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Lovinsky-Desir S, Lussier SJ, Calatroni A, Gergen PJ, Rivera-Spoljaric K, Bacharier LB, De A, O'Connor GT, Sandel MT, Wood RA, Arteaga-Solis E, Gern JE, Kattan M. Trajectories of adiposity indicators and association with asthma and lung function in urban minority children. J Allergy Clin Immunol 2021; 148:1219-1226.e7. [PMID: 34166677 PMCID: PMC8578316 DOI: 10.1016/j.jaci.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/29/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A relationship between adiposity and asthma has been described in some cohort studies, but little is known about trajectories of adiposity throughout early childhood among children at high risk for developing asthma in urban United States cities. Moreover, early life trajectories of adipokines that have metabolic and immunologic properties have not been comprehensively investigated. OBJECTIVE Our objective was to characterize trajectories of adiposity in a longitudinal birth cohort of predominately Black and Latinx children (n = 418) using several different repeated measures including body mass index (BMI) z score, bioimpedance analysis, leptin, and adiponectin in the first 10 years of life. METHODS In a longitudinal birth cohort of predominately Black and Latinx children, we used repeated annual measures of BMI, bioimpedance analysis (ie, percentage of body fat), leptin, and adiponectin to create trajectories across the first 10 years of life. Across those trajectories, we compared asthma diagnosis and multiple lung function outcomes, including spirometry, impulse oscillometry, and methacholine response. RESULTS Three trajectories were observed for BMI z score, bioimpedance analysis, and leptin and 2 for adiponectin. There was no association between trajectories of BMI, percentage of body fat, leptin, or adipokine and asthma diagnosis or lung function (P > .05). CONCLUSIONS Trajectories of adiposity were not associated with asthma or lung function in children at high risk for developing asthma. Risk factors related to geography as well as social and demographic factors unique to specific populations could explain the lack of association and should be considered in obesity and asthma studies.
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY.
| | | | | | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, Rockville, Md
| | - Katherine Rivera-Spoljaric
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Aliva De
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - George T O'Connor
- Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Megan T Sandel
- Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University Medical Center, Baltimore, Md
| | - Emilio Arteaga-Solis
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - James E Gern
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wis
| | - Meyer Kattan
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
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2
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Aris IM, Sordillo JE, Rifas-Shiman SL, Young JG, Gold DR, Camargo CA, Hivert MF, Oken E. Childhood patterns of overweight and wheeze and subsequent risk of current asthma and obesity in adolescence. Paediatr Perinat Epidemiol 2021; 35:569-577. [PMID: 33749887 PMCID: PMC8380670 DOI: 10.1111/ppe.12760] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/25/2021] [Accepted: 02/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Obesity and asthma in childhood often co-occur. Few studies have examined this relationship using repeated measures of body mass index (BMI) or asthma symptoms (such as wheeze). OBJECTIVE We compared two analytic approaches for repeated measures data to investigate this relationship. METHODS Our baseline sample consisted of 1277 children enrolled in a Boston-area cohort with BMI or wheeze at age 1 year and no missing covariates. We used latent class growth models (LCGM) and inverse probability weighting (IPW) of marginal structural models to examine the extent to which presence of overweight across childhood was associated with early adolescent current asthma, and conversely of repeated measures of wheeze across childhood with early adolescent obesity. RESULTS Using LCGM, a "persistent" childhood overweight class (vs "never") was associated with higher risk of asthma in early adolescence (RR 1.9; 95% CI 1.1, 3.0), while "persistent" childhood wheeze (vs "never") was associated with higher risk of obesity in early adolescence (RR 2.7; 95% CI 1.0, 6.4) after adjusting for baseline covariates. An IPW analysis treating childhood overweight and wheeze as time-varying exposures and adjusting for baseline and time-varying covariates resulted in weaker and less precise associations of "persistent" (vs "never") overweight with adolescent asthma (RR 1.3; 95% CI 0.3, 3.0), and of "persistent" (vs "never") wheeze with adolescent obesity (RR 2.3; 95% CI 0.4, 5.3). CONCLUSION Our point estimates from both approaches suggest an association between "persistent" childhood overweight and adolescent asthma, and between "persistent" childhood wheeze and adolescent obesity. LCGM results were stronger and more precise, whereas IPW results were less conclusive with wider 95% confidence intervals containing the null. The precision gained from LCGM may be at the expense of bias, and the use of both approaches helps to shed some light on this tradeoff.
