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Vehapoglu A, Cakın ZE, Kahraman FU, Nursoy MA, Toprak A. Is overweight/obesity a risk factor for atopic allergic disease in prepubertal children? A case-control study. J Pediatr Endocrinol Metab 2021; 34:727-732. [PMID: 33823105 DOI: 10.1515/jpem-2021-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/23/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES It is unclear whether body weight status (underweight/normal weight/overweight/obese) is associated with allergic disease. Our objective was to investigate the relationship between body weight status (body mass index; BMI) and atopic allergic disease in prepubertal children, and to compare children with atopic allergic diseases with non atopic healthy children. METHODS A prospective cross sectional study of 707 prepubertal children aged 3-10 years was performed; the participants were 278 atopic children with physician-diagnosed allergic disease (allergic rhinitis and asthma) (serum total IgE level >100 kU/l and eosinophilia >4%, or positivity to at least one allergen in skin test) and 429 non atopic healthy age- and sex-matched controls. Data were collected between December 2019 and November 2020 at the Pediatric General and Pediatric Allergy Outpatient Clinics of Bezmialem Vakıf University Hospital. RESULTS Underweight was observed in 11.6% of all participants (10.8% of atopic children, 12.2% of healthy controls), and obesity in 14.9% of all participants (18.0% of atopic children, 12.8% of controls). Obese (OR 1.71; 95% CI: 1.08-2.71, p=0.021), and overweight status (OR 1.62; 95% CI: 1.06-2.50, p=0.026) were associated with an increased risk of atopic allergic disease compared to normal weight in pre-pubertal children. This association did not differ by gender. There was no relationship between underweight status and atopic allergic disease (OR 1.03; 95% CI: 0.63-1.68, p=0.894). CONCLUSIONS Overweight and obesity were associated with an increased risk of atopic allergic disease compared to normal weight among middle-income and high-income pre pubertal children living in Istanbul.
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Affiliation(s)
- Aysel Vehapoglu
- Department of Pediatrics, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
| | - Zeynep Ebru Cakın
- Department of Pediatrics, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
| | - Feyza Ustabas Kahraman
- Department of Pediatrics, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Atilla Nursoy
- Department of Pediatric Allergy and Immunology, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
| | - Ali Toprak
- Department of Statistics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Farhat L, de Vos G, De A, Lee DS, Rastogi D. Atopy and pulmonary function among healthy-weight and overweight/obese children with asthma. Pediatr Pulmonol 2021; 56:34-41. [PMID: 32757362 PMCID: PMC7790165 DOI: 10.1002/ppul.25005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/01/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Epidemiologic studies have found low/absence of atopy in obese asthmatic children, but the association or lack thereof of atopy with disease morbidity, including pulmonary function, in obese asthma is not well understood. We sought to define the association of atopy with pulmonary function in overweight/obese minority children with asthma. METHODS In a retrospective chart review of 200 predominantly minority children evaluated at an academic Pediatric Asthma Center over 5 years, we compared the prevalence of atopy, defined as ≥ 1 positive skin prick test or serum-specific immunoglobulin E quantification to environmental allergens, and its association with pulmonary function in overweight/obese (body mass index [BMI] > 85th percentile) (n = 99) to healthy-weight children (BMI, 5th-85th percentile for age) (n = 101). RESULTS In a cohort comprised of 47.5% Hispanics and 39.5% African Americans, 81% of overweight/obese and 74% of healthy-weight children were atopic. While atopic healthy-weight children had lower percent-predicted forced expiratory volume in the first second (FEV1 ) (93 ± 13.6 vs 107% ± 33.2%, P = .03) and lower percent-predicted forced vital capacity (FVC) (93% ± 12.2% vs 104% ± 16.1%, P = .01) as compared to nonatopic children, atopy was not associated with FEV1 (P = .7) or FVC (P = .17) in overweight/obese children. Adjusting for demographic and clinical variables, atopy was found to be an independent predictor of FEV1 and FVC in healthy-weight (β = -2.4, P = .07 and β = -1.7, P = .04, respectively) but not in overweight/obese children (β = .6, P = .5 and β = .8, P = .3). CONCLUSIONS Atopy is associated with lower lung function in healthy-weight asthmatics but not in overweight/obese asthmatics, supporting the role of nonallergic mechanisms in disease burden in pediatric obesity-related asthma.
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Affiliation(s)
- Lara Farhat
- Division of Allergy and Immunology, SUNY Downstate Medical Center, New York, New York
| | - Gabriele de Vos
- Division of Allergy and Immunology, Jacobi Medical Center, Bronx, New York
| | - Aliva De
- Division of Pediatric Pulmonology, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
| | - Diana S Lee
- Division of General Pediatrics, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Deepa Rastogi
- Division of Pulmonology and Sleep Medicine, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Moonie S, Hogan MB. Challenges for the Clinician: Physical Activity Among Severe Asthmatic Patients with Comorbid Obesity. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:823-824. [PMID: 29747985 DOI: 10.1016/j.jaip.2017.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 12/20/2022]
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The Relationship Between Body Mass Index in Children and Insurance Type, Parental Eating Concern, Asthma, and Allergies. J Pediatr Health Care 2019; 33:e29-e37. [PMID: 31447014 DOI: 10.1016/j.pedhc.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Trust for America's Health reported rising levels of obesity contributed to increased disease rates and health care costs (Levi et al., 2013). Factors associated with overweight and obesity rates include lower socioeconomic status, public insurance, and increased chronic disease rates. METHODS Body mass index percentile, health insurance, parental eating concern, asthma, and allergy information were evaluated from a dataset of 870 de-identified health assessment records. RESULTS Among overweight/obese children, we found significant differences in children insured by Medicaid (26%) versus commercial insurance (15.9%), children with asthma (22.1%) versus children without asthma (14.8%), and children with known allergies (7.8%) versus children without known allergies (16.7%). The difference between children with parental eating concerns (3.7%) and children without (18.1%) was nearly significant. DISCUSSION The associations depicted can assist pediatric providers in recognizing risk factors for overweight/obesity among their patients. Combating obesity in childhood can improve health outcomes.
