Association between asthma, obesity, and health behaviors in African American youth

Burden of Allergic Disease in Racial and Ethnic Structurally Oppressed Communities Within Canada and the United States: A Scoping Review

BACKGROUND

The social determinants of health have been extensively studied as potential mediating variables in the development and/or progression of many chronic illnesses, including allergic diseases, and may contribute to social inequities as barriers in accessing health care.

OBJECTIVE

We aimed to perform a scoping literature review to describe the burden of disease and access to health care for treatment of allergic disease within literature specific to structurally oppressed racial and ethnic populations.

METHODS

We performed a scoping review, guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines for Scoping Reviews, of 3 scientific databases and 5 relevant gray literature sites. Search strategy including keywords describing race and ethnicity were selected based on the acceptable nomenclature in Canada and the United States. We imposed no restrictions on date or country of publication, study design, or age of participants.

RESULTS

Our literature search yielded 1,198 potentially relevant articles following deduplication. After title and abstract, and subsequently full-text screening, a total of 12 (1.08% of all articles) were included. These 12 included studies pointed toward a higher burden of allergic and atopic disease, including increased presentations to emergency departments, hospitalizations, mortality, younger age of diagnosis, and/or greater severity of disease, among Black or African American individuals, than the general population. Allergies beyond the top 9 food allergens, eosinophilic esophagitis, and asthma appeared to be more prevalent and more severe in this population than in the general population. There appears to be an increased burden of allergic and atopic disease among the Indigenous Peoples of Canada, whereas this was not noted for Latinx or Hispanic populations, in part due to a paucity of studies involving these populations. Owing to a lack of published literature, no conclusions could be drawn regarding allergy and atopy in Native American populations.

CONCLUSIONS

Structurally oppressed racial and ethnic communities may face an increased burden of allergic and atopic disease-but that this may be magnified by issues regarding oppression, access, and social environment that warrant further investigation.

Pilot study of a brief provider and EMR-based intervention for overweight teens with asthma

INTRODUCTION

Asthma-related morbidity is increased in overweight patients, yet providers are given little guidance on how to discuss weight and asthma management with overweight teens.

OBJECTIVE

We piloted an electronic medical record (EMR)-based tailored discussion guide (TDG) and a brief provider training, to address weight management in overweight teens with asthma. The primary outcome was intervention impact on patient-reported asthma outcomes (e.g., asthma control and morbidity). Secondary outcomes included change in BMI, patient-centeredness, and change in healthy behaviors.

METHODS

Teens aged 13-18 years with persistent asthma and a body mass index ≥ 85th percentile for their age and sex were eligible. Parents of eligible teens were contacted before an upcoming appointment to allow teen enrollment during the clinic visit. Providers reviewed Motivational Interviewing (MI) concepts and were trained in the TDG for support of conversations around weight and asthma management. Measures included asthma outcomes retrieved from the EMR at 6- and 12-month post-baseline, teen impressions of patient-provider communication at 6-week post-enrollment, and teen report of healthy behaviors at 6- and 12-month post-baseline.

RESULTS

Of 44 teens enrolled (77% African-American, 63% female), mean BMI for intervention (n=25) and control groups (n=19) at baseline were similar. Thirty participants (68%) completed a 6-week questionnaire. Compared to controls, at 6 months, intervention teens reported fewer days of limited activity and "uncontrolled asthma," but at 12 months, only restricted activity remained lower, and BMI was not reduced. Intervention teens reported clinic visits that were more patient-centered than controls, including discussion of asthma treatment options with provider, feeling ready to follow an asthma treatment routine, and receiving helpful tips about reaching a healthy weight. The healthy behavior "dinner with family" showed improvement for intervention teens at 6 and 12 months. The feasibility study also revealed a need to improve recruitment strategies and to streamline intervention delivery.

CONCLUSION

Modest improvements in patient-reported asthma outcomes and health behaviors were observed. There was strong evidence that the TDG supports provider discussion of weight and asthma to create a more patient-centered conversation from the perspective of participating teens. Challenges to recruitment and clinic adaptation must be addressed before advancing to a full-scale trial.

TRIAL REGISTRATION

NCT02575326 Teen Asthma Control Encouraging a Healthier Lifestyle, www.cllinicaltrials.gov.

DNA methylation and exposure to violence among African American young adult males

Exposure to violence (ETV) has been linked to epigenomics mechanisms such as DNA methylation (DNAm). We used epigenetic profiling of blood collected from 32 African American young adult males who lived in Washington DC to determine if changes in DNAm at CpG sites affiliated with nervous and immune system were associated with exposure to violence. Pathway analysis of differentially methylated regions comparing high and low ETV groups revealed an enrichment of gene sets annotated to nervous system and immune ontologies. Many of these genes are known to interact with each other which suggests DNAm alters gene function in the nervous and immune system in response to ETV. Using data from a unique age group, young African American adult males, we provide evidence that lifetime ETV could impact DNA methylation in genes impacted at Central Nervous System and Immune Function sites.

