Abstract
Background: Obesity may be associated with an increase in asthma and atopy in children. If so, the effect could be due to an effect of obesity on lung volume and thus airway hyperresponsiveness.
Methods: Data from 5993 caucasian children aged 7–12 years from seven epidemiological studies performed in NSW were analysed. Subjects were included if data were available for height, weight, age, skin prick test results to a common panel of aeroallergens, and a measure of airway responsiveness. History of doctor diagnosed asthma, wheeze, cough, and medication use was obtained by questionnaire. Recent asthma was defined as a doctor diagnosis of asthma ever and wheeze in the last 12 months. Body mass index (BMI) percentiles, divided into quintiles per year age, were used as a measure of standardised weight. Dose response ratio (DRR) was used as a measure of airway responsiveness. Airway hyperresponsiveness was defined as a DRR of ⩾8.1. Adjusted odds ratios were obtained by logistic regression.
Results: After adjusting for atopy, sex, age, smoking and family history, BMI was a significant risk factor for wheeze ever (OR = 1.06, p = 0.007) and cough (OR = 1.08, p = 0.001), but not for recent asthma (OR = 1.02, p = 0.43) or airway hyperresponsiveness (OR = 0.97 p = 0.17). In girls a higher BMI was significantly associated with higher prevalence of atopy (χ2 trend 7.9, p = 0.005), wheeze ever (χ2 trend 10.4, p = 0.001), and cough (χ2 trend 12.3, p<0.001). These were not significant in boys.
Conclusions: Higher BMI is a risk factor for atopy, wheeze ever, and cough in girls only. Higher BMI is not a risk factor for asthma or airway hyperresponsiveness in either boys or girls.
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- Burney P. G., Laitinen L. A., Perdrizet S., Huckauf H., Tattersfield A. E., Chinn S., Poisson N., Heeren A., Britton J. R., Jones T. Validity and repeatability of the IUATLD (1984) Bronchial Symptoms Questionnaire: an international comparison. Eur Respir J. 1989 Nov;2(10):940–945. [PubMed] [Google Scholar]
- 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]
- Castell D. O. Obesity and gastro-oesophageal reflux: is there a relationship? Eur J Gastroenterol Hepatol. 1996 Jul;8(7):625–626. [PubMed] [Google Scholar]
- Chinn S., Jarvis D., Burney P., European Community Respiratory Health Survey Relation of bronchial responsiveness to body mass index in the ECRHS. European Community Respiratory Health Survey. Thorax. 2002 Dec;57(12):1028–1033. doi: 10.1136/thorax.57.12.1028. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cole T. J., Bellizzi M. C., Flegal K. M., Dietz W. H. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000 May 6;320(7244):1240–1243. doi: 10.1136/bmj.320.7244.1240. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cronk C. E., Roche A. F. Race- and sex-specific reference data for triceps and subscapular skinfolds and weight/stature. Am J Clin Nutr. 1982 Feb;35(2):347–354. doi: 10.1093/ajcn/35.2.347. [DOI] [PubMed] [Google Scholar]
- Daniels S. R., Khoury P. R., Morrison J. A. The utility of body mass index as a measure of body fatness in children and adolescents: differences by race and gender. Pediatrics. 1997 Jun;99(6):804–807. doi: 10.1542/peds.99.6.804. [DOI] [PubMed] [Google Scholar]
- Ding D. J., Martin J. G., Macklem P. T. Effects of lung volume on maximal methacholine-induced bronchoconstriction in normal humans. J Appl Physiol (1985) 1987 Mar;62(3):1324–1330. doi: 10.1152/jappl.1987.62.3.1324. [DOI] [PubMed] [Google Scholar]
- Dixon J. B., Chapman L., O'Brien P. Marked improvement in asthma after Lap-Band surgery for morbid obesity. Obes Surg. 1999 Aug;9(4):385–389. doi: 10.1381/096089299765552981. [DOI] [PubMed] [Google Scholar]
- Figueroa-Muñoz J. I., Chinn S., Rona R. J. Association between obesity and asthma in 4-11 year old children in the UK. Thorax. 2001 Feb;56(2):133–137. doi: 10.1136/thorax.56.2.133. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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]
- 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]
- Grunstein R. R., Wilcox I. Sleep-disordered breathing and obesity. Baillieres Clin Endocrinol Metab. 1994 Jul;8(3):601–628. doi: 10.1016/s0950-351x(05)80288-5. [DOI] [PubMed] [Google Scholar]
