Abstract: ObjectiveTo systematically review the association between high fat diet (HFD) and asthma or recurrent wheezing in children. MethodsThe inclusion participants were from communities, schools or medical institutions with the exposure factor of the high fat diet(HFD). Observational studies (cross-sectional and cohort studies) assessing the outcome of asthma or recurrent wheezing were included. The databases of PubMed, Embase, Clinical trials, Central, Web of Science, VIP, Wanfang Data and CNKI up to April 1, 2018 were searched for the relevant studies. Two authors performed the literature screening, data extraction and methodological quality evaluation. Using the Newcastle-Ottawa Scale (NOS) for cohort study and Agency for Healthcare Research and Quality(AHRQ) for cross-sectional study. The meta-analysis was conducted by the Stata 12.0 software. ResultsThe final 12 observational studies with 17 622 participants, ranging from 3 to 17 years old, were included. The included studies contained 9 cross-sectional studies (5 articles in 8 points, 3 articles in 7 points and 1 article in 6 points with AHRQ) and 3 cohort studies (2 articles in 8 points and 1 article in 7 points with NOS). ①The risk of pediatric asthma with HFD was significantly 78% higher than non-HFD (OR=1.78, 95%CI: 1.44-2.21, P＜0.001, adjusted by sensitivity analysis). Pediatric asthma had a significant association with the dietary pattern of western diet (OR=1.79, 95%CI: 1.28-2.51), and with the individual high-fat foods(OR=1.86, 95%CI: 1.26-2.68).②The risk of recurrent wheezing with HFD in children was significantly 33% higher than non-HFD (OR=1.33, 95%CI: 1.16~1.51, P＜0.001, adjusted by sensitivity analysis). The test of publication bias using Egger's regression method showed the absence of publication bias in included studies. ConclusionThe HFD was significantly associated with asthma and recurrent wheezing in children.