Effects of the affinity to the Mediterranean diet pattern together with breastfeeding on the incidence of childhood asthma and other inflammatory and recurrent diseases

Main Article Content

Fernando M. Calatayud-Sáez https://orcid.org/0000-0002-1205-5725
Blanca Calatayud
Monica Luque
Ana Calatayud
JG Gallego
Francisco Rivas-Ruiz


childhood asthma, dietary awareness, dietary intervention, inflammatory disease, the Mediterranean diet


Introduction There is an increasing amount of data relating the dietetic pattern to health variables, although data concerning the child population are scarce. The aim of the study was to assess the effects of affinity to the Traditional Mediterranean Diet (TMD) pattern, together with breastfeeding, on the incidence of childhood asthma and other inflammatory and recurrent diseases (IRD) in children under 2 years of age.

Methods Single-group intervention study evaluating differences in results according to degree of adherence to TMD recommendations. According to their adhesion to the TMD-Breastfed Test, patients were classified into two groups: Group 1 (with greater adherence) and Group 2 (with less adherence). The incidence of childhood asthma and IRD was evaluated and compared with both groups.

Results The score of the TMD-Breastfed Test was optimal in Group 1 and good in Group 2. It shows a marked reduction in both consultation groups “on request” compared with “planned,” with low morbidity and low use of antibiotics. The incidence of infectious diseases and recurrent bacterial complications shows a clinically relevant difference between both groups. The incidence of childhood asthma was greater and statistically significant in Group 2, with less adherence to breastfeeding.

Conclusions In these cohorts of breastfed patients with good adherence to TMD patterns, there was evidence of a low incidence of childhood asthma and the IRD, more pronounced in the highest adherence Group 1. Some non-TMD foods have been linked to the occurrence of childhood asthma and IRD, as their dietary limitations have contributed to decreasing morbidity.

Abstract 942 | PDF Downloads 718 HTML Downloads 184 XML Downloads 7


1. Galilea-Zabalza I, Buil-Cosiales P, Salas-Salvadó J, Toledo E, Ortega-Azorín C, Díez-Espino J, et al. Mediterranean diet and quality of life: baseline cross-sectional analysis of the PREDIMED-PLUS trial. PLoS One. 2018;13(6):e0198974. 10.1371/journal.pone.0198974

2. Trichopoulou A, Martínez-González MA, Tong TY, Forouhi NG, Khandelwal S, Prabhakaran D, et al. Definitions and potential health benefits of the Mediterranean diet: views from experts around the world. BMC Med. 2014;12:112. 10.1186/1741-7015-12-112

3. Sexton P, Negro P, Metcalf P, Wall CR, Ley S, Wu L, et al. Influence of Mediterranean diet on asthma symptoms, lung function, and systemic inflammation: a randomised controlled trial. J Asthma. 2014;50(1):75–81. 10.3109/02770903.2012.740120

4. García-Marcos L, Castro Rodríguez JA, Weinmayr G, Panagiotakos DB, Priftis KN, Nagel G. Influence of Mediterranean diet on asthma in children: a systematic review and meta-analysis. Pediatr Allergy Immunol. 2013;24:330–338. 10.1111/pai.12071

5. González-Gil EM, Tognon G, Lissner L, Intemann T, Pala V, Galli C, et al. IDEFICS Consortium. Prospective associations between dietary patterns and high sensitivity C-reactive protein in European children: the IDEFICS study. Eur J Nutr. 2017 Mar 18. 10.1007/s00394-017-1419-x

6. González-Gil EM, Santabárbara J, Russo P, Ahrens W, Claessens M, Lissner L, et al. Food intake and inflammation in European children: the IDEFICS study. Eur J Nutr. 2016 Dec;55(8):2459–2468. 10.1007/s00394-015-1054-3

7. Espín-Jaime B, Díaz J, Blesa L, Claver A, Hernández A, García JI, et al. Allergy to cow’s milk proteins not mediated by IgE: consensus document of the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP). An Pediatr (Engl Ed). 2019 Mar;90(3):193.e1–193.e11. 10.1016/j.anpedi.2018.11.007