METHOD

Methylation analysis was performed on DNA collected from the blood of participants classified with either high or low lifetime ETV. Illumina®MethylationEPIC Beadchips (~850k CpG sites) were processed on the iScan System to examine whole-genome methylation differences. Differentially methylated CpG-sites between high (n ​= ​19) and low (n ​= ​13) groups were identified using linear regression with violence and substance abuse as model covariates. Gene ontology analysis was used to identify enrichment categories from probes annotated to the nearest gene.

RESULTS

A total of 595 probes (279 hypermethylated; 316 hypomethylated) annotated to 383 genes were considered differentially methylated in association with ETV. Males with high ETV showed elevated methylation in several signaling pathways but were most impacted at Central Nervous System and Immune Function affiliated sites. Eight candidate genes were identified that play important biological roles in stress response to violence with HDAC4 (10%), NR4A3 (11%), NR4A2 (12%), DSCAML1(12%), and ELAVL3 (13%) exhibiting higher levels in the low ETV group and DLGAP1 (10%), SHANK2 (10%), and NRG1(11%) having increased methylation in the high ETV group. These findings suggest that individuals subjected to high ETV may be at risk for poor health outcomes that have not been reported previously.

Nutrition Regulates Innate Immunity in Health and Disease

Nutrient content and nutrient timing are considered key regulators of human health and a variety of diseases and involve complex interactions with the mucosal immune system. In particular, the innate immune system is emerging as an important signaling hub that modulates the response to nutritional signals, in part via signaling through the gut microbiota. In this review we elucidate emerging evidence that interactions between innate immunity and diet affect human metabolic health and disease, including cardiometabolic disorders, allergic diseases, autoimmune disorders, infections, and cancers. Furthermore, we discuss the potential modulatory effects of the gut microbiota on interactions between the immune system and nutrition in health and disease, namely how it relays nutritional signals to the innate immune system under specific physiological contexts. Finally, we identify key open questions and challenges to comprehensively understanding the intersection between nutrition and innate immunity and how potential nutritional, immune, and microbial therapeutics may be developed into promising future avenues of precision treatment.

Influence of Parent Stressors on Adolescent Obesity in African American Youth

Objective

The purpose of this study was to examine the relationships between individual parent stressors (financial, legal, career, relationships, home safety, community safety, medical, housing, authority, and prejudice) and adolescent obesity in African American adolescents.

Methods

Data were from a cross section convenience sample of 273 African American parent-child dyads (ages 11-19) from Washtenaw County, Michigan. A subset of 122 dyads who completed parent and child questionnaires were included in this analysis. Parent stressors were assessed using the Crisis in Family Systems Revised (CRISYS-R) questionnaire. Height, weight, and waist circumference were measured by trained staff; height and weight were converted to BMI. Multivariate linear regression models were used to examine the relationships between individual parent stressors and adolescent BMI and waist circumference.

Results

Parental exposure to stressors related to safety in the community was positively associated with adolescent BMI (β = 1.20(0.47), p=0.01) and waist circumference (β = 2.86(1.18), p=0.02). Parental appraisal of stressors related to safety in the community as "difficult to get through" was positively associated with adolescent BMI (β = 0.39(0.14), p=0.006) and waist circumference (β = 1.00(0.35), p=0.005). These relationships remained significant when adjusting for behavioral and psychosocial covariates. There were no significant relationships observed between other parent stressors and adolescent BMI or waist circumference.

Conclusion

These findings suggest parents' exposure and appraisal of stressors related to community safety are associated with increased adolescent obesity in African American youth. Longitudinal, larger-scale studies are needed to better understand the mechanisms by which community safety may increase obesity risk in this ethnic minority pediatric population. This trail is registered with NCT02938663.

Association between overweight or obesity and the risk for childhood asthma and wheeze: An updated meta-analysis on 18 articles and 73 252 children

BACKGROUND

Overweight or obesity is increasingly recognized as a possible risk factor for childhood asthma.

OBJECTIVES

We aimed to meta-analyse the association between overweight or obesity and the risk for childhood asthma and wheeze and meanwhile explore potential causes of between-study heterogeneity.

METHODS

Literature search, study selection, and data extraction were performed independently and in duplicate. Data were analysed by STATA software.

RESULTS

Eighteen articles and 73 252 children were analysed. In overall analyses, there was a significant association between overweight or obesity and the risk for childhood asthma (odds ratio [OR] = 1.30; 95% confidence interval [CI], 1.23-1.39; P < 0.001) and wheeze (OR = 1.90; 95% CI, 1.38-2.63; P < 0.001), with none/marginal publication bias as revealed by the Egger test (P = 0.938/0.038), respectively. Subgroup analyses showed that children with obesity (OR = 1.40; 95% CI, 1.29-1.52) were more likely to have asthma than children with overweight (OR = 1.22; 95% CI, 1.14-1.31), and in children with overweight or obesity, girls (OR = 1.34; 95% CI, 1.16-1.56) were more likely to have asthma than boys (OR = 1.27; 95% CI, 1.15-1.40).

CONCLUSIONS

Our findings indicate that overweight or obesity is a significant risk factor for childhood asthma and wheeze and in children with overweight or obesity, the risk is more evident in girls than in boys.