Original Articles: Asthma, Lower Airway DiseasesObesity, inflammation, and asthma severity in childhood: data from the National Health and Nutrition Examination Survey 2001-2004
Section snippets
INTRODUCTION
Asthma and obesity are concurrently at historic high levels in pediatric populations. 1 These 2 public health epidemics share risk factors (eg, poverty and physical inactivity); asthmatic children also may be at higher risk for obesity due to reduced exercise capacity. 2, 3 Mounting evidence suggests, however, that obesity independently contributes to the incidence and severity of asthma in children and adults. 4, 5 Although controversy persists regarding the exact nature of the relationship,
Sample
The National Health and Nutrition Examination Survey (NHANES) is a federally funded data collection effort that combines interviews and physical examinations to survey the health and nutritional status of the US population. Selected individuals participate in a detailed home interview that includes demographic, socioeconomic, and health-related questions and undergo a comprehensive examination that includes medical, dental, and laboratory analysis at 1 of the mobile examination centers. We used
RESULTS
The full NHANES sample included 10,140 participants aged 0 to 19 years, representative of 76,805,481 US children. The mean (SD) age of the sample was 9.3 (6.3) years, 49.7% were girls, 30% were white, 31% were black, 34% were Mexican American and other Hispanic, and 5% were “other” racial/ethnic groups, weighted by the NHANES to represent a population with a mean age of 9.5 years, 49.2% girls, 61% white, 14% black, 18% Mexican American and other Hispanic, and 6% other racial/ethnic groups (
DISCUSSION
Asthma severity is associated with an elevated BMI and a higher serum CRP level in a representative national cohort of 0- to 19-year-olds studied between 2001 and 2004. Furthermore, when participants with the most severe symptoms of asthma are compared with the rest of the cohort, the association with elevated CRP levels is at its most pronounced.
Leptin, adiponectin, chemokines, and cytokines have been suggested as causes of the inflammation seen in the obese state. 23 In fact, low-level
REFERENCES (27)
The epidemiology of obesity and asthma
J Allergy Clin Immunol
(2005)- et al.
Paediatric asthma and obesity
Paediatr Respir Rev
(2006) - et al.
Body mass index and asthma severity among adults presenting to the emergency department
Chest
(2003) - et al.
Effect of leptin on allergic airway responses in mice
J Allergy Clin Immunol
(2005) - et al.
Obesity and asthma
Pharmacol Ther
(2006) - et al.
Serum leptin levels in asthmatic children treated with an inhaled corticosteroid
Ann Allergy Asthma Immunol
(2004) - et al.
Obstructive and restrictive lung disease and markers of inflammation: data from the Third National Health and Nutrition Examination
Am J Med
(2003) - et al.
Dietary intake, physical activity, body mass index, and childhood asthma in the Third National Health and Nutrition Survey (NHANES III)
Pediatr Pulmonol
(2004) - et al.
Lung disease and asthma severity in adults with asthma: data from the Third National Health and Nutrition Examination
J Asthma
(2005) - et al.
Increased incidence of asthmalike symptoms in girls who become overweight or obese during the school years
Am J Respir Crit Care Med
(2001)
Prospective study of body mass index, weight change, and risk of adult-onset asthma in women
Arch Intern Med
Persistence of asthma symptoms during adolescence: role of obesity and age at the onset of puberty
Am J Respir Crit Care Med
Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications
Ann Intern Med
Cited by (79)
Persistent overweight or obesity, lung function, and asthma exacerbations in Puerto Rican youth
2022, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :Our negative findings are contrary to results from a cross-sectional study of US children aged 2 to 19 years that reported higher total IgE in overweight and obese youth, but consistent with those of an international multicenter study revealing no associations between BMI and total IgE in youth.31,32 Our results suggest that persistent overweight or obese may negatively affect FEV1 and FEV1 to FVC ratio through nonallergic mechanisms, including systemic inflammation from proinflammatory cytokines in adipose tissue,22,23,28-31 increased TH17 immunity leading to steroid resistance, structural changes in the airways, or metabolic dysregulation.29,32-34 For example, we previously revealed that metabolic syndrome was associated with lower FEV1 to FVC ratio in a cross-sectional study of more than 1400 US adolescents with and without asthma, though the effect estimates were stronger in subjects with asthma.30
Overweight/obesity status in preschool children associates with worse asthma but robust improvement on inhaled corticosteroids
2018, Journal of Allergy and Clinical ImmunologyPsychological and lifestyle risk factors for asthma exacerbations and morbidity in children
2017, World Allergy Organization JournalCitation Excerpt :Obesity in children and adolescents, in general, has also been associated with increased depression and anxiety [42, 43]. In children with asthma, obesity has been found to be associated with increased uncontrolled asthma [13, 44], asthma severity [41, 45], emergency care use, and corticosteroid use [46]. Additionally, obesity presents challenges to asthma management, such as decreased responsiveness to asthma controller medications and decreased quality of life [47], and overweight children with asthma have been found to have increased negative effects from pollutant exposure when compared to healthy-weight children with asthma [13].
Contribution of weight status to asthma prevalence racial disparities, 2–19 year olds, 1988–2014
2017, Annals of EpidemiologyCitation Excerpt :This and other studies show that weight status is a risk factor for asthma [3,13,14,16,31–36]. In addition, although some studies found no association between obesity and asthma severity [34,37], several studies have shown obesity is associated with more frequent exacerbations, increased health care use, poor asthma control, and decreased response to asthma medications [14,33,38–45]. The increased asthma prevalence disparity between NHB and NHW youth observed in this study is consistent with other nationally representative data [5], but NHANES data also includes measured weight status [1], allowing for an assessment of how trends in weight status might related to trends in disparities.
Association of obesity and severity of acute asthma exacerbations in Filipino children
2016, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :The association between BMI status and asthma control and exacerbations in children is less well defined. Studies have found that being overweight or obese as a child is associated with poorly controlled asthma and increased asthma exacerbations,14,26,27 yet others have not found this association.28–30 The children in our cohort did not differ across BMI distribution in terms of asthma control indicators, such as length of time since last exacerbation, history of ICU admissions, prior intubation, or use of asthma medications.
Disclosures: Authors have nothing to disclose.