Dietary sugar and soft drink consumption in relation to atopic disease in children: evidence from the Polish global asthma network study

Abstract Background Dietary sugars, particularly sugar rich foods and beverages, have been implicated in the pathogenesis of allergic diseases, but epidemiological evidence in children remains inconsistent. Objective To examine associations between dietary sugar intake from snacks and soft drinks and atopic outcomes across multiple disease definitions in a large pediatric population. Methods A cross-sectional analysis was conducted using data from the Polish arm of the Global Asthma Network (GAN) study ( n = 4,647; ages 6–15 years). Dietary exposures, including frequency of sugary snack and soft drink consumption, were assessed using standardized questionnaires. Outcomes were categorized as current symptoms (wheeze, rhinitis, rhinoconjunctivitis, eczema), lifetime (“ever”) outcomes, and doctor-diagnosed disease. Results Overall, 546 participants (12.2%) reported low sugary snack consumption, 1,827 (40.7%) consumed sugary snacks once or twice per week, and 2,113 (47.1%) reported consumption most or all days. For soft drinks, 1,889 participants (41.8%) reported low intake, 1,661 (36.8%) moderate intake, and 969 (21.4%) high intake. Sugary snack intake was not associated with current symptom-based outcomes. However, high sugary snack consumption was associated with increased odds of lifetime hay fever (aOR 1.42, 95% CI 1.12–1.80) and eczema (aOR 1.72, 95% CI 1.20–2.46), with weaker and inconsistent associations for doctor-diagnosed outcomes. In contrast, soft drink intake was inversely associated with allergic outcomes, including hay fever and eczema, but was positively associated with current wheeze (aOR 1.48, 95% CI 1.08–2.02). Female sex and traffic exposure were consistently associated with higher odds of current symptoms. Conclusions Dietary sugar exposures are differentially associated with pediatric atopic disease depending on outcome definition. Positive associations with lifetime outcomes, alongside null findings for current symptoms and inverse associations for soft drinks, suggest a complex interplay of biological and behavioural factors, including reverse causation. Longitudinal and biomarker-based studies are needed to clarify causal pathways.