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. Author manuscript; available in PMC: 2014 Jul 1.
Published in final edited form as: J Adv Nurs. 2013 Apr 8;69(7):1446–1465. doi: 10.1111/jan.12129

Table 1. Cross-sectional studies (N=31).

Author/population Definition of Confounding factors Main result
Obesity Asthma
Ahmad, 2009/N=102,273; 0-17yr; USA Overweight: BMI ≥85th<95th
Obese: BMI≥95th 		Subjective: Parental-report of children ever diagnosed asthma by physician
Objective: None		 Age, gender, ethnicity, educational level of family, family structure, poverty level, health insurance, ETS

  1. A significant association between obesity and asthma (OR=1.33, 95% CI: 1.22-1.44).

  2. Gender (male) and race (black children) were significantly associated with asthma (OR=1.910, 95% CI: 1.587-2.298; 1.714, 95% CI: 1.275-2.305).
Belamarich, 2000/N=1322; 4-9yr; USA Nonobese: BMI>5th <95th
Obese: BMI≥95th 		Subjective: Parental-report of asthma dx by doctor, wheezing episodes, PEFR, emergency visits(EDs)
Objective: PEFR		 Age, gender, family income, caretaker's mental health, environmental tobacco smoke (ETS)

  1. Obese and non-obese children did not differ in terms of age, gender, family income, passive smoke exposure, caretaker's mental health, or SPTs reactivity to indoor allergens.

  2. Obese group had higher mean number of days of wheeze per 2-week period (4.0 vs 3.4, p<.02), unscheduled EDs (39% vs 31%, p<.04).
Bertolace, 2008/N=421;15-16yr; Brazil Overweight: BMI≥85th<95th
Obese: BMI≥95th 		Subjective: Self-report of asthma diagnosis or asthmatic symptoms (ISSAC questionnaire)
Objective: None		 Age, gender, race, social position, location of residency No significant positive association between increased BMI and the prevalence of asthma (p=.076).
Bibi, 2004/N=5984; around 8yr; Israel Overweight: None
Obese: BMI≥95th 		Subjective: Parental-report of children ever diagnosed asthmatic by a physician
Objective: FEV1, FVC, AHR test		 Age, gender, parental education and smoking habits, family crowdedness

  1. Asthma, wheezing and inhaler use more common in obese children (p<.038).

  2. Asthma was diagnosed more among obese children (p<.008).
Bidad, 2007/N=2900;11-17yr; Iran Overweight: BMI≥85th<95th
Obese: BMI≥95th 		Subjective: Self-report of asthma diagnose while interviewed by trained physician
Objective: None		 Age, gender, physical scores, waist/hip circumstances, waist-to-hip ratio, gastroesophageal reflux disease hx

  1. More frequent asthma among obese students (p=.041).

  2. Waist circumference, hip circumference and the waist-to-hip ratio greater in asthmatic students (p<.05).
Cassol, 2006/N=4010; 13-14yr; Brazil Nonobese: BMI<85th and triceps skinfold thickness<85th)
Obese: BMI≥85th and triceps skinfold thickness ≥85th 		Subjective: Self-report of wheezing or asthma attacks in the previous year (ISAAC questionnaire)questionnaire
Objective: None		 Age, gender

  1. Significant relationship between obesity and ‘wheeze ever’(OR=1.28, 95% CI: 1.08-1.52), ‘wheeze with exercise’ (OR=1.36, 95% CI: 1.11-1.66), ‘asthma ever’(OR=1.29, 95% CI: 1.03-1.62) and severe asthma (OR=1.55, 95% CI: 1.08-1.51).

  2. In boys, a significant association between obese and ‘wheeze ever’ (OR=1.38, 95% CI: 1.01-1.88).In girls, a significant positive relationship between obesity and ‘asthma ever’ (OR=1.36, 95% CI: 1.11-1.66).
Epstein, 2000/N=5154;6-16yr; USA Obese: BMI≥85th Subjective: Parental-report of children ever diagnosed asthma by a physician
Objective: None		 Age, gender, race/ethnicity, TV watching time, family income

  1. Controlling for gender, age and race/ethnicity, asthma children 1.53 (95% CI: 1.25-2.46) times more likely to be obese than children without asthma.

  2. Asthma, TV watching and maternal BMI as independent predictors of youth obesity.
Figueroa-Munoz, 2001/N=14908;4-11y; England/Scotland Obese: BMI≥90th Subjective: Parental-report of asthma and asthmatic symptoms
Objective: None		 Age, gender, ethnicity, family size, father's social class, living region, ETS BMI and sum of skinfolds were strongly and significantly associated with each of the asthma outcomes in girls only among inner city samples (OR=1.28, 95% CI: 1.11-1.48)
Gennuso, 1998/N=171;4-16yr; USA Obese: BMI≥85th <95th
Very obese: BMI≥95th 		Subjective: None
Objective: Medical record review for asthma dx		 Age, gender, ethnicity Significantly more children with asthma were obese (30.06%) compared with controls (11.6%) (p=.004).
Hasan, 2006/N=109; 13-18yr; USA Overweight: BMI≥85th
Obese: None		 Subjective: Self-report of asthma symptoms
Objective: Asthma dx confirmed by FEV1, FVC		 Age, gender, ethnicity Children with asthma almost 1.5 (RR=1.49, 95% CI: 1.015-2.17) times more likely to be overweight compared with children without asthma.
He, 2009/N=2179; 8-13yr; China Overweight: BMI≥85th<95th
Obese: BMI≥95th 		Subjective: Parental-report of children ever been diagnosed w/asthma by physicians
Objective: FEV1, FVC, FEF25, FEF75, FEF25-75 		Age, gender, allergy hx, physical activity, parental smoking and allergy Overweight or obese was positively associated with asthma with significant statistical level (obese boy: OR=1.35, 95% CI: 0.24-7.45; obese girls: OR=2.44, 95% CI: 0.62-9.59).
Henkin, 2008/N=94; 4-18yr; England Risk for overweight: BMI≥85th<95th
Overweight: BMI≥95th 		Subjective: None
Objective: Medical record review for asthma dx		 Age, gender, atopic dermatitis and allergic rhinitis hx,food allergy or other allergies

  1. The odds ratio in this analysis using BMI greater than 85th for asthmatic children vs. nonasthmatic children was 0.92 (95% CI: 0.40-2.20).

  2. No significant association between various measures of BMI and asthma in this population.
Jacobson, 2008/N=517; 3.4-4.6yr; USA; Risk for overweight: BMI≥85th<95th
Overweight: BMI≥95th 		Subjective: Parental-report of children's asthma dx/symptoms, meds use, EDs
Objective: None		 Age, gender, parental hx of asthma, birth place, parental birth place, parental education and employment, sibling's allergies, ETS Body mass was associated with asthma among girls (OR=2.0, 95% CI: 1.1-3.7), but not boys (OR=1.4, 95% CI: 0.8-2.6).
Kuschnir, 2009/N=2858; 13-14yr; Brazil Only one category—BMI≥85th Subjective: Self-report of asthma and asthmatic symptoms
Objective: None		 Age, gender, household pet, sedentary life, ETS

  1. Asthma prevalence increased with higher BMI (p=.02).

  2. Positive association between asthma and overweight in adolescent girl only, regardless of sedentary lifestyle and environmental factors (OR=1.51, 95% CI: 1.07-2.13).
Kwon, 2006/N=853; 2-11yr; USA Risk for Overweight: BMI≥85th<95th
Overweight: BMI≥95th 		Subjective: Parental-report of asthma dx, asthma-like symptoms, asthma related EDs
Objective: None		 Age, gender, race/ethnicity, nativity, insurance status, ETS

  1. Strong associations that differ by gender between BMI percentiles

  2. Among boys, asthma associated both with overweight (OR=2.4, 95% CI: 2.4-4.3) and underweight (OR=2.9, 95% CI: 1.1-7.7) compared with normal weight.