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Affiliation(s)
- 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, USA
| | - Joanne E Sordillo
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jessica G Young
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Diane R Gold
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos A Camargo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - 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, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - 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, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Yin L, Song Y, Liu Y, Ye Z. A risk factor for early wheezing in infants: rapid weight gain. BMC Pediatr 2019; 19:352. [PMID: 31615455 PMCID: PMC6792210 DOI: 10.1186/s12887-019-1720-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/12/2019] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study was to investigate the correlation between rapid weight gain and early wheezing. Methods This study screened 701 infants with lower respiratory tract infection who were no more than 4 months from Jan 1st to Dec 31st in 2018. According to weight-for-age Z-value (WAZ), these infants were divided into the considerably slow weight gain group (group I), the normal weight gain group (group II) and the excessively rapid weight gain group (group III), respectively. The clinical characteristics, weight growth speeds and serum lipid levels were analyzed, and multivariable Logistic model was conducted to select significant variables. Results Our results showed that male (OR = 1.841, 95%CI: 1.233–2.751), family wheezing (OR = 5.118, 95%CI: 2.118–12.365), age (OR = 1.273, 95%CI: 1.155–1.403), eczema (OR = 2.769, 95%CI: 1.793–4.275), respiratory syncytial virus (RSV) infection (OR = 1.790, 95%CI: 1.230–2.604), birth weight (OR = 1.746, 95%CI: 1.110–2.746) and total cholesterol (TC) (OR = 1.027, 95%CI: 1.019–1.036) and ΔWAZ (OR = 1.182, 95%CI: 1.022–1.368) were associated with early wheezing. Results indicated that serum TC (P = 0.018) and ΔWAZ (P = 0.023) were positive correlation with wheezing days. Conclusion Besides male, family wheezing, age, eczema, RSV infection, birth weight and TC, the rapid weight growth as a risk factor should be concerned in the early wheezing infants.
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Affiliation(s)
- Lijuan Yin
- Department of Respiratory Center, Children's Hospital of Chongqing Medical University, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, People's Republic of China.
| | - Ye Song
- Department of Pediatrics, The First Affiliated Hospital of Air Force Military Medical University, Xi'an, 710000, People's Republic of China
| | - Yongfang Liu
- Department of Nutrition, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Zehui Ye
- Department of Respiratory Center, Children's Hospital of Chongqing Medical University, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, People's Republic of China
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4
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Wallas A, Ekström S, Bergström A, Eriksson C, Gruzieva O, Sjöström M, Pyko A, Ögren M, Bottai M, Pershagen G. Traffic noise exposure in relation to adverse birth outcomes and body mass between birth and adolescence. ENVIRONMENTAL RESEARCH 2019; 169:362-367. [PMID: 30513507 DOI: 10.1016/j.envres.2018.11.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is growing evidence that traffic noise exposure is associated with adiposity among adults but data in children are limited. OBJECTIVE This longitudinal study examined whether pre- and postnatal noise exposure is associated with body mass index (BMI) between birth and adolescence or with adverse birth outcomes. METHODS The study was conducted using data from the BAMSE birth cohort, which included 4089 children born in Stockholm County, Sweden. Data on BMI from birth to adolescence were collected via questionnaires, clinical examinations and health care records. A national register provided information on birth outcomes. Road traffic noise levels at the most exposed façade were estimated for all residences of the children during follow-up, as well as of their mothers during pregnancy, and time-weighted average exposure was calculated for different time windows. Maternal occupational noise exposure was obtained from a job-exposure-matrix. Logistic- and quantile regression models were used to estimate associations between noise exposure and health outcomes. RESULTS We found residential road traffic noise exposure to be associated with increases in BMI from school age to adolescence, but not at earlier ages. In the age groups 8-11 years and 12-16 years the BMI increments were 0.11 kg/m2 per 10 dB Lden (95% CI 0.08-0.13) and 0.20 kg/m2 per 10 dB Lden (95% CI 0.17-0.22), respectively. Maternal noise exposure during pregnancy was generally unrelated to adverse birth outcomes and BMI from birth to adolescence in the children, however, traffic noise exposure was associated with a decreased risk of preterm birth CONCLUSION: Residential road traffic noise exposure was associated with BMI increases from school age to adolescence, but not at earlier ages. Maternal occupational noise exposure or exposure from road traffic during pregnancy were not consistently related to birth outcomes or BMI from birth to adolescence.
