Elsevier

Annals of Epidemiology

Volume 15, Issue 3, March 2005, Pages 207-213
Annals of Epidemiology

Margarine Consumption, Asthma, and Allergy in Young Adults: Results of the German National Health Survey 1998

https://doi.org/10.1016/j.annepidem.2004.04.004Get rights and content

Purpose

To examine whether frequent intake of margarine is associated with allergy prevalence in adults using data of a representative national health survey.

Methods

Data on 7124 subjects aged 18 to 79 years were obtained from the German National Health Survey 1998. Confounder-adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated by multiple logistic regression, using the frequency of intake of low-fat butter, regular and low-fat margarine as explanatory variable in relation to frequent intake of regular butter as reference group.

Results

Frequent intake of margarine of any kind was positively associated with current asthma during the past 12 months in young adults aged 18 to 29 years (aOR, 2.33; 95% CI, 1.03–5.26). In subgroup analysis, the positive association was confined to frequent intake of low-fat margarine (4.51; 1.78–11.43) or the combination of low-fat margarine and low-fat butter (4.79; 1.84–12.44). Consumption of margarine of any kind was not related to hay fever, atopic dermatitis, and atopic sensitization to inhalant allergens.

Conclusions

Frequent intake of margarine rich in n-6 PUFA is not consistently associated with allergic diseases in adults. Other constituents of low-fat margarine or certain dietary habits and lifestyle factors, characterized by use of low-fat margarine, may be related to current asthma.

Introduction

To explain the increase in allergic diseases during the past decades in those countries with a Western lifestyle, several hypotheses have been proposed. One states that the increase in consumption of polyunsaturated fatty acids (PUFA) might contribute to the observed increase in allergic diseases 1, 2. Especially, a high intake of n-6 in relation to n-3 PUFA by increased consumption of, e.g., vegetable oil and margarine would enhance the production of IgE by the formation of arachidonic acid-derived eicosanoids and thus promote the development of allergic diseases 3, 4, 5.

Evidence from epidemiologic studies is increasing that consumption of PUFA in the form of an increased ratio of n-6 to n-3 may in fact play a role in allergy development in children. In a cross-sectional study in children aged 3 to 5 years, a high dietary intake of n-6 PUFA, defined as use of polyunsaturated fats on bread and in cooking, was associated with an increased risk of recent asthma (6). Studies on n-3 PUFA further supported the hypothesis: Hodge et al. (7) reported a reduced asthma risk in children consuming oily fish rich in n-3 PUFA and an intervention study showed a reduction in the prevalence of wheeze in 18-month old infants supplemented with dietary n-3 PUFA (8).

Data on the impact of fat consumption and allergy in adults are still rare and conflicting. No relation between the intake of n-3 PUFA and the incidence of asthma in adult women has been observed in a cohort study (9). However, the intake of n-6 PUFA has been shown to be positively related to allergic rhinoconjunctivitis in women (10). In an ecological analysis of data of the European Community Respiratory Health Survey (ECRHS) intake of monounsaturated fatty acids, but not of PUFA, was positively associated with prevalence of allergic sensitization in adults (11).

Since the assessment of nutritional intake of fatty acids is difficult, several studies in children concentrated on the impact of margarine and butter as surrogate marker. The rationale behind it was that margarine may contain up to 10 to 20 times more n-6 PUFA than butter (10).

Cross-sectional studies in Germany among schoolchildren demonstrated a positive association between margarine consumption and the prevalence of hay fever and atopic sensitization 12, 13. The potential adverse effect of margarine intake was also supported by a study of Dunder et al. (14) in Finland where children with an allergic disease had used less butter and consumed more margarine.

Up to now, the effect of margarine intake on allergic diseases in adults has not been studied. Thus, the aim of our study was to analyze the association of allergic diseases with intake of butter and margarine in adults using data from a representative national sample. Use of butter or margarine as bread spread is common in Germany. Therefore, we used frequency of butter and margarine intake as a surrogate marker for intake of different types of fat and different amounts of polyunsaturated fatty acids.

If n-6 PUFA interfere with T-cell differentiation and IgE production, we assume that the effect would be more pronounced in younger age groups at early stages of the pathogenesis.

Against the background of several studies in children we hypothesized that a potential association between frequent intake of margarine rich in n-6 PUFA and allergic diseases should be still detectable in young adults.

Section snippets

Study design

The German National Health Survey 1998 was a cross-sectional study performed between October 1997 and March 1999. The study population comprised 7124 subjects (response rate 61%) aged 18 to 79 years (52% women) of a representative sample of the residential population with regard to age, gender, and community size (15).

Data collection

In the main part of the survey, a self-administered questionnaire, interview by a physician, and medical examination were used to obtain data on disease prevalences, risk factors,

Results

Characteristics of the study subjects are given in Table 1. The body mass index was slightly lower in the youngest age group (mean ± SD 24.0 ± 4.0 kg/m2) compared with the whole study population (mean ± SD 26.7 ± 4.6 kg/m2). Prevalence of obesity defined as body mass index ⩾ 30 kg/m2 was low in that age group (8.0%) compared with study subjects aged 30 to 39 years (13.7%) and 40 to 79 years (27.3%).

Women reported more frequently than men to ever having had hay fever (16.6% vs. 14.3%, p = 0.014)

Discussion

Our results based on data of a representative population sample in Germany showed that young adults eating frequently low-fat margarine alone or in combination with low-fat butter had increased odds for asthma, but not for hay fever, atopic dermatitis and allergic sensitization.

The strengths of our study lie in the representativeness of the study population and in the large sample size. Since we had to rely on self-reported data on allergic diseases, we applied several definitions for current

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