Portal de Periódicos da CAPES

The epidemiology of obesity and asthma

2005; Elsevier BV; Volume: 115; Issue: 5 Linguagem: Inglês

10.1016/j.jaci.2004.11.050

1097-6825

E FORD,

Obesity and Health Practices

The prevalences of asthma and obesity have increased substantially in recent decades in many countries, leading to speculation that obese persons might be at increased risk of asthma development. In adults cross-sectional, case-control, prospective, and weight-loss studies are in the aggregate consistent with a role for obesity in the pathogenesis of asthma. In children 3 of 4 prospective studies also show a significant association between excess weight and asthma incidence. Because of the methodologic shortcomings of many studies, these findings are inconclusive, however. Population surveys do suggest that persons with asthma are disproportionately obese compared with persons who have never had asthma. Weight-loss studies on the basis of behavioral change and bariatric studies have shown substantial improvements in the clinical status of many obese patients with asthma who lost weight. Clarifying the nature of the relationship between obesity and asthma incidence and the role of weight management among patients with asthma are both critical areas with important ramifications for the prevention and treatment of asthma. The prevalences of asthma and obesity have increased substantially in recent decades in many countries, leading to speculation that obese persons might be at increased risk of asthma development. In adults cross-sectional, case-control, prospective, and weight-loss studies are in the aggregate consistent with a role for obesity in the pathogenesis of asthma. In children 3 of 4 prospective studies also show a significant association between excess weight and asthma incidence. Because of the methodologic shortcomings of many studies, these findings are inconclusive, however. Population surveys do suggest that persons with asthma are disproportionately obese compared with persons who have never had asthma. Weight-loss studies on the basis of behavioral change and bariatric studies have shown substantial improvements in the clinical status of many obese patients with asthma who lost weight. Clarifying the nature of the relationship between obesity and asthma incidence and the role of weight management among patients with asthma are both critical areas with important ramifications for the prevention and treatment of asthma. Many countries have witnessed large increases in the prevalences of obesity and asthma during the last several decades.1World Health Organization Obesity: preventing and managing the global epidemic. WHO Technical Report Series 894. WHO, Geneva (Switzerland)2000Google Scholar, 2Masoli M. Fabian D. Holt S. Beasley R. Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA Dissemination Committee report.Allergy. 2004; 59: 469-478Crossref PubMed Scopus (2654) Google Scholar In the United States the prevalence of obesity has increased from 13.4% among US men aged 20 to 74 years in 1960 through 1962 to 27.6% in 1999 through 2002 and from 15.8% to 33.2% among women.3Hedley A.A. Ogden C.L. Johnson C.L. Carroll M.D. Curtin L.R. Flegal K.M. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002.JAMA. 2004; 291: 2847-2850Crossref PubMed Scopus (3603) Google Scholar From 1980 through 1996, the prevalence of self-reported asthma increased 73.9%.4Centers for Disease Control and Prevention. Surveillance for asthma—United States, 1980-1999.MMWR Morb Mortal Wkly Rep. 1998; 51: 1-14Google Scholar The concurrent increases in these 2 conditions raises the possibility that the two might be connected. 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Body mass index and the risk of asthma in adults.Respir Med. 2004; 98: 29-37Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar, 25Mishra V. Effect of obesity on asthma among adult Indian women.Int J Obes Relat Metab Disord. 