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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Associations between body weight, asthma burden, and type 2 inflammation among under-resourced children
David Thompson1, Cynthia M Visness2, Robert A Wood3
1Division of Respiratory and Sleep Medicine, Department of Pediatrics, Albert Einstein College of Medicine, New York, New York.
Insights
Overweight/obesity and Type 2 (T2) inflammation independently increase asthma burden in children. T2 inflammation, not obesity, is linked to poor asthma control and hospitalizations, highlighting distinct risk factors.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Public Health
Background:
- Overweight/obesity is a significant risk factor for asthma in under-resourced children, exacerbating disease burden.
- Type 2 (T2) inflammation, characterized by elevated IgE, eosinophilia, and allergen sensitization, has an inconsistent association with obesity-related asthma severity.
- Limited overlap between T2 features may explain the inconsistent associations observed in prior studies.
Purpose of the Study:
- To examine how distinct Type 2 (T2) inflammation features influence the relationship between overweight/obesity and asthma burden in under-resourced children.
- To differentiate the impact of T2 inflammation and overweight/obesity on various asthma outcomes.
Main Methods:
- Analysis of 2160 children (aged 6-20) from four Inner-City Asthma Consortium cohorts.
- Investigated associations between overweight/obesity and asthma burden indicators: unscheduled visits, hospitalizations, exacerbations, asthma control, and pulmonary function.
- Assessed the modifying effect of T2 features (elevated total IgE, eosinophilia >300 cells/µL, or sensitization to ≥2 allergens) on these associations.
Main Results:
- Overweight/obesity and allergen sensitization were linked to increased odds of unscheduled visits.
- Elevated total IgE and eosinophilia correlated with higher hospitalization rates.
- Elevated total IgE was associated with poorer asthma control.
- Both overweight/obesity and all T2 features were associated with reduced forced expiratory volume in 1 second/forced vital capacity ratio.
- No synergistic or significant mediating effects of T2 features were found on the overweight/obesity-asthma burden link.
Conclusions:
- In under-resourced children with asthma, overweight/obesity and T2 inflammation are largely independent contributors to unscheduled visits and impaired pulmonary function.
- Type 2 inflammation, rather than overweight/obesity, is significantly associated with poor asthma control and hospitalizations.
- Findings suggest distinct pathways through which T2 inflammation and obesity impact pediatric asthma.
Background:
Overweight/obesity is a risk factor for asthma, particularly in under-resourced children, and contributes to higher disease burden. Type 2 (T2) inflammation, a key characteristic of asthma endotypes, has been inconsistently associated with burden of obesity-related asthma, which may be due to limited overlap between different T2 features, including elevated total serum IgE level, eosinophilia, and allergen sensitization.
Objective:
To investigate the effects of different T2 features on association of overweight/obesity with asthma burden in under-resourced children.
Methods:
Among 2160 children aged 6 to 20 years from 4 Inner-City Asthma Consortium cohorts, the association of overweight/obesity with asthma burden (unscheduled visits, hospitalizations, exacerbations, asthma control, and pulmonary function) and the effect of T2 features (total IgE level higher than age-specific cutoffs, total eosinophils > 300 cells/µL, or sensitization to ≥2 allergens) on the association were investigated.
Results:
The odds (odds ratio [95% CI]) of unscheduled visits were higher among those with overweight/obesity (1.35 [1.04-1.75]) and allergen sensitization (1.35 [1.02-1.80]), hospitalizations were higher among those with elevated total IgE level (2.17 [1.27-3.69]) and eosinophilia (2.80 [1.56-5.21]), and poor asthma control was higher among those with elevated total IgE level (1.27 [1.09-1.41]). Overweight/obesity and all T2 features were associated with lower forced expiratory volume in 1 second/forced vital capacity ratio. There was no synergistic or clinically significant mediating influence of any of T2 features on the association of overweight/obesity with asthma burden.
Conclusion:
Among under-resourced children with asthma, overweight/obesity and T2 inflammation are largely independently associated with unscheduled visits and pulmonary function deficits. T2 inflammation, but not overweight/obesity, is associated with poor control and hospitalizations.
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