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Lucas JA, Marino M, Fankhauser K, Bailey SR, Ezekiel-Herrera D, Kaufmann J, Cowburn S, Suglia SF, Bazemore A, Puro J, Heintzman J. Oral corticosteroid use, obesity, and ethnicity in children with asthma. J Asthma 2019; 57:1288-1297. [PMID: 31437069 DOI: 10.1080/02770903.2019.1656228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Comorbid asthma and obesity leads to poorer asthma outcomes, partially due to decreased response to controller medication. Increased oral steroid prescription, a marker of uncontrolled asthma, may follow. Little is known about this phenomenon among Latino children. Our objective was to determine whether obesity is associated with increased oral steroid prescription for children with asthma, and to assess potential disparities in these associations between Latino and non-Hispanic white children.Methods: We examined electronic health record data from the ADVANCE national network of community health centers. The sample included 16,763 children aged 5-17 years with an asthma diagnosis and ≥1 ambulatory visit in ADVANCE clinics across 22 states between 2012 and 2017. Poisson regression analysis was used to examine the rate of oral steroid prescription overall and by ethnicity controlling for potential confounders.Results: Among Latino children, those who were always overweight/obese at study visits had a 15% higher rate of receiving an oral steroid prescription than those who were never overweight/obese [rate ratio (RR) = 1.15, 95% CI 1.05-1.26]. A similar effect size was observed for non-Hispanic white children, though the relationship was not statistically significant (RR = 1.10, 95% CI: 0.92-1.33). The interactions between body mass index and ethnicity were not significant (sometimes overweight/obese p = 0.95, always overweight/obese p = 0.58), suggesting a lack of disparities in the association between obesity and oral steroid prescription by ethnicity.Conclusions: Children with obesity received more oral steroid prescriptions than those at a healthy weight, which may be indicative of worse asthma control. We did not observe significant ethnic disparities.
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Affiliation(s)
- Jennifer A Lucas
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA.,Division of Biostatistics, School of Public Health, Oregon Health and Science University, Portland State University, Portland, OR, USA
| | - Katie Fankhauser
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - David Ezekiel-Herrera
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Jorge Kaufmann
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Andrew Bazemore
- The Robert Graham Center for Policy Studies, Washington, DC, USA
| | | | - John Heintzman
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA.,OCHIN, Inc, Portland, OR, USA
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Han J, Nguyen J, Kim Y, Geng B, Romanowski G, Alejandro L, Proudfoot J, Xu R, Leibel S. Effect of inhaled corticosteroid use on weight (BMI) in pediatric patients with moderate-severe asthma. J Asthma 2018; 56:263-269. [PMID: 29672188 DOI: 10.1080/02770903.2018.1455853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Assess the relationship between inhaled corticosteroid use (ICS) and weight (BMI) in pediatric patients with moderate-severe asthma. Assess if the number of emergency department (ED) visits correlates with overall BMI trajectory. Assess the trend of prescribing biologic therapy in pediatric patients with moderate-severe asthma and determine its relationship with weight (BMI). METHODS A retrospective chart review was performed on 93 pediatric patients with moderate-severe asthma to determine the relationship between ICS use and weight (BMI), biologic therapy and BMI, and number of ED visits and BMI trajectory. A mixed effects model was employed with the correlation between repeated measures accounted for through the random effects. RESULTS There is a statistically significant increase of 0.369 kg/m2 in BMI trajectory per year in subjects on high-dose steroids compared to an increase of 0.195 kg/m2 in the low dose group (p < 0.05). The BMI of subjects initiated on biologic therapy (omalizumab or mepolizumab) had a statistically significant decrease in BMI trajectory of 0.818 kg/m2 per year (p < 0.05). Subjects with ≥5 ED visits due to asthma exacerbations had a significantly higher BMI trajectory (p < 0.05). CONCLUSIONS The potency of ICS use in pediatric patients with moderate-severe asthma affects BMI trajectory; the higher the dose, the greater the projected BMI increase per year. Initiation of biologic therapy decreased BMI trajectory over time. Lastly, those with frequent ED visits had a higher BMI trend. Future prospective studies are warranted that further evaluate the potential metabolic impacts of ICS and assess the effects of biologic therapy on BMI.
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Affiliation(s)
| | | | - Yuna Kim
- a Rady Children's Hospital San Diego , CA
| | - Bob Geng
- b UCSD Department of Pediatrics and Medicine San Diego , CA
| | | | | | - James Proudfoot
- c Altman Clinical and Translational Research Institute, UCSD La Jolla , CA
| | - Ronghui Xu
- c Altman Clinical and Translational Research Institute, UCSD La Jolla , CA
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