2004; 28: 1048-1058Crossref PubMed Scopus (50) Google Scholar Most of these studies used self-reported asthma, whether diagnosed by a physician or not. Furthermore, all studies used body mass index as the principal anthropometric measure, although there was some variability in how categories of body mass index were created. In a few studies that examined differences by sex, a stronger association was reported among women than men.17Von Behren J. Kreutzer R. Hernandez A. Self-reported asthma prevalence in adults in California.J Asthma. 2002; 39: 429-440Crossref PubMed Scopus (43) Google Scholar, 22Kim S. Camargo Jr., C.A. Sex-race differences in the relationship between obesity and asthma: the behavioral risk factor surveillance system, 2000.Ann Epidemiol. 2003; 13: 666-673Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar In 2 other studies, however, there was no significant effect modification by sex,9Shaheen S.O. Sterne J.A. Montgomery S.M. Azima H. Birth weight, body mass index and asthma in young adults.Thorax. 1999; 54: 396-402Crossref PubMed Scopus (332) Google Scholar, 24Luder E. Ehrlich R.I. Lou W.Y. Melnik T.A. Kattan M. Body mass index and the risk of asthma in adults.Respir Med. 2004; 98: 29-37Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar although in one of these studies there was a sex difference for the underweight category but not the overweight and obesity classes.24Luder E. Ehrlich R.I. Lou W.Y. Melnik T.A. Kattan M. Body mass index and the risk of asthma in adults.Respir Med. 2004; 98: 29-37Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar In children and adolescents the results of cross-sectional studies are less consistent in linking measures of excess weight to asthma.26Somerville S.M. Rona R.J. Chinn S. Obesity and respiratory symptoms in primary school.Arch Dis Child. 1984; 59: 940-944Crossref PubMed Scopus (51) Google Scholar, 27Shohat M. Shohat T. Kedem R. Mimouni M. Danon Y.L. Childhood asthma and growth outcome.Arch Dis Child. 1987; 62: 63-65Crossref PubMed Scopus (56) Google Scholar, 28Kaplan B.A. Brush G. Mascie-Taylor C.G. The relationship of childhood asthma and wheezy bronchitis with height, weight and body mass index.Hum Biol. 1987; 59: 921-931PubMed Google Scholar, 29Unger R. Kreeger L. Christoffel K.K. Childhood obesity. 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Association between obesity and asthma in 4-11 year old children in the UK.Thorax. 2001; 56: 133-137Crossref PubMed Scopus (264) Google Scholar, 38von Kries R. Hermann M. Grunert V.P. von Mutius E. Is obesity a risk factor for childhood asthma?.Allergy. 2001; 56: 318-322Crossref PubMed Scopus (142) Google Scholar, 39von Mutius E. Schwartz J. Neas L.M. Dockery D. Weiss S.T. Relation of body mass index to asthma and atopy in children: the National Health and Nutrition Examination Study III.Thorax. 2001; 56: 835-838Crossref PubMed Scopus (375) Google Scholar, 40Schachter L.M. Peat J.K. Salome C.M. Asthma and atopy in overweight children.Thorax. 2003; 58: 1031-1035Crossref PubMed Scopus (191) Google Scholar In most studies the definition of asthma was based on physician-diagnosed asthma reported by the respondent or a parent. Body mass index was commonly used as the principal anthropometric measure, although several studies have also used other anthropometric measures. In the majority of studies, the determination of body mass index was based on measured weight and height, and categories of body mass index were generally calculated on the basis of age and sex. In at least one study, a significant association was limited to female subjects. In several other studies, however, no statistical evidence was found to suggest that associations between body mass index and asthma differed by sex. In addition, several case-control studies provided inconsistent results.41Gennuso J. Epstein L.H. Paluch R.A. Cerny F. The relationship between asthma and obesity in urban minority children and adolescents.Arch Pediatr Adolesc Med. 1998; 152: 1197-1200Crossref PubMed Scopus (202) Google Scholar, 42Luder E. Melnik T.A. DiMaio M. Association of being overweight with greater asthma symptoms in inner city black and Hispanic children.J Pediatr. 1998; 132: 699-703Abstract Full Text Full Text PDF PubMed Scopus (243) Google Scholar, 43Brenner J.S. Kelly C.S. Wenger A.D. Brich S.M. Morrow A.L. Asthma and obesity in adolescents: is there an association?.J Asthma. 2001; 38: 509-515Crossref PubMed Scopus (46) Google Scholar, 44Mai X.M. Nilsson L. Axelson O. Braback L. Sandin A. Kjellman N.I. et al.High body mass index, asthma and allergy in Swedish schoolchildren participating in the International Study of Asthma and Allergies in Childhood: Phase II.Acta Paediatr. 2003; 92: 1144-1148Crossref PubMed Google Scholar Because the presence of obesity and asthma are determined simultaneously in cross-sectional studies, cause and effect cannot be determined. These studies are thought provoking, however, and at least suggest the possibility that obesity could increase the risk of asthma development. The results of 8 prospective studies that have reported on whether excess weight raises the risk of asthma development in adults are shown in Table I.9Shaheen S.O. Sterne J.A. Montgomery S.M. Azima H. Birth weight, body mass index and asthma in young adults.Thorax. 1999; 54: 396-402Crossref PubMed Scopus (332) Google Scholar, 16Beckett W.S. Jacobs Jr., D.R. Yu X. Iribarren C. Williams O.D. Asthma is associated with weight gain in females but not males, independent of physical activity.Am J Respir Crit Care Med. 2001; 164: 2045-2050Crossref PubMed Scopus (270) Google Scholar, 18Xu B. Pekkanen J. Laitinen J. Jarvelin M.R. Body build from birth to adulthood and risk of asthma.Eur J Public Health. 2002; 12: 166-170Crossref PubMed Scopus (67) Google Scholar, 45Shaheen S.O. Obesity and asthma: cause for concern?.Clin Exp Allergy. 1999; 29: 291-293Crossref PubMed Scopus (55) Google Scholar, 46Camargo Jr., C.A. Weiss S.T. Zhang S. Willett W.C. Speizer F.E. Prospective study of body mass index, weight change, and risk of adult-onset asthma in women.Arch Intern Med. 1999; 159: 2582-2588Crossref PubMed Scopus (680) Google Scholar, 47Chen Y. Dales R. Tang M. Krewski D. Obesity may increase the incidence of asthma in women but not in men: longitudinal observations from the Canadian National Population Health Surveys.Am J Epidemiol. 2002; 155: 191-197Crossref PubMed Scopus (309) Google Scholar, 48Guerra S. Sherrill D.L. Bobadilla A. Martinez F.D. Barbee R.A. The relation of body mass index to asthma, chronic bronchitis, and emphysema.Chest. 2002; 122: 1256-1263Crossref PubMed Scopus (292) Google Scholar, 49Huovinen E. Kaprio J. Koskenvuo M. Factors associated to lifestyle and risk of adult onset asthma.Respir Med. 2003; 97: 273-280Abstract Full Text PDF PubMed Scopus (125) Google Scholar, 50Ford E.S. Mannino D.M. Redd S.C. Mokdad A.H. Body mass index and asthma incidence: findings from National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study.Eur Respir J. 2004; 24: 740-744Crossref PubMed Scopus (100) Google Scholar Among 6420 participants in the 1970 British Cohort Study, of whom 714 reported having asthma at age 26 years, body mass index at age 10 years was not significantly associated with asthma at age 26 years.45Shaheen S.O. Obesity and asthma: cause for concern?.Clin Exp Allergy. 