title: Per capita sugar consumption is associated with severe childhood asthma: an ecological study of 53 countries.
abstract: OBJECTIVE
  To examine the ecological association between population asthma symptom prevalence in six to seven year-old children and per capita sugar consumption seven years earlier (during the perinatal period).
  
  
  METHODS
  The asthma data (from the International Study of Asthma and Allergies in Childhood [ISAAC] study) were collected between 1999 and 2004 from 53 countries, and per capita sugar consumption data (seven years before the asthma prevalence) were extracted from United Nations Food and Agriculture (UNFAO) food balance sheets. Linear regression and Spearman's rank coefficient were used to evaluate the relationship between exposure and disease outcome.
  
  
  RESULTS
  Per capita sugar consumption varied more than six fold-between countries. A log-linear relationship was found between severe asthma symptoms (%) and per capita added sugar consumption in kg/capita/year (exponentiated beta coefficient 1.020; 95% CI 1.005 to 1.034; P = 0.012). Spearman's rank correlation coefficient was 0.34 (P= 0.015), which indicates moderate correlation.
  
  
  CONCLUSIONS
  We have demonstrated an ecological association between sugar consumption during the perinatal period and subsequent risk of severe asthma symptoms in six and seven year-olds.
authors.affiliation: Section of Epidemiology and Biostatistics, School of Population Health, Tamaki Campus, University of Auckland, Auckland, New Zealand. s.thornley@auckland.ac.nz
authors.forename: Simon
authors.initials: S
authors.lastname: Thornley
authors.forename: Alistair
authors.initials: A
authors.lastname: Stewart
authors.forename: Roger
authors.initials: R
authors.lastname: Marshall
authors.forename: Rod
authors.initials: R
authors.lastname: Jackson
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D015331:Cohort Studies; D016001:Confidence Intervals; D004040:Dietary Carbohydrates / Q000009:adverse effects*; D004463:Ecology; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution
chemical_list: D004040:Dietary Carbohydrates