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Obesity and asthma

Weight likely cause for one-fourth of asthma cases in kids with obesity

An estimated 23% to 27% of new asthma cases in children with obesity is directly attributable to obesity

A study including health data for more than 500,000 children in the US suggests obesity might be to blame for about a quarter (23 to 27 percent) of asthma in children who are obese. This could mean about 10 percent of all kids ages 2 to 17 with asthma - almost one million children in the US - might have avoided the illness by maintaining a healthy weight, according to researchers at Duke University and collaborators with the National Pediatric Learning Health System (PEDSnet). The findings, ‘Being Overweight or Obese and the Development of Asthma’, were published in the journal Pediatrics.

"Asthma is the No. 1 chronic disease in children and some of the causes such as genetics and viral infections during childhood are things we can't prevent," said Dr Jason E Lang, associate professor of pediatrics at Duke and the study's lead author. "Obesity may be the only risk factor for childhood asthma that could be preventable. This is another piece of evidence that keeping kids active and at a healthy weight is important."

In the study, the researchers sought to describe the relationship between overweight and obesity and incident asthma in childhood and quantify attributable risk (AR) statistics in the US for overweight and obesity on paediatric asthma. They carried out a retrospective cohort study (January 2009–December 2015) to compare asthma incidence among overweight and/or obese versus healthy weight 2- to 17-year-old children. Asthma incidence was defined as ≥2 encounters with a diagnosis of asthma and ≥1 asthma controller prescription. Stricter diagnostic criteria involved confirmation by spirometry.

The study included data from 507, 496 children and 19,581,972 encounters were included. The mean participant observation period was four years. The adjusted risk for incident asthma was increased among children who were overweight (relative risk [RR]: 1.17; 95% confidence interval [CI]: 1.10–1.25) and obese (RR: 1.26; 95% CI: 1.18–1.34). The adjusted risk for spirometry-confirmed asthma was increased among children with obesity (RR: 1.29; 95% CI: 1.16–1.42). An estimated 23% to 27% of new asthma cases in children with obesity is directly attributable to obesity. In the absence of overweight and obesity, 10% of all cases of asthma would be avoided.

Jason Lang (Credit: Duke Health)

The researchers calculated asthma risk using several models and adjusted for risk factors such as sex, age, socioeconomic status and allergies. The results remained similar.

The study has several limitations, Lang said, including that the data were collected during doctor's visits and not in a controlled clinical research setting. Lang said more experiments are needed to prove overweight and obesity directly cause changes that lead to asthma because scientists don't completely understand how or why this would occur.

Scientists have explored hypotheses including potential differences in how children's lungs and airways develop when they are overweight, and inflammatory changes in the body due to obesity, Lang said.

Still, these findings and others, such as how asthma often improves with weight loss, suggests obesity plays a key role or is directly to blame, he added.

"I think it's reasonable to be concerned that it's a causal relationship," Lang concluded. "It appears becoming overweight or obese as a child significantly increases your risk of developing asthma, and it's a significant increase, directing attention again to the importance of preventing obesity at an early age."

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