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Wu T, Santos S, Quezada-Pinedo HG, Vernooij MW, Jaddoe VWV, Klein S, Duijts L, Oei EHG. Body composition and respiratory outcomes in children: a population-based prospective cohort study. Thorax 2024; 79:448-456. [PMID: 38182426 DOI: 10.1136/thorax-2023-220014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 12/09/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Body composition might influence lung function and asthma in children, but its longitudinal relations are unclear. We aimed to identify critical periods for body composition changes during childhood and adolescence in relation to respiratory outcomes in adolescents. METHODS In a population-based prospective cohort study, we measured body mass index, fat mass index (FMI), lean mass index (LMI) and the ratio of android fat mass divided by gynoid fat mass (A/G ratio) by dual-energy X-ray absorptiometry at 6, 10 and 13 years. At 13 years, lung function was measured by spirometry, and current asthma was assessed by questionnaire. RESULTS Most prominently and consistently, higher FMI and A/G ratio at age 13 years were associated with lower forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and forced expiratory flow after exhaling 75% of FVC (FEF75) (range Z-score difference -0.13 (95% CI -0.16 to -0.10) to -0.08 (95% CI -0.11 to -0.05) per SD score increase), and higher LMI at all ages was associated with higher FEF75 (range Z-score difference 0.05 (95% CI 0.01 to 0.08) to 0.09 (95% CI 0.06 to 0.13)). Between the ages of 6 and 13 years, normal to high FMI and A/G ratio were associated with lower FEV1/FVC and FEF75 (range Z-score difference -0.20 (95% CI -0.30 to -0.10) to -0.17 (95% CI -0.28 to -0.06)) and high to high LMI with higher FEF75 (range Z-score difference0.32 (95% CI 0.23 to 0.41)). Body composition changes were not associated with asthma. CONCLUSION Adolescents with higher total and abdominal fat indices may have impaired lung function, while those with a higher lean mass during childhood and adolescence may have better small airway function. Public health measures should focus on a healthy body composition in adolescents to minimise respiratory morbidity.
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Affiliation(s)
- Tong Wu
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Susana Santos
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hugo G Quezada-Pinedo
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Stefan Klein
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Navaratnam V, Forrester DL, Chang AB, Dharmage SC, Singh GR. Association between perinatal and early life exposures and lung function in Australian Indigenous young adults: The Aboriginal Birth Cohort study. Respirology 2024; 29:166-175. [PMID: 38096035 DOI: 10.1111/resp.14639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/02/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Despite the high burden of respiratory disease amongst Indigenous populations, prevalence data on spirometric deficits and its determinants are limited. We estimated the prevalence of abnormal spirometry in young Indigenous adults and determined its relationship with perinatal and early life factors. METHODS We used prospectively collected data from the Australian Aboriginal Birth Cohort, a birth cohort of 686 Indigenous Australian singletons. We calculated the proportion with abnormal spirometry (z-score <-1.64) and FEV1 below the population mean (FEV1 % predicted 0 to -2SD) measured in young adulthood. We evaluated the association between perinatal and early life exposures with spirometry indices using linear regression. RESULTS Fifty-nine people (39.9%, 95%CI 31.9, 48.2) had abnormal spirometry; 72 (49.3%, 95%CI 40.9, 57.7) had a FEV1 below the population mean. Pre-school hospitalisations for respiratory infections, younger maternal age, being overweight in early childhood and being born remotely were associated with reduced FEV1 and FVC (absolute, %predicted and z-score). The association between maternal age and FEV1 and FVC were stronger in women, as was hospitalization for respiratory infections before age 5. Being born remotely had a stronger association with reduced FEV1 and FVC in men. Participants born in a remote community were over 6 times more likely to have a FEV1 below the population mean (odds ratio [OR] 6.30, 95%CI 1.93, 20.59). CONCLUSION Young Indigenous adults have a high prevalence of impaired lung function associated with several perinatal and early life factors, some of which are modifiable with feasible interventions.
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Affiliation(s)
- Vidya Navaratnam
- Department of Respiratory Medicine, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
- Centre for Respiratory Research, University of Western Australia, Perth, Western Australia, Australia
| | - Douglas L Forrester
- Department of Respiratory Medicine, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia
- Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
- Centre for Respiratory Research, University of Western Australia, Perth, Western Australia, Australia
- Department of Respiratory Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Respiratory Medicine, Queensland Children's Hospital, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gurmeet R Singh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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3
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Bradfield JP, Kember RL, Ulrich A, Balkhiyarova Z, Alyass A, Aris IM, Bell JA, Broadaway KA, Chen Z, Chai JF, Davies NM, Fernandez-Orth D, Bustamante M, Fore R, Ganguli A, Heiskala A, Hottenga JJ, Íñiguez C, Kobes S, Leinonen J, Lowry E, Lyytikainen LP, Mahajan A, Pitkänen N, Schnurr TM, Have CT, Strachan DP, Thiering E, Vogelezang S, Wade KH, Wang CA, Wong A, Holm LA, Chesi A, Choong C, Cruz M, Elliott P, Franks S, Frithioff-Bøjsøe C, Gauderman WJ, Glessner JT, Gilsanz V, Griesman K, Hanson RL, Kaakinen M, Kalkwarf H, Kelly A, Kindler J, Kähönen M, Lanca C, Lappe J, Lee NR, McCormack S, Mentch FD, Mitchell JA, Mononen N, Niinikoski H, Oken E, Pahkala K, Sim X, Teo YY, Baier LJ, van Beijsterveldt T, Adair LS, Boomsma DI, de Geus E, Guxens M, Eriksson JG, Felix JF, Gilliland FD, Biobank PM, Hansen T, Hardy R, Hivert MF, Holm JC, Jaddoe VWV, Järvelin MR, Lehtimäki T, Mackey DA, Meyre D, Mohlke KL, Mykkänen J, Oberfield S, Pennell CE, Perry JRB, Raitakari O, Rivadeneira F, Saw SM, Sebert S, Shepherd JA, Standl M, Sørensen TIA, Timpson NJ, Torrent M, Willemsen G, Hypponen E, Power C, McCarthy MI, Freathy RM, Widén E, Hakonarson H, Prokopenko I, Voight BF, Zemel BS, Grant SFA, Cousminer DL. Trans-ancestral genome-wide association study of longitudinal pubertal height growth and shared heritability with adult health outcomes. Genome Biol 2024; 25:22. [PMID: 38229171 PMCID: PMC10790528 DOI: 10.1186/s13059-023-03136-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 11/30/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Pubertal growth patterns correlate with future health outcomes. However, the genetic mechanisms mediating growth trajectories remain largely unknown. Here, we modeled longitudinal height growth with Super-Imposition by Translation And Rotation (SITAR) growth curve analysis on ~ 56,000 trans-ancestry samples with repeated height measurements from age 5 years to adulthood. We performed genetic analysis on six phenotypes representing the magnitude, timing, and intensity of the pubertal growth spurt. To investigate the lifelong impact of genetic variants associated with pubertal growth trajectories, we performed genetic correlation analyses and phenome-wide association studies in the Penn Medicine BioBank and the UK Biobank. RESULTS Large-scale growth modeling enables an unprecedented view of adolescent growth across contemporary and 20th-century pediatric cohorts. We identify 26 genome-wide significant loci and leverage trans-ancestry data to perform fine-mapping. Our data reveals genetic relationships between pediatric height growth and health across the life course, with different growth trajectories correlated with different outcomes. For instance, a faster tempo of pubertal growth correlates with higher bone mineral density, HOMA-IR, fasting insulin, type 2 diabetes, and lung cancer, whereas being taller at early puberty, taller across puberty, and having quicker pubertal growth were associated with higher risk for atrial fibrillation. CONCLUSION We report novel genetic associations with the tempo of pubertal growth and find that genetic determinants of growth are correlated with reproductive, glycemic, respiratory, and cardiac traits in adulthood. These results aid in identifying specific growth trajectories impacting lifelong health and show that there may not be a single "optimal" pubertal growth pattern.