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Affiliation(s)
- Alva Wallas
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Sandra Ekström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Charlotta Eriksson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Olena Gruzieva
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Mattias Sjöström
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Andrei Pyko
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Mikael Ögren
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Matteo Bottai
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Registries as useful tools in characterization of allergic manifestations. Curr Opin Allergy Clin Immunol 2017; 16:250-6. [PMID: 27031675 DOI: 10.1097/aci.0000000000000265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Registries are useful to discover the applicability of data generated from randomized clinical trials (RCTs) into daily practice, and to search for real-life data usually not covered by them. RECENT FINDINGS In allergy, registry research brought clues to important epidemiological and clinical problems hardly accessible with other methods. The increase in the asthma prevalence in Sweden in contrast with stabilization in Denmark; the association of the prevalence of asthma and environmental factors; the knowledge of existing rhinitis international guidelines, but the poorly complacence of some of their recommendations; the low epinephrine use in anaphylaxis and the difference among European and Latin American elicitors; the predominance of β lactams or NSAIDs as drug hypersensitivity reactions inducers in different regions; the fact that most of the hereditary angioedema patients were receiving long-term prophylaxis with attenuated androgens; all the mentioned are clear examples of relevant and important data provided by current registries. SUMMARY Registries in allergy enlighten knowledge in areas not covered by classical investigational methods. As the number and importance of registries is growing, its contribution to the knowledge and management of allergic diseases will increase in the near future.
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6
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Ekström S, Magnusson J, Kull I, Andersson N, Bottai M, Besharat Pour M, Melén E, Bergström A. Body Mass Index Development and Asthma Throughout Childhood. Am J Epidemiol 2017; 186:255-263. [PMID: 28838063 PMCID: PMC5860555 DOI: 10.1093/aje/kwx081] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 08/29/2016] [Indexed: 12/16/2022] Open
Abstract
Several studies have found an association between overweight and asthma, yet the temporal relationship between their onsets remains unclear. We investigated the development of body mass index (BMI) from birth to adolescence among 2,818 children with and without asthma from a Swedish birth cohort study, the BAMSE (a Swedish acronym for “children, allergy, milieu, Stockholm, epidemiology”) Project, during 1994–2013. Measured weight and height were available at 13 time points throughout childhood. Asthma phenotypes (transient, persistent, and late-onset) were defined by timing of onset and remission. Quantile regression was used to analyze percentiles of BMI, and generalized estimating equations were used to analyze the association between asthma phenotypes and the risk of high BMI. Among females, BMI development differed between children with and without asthma, with the highest BMI being seen among females with persistent asthma. The difference existed throughout childhood but increased with age. For example, females with persistent asthma had 2.33 times’ (95% confidence interval: 1.21, 4.49) greater odds of having a BMI above the 85th percentile at age ≥15 years than females without asthma. Among males, no clear associations between asthma and BMI were observed. In this study, persistent asthma was associated with high BMI throughout childhood among females, whereas no consistent association was observed among males.
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Affiliation(s)
- Sandra Ekström
- Correspondence to Sandra Ekström, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden (e-mail: )
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7
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Chastang J, Baiz N, Parnet L, Cadwallader JS, De Blay F, Caillaud D, Charpin DA, Dwyer J, Lavaud F, Raherison C, Ibanez G, Annesi-Maesano I. Changes in body mass index during childhood and risk of various asthma phenotypes: a retrospective analysis. Pediatr Allergy Immunol 2017; 28:273-279. [PMID: 28140475 DOI: 10.1111/pai.12699] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND It is known that asthma is related to obesity but also to small birthweight. The objective of this study was to clarify this issue by assessing the putative relationship between the changes in corpulence between birth and childhood as assessed by body mass index (BMI) and asthma phenotypes. METHODS The following status in corpulence was assessed in 7781 schoolchildren using quartile of BMI at birth and at around 10 (9-11 years): underweight at birth and at around 10, underweight at birth and overweight at around 10, overweight at birth and underweight at around 10, overweight at birth and at around 10, and the reference group constituted by all the other children in whom corpulence changes were not extreme. Determination of asthma phenotypes (allergic, non-allergic, and exercise-induced asthma) was based on a clinical examination including skin prick tests, an exercise challenge test, and a questionnaire. RESULTS The risk of allergic asthma was higher in children with persistent underweight, children with persistent overweight, and children becoming markedly more corpulent. In boys, the risk of allergic asthma was significantly higher for the less corpulent children at birth, regardless of whether they remained so or become overweight. In girls, the risk of allergic asthma was significantly higher in those with persistent overweight. There were no significant associations between BMI changes and non-allergic and exercise-induced asthma. CONCLUSIONS We observed that some extreme changes in BMI, persistent underweight, and persistent overweight in childhood increased the risk of allergic asthma.
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Affiliation(s)
- Julie Chastang
- Faculté de médecine de l'hôpital Saint-Antoine, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136 Equipe Epidémiologie des maladies allergiques et respiratoires (EPAR), UPMC Univ Paris 06, Universités Paris Sorbonne, Paris, France.,Département de Médecine générale, Faculté de Médecine, Paris UPMC, Université Paris 6, Paris, France
| | - Nour Baiz
- Faculté de médecine de l'hôpital Saint-Antoine, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136 Equipe Epidémiologie des maladies allergiques et respiratoires (EPAR), UPMC Univ Paris 06, Universités Paris Sorbonne, Paris, France
| | - Laure Parnet
- Faculté de médecine de l'hôpital Saint-Antoine, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136 Equipe Epidémiologie des maladies allergiques et respiratoires (EPAR), UPMC Univ Paris 06, Universités Paris Sorbonne, Paris, France.,Département de Médecine générale, Faculté de Médecine, Paris UPMC, Université Paris 6, Paris, France
| | | | | | - Denis Caillaud
- Service de pneumologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - John Dwyer
- Faculté de médecine de l'hôpital Saint-Antoine, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136 Equipe Epidémiologie des maladies allergiques et respiratoires (EPAR), UPMC Univ Paris 06, Universités Paris Sorbonne, Paris, France
| | - François Lavaud
- Service de pneumologie et allergologie, CHU de Reims, Reims, France
| | - Chantal Raherison
- Service de pneumologie et affections respiratoires, CHU de Bordeaux, Bordeaux, France
| | - Gladys Ibanez
- Faculté de médecine de l'hôpital Saint-Antoine, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136 Equipe Epidémiologie des maladies allergiques et respiratoires (EPAR), UPMC Univ Paris 06, Universités Paris Sorbonne, Paris, France.,Département de Médecine générale, Faculté de Médecine, Paris UPMC, Université Paris 6, Paris, France
| | - Isabella Annesi-Maesano
- Faculté de médecine de l'hôpital Saint-Antoine, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136 Equipe Epidémiologie des maladies allergiques et respiratoires (EPAR), UPMC Univ Paris 06, Universités Paris Sorbonne, Paris, France
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8
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Quality of Life and Health Outcomes in Overweight and Non-Overweight Children With Asthma. J Pediatr Health Care 2017; 31:37-45. [PMID: 26874457 DOI: 10.1016/j.pedhc.2016.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/13/2016] [Accepted: 01/18/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND During the past two decades, the number of children and adolescents who are obese has more than doubled. Following this trend in childhood obesity, there has been an alarming increase in the number of children with asthma who are overweight. OBJECTIVE The aim of this study was to examine the differences in quality of life (QOL) and health outcomes of obese and overweight children with asthma compared with normal-weight children with asthma using a descriptive comparative survey design. METHODS This comparative study consisted of 90 overweight and normal-weight 9- to 14-year-olds with asthma. Health outcomes examined included asthma-related missed number of school days, emergency department (ED) visits, hospitalizations, number of days wheezing, and number of night awakenings. QOL was measured using the Pediatric Asthma Quality of Life Questionnaire. RESULTS The obese group reported the highest percentage of ED visits, hospitalizations, and number of days wheezing compared with the normal-weight group. A risk ratio analysis showed that the obese group had an overall 2.73 (95% confidence interval [CI] 2.15, 3.63) times higher likelihood of going to the ED and a 2.46 (95% CI 1.97, 3.19) times higher likelihood of hospitalization than the overweight and normal-weight groups. Asthma severity was a significant predictor of overall QOL (β = -23.737, p = .002). CONCLUSIONS The study results are consistent with other investigations that demonstrate that obese persons are at higher risk of experiencing severe asthma symptoms and support obesity as a potentially modifiable risk factor for asthma mitigation and prevention.
