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Maurer DJ, Liu C, Xepapadaki P, Stanic B, Bachert C, Finotto S, Gao Y, Graser A, Jartti T, Kistler W, Kowalski M, Lukkarinen H, Pasioti M, Tan G, Villiger M, Zhang L, Zhang N, Akdis M, Papadopoulos NG, Akdis CA. Physical activity in asthma control and its immune modulatory effect in asthmatic preschoolers. Allergy 2022; 77:1216-1230. [PMID: 34547110 PMCID: PMC9291774 DOI: 10.1111/all.15105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The impact of physical activity on immune response is a hot topic in exercise immunology, but studies involving asthmatic children are scarce. Our aims were to examine whether there were any differences in the level of physical activity and daily TV attendance, to assess its role on asthma control and immune responses to various immune stimulants. METHODS Weekly physical activity and daily television attendance were obtained from questionnaires at inclusion of the PreDicta study. PBMC cultures were stimulated with phytohemagglutinin (PHA), R848, poly I:C, and zymosan. A panel of cytokines was measured and quantified in cell culture supernatants using luminometric multiplex immunofluorescence beads-based assay. RESULTS Asthmatic preschoolers showed significantly more TV attendance than their healthy peers (58.6% vs. 41.5% 1-3 h daily and only 25.7% vs. 47.2% ≤1 h daily) and poor asthma control was associated with less frequent physical activity (PA) (75% no or occasional activity in uncontrolled vs. 20% in controlled asthma; 25% ≥3 times weekly vs. 62%). Asthmatics with increased PA exhibited elevated cytokine levels in response to polyclonal stimulants, suggesting a readiness of circulating immune cells for type 1, 2, and 17 cytokine release compared to subjects with low PA and high TV attendance. This may also represent a proinflammatory state in high PA asthmatic children. Low physical activity and high TV attendance were associated with a decrease in proinflammatory cytokines. Proinflammatory cytokines were correlating with each other in in vitro immune responses of asthmatic children, but not healthy controls, this correlation was more pronounced in children with sedentary behavior. CONCLUSION Asthmatic children show more sedentary behavior than healthy subjects, while poor asthma control is associated with a substantial decrease in physical activity. Our results suggest that asthmatic children may profit from regular exercise, as elevated cytokine levels in stimulated conditions indicate an immune system prepared for responding strongly in case of different types of infections. However, it has to be considered that a hyperinflammatory state in high PA may not be beneficial in asthmatic children.
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Affiliation(s)
- Debbie J. Maurer
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Swiss Research Institute for Sports Medicine (SRISM) Davos Switzerland
- Department of Sports Medicine Davos Hospital Davos Switzerland
| | - Chengyao Liu
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital Capital Medical University Beijing China
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
| | - Barbara Stanic
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Claus Bachert
- Upper Airway Research Laboratory Ghent University Hospital Ghent Belgium
| | - Susetta Finotto
- Department of Molecular Pneumology Friedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg, Universitätsklinikum Erlangen Erlangen Germany
| | - Ya‐Dong Gao
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Anna Graser
- Department of Molecular Pneumology Friedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg, Universitätsklinikum Erlangen Erlangen Germany
| | - Tuomas Jartti
- Department of Pediatrics and Adolescent Medicine University of Turku and Turku University Hospital Turku Finland
- PEDEGO Research Unit, Medical Research Center University of Oulu Oulu Finland
- Department of Pediatrics and Adolescent Medicine Oulu University Hospital Oulu Finland
| | - Walter Kistler
- Swiss Research Institute for Sports Medicine (SRISM) Davos Switzerland
- Department of Sports Medicine Davos Hospital Davos Switzerland
| | - Marek Kowalski
- Department of Immunology, Rheumatology and Allergy Central University Hospital Lodz Poland
| | - Heikki Lukkarinen
- Department of Pediatrics and Adolescent Medicine University of Turku and Turku University Hospital Turku Finland
| | - Maria Pasioti
- Allergy Department, 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
| | - Ge Tan
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Michael Villiger
- Swiss Research Institute for Sports Medicine (SRISM) Davos Switzerland
- Department of Sports Medicine Davos Hospital Davos Switzerland
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital Capital Medical University Beijing China
- Department of Allergy, Beijing TongRen Hospital Capital Medical University Beijing China
| | - Nan Zhang
- Upper Airway Research Laboratory Ghent University Hospital Ghent Belgium
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
- Division of Infection, Immunity & Respiratory Medicine University of Manchester Manchester UK
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Swiss Research Institute for Sports Medicine (SRISM) Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
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2
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Ahmad K, Kabir E, Ormsby GM, Khanam R. Are wheezing, asthma and eczema in children associated with mother's health during pregnancy? Evidence from an Australian birth cohort. ACTA ACUST UNITED AC 2021; 79:193. [PMID: 34749801 PMCID: PMC8577022 DOI: 10.1186/s13690-021-00718-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study investigated the prevalence of wheezing, asthma, and eczema among Australian children using longitudinal data from birth to 15 years of age. This study also examined the association between maternal health status during pregnancy and their offspring's respiratory and allergic morbidities using sex-segregated data. METHODS This study used data from the Longitudinal Study of Australian Children (LSAC) where approximately 5000 children of a birth cohort across Australia were surveyed in 2004. These children were followed biennially in eight waves up to their age of 15 years until 2018. The status of the children's wheezing, asthma, and eczema were reported by the mothers upon doctors' diagnosis (for asthma) or self-assessment (for wheezing or eczema). Binomial logistic regression models were used to analyse associations between maternal health during pregnancy and their children's health outcomes. RESULTS Asthma prevalence among 0-1-year aged children was 11.7%, increased to 15.4% when the children were 10-11 years old, and then decreased to 13.6% when they were 14-15 years old. Wheezing and eczema were most prevalent when the children were 2-3 years old (26.0 and 17.8% respectively) and were least prevalent when the children were 14-15 years old (7.3 and 9.5% respectively). Maternal asthma, smoking during pregnancy, and pre-pregnancy obesity were significantly associated with an increased risk of wheezing and asthma in Australian children. Childhood eczema was associated only with maternal asthma. These associations were stronger among male children up to age 10-11 and during adolescence (12-15 years of age), female children were more prone to wheezing, asthma, and eczema. CONCLUSION This is a comprehensive longitudinal study of Australian children (0-15 years of age) to assess the prevalence (with sex-specific differences) of wheezing, asthma and eczema as well as the association between these respiratory and allergic morbidities and maternal health during pregnancy. The study findings suggest that careful medical and obstetric monitoring, improved specific age-sex wise risk factor prevention for children and health promotion for pregnant women would help protect child health.
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Affiliation(s)
- Kabir Ahmad
- School of Business, Faculty of Business, Education, Law and Arts, and Centre for Health Research, University of Southern Queensland, Toowoomba, Australia. .,Research Unit, Purple Informatics, Dhaka, Bangladesh. .,Present Address: School of Business, Faculty of Business, Education, Law and Arts, and Centre for Health Research, University of Southern Queensland, Toowoomba, Australia.
| | - Enamul Kabir
- School of Sciences, Faculty of Health, Engineering and Sciences, and Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| | - Gail M Ormsby
- Independent Researcher, Professional Studies, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
| | - Rasheda Khanam
- School of Business, Faculty of Business, Education, Law and Arts, and Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
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Winn CON, Mackintosh KA, Eddolls WTB, Stratton G, Wilson AM, McNarry MA, Davies GA. Effect of high-intensity interval training in adolescents with asthma: The eXercise for Asthma with Commando Joe's® (X4ACJ) trial. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:488-498. [PMID: 34304826 PMCID: PMC8343006 DOI: 10.1016/j.jshs.2019.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/15/2019] [Accepted: 03/15/2019] [Indexed: 05/07/2023]
Abstract
BACKGROUND Higher levels of cardiorespiratory fitness are associated with reduced asthma severity and increased quality of life in those with asthma. Therefore, the purpose of this study was to evaluate the effectiveness of a 6-month high-intensity interval training (HIIT) intervention in adolescents with and without asthma. METHODS A total of 616 adolescents (334 boys; 13.0 ± 1.1 years, 1.57 ± 0.10 m, 52.6 ± 12.9 kg, mean ± SD), including 155 with asthma (78 boys), were recruited as part of a randomized controlled trial from 5 schools (4 control and 1 intervention). The 221 intervention participants (116 boys; 47 asthma) completed 6 months of school-based HIIT (30 min, 3 times per week, 10-30 s bouts at >90% age-predicted maximum heart rate with equal rest). At baseline, mid-intervention, post-intervention, and 3-month follow-up, measurements for 20-m shuttle run, body mass index (BMI), lung function, Pediatric Quality of Life Inventory, Paediatric Asthma Quality of Life Questionnaire, and Asthma Control Questionnaire were collected. Additionally, 69 adolescents (39 boys (of the 36 with asthma there were 21 boys)) also completed an incremental ramp test. For analysis, each group's data (intervention and control) were divided into those with and without asthma. RESULTS Participants with asthma did not differ from their peers in any parameter of aerobic fitness, at any time-point, but were characterized by a greater BMI. The intervention elicited a significant improvement in maximal aerobic fitness but no change in sub-maximal parameters of aerobic fitness, lung function, or quality of life irrespective of asthma status. Those in the intervention group maintained their BMI, whereas BMI significantly increased in the control group throughout the 6-month period. CONCLUSION HIIT represents an effective tool for improving aerobic fitness and maintaining BMI in adolescents, irrespective of asthma status. HIIT was well-tolerated by those with asthma, who evidenced a similar aerobic fitness to their healthy peers and responded equally well to a HIIT program.
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Affiliation(s)
- Charles O N Winn
- Swansea University Medical School, Singleton Campus, Swansea University, Swansea SA2 8PP, UK; Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Bay Campus, Swansea University, Swansea SA1 8EN, UK
| | - Kelly A Mackintosh
- Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Bay Campus, Swansea University, Swansea SA1 8EN, UK
| | - William T B Eddolls
- Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Bay Campus, Swansea University, Swansea SA1 8EN, UK
| | - Gareth Stratton
- Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Bay Campus, Swansea University, Swansea SA1 8EN, UK
| | - Andrew M Wilson
- Norwich Medical School, University of East Anglia, Norwich, England NR4 7TJ, UK
| | - Melitta A McNarry
- Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Bay Campus, Swansea University, Swansea SA1 8EN, UK.
| | - Gwyneth A Davies
- Swansea University Medical School, Singleton Campus, Swansea University, Swansea SA2 8PP, UK.
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Lu KD, Forno E, Radom-Aizik S, Cooper DM. Low fitness and increased sedentary time are associated with worse asthma-The National Youth Fitness Survey. Pediatr Pulmonol 2020; 55:1116-1123. [PMID: 32040886 PMCID: PMC7187732 DOI: 10.1002/ppul.24678] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Asthma is the most common chronic illness in children and is independently impacted by obesity and by fitness. The National Youth Fitness Survey collected data on aerobic fitness, body composition, and health outcomes in children 6 to 11 years old. The goal of this study is to test hypotheses regarding relationships between asthma, aerobic fitness, and sedentary time in this uniquely studied cohort of young children. METHODS A total of 665 children (6-11 years old; 49% male) were included in analyses. We explored relationships between asthma outcomes and aerobic fitness (measured by endurance time), self-reported sedentary time, and body mass index categories. Fitness was categorized as unfit (lowest 25% of endurance times) or fit. Multivariate logistic regression models were created for asthma outcomes and adjusted for race, age, sex, poverty status, and overweight/obesity. RESULTS Among the participants, 17.9% had a previous history of asthma and 11.4% had current asthma. Additionally, 37.3% of participants were overweight or obese. Low fitness was significantly associated with increased odds of past asthma, current asthma, asthma attacks, wheeze with exercise, and wheeze with activity limitations in multivariate models. Increased sedentary time was significantly associated with increased odds of previous asthma, current asthma, asthma attacks, and wheeze with activity limitations. CONCLUSION Decreased aerobic fitness and increased sedentary time were associated with worse asthma outcomes in this group of children (6-11 years old). This data suggest that fitness and sedentary time, both modifiable factors, each have an independent effect on asthma and should be included in assessments and management of asthma health.
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Affiliation(s)
- Kim D. Lu
- Pediatric Exercise and Genomics Research Center (PERC), Department of Pediatrics, University of California, Irvine School of Medicine, Irvine, CA
| | - Erick Forno
- University of Pittsburgh School of Medicine, Pittsburgh, PA
- Division of Pediatric Pulmonary Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Shlomit Radom-Aizik
- Pediatric Exercise and Genomics Research Center (PERC), Department of Pediatrics, University of California, Irvine School of Medicine, Irvine, CA
| | - Dan M. Cooper
- Pediatric Exercise and Genomics Research Center (PERC), Department of Pediatrics, University of California, Irvine School of Medicine, Irvine, CA
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Ansari S, Haboubi H, Haboubi N. Adult obesity complications: challenges and clinical impact. Ther Adv Endocrinol Metab 2020; 11:2042018820934955. [PMID: 32612803 PMCID: PMC7309384 DOI: 10.1177/2042018820934955] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/24/2020] [Indexed: 12/18/2022] Open
Abstract
The complications associated with adult obesity are overwhelming national healthcare systems. No country has yet implemented a successful population-level strategy to reverse the rising trends of obesity. This article presents epidemiological data on the complications of adult obesity and discusses some of the challenges associated with managing this disease at a population and individual level.
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Affiliation(s)
| | - Hasan Haboubi
- Department of Gastroenterology, Guy’s & St Thomas’ Foundation trust, London, England, UK
| | - Nadim Haboubi
- Consultant Physician, University of South Wales, Pontypridd, Rhondda Cynon Taff, UK
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6
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the most recent studies on lifestyle interventions in pediatric asthma. We include studies on physical activity and exercise, sedentary time, nutrition, behavioral therapy and the role of schools. RECENT FINDINGS Several small studies in children with asthma suggest that exercise interventions can improve aerobic fitness, asthma symptoms or control and quality of life. Existing evidence supports recommending higher intake of fruits and vegetables for asthma risk and control. In contrast, the 'Western diet' - high in refined grains, highly processed foods, red meats and fried foods with low intake of fruits and vegetables - has a proinflammatory effect and may alter microbiota composition leading to worse asthma outcomes. Finally, there are opportunities to utilize schools to promote physical activity, though standardization of asthma management in the schools is needed. SUMMARY Assessing physical activity/fitness levels, sedentary time and nutritional status is important in the management of children with asthma, as they are modifiable factors. Larger rigorous studies evaluating lifestyle interventions are needed to better inform current asthma guidelines as well as to understand the underlying mechanism(s) related to physical activity and diet in asthma.
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Affiliation(s)
- Kim D. Lu
- Pediatric Exercise and Genomics Research Center (PERC), Department of Pediatrics, University of California, Irvine School of Medicine, Irvine, CA
| | - Erick Forno
- University of Pittsburgh School of Medicine, Pittsburgh, PA
- Division of Pediatric Pulmonary Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
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7
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Azmeh R, Greydanus DE, Agana MG, Dickson CA, Patel DR, Ischander MM, Lloyd RD. Update in Pediatric Asthma: Selected Issues. Dis Mon 2019; 66:100886. [PMID: 31570159 DOI: 10.1016/j.disamonth.2019.100886] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is a complex condition that affects 14% of the world's children and the approach to management includes both pharmacologic as well as non-pharmacologic strategies including attention to complex socioeconomic status phenomena. After an historical consideration of asthma, allergic and immunologic aspects of asthma in children and adolescents are presented. Concepts of socioeconomic aspects of asthma are considered along with environmental features and complications of asthma disparities. Also reviewed are links of asthma with mental health disorders, sleep disturbances and other comorbidities. A stepwise approach to asthma management is discussed that includes pharmacologic and non-pharmacologic strategies in the pediatric population. The role of immunotherapy and use of various immunomodulators are considered as well.
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Affiliation(s)
- Roua Azmeh
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Marisha G Agana
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Cheryl A Dickson
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States; Health Equity and Community Affairs, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Mariam M Ischander
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Robert D Lloyd
- Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, Washington, United States
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8
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Obesity and adiposity indicators in asthma and allergic rhinitis in children. Curr Opin Allergy Clin Immunol 2019; 19:7-11. [PMID: 30507714 DOI: 10.1097/aci.0000000000000504] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The prevalence of obesity and allergic diseases, such as asthma and allergic rhinitis, is increasing worldwide not only in adults, but also in children. Experimental and clinical studies have demonstrated the effect of obesity not only on asthma, but also on other allergic diseases. RECENT FINDINGS Allergic diseases, such as asthma and allergic rhinitis, are common chronic inflammatory diseases of the airways. Obesity is an increasingly common pediatric disease and is a risk factor for the development of asthma in that obese patients with asthma tend to have more severe asthma that does not respond well to standard asthma therapy. On the contrary, children with asthma maybe at a high risk of obesity, suggesting that the relationship of asthma and obesity seems to be interrelated. The role of obesity on the development of allergic rhinitis is not well defined, whereas allergic rhinitis may have an impact on obesity. SUMMARY Childhood obesity is often considered to be less serious than obesity in adults because of the greater risk of complications in obese adults. In this review, we discuss the allergic confounders of obesity and the impact of allergic diseases on obesity. Proper control of the BMI within the normal range in children with allergic diseases is important.
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Abstract
Global obesity rates have increased exponentially in recent decades. People are becoming obese younger, morbid obesity is increasing and the full health implications are only beginning to be seen. This article discusses the latest epidemiological data on obesity in adults and children, and systemically reviews the complications associated with the condition.
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Affiliation(s)
- D Kinlen
- From the Obesity Immunology Group, Education and Research Centre, St Vincent's University Hospital, University College Dublin, Dublin 4, Ireland
- National Children's Research Centre, Crumlin, Dublin 12, Ireland
- Department of Diabetes and Endocrinology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - D Cody
- National Children's Research Centre, Crumlin, Dublin 12, Ireland
- Department of Diabetes and Endocrinology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - D O'Shea
- From the Obesity Immunology Group, Education and Research Centre, St Vincent's University Hospital, University College Dublin, Dublin 4, Ireland
- Department of Endocrinology, St Columcille's Hospital, Loughlinstown, Co. Dublin, Ireland
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10
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Lu KD, Billimek J, Bar-Yoseph R, Radom-Aizik S, Cooper DM, Anton-Culver H. Sex Differences in the Relationship between Fitness and Obesity on Risk for Asthma in Adolescents. J Pediatr 2016; 176:36-42. [PMID: 27318375 PMCID: PMC5003726 DOI: 10.1016/j.jpeds.2016.05.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/04/2016] [Accepted: 05/12/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the relationship of fitness and obesity on asthma risk in adolescent girls and boys. STUDY DESIGN A cross-sectional assessment of participants 12-19 years of age was conducted by the use of data from the 1999-2004 National Health and Nutrition Examination Survey. Participants completed cardiorespiratory fitness testing, body composition measurements, and respiratory questionnaires. RESULTS A total of 4828 participants were included. Overweight/obesity was associated with increased odds of history of asthma (aOR 1.63, 95% CI 1.16-2.30), current asthma (aOR 1.73, 95% CI 1.13, 2.64), and wheezing (aOR 1.40, 95% CI 1.03-1.91) in girls. Overweight/obesity also was associated with increased odds of asthma attacks (aOR 2.67, 95% CI 1.56-4.65) and wheezing related to exercise (aOR 1.60, 95% CI 1.07-2.38) in girls. High fitness was associated with lower odds of asthma-related visits to the emergency department (aOR 0.24, 95% CI 0.07-0.89), wheezing-related medical visits (aOR 0.31, 95% CI 0.13-0.75), wheezing-related missed days (aOR 0.14, 95% CI 0.06-0.33), and wheezing related to exercise (aOR 0.43, 95% CI 0.24-0.76) in boys. CONCLUSION Overweight/obesity is associated with increased asthma prevalence and morbidity in girls but not in boys, independent of fitness. High fitness is associated with decreased rates of asthma morbidity in boys but not in girls, independent of weight status. Obesity and fitness may each influence asthma onset and severity in different ways for girls compared with boys.
