Childhood Obesity and Respiratory Diseases: Which Link?

Abstract

Prevalence of childhood obesity is progressively increasing, reaching worldwide levels of 5.6% in girls and of 7.8% in boys. Several evidences showed that obesity is a major preventable risk factor and disease modifier of some respiratory conditions such as asthma and Obstructive Sleep Apnea Syndrome (OSAS). Co-occurrence of asthma and obesity may be due to common pathogenetic factors including exposure to air pollutants and tobacco smoking, Western diet, and low Vitamin D levels. Lung growth and dysanapsis phenomenon in asthmatic obese children play a role in impaired respiratory function which appears to be different than in adults. Genes involved in both asthma and obesity have been identified, though a gene-by-environment interaction has not been properly investigated yet. The identification of modifiable environmental factors influencing gene expression through epigenetic mechanisms may change the natural history of both diseases. Another important pediatric respiratory condition associated with obesity is Sleep-Disordered Breathing (SDB), especially Obstructive Sleep Apnea Syndrome (OSAS). OSAS and obesity are linked by a bidirectional causality, where the effects of one affect the other. The factors most involved in the association between OSAS and obesity are oxidative stress, systemic inflammation, and gut microbiota. In OSAS pathogenesis, obesity’s role appears to be mainly due to mechanical factors leading to an increase of respiratory work at night-time. However, a causal link between obesity-related inflammatory state and OSAS pathogenesis still needs to be properly confirmed. To prevent obesity and its complications, family education and precocious lifestyle changes are critical. A healthy diet may lead to an improved quality of life in obese children suffering from respiratory diseases. The present review aimed to investigate the links between obesity, asthma and OSAS, focusing on the available evidence and looking for future research fields.

Pediatric Obesity-Related Asthma: The Role of Nutrition and Nutrients in Prevention and Treatment

“…Considering these contrasting elements, we can say that asthma and obesity may be comorbid, or asthma could lead to obesity, and obesity may confound its diagnosis [61]. However, studies performed in recent years point toward the "obese asthma" phenotype, in which obesity is a transformer element for asthma [62,63], characterized by additional symptoms, worse asthma exacerbations, and a lower response to inhaled corticosteroids [55,64,65].…”

An Overview of the Obese-Asthma Phenotype in Children

“…The possible correlation between obesity and asthma has been investigated over the last decade by different authors who suggest a complex multi factorial relationship [ 10 ]. Although the particular non-eosinophilic endotype of obesity-related asthma supports the concept that high body weight precedes asthma development, there is ongoing debate about the direct causality of these two entities [ 11 ].…”

Management of Children with Acute Asthma Attack: A RAND/UCLA Appropriateness Approach

“…The acute attack occurs regardless of the different phenotypes (observable clinical characteristics) and endotypes (underlying mechanisms of pathogenesis) of asthma [ 4 ]. Prevention of asthma attacks includes avoidance of triggers (allergens, infections, smoke and other pollutants), assessment and treatment of comorbidities (rhinosinusitis, obesity, gastroesophageal reflux, obstructive apnea syndrome, anxiety) [ 6 ] and self-management education with a written personalized asthma action plan. Maintenance treatment must be adapted to each patient with the lowest effective dose in order to achieve asthma control and reduce exacerbations and absences from school, allow physical activity and improve quality of life [ 7 , 8 ].…”