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Affiliation(s)
- Jonathan P Bradfield
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Center for Spatial and Functional Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Rachel L Kember
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Anna Ulrich
- Department of Clinical & Experimental Medicine, University of Surrey, Guildford, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Zhanna Balkhiyarova
- Department of Clinical & Experimental Medicine, University of Surrey, Guildford, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- People-Centred Artificial Intelligence Institute, University of Surrey, Guildford, UK
| | - Akram Alyass
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
| | - Joshua A Bell
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - K Alaine Broadaway
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Zhanghua Chen
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, 90032, USA
| | - Jin-Fang Chai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Neil M Davies
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Ruby Fore
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
| | - Amitavo Ganguli
- Center for Spatial and Functional Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Anni Heiskala
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jouke-Jan Hottenga
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carmen Íñiguez
- Department of Statistics and Computational Research, Universitat de València, Valencia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Sayuko Kobes
- Phoenix Epidemiology and Clinical Research Center, NIDDK, NIH, Bethesda, USA
| | - Jaakko Leinonen
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Estelle Lowry
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Leo-Pekka Lyytikainen
- Department of Clinical Physiology, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, 33014, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, 33521, Tampere, Finland
| | - Anubha Mahajan
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Niina Pitkänen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Theresia M Schnurr
- Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Christian Theil Have
- Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - David P Strachan
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Elisabeth Thiering
- Institute of Epidemiology, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
- Division of Metabolic and Nutritional Medicine, Dr. Von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Suzanne Vogelezang
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kaitlin H Wade
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Carol A Wang
- School of Medicine and Public Health, Faculty of Medicine and Health, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Louise Aas Holm
- Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, The Children's Obesity Clinic, Copenhagen University Hospital Holbæk, Holbæk, Denmark
| | - Alessandra Chesi
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine Choong
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Miguel Cruz
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Paul Elliott
- MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Steve Franks
- Institute of Reproductive & Developmental Biology, Imperial College London, London, UK
| | - Christine Frithioff-Bøjsøe
- Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, The Children's Obesity Clinic, Copenhagen University Hospital Holbæk, Holbæk, Denmark
| | - W James Gauderman
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, 90032, USA
| | - Joseph T Glessner
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Vicente Gilsanz
- Center for Endocrinology, Diabetes & Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Robert L Hanson
- Phoenix Epidemiology and Clinical Research Center, NIDDK, NIH, Bethesda, USA
| | - Marika Kaakinen
- Department of Clinical & Experimental Medicine, University of Surrey, Guildford, UK
- Institute of Reproductive & Developmental Biology, Imperial College London, London, UK
| | - Heidi Kalkwarf
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH, USA
| | - Andrea Kelly
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Division of Endocrinology & Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Joseph Kindler
- College of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
| | - Mika Kähönen
- Department of Clinical Physiology, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, 33014, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, 33521, Tampere, Finland
| | - Carla Lanca
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Joan Lappe
- Department of Medicine and College of Nursing, Creighton University School of Medicine, Omaha, NB, USA
| | - Nanette R Lee
- USC-Office of Population Studies Foundation, Inc, University of San Carlos, Cebu, Philippines
| | - Shana McCormack
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Division of Endocrinology & Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Frank D Mentch
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Jonathan A Mitchell
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Nina Mononen
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center - Tampere, Tampere University, 33014, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, 33520, Tampere, Finland
| | - Harri Niinikoski
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Physiology, University of Turku, Turku, Finland
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
- Department of Nutrition, Harvard T.H Chan School of Public Health, Boston, MA, 02115, USA
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Paavo Nurmi Centre, Unit for Health and Physical Activity, University of Turku, Turku, Finland
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Yik-Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Leslie J Baier
- Phoenix Epidemiology and Clinical Research Center, NIDDK, NIH, Bethesda, USA
| | - Toos van Beijsterveldt
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Dorret I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development (AR&D) Research Institute, Amsterdam, the Netherlands
| | - Eco de Geus
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mònica Guxens
- ISGlobal, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Johan G Eriksson
- Institute of Clinical Medicine Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Frank D Gilliland
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, 90032, USA
| | | | - Torben Hansen
- Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Rebecca Hardy
- Cohort and Longitudinal Studies Enhancement Resources (CLOSER), UCL Institute of Education, London, UK
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
| | - Jens-Christian Holm
- Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, The Children's Obesity Clinic, Copenhagen University Hospital Holbæk, Holbæk, Denmark
- The Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Department of Epidemiology and Biostatistics, School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, W2 1PG, UK
- Unit of Primary Health Care, Oulu University Hospital, OYS, Kajaanintie 50, 90220, Oulu, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center - Tampere, Tampere University, 33014, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, 33520, Tampere, Finland
| | - David A Mackey
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, Centre for Eye Research Australia, University of Western Australia, Perth, WA, Australia
| | - David Meyre
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
- Inserm UMR_S1256 Nutrition-Genetics-Environmental Risk Exposure, University of Lorraine, Nancy, France
- Department of Biochemistry-Molecular Biology-Nutrition, University Hospital Centre of Nancy, Nancy, France
| | - Karen L Mohlke
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Juha Mykkänen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Sharon Oberfield
- Division of Pediatric Endocrinology, Columbia University Medical Center, New York, NY, USA
| | - Craig E Pennell
- School of Medicine and Public Health, Faculty of Medicine and Health, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
- Department of Maternity and Gynaecology, John Hunter Hospital, Newcastle, NSW, 2305, Australia
| | - John R B Perry
- Metabolic Research Laboratory, School of Clinical Medicine, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
- MRC Epidemiology Unit, School of Clinical Medicine, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Fernando Rivadeneira
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sylvain Sebert
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Department of Epidemiology and Biostatistics, School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, W2 1PG, UK
| | - John A Shepherd
- Department of Epidemiology and Population Science, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
| | - Thorkild I A Sørensen
- Faculty of Health and Medical Sciences, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicholas J Timpson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Maties Torrent
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Fundació Institut d'Investigació Sanitària Illes Balears - IdISBa, Palma, Spain
| | - Gonneke Willemsen
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Elina Hypponen
- UCL Great Ormond Street Institute of Child Health, London, UK
- Australian Centre for Precision Health, Unit of Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Chris Power
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Mark I McCarthy
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
- Current Address: Genentech, 1 DNA Way, San Francisco, CA, 94080, USA
| | - Rachel M Freathy
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, EX2 5DW, UK
| | - Elisabeth Widén
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Hakon Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Inga Prokopenko
- Department of Clinical & Experimental Medicine, University of Surrey, Guildford, UK
- People-Centred Artificial Intelligence Institute, University of Surrey, Guildford, UK
- UMR 8199 - EGID, Institut Pasteur de Lille, CNRS, University of Lille, 59000, Lille, France
| | - Benjamin F Voight
- Department of Genetics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Institute of Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Babette S Zemel
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Struan F A Grant
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- Center for Spatial and Functional Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA.
- Division of Endocrinology & Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- Department of Genetics, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
| | - Diana L Cousminer
- Center for Spatial and Functional Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- Department of Genetics, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- Currently Employed By GlaxoSmithKline, 1250 S Collegeville Rd, Collegeville, PA, 19426, USA.
