The obesity-asthma link in different ages and the role of Body Mass Index in its investigation: findings from the Genesis and Healthy Growth Studies
ABSTRACT To date, an obesity/asthma link is well defined in adults; however, the nature of such a link is obscure in children, partly due to Body Mass Index (BMI) limitations as a surrogate fat mass marker in childhood. We thus opted to investigate the association of adiposity with asthma in children of different ages, using several indices to assess fat mass.
Wheeze ever/in the last 12 months (current) and physician-diagnosed asthma were retrospectively reported via questionnaire by the parents of 3641 children, participating in two cross-sectional studies: 1626 children aged 2-5 (the Genesis Study) and 2015 children aged 9-13 (the Healthy Growth Study). Perinatal data were recorded from the children's medical records or reported by parents. Anthropometric measurements (i.e., BMI, waist/hip circumference, biceps/triceps/subscapular/suprailiac skinfold thickness) were conducted in both cohorts; bioelectric impedance analysis (BIA) was conducted only in preadolescent children.
In children aged 2-5, asthma was positively correlated with conicity index, waist/hip circumference, waist-to-height ratio, skinfold thickness, and skinfold-derived percentage fat mass (P < 0.05) but not BMI or BMI-defined overweight/obesity, after adjusting for several confounders. In children aged 9-13, asthma was positively associated with conicity index, waist circumference, waist-to-height ratio, skinfold thickness, skinfold-derived percentage fat mass, BIA-derived percentage fat mass, BMI, and BMI-defined overweight/obesity, following adjustment (P < 0.05). Current/ever wheeze was not consistently associated with fat mass in either population.
Fat mass is positively linked to asthma in both 2-5 and 9-13 age spans. However, the failure of BMI to correlate with preschool asthma suggests its potential inefficiency in asthma studies at this age range.
Full-textDOI: · Available from: George Moschonis, Jun 02, 2015
SourceAvailable from: Erkka Valovirta
Article: Allergy and asthma prevention 2014[Show abstract] [Hide abstract]
ABSTRACT: Asthma and allergic diseases have become one of the epidemics of the 21st century in developed countries. Much of the success of other areas of Medicine, such as infectious diseases, lies on preventive measures. Thus, much effort is also being placed lately in the prevention of asthma and allergy. This manuscript reviews the current evidence, divided in four areas of activity. Interventions modifying environmental exposure to allergens have provided inconsistent results, with multifaceted interventions being more effective in the prevention of asthma. Regarding nutrition, the use of hydrolysed formulas in high risk infants reduces the incidence of atopic dermatitis, while there is for now not enough evidence to recommend other dietary modifications, prebiotics, probiotics, or other microbial products. Pharmacologic agents used until now for prevention have not proved useful, while there is hope that antiviral vaccines could be useful in the future. Allergen-specific immunotherapy is effective for the treatment of allergic patients with symptoms; the study of its value for primary and secondary prevention of asthma and allergy is in its very preliminary phases. The lack of success in the prevention of these disorders lies on their complexity, which involves many genetic, epigenetic and environmental interactions. There is a need to identify target populations, involved mechanisms and interactions, and the best interventions. These must be effective, feasible, implementable and affordable.This article is protected by copyright. All rights reserved.Pediatric Allergy and Immunology 09/2014; 25(6). DOI:10.1111/pai.12272 · 3.86 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: It has been claimed that overweight/obesity and childhood asthma and wheezing disorders are associated, although the results of observational studies have remained inconsistent. We conducted a systematic review and meta-analysis to investigate this. An online search of published papers linking childhood asthma and wheezing with overweight/obesity up to May 2014 using EMBASE and Medline medical research databases was carried out. Summary odds ratios (OR) were estimated using random-effects models. Sub-group meta-analyses were performed to assess the robustness of risk associations and between-study heterogeneity. A total of 38 studies comprising 1,411,335 participants were included in our meta-analysis. The summary ORs of underweight (<5(th) percentile), overweight (>85(th) to <95(th) percentile), and obesity (≥95(th) percentile) were 0.85 (95% CI: 0.75 to 0.97; P=0.02), 1.23 (95% CI: 1.17 to 1.29; p<0.001), and 1.46, (95% CI: 1.36 to 1.57, P<0.001) respectively. Heterogeneity was significant and substantial in all three weight categories, and not accounted for by predefined study characteristics. Our results suggest that underweight is associated with a reduced risk of childhood asthma, and overweight and obesity are associated with an increased risk of childhood asthma. Although our findings assert that overweight/obesity and childhood asthma are associated, the causal pathway and temporal aspects of this relationship remain unanswered and deserve further epidemiological investigation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.Pediatric Allergy and Immunology 12/2014; 26(1). DOI:10.1111/pai.12321 · 3.86 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Both obesity and asthma are highly prevalent, complex diseases modified by multiple factors. Genetic, developmental, lung mechanical, immunological and behavioural factors have all been suggested as playing a causal role between the two entities, however their complex mechanistic interactions are still poorly understood and evidence of causality in children remains scant. Equally lacking is evidence of effective treatment strategies, despite the fact that imbalances at vulnerable phases in childhood can impact long-term health. This review is targeted at both clinicians frequently faced with the dilemma of how to investigate and treat the obese asthmatic child and researchers interested in the topic. Highlighting the breadth of the spectrum of factors involved, this review collates evidence regarding the investigation and treatment of asthma in obese children, particularly in comparison to current approaches in ‘difficult-to-treat’ childhood asthma. Finally, the authors propose hypotheses for future research from a systems-based perspective.This article is protected by copyright. All rights reserved.Allergy 09/2014; DOI:10.1111/all.12525 · 6.00 Impact Factor