title: Influence of Mediterranean diet on asthma in children: a systematic review and meta-analysis.
abstract: BACKGROUND
  There is epidemiological evidence that Mediterranean diet exposure is associated with lower asthma prevalence in children. We aimed to summarize the available data and to know whether the Mediterranean setting modifies this association.
  
  
  METHODS
  The literature search, up to May 2012, was on epidemiological studies in the general population of children assessing whether adherence to Mediterranean diet (measured as a score) was associated with the prevalence of 'current wheeze'; 'current severe wheeze'; or 'asthma ever'. Odds ratios (OR) of the eight included studies compared the highest tertile of the score with the lowest. Random-effects meta-analyses for the whole group of studies and stratified by Mediterranean setting (centers <100 Km from the Mediterranean coast) were performed. Differences between strata were assessed using the Q test.
  
  
  RESULTS
  For 'current wheeze', there was a negative significant association with the highest tertile of Mediterranean diet score (OR 0.85, 95% CI 0.75-0.98; p = 0.02), driven by Mediterranean centers (0.79, 0.66-0.94, p = 0.009), although the difference with the non-Mediterranean centers (0.91, 0.78-1.05, p = 0.18) was not significant. The results for 'current severe wheeze' were as follows: 0.82, 0.55-1.22, p = 0.330 (all); 0.66, 0.48-0.90, p = 0.008 (Mediterranean); and 0.99, 0.79-1.25, p = 0.95 (non-Mediterranean); with the difference between regions being significant. For 'asthma ever', the associations were as follows: 0.86, 0.78-0.95, p = 0.004 (all); 0.86, 0.74-1.01, p = 0.06 (Mediterranean); 0.86, 0.75-0.98; p = 0.027 (non-Mediterranean); with the difference between regions being negligible.
  
  
  CONCLUSIONS
  Adherence to the Mediterranean diet tended to be associated with lower occurrence of the three respiratory outcomes. For current and current severe wheeze, the association was mainly driven by the results in Mediterranean populations.
authors.affiliation: Pediatric Respiratory and Allergy Units, 'Virgen de la Arrixaca' University Children's Hospital, University of Murcia, Murcia, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Garcia-Marcos
authors.forename: J A
authors.initials: JA
authors.lastname: Castro-Rodriguez
authors.forename: G
authors.initials: G
authors.lastname: Weinmayr
authors.forename: D B
authors.initials: DB
authors.lastname: Panagiotakos
authors.forename: K N
authors.initials: KN
authors.lastname: Priftis
authors.forename: G
authors.initials: G
authors.lastname: Nagel
mesh_terms: D000818:Animals; D001249:Asthma / Q000150:complications / Q000453:epidemiology*; D002648:Child; D038441:Diet, Mediterranean / Q000706:statistics & numerical data*; D006801:Humans; D015995:Prevalence; D012135:Respiratory Sounds / Q000209:etiology; D013030:Spain