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4
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Yamada S, Fujisawa T, Nagao M, Matsuzaki H, Motomura C, Odajima H, Nakamura T, Imai T, Nagakura KI, Yanagida N, Mitomori M, Ebisawa M, Kabashima S, Ohya Y, Habukawa C, Tomiita M, Hirayama M. Risk Factors for Lung Function Decline in Pediatric Asthma under Treatment: A Retrospective, Multicenter, Observational Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101516. [PMID: 36291452 PMCID: PMC9600699 DOI: 10.3390/children9101516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022]
Abstract
Background: Childhood asthma is a major risk for low lung function in later adulthood, but what factors in asthma are associated with the poor lung function during childhood is not known. Objective: To identify clinical factors in children with asthma associated with low or declining lung function during the treatment. Methods: We enrolled children with asthma who had been treated throughout three age periods, i.e., 6−9, 10−12, and 13−15 years old, at seven specialized hospitals in Japan. Clinical information and lung function measurements were retrieved from the electronic chart systems. To characterize the lung function trajectories during each age period, we evaluated the forced expiratory volume 1 (FEV1) with % predicted values and individual changes by the slope (S) from linear regression. We defined four trajectory patterns: normal (Group N) and low (Group L), showing %FEV1 ≥80% or <80% throughout all three periods; upward (Group U) and downward (Group D), showing S ≥ 0 or S < 0%. Logistic regression analysis was performed to compare factors associated with the unfavorable (D/L) versus favorable (N/U) groups. Results: Among 273 eligible patients, 197 (72%) were classified into Group N (n = 150)/U (n = 47), while 76 (28%) were in Group D (n = 66)/L (n = 10). A history of poor asthma control, long-acting beta2 agonist use, and a lower height Z-score during 13−15 years were associated with an unfavorable outcome (Group D/L). Conversely, inhaled corticosteroid (ICS) use during 10−12 years and high-dose ICS use during 13−15 years were associated with a favorable outcome (Group N/U). Conclusion: We identified several factors that are associated with unfavorable lung function changes in pediatric asthma. Attention should be paid to the possible relationship between yearly changes in lung function and poor asthma control, use of ICS (and its dose) and use of LABA.
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Affiliation(s)
- Shingo Yamada
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu 514-0125, Japan
| | - Takao Fujisawa
- Allergy Center, National Hospital Organization Mie National Hospital, 357 Ozato-kubota, Tsu 514-0125, Japan
- Correspondence: ; Tel.: +81-59-232-2531
| | - Mizuho Nagao
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu 514-0125, Japan
| | - Hiroshi Matsuzaki
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka 811-1394, Japan
| | - Chikako Motomura
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka 811-1394, Japan
| | - Hiroshi Odajima
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka 811-1394, Japan
| | - Toshinori Nakamura
- Department of Pediatrics, Showa University School of Medicine, Tokyo 142-8666, Japan
| | - Takanori Imai
- Department of Pediatrics, Showa University School of Medicine, Tokyo 142-8666, Japan
| | - Ken-ichi Nagakura
- Department of Pediatrics, National Hospital Organization Sagamihara National Hospital, Sagamihara 252-0392, Japan
| | - Noriyuki Yanagida
- Department of Pediatrics, National Hospital Organization Sagamihara National Hospital, Sagamihara 252-0392, Japan
| | - Masatoshi Mitomori
- Department of Pediatrics, National Hospital Organization Sagamihara National Hospital, Sagamihara 252-0392, Japan
| | - Motohiro Ebisawa
- Department of Pediatrics, National Hospital Organization Sagamihara National Hospital, Sagamihara 252-0392, Japan
| | - Shigenori Kabashima
- Allergy Center, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Chizu Habukawa
- Department of Pediatric Allergy, National Hospital Organization Minami Wakayama Medical Center, Tanabe 656-8558, Japan
| | - Minako Tomiita
- Center of Pediatric Allergy and Rheumatology, National Hospital Organization Shimoshizu National Hospital, Yotsukaido 284-0003, Japan
| | - Masahiro Hirayama
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
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5
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Sakic A, Ekström M, Sharma S, Nilsson PM. Can birth weight predict offspring's lung function in adult age? Evidence from two Swedish birth cohorts. Respir Res 2022; 23:348. [PMID: 36522741 PMCID: PMC9753232 DOI: 10.1186/s12931-022-02269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Associations between birth weight (BW) and adult lung function have been inconsistent and limited to early adulthood. We aimed to study this association in two population-based cohorts and explore if BW, adjusted for gestational age, predicts adult lung function. We also tested adult lung function impairment according to the mis-match hypothesis-small babies growing big as adults. METHODS We included 3495 individuals (aged 46.4 ± 5.4 years) from the Malmo Preventive Project (MPP), Sweden, born between 1921 and 1949, and 1401 young to middle-aged individuals (aged 28.6 ± 6.7 years) from the Malmo Offspring Study (MOS) with complete data on BW and gestational age. Adult lung function (forced vital capacity [FVC], forced expiratory volume in one second [FEV1] and the FEV1/FVC-ratio) were analysed as level of impairment (z-score), using multiple linear and logistic regressions. RESULTS BW (z-score) did not predict adult lung function in MPP, whereas BW was a significant (p = 0.003) predictor of FEV1 following full adjustment in MOS. For every additional unit increase in BW, children were 0.77 (95% CI 0.65-0.92) times less likely to have impaired adult lung function (FEV1). Moreover, adults born with lower BW (< 3510 g) showed improved lung function (FEV1 and FEV1/FVC in MOS and MPP, respectively) if they achieved higher adult body weight. CONCLUSIONS Adults born with lower birth weight, adjusted for gestational age, are more likely to have impaired lung function, seen in a younger birth cohort. Postnatal growth pattern may, however, compensate for low birth weight and contribute to better adult lung function.
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Affiliation(s)
- Aleksandra Sakic
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
| | - Magnus Ekström
- grid.4514.40000 0001 0930 2361Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Shantanu Sharma
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
| | - Peter M. Nilsson
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden ,grid.4514.40000 0001 0930 2361Department of Clinical Sciences, and Department of Internal Medicine, Lund University, Skåne University Hospital, Jan Waldenströms Gata 15, 5th floor, 20502 Malmö, Sweden
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6
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Socioeconomic circumstances and lung function growth from early adolescence to early adulthood. Pediatr Res 2021; 90:1235-1242. [PMID: 33603209 DOI: 10.1038/s41390-021-01380-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 10/17/2020] [Accepted: 01/11/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND A reduced lung function in early adulthood is associated with respiratory and non-respiratory diseases and is a long-term predictor of mortality. This study investigated the association between early socioeconomic circumstances (SEC) and lung function growth trajectories from early adolescence until early adulthood. METHODS We analysed data from the EPITeen population-based study, including adolescents born in 1990. Study waves occurred at 13, 17 and 21 years of age. Information on sociodemographic, behavioural and health factors, anthropometry and spirometry was collected. Early-life SEC were assessed using maternal education and paternal occupational position. The forced expiratory volume in the first second (FEV1) growth trajectories were drawn considering sex-and-height interactions over an 8-year period. Our sample included 2022 participants with complete information for the relevant variables. RESULTS Participants from most disadvantaged SEC presented lower FEV1 at early adolescence compared to high-SEC counterparts, but differences seem to diminish with height growth. The effect of paternal occupational position in lung function growth trajectories was moderated by height, thus individuals from fathers with less advantaged occupational position had lower FEV1 at early adolescence, but they had a faster FEV1 growth over time. CONCLUSIONS Individuals from most disadvantaged SEC presented lower lung function at early adolescence compared to high-SEC counterparts; nevertheless, a catch-up growth was observed. IMPACT Lower socioeconomic circumstances were previously associated with reduced lung function and a higher risk of respiratory diseases in adults. Fewer studies analysed the effects of early-life socioeconomic circumstances in lung function growth during adolescence. Disadvantaged socioeconomic circumstances were associated with lower lung function in early adolescence. However, social differences diminished over adolescence, suggesting a catch-up growth of lung function among those from lower socioeconomic circumstances. An improved understanding of the mechanism underlying lung function catch-up (or the absence of catch-up) might support interventions to narrow social inequalities in respiratory health and should be further investigated.