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Affiliation(s)
- Kim D Lu
- Department of Pediatrics and Pediatric Exercise and Genomics Research Center, University of California, Irvine, CA.
| | - John Billimek
- Health Policy Research Institute and Division of General Internal Medicine, School of Medicine, University of California, Irvine, CA
| | - Ronen Bar-Yoseph
- Department of Pediatrics and Pediatric Exercise and Genomics Research Center, University of California, Irvine, CA
| | - Shlomit Radom-Aizik
- Department of Pediatrics and Pediatric Exercise and Genomics Research Center, University of California, Irvine, CA
| | - Dan M Cooper
- Department of Pediatrics and Pediatric Exercise and Genomics Research Center, University of California, Irvine, CA
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Willeboordse M, van de Kant KDG, van der Velden CA, van Schayck CP, Dompeling E. Associations between asthma, overweight and physical activity in children: a cross-sectional study. BMC Public Health 2016; 16:919. [PMID: 27587091 PMCID: PMC5009538 DOI: 10.1186/s12889-016-3600-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/25/2016] [Indexed: 01/07/2023] Open
Abstract
Background Asthma and obesity are highly prevalent in children, and are interrelated resulting in a difficult-to-treat asthma-obesity phenotype. The exact underlying mechanisms of this phenotype remain unclear, but decreased physical activity (PA) could be an important lifestyle factor. We hypothesize that both asthma and overweight/obesity decrease PA levels and interact on PA levels in asthmatic children with overweight/obesity. Methods School-aged children (n = 122) were divided in 4 groups (healthy control, asthma, overweight/obesity and asthma, and overweight/obesity). Children were asked to perform lung function tests and wear an activity monitor for 7 days. PA was determined by: step count, active time, screen time, time spent in organized sports and active transport forms. We used multiple linear regression techniques to investigate whether asthma, body mass index-standard deviation score (BMI-SDS), or the interaction term asthma x BMI-SDS were associated with PA. Additionally, we tested if asthma features (including lung function and medication) were related to PA levels in asthmatic children. Results Asthma, BMI-SDS and the interaction between asthma x BMI-SDS were not related to any of the PA variables (p ≥ 0.05). None of the asthma features could predict PA levels (p ≥ 0.05). Less than 1 in 5 children reached the recommended daily step count guidelines of 12,000 steps/day. Conclusion We found no significant associations between asthma, overweight and PA levels in school-aged children in this study. However, as PA levels were worryingly low, effective PA promotion in school-aged children is necessary. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3600-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maartje Willeboordse
- Department of Pediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands. .,Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Kim D G van de Kant
- Department of Pediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.,Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Charlotte A van der Velden
- Department of Pediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Constant P van Schayck
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Edward Dompeling
- Department of Pediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
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Leinaar E, Alamian A, Wang L. A systematic review of the relationship between asthma, overweight, and the effects of physical activity in youth. Ann Epidemiol 2016; 26:504-510.e6. [PMID: 27449571 DOI: 10.1016/j.annepidem.2016.06.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 05/25/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE The association of asthma and overweight in youth is well studied. However, the temporal relationship between asthma and overweight, the strength of their association, and mediating factors involved in this relationship remain unclear. This review investigates the relationship between asthma and overweight in youth, while examining the role of physical activity as a mediator. METHODS A systematic review of literature was conducted using PubMed and Medline databases. Studies conducted among youth aged 0-18 years, published in English between 2000-2014 were included. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were consulted to evaluate quality of selected citations. RESULTS A comprehensive search yielded 143 studies in PubMed and 133 studies in Medline databases. Of these, 75 studies met the eligibility criteria. The review found varying hypotheses regarding the temporal relationship between asthma and overweight in youth; existing evidence supports the mediation of this association by decreased expenditure of energy due to reduced physical activity. Negative self-perception or parental perception of exercise ability due to asthma symptoms secondary to physical exertion was identified as a determinant of physical activity in asthmatic youth. CONCLUSIONS Physical activity likely mediates the relationship between asthma and overweight in youth. Temporality of this relationship remains unclear.
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Affiliation(s)
- Edward Leinaar
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City
| | - Arsham Alamian
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City.
| | - Liang Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City
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Heinzmann-Filho JP, Vendrusculo FM, Woszezenki CT, Piva TC, Santos AN, Barcellos AB, Vagliatti BB, Corrêa DG, Mattiello R, Donadio MVF. Inspiratory muscle function in asthmatic and healthy subjects: influence of age, nutrition and physical activity. J Asthma 2016; 53:893-9. [PMID: 27057823 DOI: 10.3109/02770903.2016.1165698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare inspiratory muscle function (strength and endurance) between asthmatics and healthy controls, and the influence of age, nutritional status and physical activity on them. METHODS This is a cross-sectional study. Asthmatic and healthy subjects, aged 6 to 18 years old, recruited from two public schools in Southern Brazil were included in the study. Asthmatic subjects were selected using the criteria presented by the International Study on Asthma and Allergies in Children and control subjects based on the absence of respiratory symptoms. Anthropometric data was measured, body mass index calculated and subjects classified as normal weight, overweight or obese. Physical activity levels, maximum inspiratory pressure (MIP) and inspiratory muscle endurance (IME) were also evaluated. RESULTS A total of 314 participants were included, separated into control group (181) and asthmatics (133), with a total mean age of 11 years. When both groups were compared, there were no significant differences in both MIP and IME. However, when groups were analyzed subdivided in children and adolescents, IME was significantly reduced (p = 0.003) in asthmatic adolescents. Indeed, when groups were also stratified considering the nutritional status, IME showed a reduction in asthmatic adolescents with overweight (p = 0.042) and obesity (p = 0.041) when compared to healthy controls. No effects of physical activity levels between groups were found. CONCLUSIONS Results demonstrate a reduction in the IME in asthmatic adolescents with overweight and obesity, indicating an association between asthma, nutritional status and respiratory muscle function.
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Affiliation(s)
- João Paulo Heinzmann-Filho
- a Graduate Program in Pediatrics and Child Health , Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre , Rio Grande do Sul , Brazil
| | - Fernanda Maria Vendrusculo
- a Graduate Program in Pediatrics and Child Health , Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre , Rio Grande do Sul , Brazil
| | - Cristhiele Taís Woszezenki
- a Graduate Program in Pediatrics and Child Health , Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre , Rio Grande do Sul , Brazil
| | - Taila Cristina Piva
- b School of Nursing , Nutrition and Physiotherapy, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre , Rio Grande do Sul , Brazil
| | - Andressa Nunes Santos
- b School of Nursing , Nutrition and Physiotherapy, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre , Rio Grande do Sul , Brazil
| | - Andressa Bombardi Barcellos
- b School of Nursing , Nutrition and Physiotherapy, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre , Rio Grande do Sul , Brazil
| | - Bruna Brufatto Vagliatti
- b School of Nursing , Nutrition and Physiotherapy, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre , Rio Grande do Sul , Brazil
| | - Débora Gonzales Corrêa
- b School of Nursing , Nutrition and Physiotherapy, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre , Rio Grande do Sul , Brazil
| | - Rita Mattiello
- a Graduate Program in Pediatrics and Child Health , Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre , Rio Grande do Sul , Brazil.,c Centro Infant , Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre , Rio Grande do Sul , Brazil
| | - Márcio Vinícius Fagundes Donadio
- a Graduate Program in Pediatrics and Child Health , Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre , Rio Grande do Sul , Brazil.,b School of Nursing , Nutrition and Physiotherapy, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre , Rio Grande do Sul , Brazil.,c Centro Infant , Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre , Rio Grande do Sul , Brazil
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Kamal R, Kesavachandran CN, Bihari V, Sathian B, Srivastava AK. Alterations in Lung Functions Based on BMI and Body Fat % Among Obese Indian Population at National Capital Region. Nepal J Epidemiol 2015; 5:470-9. [PMID: 26913206 DOI: 10.3126/nje.v5i2.12829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In India, non-asthmatic hospital admission case study has been conducted to find out the relationship between obesity and lung functions. The main objective of the present study was to find out the alterations in lung functions due to obesity among Indian population living at National Capital Region (NCR). MATERIALS AND METHODS We examined 609 non obese and 211 obese subjects in a cross sectional study from National Capital Region, India with age group ranges between 18-70 years. BMI and body fat % was determined using body fat analyzer. Obese and non-obese subjects were classified based on criteria for BMI and Body fat %. Lung function test viz., FEV1 and PEFR were conducted using portable spirometer (PIKO-1). RESULTS A significant correlation (p<0.05) was observed between BMI and PEFR among non-obese male and female subjects. Decline in PEFR and FEV1 values for corresponding increase in body fat % was observed among study subjects. A significant (p<0.01) decline in mean FEV1 and PEFR was observed among non-obese and obese subjects, compared to their Indian reference standards for lung functions. A significant negative correlation (p<0.01) was observed between body fat % and lung functions (FEV1, PEFR). CONCLUSION It is concluded that obese subjects are at a risk of lung function impairment, based on the criteria followed for BMI and body fat %. The study also demonstrate that body fat% classification as a better index for determination of obese subjects compared to BMI classification, with respect to lung function impairments.
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Affiliation(s)
- Ritul Kamal
- Epidemiology Division, CSIR-Indian Institute of Toxicology Research PB No 80 , MG Marg, Lucknow 226001, U.P, India
| | | | - Vipin Bihari
- Epidemiology Division, CSIR-Indian Institute of Toxicology Research PB No 80 , MG Marg, Lucknow 226001, U.P, India
| | - Brijesh Sathian
- Department of Community Medicine, Manipal College of Medical Sciences , Pokhara, Nepal
| | - Anup Kumar Srivastava
- Epidemiology Division, CSIR-Indian Institute of Toxicology Research PB No 80, MG Marg, Lucknow 226001, U.P, India; Department of Community Medicine, Hind Institute of Medical Sciences, Near Canal, Safedabad Barabanki Road, Lucknow, U.P. India
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Butterfield SA, Mason CA, Tu S, Lehnhard RA, Schaper M. Performance by middle school children with and without asthma on the pacer. Percept Mot Skills 2015; 120:628-41. [PMID: 25799031 DOI: 10.2466/15.pms.120v10x9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Asthma is a chronic lung disease characterized by airway hyper-reactivity, inflammation, and obstruction. Asthma is also a leading cause of school absenteeism, and thus of concern to physical educators and health professionals. The purpose of this study was to assess aerobic performance by children with and without asthma. All participants were tested on the Progressive Aerobic Cardiovascular Endurance Run (PACER). Of particular interest was children's aerobic performance over an extended time, i.e., 15 months. Participants (Grades 4-8, N=809) were tested on the PACER three times during the school year with two follow-up tests during the succeeding school year. Among the 809 participants were 103 children with mild-moderate asthma. Hierarchical Linear Modeling (HLM) was applied to analyze the data. Notwithstanding their lower scores at baseline (intercept), children with asthma increased their PACER scores at a rate more than double that of their peers without asthma. Although more than one PACER trial may be needed to accurately determine children's aerobic performance, repeated trials may be especially necessary for children with asthma. It was further concluded that the PACER is an effective tool with which to assess aerobic performance by middle school children with well-managed asthma.
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Andrade LS, Araújo ACTB, Cauduro TM, Watanabe LA, Castro APBM, Jacob CMA, Pastorino AC. Obesity and asthma: association or epiphenomenon? REVISTA PAULISTA DE PEDIATRIA 2014; 31:138-44. [PMID: 23828048 DOI: 10.1590/s0103-05822013000200002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/12/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To relate obesity and asthma by comparing gender, age, initial classification of asthma, clinical control, basal forced expiratory volume in one second (FEV1) and forced expiratory flow between 25 and 75% (FEF25-75%) with rates of body mass index (BMI) in asthmatic adolescents. METHODS Cross-sectional study involving 120 asthmatics patients (1.9 male: 1 female) with a mean age of 14.1 years (9 to 20.1 years of age), classified according to asthma severity and control, and evaluated by spirometry using their basal FEV1 and FEF25-75%. The data were described by frequency, mean and standard deviation or median and range and analyzed by ANOVA, unpaired t test, Fischer's exact test, Kruskal-Wallis and Pearson's correlation, considering significant p<0.05. RESULTS There was no difference between gender in relation to the initial classification and the level of asthma control; 91.7% (100 cases) received initial classification as persistent and 106 cases (88.3%) were partially or totally controlled. There was no statistical difference between controlled patients and the others in relation to BMI. No significant correlations were found between zBMI and FEV1 and between zBMI and FEF25-75%, analyzing all patients and only patients with overweight or obese. CONCLUSIONS In this study, no significant correlation was found between overweight/obesity and asthma using clinical, anthropometric and spirometric parameters.