- Hsu K. H., Jenkins D. E., Hsi B. P., Bourhofer E., Thompson V., Tanakawa N., Hsieh G. S. Ventilatory functions of normal children and young adults--Mexican-American, white, and black. I. Spirometry. J Pediatr. 1979 Jul;95(1):14–23. doi: 10.1016/s0022-3476(79)80075-x. [DOI] [PubMed] [Google Scholar]
- 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]
- Jarvis D., Chinn S., Potts J., Burney P., European Community Respiratory Health Survey Association of body mass index with respiratory symptoms and atopy: results from the European Community Respiratory Health Survey. Clin Exp Allergy. 2002 Jun;32(6):831–837. doi: 10.1046/j.1365-2222.2002.01380.x. [DOI] [PubMed] [Google Scholar]
- Kaplan T. A., Montana E. Exercise-induced bronchospasm in nonasthmatic obese children. Clin Pediatr (Phila) 1993 Apr;32(4):220–225. doi: 10.1177/000992289303200407. [DOI] [PubMed] [Google Scholar]
- 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]
- Magarey A. M., Daniels L. A., Boulton T. J. Prevalence of overweight and obesity in Australian children and adolescents: reassessment of 1985 and 1995 data against new standard international definitions. Med J Aust. 2001 Jun 4;174(11):561–564. doi: 10.5694/j.1326-5377.2001.tb143435.x. [DOI] [PubMed] [Google Scholar]
- Mulligan J. Standard definition of child overweight and obesity worldwide. Body mass index is harder to interpret in children than adults. BMJ. 2000 Nov 4;321(7269):1159–1159. [PubMed] [Google Scholar]
- Peat J. K., Salome C. M., Xuan W. On adjusting measurements of airway responsiveness for lung size and airway caliber. Am J Respir Crit Care Med. 1996 Oct;154(4 Pt 1):870–875. doi: 10.1164/ajrccm.154.4.8887577. [DOI] [PubMed] [Google Scholar]
- Peat J. K., Toelle B. G., Gray E. J., Haby M. M., Belousova E., Mellis C. M., Woolcock A. J. Prevalence and severity of childhood asthma and allergic sensitisation in seven climatic regions of New South Wales. Med J Aust. 1995 Jul 3;163(1):22–26. doi: 10.5694/j.1326-5377.1995.tb126083.x. [DOI] [PubMed] [Google Scholar]
- Peat J. K., van den Berg R. H., Green W. F., Mellis C. M., Leeder S. R., Woolcock A. J. Changing prevalence of asthma in Australian children. BMJ. 1994 Jun 18;308(6944):1591–1596. doi: 10.1136/bmj.308.6944.1591. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pelosi P., Croci M., Ravagnan I., Tredici S., Pedoto A., Lissoni A., Gattinoni L. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg. 1998 Sep;87(3):654–660. doi: 10.1097/00000539-199809000-00031. [DOI] [PubMed] [Google Scholar]
- Reilly J. J., Dorosty A. R., Emmett P. M., Avon Longitudinal Study of Pregnancy and Childhood Study Team Identification of the obese child: adequacy of the body mass index for clinical practice and epidemiology. Int J Obes Relat Metab Disord. 2000 Dec;24(12):1623–1627. doi: 10.1038/sj.ijo.0801436. [DOI] [PubMed] [Google Scholar]
- Schachter L. M., Salome C. M., Peat J. K., Woolcock A. J. Obesity is a risk for asthma and wheeze but not airway hyperresponsiveness. Thorax. 2001 Jan;56(1):4–8. doi: 10.1136/thorax.56.1.4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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]
- Stenius-Aarniala B., Poussa T., Kvarnström J., Grönlund E. L., Ylikahri M., Mustajoki P. Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study. BMJ. 2000 Mar 25;320(7238):827–832. doi: 10.1136/bmj.320.7238.827. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Unger R., Kreeger L., Christoffel K. K. Childhood obesity. Medical and familial correlates and age of onset. Clin Pediatr (Phila) 1990 Jul;29(7):368–373. doi: 10.1177/000992289002900701. [DOI] [PubMed] [Google Scholar]
- White E. M., Wilson A. C., Greene S. A., McCowan C., Thomas G. E., Cairns A. Y., Ricketts I. W. Body mass index centile charts to assess fatness of British children. Arch Dis Child. 1995 Jan;72(1):38–41. doi: 10.1136/adc.72.1.38. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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]
- Woolcock A. J. Use of corticosteroids in treatment of patients with asthma. J Allergy Clin Immunol. 1989 Dec;84(6 Pt 1):975–978. doi: 10.1016/0091-6749(89)90397-7. [DOI] [PubMed] [Google Scholar]
- Yan K., Salome C., Woolcock A. J. Rapid method for measurement of bronchial responsiveness. Thorax. 1983 Oct;38(10):760–765. doi: 10.1136/thx.38.10.760. [DOI] [PMC free article] [PubMed] [Google Scholar]