1999; 29: 291-293Crossref PubMed Scopus (55) Google Scholar Birth weight was inversely associated with incident asthma in this study. In the Nurses' Health Study II, of 85,911 women aged 26 to 46 years who were followed for 4 years, 1596 had asthma.46Camargo Jr., C.A. Weiss S.T. Zhang S. Willett W.C. Speizer F.E. Prospective study of body mass index, weight change, and risk of adult-onset asthma in women.Arch Intern Med. 1999; 159: 2582-2588Crossref PubMed Scopus (680) Google Scholar A positive association was found between body mass index and asthma incidence, and the strength of the association increased as the definition of asthma became stricter. Among 4547 men and women aged 18 to 30 years who participated in the Coronary Artery Risk Development in Young Adults study and were followed for 10 years, 310 had asthma.16Beckett W.S. Jacobs Jr., D.R. Yu X. Iribarren C. Williams O.D. Asthma is associated with weight gain in females but not males, independent of physical activity.Am J Respir Crit Care Med. 2001; 164: 2045-2050Crossref PubMed Scopus (270) Google Scholar Obesity was associated with asthma among women only. In the National Population Health Survey in Canada, among 9149 participants aged 20 to 64 years who were followed for 2 years, 49 men and 127 women had asthma. Baseline body mass index was associated with self-reported asthma incidence among women but not men.47Chen Y. Dales R. Tang M. Krewski D. Obesity may increase the incidence of asthma in women but not in men: longitudinal observations from the Canadian National Population Health Surveys.Am J Epidemiol. 2002; 155: 191-197Crossref PubMed Scopus (309) Google Scholar A study of 4719 Finnish participants born in 1966 (about 189 had asthma) showed that obesity at age 14 years increased the risk of having adult asthma at age 31 years.18Xu B. Pekkanen J. Laitinen J. Jarvelin M.R. Body build from birth to adulthood and risk of asthma.Eur J Public Health. 2002; 12: 166-170Crossref PubMed Scopus (67) Google Scholar Adjusting obesity during adolescence for obesity during adulthood attenuated the association. Participants who were obese at both 14 and 31 years of age, however, had more than 2 times the odds of having asthma at age 31 years as those who were not obese at either age. In addition, the ponderal index at birth showed a U-form association with adult onset of asthma. Using a nested case-control study design, investigators of the Tucson Epidemiologic Study of Airways Obstructive Diseases found that participants with a body mass index of ≥28 kg/m2 had an increased risk of subsequently being given a diagnosis of asthma.48Guerra S. Sherrill D.L. Bobadilla A. Martinez F.D. Barbee R.A. The relation of body mass index to asthma, chronic bronchitis, and emphysema.Chest. 2002; 122: 1256-1263Crossref PubMed Scopus (292) Google Scholar A stronger association was found among women than men, and the form of the association differed also. More recently, a 9-year follow-up of 9671 adult Finnish twins (139 had asthma) showed that obese participants had a substantially higher risk of asthma development than participants with a normal body mass index.49Huovinen E. Kaprio J. Koskenvuo M. Factors associated to lifestyle and risk of adult onset asthma.Respir Med. 2003; 97: 273-280Abstract Full Text PDF PubMed Scopus (125) Google Scholar In addition, an analysis of data from 9456 participants in the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Followup Study found a moderately increased risk for asthma development among obese adults aged 25 to 74 years who entered the study between 1971 and 1975 and were followed through 1982 to 1984.50Ford E.S. Mannino D.M. Redd S.C. Mokdad A.H. Body mass index and asthma incidence: findings from National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study.Eur Respir J. 2004; 24: 740-744Crossref PubMed Scopus (100) Google ScholarTable IProspective studies of obesity and asthma incidence among adultsReferenceStudyFollow-up (y)PeriodAge (y)Sample sizeAsthma no.Asthma diagnosisAnthropometric measureRR estimate95% CIAdjusted for:Shaheen et al,9Shaheen S.O. Sterne J.A. Montgomery S.M. Azima H. Birth weight, body mass index and asthma in young adults.Thorax. 1999; 54: 396-402Crossref PubMed Scopus (332) Google Scholar 19991970 British Cohort Study, UK261970-1996Birth2892 M, 3528 F714Self-reported asthma-wheezeBMI (measured weight and height) at age 10 yNot associatedNot reportedCamargo et al,46Camargo Jr., C.A. Weiss S.T. Zhang S. Willett W.C. Speizer F.E. Prospective study of body mass index, weight change, and risk of adult-onset asthma in women.Arch Intern Med. 1999; 159: 2582-2588Crossref PubMed Scopus (680) Google Scholar 1999Nurses' Health Study II, US41991-199526-4685911 F1596Self-reported physician-diagnosed asthma; 2 stricter definitions as well.BMI (self-reported weight and height)Age, race, US region, smoking, physical activity, total energy intake, hysterectomy status, birth weight, duration of breast-feeding<20.00.90.7-1.120.0-22.41.022.5-24.91.11.0-1.325.0-27.41.61.3-1.927.5-29.91.71.4-2.0≥302.72.3-3.1Beckett et al,16Beckett W.S. Jacobs Jr., D.R. Yu X. Iribarren C. Williams O.D. Asthma is associated with weight gain in females but not males, independent of physical activity.Am J Respir Crit Care Med. 2001; 164: 2045-2050Crossref PubMed Scopus (270) Google Scholar 2001Coronary Artery Risk Development in Young Adults Study, US101985-1986 to not reported18-302049 M, 2498 F310Self-reported asthma medication use or diagnosis by doctor or nurseBMI (measured weight and height) quintilesAge, sex, race, center, educationLowest1.390.97-1.9921.0031.070.73-1.5841.190.81-1.75Highest1.601.12-2.30Chen et al,47Chen Y. Dales R. Tang M. Krewski D. Obesity may increase the incidence of asthma in women but not in men: longitudinal observations from the Canadian National Population Health Surveys.Am J Epidemiol. 2002; 155: 191-197Crossref PubMed Scopus (309) Google Scholar 2002National Population Health Survey, Canada21994-1995 to 1996-199720-649149 M F176Self-reported health professional-diagnosed asthmaBMI (self-reported weight and height)Age, smoking, pets, immigrant status, allergy history, income adequacy, alcohol4266 M49MenNot associated4883 F127Women<200.620.24-1.6220-24.91.025-29.91.250.72-2.18≥301.921.90-3.41Xu et al,18Xu B. Pekkanen J. Laitinen J. Jarvelin M.R. Body build from birth to adulthood and risk of asthma.Eur J Public Health. 2002; 12: 166-170Crossref PubMed Scopus (67) Google Scholar 2002Finnish birth cohort from 1966, Finland311966-1997Birth4719 M FAbout 189Self-reported physician-diagnosed asthmaBMI (self-reported weight and height) at 14 yMaternal age, BMI before pregnancy, smoking during pregnancy, parity, paternal social class, parental allergic disorders, month at birth, sex, gestational age, smoking, physical activity, professional training<85th percentile1.0085th-<95th percentile1.320.82-2.14≥95th percentile2.091.23-3.57Guerra et al,48Guerra S. Sherrill D.L. Bobadilla A. Martinez F.D. Barbee R.A. The relation of body mass index to asthma, chronic bronchitis, and emphysema.Chest. 2002; 122: 1256-1263Crossref PubMed Scopus (292) Google Scholar 2002Tucson Epidemiologic Study of Airways Obstructive Diseases, US201972-1973 to 1992≥201577 M F102Physician-confirmed asthmaBMI (measured weight and height): ≥28 vs <282.801.75-4.48Age, sex, atopic status, smokingHuovinen et al,49Huovinen E. Kaprio J. Koskenvuo M. Factors associated to lifestyle and risk of adult onset asthma.Respir Med. 2003; 97: 273-280Abstract Full Text PDF PubMed Scopus (125) Google Scholar 2003Finnish Twin Cohort, Finland91982-199025-529671 M F149Self-reported physician-diagnosed asthmaBMI (self-reported weight and height): ≥30 vs 20-<253.001.64-5.50Age, atopy, respiratory symptoms4449 MMenUnderweight0.390.05-2.82Normal1.00Overweight1.060.60-1.85Obese3.131.41-6.975222 FWomenUnderweight1.530.85-2.75Normal1.00Overweight1.410.80-2.50Obese1.700.66-4.39Ford et al,50Ford E.S. Mannino D.M. Redd S.C. Mokdad A.H. Body mass index and asthma incidence: findings from National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study.Eur Respir J. 2004; 24: 740-744Crossref PubMed Scopus (100) Google Scholar 2004NHANES I Epidemiologic Follow-up Study, US101971-1975 to 1982-198425-749456 M F317Self-reported physician-diagnosed asthmaBMI (measured weight and height)Age, sex (except sex-specific models), race or ethnicity, education, smoking status, recreational physical activity, and nonrecreational physical activity18.5-<251.0025-<300.950.68-1.3330-<351.280.83-1.96≥351.871.12-3.133621 M102Men18.5-<251.0025-<300.790.47-1.3430-<351.520.82-2.82≥351.980.60-6.545835 F215Women18.5-<251.0025-<301.130.73-1.7530-<351.100.64-1.89≥351.871.05-3.33RR, Relative risk; BMI, body mass index. Open table in a new tab RR, Relative risk; BMI, body mass index. Seven of the 8 prospective studies in adults found a positive association between body mass index at baseline and the subsequent development of asthma (Table I), thereby providing considerable support for the thesis that excess weight might be causally related to asthma incidence. An important aspect of these studies is that obesity anteceded the development of asthma. The measures of relative risk have ranged from 1.6 to about 3.0, and in several studies there was a dose-response relationship. The associations have not been consistent between men and women in all studies, however. Several prospective studies have been conducted among children and adolescents (Table II).51Chinn S. Rona R.J. Can the increase in body mass index explain the rising trend in asthma in children?.Thorax. 2001; 56: 845-850Crossref PubMed Scopus (169) Google Scholar, 52Gilliland F.D. Berhane K. Islam T. McConnell R. Gauderman W.J. Gilliland S.S. et al.Obesity and the risk of newly diagnosed asthma in school-age children.Am J Epidemiol. 2003; 158: 406-415Crossref PubMed Scopus (338) Google Scholar, 53Gold D.R. Damokosh A.I. Dockery D.W. Berkey C.S. Body-mass index as a predictor of incident asthma in a prospective cohort of children.Pediatr Pulmonol. 2003; 36: 514-521Crossref PubMed Scopus (202) Google Scholar In a study of 3415 British boys and 3329 British girls aged 5 to 6 years, obese children had an increased risk of asthma development after 4 years.51Chinn S. Rona R.J. Can the increase in body mass index explain the rising trend in asthma in children?.Thorax. 2001; 56: 845-850Crossref PubMed Scopus (169) Google Scholar However, the authors concluded that the increasing prevalence of increased body mass index was not responsible for the increasing prevalence of asthma because trends in the prevalence of asthma among children aged 8 to 9 years were unaffected by adjustment for standard deviation score of body mass index. Rather, they postulated that lifestyle changes common to both conditions were the reason for their apparent association in cross-sectional studies. Among 3792 participants in the Children's Health Study aged 7 to 18 years who were followed from 1993 through 1998, the risk of asthma development increased among overweight and obese boys but not girls.52Gilliland F.D. Berhane K. Islam T. McConnell R. Gauderman W.J. Gilliland S.S. et al.Obesity and the risk of newly diagnosed asthma in school-age children.Am J Epidemiol. 2003; 158: 406-415Crossref PubMed Scopus (338) Google Scholar Finally, among 9828 children aged 6 to 14 years from 6 US cities, body mass index was positively associated with the risk of asthma development among female subjects.53Gold D.R. Damokosh A.I. Dockery D.W. Berkey C.S. Body-mass index as a predictor of incident asthma in a prospective cohort of children.Pediatr Pulmonol. 2003; 36: 514-521Crossref PubMed Scopus (202) Google ScholarTable IIProspective studies of obesity and asthma incidence among children and adolescentsReferenceStudyFollow-up (y)PeriodAge (y)Sample sizeAsthma no.Asthma diagnosisAnthropometric measureRR estimate95% CIAdjusted for:Chinn and Rona,51Chinn S. Rona R.J. Can the increase in body mass index explain the rising trend in asthma in child