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Affiliation(s)
- Larissa Smiljanic Andrade
- Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
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Abstract
With the childhood prevalence of obesity and asthma increasing, it is important for pediatric professionals to appreciate that obesity modifies the diagnosis and management of asthma. These disease modifications present challenges to clinical management, including decreased responsiveness to controller therapy and decreased quality of life compared with normal-weight asthmatic children. While consensus guidelines do not currently suggest specific changes in asthma management for obese patients, management of some patients may be improved with consideration of the latest evidence. This article briefly summarizes what is known regarding the complex relationship between obesity and asthma in children, and discusses practical issues associated with the diagnosis and effective clinical management of asthma in obese children. On average, obese patients with asthma do not respond as well to inhaled corticosteroid therapy. Management approaches including weight loss and routine exercise are safe, and may improve important asthma outcomes. Asthma providers should learn to facilitate weight loss for their obese patients. In addition, pharmacologic interventions for weight loss in obese asthma, though not currently recommended, may soon be considered.
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Affiliation(s)
- Jason E. Lang
- Center for Pharmacogenomics & Translational Research, Nemours Children’s Hospital, 13535 Nemours Parkway, Orlando, FL 32827, , Phone: 407-567-7535 Fax: 407-650-7663
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Yuksel H, Yilmaz O, Vatansever S, Onur E, Kirmaz C, Nal E, Turkeli A, Bozyigit FD. Peripheral Mononuclear Response to Antigenic Stimulation in Children with Obese Asthma Phenotype. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2013; 26:193-198. [PMID: 35923042 DOI: 10.1089/ped.2012.0216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
An investigation of immunopathogenetic mechanisms of obesity-associated asthma may demonstrate novel therapeutic targets. The aim of this study was to compare levels of T-helper lymphocyte (Th)1, Th2, regulatory T lymphocyte (Treg), and Th17 cytokines secreted by peripheral blood mononuclear cell culture (PBMC) in response to nonspecific stimulation in obese and nonobese children with asthma. Obese and nonobese children with asthma aged 5-16 were enrolled into this case-control study consecutively. Age at asthma diagnosis and clinical severity were recorded. A skin prick test was performed. Serum adipokine levels and PBMC supernatant interleukin (IL)-4, IL-10, IL-17, IL-23, interferon (IFN)γ, and transforming growth factor (TGF)-β levels were measured. Mean (±standard deviation) ages of obese (n=28) and nonobese (n=39) children with asthma were 8.7±2.9 and 10.5±3.2, respectively. Asthma symptom score was higher, and age at asthma diagnosis was lower in obese compared with nonobese children with asthma (P=0.03 and P=0.004, respectively). Leptin levels were significantly higher in obese than in nonobese asthma group (P<0.001). IL-10 and IL-17 levels in obese group were significantly lower than in nonobese group (P=0.005 and P=0.017, respectively). On the other hand, TGF-β levels were significantly higher in obese compared with nonobese children with asthma (P=0.015). IL-4, IL-23, and IFNγ levels were not significantly different between the groups (P<0.05 for all). Low IL-10 and high TGF-β levels in obese compared with nonobese children with asthma might indicate lower anti-inflammatory cytokine secretion and Treg function as well as a higher remodeling process in obesity-associated asthma in children.
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Affiliation(s)
- Hasan Yuksel
- Department of Pediatric Allergy and Pulmonology, Celal Bayar University, Manisa, Turkey
| | - Ozge Yilmaz
- Department of Pediatric Allergy and Pulmonology, Celal Bayar University, Manisa, Turkey
| | - Seda Vatansever
- Department of Histology and Embryology, Celal Bayar University, Manisa, Turkey
| | - Ece Onur
- Department of Biochemistry, Celal Bayar University, Manisa, Turkey
| | - Cengiz Kirmaz
- Allergy and Immunology, Celal Bayar University, Manisa, Turkey
| | - Emine Nal
- Department of Histology and Embryology, Celal Bayar University, Manisa, Turkey
| | - Ahmet Turkeli
- Department of Pediatric Allergy and Pulmonology, Celal Bayar University, Manisa, Turkey
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McNarry MA, Boddy LM, Stratton GS. The relationship between body mass index, aerobic performance and asthma in a pre-pubertal, population-level cohort. Eur J Appl Physiol 2013; 114:243-9. [PMID: 24213885 DOI: 10.1007/s00421-013-2772-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/31/2013] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess the relationship between asthma, body mass index (BMI) and aerobic performance, as indicated by a shuttle test. METHODS 20,577 participants (10,413 boys) from the SportsLinx serial cross-sectional study participated. Parental reports of asthma status and home postcode data were gathered from consent forms. Stature, sitting stature and body mass were measured and BMI, somatic maturity and indices of multiple deprivation scores (IMD) were derived. Performance on the 20 m multi-stage shuttle runs test (20mSRT) was used to estimate cardiorespiratory fitness (CRF). RESULTS Asthma [F (1, 17,015) = 82.26, P < 0.01] and gender [F (1, 17,015) = 678.491, P < 0.001] significantly influenced 20mSRT. The addition of BMI, maturity and IMD to the model did not alter these significant effects. There was a significant interaction between 20mSRT and BMI [F (1, 16,723) = 132.80, P < 0.01], with a significant decrease in 20mSRT from the 50th BMI percentile upwards [t (16,699) = 36.88, P < 0.01]. Binary logistic regression revealed gender and 20mSRT to be significant predictors of asthma occurrence; BMI SDS just reached significance whilst maturity and IMD were not significant contributors to the model. CONCLUSIONS This study demonstrates the negative influences of low CRF and high BMI on the risk of asthma occurrence in pre-pubertal children. Furthermore, it highlights the significant influence of BMI on CRF, revealing these effects to be manifest considerably below those BMI percentiles conventionally associated with being overweight or obese.
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Affiliation(s)
- M A McNarry
- Applied Sports Technology Exercise and Medicine Research Centre, College of Engineering, Swansea University, Singleton Park, Swansea, Wales, SA2 8PP, UK,
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Dugger KJ, Chrisman T, Jones B, Chastain P, Watson K, Estell K, Zinn K, Schwiebert L. Moderate aerobic exercise alters migration patterns of antigen specific T helper cells within an asthmatic lung. Brain Behav Immun 2013; 34:67-78. [PMID: 23928286 PMCID: PMC3826814 DOI: 10.1016/j.bbi.2013.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/10/2013] [Accepted: 07/22/2013] [Indexed: 12/28/2022] Open
Abstract
Studies have indicated increased incidence and severity of allergic asthma due to western lifestyle and increased sedentary activity. Investigations also indicate that exercise reduces the severity of asthma; however, a mechanism of action has not been elucidated. Additional work implicates re-distribution of T helper (Th) cells in mediating alterations of the immune system as a result of moderate aerobic exercise in vivo. We have previously reported that exercise decreases T helper 2 (Th2) responses within the lungs of an ovalbumin (OVA)-sensitized murine allergic asthma model. Therefore, we hypothesized that exercise alters the migration of OVA-specific Th cells in an OVA-challenged lung. To test this hypothesis, wildtype mice received OVA-specific Th cells expressing a luciferase-reporter construct and were OVA-sensitized and exercised. OVA-specific Th cell migration was decreased in OVA-challenged lungs of exercised mice when compared to their sedentary controls. Surface expression levels of lung-homing chemokine receptors, CCR4 and CCR8, on Th cells and their cognate lung-homing chemokine gradients revealed no difference between exercised and sedentary OVA-sensitized mice. However, transwell migration experiments demonstrated that lung-derived Th cells from exercised OVA-sensitized mice exhibited decreased migratory function versus controls. These data suggest that Th cells from exercised mice are less responsive to lung-homing chemokine. Together, these studies demonstrate that moderate aerobic exercise training can reduce the accumulation of antigen-specific Th cell migration into an asthmatic lung by decreasing chemokine receptor function.
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Affiliation(s)
- Kari J. Dugger
- Department of Biomedical Sciences, College of Allied Health, University of South Alabama, 5721 USA Dr. N, HAHN 4021, Mobile, AL, 36688
| | - Taylor Chrisman
- Department of Biomedical Sciences, College of Allied Health, University of South Alabama, 5721 USA Dr. N, HAHN 4021, Mobile, AL, 36688
| | - Ben Jones
- Department of Biomedical Sciences, College of Allied Health, University of South Alabama, 5721 USA Dr. N, HAHN 4021, Mobile, AL, 36688
| | - Parker Chastain
- Department of Biomedical Sciences, College of Allied Health, University of South Alabama, 5721 USA Dr. N, HAHN 4021, Mobile, AL, 36688
| | - Kacie Watson
- Department of Biomedical Sciences, College of Allied Health, University of South Alabama, 5721 USA Dr. N, HAHN 4021, Mobile, AL, 36688
| | - Kim Estell
- Department of Cell Biology, University of Alabama at Birmingham, BBRB 863, 845 19th St. S., Birmingham, Alabama, 35294
| | - Kurt Zinn
- Department of Radiology, University of Alabama at Birmingham, BBRB 863, 845 19th St. S., Birmingham, Alabama, 35294
| | - Lisa Schwiebert
- Department of Cell Biology, University of Alabama at Birmingham, BBRB 863, 845 19th St. S., Birmingham, Alabama, 35294
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Obesity and asthma: physiological perspective. J Allergy (Cairo) 2013; 2013:198068. [PMID: 23970905 PMCID: PMC3732624 DOI: 10.1155/2013/198068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 05/27/2013] [Accepted: 07/03/2013] [Indexed: 12/19/2022] Open
Abstract
Obesity induces some pertinent physiological changes which are conducive to either development of asthma or cause of poorly controlled asthma state. Obesity related mechanical stress forces induced by abdominal and thoracic fat generate stiffening of the lungs and diaphragmatic movements to result in reduction of resting lung volumes such as functional residual capacity (FRC). Reduced FRC is primarily an outcome of decreased expiratory reserve volume, which pushes the tidal breathing more towards smaller high resistance airways, and consequentially results in expiratory flow limitation during normal breathing in obesity. Reduced FRC also induces plastic alteration in the small collapsible airways, which may generate smooth muscle contraction resulting in increased small airway resistance, which, however, is not picked up by spirometric lung volumes. There is also a possibility that chronically reduced FRC may generate permanent adaptation in the very small airways; therefore, the airway calibres may not change despite weight reduction. Obesity may also induce bronchodilator reversibility and diurnal lung functional variability. Obesity is also associated with airway hyperresponsiveness; however, the mechanism of this is not clear. Thus, obesity has effects on lung function that can generate respiratory distress similar to asthma and may also exaggerate the effects of preexisting asthma.