8. García-Mérida MJ, Espín-Jaime B. Allergy to cow’s milk proteins not mediated by IgE. In: AEPap (ed.), 2020 Pediatrics Update Congress. Madrid: Lúa Ediciones 3.0; 2020. p. 239–245. https://www.aepap.org/sites/default/files/documento/archivos-adjuntos/congreso2020/239-246_Alergia%20a%20las%20prote%C3%ADnas%20de%20la%20leche.pdf

9. Fox A, Brown T, Walsh J, Venter C, Meyer R, Nowak-Wegrzyn A, et al. An update to the milk allergy in primary care guideline. Clin Transl Allergy. 2019;9:40. 10.1186/s13601-019-0281-8

10. Lucendo AJ, Molina-Infante J, Arias A, von Arnim U, Bredenoord AJ, Bussmann C, et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. Unit Eur Gastroenterol J. 2017;5:335–358. 10.1177/2050640616689525

11. Catassi C, Alaedini A, Bojarski C, Bonaz B, Bouma G, Carroccio A, et al. The overlapping area of non-celiac gluten sensitivity (NCGS) and wheat-sensitive irritable bowel syndrome (IBS): an update. Nutrients. 2017;9:pii: E1268. 10.3390/nu9111268

12. Calatayud-Sáez FM, Calatayud B, Gallego JG, González-Martín C, Alguacil Merino LF. Mediterranean diet and childhood asthma. Allergol Immunopathol. 2016;44(2):99–105. 10.1016/j.aller.2015.04.007

13. Calatayud-Sáez FM, Calatayud B, Gallego JG, González-Martín C, Alguacil Merino LF. Effects of Mediterranean diet in patients with recurring colds and frequent complications. Allergol Immunpathol. Sep-Oct 2017;45(5):427–424. 10.1016/j.aller.2016.08.006

14. Calatayud-Sáez FM, Calatayud B, Calatayud A. Effects of the traditional Mediterranean diet in patients with otitis media with effusion. Nutrients. 2021;13:2181. 10.3390/nu13072181

15. Elorza FL, Rubio N, Lizaso M, Malagón F, Dorado ME. Standardization of the histamina liberation test. Allergol Immunopathol. 1982;10:221–228. https://pubmed.ncbi.nlm.nih.gov/6183962/

16. Gimeno-Navarro A. Breastfeeding Committee of the AEP. Breastfeeding in figures: rates of initiation and duration of breastfeeding in Spain and in other countries. Year of edition. 2017. http://www.aeped.es/sites/default/files/documentos/201602-lactancia-materna-cifras.pdf

17. WHO. Childhood overweight and obesity. Commission to end childhood obesity. Facts and figures on childhood obesity. https://www.who.int/end-childhood-obesity/facts/es/

18. Del Castillo-Aguas A, Gallego-Iborra A, Gutiérrez-Olid M, Pérez-González O, Moreno-Muñoz G, Ledesma-Albarrán JM. Infectious morbidity and resource use in children under 2 years old at childcare centres. J Paediatr Child Health. 2017;53(2):116–122. 10.1111/jpc.13372

19. Domínguez-Aurrecoechea B, Fernández M, Ordóñez MÁ, López P, Pérez JL, Merino L, et al. Infectious diseases and use of health care resources in children less than 2 years-old who attend kindergarten. An Pediatr (Barc). 2015;83(3):149–159. 10.1016/j.anpedi.2014.10.008

20. Ordoñez-Alonso MA, Domínguez-Aurrecoechea B, Pérez-Candás JL, López-Villar P, Fernández-Francés M, Coto-Fuente M, et al. Influence of daycare attendance on attendance at Emergency and Primary Care. Rev Pediatr Aten Primaria. 2016;18:243–252. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1139-76322016000300005

21. Chonmaitree T, Trujillo R, Jennings K, Alvárez-Fernández P, Patel JA, Loeffelholz MJ, et al. Acute otitis media and other complications of viral respiratory infection. Pediatrics. 2016;137(4):e20153555. 10.1542/peds.2015-3555. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811317/

22. Toivonen L, Schuez-Havupalo L, Karppinen S, Teros-Jaakkola T, Rulli M, Mertsola J, et al. Rhinovirus infections in the first 2 years of life. Pediatrics. 2016;138(3):e20161309. 10.1542/peds.2016-1309

23. Kaur R, Morris M, Pichichero ME. Epidemiology of acute otitis media in the post pneumococcal conjugate vaccine era. Pediatrics. 2017;140(3):e20170181. 10.1542/peds.2017-0181

