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a Department of
Community Medicine and Primary Health Care, Faculty of Medicine and
Allied Sciences, King Abdulaziz University, Jeddah, Saudi Arabia, b Department
of Environmental and Occupational Medicine, Aberdeen University Medical
School, Aberdeen AB25 2ZD, UK
Correspondence to: Professor A Seaton email: a.seaton{at}abdn.ac.uk
Received 3 March 2000; Returned to authors 28 April 2000; Revised version received 22 May 2000; Accepted for publication 12 June 2000
BACKGROUND
The causes
of the worldwide increases in asthma and allergic diseases in
childhood, which seem to relate to increasing prosperity, are unknown.
We have previously hypothesised that a reduction in the antioxidant
component of the diet is an important factor. An investigation was
undertaken of dietary and other risk factors for asthma in Saudi Arabia
where major lifestyle differences and prevalences of allergic disease
are found in different communities.
METHODSFrom a cross
sectional study of 1444 children with a mean age of 12 (SD 1) years in
Jeddah and a group of rural Saudi villages, we selected 114 cases with
a history of asthma and wheeze in the last 12 months and 202 controls
who had never complained of wheeze or asthma, as recorded on the ISAAC
questionnaire. Risk factors for asthma and allergies (family history,
social class, infections, immunisations, family size, and diet) were
ascertained by questionnaire. Atopy was assessed by skin prick testing.
RESULTSIn univariate
analyses, family history, atopy, and eating at fast food outlets were
significant risk factors for wheezy illness, as were the lowest intakes
of milk and vegetables and of fibre, vitamin E, calcium, magnesium,
sodium, and potassium. These differences were present also in the urban
children considered separately. Sex, family size, social class,
infections, and parental smoking showed no relationship to risk. In
multiple logistic regression analysis, urban residence, positive skin
tests, family history of allergic disease, and the lowest intakes of
vitamin E, magnesium and sodium related significantly and independently
to risk. The lowest tertile of intake of vitamin E was associated with
a threefold (95% CI 1.38 to 6.50) increase in risk when adjusted for
the other factors. Intake of milk and vegetables both showed inverse
linear relationships to being a case.
CONCLUSIONSThis study
suggests that dietary factors during childhood are an important
influence in determining the expression of wheezy illness, after
allowing for urban/rural residence, sex, family history, and atopy. The
findings are consistent with previous studies in adults and with the
hypothesis that change in diet has been a determinant of the worldwide
increases in asthma and allergies.
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