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Rzehak P, Wijga AH, Keil T, Eller E, Bindslev-Jensen C, Smit HA, Weyler J, Dom S, Sunyer J, Mendez M, Torrent M, Vall O, Bauer CP, Berdel D, Schaaf B, Chen CM, Bergström A, Fantini MP, Mommers M, Wahn U, Lau S, Heinrich J. Body mass index trajectory classes and incident asthma in childhood: Results from 8 European Birth Cohorts—a Global Allergy and Asthma European Network initiative. J Allergy Clin Immunol 2013; 131:1528-36. [DOI: 10.1016/j.jaci.2013.01.001] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 11/26/2012] [Accepted: 01/03/2013] [Indexed: 01/02/2023]
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Childhood Overweight/Obesity and Asthma: Is There a Link? A Systematic Review of Recent Epidemiologic Evidence. J Acad Nutr Diet 2013; 113:77-105. [DOI: 10.1016/j.jand.2012.08.025] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 08/22/2012] [Indexed: 11/23/2022]
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Rastogi D, Khan UI, Isasi CR, Coupey SM. Associations of obesity and asthma with functional exercise capacity in urban minority adolescents. Pediatr Pulmonol 2012; 47:1061-9. [PMID: 22467360 PMCID: PMC3389560 DOI: 10.1002/ppul.22547] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 02/23/2012] [Indexed: 01/01/2023]
Abstract
PURPOSE To examine the independent association of asthma and obesity and of their co-existence with functional exercise capacity among urban adolescents. METHODS One hundred eighteen Hispanic- and African-American adolescents including 33 obese asthmatics, 18 normal-weight asthmatics, 38 obese non-asthmatics, and 29 normal-weight non-asthmatics underwent anthropometric measures, 6-minute walk test (6MWT) as measure of functional exercise capacity and spirometry as measure of pulmonary function. The 6-minute walk distance (6MWD) was compared between the four study groups. The association of 6MWD with measures of lower airway obstruction, and measures of adiposity was assessed. RESULTS The 6MWD was lower among the obese groups with the least distance covered by the obese asthmatic group (P = 0.02). In the obese asthmatic group, there was a negative correlation between 6MWD and body mass index (BMI) (r = -0.35, P = 0.03), but no association was noted with percent-predicted forced expiratory volume in the 1st second (FEV(1) ; r = 0.07, P = 0.70). Conversely, the 6MWD correlated with FEV(1) among normal-weight asthmatics (r = 0.45, P = 0.04) and normal-weight non-asthmatics (r = 0.4, P = 0.03), but was not associated with BMI in either of the two groups. After adjusting for age, height, gender, and ethnicity, BMI was noted to be a significant predictor (β -2.76, 95% CI -4.77 to -0.76, P < 0.01) of the 6MWD among the obese while percent predicted FEV(1) (β 1.87, 95% CI 0.28-3.45, P = 0.02) was a significant predictor among the normal-weight participants. CONCLUSIONS Our findings suggest that among urban minority obese asthmatic adolescents, functional exercise capacity was associated with obesity, rather than pulmonary function.
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Affiliation(s)
- Deepa Rastogi
- Division of Respiratory and Sleep Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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Anthracopoulos MB, Fouzas S, Papadopoulos M, Antonogeorgos G, Papadimitriou A, Panagiotakos DB, Nicolaidou P, Priftis KN. Physical activity and exercise-induced bronchoconstriction in Greek schoolchildren. Pediatr Pulmonol 2012; 47:1080-7. [PMID: 22811318 DOI: 10.1002/ppul.22620] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 05/03/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the association between physical activity and exercise-induced bronchoconstriction (EIB) in an urban population sample of schoolchildren, taking into account potential confounders such as asthma symptoms and overweight. METHODS Children aged 10-12 years answered validated questionnaires on physical activity (Physical Activity and Lifestyle Questionnaire) and asthma symptoms (ISAAC questionnaire), and were categorized according to their body mass index (BMI). EIB (FEV(1) decrease from baseline ≥13%) was assessed by a standardized free running Exercise Challenge Test (ECT). RESULTS Six hundred seven children completed the ECT. There were no differences among asthma groups (diagnosed asthma, asthma-related symptoms not diagnosed as asthma, no asthma-related symptoms) regarding total daily energy expenditure and time spent in mild (1.1-2.9 metabolic equivalents-METs), moderate (3-6 METs), and vigorous (>6 METs) activities. Only overweight/obese EIB-positive children had shorter duration of vigorous activity as compared to their EIB-negative or non-overweight/obese EIB-positive peers. Total daily energy expenditure and duration of mild- and moderate-intensity activity were negatively associated with EIB independently of BMI status or asthma-related symptoms. CONCLUSIONS Decreased levels of physical activity are associated with EIB irrespectively of BMI status and asthma-related symptoms. Longitudinal studies are needed to confirm the negative impact of sedentary lifestyle on the development of EIB suggested by these findings.
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Lang JE. Obesity, Nutrition, and Asthma in Children. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2012; 25:64-75. [PMID: 22768385 DOI: 10.1089/ped.2011.0137] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 01/15/2012] [Indexed: 02/06/2023]
Abstract
Obesity rates have increased dramatically among children in many parts of the world, especially in North America and several other English-speaking countries. The impact of obesity on pediatric health has become a major prevention initiative by the Obama administration and several public health organizations. Children with obesity are at increased risk for developing asthma, which is already one of the most common chronic diseases among children. The cause underlying obesity's impact on asthma risk is unknown. Commonly cited potential etiologies include airway smooth muscle dysfunction from thoracic restriction, obesity-related circulating inflammation priming the lung, and obesity-related comorbidities mediating asthma symptom development. Each of these theories does not fit precisely with all of the data that have accumulated over the last decade. In this review, I will explore other possible causes including: (1) dietary characteristics common in Westernized countries that might lead to both obesity and asthma; (2) reductions in physical activity; and (3) genetic alterations that increase the propensity to both obesity and asthma together. Next, I will review the current data on how obesity affects common characteristics of asthma such as airway inflammation, lung function, risk of exacerbation, atopy, and response to treatment. Obesity in children with asthma appears to be associated with greater airflow obstruction and a mildly diminished response to inhaled corticosteroids. Little objective evidence in children suggests that obesity significantly heightens the risk of exacerbation or worsens disease stability in children. Lastly, I will discuss the current literature that suggests that obese children with asthma generally should receive the same guidelines-based management as lean children. However, interventions that encourage daily physical activity, weight-loss, normalization of nutrient levels, and monitoring of common obesity-related sequelae should be considered by healthcare providers managing obese children with difficult-to-control asthma.
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Lang JE, Hossain J, Smith K, Lima JJ. Asthma severity, exacerbation risk, and controller treatment burden in underweight and obese children. J Asthma 2012; 49:456-63. [PMID: 22530959 DOI: 10.3109/02770903.2012.677895] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The relationship between weight status and asthma characteristics in children remains inadequately defined. Very little has been published on the risk of exacerbation, physician perception of severity, and the level controller treatment prescribed to underweight and obese children with asthma in a real-world setting. METHODS We assessed the diagnostic severity, pulmonary function, exacerbation prevalence, and controller treatment level in 10,559 new asthma patients seen at one of four pediatric asthma subspecialty clinics among three BMI groups. Participants were analyzed by body mass index (BMI)-percentile based on Centers for Disease Control & Prevention classification. Multivariable logistic regression models were used to assess the associations between BMI-percentile cohort group and asthma outcomes. RESULTS. Underweight asthmatics were rare (2.5%) relative to obese asthmatics but appeared to have the greatest impairment in forced vital capacity and had the greatest controller treatment burden. Obese asthmatic children made up 26.2% of our cohort and were more likely to have severe disease (odds ratio (OR) 1.40, 95% confidence interval (CI) 1.06-1.85) and airflow obstruction (OR 1.36, 95% CI 1.16-1.59) compared to normal weight asthmatics. Obese asthmatics were not at greater risk for exacerbation (OR 1.41, 95% CI 0.64-3.11) or high treatment burden (OR 1.03, 95% CI 0.83-1.28). CONCLUSIONS. Obesity is more common than underweight status among children with asthma. Both underweight and obese children with asthma have worse lung function and asthma-related outcomes compared to similar normal weight children, though the phenotypic characteristics of underweight and obese asthmatics differed considerably.
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Affiliation(s)
- Jason E Lang
- Division of Pulmonology, Allergy & Immunology, Nemours Children's Clinic, Jacksonville, FL 32207, USA.
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Rosenkranz SK, Rosenkranz RR, Hastmann TJ, Harms CA. High-intensity training improves airway responsiveness in inactive nonasthmatic children: evidence from a randomized controlled trial. J Appl Physiol (1985) 2012; 112:1174-83. [PMID: 22241059 DOI: 10.1152/japplphysiol.00663.2011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE the relationship between physical activity and airway health in children is not well understood. The purpose of this study was to determine whether 8 wk of high-intensity exercise training would improve airway responsiveness in prepubescent, nonasthmatic, inactive children. METHODS 16 healthy, prepubescent children were randomized [training group (TrG) n = 8, control group (ConG) n = 8]. Prior to and following 8 wk of training (or no training), children completed pulmonary function tests (PFTs): forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC), forced expiratory flow at 25-75% of vital capacity (FEF(25-75)), and exhaled nitric oxide (FENO). Children completed an incremental cycle Vo(2max) test, eucapnic voluntary hyperventilation (EVH), anthropometric tests, and blood tests to determine fasting blood glucose, total cholesterol, HDL, LDL, and triglycerides. Body fat percentage was determined using dual-energy X-ray absorptiometry pretraining and bioelectrical impedance pre- and posttraining. RESULTS there were no differences (P > 0.05) in anthropometric measures or PFTs between TrG and ConG at baseline. In the TrG, there was a significant increase in Vo(2max) (∼24%) and a decrease in total cholesterol (∼13%) and LDL cholesterol (∼35%) following training. There were improvements (P < 0.05) in ΔFEV(1) both postexercise (pre: -7.60 ± 2.10%, post: -1.10 ± 1.80%) and post-EVH (pre: -6.71 ± 2.21%, post: -1.41 ± 1.58%) with training. The ΔFEF(25-75) pre-post exercise also improved with training (pre: -16.10 ± 2.10%, post: -6.80 ± 1.80%; P < 0.05). Lower baseline body fat percentages were associated with greater improvements in pre-post exercise ΔFEV(1) following training (r = -0.80, P < 0.05). CONCLUSION these results suggest that in nonasthmatic prepubescent children, inactivity negatively impacts airway responsiveness, which can be improved with high-intensity training. Excess adiposity, however, may constrain these improvements.
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Affiliation(s)
- Sara K Rosenkranz
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA.