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7
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Mishra N, Salvi S, Lyngdoh T, Agrawal A. Low lung function in the developing world is analogous to stunting: a review of the evidence. Wellcome Open Res 2020; 5:147. [PMID: 33381655 PMCID: PMC7745193 DOI: 10.12688/wellcomeopenres.15929.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Low vital capacity, one of the consequences of restricted lung growth, is a strong predictor of cardiovascular mortality. Vital capacity is lower in the developing world than the developed world, even after adjusting for height, weight and gender. This difference is typically dismissed as ethnic variation, adjusted for by redefining normal. Whether this is a consequence of stunted lung growth, rather than just genetically smaller lungs, has not been investigated in detail. Therefore, we sought to compare factors implicated in both stunting and lung development, particularly in the developing world. Methods: We conducted a manual screen of articles identified through Google Scholar and assessed risk of bias. No language restrictions were applied, so long as there was an associated English abstract. We queried VizHub (Global Burden of Disease Visualization Tool) and Google Dataset search engines for disease burden and genome wide association studies. The scope of the article and the heterogeneity of the outcome measures reported required a narrative review of available evidence. To the extent possible, the review follows PRISMA reporting guidelines. Results: Early life influences operate in synergism with genetic, environmental and nutritional factors to influence lung growth and development in children. Low lung function and stunting have common anthropometric, environmental and nutritional correlates originating during early development. Similar anthropometric correlates shared chronic inflammatory pathways, indicated that the two conditions were analogous. Conclusion: The analogy between poor lung function and stunting is conspicuous in the developing world, with malnutrition at the center of non -achievement of growth potential, susceptibility to infectious diseases and intrauterine programming for metabolic syndrome. This counter the idea of redefining the normal for lung function measurements, since observed inter-ethnic variations are likely a mix of natural genetic differences as well as differences in nurture such that reduced lung function reflects early life adversities.
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Affiliation(s)
- Navya Mishra
- Public Health Foundation of India, Delhi, India.,Academy of Scientific and Innovative Research, Ghaziabad, India
| | | | | | - Anurag Agrawal
- Academy of Scientific and Innovative Research, Ghaziabad, India.,CSIR Institute of Genomics and Integrative Biology, Delhi, Delhi, India
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8
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Mishra N, Salvi S, Lyngdoh T, Agrawal A. Low lung function in the developing world is analogous to stunting: a review of the evidence. Wellcome Open Res 2020; 5:147. [DOI: 10.12688/wellcomeopenres.15929.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Low vital capacity, one of the consequences of restricted lung growth, is a strong predictor of cardiovascular mortality. Vital capacity is lower in the developing world than the developed world, even after adjusting for height, weight and gender. This difference is typically dismissed as ethnic variation, adjusted for by redefining normal. Whether this is a consequence of stunted lung growth, rather than genetically smaller lungs, has not been investigated in detail. Therefore, we sought to compare factors implicated in both stunting and lung development, particularly in the developing world. Methods: We conducted a manual screen of articles identified through Google Scholar and assessed risk of bias. No language restrictions were applied, so long as there was an associated English abstract. We queried VizHub (Global Burden of Disease Visualization Tool) and Google Dataset search engines for disease burden and genome wide association studies. The scope of the article and the heterogeneity of the outcome measures reported required a narrative review of available evidence. To the extent possible, the review follows PRISMA reporting guidelines. Results: Early life influences operate in synergism with environmental and nutritional factors to influence lung growth and development in children. Low lung function and stunting have common anthropometric, environmental and nutritional correlates originating during early development. Similar anthropometric correlates and shared chronic inflammatory pathways indicated that the two conditions were analogous. Conclusion: The analogy between poor lung function and stunting is conspicuous in the developing world, where malnutrition lies at the center of non -achievement of growth potential, susceptibility to infectious diseases and intrauterine programming for metabolic syndrome. The common pathological mechanisms governing stunting and lung function deficits counter the idea of redefining the normal for lung function measurements.
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9
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Szefler SJ, Fitzgerald DA, Adachi Y, Doull IJ, Fischer GB, Fletcher M, Hong J, García‐Marcos L, Pedersen S, Østrem A, Sly PD, Williams S, Winders T, Zar HJ, Bush A, Lenney W. A worldwide charter for all children with asthma. Pediatr Pulmonol 2020; 55:1282-1292. [PMID: 32142219 PMCID: PMC7187318 DOI: 10.1002/ppul.24713] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022]
Abstract
Childhood asthma is a huge global health burden. The spectrum of disease, diagnosis, and management vary depending on where children live in the world and how their community can care for them. Global improvement in diagnosis and management has been unsatisfactory, despite ever more evidence-based guidelines. Guidelines alone are insufficient and need supplementing by government support, changes in policy, access to diagnosis and effective therapy for all children, with research to improve implementation. We propose a worldwide charter for all children with asthma, a roadmap to better education and training which can be adapted for local use. It includes access to effective basic asthma medications. It is not about new expensive medications and biologics as much can be achieved without these. If implemented carefully, the overall cost of care is likely to fall and the global future health and life chance of children with asthma will greatly improve. The key to success will be community involvement together with the local and national development of asthma champions. We call on governments, institutions, and healthcare services to support its implementation.
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Affiliation(s)
- Stanley J. Szefler
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, Pediatric Asthma Research Program, Anschutz Medical Campus, Breathing Institute, Children's Hospital ColoradoUniversity of Colorado School of MedicineAuroraColorado
| | - Dominic A. Fitzgerald
- Discipline of Child and Adolescent HealthSydney Medical School, University of SydneySydneyAustralia
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Yuichi Adachi
- Department of PediatricsUniversity of ToyamaToyamaJapan
| | - Iolo J. Doull
- Department of Paediatric Respiratory MedicineChildren's Hospital for WalesCardiffUK
| | - Gilberto B. Fischer
- Department of PaediatricsUniversidade Federal de Ciencias da Saúde de Porto AlegrePorto AlegreRio Grande do SulBrazil
| | - Monica Fletcher
- Asthma UK Centre for Applied ResearchUniversity of EdinburghEdinburghUK
| | - Jianguo Hong
- Department of Paediatrics, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Luis García‐Marcos
- Department of Paediatrics, “Virgen de la Arrixaca” University Children's HospitalUniversity of MurciaMurciaSpain
| | - Søren Pedersen
- Paediatric Research Unit, Kolding HospitalUniversity of Southern DenmarkKoldingDenmark
| | | | - Peter D. Sly
- Children's Health and Environment Program and World Health Organisation Collaborating Centre for Children's Health and Environment, Child Health Research CentreUniversity of QueenslandBrisbaneAustralia
| | - Siân Williams
- International Primary Care Respiratory GroupLondonUK
| | - Tonya Winders
- Allergy & Asthma NetworkViennaVirginia
- Global Allergy & Asthma Patient PlatformViennaVirginia
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalMRC Unit on Child & Adolescent Health, University of Cape TownCape TownSouth Africa
| | - Andy Bush
- Department of Paediatrics, National Heart and Lung Institute and Royal Brompton & Harefield NHS Foundation TrustImperial CollegeLondonUK
| | - Warren Lenney
- Department of Child Health, Institute of Applied Clinical ScienceKeele UniversityKeeleUK
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10
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Abstract
OBJECTIVE Chronic undernutrition is a common phenomenon in Bangladesh. However, information is grossly lacking to report the correlation between chronic undernutrition trajectory and lung function in children. The aim of the current study was to understand the association between early-childhood chronic undernutrition trajectory and lung function at preadolescence. DESIGN The current study is a part of the 9-year follow-up of a large-scale cohort study called the Maternal and Infant Nutrition Interventions in Matlab. SETTINGS The current study was conducted in Matlab, a sub-district area of Bangladesh that is located 53 km south of the capital, Dhaka. PARTICIPANTS A total of 517 children participated in lung function measured with a spirometer at the age of 9 years. Weight and height were measured at five intervals from birth till the age of 9 years. RESULTS Over half of the cohort have experienced a stunting undernutrition phenomenon up to 9 years of age. Children who were persistently or intermittently stunted showed lower forced expiratory volume (ml/s) than normal-stature children (P < 0·05). Children who exhibited catch-up growth throughout 4·5 years from the stunted group showed similar lung function with normal counterparts, and a better lung function than in children with the same growth velocity or who had faltering growth. In the multivariable models, similar associations were observed in children who experienced catch-up growth than their counterparts after adjusting for covariates. CONCLUSION Our data suggest that catch-up growth in height during early childhood is associated with a better lung function at preadolescence.
