Obesity-Associated Asthma in Children

Rastogi, Deepa; Canfield, Stephen M.; Andrade, Andrea; Isasi, Carmen R.; Hall, Charles B.; Rubinstein, Arye; Arens, Raanan

doi:10.1378/chest.11-0930

Cited by 122 publications

(145 citation statements)

References 42 publications

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“…Higher IC in conjunction with low FEV 1 /FVC ratio, ERV, FRC, and RV have also been reported among obese adults with (40,41) and without asthma (42,43), where they correlated with the duration of obesity (44). In addition, we have previously reported lower FRC, RV, and RV/TLC ratio among urban obese preadolescent children (45). These studies suggest that pulmonary function deficits associated with obesity among urban children may develop as early as the preadolescent years and persist into adolescence.…”

Section: Original Researchsupporting

confidence: 61%

Association of Pulmonary Function with Adiposity and Metabolic Abnormalities in Urban Minority Adolescents

Rastogi

Bhalani²,

Hall³

et al. 2014

Annals ATS

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Rationale: Childhood obesity is a known risk factor for pulmonary diseases, likely due to obesity-mediated alteration of pulmonary function. Inflammation and mechanical fat load are two proposed causative mechanisms for altered pulmonary function among obese children; however, the association of metabolic abnormalities with pulmonary function among children is poorly understood.Objectives: We investigated the independent association of truncal and general adiposity and metabolic abnormalities with pulmonary function in a sample of urban minority adolescents.Methods: Spirometry and lung volume indices were compared between adolescents with general (body mass index [BMI] . 95th percentile) or truncal adiposity (waist circumference . 90th percentile) and normal-weight (BMI , 85th percentile or waist circumference < 90th percentile) and between those with metabolic abnormalities (homeostatic model assessment of insulin resistance [HOMA-IR] in the top quartile or high-density lipoprotein [HDL] , 40 mg/dl) and those with a normal metabolic profile.Measurements and Main Results: Obese adolescents had lower lung volumes, including residual volume (RV), RV/TLC ratio, expiratory reserve volume (ERV), and FRC, and higher inspiratory capacity (IC) than normal-weight adolescents, but did not differ in measures of lower airway obstruction, FEV 1 /FVC ratio, and mid-expiratory flow rate. Adolescents with high HOMA-IR had lower FEV 1 /FVC ratio, RV, RV/TLC ratio, ERV, and FRC and higher IC, whereas those with low HDL had lower FEV 1 /FVC and RV/TLC ratios. After adjusting for adiposity, HOMA-IR remained a predictor of ERV (b = 21.4; P = 0.02) and FEV 1 /FVC ratio (b = 20.5; P = 0.03), and HDL remained a predictor of FEV 1 /FVC ratio (b = 0.1; P = 0.01). General adiposity was a predictor of FRC (b = 20.5; P , 0.001), IC (b = 0.3; P , 0.001), RV (b = 20.8; P , 0.0001), and RV/TLC ratio (b = 20.2; P , 0.0001), and truncal adiposity was a predictor of RV (b = 220.3; P = 0.03) and FRC (b = 213.8; P = 0.004). Thus, adiposity and metabolic abnormalities were independent predictors of ERV, but only metabolic abnormalities independently predicted FEV 1 /FVC ratio. Although general adiposity predicted RV and RV/TLC ratio, truncal adiposity was predictive of RV and FRC, conferring additional risk above general adiposity. Conclusions:These results suggest that metabolic abnormalities and adiposity are independently associated with pulmonary function deficits among urban adolescents. Metabolic assessment of obese adolescents may identify those at risk of developing obesity-associated pulmonary morbidity.

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Section: Original Researchsupporting

confidence: 61%

Association of Pulmonary Function with Adiposity and Metabolic Abnormalities in Urban Minority Adolescents

Rastogi

Bhalani²,

Hall³

et al. 2014

Annals ATS

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“…Our data are corroborated by Rastogi et al, who demonstrated that obese children with asthma had lower FEV 1 /FVC ratios than did non-obese children with asthma and children without asthma, and that the FEV 1 /FVC ratio was negatively correlated with serum IFN-γ levels. (29) In addition, a greater proportion of IFN-γ-secreting CD4− T cells was observed in blood samples of obese children than in those of lean children, and that difference correlated with serum leptin levels. Our findings corroborate those of Yuksel et al, who concluded that leptin plays a role in the severity of asthma in children.…”