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Stevens W, Addo-Yobo E, Roper J, Woodcock A, James H, Platts-Mills T, Custovic A. Differences in both prevalence and titre of specific immunoglobulin E among children with asthma in affluent and poor communities within a large town in Ghana. Clin Exp Allergy 2011; 41:1587-94. [PMID: 21810123 PMCID: PMC3505371 DOI: 10.1111/j.1365-2222.2011.03832.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Reports from several African countries have noted an increasing prevalence of asthma in areas of extensive urbanization. OBJECTIVE To investigate the relevance of allergen-specific sensitization and body mass index (BMI) to asthma/wheezing and exercise-induced bronchospasm (EIB) among children from affluent and poorer communities within a large town in Ghana. METHODS Children with physician-diagnosed asthma and/or current wheezing aged 9-16 years (n=99; cases) from three schools with differing socio-economic backgrounds [urban affluent (UA), urban poor (UP) or suburban/rural (SR)] were recruited from a cross-sectional study (n=1848) in Kumasi, Ghana, and matched according to age, sex and area of residence with non-asthmatic/non-wheezy controls. We assayed sera for IgE antibodies to mite, cat, dog, cockroach, Ascaris and galactose-α-1,3-galactose. RESULTS Children from the UA school had the lowest total serum IgE. However, cases from the UA school had a higher prevalence and mean titre of sIgE to mite (71.4%, 21.2 IU/mL) when compared with controls (14.3%, 0.8 IU/mL) or cases from UP (30%, 0.8 IU/mL) and SR community (47.8%, 1.6 IU/mL). While similar findings were observed with EIB in the whole population, among cases there was no difference in IgE antibody prevalence or titre between children with or without EIB. BMI was higher among UA children with and without asthma; in UP and SR communities, children with EIB (n=14) had a significantly higher BMI compared with children with asthma/wheezing without EIB (n=38) (18.2 vs. 16.4, respectively, P<0.01). CONCLUSIONS AND CLINICAL RELEVANCE In the relatively affluent school, asthma/wheezing and EIB were associated with high titre IgE antibodies to mite, decreased total IgE, and increased BMI. This contrasted with children in the urban poor school and suggests that changes relevant to a Western model of childhood asthma can occur within a short geographical distance within a large city in Africa.
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Affiliation(s)
- W Stevens
- University of Virginia Asthma and Allergic Diseases Center, Charlottesville, VA, USA
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Rosenkranz SK, Swain KE, Rosenkranz RR, Beckman B, Harms CA. Modifiable lifestyle factors impact airway health in non-asthmatic prepubescent boys but not girls. Pediatr Pulmonol 2011; 46:464-72. [PMID: 21194140 DOI: 10.1002/ppul.21393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 08/15/2010] [Accepted: 09/27/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The prevalence of both childhood obesity and childhood asthma has increased dramatically over the past few decades. Little is known concerning the role of body composition and lifestyle influences on airway health in children. PURPOSE To determine whether body composition, fruit and vegetable intake (FV) and physical activity (PA) impact airway health in healthy prepubescent children. METHODS Pulmonary function tests (forced expiratory flow in 1-sec, forced vital capacity, forced expiratory flow at 25-75% of vital capacity) and exhaled nitric oxide (eNO) were measured pre- and post-exercise in 40 healthy (20 boys, 20 girls), non-asthmatic prepubescent children (age 9.7 ± 0.8 years). PA and FV intake were assessed via questionnaire. Each participant completed an incremental cycle-ergometer exercise test to exhaustion (V02 max). Body composition was measured via Dual Energy X-ray Absorptiometry. Participants were stratified by sex for analyses, and follow-up analyses were performed using a clinically significant drop in FEV1 of ≥ 10% to divide participants into groups. RESULTS In the overall group, the change in FEV1 (pre- and post-exercise) was inversely related (r = -0.47, P < 0.05) to % body fat; participants with the highest body fat demonstrated the greatest decrease in FEV1 (i.e., airway narrowing). When participants were divided by sex, this association held true only for boys (r = -0.61, P < 0.01). Percent body fat was the only significant contributor to the overall prediction of ΔFEV1 in boys. Boys engaged in significantly more PA than girls (3.45 ± 2.39; 2.00 ± 1.30 activities/day). Boys also had significantly higher V02 max adjusted for lean body mass than girls (48.06 ± 5.09; 42.30 ± 6.06). Body fat percent was not different by sex (P > 0.05). The participants in the ≥ 10% FEV1 group had a significantly greater body fat (28.1 ± 9.6%) compared to the <10% drop group (18.8 ± 9.8%). CONCLUSION These results suggest that PA, FV consumption, and body fat collectively impact airway health in prepubescent boys but not girls. Body fat, however, is the only independent predictor of post-exercise airway narrowing.
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Affiliation(s)
- Sara K Rosenkranz
- Department of Kinesiology, Kansas State University, Manhattan, Kansas 66506; College of Health and Science, University of Western Sydney, Campbelltown, New South Wales, Australia
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Zhang Z, Lai HJ, Roberg KA, Gangnon RE, Evans MD, Anderson EL, Pappas TE, Dasilva DF, Tisler CJ, Salazar LP, Gern JE, Lemanske RF. Early childhood weight status in relation to asthma development in high-risk children. J Allergy Clin Immunol 2010; 126:1157-62. [PMID: 21051081 PMCID: PMC2998556 DOI: 10.1016/j.jaci.2010.09.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 09/03/2010] [Accepted: 09/09/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND Obesity has been proposed to be a risk factor for the development of childhood asthma. OBJECTIVE We sought to examine weight status from birth to age 5 years in relation to the occurrence of asthma at ages 6 and 8 years. METHODS Two hundred eighty-five full-term high-risk newborns with at least 1 asthmatic/atopic parent enrolled in the Childhood Origin of Asthma project were studied from birth to age 8 years. Overweight was defined by weight-for-length percentiles of greater than the 85th percentile before the age of 2 years and a body mass index percentile of greater than the 85th percentile at ages 2 to 5 years. RESULTS No significant concurrent association was found between overweight status and wheezing/asthma occurrence at each year of age. In contrast, longitudinal analyses revealed complex relationships between being overweight and asthma. Being overweight at age 1 year was associated with a decreased risk of asthma at age 6 (odds ratio [OR], 0.32; P = .02) and 8 (OR, 0.35; P = .04) years, as well as better lung function. However, being overweight beyond infancy was not associated with asthma occurrence. In fact, only children who were overweight at age 5 years but not at age 1 year had an increased risk of asthma at age 6 years (OR, 5.78; P = .05). CONCLUSION In children genetically at high risk of asthma, being overweight at age 1 year was associated with a decreased risk of asthma and better lung function at ages 6 and 8 years. However, being overweight beyond infancy did not have any protective effect and even could confer a higher risk for asthma.
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Affiliation(s)
- Zhumin Zhang
- Department of Nutritional Sciences, University of Wisconsin College of Agriculture and Life Sciences, Madison, WI 53706-1562, USA.
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Kier C, Forde SA. Childhood Overweight and Obesity and Their Association With Asthma. ACTA ACUST UNITED AC 2010. [DOI: 10.1177/2150129710384503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Catherine Kier
- Stony Brook University Medical Center, Stony Brook, New York (CK)
- Boston University School of Medicine, Boston, Massachusetts (SAF)
| | - Simone A. Forde
- Stony Brook University Medical Center, Stony Brook, New York (CK)
- Boston University School of Medicine, Boston, Massachusetts (SAF)
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Affiliation(s)
- Ilene Fennoy
- Division of Pediatric Endocrinology, Columbia University Medical Center, New York, NY 10032, USA.
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Lowder T, Dugger K, Deshane J, Estell K, Schwiebert LM. Repeated bouts of aerobic exercise enhance regulatory T cell responses in a murine asthma model. Brain Behav Immun 2010; 24:153-9. [PMID: 19781626 PMCID: PMC2787986 DOI: 10.1016/j.bbi.2009.09.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 09/16/2009] [Accepted: 09/17/2009] [Indexed: 11/30/2022] Open
Abstract
We have reported previously that moderate intensity aerobic exercise training attenuates airway inflammation in a murine asthma model. Recent studies implicate regulatory T (Treg) cells in decreasing asthma-related airway inflammation; as such, the current study examined the effect of exercise on Treg cell function in a murine asthma model. Mice were sensitized with ovalbumin (OVA) prior to the start of exercise training at a moderate intensity 3x/week for 4weeks; exercise was performed as treadmill running (13.5m/min, 0% grade). Mice were OVA challenged repeatedly throughout the exercise protocol. At protocol completion, mice were analyzed for changes in the number and suppressive function of CD4(+)CD25(+)Foxp3(+) cells isolated from lungs, mediastinal lymph nodes, and spleens. Results show that exercise increased significantly the number of Foxp3(+) cells within the lungs and mediastinal lymph nodes, but not the spleens, of OVA-treated mice as compared with sedentary controls. Exercise also enhanced the suppression function of CD4(+)CD25(+)Foxp3(+) Treg cells derived from OVA-treated mice as compared with sedentary controls. Specifically, Treg cells from exercised, OVA-treated mice more effectively suppressed CD4(+)CD25(-) cell proliferation and Th2 cytokine production in vitro. Enhanced suppression was associated with increased protein levels of TGF-beta and lesser amounts of IL-10 and IL-17; however, blocking TGF-beta had no effect on suppressive functions. These data demonstrate that exercise-mediated increases in Treg cell function may play a role in the attenuation of airway inflammation. Further, these results indicate that moderate intensity aerobic exercise training may alter the Treg cell function within the asthmatic airway.
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Affiliation(s)
- Thomas Lowder
- Department of Physiology and Biophysics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kari Dugger
- Department of Physiology and Biophysics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessy Deshane
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kim Estell
- Department of Physiology and Biophysics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lisa M. Schwiebert
- Department of Physiology and Biophysics, University of Alabama at Birmingham, Birmingham, AL, USA
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Michelson PH, Williams LW, Benjamin DK, Barnato AE. Obesity, inflammation, and asthma severity in childhood: data from the National Health and Nutrition Examination Survey 2001-2004. Ann Allergy Asthma Immunol 2009; 103:381-5. [PMID: 19927535 DOI: 10.1016/s1081-1206(10)60356-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The prevalences of asthma and obesity in children have increased significantly during the past 2 decades. The basis for the relationship between pediatric asthma and obesity is not well established. OBJECTIVES To explore the association between obesity and asthma severity in children and adolescents and to test whether obesity-induced inflammation, as characterized by serum C-reactive protein (CRP), is associated with increased severity of asthma. METHODS Retrospective cohort analysis of interview, physical examination, and laboratory test data from participants younger than 20 years in 2 rounds of the National Health and Nutrition Examination Survey (2001-2002 and 2003-2004). We also performed generalized ordered logistic regression to evaluate the effect of body mass index (BMI) z score and CRP level on asthma severity, controlling for the impact of age, sex, race, income, insurance, and tobacco smoke exposure. RESULTS Of the 77 million individuals younger than 20 years represented by this weighted sample, 19% met the study-defined criteria for asthma; most cases were defined as mild (11%) or moderate (6%); 2% had severe asthma. In multivariable models, elevated BMI z scores (odds ratio, 1.12; 95% confidence interval, 1.05-1.21) were associated with worse asthma severity. Elevated CRP level was associated with obesity (P < .001) and asthma severity (odds ratio, 1.33; 95% confidence interval, 1.16-1.52). CONCLUSIONS Higher BMI z scores and elevated serum CRP levels are associated with increased asthma severity. These findings highlight the importance of controlling for inflammation when considering the role of obesity and provide support for the hypothesis that obesity-induced inflammation may contribute to greater asthma severity.