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11
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Longitudinal Analysis of Pulmonary Function in Survivors of Congenital Diaphragmatic Hernia. J Pediatr 2020; 216:158-164.e2. [PMID: 31704056 PMCID: PMC6917899 DOI: 10.1016/j.jpeds.2019.09.072] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/12/2019] [Accepted: 09/25/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To analyze longitudinal trends of pulmonary function testing in patients with congenital diaphragmatic hernia (CDH) followed in our multidisciplinary clinic. STUDY DESIGN This was a retrospective cohort study of CDH patients born between 1991 and 2013. A linear mixed effects model was fitted to estimate the trends of percent predicted forced expiratory volume in 1 second (FEV1pp), percent predicted forced vital capacity (FVCpp), and FEV1/FVC over time. RESULTS Of 268 patients with CDH who survived to discharge, 119 had at least 1 pulmonary function test study. The FEV1pp (P < .001), FVCpp (P = .017), and FEV1/FVC (P = .001) decreased with age. Compared with defect size A/B, those with defect size C/D had lower FEV1pp by an average of 11.5% (95% CI, 2.9%-20.1%; P = .010). A history of oxygen use at initial hospital discharge also correlated with decreased FEV1pp by an average of 8.0% (95% CI, 1.2%-15.0%; P = .023). CONCLUSIONS In a select cohort of CDH survivors, average pulmonary function declines with age relative to expected population normative values. Those with severe CDH represent a population at risk for worsening pulmonary function test measurements who may benefit from recognition and monitoring for complications.
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12
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The Differential Influence of Early Life Weight Gain on Asthma Risk in Later Childhood. Ann Am Thorac Soc 2019; 15:1495-1496. [PMID: 30211617 DOI: 10.1513/annalsats.201808-523le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Peralta GP, Fuertes E, Granell R, Mahmoud O, Roda C, Serra I, Jarvis D, Henderson J, Garcia-Aymerich J. Childhood Body Composition Trajectories and Adolescent Lung Function. Findings from the ALSPAC study. Am J Respir Crit Care Med 2019; 200:75-83. [PMID: 30630337 PMCID: PMC6811931 DOI: 10.1164/rccm.201806-1168oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/11/2019] [Indexed: 01/08/2023] Open
Abstract
Rationale: Body composition changes throughout life may explain the inconsistent associations reported between body mass index and lung function in children. Objectives: To assess the associations of body weight and composition trajectories from 7 to 15 years with lung function at 15 years and lung function growth between 8 and 15 years. Methods: Sex-specific body mass index, lean body mass index, and fat mass index trajectories were developed using Group-Based Trajectory Modeling on data collected at least twice between 7 and 15 years from 6,964 children (49% boys) in the UK Avon Longitudinal Study of Parents and Children birth cohort. Associations of these trajectories with post-bronchodilation lung function parameters at 15 years and with lung function growth rates from 8 to 15 years were assessed using multivariable linear regression models, stratified by sex, in a subgroup with lung function data (n = 3,575). Measurements and Main Results: For all body mass measures we identified parallel trajectories that increased with age. There was no consistent evidence of an association between the body mass index trajectories and lung function measures. Higher lean body mass index trajectories were associated with higher levels and growth rates of FVC, FEV1, and forced expiratory flow, midexpiratory phase in both sexes (e.g., boys in the highest lean body mass index trajectory had on average a 0.62 L [95% confidence interval, 0.44-0.79; P trend < 0.0001] higher FVC at 15 yr than boys in the lowest trajectory). Increasing fat mass index trajectories were associated with lower levels and growth rates of FEV1 and forced expiratory flow, midexpiratory phase only in boys and lower levels of FEV1/FVC in both sexes. Conclusions: Higher lean body mass during childhood and adolescence is consistently associated with higher lung function at 15 years in both sexes, whereas higher fat mass is associated with lower levels of only some lung function parameters.
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Affiliation(s)
- Gabriela P Peralta
- 1 ISGlobal, Barcelona, Spain
- 2 Universitat Pompeu Fabra, Barcelona, Spain
- 3 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Elaine Fuertes
- 1 ISGlobal, Barcelona, Spain
- 2 Universitat Pompeu Fabra, Barcelona, Spain
- 3 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Raquel Granell
- 4 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Osama Mahmoud
- 4 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- 5 Department of Applied Statistics, Helwan University, Cairo, Egypt; and
| | - Célina Roda
- 1 ISGlobal, Barcelona, Spain
- 2 Universitat Pompeu Fabra, Barcelona, Spain
- 3 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Ignasi Serra
- 1 ISGlobal, Barcelona, Spain
- 2 Universitat Pompeu Fabra, Barcelona, Spain
- 3 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Deborah Jarvis
- 6 National Heart and Lung Institute and
- 7 MRC-PHE Centre for Environment and Health, Imperial College, London, United Kingdom
| | - John Henderson
- 4 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Judith Garcia-Aymerich
- 1 ISGlobal, Barcelona, Spain
- 2 Universitat Pompeu Fabra, Barcelona, Spain
- 3 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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14
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Suresh S, Sly P. Body Composition in Childhood: Is the Window for Influencing Lung Function Still Open? Am J Respir Crit Care Med 2019; 200:10-11. [PMID: 30630339 PMCID: PMC6603063 DOI: 10.1164/rccm.201812-2327ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sadasivam Suresh
- 1 Department of Respiratory and Sleep Medicine Queensland Children's Hospital Brisbane, Australia.,2 Institute for Social Science Research Faculty of Medicine and.,3 Centre for Children's Health Research The University of Queensland Brisbane, Australia
| | - Peter Sly
- 3 Centre for Children's Health Research The University of Queensland Brisbane, Australia
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15
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Agusti A, Faner R, Donaldson G, Heuvelin E, Breyer-Kohansal R, Melén E, Maitland-van der Zee AH, Vestbo J, Allinson JP, Vanfleteren LEGW, van den Berge M, Adcock IM, Lahousse L, Brusselle G, Wedzicha JA. Chronic Airway Diseases Early Stratification (CADSET): a new ERS Clinical Research Collaboration. Eur Respir J 2019; 53:53/3/1900217. [PMID: 30886026 DOI: 10.1183/13993003.00217-2019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/03/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Alvar Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Rosa Faner
- CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Gavin Donaldson
- Asthma and COPD Group, Airways Disease Section, Imperial College London, National Heart and Lung Institute, London, UK
| | | | - Robab Breyer-Kohansal
- Dept of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Erik Melén
- Sachs' Children's Hospital and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anke H Maitland-van der Zee
- Dept of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Pediatric Respiratory Medicine, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jørgen Vestbo
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, and Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - James P Allinson
- Asthma and COPD Group, Airways Disease Section, Imperial College London, National Heart and Lung Institute, London, UK
| | - Lowie E G W Vanfleteren
- COPD Center, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Maarten van den Berge
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ian M Adcock
- Cell and Molecular Biology Group, Airways Disease Section, Imperial College London, National Heart and Lung Institute, London, UK
| | | | | | - Jadwiga A Wedzicha
- Asthma and COPD Group, Airways Disease Section, Imperial College London, National Heart and Lung Institute, London, UK
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16
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Agusti A, Faner R. Lung function trajectories in health and disease. THE LANCET RESPIRATORY MEDICINE 2019; 7:358-364. [PMID: 30765254 DOI: 10.1016/s2213-2600(18)30529-0] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022]
Abstract
The normal lung function trajectory from birth to death has three phases: a growth phase (from birth to early adulthood), a plateau phase (that lasts for a few years), and a decline phase resulting from physiological lung ageing. Numerous genetic and environmental factors can alter one or more of these phases. Evidence shows that several lung function trajectories exist throughout the life course and, importantly, that some of them are associated with substantial implications for health and disease. Here, we review the evidence, formulate a series of questions, and identify various challenges that need to be addressed to identify potential opportunities to promote respiratory health.
