Long-term effect of asthma on the development of obesity among adults: an international cohort study, ECRHS

Abstract

IntroductionObesity is a known risk factor for asthma. Although some evidence showed asthma causing obesity in children, the link between asthma and obesity has not been investigated in adults.MethodsWe used data from the European Community Respiratory Health Survey (ECRHS), a cohort study in 11 European countries and Australia in 3 waves between 1990 and 2014, at intervals of approximately 10 years. We considered two study periods: from ECRHS I (t) to ECRHS II (t+1), and from ECRHS II (t) to ECRHS III (t+1). We excluded obese (body mass index≥30 kg/m2) individuals at visit t. The relative risk (RR) of obesity at t+1 associated with asthma at t was estimated by multivariable modified Poisson regression (lag) with repeated measurements. Additionally, we examined the association of atopy and asthma medication on the development of obesity.ResultsWe included 7576 participants in the period ECRHS I-II (51.5% female, mean (SD) age of 34 (7) years) and 4976 in ECRHS II-III (51.3% female, 42 (8) years). 9% of participants became obese in ECRHS I-II and 15% in ECRHS II—III. The risk of developing obesity was higher among asthmatics than non-asthmatics (RR 1.22, 95% CI 1.07 to 1.38), and particularly higher among non-atopic than atopic (1.47; 1.17 to 1.86 vs 1.04; 0.86 to 1.27), those with longer disease duration (1.32; 1.10 to 1.59 in >20 years vs 1.12; 0.87 to 1.43 in ≤20 years) and those on oral corticosteroids (1.99; 1.26 to 3.15 vs 1.15; 1.03 to 1.28). Physical activity was not a mediator of this association.ConclusionThis is the first study showing that adult asthmatics have a higher risk of developing obesity than non-asthmatics, particularly those non-atopic, of longer disease duration or on oral corticosteroids.

Asthma and its relationship with anthropometric markers among adults

“…Obesity and asthma are common illnesses that pose substantial risks to public health [1]. Social and environmental risk factors can contribute to the development of both diseases [2]. Recent studies have identified possible connections between these illnesses, which have seen parallel growth globally [2].…”

“…Social and environmental risk factors can contribute to the development of both diseases [2]. Recent studies have identified possible connections between these illnesses, which have seen parallel growth globally [2]. Specifically, obesity has been linked to a higher risk for asthma, and 38% of Americans who have asthma at present also have obesity [3].…”

“…Although the causes of obesity in people with asthma are not well known, recent research has identified multiple factors [2]. For example, oral corticosteroids may increase lipid uptake and storage in the peripheral tissue, or they may increase insulin resistance.…”

“…For example, oral corticosteroids may increase lipid uptake and storage in the peripheral tissue, or they may increase insulin resistance. In addition, the reduction of physical activity in people with asthma due to recurrent dyspnea may contribute to an increased body weight [2,4].…”

“…The unidirectional relationship between obesity and asthma has been extensively investigated. However, recently, a recent paradigm shift has occurred, and asthma is now considered a risk factor for obesity development [2,4]. One recent study provided insight into this inverse association in adults: in European nations, adults with asthma are more likely to become obese than adults without it [2].…”