  3. Among girls, asthma associated with at risk for overweight (OR=2.6, 95% CI: 1.4-5.0) and overweight (OR=2.1, 95% CI: 1.2-3.8) compared with normal weight.
Leung, 2009/N=486; 14-18yr; Hong Kong Overweight: BMI≥85th<95th
Obese: BMI≥95th 		Subjective: Self-report of asthma dx
Objective: lipid profile and inflammatory biomarkers		 Age, gender, allergic rhinitis and eczema hx; serum Obesity not associated with asthma or atopy in Chinese children (p=.257).
Luder, 1998/N=209; 2-18yr;USA Risk for Overweight: BMI≥85th<95th
Overweight: BMI≥95th 		Subjective: Parental report of asthmatic symptoms and meds use
Objective: Asthma dx by a doctor PEFR measurement		 Age, gender, race, prematurity, breast feeding, avoidance of foods for asthma, ethnomedical-folk remedies, insurance status, ETS Prevalence of overweight significantly higher in children with moderate to severe asthma than in their peers (OR=1.34, 95% CI: 0.99-1.82).
Mai, 2003/N=457; 11-13yr; Sweden High BMI: BMI≥75th
Overweight: BMI≥95th 		Subjective: Parental-report of ISAAC, asthma dx, current wheezing and asthma severity
Objective: AHR test		 Age, gender, SPTs for allergens, episodes of hay fever

  1. Current wheeze associated with high BMI (OR=1.7, 95% CI: 1.0-3.6).

  2. Overweight had an even more pronounced effect (OR=1.9, 95% CI: 1.0-3.6).

  3. Asthma severity associated with high BMI (OR=2.0, 95% CI: 1.0-4.0).
Rodriguez, 2002/N=12388; 2months-16yr;USA Only one category—BMI≥85th Subjective: Parental- report of current diagnosed asthma
Objective: None		 Age, gender, race/ethnicity, household head's education, family income/size, insurance status, urban status, ETS

  1. Children with BMI≥85th have greater risk in having current asthma (OR=1.94, 95% CI: 1.09-3.46).

  2. A strong independent association between obesity and current asthma in children and adolescents.
Schachter, 2003/N=5993; 7-12yr; Australia Overweight: BMI≥85th<95th
Obese: BMI≥95th 		Subjective: Recent wheeze hx, recent asthma hx/dx
Objective: FEV1, FVC, PEFR		 Age, gender, SPTs for allergens, AHR hx, ETS

  1. BMI was a risk factor for wheeze ever (OR=1.06, p=.007) and cough (OR=1.08, p=.001), but not for recent asthma (OR=1.02, p=.43) or AHR (OR=0.97, p=.17)

  2. Higher BMI associated with higher prevalence of atopy (p=.005), wheeze ever (p=.001) and cough (p<.001) in girls.
Shamssain, 2006/N=7000; 5-16yr; England Overweight: BMI≥85th<95th
Obese: BMI≥95th 		Subjective: Self-report of asthma diagnose and asthmatic symptoms
Objective: None		 Age, gender, ETS

  1. Boys and girls in the highest BMI percentile had higher prevalence of asthma and asthma symptoms than those in the middle and lowest percentile (OR=1.26, 95% CI: 1.02-1.51; OR=1.16, 95% CI: 0.91-1.50).

  2. Association between overweight and exercise-induced wheezing stronger in boys than girls (OR: 2.66 vs 1.69).
Sithole, 2008/N=3804; 10-11yr; Canada Overweight: BMI≥20.4(boys) BMI≥20.5(girls)
Obese: BMI≥24.8 (boys) BMI≥25.1 (girls)		 Subjective: Parental-report of children diagnosed with asthma
Objective: None		 Age, gender, parental education, household income, neighborhood income A unit increase of BMI associated with 6% increase of prevalence for asthma both in boys and girls.
To,2004/N= 11199; 4-11yr; Canada; Obese: BMI≥85th Subjective: Parental- report of asthma dx, prescribed inhalants, asthma attacks, limited activities by asthma
Objective: None		 Age, gender, single child status; parental smoking, maternal asthma hx and depression, SES No statistical association between obesity and asthma among Canadian children age 4 to 11 years.
Tsai, 2007/N=2290; 5th-graders; Taiwan Risk for Overweight: BMI≥85th<95th
Overweight: BMI≥95th 		Subjective: Self-report physician diagnosed asthma and respiratory symptoms
Objective: None		 Age, gender, TV-watching time, Physical activity Obesity was positively associated with an increased risk of suspected asthma in boys (aOR=1.56, 95% CI: 1.07-2.29), but not in girls.
Vargas, 2007/N=1029; 3-5yr; USA Risk for Overweight: BMI≥85th<95th
Overweight: BMI≥95th 		Subjective: Parental-report of asthma morbidity, symptoms, health care/meds use, school days missed, quality of life
Objective: Physician diagnosed or algorithm identified asthma		 Age, gender, ETS, SPTs Prevalence of overweight significantly higher in children with asthma compared with the two control groups (Arkansas prekindergarten group: p=.05 and National Health and Nutrition Examination Survey [NHANES]: p<.001, respectively).
Vázquez-Nava, 2010/N=1160; 4-6yr; Mexico Overweight: BMI≥85th<95th
Obese: BMI≥95th 		Subjective: Parental-report of children diagnosed with asthma
Objective: None		 Age, gender, related symptoms (dry cough, wheezing, sleep disturbance), ETS, physical activity, intake of high sugar/oil food

