adults. Am J Respir Crit Care Med. 1998 Sep;158(3):728–733. doi: 10.1164/ajrccm.158.3.9712065. [DOI] [PubMed] [Google Scholar]
  6. Cook D. G., Carey I. M., Whincup P. H., Papacosta O., Chirico S., Bruckdorfer K. R., Walker M. Effect of fresh fruit consumption on lung function and wheeze in children. Thorax. 1997 Jul;52(7):628–633. doi: 10.1136/thx.52.7.628. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Dry J., Vincent D. Effect of a fish oil diet on asthma: results of a 1-year double-blind study. Int Arch Allergy Appl Immunol. 1991;95(2-3):156–157. doi: 10.1159/000235421. [DOI] [PubMed] [Google Scholar]
  8. Fawzi W., Herrera M. G., Nestel P. Tomato intake in relation to mortality and morbidity among Sudanese children. J Nutr. 2000 Oct;130(10):2537–2542. doi: 10.1093/jn/130.10.2537. [DOI] [PubMed] [Google Scholar]
  9. Forastiere F., Pistelli R., Sestini P., Fortes C., Renzoni E., Rusconi F., Dell'Orco V., Ciccone G., Bisanti L. Consumption of fresh fruit rich in vitamin C and wheezing symptoms in children. SIDRIA Collaborative Group, Italy (Italian Studies on Respiratory Disorders in Children and the Environment). Thorax. 2000 Apr;55(4):283–288. doi: 10.1136/thorax.55.4.283. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hijazi N., Abalkhail B., Seaton A. Diet and childhood asthma in a society in transition: a study in urban and rural Saudi Arabia. Thorax. 2000 Sep;55(9):775–779. doi: 10.1136/thorax.55.9.775. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hodge L., Salome C. M., Peat J. K., Haby M. M., Xuan W., Woolcock A. J. Consumption of oily fish and childhood asthma risk. Med J Aust. 1996 Feb 5;164(3):137–140. doi: 10.5694/j.1326-5377.1996.tb122010.x. [DOI] [PubMed] [Google Scholar]
  12. Hu F. B., Rimm E., Smith-Warner S. A., Feskanich D., Stampfer M. J., Ascherio A., Sampson L., Willett W. C. Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. Am J Clin Nutr. 1999 Feb;69(2):243–249. doi: 10.1093/ajcn/69.2.243. [DOI] [PubMed] [Google Scholar]
  13. La Vecchia C., Decarli A., Pagano R. Vegetable consumption and risk of chronic disease. Epidemiology. 1998 Mar;9(2):208–210. [PubMed] [Google Scholar]
  14. Maple C., McLaren M., Bancroft A., Ho M., Belch J. J. Dietary supplementation with omega 3 and omega 6 fatty acids reduces induced white blood cell aggregation in healthy volunteers. Prostaglandins Leukot Essent Fatty Acids. 1998 May;58(5):365–368. doi: 10.1016/s0952-3278(98)90072-2. [DOI] [PubMed] [Google Scholar]
  15. Miedema I., Feskens E. J., Heederik D., Kromhout D. Dietary determinants of long-term incidence of chronic nonspecific lung diseases. The Zutphen Study. Am J Epidemiol. 1993 Jul 1;138(1):37–45. doi: 10.1093/oxfordjournals.aje.a116775. [DOI] [PubMed] [Google Scholar]
  16. Morabia A., Sorenson A., Kumanyika S. K., Abbey H., Cohen B. H., Chee E. Vitamin A, cigarette smoking, and airway obstruction. Am Rev Respir Dis. 1989 Nov;140(5):1312–1316. doi: 10.1164/ajrccm/140.5.1312. [DOI] [PubMed] [Google Scholar]
  17. Powell W. S., Gravel S., Gravelle F. Formation of a 5-oxo metabolite of 5,8,11,14,17-eicosapentaenoic acid and its effects on human neutrophils and eosinophils. J Lipid Res. 1995 Dec;36(12):2590–2598. [PubMed] [Google Scholar]
  18. Sandham James Dean, Hull Russell Douglas, Brant Rollin Frederick, Knox Linda, Pineo Graham Frederick, Doig Christopher J., Laporta Denny P., Viner Sidney, Passerini Louise, Devitt Hugh. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003 Jan 2;348(1):5–14. doi: 10.1056/NEJMoa021108. [DOI] [PubMed] [Google Scholar]
  19. Smit H. A. Chronic obstructive pulmonary disease, asthma and protective effects of food intake: from hypothesis to evidence? Respir Res. 2001 Jul 9;2(5):261–264. doi: 10.1186/rr65. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Strachan D. P., Cox B. D., Erzinclioglu S. W., Walters D. E., Whichelow M. J. Ventilatory function and winter fresh fruit consumption in a random sample of British adults. Thorax. 1991 Sep;46(9):624–629. doi: 10.1136/thx.46.9.624. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Tabak C., Smit H. A., Räsänen L., Fidanza F., Menotti A., Nissinen A., Feskens E. J., Heederik D., Kromhout D. Dietary factors and pulmonary function: a cross sectional study in middle aged men from three European countries. Thorax. 1999 Nov;54(11):1021–1026. doi: 10.1136/thx.54.11.1021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Troisi R. J., Willett W. C., Weiss S. T., Trichopoulos D., Rosner B., Speizer F. E. A prospective study of diet and adult-onset asthma. Am J Respir Crit Care Med. 1995 May;151(5):1401–1408. doi: 10.1164/ajrccm.151.5.7735592. [DOI] [PubMed] [Google Scholar]
  23. Villani F., Comazzi R., De Maria P., Galimberti M. Effect of dietary supplementation with polyunsaturated fatty acids on bronchial hyperreactivity in subjects with seasonal asthma. Respiration. 1998;65(4):265–269. doi: 10.1159/000029274. [DOI] [PubMed] [Google Scholar]
  24. Weiss S. T. Diet as a risk factor for asthma. Ciba Found Symp. 1997;206:244–257. [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES