Am. J. Respir. Crit. Care Med., Vol 154, No. 2, 08 1996, 537-540.
The effect of lifestyle on wheeze, atopy, and bronchial hyperreactivity in Asian and white children
OJ Carey, JB Cookson, J Britton and AE Tattersfield
Department of Medicine, Glenfield General Hospital, Leicester, United Kingdom.
There is increasing evidence linking Western culture to increasing
prevalence of asthma. We have measured the prevalence of symptoms of
asthma, bronchial hyperreactivity, and atopy in a sample of white and Asian
inner city schoolchildren aged 8-11 yr in the U.K. and assessed the
influence of certain aspects of western culture on these variables.
Bronchial reactivity was measured by methacholine challenge, atopy by
allergen skin prick tests, and symptoms of asthma and aspects of lifestyle
by questionnaire. Degree of Westernization was assessed from dietary habit
categorized as exclusively Asian, mostly Asian, mixed, or exclusively
English. The questionnaire was completed by 92% of children. The 308 white
and 539 Asian children were of similar age (mean 9.3 yr versus 9.4 yr) with
slightly more girls in the Asian group (52.6% versus 47.4%). The white
children reported more wheeze within the past year (14.2% versus 8.8%, p =
0.01) but less were atopic (29.5% versus 38.4%, p = 0.01) with no
significant difference in the prevalence of hyperreactivity (31.5% versus
29.6%, p = 0.57). Most Asians (97%) included Asian food in their diet; 35%
ate a mostly Asian diet, 45% ate a mixed English and Asian diet, and 17%
ate an exclusively Asian diet. After controlling for confounding factors
whites were at higher risk of hyperreactivity and lower risk of atopy, and
the risk of hyperreactivity and to a lesser extent atopy among Asian
children was related to diet in a dose response fashion. The relative odds
for hyperreactivity with an exclusively Asian, mostly Asian, or a mixed
diet relative to an English diet were 0.31 (95% CI 0.15 to 0.62), 0.88
(0.56 to 1.37), and 0.99 (0.65 to 1.49), and for atopy were 1.22 (0.72 to
2.06), 1.47 (0.99 to 2.19), and 1.78 (1.23 to 2.58). These results suggest
that diet or other closely related factors associated with Westernization
are involved in the etiology of atopy and hyperreactivity.
