{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T22:53:08Z","timestamp":1793055188772,"version":"4.5.0"},"reference-count":53,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007771","name":"Medical University of Silesia","doi-asserted-by":"publisher","award":["BNW-1-021\/K\/5\/I"],"award-info":[{"award-number":["BNW-1-021\/K\/5\/I"]}],"id":[{"id":"10.13039\/100007771","id-type":"DOI","asserted-by":"publisher"}]},{"award":["BNW-1-021\/K\/5\/I"],"award-info":[{"award-number":["BNW-1-021\/K\/5\/I"]}],"id":[{"id":"https:\/\/ror.org\/005k7hp45","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Mechanistic evidence increasingly implicates fructose exposures as contributors to the development and exacerbation of asthma and other atopic diseases. Proposed mechanisms include gut dysbiosis, impaired epithelial barrier integrity in the gut and airways, metabolic endotoxemia, and amplification of type 2 immune responses. However, epidemiologic findings linking fructose intake with asthma and atopic disorders remain heterogeneous. Objective: To conduct a review of epidemiologic studies evaluating associations between dietary fructose-containing exposures and atopic outcomes in pediatric populations. Methods: A systematic search of PubMed and Embase identified cohort, case-control, cross-sectional, and randomized feeding studies assessing fructose exposure in relation to asthma and atopic outcomes in pediatric populations. Eligibility screening, data extraction, and risk-of-bias assessment were conducted by one reviewer and confirmed by the other. Results: Seventeen epidemiologic studies met criteria. Multiple cohorts (e.g., BRISA, PIAMA) reported modest to moderate associations between higher sugar-sweetened beverage (SSB) intake and pediatric asthma or \u201casthma traits.\u201d Cross-sectional analyses from NHANES and the National Children\u2019s Study showed stronger associations, with greater fructose exposures linked to two- to five-fold higher odds of asthma. High fructose beverage consumption demonstrated the most consistent positive associations. Large ISAAC-based studies reported largely null findings, reflecting broad dietary exposure categories and limited specificity for fructose-rich beverages. Evidence for rhinitis, eczema, and sensitization was directionally consistent. Conclusions: Despite heterogeneity, the convergence of mechanistic plausibility with epidemiologic signals supports a potential contributory role of high fructose exposure in pediatric atopic disease. More rigorous longitudinal studies with biomarker-based exposure assessment are needed to refine causal inference.<\/jats:p>","DOI":"10.3390\/nu18071057","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T13:48:41Z","timestamp":1774532921000},"page":"1057","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Fructose-Containing Dietary Exposures and Pediatric Atopic Disease: A Review of Epidemiologic Evidence"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1548-3564","authenticated-orcid":false,"given":"Charles","family":"Prendergast","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-751 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0106-9662","authenticated-orcid":false,"given":"Kamil","family":"Bara\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-751 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2102866","DOI":"10.1183\/13993003.02866-2021","article-title":"The burden of asthma, hay fever and eczema in children in 25 countries: GAN Phase I study","volume":"60","author":"Pearce","year":"2022","journal-title":"Eur. Respir. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/S2213-2600(25)00003-7","article-title":"Global, regional, and national burden of asthma and atopic dermatitis, 1990\u20132021, and projections to 2050: A systematic analysis of the Global Burden of Disease Study 2021","volume":"13","author":"Oh","year":"2025","journal-title":"Lancet Respir. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.rmed.2017.11.001","article-title":"An international comparison of asthma, wheeze, and breathing medication use among children","volume":"133","author":"Lawson","year":"2017","journal-title":"Respir. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"119","DOI":"10.5588\/ijtld.24.0331","article-title":"Asthma and allergies in schoolchildren: Data from the European SINPHONIE study","volume":"29","author":"Sarno","year":"2025","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Bro\u017cek, G., Lawson, J., Shpakou, A., Fedortsiv, O., Hryshchuk, L., Rennie, D., and Zejda, J. (2016). Childhood asthma prevalence in Belarus, Ukraine, and Poland: BUPAS study. BMC Pulm. Med., 16.","DOI":"10.1186\/s12890-016-0172-x"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1111\/all.15560","article-title":"Frequency of food allergy in Europe: An updated systematic review and meta-analysis","volume":"78","author":"Spolidoro","year":"2022","journal-title":"Allergy"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2547","DOI":"10.1016\/j.jaip.2023.05.016","article-title":"Epidemiology of Allergic Rhinitis in Children: A Systematic Review and Meta-Analysis","volume":"11","author":"Licari","year":"2023","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2004173","DOI":"10.1183\/13993003.04173-2020","article-title":"Diagnosis of asthma in children aged 5\u201316 years: ERS guidelines","volume":"58","author":"Gaillard","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100128","DOI":"10.1016\/j.advnut.2023.10.001","article-title":"Effects of early diet on allergic diseases: A meta-analysis","volume":"15","author":"Wang","year":"2023","journal-title":"Adv. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1183\/09031936.95.08030483","article-title":"International study of asthma and allergies in childhood (ISAAC): Rationale and methods","volume":"8","author":"Asher","year":"1995","journal-title":"Eur. Respir. J."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Acevedo, N., Alashkar Alhamwe, B., Caraballo, L., Ding, M., Ferrante, A., Garn, H., Garssen, J., Hii, C.S., Irvine, J., and Llin\u00e1s-Caballero, K. (2021). Perinatal and Early-Life Nutrition, Epigenetics, and Allergy. Nutrients, 13.","DOI":"10.3390\/nu13030724"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Zhang, P. (2023). The Role of Diet and Nutrition in Allergic Diseases. Nutrients, 15.","DOI":"10.3390\/nu15173683"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ma, X., Nan, F., Liang, H., Shu, P., Fan, X., Song, X., Hou, Y., and Zhang, D. (2022). Excessive intake of sugar: An accomplice of inflammation. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.988481"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e04698-22","DOI":"10.1128\/spectrum.04698-22","article-title":"Disruption of the Intestinal Mucosal Barrier Induced by High Fructose and Restraint Stress Is Regulated by the Intestinal Microbiota and Microbiota Metabolites","volume":"11","author":"Yu","year":"2023","journal-title":"Microbiol. Spectr."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Merkiel, S. (2014). Dietary intake in 6-year-old children from southern Poland: Part 1\u2014Energy and macronutrient intakes. BMC Pediatr., 14.","DOI":"10.1186\/1471-2431-14-197"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Keshavarz, F., Zeinalabedini, M., Ebrahimpour-Koujan, S., and Azadbakht, L. (2024). A systematic review and meta-analysis of the association of all types of beverages high in fructose with asthma in children and adolescents. BMC Nutr., 10.","DOI":"10.1186\/s40795-024-00930-1"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1042\/bj3600265","article-title":"Dietary and developmental regulation of intestinal sugar transport","volume":"360","author":"Ferraris","year":"2001","journal-title":"Biochem. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1152\/physrev.00019.2009","article-title":"Metabolic Effects of Fructose and the Worldwide Increase in Obesity","volume":"90","author":"Tappy","year":"2010","journal-title":"Physiol. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E227","DOI":"10.1152\/ajpendo.90245.2008","article-title":"Regulation of the fructose transporter GLUT5 in health and disease","volume":"295","author":"Douard","year":"2008","journal-title":"Am. J. Physiol.\u2014Endocrinol. Metab."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Sim\u00f5es, C.D., Sousa, A.S., Fernandes, S., and Sarmento, A. (2025). Fructose Malabsorption, Gut Microbiota and Clinical Consequences: A Narrative Review of the Current Evidence. Life, 15.","DOI":"10.3390\/life15111720"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"10186","DOI":"10.1074\/jbc.M117.796631","article-title":"Lipopolysaccharide (LPS)-binding protein stimulates CD14-dependent Toll-like receptor 4 internalization and LPS-induced TBK1\u2013IKK\u03f5\u2013IRF3 axis activation","volume":"293","author":"Tsukamoto","year":"2018","journal-title":"J. Biol. Chem."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Frati, F., Salvatori, C., Incorvaia, C., Bellucci, A., Di Cara, G., Marcucci, F., and Esposito, S. (2018). The Role of the Microbiome in Asthma: The Gut\u2013Lung Axis. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20010123"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Dora, D., Sz\u0151cs, E., So\u00f3s, \u00c1., Halasy, V., Somodi, C., Mihucz, A., Rost\u00e1s, M., M\u00f3gor, F., Lohinai, Z., and Nagy, N. (2024). From bench to bedside: An interdisciplinary journey through the gut-lung axis with insights into lung cancer and immunotherapy. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1434804"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.2147\/JAA.S528965","article-title":"Research Progress on Glycolysis in the Pathogenesis of Asthma","volume":"18","author":"Luo","year":"2025","journal-title":"J. Asthma Allergy"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1111\/cei.13299","article-title":"High fructose-induced metabolic changes enhance inflammation in human dendritic cells","volume":"197","author":"Jaiswal","year":"2019","journal-title":"Clin. Exp. Immunol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1016\/j.jaci.2024.07.023","article-title":"Microbial intestinal dysbiosis drives long-term allergic susceptibility by sculpting an ILC2-B1 cell\u2013innate IgE axis","volume":"154","author":"Kabil","year":"2024","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"230014","DOI":"10.1098\/rsob.230014","article-title":"Short chain fatty acids: Key regulators of the local and systemic immune response in inflammatory diseases and infections","volume":"13","author":"Ney","year":"2023","journal-title":"Open Biol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2316","DOI":"10.1016\/j.cmet.2021.09.004","article-title":"\u201cSweet death\u201d: Fructose as a metabolic toxin that targets the gut-liver axis","volume":"33","author":"Febbraio","year":"2021","journal-title":"Cell Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.chest.2016.10.008","article-title":"Asthma Metabolomics and the Potential for Integrative Omics in Research and the Clinic","volume":"151","author":"Kelly","year":"2017","journal-title":"Chest"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"109080","DOI":"10.1016\/j.jnutbio.2022.109080","article-title":"Fructose-mediated NLRP3 activation induces inflammation and lipogenesis in adipose tissue","volume":"107","author":"Singh","year":"2022","journal-title":"J. Nutr. Biochem."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s12072-020-10121-2","article-title":"How does hepatic lipid accumulation lead to lipotoxicity in non-alcoholic fatty liver disease?","volume":"15","author":"Geng","year":"2021","journal-title":"Hepatol. Int."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Hern\u00e1ndez-D\u00edazcouder, A., Gonz\u00e1lez-Ram\u00edrez, J., Sanchez, F., Leija-Mart\u00ednez, J.J., Mart\u00ednez-Coronilla, G., Amezcua-Guerra, L.M., and S\u00e1nchez-Mu\u00f1oz, F. (2022). Negative Effects of Chronic High Intake of Fructose on Lung Diseases. Nutrients, 14.","DOI":"10.3390\/nu14194089"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"226","DOI":"10.3945\/an.112.002998","article-title":"Fructose: It\u2019s \u201cAlcohol Without the Buzz\u201d","volume":"4","author":"Lustig","year":"2013","journal-title":"Adv. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/S2352-4642(22)00185-7","article-title":"Obesity-related asthma in children and adolescents","volume":"6","author":"Kaviany","year":"2022","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1159\/000512920","article-title":"Obesity Can Contribute to Severe Persistent Allergic Rhinitis in Children Through Leptin and Interleukin-1\u03b2","volume":"182","author":"Han","year":"2021","journal-title":"Int. Arch. Allergy Immunol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/j.jaci.2011.01.063","article-title":"Association between obesity and atopic dermatitis in childhood: A case-control study","volume":"127","author":"Silverberg","year":"2011","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Muniz, A.K.O.A., Vianna, E.O., Padilha, L.L., Nascimento, J.X.P.T., Batista, R.F.L., Barbieri, M.A., Bettiol, H., and Ribeiro, C.C.C. (2023). Sugar-Sweetened Beverages and Allergy Traits at Second Year of Life: BRISA Cohort Study. Nutrients, 15.","DOI":"10.3390\/nu15143218"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1111\/pai.13243","article-title":"Pathways in the association between sugar sweetened beverages and child asthma traits in the 2nd year of life: Findings from the BRISA Cohort","volume":"31","author":"Padilha","year":"2020","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1513\/AnnalsATS.201707-530OC","article-title":"Prenatal and Early Life Fructose, Fructose-Containing Beverages, and Midchildhood Asthma","volume":"15","author":"Wright","year":"2018","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1080\/02770903.2021.1895210","article-title":"Association between asthma and sugar-sweetened beverage consumption in the United States pediatric population","volume":"59","author":"Xie","year":"2021","journal-title":"J. Asthma"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s12937-020-00578-0","article-title":"Excess free fructose, apple juice, high fructose corn syrup and childhood asthma risk\u2014The National Children\u2019s Study","volume":"19","author":"DeChristopher","year":"2020","journal-title":"Nutr. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1038\/ejcn.2014.153","article-title":"Associations of sugar-containing beverages with asthma prevalence in 11-year-old children: The PIAMA birth cohort","volume":"69","author":"Berentzen","year":"2015","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"101877","DOI":"10.1016\/j.pmedr.2022.101877","article-title":"The association of pure fruit juice, sugar-sweetened beverages and fruit consumption with asthma prevalence in adolescents growing up from 11 to 20 years: The PIAMA birth cohort study","volume":"28","author":"Scheffers","year":"2022","journal-title":"Prev. Med. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Saadeh, D., Salameh, P., Caillaud, D., Charpin, D., De Blay, F., Kopferschmitt, C., Lavaud, F., Annesi-Maesano, I., Baldi, I., and Raherison, C. (2015). Prevalence and association of asthma and allergic sensitization with dietary factors in schoolchildren: Data from the french six cities study. BMC Public Health, 15.","DOI":"10.1186\/s12889-015-2320-2"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1017\/S1368980015000865","article-title":"Intakes of apple juice, fruit drinks and soda are associated with prevalent asthma in US children aged 2\u20139 years","volume":"19","author":"DeChristopher","year":"2016","journal-title":"Public Health Nutr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/j.1399-3038.2010.01013.x","article-title":"Dietary intake in adolescents with asthma\u2014Potential for improvement","volume":"22","author":"Bueso","year":"2011","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1136\/thx.2009.128256","article-title":"Effect of diet on asthma and allergic sensitisation in the International Study on Allergies and Asthma in Childhood (ISAAC) Phase Two","volume":"65","author":"Nagel","year":"2010","journal-title":"Thorax"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2435","DOI":"10.1017\/S1368980015003109","article-title":"The potential link between sugar-sweetened beverage consumption and post-exercise airway narrowing across puberty: A longitudinal cohort study","volume":"19","author":"Emerson","year":"2016","journal-title":"Public Health Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e79\u201382","DOI":"10.2500\/ajra.2016.30.4293","article-title":"Prevalence of Rhinitis and Associated Factors in Schoolchildren who Live in the Amazon Islands","volume":"30","author":"Freitas","year":"2016","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1089\/ped.2020.1157","article-title":"Dietary Factors Associated with Asthma Prevalence Among Children in California","volume":"33","author":"Reis","year":"2020","journal-title":"Pediatr. Allergy Immunol. Pulmonol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1111\/pai.12911","article-title":"Associations of ultra-processed food and drink products with asthma and wheezing among Brazilian adolescents","volume":"29","author":"Melo","year":"2018","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s13312-015-0561-x","article-title":"Association between dietary habits and asthma severity in children","volume":"52","author":"Silveira","year":"2015","journal-title":"Indian Pediatr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1159\/000539518","article-title":"Association of Soda Drinks and Fast Food with Allergic Diseases in Korean Adolescents: A Nationwide Representative Study","volume":"185","author":"Jeong","year":"2024","journal-title":"Int. Arch. Allergy Immunol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/7\/1057\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T15:56:35Z","timestamp":1775058995000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/7\/1057"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,26]]},"references-count":53,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["nu18071057"],"URL":"https:\/\/doi.org\/10.3390\/nu18071057","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,26]]}}}