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Affiliation(s)
- Alvar Agusti
- Respiratory Institute, Hospital Clinic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red, Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBER), Madrid, Spain.
| | - Rosa Faner
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Barcelona, Spain; Centro de Investigación Biomédica en Red, Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBER), Madrid, Spain
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17
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Goss K. Long-term pulmonary vascular consequences of perinatal insults. J Physiol 2018; 597:1175-1184. [PMID: 30067297 DOI: 10.1113/jp275859] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/10/2018] [Indexed: 01/01/2023] Open
Abstract
Development of the pulmonary circulation is a critical component of fetal lung development, and continues throughout infancy and childhood, marking an extended window of susceptibility to vascular maldevelopment and maladaptation. Perinatal vascular insults may result in abnormal vascular structure or function, including decreased angiogenic signaling and vascular endowment, impaired vasoreactivity through increased pulmonary artery endothelial dysfunction and remodeling, or enhanced genetic susceptibility to pulmonary vascular disease through epigenetic modifications or germline mutations. Although some infants develop early onset pulmonary hypertension, due to the unique adaptive capabilities of the immature host many do not have clinically evident early pulmonary vascular dysfunction. These individuals remain at increased risk for development of late-onset pulmonary hypertension, and may be particularly susceptible to secondary insults. This review will address the role of perinatal vascular insults in the development of late pulmonary vascular dysfunction with an effort to highlight areas of critical research need.
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Affiliation(s)
- Kara Goss
- Department of Medicine, University of Wisconsin, Madison, WI, USA
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18
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Nawabi J, Vohlen C, Dinger K, Thangaratnarajah C, Klaudt C, Lopez Garcia E, Hirani DV, Karakaya PH, Macheleidt I, Odenthal M, Nüsken KD, Dötsch J, Alejandre Alcazar MA. Novel functional role of GH/IGF-I in neonatal lung myofibroblasts and in rat lung growth after intrauterine growth restriction. Am J Physiol Lung Cell Mol Physiol 2018; 315:L623-L637. [PMID: 30047284 DOI: 10.1152/ajplung.00413.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Intrauterine growth restriction (IUGR) is a risk factor for neonatal chronic lung disease (CLD) characterized by reduced alveoli and perturbed matrix remodeling. Previously, our group showed an activation of myofibroblasts and matrix remodeling in rat lungs after IUGR. Because growth hormone (GH) and insulin-like growth factor I (IGF-I) regulate development and growth, we queried 1) whether GH/IGF-I signaling is dysregulated in lungs after IUGR and 2) whether GH/IGF-I signaling is linked to neonatal lung myofibroblast function. IUGR was induced in Wistar rats by isocaloric low-protein diet during gestation. Lungs were obtained at embryonic day (E) 21, postnatal day (P) 3, P12, and P23. Murine embryonic fibroblasts (MEF) or primary neonatal myofibroblasts from rat lungs of control (pnFCo) and IUGR (pnFIUGR) were used for cell culture studies. In the intrauterine phase (E21), we found a reduction in GH receptor (GH-R), Stat5 signaling and IGF-I expression in lungs after IUGR. In the postnatal phase (P3-P23), catchup growth after IUGR was linked to increased GH mRNA, GH-R protein, activation of proliferative Stat5/Akt signaling, cyclin D1 and PCNA in rat lungs. On P23, a thickening of the alveolar septae was related to increased vimentin and matrix deposition, indicating fibrosis. In cell culture studies, nutrient deprivation blocked GH-R/IGF-IR signaling and proliferation in MEFs; this was reversed by IGF-I. Proliferation and Stat5 activation were increased in pnFIUGR. IGF-I and GH induced proliferation and migration of pnFCo; only IGF-I had these effects on pnFIUGR. Thus, we show a novel mechanism by which the GH/IGF-I axis in lung myofibroblasts could account for structural lung changes after IUGR.
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Affiliation(s)
- Jawed Nawabi
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne , Cologne , Germany
| | - Christina Vohlen
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne , Cologne , Germany.,University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne , Cologne , Germany.,Center for Molecular Medicine of Cologne, University of Cologne , Cologne , Germany
| | - Katharina Dinger
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne , Cologne , Germany
| | - Chansutha Thangaratnarajah
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne , Cologne , Germany
| | - Christian Klaudt
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne , Cologne , Germany
| | - Eva Lopez Garcia
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne , Cologne , Germany
| | - Dharmesh V Hirani
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne , Cologne , Germany.,Center for Molecular Medicine of Cologne, University of Cologne , Cologne , Germany
| | - Pinar Haznedar Karakaya
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne , Cologne , Germany
| | - Iris Macheleidt
- Center for Molecular Medicine of Cologne, University of Cologne , Cologne , Germany.,Institute for Pathology, University Hospital of Cologne , Cologne , Germany
| | - Margarete Odenthal
- Center for Molecular Medicine of Cologne, University of Cologne , Cologne , Germany.,Institute for Pathology, University Hospital of Cologne , Cologne , Germany
| | - Kai D Nüsken
- University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne , Cologne , Germany
| | - Jörg Dötsch
- University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne , Cologne , Germany
| | - Miguel A Alejandre Alcazar
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne , Cologne , Germany.,University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne , Cologne , Germany.,Center for Molecular Medicine of Cologne, University of Cologne , Cologne , Germany
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19
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Kim D, Chen Z, Zhou LF, Huang SX. Air pollutants and early origins of respiratory diseases. Chronic Dis Transl Med 2018; 4:75-94. [PMID: 29988883 PMCID: PMC6033955 DOI: 10.1016/j.cdtm.2018.03.003] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Indexed: 12/13/2022] Open
Abstract
Air pollution is a global health threat and causes millions of human deaths annually. The late onset of respiratory diseases in children and adults due to prenatal or perinatal exposure to air pollutants is emerging as a critical concern in human health. Pregnancy and fetal development stages are highly susceptible to environmental exposure and tend to develop a long-term impact in later life. In this review, we briefly glance at the direct impact of outdoor and indoor air pollutants on lung diseases and pregnancy disorders. We further focus on lung complications in later life with early exposure to air pollutants. Epidemiological evidence is provided to show the association of prenatal or perinatal exposure to air pollutants with various adverse birth outcomes, such as preterm birth, lower birth weight, and lung developmental defects, which further associate with respiratory diseases and reduced lung function in children and adults. Mechanistic evidence is also discussed to support that air pollutants impact various cellular and molecular targets at early life, which link to the pathogenesis and altered immune responses related to abnormal respiratory functions and lung diseases in later life.