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Affiliation(s)
- Peter H Michelson
- Division of Pediatric Pulmonary and Sleep Medicine, Duke Children's Hospital, Durham, North Carolina 27710, USA.
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Sharp LK, Curtis LM, Mosnaim G, Shalowitz MU, Catrambone C, Sadowski LS. The influence of caregiver's psychosocial status on childhood asthma and obesity. Ann Allergy Asthma Immunol 2009; 103:386-94. [PMID: 19927536 DOI: 10.1016/s1081-1206(10)60357-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The prevalence of childhood asthma and childhood overweight has increased in the last 2 decades, disproportionately burdening ethnic minority children and those living in poverty with no clear understanding of underlying mechanisms. OBJECTIVE To explore the influence of demographic variables, childhood obesity (adjusted body mass index > or = 95th percentile), caregivers' smoking status, and caregiver psychosocial status on asthma severity and asthma control in an urban sample of children with persistent asthma. METHODS Child (with asthma)-caregiver dyads were recruited from public and archdiocese schools in Chicago, Illinois, as part of the Chicago Initiative to Raise Asthma Health Equity. Data were collected as part of the baseline face-to-face surveys conducted within the community. RESULTS The 531 dyads were divided into 2 groups: 294 taking controller medications were in the asthma control analyses and 237 taking rescue medications only were in the asthma severity analyses. In multivariate models, asthma control was significantly worse in obese children (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.17-3.05), African American children (OR, 2.16; 95% CI, 1.05-4.46), and those with caregivers who had higher stress (OR, 1.09; 95% CI, 1.01-1.18). Older children had better control (OR, 0.79; 95% CI, 0.69-0.90). Children with caregivers who wanted more asthma-specific social support were more likely to have moderate to severe asthma (OR, 2.07; 95% CI, 1.06-4.05). CONCLUSION In this community-based sample of children with active asthma, asthma control and asthma severity were associated with different factors. Caregiver variables were significant in both outcomes, and childhood obesity was associated only with poor asthma control.
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Affiliation(s)
- Lisa K Sharp
- Department of Medicine, Section of Health Promotion Research, University of Illinois at Chicago, Chicago, Illinois 60608, USA.
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Park YH, Kim KW, Lee KE, Kim ES, Sohn MH, Kim KE. Clinical implications of serum retinol-binding protein 4 in asthmatic children. J Korean Med Sci 2009; 24:1010-4. [PMID: 19949653 PMCID: PMC2775845 DOI: 10.3346/jkms.2009.24.6.1010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 12/22/2008] [Indexed: 11/20/2022] Open
Abstract
Recently the prevalence of both asthma and obesity have increased substantially in many countries. The aim of this study was to evaluate the role of retinol-binding protein (RBP) 4 in childhood asthma and its association with atopy markers, pulmonary function, and bronchial hyperresponsiveness in relation to obesity. We studied 160 children between the ages 6 to 10 yr, including 122 asthmatics and 38 controls. The body mass index, pulmonary function tests, and methacholine challenge tests were measured on the same day. Total eosinophil count, serum total IgE, serum eosinophil cationic protein, and serum RBP4 were measured in all subjects. There was no difference in serum RBP4 levels between the asthmatics and the control group. In all subjects or subgroups, serum RBP4 was not associated with total eosinophil count, serum total IgE, serum eosinophil cationic protein, or PC(20). There was no relationship between serum RBP4 and pulmonary function in female asthmatics. Forced expiratory volume in 1 second/forced vital capacity (FVC) and forced expiratory flow between 25% and 75% of FVC contributed to serum RBP4 in male asthmatics. Our findings show an association between RBP4 and pulmonary function in prepubertal male asthmatics. This relationship may indirectly affect the high prevalence of childhood asthma in males.
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Affiliation(s)
- Yeo Hoon Park
- Department of Pediatrics and Institute of Allergy, BK 21 Project for Medical Sciences, Research Center for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics and Institute of Allergy, BK 21 Project for Medical Sciences, Research Center for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Eun Lee
- Department of Pediatrics and Institute of Allergy, BK 21 Project for Medical Sciences, Research Center for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Soo Kim
- Department of Pediatrics and Institute of Allergy, BK 21 Project for Medical Sciences, Research Center for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics and Institute of Allergy, BK 21 Project for Medical Sciences, Research Center for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Earn Kim
- Department of Pediatrics and Institute of Allergy, BK 21 Project for Medical Sciences, Research Center for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Korea
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Hewitt M, Estell K, Davis IC, Schwiebert LM. Repeated bouts of moderate-intensity aerobic exercise reduce airway reactivity in a murine asthma model. Am J Respir Cell Mol Biol 2009; 42:243-9. [PMID: 19423772 DOI: 10.1165/rcmb.2009-0038oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We have reported that moderate-intensity aerobic exercise training attenuates airway inflammation in mice sensitized/challenged with ovalbumin (OVA). The current study determined the effects of repeated bouts of aerobic exercise at a moderate intensity on airway hyperresponsiveness (AHR) in these mice. Mice were sensitized/challenged with OVA or saline and exercised at a moderate intensity 3 times/week for 4 weeks. At protocol completion, mice were analyzed for changes in AHR via mechanical ventilation. Results show that exercise decreased total lung resistance 60% in OVA-treated mice as compared with controls; exercise also decreased airway smooth muscle (ASM) thickness. In contrast, exercise increased circulating epinephrine levels 3-fold in saline- and OVA-treated mice. Because epinephrine binds beta(2)-adrenergic receptors (AR), which facilitate bronchodilatation, the role of beta(2)-AR in exercise-mediated improvements in AHR was examined. Application of the beta(2)-AR antagonist butoxamine HCl blocked the effects of exercise on lung resistance in OVA-treated mice. In parallel, ASM cells were examined for changes in the protein expression of beta(2)-AR and G-protein receptor kinase-2 (GRK-2); GRK-2 promotes beta(2)-AR desensitization. Exercise had no effect on beta(2)-AR expression in ASM cells of OVA-treated mice; however, exercise decreased GRK-2 expression by 50% as compared with controls. Exercise also decreased prostaglandin E(2) (PGE(2)) production 5-fold, but had no effect on E prostanoid-1 (EP1) receptor expression within the lungs of OVA-treated mice; both PGE(2) and the EP1 receptor have been implicated in beta(2)-AR desensitization. Together, these data indicate that moderate-intensity aerobic exercise training attenuates AHR via a mechanism that involves beta(2)-AR.
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Affiliation(s)
- Matt Hewitt
- Department of Physiology and Biophysics, University of Alabama at Birmingham, 1918 University Boulevard, Birmingham, AL 35294-0005, USA
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40
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Lang JE, Feng H, Lima JJ. Body mass index-percentile and diagnostic accuracy of childhood asthma. J Asthma 2009; 46:291-9. [PMID: 19373639 DOI: 10.1080/02770900802712963] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine whether high BMI-percentile is associated with misdiagnosis of asthma among children referred to an asthma specialist. METHODS We queried the electronic records of children 8 to 18 years of age seen by a Nemours pediatric pulmonologist. All visits during a 6-year period with the chief complaint of asthma, or an asthma-like symptom such as wheeze, cough, or dyspnea, were included. We collected spirometry, blood counts, and immunoglobulin E (IgE) if available. We determined whether the child had referring physician-diagnosed asthma, specialist-diagnosed asthma, or both. Specialist-diagnosed asthmatics who met additional objective "gold-standard" criterion were labeled strict-criterion asthma. RESULTS Prevalence of high BMI-percentile was extremely common in all defined asthma groups, even those meeting strict criteria for diagnosis. Referring physician-diagnosed asthmatics did not have higher rates of obesity, and referring physician-diagnosed asthmatics had objective indicators of asthma that were the same as asthmatics diagnosed by a specialist. There was good diagnostic correlation between referring physicians and asthma specialists that was not affected by BMI. Among specialist-diagnosed asthmatics, increased BMI-percentile associated with significantly reduced forced expiratory volume in 1 second (FEV(1)), forced expiratory flow during the middle half of the forced vital capacity (FEF(25 - 75)), and FEV(1)/forced vital capacity (FVC); and significantly increased total blood leukocytes, neutrophils, and platelets compared to leans. For all 2,258 referrals, the estimated odds ratio of receiving a specialist-diagnosis of asthma increased by 0.4% with each increasing BMI percentile. CONCLUSIONS Referring physicians do not appear to erroneously diagnose children with asthma due to overweight status. Our data confirm that overweight status is extremely high in children with true asthma and likely increases the risk for true asthma. Although these data cannot discern causality, high BMI-percentile is associated with greater airflow obstruction and elevated markers of systemic inflammation that could contribute to underlying mechanisms of asthma.
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Affiliation(s)
- Jason E Lang
- Division of Pulmonology, Allergy & Immunology, Nemours Children's Clinic, Jacksonville, FL 32207, USA.
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Castro-Rodriguez JA. Asthma, obesity, sedentary lifestyle and physical activity: an important issue still unresolved? Allergol Immunopathol (Madr) 2009; 36:245-6. [PMID: 19080794 DOI: 10.1016/s0301-0546(08)75217-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Anthracopoulos MB, Antonogeorgos G, Liolios E, Triga M, Panagiotopoulou E, Priftis KN. Increase in chronic or recurrent rhinitis, rhinoconjunctivitis and eczema among schoolchildren in Greece: three surveys during 1991-2003. Pediatr Allergy Immunol 2009; 20:180-6. [PMID: 18433422 DOI: 10.1111/j.1399-3038.2008.00752.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The prevalence of allergic rhinitis, hay fever and eczema has risen worldwide during the last four decades but may have reached a plateau in some westernized societies. We examined time trends in the prevalence of childhood chronic or recurrent rhinitis, rhinoconjunctivitis and eczema in urban Greece. Using identical methodology, three population-based cross-sectional parental questionnaire surveys on current (last two years) and lifetime allergic symptoms of the nose, eyes and skin were performed among 8-10-yr-old children in 1991, 1998 and 2003 in Patras, Greece. Exactly 2417, 3006 and 2725 questionnaires were completed in 1991, 1998 and 2003, respectively. Prevalence rates of current (lifetime) symptoms of chronic or recurrent rhinitis were 5.1% (6.0%) for 1991, 6.5% (8.0%) for 1998 and 8.0% (9.8%) for 2003. Respective values for rhinoconjunctivitis were 1.8% (2.1%), 2.7% (3.4%) and 3.6% (4.6%) and for eczema 2.5% (4.5%), 3.4% (6.3%) and 5.0% (9.5%) (p for trend <0.001). Among current asthmatics there was an increase in lifetime rhinitis (p = 0.038), current (p = 0.025) and lifetime rhinoconjunctivitis (p = 0.007) and current (p = 0.001) and lifetime eczema (p < 0.001); male predominance increased throughout the study. The proportion of atopic asthma (current asthma with chronic or recurrent rhinitis and/or rhinoconjunctivitis and/or eczema) increased during the same period (p < 0.001). In conclusion, there is a continuous increase in the prevalence of allergic manifestations among preadolescent children in Patras, Greece during the period 1991-2003. In our population, boys have contributed to this increase more than girls and the increase of atopy is, at least partially, responsible for the increase of asthma.
