Introduction: Food allergy has become increasingly common in early childhood, yet the reasons behind this rise are still not fully understood. Although genetic factors are important, the rapid increase in prevalence suggests that early life environmental exposures also play a role. Maternal diet during pregnancy has gained attention as a potential influence on immune development in early life. The Mediterranean Diet, characterised by high consumption of plant-based foods and olive oil and lower intake of processed foods, has been linked to beneficial immune and inflammatory outcomes. However, evidence linking maternal adherence to the Mediterranean Diet during pregnancy with food allergy in early childhood remains limited, particularly in Mediterranean populations. This PhD aimed to explore the association between maternal Mediterranean Diet adherence during pregnancy and food allergy in children aged 0-3 years in Cyprus, as well as to examine the impact of food allergy on family quality of life. Methods: Two systematic reviews were conducted to synthesise the existing evidence. The first examined adherence to the Mediterranean Diet and allergic outcomes, including a meta- analysis, while the second focused on individual components of the Mediterranean Diet in 3 relation to food allergy. A sequential mixed-methods study was then undertaken. The quantitative phase examined associations between maternal diet and food allergy in 269 mother–child pairs (100 with food allergy, 169 non-allergic). Maternal diet during pregnancy was assessed using a validated Mediterranean Diet score and a food frequency questionnaire. Family quality of life was measured using the Food Allergy Quality of Life Questionnaire – Parent Form, translated and culturally adapted into Greek. Logistic regression analyses examined associations between maternal diet, background characteristics, and food allergy outcomes. The qualitative phase subsequently explored lived experiences and psychosocial pathways underlying these associations through semi-structured interviews with 12 mothers of children with food allergy, analysed using thematic analysis. Results: Higher adherence to the Mediterranean dietary pattern during pregnancy was associated with lower odds of food allergy in early childhood. Protective associations were most consistently observed for dietary patterns related to fat quality, including higher olive oil intake and lower consumption of sugary foods and beverages. Although associations were not uniform across all dietary components, the findings suggest that overall dietary quality during pregnancy may be relevant to food allergy risk. Male sex, family history of food allergy, and urban residence were independently associated with food allergy. Quality of life findings showed substantial parental emotional burden, particularly anxiety around food preparation, social situations, and accidental exposure. Interviews highlighted constant vigilance, challenges in childcare and social settings, and a lack of practical and consistent guidance. Conclusions: Maternal dietary patterns during pregnancy, embedded within everyday Mediterranean food practices, were associated with food allergy development in early childhood alongside strong non-dietary risk factors. Food allergy was also associated with significant psychosocial burden for families in cultural settings where shared meals and food-centred social interactions are central to daily life. These findings highlight the importance of approaches considering both biological pathways and cultural and social contexts in which food choices and family routines occur.
The Effect of the Mediterranean Diet During Pregnancy on Food Allergies in Infants and Toddlers in Cyprus - Identifier: 6743
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