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Affiliation(s)
- Dasom Kim
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH 45249, USA
| | - Zi Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Lin-Fu Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Shou-Xiong Huang
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH 45249, USA
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20
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Fretzayas A, Moustaki M, Loukou I, Douros K. Is obesity related to the lung function of non-asthmatic children? World J Clin Pediatr 2018; 7:67-74. [PMID: 29881704 PMCID: PMC5988558 DOI: 10.5409/wjcp.v7.i2.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/12/2018] [Accepted: 05/13/2018] [Indexed: 02/06/2023] Open
Abstract
Overweight and obesity are highly prevalent in developed and developing countries among children and adolescents. During the last two decades, it became evident that excess weight is adversely related to respiratory health in childhood and adolescence mainly in terms of asthma occurrence. Additionally, there is a mounting body of evidence that overweight/obesity may also affect lung function in non-asthmatic subjects. The aim of this review was to present and discuss the studies that investigated this issue in non-asthmatic children and adolescents. Only a few studies have evaluated the impact of excess weight on static volumes and their results point towards an inverse relationship between overweight/obesity and functional residual capacity. More studies have been conducted on the impact of excess weight on dynamic lung volumes with inconsistent, however, results. Nevertheless, a relatively consistent finding was that the ratio of forced expiratory volume in 1 s/forced vital capacity was significantly lower among overweight/obese children compared to their counterparts with normal weight. The underlying mechanisms of these observations have not been adequately elucidated but it is believed to result from complex interaction of mechanical, developmental, and metabolic causes. There is a need for more well-designed studies in order to clarify the impact of excess weight on lung function in non-asthmatic subjects, as well as to explore the contribution of factors such as duration and degree of obesity, and fat distribution. Despite the absence of conclusive data, there are still convincing evidence to be communicated to the children and their families as part of the arguments to encourage them to adopt a healthier lifestyle.
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Affiliation(s)
- Andrew Fretzayas
- School of Medicine, University of Athens, Athens 11527, Greece
- Department of Pediatrics, Athens Medical Center, Athens University Medical School, Maroussi 15125, Greece
| | - Maria Moustaki
- Department of Cystic Fibrosis, “Agia Sofia”, Children’s Hospital, Athens 11527, Greece
| | - Ioanna Loukou
- Department of Cystic Fibrosis, “Agia Sofia”, Children’s Hospital, Athens 11527, Greece
| | - Konstantinos Douros
- Respiratory Unit, Third Department of Pediatrics, Athens University Medical School, “Attikon” University Hospital, Haidari 15125, Greece
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21
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Birth Weight and Lung Function in Adulthood: A Systematic Review and Meta-analysis. Ann Am Thorac Soc 2018; 14:994-1004. [PMID: 28362513 DOI: 10.1513/annalsats.201609-746sr] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
RATIONALE There is evidence suggesting that birth weight may influence lung function in adulthood, but it is unclear whether it might differentially affect restrictive (FVC) and obstructive (FEV1/FVC) patterns. OBJECTIVES To summarize evidence available on the association of birth weight, weight at 1 year, and weight gain in the first year of life with FVC and FEV1/FVC in adulthood. METHODS We performed a systematic review of the literature by searching MEDLINE, EMBASE, and Web of Science through January 2015. Data were combined using inverse-variance weighted meta-analysis with random effects models and between-study heterogeneity evaluated. We conducted a priori subgroup or sensitivity analyses by age, country wealth, ethnicity, sex, and smoking. We evaluated risk of bias using the Newcastle Ottawa Scale and reporting bias using funnel plots. RESULTS Eighteen articles were included in the review and 13 in the meta-analyses. Most studies were from high-income countries, and all had a low risk of bias. We found strong evidence of an association of birth weight with adult FVC, a 59.4 ml higher FVC in adulthood per kilogram increase in birth weight (95% confidence interval, 43.3-75.5), with no evidence of heterogeneity. Evidence of an association of birth weight with FEV1/FVC was weaker and showed some inconsistency across studies. Only one study investigated weight at 1 year, and another one reported weight gain in the first year. CONCLUSIONS Our meta-analyses show strong and consistent evidence of an association of birth weight with adult FVC, a measure of restrictive impairment, with much weaker evidence for airflow obstruction.
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22
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Foetal growth restriction in mice modifies postnatal airway responsiveness in an age and sex-dependent manner. Clin Sci (Lond) 2018; 132:273-284. [PMID: 29263136 DOI: 10.1042/cs20171554] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 01/22/2023]
Abstract
Epidemiological studies demonstrate an association between intrauterine growth restriction (IUGR) and asthma; however the underlying mechanism is unknown. We investigated the impact of maternal hypoxia-induced IUGR on airway responsiveness in male and female mice during juvenility and adulthood. Pregnant BALB/c mice were housed under hypoxic conditions for gestational days 11-17.5 and then returned to normoxic conditions for the remainder of pregnancy. A control group was housed under normoxic conditions throughout pregnancy. Offspring were studied at 2 weeks (juveniles) and 8 weeks (adults), where lung volume was assessed by plethysmography, airway responsiveness to methacholine determined by the forced oscillation technique and lungs fixed for morphometry. IUGR offspring were lighter at birth, exhibited "catch-up growth" by 2 weeks, but were again lighter in adulthood. IUGR males were "hyper-responsive" at 2 weeks and "hypo-responsive" as adults, in contrast with IUGR females who were hyper-responsive in adulthood. IUGR males had increased inner and total wall thickness at 2 weeks which resolved by adulthood, while airways in IUGR females were structurally normal throughout life. There were no differences in lung volume between Control and IUGR offspring at any age. Our data demonstrate changes in airway responsiveness as a result of IUGR that could influence susceptibility to asthma development and contribute to sexual dimorphism in asthma prevalence which switches from a male dominated disease in early life to a female dominated disease in adulthood.
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23
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Byberg KK, Mikalsen IB, Eide GE, Forman MR, Júlíusson PB, Øymar K. The associations between weight-related anthropometrics during childhood and lung function in late childhood: a retrospective cohort study. BMC Pulm Med 2018; 18:10. [PMID: 29351745 PMCID: PMC5775530 DOI: 10.1186/s12890-017-0567-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/21/2017] [Indexed: 02/08/2023] Open
Abstract
Background An association between body weight in childhood and subsequent lung function and asthma has been suggested, but few longitudinal studies exist. Our aim was to explore whether weight-related anthropometric measurements through childhood were associated with lung function in late childhood. Methods From an original nested case-control study, a cohort study was conducted, where lung function was measured in 463 children aged 12.8 years, and anthropometry was measured at several ages from birth through 12.8 years of age. Associations between anthropometrics and lung function were analysed using multiple linear and fractional polynomial regression analysis. Results Birthweight and body mass index (BMI; kg/m2) at different ages through childhood were positively associated with forced vital capacity in percent of predicted (FVC %) and forced expiratory volume in the first second in percent of predicted (FEV1%) at 12.8 years of age. BMI, waist circumference, waist-to-height ratio and skinfolds at 12.8 years of age and the change in BMI from early to late childhood were positively associated with FVC % and FEV1% and negatively associated with FEV1/FVC and forced expiratory flow at 25–75% of FVC/FVC. Interaction analyses showed that positive associations between anthropometrics other than BMI and lung function were mainly found in girls. Inverse U-shaped associations were found between BMI at the ages of 10.8/11.8 (girls/boys) and 12.8 years (both genders) and FVC % and FEV1% at 12.8 years of age. Conclusions Weight-related anthropometrics through childhood may influence lung function in late childhood. These findings may be physiological or associated with air flow limitation. Inverse U-shaped associations suggest a differential impact on lung function in normal-weight and overweight children. Trial registration This study was observational without any health care intervention for the participants. Therefore, no trial registration number is available. Electronic supplementary material The online version of this article (doi: 10.1186/s12890-017-0567-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristine Kjer Byberg
- Department of Paediatrics, Stavanger University Hospital, POB 8100, N-4068, Stavanger, Norway.