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Williams DR, Sternthal M, Wright RJ. Social determinants: taking the social context of asthma seriously. Pediatrics 2009; 123 Suppl 3:S174-84. [PMID: 19221161 PMCID: PMC3489274 DOI: 10.1542/peds.2008-2233h] [Citation(s) in RCA: 202] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although asthma has emerged as a major contributor to disease and disability among US children, the burden of this disease is unevenly distributed within the population. This article provides a brief overview of social-status variables that predict variations in asthma risks and social exposures, such as stress and violence, that are emerging as important risk factors. The central focus of the article is on the distal social variables that have given rise to unhealthy residential environments in which the risk factors for asthma and other diseases are clustered. Effective initiatives for the prevention and treatment of childhood asthma need to address these nonmedical determinants of the prevalence of asthma.
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Affiliation(s)
- David R. Williams
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts
,Departments of African and African American Studies and Sociology, Harvard University, Cambridge, Massachusetts
| | - Michelle Sternthal
- Departments of Public Policy and Sociology, University of Michigan, Ann Arbor, Michigan
| | - Rosalind J. Wright
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts
,Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Verhulst SL, Aerts L, Jacobs S, Schrauwen N, Haentjens D, Claes R, Vaerenberg H, Van Gaal LF, De Backer WA, Desager KN. Sleep-Disordered Breathing, Obesity, and Airway Inflammation in Children and Adolescents. Chest 2008; 134:1169-1175. [DOI: 10.1378/chest.08-0535] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Sithole F, Douwes J, Burstyn I, Veugelers P. Body mass index and childhood asthma: a linear association? J Asthma 2008; 45:473-7. [PMID: 18612899 DOI: 10.1080/02770900802069117] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Our objective was to characterize the association between body mass index (BMI) and childhood asthma while adjusting for individual and neighborhood socioeconomic factors. Data were obtained from 3,804 students 10 to 11 years of age in Nova Scotia, Canada. Asthma was defined as parent-reported doctor-diagnosed asthma or bronchitis. Smoothed curves suggested a linear association between BMI and asthma with a 6 % increase in prevalence per unit increase of BMI. This association was independent of allergies, sex, and socioeconomic factors. Girls from socioeconomically disadvantaged neighborhoods were less likely to be asthmatic as were boys from well-educated and wealthy families.
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Affiliation(s)
- Fortune Sithole
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Lang A, Carlsen KH, Haaland G, Devulapalli CS, Munthe-Kaas M, Mowinckel P, Carlsen K. Severe asthma in childhood: assessed in 10 year olds in a birth cohort study. Allergy 2008; 63:1054-60. [PMID: 18691307 DOI: 10.1111/j.1398-9995.2008.01672.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited information is available regarding the prevalence of severe asthma in children. The present study aimed at investigating the prevalence of severe asthma in an urban child population; secondarily evaluating the applicability of the chosen definition by clinical characteristics. METHODS Children enrolled in the prospective birth cohort; the Environment and Childhood Asthma Study in Oslo; were reinvestigated at the age of 10 years (n = 1019). A representative population based cohort of 616 children [mean age 10.9 (SD 0.9) years] with lung function measurements at birth was used for prevalence estimates, whereas all 1019 children (154 with current asthma) attending the 10-year follow-up were included for verification of the definition of severe asthma. Clinical investigations included spirometry, tests of bronchial hyperresponsiveness, skin prick tests and exhaled nitric oxide. Severe asthma was defined as poorly controlled asthma despite treatment with > or = 800 microg budesonide or equivalent; assessed by a detailed structured interview. RESULTS The population point prevalence at age 10 years of current severe asthma was 0.5% (three of 616) and among children with current asthma 4.5% (three of 67). The 10/154 children identified as suffering from severe asthma more often had severe bronchial hyperresponsiveness (PD(20) methacholine <1 micromol) (60%vs 22%, P = 0.015), lower median forced expiratory volume in 1 s/forced vital capacity ratio (93%vs 99%, P = 0.04) and higher body mass index (mean BMI 22.3 vs 18.3, P < 0.001) than nonsevere current asthmatics. CONCLUSIONS The prevalence of severe asthma was 0.5% in all 10-year olds, and 4.5% among current asthmatics. The severe asthma definition applied in this study is supported by results of clinical investigations.
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Affiliation(s)
- A Lang
- Department of Pediatrics, Ullevål University Hospital, Oslo, Norway
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Castro-Rodriguez JA, Garcia-Marcos L, Alfonseda Rojas JD, Valverde-Molina J, Sanchez-Solis M. Mediterranean diet as a protective factor for wheezing in preschool children. J Pediatr 2008; 152:823-8, 828.e1-2. [PMID: 18492525 DOI: 10.1016/j.jpeds.2008.01.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 11/12/2007] [Accepted: 01/04/2008] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To test the hypothesis that the Mediterranean diet can be a protective factor for current wheezing in preschoolers. STUDY DESIGN Questionnaires were completed by parents of 1784 preschoolers (mean age, 4.08 +/- 0.8 years). Children were stratified according to whether they experienced wheezing (20.0%) or not in the previous year. A Mediterranean diet score was built according to the intake frequency of several foods. RESULTS Age, birth by cesarean section, low birth weight, exposure to livestock during pregnancy, antibiotic use in the first year of life, acetaminophen consumption in the previous 12 months, rhinoconjunctivitis, eczema, parental asthma and tobacco consumption, maternal educational level, maternal age, physical activity, cat at home, and Mediterranean diet were associated with current wheezing but not with obesity. In the multivariate analysis, eczema, rhinoconjunctivitis, paternal asthma, and acetaminophen consumption remained risk factors for current wheezing (adjusted odds ratio [aOR] = 2.35 [95% confidence interval (CI) = 1.2 to 4.8], 2.78 [95% CI =1.3 to 6.1], 3.89 [95% CI = 1.4 to 10.7], and 2.38 [95% CI = 1.2 to 4.6], respectively). Conversely, Mediterranean diet and older age remained protective factors (aOR = 0.54 [95% CI = 0.3 to 0.9] and 0.67 [95% CI = 0.5 to 0.9], respectively). CONCLUSIONS The Mediterranean diet is an independent protective factor for current wheezing in preschoolers, irrespective of obesity and physical activity.
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Litonjua AA, Gold DR. Asthma and obesity: common early-life influences in the inception of disease. J Allergy Clin Immunol 2008; 121:1075-84; quiz 1085-6. [PMID: 18378287 DOI: 10.1016/j.jaci.2008.03.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 03/07/2008] [Accepted: 03/07/2008] [Indexed: 12/21/2022]
Abstract
The respective prevalences of both asthma and obesity have seen a significant rise in the past few decades. Although the association between these 2 conditions has been found in many studies from different areas around the world, the exact mechanisms for how this association arises remains unresolved. Because both asthma and obesity appear to have their beginnings in early childhood, common exposures that predispose individuals to both these conditions may explain how they are associated. These exposures include common genetic predictors, prenatal exposure to specific nutrients and overall maternal nutrition, patterns of colonization of the neonatal and infant gut, birth weight and infant weight gain, sedentary behaviors, and levels of adipokines in early life.
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Affiliation(s)
- Augusto A Litonjua
- Channing Laboratory, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Abstract
PURPOSE OF REVIEW Childhood asthma and obesity are significant public health problems. The prevalence of both disorders has increased considerably in the past decade. This review will highlight recent publications regarding the nature of the relationship between asthma and obesity and the clinical effects of obesity in children with asthma. RECENT FINDINGS Most prospective studies suggest that obesity increases the risk of subsequent asthma. Possible mechanisms for the relationship between asthma and obesity include airway inflammation, mechanical changes associated with obesity, changes in airway hyper-responsiveness, and changes in physical activity and diet. Most studies suggest that obesity increases the clinical severity of asthma and decreases quality of life in children with asthma. More research is required to further define and clarify the relationship between asthma and obesity in children. SUMMARY There are many questions and few answers regarding the relationship between asthma and obesity in children. Additional studies are needed to clarify the relationship between the two epidemics so that effective interventions can be developed to improve the health and lives of children with both asthma and obesity.
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Hersoug LG, Linneberg A. The link between the epidemics of obesity and allergic diseases: does obesity induce decreased immune tolerance? Allergy 2007; 62:1205-13. [PMID: 17845592 DOI: 10.1111/j.1398-9995.2007.01506.x] [Citation(s) in RCA: 189] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
There is increasing epidemiological evidence that obesity increases the risk of asthma, atopic, and autoimmune diseases. We hypothesize that the increase in these diseases is caused, at least in part, by decreased immunological tolerance as a consequence of immunological changes induced by adipokines (e.g. leptin and adiponectin) and cytokines [e.g. interleukin 6 (IL6) and tumor necrosis factor alpha (TNFalpha)] secreted by white adipose tissue. The increasing body weight increases the levels of circulating IL6, leptin, and TNFalpha. IL6 and leptin down-regulate the activity of regulatory T-lymphocytes (Tregs). Additionally, adiponectin, which decreases with increasing obesity, down-regulates the secretion of IL10 from macrophages and adipocytes. These changes in IL6, leptin, and IL10 decrease the regulatory effect of Tregs resulting in decreased immunological tolerance to antigens. In pregnant women, these obesity-induced immunological changes might be transmitted to the fetus by epigenetic inheritance thereby increasing the risk of atopic disease. We propose that obesity results in immunological changes resulting in decreased immunological tolerance to antigens and skewing of the immune system towards a Th2 cytokine profile increasing the risk of allergy and other immune-mediated diseases. Furthermore, this hypothesis offers a unifying explanation for the observation that older siblings appear to confer protection against atopic diseases, preeclampsia, and certain autoimmune diseases. More studies are definitely needed to explore further the immunological effects of obesity and its possible effects on allergic disease.
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Affiliation(s)
- L-G Hersoug
- Research Centre for Prevention and Health, Copenhagen County, Denmark
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