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9
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Pacheco-Gonzalez RM, Mallol J, Solé D, Brand PLP, Perez-Fernandez V, Sanchez-Solis M, Garcia-Marcos L. Factors associated with the time to the first wheezing episode in infants: a cross-sectional study from the International Study of Wheezing in Infants (EISL). NPJ Prim Care Respir Med 2016; 26:15077. [PMID: 26796896 PMCID: PMC4721498 DOI: 10.1038/npjpcrm.2015.77] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 12/17/2022] Open
Abstract
Male gender, asthmatic heredity, perinatal tobacco smoke exposure and respiratory infections have been associated with wheeze in the first years of life, among other risk factors. However, information about what factors modify the time to the first episode of wheeze in infants is lacking. The present study analyses which factors are associated with shorter time to the first episode of wheeze in infants. Parents of 11- to 24-month-old children were surveyed when attending their health-care centres for a control visit. They answered a questionnaire including the age in months when a first wheeze episode (if any) had occurred (outcome variable). The study was performed in 14 centres in Latin America (LA) and in 8 centres in Europe (EU) (at least 1,000 infants per centre). Factors known to be associated with wheezing in the cohort were included in a survival analysis (Cox proportional hazards model). Summary hazard ratios adjusted for all risk factors (aHR) were calculated using the meta-analysis approach with random effects. A total of 15,067 infants had experienced wheezing at least once, out of 35,049 surveyed. Male gender in LA (aHR 1.05, 95% confidence interval (CI) 1.00-1.10, P=0.047), parental asthma in LA and EU (aHR 1.05, 95% CI 1.00-1.11, P=0.037), infant eczema in EU (aHR 1.25, 95% CI 1.12-1.39, P<0.001) and having a cold during the first 3 months in LA and EU (aHR 1.97, 95% CI 1.90-2.04, P<0.001), in LA (aHR 1.98, 95% CI 1.90-2.06, P<0.001) and in EU (aHR 1.91, 95% CI 1.75-2.09, P<0.001) were associated with a shorter period of time to the first episode. Breast feeding for at least 3 months was associated with a longer period, only in LA (aHR 0.91, 95% CI 0.86-0.96, P<0.001). Cold symptoms during the first 3 months is the most consistent factor shortening the time to the first episode of wheezing; breast feeding for ⩾3 months delays it only in LA, whereas eczema shortens it only in EU. Avoiding a common cold in the first months of life could be a good strategy to delay the first wheeze episode; however, cohort studies will help to elucidate this association.
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Affiliation(s)
- Rosa M Pacheco-Gonzalez
- Pediatric Respiratory and Allergy Unit, 'Virgen de la Arrixaca' University Children's Hospital, University of Murcia, Murcia, Spain
| | - Javier Mallol
- Department of Pediatric Respiratory Medicine, Hospital El Pino, University of Santiago de Chile (USACH), Chile, USA
| | - Dirceu Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Paul L P Brand
- Princess Amalia Children's Clinic, Isala Klinieken, Zwolle, The Netherlands.,UMCG Postgraduate School of Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Manuel Sanchez-Solis
- Pediatric Respiratory and Allergy Unit, 'Virgen de la Arrixaca' University Children's Hospital, University of Murcia, Murcia, Spain
| | - Luis Garcia-Marcos
- Pediatric Respiratory and Allergy Unit, 'Virgen de la Arrixaca' University Children's Hospital, University of Murcia, Murcia, Spain.,IMIB Bioresearch Institute, Murcia, Spain
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10
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Mebrahtu TF, Feltbower RG, Parslow RC. Effects of birth weight and growth on childhood wheezing disorders: findings from the Born in Bradford Cohort. BMJ Open 2015; 5:e009553. [PMID: 26610764 PMCID: PMC4663430 DOI: 10.1136/bmjopen-2015-009553] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/23/2015] [Accepted: 10/26/2015] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To examine the effects of birth weight and childhood growth on childhood wheezing disorders. We hypothesised that low birth weight and fast growth during early age would increase the risk of wheezing disorders. SETTING Observational secondary analysis of data from the Born in Bradford cohort. PARTICIPANTS All children who were born at the Bradford Royal Infirmary hospital between March 2007 and December 2010 were eligible for the study. A total of 13,734 and 1598 children participated in the analyses of the effects of birth weight and growth on wheezing disorders, respectively. PRIMARY AND SECONDARY OUTCOME MEASURES Wheezing disorders diagnosis (diagnosed as asthma or had wheezing symptom) during the ages of 0-7 years were the primary outcome measures. Diagnosis of asthma and occurrence of wheezing during the same period were secondary outcome measures. Birth weight was classified as normal (2.5-4.0 kg), low (<2.5 kg) and high (>4.0 kg). Growth mixture models were used to drive growth pattern outcomes which were classified as 'normal', 'fast' and 'slow' growth based on their velocities between birth and 36 months. RESULTS The adjusted relative risks (RRs) of wheezing disorders diagnosis for the low and high birthweight children were 1.29 (95% CI 1.12 to 1.50; p=0.001) and 0.91 (95% CI 0.79 to 1.04; p=0.17), respectively. The adjusted RRs of wheezing disorders diagnosis were 1.30 (95% CI 0.56 to 3.06; p=0.54) and 0.60 (95% CI 0.16 to 2.18; p=0.44), respectively, for the 'fast' and 'slow' growth as compared with the 'normal' growth. CONCLUSIONS Low birth weight is associated with an increased risk of wheezing disorders; however, there is a weak evidence that suggests high birthweight children have a reduced risk in this birth cohort. Low birth weight coupled with a slower growth until 3 months and a sharp growth between 3 and 12 months has an increased risk of wheezing disorders diagnosis.
