Asthma and insulin resistance in morbidly obese children and adolescents
Baha A Al-Shawwa1, Nidal H Al-Huniti, Laure DeMattia
1Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA. balshaww@mcw.edu
Insights
Morbidly obese children with asthma exhibit higher insulin resistance (IR). This suggests that IR may contribute to asthma development in obese youth, warranting further investigation.
Area of Science:
- Pediatric Endocrinology
- Pulmonology
- Metabolic Disorders
Background:
- Obesity is linked to increased insulin resistance and is a risk factor for childhood asthma.
- The specific mechanisms connecting asthma and obesity, particularly the role of inflammation and insulin resistance, are not well understood.
Purpose of the Study:
- To investigate the association between insulin resistance and asthma in a cohort of morbidly obese children.
- To determine if insulin resistance is a significant factor related to the prevalence of asthma in this population.
Main Methods:
- Retrospective review of patients in a pediatric obesity management program.
- Asthma diagnosis confirmed by physician evaluation or inhaled corticosteroid use.
- Insulin resistance (IR) quantified using the Homeostasis Model Assessment (HOMA).
- Multivariate logistic regression analysis to identify predictors of asthma.
Main Results:
- Of 415 patients, 35% had asthma. Asthma and non-asthma groups were similar in age, gender, BMI, and smoking exposure.
- Family history of asthma was significantly higher in the asthma group (71% vs. 40%).
- Insulin resistance levels were significantly higher in the asthma group (8.5 vs. 5.3, p<0.0001).
- Multivariate analysis identified younger age, smoking exposure, family history of asthma, and insulin resistance as significant factors associated with asthma (OR 4.1 for IR).
Conclusions:
- Morbidly obese children with asthma demonstrate elevated insulin resistance compared to their non-asthmatic counterparts.
- Insulin resistance, possibly via a pro-inflammatory state, may play a role in the pathogenesis of asthma in obese children.
- Further prospective research is recommended to confirm insulin resistance as a risk factor for asthma in obese pediatric populations.
Background:
Obesity is well recognized as a state of increased insulin resistance and has been implicated as a significant risk factor for both asthma prevalence and asthma severity in children and adolescents. However, little is known about the specific factors that relate asthma and obesity. Recently, the pro-inflammatory state in obesity and its association with insulin resistance have been recognized. We hypothesize that the effect of morbid obesity on asthma is related to insulin resistance.
Methods:
The patient cohort in the obesity management program at the Children's Hospital of Wisconsin was retrospectively reviewed. Variables were collected from the program data base and chart review was done for missing variables. Patients were considered to have asthma if the evaluating physician confirmed the diagnosis through history and/or the patient had been on inhaled corticosteroids. Insulin resistance (IR) was calculated using a homeostasis model assessment (HOMA). Multivariate logistic regression was performed to identify variables that were significantly related to the odds of having asthma.
Results:
Of the 415 patients included in the study, 146 (35%) were asthmatic and 269 (65%) were non-asthmatic. The asthma (AG) and non-asthma (NAG) groups were similar with respect to mean age (11.3 vs. 11.5 years), gender (45% vs. 43% males), mean body mass index (BMI) (36.4 vs. 34.9), and exposure to smoking (43% vs. 42%). Fhx of asthma was significantly higher in AG (71%) compared to NAG (40%). IR level+/-SD was 8.5+/-9.7 in AG compared to 5.3+/-6.7 in NAG (p<0.0001). Multivariate regression analysis found the following variables to be associated with having asthma: younger age (p<0.05), smoking exposure (p<0.05), positive Fhx of asthma (p<0.0001, odds ratio of 3.1), and IR (p<0.0001, odds ratio of 4.1).
Conclusion:
Morbidly obese asthma patients have a higher degree of insulin resistance compared to morbidly obese non-asthma patients. We speculate that the pro-inflammatory state of insulin resistance may contribute to the pathogenesis of asthma in obese patients. Future prospective studies should address insulin resistance as a possible risk factor for asthma in obese children and adolescents.
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Critical processes in asthma pathophysiology include: