# Dietary Factors Affecting Asthma Outcomes among Asthmatic Children in California
## 4 Discussion  
The main regression finding from this study was that soda consumption (two or more servings per day) was positively associated with higher frequency of asthma symptoms (i.e., coughing, wheezing, and shortness of breath). Multiple logistic regression findings included soda consumption (two or more servings per day) being associated with higher frequency of asthma symptoms. On the other hand, consumption of at least two fruit servings per day showed a negative association with missing days at school due to asthma. Other research supports the findings of the present study. For example, an analysis of over 2000 children in the Dutch Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort found that asthma risk was increased among 11-year-old children who consumed high quantities (\(\geq\)10 glasses per week) of drinks with added sugar [13]. A similar trend was found among U.S. high school students, in which the odds of having current asthma were higher among those who drank regular soda at least 2 or more times per day compared to students who did not drink regular soda [14]. Increased consumption of sugar-sweetened beverages may indeed play a role in increasing asthma symptoms by promoting an inflammatory response of the airways, which can lead to wheezing and other respiratory problems [15]. Previous studies have demonstrated a positive relationship between consuming fast food and asthma risk. For instance, research by the International Study of Asthma and Allergies in Childhood (ISAAC) found that there was an increased risk of asthma and wheezing among a large sample of children and adolescents when consuming fast food at least 3 times per week [16]. Similarly, a systematic review of 16 studies (including 13 cross-sectional and 3 case control studies) found that consumption of fast food was significantly related to current and severe asthma risk [17]. Therefore, poor quality of diet associated with fast food consumption may contribute to increased asthma risk among children related to an exacerbation of the airways, which can reduce a parent's belief in their ability to manage their child's condition effectively. The present study did not find significant associations between asthma outcomes and dietary measures such as fast food, french fries, and highly sugary foods. Others have shown that Taiwanese children with energy-dense/nutrient-poor foods and dietary practices were more likely to have current asthma (OR = 2.42, 95% CI: 1.19-4.93) and current severe asthma (OR = 3.21, 95% CI: 1.11-9.25) [18]. High-fat and -sugar snacks were included in their analysis; however, soda was excluded due to it not being a part of their typical diet. Fruit was observed through this study to have protective effects on asthma outcomes. A recent randomized control trial on the DASH (Dietary Approach to Stop Hypertension) diet showed efficacy to improve asthma control in adults. After 6 months on the DASH diet, there were clinically significant improvements in the participants' overall well-being reflected by their scores on Asthma Control Questionnaire (ACQ) and Mini Asthma-specific Quality of Life Questionnaire (MiniAQLQ) [19]. In addition, there have been multiple studies on the Mediterranean diet and its association with decreased symptoms related to wheeze and cough [20]. It is understood that establishing healthy lifestyle practices and dietary habits prevent long-term health consequences. Previous research found that increased fast-food accessibility in a child's neighborhood was significantly associated with decreased fruit and vegetable consumption. In addition, younger children were found to drink more juice than older children and the mother's education level played a significant role on the children's consumption of sweets, juice, and milk [21]. Older children, especially those between 9 and 10 years old, were less likely to have asthma symptoms, visit the ED, take asthma medications, and miss days at school due to asthma.