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Affiliation(s)
- Teumzghi F Mebrahtu
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
| | - Richard G Feltbower
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
| | - Roger C Parslow
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
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Loid P, Goksör E, Alm B, Pettersson R, Möllborg P, Erdes L, Åberg N, Wennergren G. A persistently high body mass index increases the risk of atopic asthma at school age. Acta Paediatr 2015; 104:707-12. [PMID: 25818987 PMCID: PMC4654247 DOI: 10.1111/apa.13015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 02/19/2015] [Accepted: 03/25/2015] [Indexed: 01/14/2023]
Abstract
Aim Being overweight has been associated with the risk of developing childhood asthma, but studies have produced conflicting results, for example with regard to possible links to allergic diseases. This study aimed to explore the relationship between body mass index (BMI) and school-age asthma. Methods Data were obtained from a prospective, longitudinal study of 5044 children born in western Sweden. The parents answered questionnaires at six months and one, four-and-a-half and eight years of age. The response rate to the final questionnaire at the age of eight was just over 80%. BMI was adjusted for age and gender, and a high BMI was defined as the 85th percentile and above. Results A multivariate analysis showed an independently increased risk of doctor-diagnosed asthma among children with a persistently high BMI, both in infancy and at school age, with an adjusted odds ratio (aOR) of 2.9 and a 95% confidence interval (CI) of 1.3–6.4. In addition, persistently high BMI was associated with an increased risk of atopic asthma (aOR 4.7, 95% CI 2.0–11.0). Conclusion A persistently high BMI during childhood increased the risk of doctor-diagnosed asthma at school age. The increased risk of atopic asthma suggests an effect mediated via the immune system.
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Affiliation(s)
- Petra Loid
- Department of Paediatrics University of Gothenburg Queen Silvia Children′s Hospital Gothenburg Sweden
| | - Emma Goksör
- Department of Paediatrics University of Gothenburg Queen Silvia Children′s Hospital Gothenburg Sweden
| | - Bernt Alm
- Department of Paediatrics University of Gothenburg Queen Silvia Children′s Hospital Gothenburg Sweden
| | - Rolf Pettersson
- Department of Paediatrics University of Gothenburg Queen Silvia Children′s Hospital Gothenburg Sweden
| | - Per Möllborg
- Department of Paediatrics University of Gothenburg Queen Silvia Children′s Hospital Gothenburg Sweden
| | - Laslo Erdes
- Department of Paediatrics University of Gothenburg Queen Silvia Children′s Hospital Gothenburg Sweden
| | - Nils Åberg
- Department of Paediatrics University of Gothenburg Queen Silvia Children′s Hospital Gothenburg Sweden
| | - Göran Wennergren
- Department of Paediatrics University of Gothenburg Queen Silvia Children′s Hospital Gothenburg Sweden
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12
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Obeng BB, Amoah AS, Larbi IA, de Souza DK, Uh HW, Fernández-Rivas M, van Ree R, Rodrigues LC, Boakye DA, Yazdanbakhsh M, Hartgers FC. Schistosome infection is negatively associated with mite atopy, but not wheeze and asthma in Ghanaian schoolchildren. Clin Exp Allergy 2015; 44:965-75. [PMID: 24641664 DOI: 10.1111/cea.12307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 12/12/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epidemiological evidence suggests that helminth infection and rural living are inversely associated with allergic disorders. OBJECTIVE The aim of the study was to investigate the effect of helminth infections and urban versus rural residence on allergy in schoolchildren from Ghana. METHODS In a cross-sectional study of 1385 children from urban-high socio-economic status (SES), urban-low SES and rural schools, associations between body mass index (BMI), allergen-specific IgE (sIgE), parasitic infections and allergy outcomes were analysed. Allergy outcomes were skin prick test (SPT) reactivity, reported current wheeze and asthma. RESULTS Helminth infections were found predominantly among rural subjects, and the most common were hookworm (9.9%) and Schistosoma spp (9.5%). Being overweight was highest among urban-high SES (14.6%) compared to urban-low SES (5.5%) and rural children (8.6%). The prevalence of SPT reactivity to any allergen was 18.3%, and this was highest among rural children (21.4%) followed by urban-high SES (20.2%) and urban-low SES (10.5%) children. Overall, SPT reactivity to mite (12%) was most common. Wheeze and asthma were reported by 7.9% and 8.3%, respectively. In multivariate analyses, factors associated with mite SPT were BMI (aOR 2.43, 95% CI 1.28-4.60, P = 0.007), schistosome infection (aOR 0.15, 95% CI 0.05-0.41) and mite sIgE (aOR 7.40, 95% CI 5.62-9.73, P < 0.001) but not area. However, the association between mite IgE and SPT differed by area and was strongest among urban-high SES children (aOR = 15.58, 95% CI 7.05-34.43, P < 0.001). Compared to rural, urban-low SES area was negatively associated with current wheeze (aOR 0.41, 95% CI 0.20-0.83, P = 0.013). Both mite sIgE and mite SPT were significantly associated with current wheeze and asthma. CONCLUSION AND CLINICAL RELEVANCE Infection with schistosomes appeared to protect against mite SPT reactivity. This needs to be confirmed in future studies, preferably in a longitudinal design where schistosome infections are treated and allergic reactions reassessed.