24. Brennan-Jones CG, Eikelboom RH, Jacques A, Swanepoel D, Atlas MD, Whitehouse AJ, et al. Protective benefit of predominant breastfeeding against otitis media may be limited to early childhood: results from a prospective birth cohort study. Clin Otolaryngol. 2017;42(1):29–37. 10.1111/coa.12652

25. Brennan-Jones CG, Whitehouse A, Park J, Hegarty M, Jacques A, Eikelboom RH, et al. Prevalence and risk factors for parent-reported recurrent otitis media during early childhood in the Western Australian Pregnancy Cohort (Raine) study. J Paediatr Child Health. 2015;51(4):403–409. 10.1111/jpc.12741

26. Working group of the Clinical Practice Guide on Childhood Asthma. Clinical practice guide on childhood asthma. Clinical Practice Guidelines in the SNS. Ministry of Health, Social Services and Equality; 2015. http://www.guiasalud.es/GPC/GPC_548_Asma_infantil_Osteba_compl.pdf [access 16 April 2020].

27. Von Berg A, Filipiak-Pittroff B, Kramer U, Hoffmann B, Link E, Beckmann C, et al. Allergies in high-risk schoolchildren after early intervention with cow’s milk protein hydrolysates: 10-year results from the German Infant Nutritional Intervention (GINI) study. J Allergy Clin Immunol. 2013;131:1565–1573. 10.1016/j.jaci.2013.01.006

28. Alwarith J, Kahleova H, Crosby L, et al. The role of nutrition in asthma prevention and treatment. Nutr Rev. 2020:nuaa005. 10.1093/nutrit/nuaa005

29. Differding MK, Benjamin-Neelon SE, Hoyo C, Østbye T, Mueller NT. Timing of complementary feeding is associated with gut microbiota diversity and composition and short chain fatty acid concentrations over the first year of life. BMC Microbiol. 2020;20(1):56. 10.1186/s12866-020-01723-9

30. Layhadi JA, Samji MH. Uncovering the immunological properties of isolated lymphoid follicles. Allergy. 2020;00:1–2. 10.1111/all.14598

31. Rezende RM, Weiner HL. History and mechanisms of oral tolerance. Semin Immunol. 2017;30:3–11. 10.1016/j.smim.2017.07.004

32. Hachimura S, Totsuka M, Hosono A. Immunomodulation by food: impact on gut immunity and immune cell function. Biosci Biotechnol Biochem. 2018;82(4):584–599. 10.1080/09168451.2018.1433017

33. Meslier V, Laiola M, Roager HM, De Filippis F, Roume H, Quinquis B, et al. Mediterranean diet intervention in overweight and obese subjects lowers plasma cholesterol and causes changes in the gut microbiome and metabolome independently of energy intake. Gut. 2020 Feb 19. Pii: gutjnl-2019-320438. 10.1136/gutjnl-2019-320438

34. Domínguez-Andrés J, Netea MG. Impact of historic migrations and evolutionary processes on human immunity. Trends Immunol. 2019. 10.1016/j.it.2019.10.001

35. Salas-Salvadó J, García P, Sánchez JM. Food and nutrition through history. Editorial Glosa S.L.; 2005. ISBN 84-7429-257-3. www.editorialglosa.es https://www.iberlibro.com/servlet/BookDetailsPL?bi=30100048293&cm_sp=plp-_-9788474292572-_-used

36. Campbell TC, Campbell TM. The China study. Cap. 11–12. BenBella Books, Inc. 10300 N. Central Expressway; 2012. https://www.socakajak-klub.si/mma/The=China=Study.pdf/20111116065942/

37. Calder PC, Carr AC, Gombart AF, Eggersdorfer M. Optimal nutritional status for a well-functioning immune system is an important factor to protect against viral infections. Nutrients. 2020;12:1181. 10.3390/nu12041181

38. Calatayud-Sáez FM, Calatayud B, Calatayud A. Persistent nasal obstruction: an expression of the pro-inflammatory state? Sinusitis. 2021;5:90–100. 10.3390/sinusitis5010010

39. Calatayud-Sáez FM, Calatayud B, Calatayud A. Effects of the traditional Mediterranean diet in childhood recurrent acute Rhinosinusitis. Sinusitis. 2021;5(2):101–115. 10.3390/sinusitis5020011