Section: Resultsmentioning

confidence: 88%

The influence of leptin on Th1/Th2 balance in obese children with asthma

et al. 2013

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Objective: In individuals with asthma, obesity induces the production of leptin and is associated with disease severity. Our objective was to evaluate the levels of serum leptin and their effect on Th1/Th2 balance in obese and non-obese children with asthma, as well as to investigate the association between serum leptin levels and clinical outcomes. Methods: We evaluated 50 atopic children with physician-diagnosed moderate-to-severe persistent asthma and 20 controls. The children with asthma were divided into two groups, by body mass index percentile: obese (n = 25) and non-obese (n = 25). From all subjects, we collected peripheral blood samples in order to determine the levels of leptin, IFN-γ, and IL-4. Asthma severity was assessed by an asthma symptom score, and the results were correlated with the parameters studied. Results: Serum leptin levels were significantly higher in the obese asthma group than in the non-obese asthma group, as well as being significantly higher in the children with asthma than in the controls, whereas IFN-γ levels were significantly higher and IL-4 levels were significantly lower in the obese asthma group than in the non-obese asthma group. In addition, the obese asthma group showed higher asthma symptom scores and significantly lower FEV 1 (% of predicted) than did the non-obese asthma group. There was a significant positive correlation between leptin and IFN-γ levels only in the obese asthma group. Conclusions: Although leptin is involved in the pathogenesis of asthma in obese and non-obese children, its effect is more pronounced in the former. In the presence of high leptin levels, only obese children with asthma exhibited Th1 polarization, with higher IFN-γ levels and greater asthma severity.Keywords: Leptin; Asthma; Interferon-gamma; Interleukin-4. ResumoObjetivo: A obesidade induz a produção de leptina em asmáticos e está associada à gravidade da doença. Nosso objetivo foi avaliar os níveis de leptina sérica e seu efeito no equilíbrio Th1/Th2 em crianças asmáticas obesas e não obesas e investigar a associação desses níveis com desfechos clínicos. Métodos: O estudo envolveu 50 crianças atópicas com diagnóstico médico de asma persistente moderada a grave e 20 controles. Os asmáticos foram agrupados como obesos (n = 25) e não obesos (n = 25) de acordo com o percentil do índice de massa corpórea. Amostras de sangue periférico foram coletadas de todos os sujeitos, e os níveis de leptina, IFN-γ e IL-4 foram determinados. A gravidade da asma foi avaliada por um escore de sintomas de asma, e os resultados foram correlacionados com os parâmetros estudados. Resultados: Os níveis séricos de leptina foram significativamente maiores nos asmáticos obesos do que nos asmáticos não obesos, assim como nos asmáticos comparados aos controles, enquanto os níveis de IFN-γ foram significativamente maiores e os de IL-4 foram significativamente menores nos asmáticos obesos do que nos asmáticos não obesos. Os asmáticos obesos tiveram maiores escores de sintomas de asma e VEF 1 (% do previsto) si...

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“…10,28,29 Others hypothesize that chronic inflammation and oxidative stress in obesity may be the link between asthma and obesity. 11,30 Abnormal lung function may be further complicated by a decreased response to both corticosteroids and bronchodilators in overweight children.…”

Section: Discussionmentioning

confidence: 99%

Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus

Aragona

El-Magbri

Wang

et al. 2016

Hospital Pediatrics

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A B S T R A C T BACKGROUND AND OBJECTIVE:The prevalence of both childhood asthma and obesity remain at historically high levels and disproportionately affect urban children. Asthma is a common and costly cause for pediatric hospitalization. Our objective was to determine the effect of obesity on outcomes among urban children hospitalized with status asthmaticus. METHODS:A retrospective cohort study was performed by using billing system data and chart review to evaluate urban children admitted for asthma. Demographics, asthma severity, reported comorbidities, and outcomes were assessed. Obesity was defined by BMI percentile (lean ,85%, overweight 85%-95%, obese $95%). Outcomes were length of stay, hospitalization charges, ICU stay, repeat admissions, and subsequent emergency department (ED) visits. Bivariate analysis assessed for differences between overweight/obese and lean children. Multivariable regression assessed the relationship between overweight status and primary outcomes while controlling for other variables. Post hoc age-stratified analysis was also performed. RESULTS:The study included 333 subjects; 38% were overweight/obese. Overweight/obese children admitted with asthma were more likely than lean children to have subsequent ED visits (odds ratio 1.6, 95% confidence interval 1.0-2.6). When stratified by age, overweight/obese preschool-age children (,5 years) were .2 times as likely to have repeat ED visits than lean preschool-age children (odds ratio 2.3, 95% confidence interval 1.0-5.6). There were no differences in the other outcomes between overweight/obese and lean individuals within the entire cohort or within other age groups.

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Obesity-Associated Asthma in Children

Cited by 122 publications

References 42 publications

Association of Pulmonary Function with Adiposity and Metabolic Abnormalities in Urban Minority Adolescents

Association of Pulmonary Function with Adiposity and Metabolic Abnormalities in Urban Minority Adolescents

The influence of leptin on Th1/Th2 balance in obese children with asthma

Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus

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