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Affiliation(s)
- B B Obeng
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Parasitology, Noguchi Memorial Institute for Medical Research, Accra, Ghana
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13
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Mebrahtu TF, Feltbower RG, Greenwood DC, Parslow RC. Childhood body mass index and wheezing disorders: a systematic review and meta-analysis. Pediatr Allergy Immunol 2015; 26:62-72. [PMID: 25474092 DOI: 10.1111/pai.12321] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND It has been claimed that overweight/obesity, childhood asthma and wheezing disorders are associated, although the results of observational studies have remained inconsistent. We conducted a systematic review and meta-analysis to investigate this. METHODS An online search of published papers linking childhood asthma and wheezing with overweight/obesity up to May 2014 using EMBASE and MEDLINE medical research databases was carried out. Summary odds ratios (OR) were estimated using random-effects models. Subgroup meta-analyses were performed to assess the robustness of risk associations and between-study heterogeneity. RESULTS A total of 38 studies comprising 1,411,335 participants were included in our meta-analysis. The summary ORs of underweight (<5th percentile), overweight (>85th to <95th percentile) and obesity (≥ 95 th percentile) were 0.85 (95% CI: 0.75 to 0.97; p = 0.02), 1.23 (95% CI: 1.17 to 1.29; p < 0.001) and 1.46 (95% CI: 1.36 to 1.57, p < 0.001), respectively. Heterogeneity was significant and substantial in all three weight categories, and not accounted for by pre-defined study characteristics. CONCLUSION Our results suggest that underweight is associated with a reduced risk of childhood asthma, and overweight and obesity are associated with an increased risk of childhood asthma. Although our findings assert that overweight/obesity and childhood asthma are associated, the causal pathway and temporal aspects of this relationship remain unanswered and deserve further epidemiological investigation.
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Affiliation(s)
- Teumzghi F Mebrahtu
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
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14
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Abstract
PURPOSE OF REVIEW When evaluating the causal link between obesity and the development of asthma in children, prospective cohort studies are essential. The results of the most recently published birth cohort studies from Sweden, Germany, Brazil, Belarus, and California, USA, as well as from a joint analysis of eight European birth cohorts of the Global Allergy and Asthma European Network are evaluated. Moreover, the results of two meta-analyses are presented. RECENT FINDINGS Most recent prospective cohort studies found a dose-response association between overweight or obesity and asthma. The evidence of effect modification by sex, ethnicity, and age was inconsistent. Both meta-analyses also showed that overweight children were at an increased risk of incident asthma compared with nonoverweight children and that the relationship was further elevated for obesity. SUMMARY Prospective cohort studies and two recently published meta-analyses found an association between overweight (and especially obesity) and asthma in the appropriate temporal sequence and in a dose-response manner. Children with a pronounced weight gain slope in early life were particularly at risk for asthma within the first 6 years of life. The gain in BMI over time during infancy may be an even more important predictor for asthma in childhood than excess weight at any specific age.
