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a Department of
Epidemiology, Regional Health Authority, Lazio, Rome, Italy, b Department of Respiratory Physiology, Catholic
University, Rome, Italy, c Institute of Respiratory Diseases, University of
Siena, Siena, Italy, d Department
of Pediatrics, University of Milano, Milan, Italy, e Unit of Cancer Epidemiology, S. Giovanni B. Hospital and Center for Cancer Prevention (CPO)-Piemonte, Turin, Italy, f Department of Epidemiology,
Milano Health Authority, Milan, Italy
Correspondence to: Dr F Forastiere, Osservatorio Epidemiologico Regionale, Lazio, Via Santa Costanza 53, 00198 Roma, Italy email: oer.f.forastiere{at}agora.stm.it
Received 3 September 1999; Returned to authors 15 October 1999; Revised version received 5 January 2000; Accepted for publication 12 January 2000
BACKGROUND
A
beneficial effect of fresh fruit consumption on lung function has been
observed in several studies. The epidemiological evidence of the effect
on respiratory symptoms and asthma is limited. The consumption of fruit
rich in vitamin C was examined in relation to wheezing and other
respiratory symptoms in cross sectional and follow up studies of
Italian children.
METHODSStandardised
respiratory questionnaires were filled in by parents of 18 737
children aged 6-7 years living in eight areas of Northern and Central
Italy. The winter intake of citrus fruit and kiwi fruit by the children
was categorised as less than once per week, 1-2 per week, 3-4 per
week, and 5-7 per week. A subset of 4104 children from two areas was
reinvestigated after one year using a second parental questionnaire to
record the occurrence of wheezing symptoms over the intervening period.
RESULTSIn the cross
sectional analysis, after controlling for several confounders (sex,
study area, paternal education, household density, maternal smoking,
paternal smoking, dampness or mould in the child's bedroom, parental
asthma), intake of citrus fruit or kiwi fruit was a highly significant
protective factor for wheeze in the last 12 months (odds ratio (OR) = 0.66, 95% confidence intervals (CI) 0.55 to 0.78, for those eating
fruit 5-7 times per week compared with less than once per week),
shortness of breath with wheeze (OR = 0.68, 95% CI 0.56 to 0.84),
severe wheeze (OR = 0.59, 95% CI 0.40 to 0.85), nocturnal cough (OR = 0.73, 95% CI 0.65 to 0.83), chronic cough (OR = 0.75, 95% CI 0.65 to 0.88), and non-coryzal rhinitis (OR = 0.72, 95% CI 0.63 to 0.83). In
the follow up study fruit intake recorded at baseline was a strong and
independent predictor of all symptoms investigated except non-coryzal
rhinitis. In most cases the protective effect was evident even among
children whose intake of fruit was only 1-2 times per week and no
clear dose-response relationship was found. The effect was stronger
(although not significantly so (p = 0.13)) in subjects with a history
of asthma; those eating fresh fruit at least once a week experienced a
lower one year occurrence of wheeze (29.3%) than those eating fruit
less than once per week (47.1%) (OR = 0.46, 95% CI 0.27 to 0.81).
CONCLUSIONSAlthough
the effect of other dietary components cannot be excluded, it is
concluded that the consumption of fruit rich in vitamin C, even at a
low level of intake, may reduce wheezing symptoms in childhood,
especially among already susceptible individuals.
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