Ultra-processed foods, Mediterranean diet and respiratory health in Italian schoolchildren
Abstract
Background: High consumption of ultra-processed foods (UPFs) is increasingly common in children and may impact respiratory health. Evidence on whether healthy diets can counterbalance these effects is limited.
Methods: In this cross-sectional study, we enrolled children from 5 schools in Northern Italy. A parental food frequency questionnaire enabled assessment of UPF intake and adherence to the Mediterranean diet (AMD; KIDMED index). Lung function and respiratory symptoms were assessed through spirometry and a standardised questionnaire. Mixed linear and logistic models, adjusted for age, sex, BMI, and smoke exposure (random intercept: school), were used and repeated, excluding asthmatic children.
Results: Overall, 315 children (8–11 years, 47% females) were included in a complete-case analysis. Greater UPF consumption was associated with poorer lung function, particularly FVC. Children in the lowest UPF tertile had higher FVC compared to those in the highest tertile. (β = 0.10 L, 95%CI 0.01 to 0.19, p = 0.031), with attenuation after excluding asthmatics (p = 0.065). Similar but weaker patterns were observed for FEV1 (p = 0.084 and p = 0.161, respectively). AMD alone was not associated with lung function. However, moderate adherence was associated with higher FVC and FEV1 among children with low-to-medium UPF intake (FVC β = 0.33 95%CI 0.12 to 0.55, p = 0.002; β = 0.27 95%CI 0.07 to 0.46, p = 0.007; FEV1 β = 0.21, 95%CI 0.02 to 0.40, p = 0.034; β = 0.22 95%CI 0.05 to 0.40, p = 0.014), suggesting a mitigation of the adverse effects of UPF consumption. Additionally, a 10% increase in UPF intake was associated with higher odds of snoring (OR = 1.38, 95%CI 1.06–1.79, p = 0.015), while higher AMD was protective (OR = 0.81, 0.71–0.94, p = 0.004).
Conclusions: High UPF intake may compromise respiratory health in children, while moderate AMD may mitigate these effects. Promoting healthy diets and reducing UPF intake in childhood could be an effective and scalable strategy for health prevention.
Key messages: • Ultra-processed food intake is associated with lower lung function in children.
• Moderate adherence to the Mediterranean diet may mitigate harms of ultra-processed foods.
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BibTeX
@article{squillacioti2026ultraprocessed,
title = {{Ultra-processed foods, Mediterranean diet and respiratory health in Italian schoolchildren}},
author = {G Squillacioti and S El Sherbiny and S Levra and R Bono},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1329},
url = {https://doi.org/10.1093/eurpub/ckag169.1329},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Ultra-processed foods, Mediterranean diet and respiratory health in Italian schoolchildren
AU - G Squillacioti
AU - S El Sherbiny
AU - S Levra
AU - R Bono
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1329
UR - https://doi.org/10.1093/eurpub/ckag169.1329
AB - Background: High consumption of ultra-processed foods (UPFs) is increasingly common in children and may impact respiratory health. Evidence on whether healthy diets can counterbalance these effects is limited. Methods: In this cross-sectional study, we enrolled children from 5 schools in Northern Italy. A parental food frequency questionnaire enabled assessment of UPF intake and adherence to the Mediterranean diet (AMD; KIDMED index). Lung function and respiratory symptoms were assessed through spirometry and a standardised questionnaire. Mixed linear and logistic models, adjusted for age, sex, BMI, and smoke exposure (random intercept: school), were used and repeated, excluding asthmatic children. Results: Overall, 315 children (8–11 years, 47% females) were included in a complete-case analysis. Greater UPF consumption was associated with poorer lung function, particularly FVC. Children in the lowest UPF tertile had higher FVC compared to those in the highest tertile. (β = 0.10 L, 95%CI 0.01 to 0.19, p = 0.031), with attenuation after excluding asthmatics (p = 0.065). Similar but weaker patterns were observed for FEV1 (p = 0.084 and p = 0.161, respectively). AMD alone was not associated with lung function. However, moderate adherence was associated with higher FVC and FEV1 among children with low-to-medium UPF intake (FVC β = 0.33 95%CI 0.12 to 0.55, p = 0.002; β = 0.27 95%CI 0.07 to 0.46, p = 0.007; FEV1 β = 0.21, 95%CI 0.02 to 0.40, p = 0.034; β = 0.22 95%CI 0.05 to 0.40, p = 0.014), suggesting a mitigation of the adverse effects of UPF consumption. Additionally, a 10% increase in UPF intake was associated with higher odds of snoring (OR = 1.38, 95%CI 1.06–1.79, p = 0.015), while higher AMD was protective (OR = 0.81, 0.71–0.94, p = 0.004). Conclusions: High UPF intake may compromise respiratory health in children, while moderate AMD may mitigate these effects. Promoting healthy diets and reducing UPF intake in childhood could be an effective and scalable strategy for health prevention. Key messages: • Ultra-processed food intake is associated with lower lung function in children. • Moderate adherence to the Mediterranean diet may mitigate harms of ultra-processed foods.
SN - 1101-1262
SN - 1464-360X
ER -