title: Protective effect of fruits, vegetables and the Mediterranean diet on asthma and allergies among children in Crete.
abstract: BACKGROUND
  Atopy is not uncommon among children living in rural Crete, but wheeze and rhinitis are rare. A study was undertaken to examine whether this discrepancy could be attributed to a high consumption of fresh fruit and vegetables or adherence to a traditional Mediterranean diet.
  
  
  METHODS
  A cross-sectional survey was performed in 690 children aged 7-18 years in rural Crete. Parents completed a questionnaire on their child's respiratory and allergic symptoms and a 58-item food frequency questionnaire. Adherence to a Mediterranean diet was measured using a scale with 12 dietary items. Children underwent skin prick tests with 10 common aeroallergens.
  
  
  RESULTS
  80% of children ate fresh fruit (and 68% vegetables) at least twice a day. The intake of grapes, oranges, apples, and fresh tomatoes-the main local products in Crete-had no association with atopy but was protective for wheezing and rhinitis. A high consumption of nuts was found to be inversely associated with wheezing (OR 0.46; 95% CI 0.20 to 0.98), whereas margarine increased the risk of both wheeze (OR 2.19; 95% CI 1.01 to 4.82) and allergic rhinitis (OR 2.10; 95% CI 1.31 to 3.37). A high level of adherence to the Mediterranean diet was protective for allergic rhinitis (OR 0.34; 95% CI 0.18 to 0.64) while a more modest protection was observed for wheezing and atopy.
  
  
  CONCLUSIONS
  The results of this study suggest a beneficial effect of commonly consumed fruits, vegetables and nuts, and of a high adherence to a traditional Mediterranean diet during childhood on symptoms of asthma and rhinitis. Diet may explain the relative lack of allergic symptoms in this population.
authors.affiliation: Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
authors.forename: Leda
authors.initials: L
authors.lastname: Chatzi
authors.forename: Gianna
authors.initials: G
authors.lastname: Apostolaki
authors.forename: Ioannis
authors.initials: I
authors.lastname: Bibakis
authors.forename: Isabel
authors.initials: I
authors.lastname: Skypala
authors.forename: Vasilki
authors.initials: V
authors.lastname: Bibaki-Liakou
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tzanakis
authors.forename: Manolis
authors.initials: M
authors.lastname: Kogevinas
authors.forename: Paul
authors.initials: P
authors.lastname: Cullinan
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000517:prevention & control; D002648:Child; D003430:Cross-Sectional Studies; D038441:Diet, Mediterranean; D005260:Female; D005638:Fruit; D006115:Greece; D006801:Humans; D006967:Hypersensitivity / Q000517:prevention & control*; D008297:Male; D012044:Regression Analysis; D012423:Rural Health; D012882:Skin Tests; D014675:Vegetables