  1. Overweight (OR=1.02, 95% CI: 0.66-1.58, p>.05) and obesity (OR= 0.94, 95% CI: 0.68-1.30, p>.05) were not associated with asthma and wheezing.

  2. No association found between overweight, obesity and asthma-associated hospitalization (overweight: OR=0.41, 95% CI: 0.09-1.80, p>.05; obesity: OR=0.35, 95% CI: 0.11-1.04, p>.05).
Vignolo, 2005/N=1179; 2.2-16.1yr; Italy Only one category—BMI-SDS(BMI standard deviation score units) ≥2 Subjective: None
Objective: Medical record review for asthma dx, FEV1, FVC, FEF25-75% 		Age, gender, allergic symptoms, IgE, SPTs for allergens

  1. The proportion of the overweight/obesity subjects was similar in two groups (p=.08).

  2. BMI-SDS significantly higher in controls than in asthmatics (p=.04).

  3. No correlation between BMI-SDS and pulmonary function tests (r= -.03; p=.51).
von Kries, 2001/N=9357; 5-6yr; German Overweight: BMI>90th≤97th
Obese: BMI>97th 		Subjective: Parental-report of asthma diagnosed by physician and asthma severity.
Objective: None		 Age, gender, prematurity, breast-feeding, febrile episodes in 0-1 yr, full-fat milk consumption; parental education and atopic diseases hx, living environment, ETS

  1. A clear dose effect between the asthma prevalence and the proportional of overweight/obesity incidence (5.7% asthma in BMI<90th; 6.5% asthma in overweight; and 9.9% in obesity).

  2. The adjusted odds ratio for asthma in girls was 2.12 (95% CI: 1.22-3.68) for overweight and 2.33 (95% CI: 1.13-4.82) for obesity.
von Mutius, 2001/N=7505; 4-17yr; USA; Obese: BMI≥75th Subjective: Parental-report of diagnosed or treated for asthma, or still had asthma
Objective: None		 Age, gender, ethnicity, ETS, birth weight, breast fed, household size; SPTs for allergens

  1. Significant positive relationship between BMI and asthma (OR=1.77, 95% CI: 1.44-2.19)

  2. No effect modification by gender or ethnic group seen in obesity-asthma relationship.
Wickens, 2005/N=305;10.1-12.6yr;New Zealand Overweight: Boys:BMIat10y≥19.8BMIat12.5y≥21.6 Girls:BMIat10y≥19.9 BMIat12.5y≥22.1
Obese: Boys:BMIat10y≥24.0BMIat12.5y≥26.4 Girls:BMIat10y≥24.1 BMIat12.5y≥27.2		 Subjective: Parental-report of wheezing and asthma dx, meds use and hospital admissions for asthma
Objective: PEFR variability before and after exercise, AHR to exercise test		 Age, gender, ethnicity, birth weight; family allergic hx, family size, ETS, father's education, frequency of exercise and hamburger consumption;SPTs for allergens

  1. Increasing BMI standard deviation score was significantly associated with current wheeze (p=0.002), inhaled steroid use (p=.004) and the use of any medication (p=.001).

  2. Some evidence for an association of obesity with asthma symptoms and treatment but not explain increasing prevalence of asthma.
Yoo, 2011/N=717; 15-17yr; Korean Overweight: BMI≥85th Subjective: Self-report of Self-report of asthma and asthmatic symptoms (ISAAC questionnaire)
Objective: AHR test		 Age, gender, recent physical activity, current smoking, parental smoking/education, family hx of allergic dx

  1. Overweight male adolescents more frequently reported asthmatic symptoms compared with normal weight subjects (11.5 vs. 6.3%, p=.02).

  2. The presence of AHR was more common only among overweight adolescent girls (32.8 vs. 18.0%, p=.028).
*

ATS: American Thoracic Society