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Nahhas M, Bhopal R, Anandan C, Elton R, Sheikh A. Investigating the association between obesity and asthma in 6- to 8-year-old Saudi children: a matched case-control study. NPJ Prim Care Respir Med 2014; 24:14004. [PMID: 24899344 PMCID: PMC4373259 DOI: 10.1038/npjpcrm.2014.4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 02/28/2014] [Accepted: 03/01/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Previous studies have demonstrated an association between obesity and asthma, but there remains considerable uncertainty about whether this reflects an underlying causal relationship. AIMS To investigate the association between obesity and asthma in pre-pubertal children and to investigate the roles of airway obstruction and atopy as possible causal mechanisms. METHODS We conducted an age- and sex-matched case-control study of 1,264 6- to 8-year-old schoolchildren with and without asthma recruited from 37 randomly selected schools in Madinah, Saudi Arabia. The body mass index (BMI), waist circumference and skin fold thickness of the 632 children with asthma were compared with those of the 632 control children without asthma. Associations between obesity and asthma, adjusted for other potential risk factors, were assessed separately in boys and girls using conditional logistic regression analysis. The possible mediating roles of atopy and airway obstruction were studied by investigating the impact of incorporating data on sensitisation to common aeroallergens and measurements of lung function. RESULTS BMI was associated with asthma in boys (odds ratio (OR)=1.14, 95% confidence interval (CI), 1.08-1.20; adjusted OR=1.11, 95% CI, 1.03-1.19) and girls (OR=1.37, 95% CI, 1.26-1.50; adjusted OR=1.38, 95% CI, 1.23-1.56). Adjusting for forced expiratory volume in 1 s had a negligible impact on these associations, but these were attenuated following adjustment for allergic sensitisation, particularly in girls (girls: OR=1.25; 95% CI, 0.96-1.60; boys: OR=1.09, 95% CI, 0.99-1.19). CONCLUSIONS BMI is associated with asthma in pre-pubertal Saudi boys and girls; this effect does not appear to be mediated through respiratory obstruction, but in girls this may at least partially be mediated through increased risk of allergic sensitisation.
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Affiliation(s)
- Mahmoud Nahhas
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, Medical School, The University of Edinburgh, Edinburgh, UK
| | - Raj Bhopal
- Bruce and John Usher Professor of Public Health, Centre for Population Health Sciences, Medical School, The University of Edinburgh, Edinburgh, UK
| | - Chantelle Anandan
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, Medical School, The University of Edinburgh, Edinburgh, UK
| | - Rob Elton
- Centre for Population Health Sciences, Medical School, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- 1] Allergy and Respiratory Research Group, Centre for Population Health Sciences, Medical School, The University of Edinburgh, Edinburgh, UK [2] Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
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Egan KB, Ettinger AS, Bracken MB. Childhood body mass index and subsequent physician-diagnosed asthma: a systematic review and meta-analysis of prospective cohort studies. BMC Pediatr 2013; 13:121. [PMID: 23941287 PMCID: PMC3751452 DOI: 10.1186/1471-2431-13-121] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 08/07/2013] [Indexed: 12/04/2022] Open
Abstract
Background Childhood asthma and obesity prevalence have increased in recent years suggesting a potential association. However, the direction of any association is poorly understood and the potential causal-relationship is unknown. Methods We examined the association between overweight/obesity, defined by body mass index (BMI) <18 years of age, and subsequent physician-diagnosed incident asthma at least one year after BMI assessment. We sought to explore potential effect modification by sex. PubMed and Embase were searched using keywords and restricted to subjects aged 0–18 years. There were no date or language restrictions. From each study we extracted: authors, publication date, location, overweight/obesity definitions, asthma definitions, number of participants, recruitment duration, description of cohort, follow-up time, adjusted effect estimates (with 95% CI) and estimates of subgroup analysis. Results Six prospective cohort studies which focused on children <18 years of age met criteria for inclusion. The combined risk ratio (RR) of overweight was associated with asthma (RR = 1.35; 95% CI = 1.15, 1.58). In boys, the combined RR of overweight on asthma was significant (RR = 1.41; 95% CI = 1.05, 1.88). For girls, when BMI was defined by Z-score, the combined RR of overweight on asthma was also significant (RR = 1.19; 95% CI = 1.06, 1.34). The combined risk ratio (RR) of obesity was associated with asthma in both boys and girls (RR = 1.50; 95% CI = 1.22, 1.83), in boys only (RR = 1.40; 95% CI = 1.01, 1.93) and in girls only (RR = 1.53; 95% CI = 1.09, 2.14). Conclusions Overweight and, especially, obese children are at increased risk of subsequent physician diagnosed asthma in comparison to normal weight children. Except for sex, no studies reported any other potential effect modifiers. The observed sex effects were inconsistent.
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