| | - Ingvild Bruun Mikalsen
- Department of Paediatrics, Stavanger University Hospital, POB 8100, N-4068, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Michele R Forman
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Pétur Benedikt Júlíusson
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | - Knut Øymar
- Department of Paediatrics, Stavanger University Hospital, POB 8100, N-4068, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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24
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Thangaratnarajah C, Dinger K, Vohlen C, Klaudt C, Nawabi J, Lopez Garcia E, Kwapiszewska G, Dobner J, Nüsken KD, van Koningsbruggen-Rietschel S, von Hörsten S, Dötsch J, Alejandre Alcázar MA. Novel role of NPY in neuroimmune interaction and lung growth after intrauterine growth restriction. Am J Physiol Lung Cell Mol Physiol 2017; 313:L491-L506. [PMID: 28572154 DOI: 10.1152/ajplung.00432.2016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 05/02/2017] [Accepted: 05/26/2017] [Indexed: 01/21/2023] Open
Abstract
Individuals with intrauterine growth restriction (IUGR) are at risk for chronic lung disease. Using a rat model, we showed in our previous studies that altered lung structure is related to IL-6/STAT3 signaling. As neuropeptide Y (NPY), a coneurotransmitter of the sympathetic nervous system, regulates proliferation and immune response, we hypothesized that dysregulated NPY after IUGR is linked to IL-6, impaired myofibroblast function, and alveolar growth. IUGR was induced in rats by isocaloric low-protein diet; lungs were analyzed on embryonic day (E) 21, postnatal day (P) 3, P12, and P23. Finally, primary neonatal lung myofibroblasts (pnF) and murine embryonic fibroblasts (MEF) were used to assess proliferation, apoptosis, migration, and IL-6 expression. At E21, NPY and IL-6 expression was decreased, and AKT/PKC and STAT3/AMPKα signaling was reduced. Early reduction of NPY/IL-6 was associated with increased chord length in lungs after IUGR at P3, indicating reduced alveolar formation. At P23, however, IUGR rats exhibited a catch-up of body weight and alveolar growth coupled with more proliferating myofibroblasts. These structural findings after IUGR were linked to activated NPY/PKC, IL-6/AMPKα signaling. Complementary, IUGR-pnF showed increased survival, impaired migration, and reduced IL-6 compared with control-pnF (Co-pnF). In contrast, NPY induced proliferation, migration, and increased IL-6 synthesis in fibroblasts. Additionally, NPY-/- mice showed reduced IL-6 signaling and less proliferation of lung fibroblasts. Our study presents a novel role of NPY during alveolarization: NPY regulates 1) IL-6 and lung STAT3/AMPKα signaling, and 2) proliferation and migration of myofibroblasts. These new insights in pulmonary neuroimmune interaction offer potential strategies to enable lung growth.
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Affiliation(s)
- Chansutha Thangaratnarajah
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Katharina Dinger
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Christina Vohlen
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.,University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Christian Klaudt
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Jawed Nawabi
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Eva Lopez Garcia
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | - Julia Dobner
- Experimental Therapy, Preclinical Centre, University Hospital Erlangen, Erlangen, Germany
| | - Kai D Nüsken
- University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Silke van Koningsbruggen-Rietschel
- Pediatric Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany; and
| | - Stephan von Hörsten
- Experimental Therapy, Preclinical Centre, University Hospital Erlangen, Erlangen, Germany
| | - Jörg Dötsch
- University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Miguel A Alejandre Alcázar
- Translational Experimental Pediatrics, Experimental Pulmonology, University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany; .,University Hospital for Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
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25
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Wang KCW, Morton JS, Davidge ST, Larcombe AN, James AL, Donovan GM, Noble PB. Increased heterogeneity of airway calibre in adult rats after hypoxia-induced intrauterine growth restriction. Respirology 2017; 22:1329-1335. [PMID: 28516728 DOI: 10.1111/resp.13071] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/16/2017] [Accepted: 03/23/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Intrauterine growth restriction (IUGR) is associated with asthma development. We hypothesized that IUGR disrupts airway development leading to postnatal structural abnormalities of the airway that predispose to disease. This study therefore examined structural changes to the airway and lung in a rat model of maternal hypoxia-induced IUGR. METHODS Pregnant rats were housed under hypoxic conditions (11.5% O2 ) from gestational days (GDs) 13 to 20 (pseudoglandular-canalicular stages, i.e. period of airway development) and then returned to normoxic conditions (21% O2 ). A control group of pregnant rats was housed under normoxic conditions throughout pregnancy. Weights of male offspring were recorded at birth and 7 weeks of age (adulthood), at which point lungs were fixed for morphometry and stereology (n = 6/group), or bronchoalveolar lavage fluid (BALF) was collected for cell counts (n = 6/group). RESULTS IUGR offspring were lighter at birth compared with control, but not at 7 weeks. While there was no difference in mean airway dimensions or lung volume, there was greater anatomical variation in airway lumen area in the IUGR group. A mathematical model of the human lung was used to show that greater heterogeneity in lumen area in IUGR-affected individuals increases bronchoconstriction during simulated bronchial challenge. More macrophages were identified in the BALF of IUGR offspring. CONCLUSION The rat model demonstrates that IUGR leads to a more heterogeneous distribution of airway lumen calibre in adulthood with potential implications for bronchoconstriction in human subjects. Together with increased lung macrophages, these findings support a phenotypic shift after IUGR that may impact disease susceptibility.
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Affiliation(s)
- Kimberley C W Wang
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Jude S Morton
- Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute and the Cardiovascular Research Centre, Edmonton, Alberta, Canada
| | - Sandra T Davidge
- Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute and the Cardiovascular Research Centre, Edmonton, Alberta, Canada.,Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander N Larcombe
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia
| | - Graham M Donovan
- Department of Mathematics, University of Auckland, Auckland, New Zealand
| | - Peter B Noble
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, Perth, Western Australia, Australia
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26
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Abstract
BACKGROUND Chronic lung diseases are increasingly recognized complications of vertically-acquired HIV among adolescents in sub-Saharan Africa and may manifest with hypoxia or tachypnea. We sought to determine the prevalence of and risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi, Kenya. METHODS We performed a cross-sectional analysis of 258 adolescents with vertically-acquired HIV who were initiating care at the Coptic Hope Center for Infectious Diseases. Adolescents with documented pneumonia were excluded. Hypoxia was defined as resting oxygen saturation ≤92%, and tachypnea was based on the 99th percentile of age-appropriate respiratory rates. Logistic regression models adjusted for demographics, and HIV severity estimated odds ratios for risk of hypoxia and tachypnea associated with potential risk factors. RESULTS Overall, 11% of adolescents had hypoxia and 55% had tachypnea. Advanced HIV [adjusted odds ratio (aOR): 2.41] and low CD4 (aOR: 1.74) were associated with greater hypoxia risk, but confidence intervals (CIs) were wide and included the null (95% CI: 0.93-6.23 and 0.69-4.39, respectively). Low CD4 (aOR: 2.45, 95% CI: 1.39-4.32), current antiretroviral therapy use (aOR: 0.48, 95% CI: 0.27-0.86) and stunted growth (aOR: 3.46, 95% CI: 1.94-6.18) were associated with altered tachypnea risk. CONCLUSIONS Hypoxia and tachypnea are common among adolescents with vertically-acquired HIV. There was a suggestion that advanced HIV and low CD4 were associated with greater hypoxia risk. Low CD4, lack of antiretroviral therapy use and stunted growth are risk factors for tachypnea. Our findings highlight the chronic lung disease burden in this population and may inform diagnostic algorithms.
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27
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Bush A, Bolton CE. Longer Term Sequelae of Prematurity: The Adolescent and Young Adult. RESPIRATORY OUTCOMES IN PRETERM INFANTS 2017. [DOI: 10.1007/978-3-319-48835-6_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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28
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Affiliation(s)
- Fernando D Martinez
- From the Asthma and Airway Disease Research Center, University of Arizona, Tucson
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Programmierung durch intrauterine Mangelversorgung. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3420-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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