Skip to main content
PMC home page
Thorax logoLink to Thorax
. 2001 Nov;56(11):835–838. doi: 10.1136/thorax.56.11.835

Relation of body mass index to asthma and atopy in children: the National Health and Nutrition Examination Study III

E von Mutius 1, J Schwartz 1, L Neas 1, D Dockery 1, S Weiss 1
PMCID: PMC1745951  PMID: 11641506

Abstract

BACKGROUND—An increase in the prevalence of obesity and asthma over recent decades has been reported in affluent societies. Both overweight and obesity have been shown to be inversely related to having been breastfed, which is also a potential protective factor against childhood atopic diseases. The aim of this analysis was to explore the relation of body mass index (BMI) to asthma and atopy in a large representative sample of the United States population.
METHODS—Children aged 4-17 years were included in the NHANES III survey. Prevalences of atopic diseases and potential confounding factors such as exposure to environmental tobacco smoke, birth weight, breast feeding, and household size were assessed using structured interviews with parents. Height and weight were measured, and BMI was calculated as kg/m2 and transformed into Z scores. Children underwent skin prick tests for atopy to a battery of food and inhalant allergens.
RESULTS—The prevalence of asthma (8.7% v 9.3% v 10.3% v 14.9%, p=0.0001) and atopy (48.6% v 50.5% v 53.0% v 53.2%, p=0.05) rose significantly with increasing quartiles of BMI. After adjustment for confounders, a significant positive association between BMI and asthma remained (adjusted OR 1.77, 95% confidence interval 1.44 to 2.19 between the highest and lowest quartiles of BMI), whereas no independent relation between BMI and atopy was evident. No effect modification by sex or ethnic group was seen.
CONCLUSIONS—The effects of increased BMI on asthma may be mediated by mechanical properties of the respiratory system associated with obesity or by upregulation of inflammatory mechanisms rather than by allergic eosinophilic inflammation of the airway epithelium.



Full Text

The Full Text of this article is available as a PDF (114.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Camargo C. A., Jr, Weiss S. T., Zhang S., Willett W. C., Speizer F. E. Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. Arch Intern Med. 1999 Nov 22;159(21):2582–2588. doi: 10.1001/archinte.159.21.2582. [DOI] [PubMed] [Google Scholar]
  2. Chen Y., Dales R., Krewski D., Breithaupt K. Increased effects of smoking and obesity on asthma among female Canadians: the National Population Health Survey, 1994-1995. Am J Epidemiol. 1999 Aug 1;150(3):255–262. doi: 10.1093/oxfordjournals.aje.a009996. [DOI] [PubMed] [Google Scholar]
  3. Chinn S., Rona R. J. Trends in weight-for-height and triceps skinfold thickness for English and Scottish children, 1972-1982 and 1982-1990. Paediatr Perinat Epidemiol. 1994 Jan;8(1):90–106. doi: 10.1111/j.1365-3016.1994.tb00438.x. [DOI] [PubMed] [Google Scholar]
  4. Fredberg J. J., Inouye D. S., Mijailovich S. M., Butler J. P. Perturbed equilibrium of myosin binding in airway smooth muscle and its implications in bronchospasm. Am J Respir Crit Care Med. 1999 Mar;159(3):959–967. doi: 10.1164/ajrccm.159.3.9804060. [DOI] [PubMed] [Google Scholar]
  5. Gennuso J., Epstein L. H., Paluch R. A., Cerny F. The relationship between asthma and obesity in urban minority children and adolescents. Arch Pediatr Adolesc Med. 1998 Dec;152(12):1197–1200. doi: 10.1001/archpedi.152.12.1197. [DOI] [PubMed] [Google Scholar]
  6. Huang S. L., Shiao G., Chou P. Association between body mass index and allergy in teenage girls in Taiwan. Clin Exp Allergy. 1999 Mar;29(3):323–329. doi: 10.1046/j.1365-2222.1999.00455.x. [DOI] [PubMed] [Google Scholar]
  7. Jedrychowski W., Maugeri U., Flak E., Mroz E., Bianchi I. Predisposition to acute respiratory infections among overweight preadolescent children: an epidemiologic study in Poland. Public Health. 1998 May;112(3):189–195. doi: 10.1038/sj.ph.1900438. [DOI] [PubMed] [Google Scholar]
  8. Luder E., Melnik T. A., DiMaio M. Association of being overweight with greater asthma symptoms in inner city black and Hispanic children. J Pediatr. 1998 Apr;132(4):699–703. doi: 10.1016/s0022-3476(98)70363-4. [DOI] [PubMed] [Google Scholar]
  9. Negri E., Pagano R., Decarli A., La Vecchia C. Body weight and the prevalence of chronic diseases. J Epidemiol Community Health. 1988 Mar;42(1):24–29. doi: 10.1136/jech.42.1.24. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Oddy W. H., Holt P. G., Sly P. D., Read A. W., Landau L. I., Stanley F. J., Kendall G. E., Burton P. R. Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study. BMJ. 1999 Sep 25;319(7213):815–819. doi: 10.1136/bmj.319.7213.815. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Poskitt E. M., Cole T. J. Nature, nurture, and childhood overweight. Br Med J. 1978 Mar 11;1(6113):603–605. doi: 10.1136/bmj.1.6113.603. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Saarinen U. M., Kajosaari M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet. 1995 Oct 21;346(8982):1065–1069. doi: 10.1016/s0140-6736(95)91742-x. [DOI] [PubMed] [Google Scholar]
  13. Shaheen S. O., Sterne J. A., Montgomery S. M., Azima H. Birth weight, body mass index and asthma in young adults. Thorax. 1999 May;54(5):396–402. doi: 10.1136/thx.54.5.396. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Visser M., Bouter L. M., McQuillan G. M., Wener M. H., Harris T. B. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999 Dec 8;282(22):2131–2135. doi: 10.1001/jama.282.22.2131. [DOI] [PubMed] [Google Scholar]
  15. Wilkinson P. W., Parkin J. M., Pearlson J., Philips P. R., Sykes P. Obesity in childhood: A community study in Newcastle upon Tyne. Lancet. 1977 Feb 12;1(8007):350–352. doi: 10.1016/s0140-6736(77)91147-3. [DOI] [PubMed] [Google Scholar]
  16. Woolcock A. J., Peat J. K. Evidence for the increase in asthma worldwide. Ciba Found Symp. 1997;206:122-34; discussion 134-9, 157-9. doi: 10.1002/9780470515334.ch8. [DOI] [PubMed] [Google Scholar]
  17. von Kries R., Koletzko B., Sauerwald T., von Mutius E., Barnert D., Grunert V., von Voss H. Breast feeding and obesity: cross sectional study. BMJ. 1999 Jul 17;319(7203):147–150. doi: 10.1136/bmj.319.7203.147. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES