The meta-analysis14 excluded six studies for the following reasons: three studies derived dietary patterns a posteriori,32,41,43 one measured lung function as the lone outcome,33 and two34,35 reported data published in other studies that were included in the meta-analysis. The limited additional studies on dietary patterns and child asthma or wheeze precluded another meta-analysis. Among these six studies, five found either a beneficial effect of the Mediterranean diet or a detrimental effect of an unhealthy (eg, Western) pattern. Interestingly, one study reported that the Mediterranean diet was a risk factor for severe asthma in girls aged 6–7 years.35 The authors speculated this could be due to a reverse causal effect (families of children with severe asthma may improve their diet) and residual confounding.