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Barenie MJ, Howie EK, Weber KA, Thakur D, Murphy CM, Thomsen MR. Where the children play: Gender gaps in recess physical activity by age and playground area. Prev Med Rep 2024; 41:102699. [PMID: 38560596 PMCID: PMC10981088 DOI: 10.1016/j.pmedr.2024.102699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
Objective Recess contributes meaningfully to physical activity (PA), but recess time has declined. The study's purpose was to report PA by age, gender, and playground feature to inform potential playground configurations more conducive to PA during recess. Methods Using the System for Observing Play and Leisure Activity in the Youth, kindergarten through 5th grade recesses were observed on at least four days at four schools in Little Rock, Arkansas, United States during May 2023. Target playground features were ball courts, grass, pavement, play structures, and swings. To provide inferential analysis, a comparison of conditional means across playground features, age, and gender was conducted using linear regression with robust standard errors clustered by school. Results 3,356 playground scans (intercoder correlation = 0.93) were collected and aggregated by school, day, gender, age (grade), and target feature for a sample size of 292 observations. The gender gap was widest among 4-5th graders, 79 % (95 % CI: 72, 86) for males and 64 % (95 % CI: 58, 70) for females. Among females, PA was highest on swings [82 % (95 % CI: 77, 86)] and lowest on paved areas [56 % (95 % CI: 43, 69)]. Among males, it was highest on both swings [81 % (95 % CI: 75, 86)] and ball courts [83 % (95 % CI: 77, 89)] and lowest on grassy areas [64 % (95 % CI: 60, 67)]. Conclusion Swings, courts, and play structures were associated with a higher proportion of children being engaged in PA. Research is needed to identify whether physical improvements to facilitate access to these features increase PA.
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Affiliation(s)
- Matthew J. Barenie
- Center for the Study of Obesity, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 820, Little Rock, AR, USA
| | - Erin K. Howie
- Department of Health, Human Performance and Recreation, University of Arkansas, 155 Stadium Drive, Fayetteville, AR, USA
| | - Kari A. Weber
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 82, Little Rock, AR, USA
| | - Deboleena Thakur
- Center for the Study of Obesity, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 820, Little Rock, AR, USA
| | - Christopher M. Murphy
- Department of Health, Human Performance and Recreation, University of Arkansas, 155 Stadium Drive, Fayetteville, AR, USA
| | - Michael R. Thomsen
- Center for the Study of Obesity, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 820, Little Rock, AR, USA
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Swilley-Martinez ME, Coles SA, Miller VE, Alam IZ, Fitch KV, Cruz TH, Hohl B, Murray R, Ranapurwala SI. "We adjusted for race": now what? A systematic review of utilization and reporting of race in American Journal of Epidemiology and Epidemiology, 2020-2021. Epidemiol Rev 2023; 45:15-31. [PMID: 37789703 DOI: 10.1093/epirev/mxad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/31/2023] [Accepted: 09/28/2023] [Indexed: 10/05/2023] Open
Abstract
Race is a social construct, commonly used in epidemiologic research to adjust for confounding. However, adjustment of race may mask racial disparities, thereby perpetuating structural racism. We conducted a systematic review of articles published in Epidemiology and American Journal of Epidemiology between 2020 and 2021 to (1) understand how race, ethnicity, and similar social constructs were operationalized, used, and reported; and (2) characterize good and poor practices of utilization and reporting of race data on the basis of the extent to which they reveal or mask systemic racism. Original research articles were considered for full review and data extraction if race data were used in the study analysis. We extracted how race was categorized, used-as a descriptor, confounder, or for effect measure modification (EMM)-and reported if the authors discussed racial disparities and systemic bias-related mechanisms responsible for perpetuating the disparities. Of the 561 articles, 299 had race data available and 192 (34.2%) used race data in analyses. Among the 160 US-based studies, 81 different racial categorizations were used. Race was most often used as a confounder (52%), followed by effect measure modifier (33%), and descriptive variable (12%). Fewer than 1 in 4 articles (22.9%) exhibited good practices (EMM along with discussing disparities and mechanisms), 63.5% of the articles exhibited poor practices (confounding only or not discussing mechanisms), and 13.5% were considered neither poor nor good practices. We discuss implications and provide 13 recommendations for operationalization, utilization, and reporting of race in epidemiologic and public health research.
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Affiliation(s)
- Monica E Swilley-Martinez
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Serita A Coles
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7440, United States
| | - Vanessa E Miller
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Ishrat Z Alam
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Kate Vinita Fitch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Theresa H Cruz
- Prevention Research Center, Department of Pediatrics, Health Sciences Center, University of New Mexico, Albuquerque, NM 87131, United States
| | - Bernadette Hohl
- Penn Injury Science Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-6021, United States
| | - Regan Murray
- Center for Public Health and Technology, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR 72701, United States
| | - Shabbar I Ranapurwala
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, United States
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27599, United States
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Kozioł-Kozakowska A, Januś D, Stępniewska A, Szczudlik E, Stochel-Gaudyn A, Wójcik M. Beyond the Metabolic Syndrome: Non-Obvious Complications of Obesity in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1905. [PMID: 38136107 PMCID: PMC10742254 DOI: 10.3390/children10121905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
Obesity is currently one of the most significant public health challenges worldwide due to the continuous increase in obesity rates among children, especially younger children. Complications related to obesity, including serious ones, are increasingly being diagnosed in younger children. A search was performed from January 2023 to September 2023 using the PubMed, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases. The focus was on English-language meta-analyses, systematic reviews, randomized clinical trials, and observational studies worldwide. Four main topics were defined as follows: disorders of glucose metabolism; liver disease associated with childhood obesity; the relationship between respiratory disorders and obesity in children; and the effects of obesity on the hypothalamic-pituitary-gonadal axis and puberty. Understanding potential complications and their underlying mechanisms can expedite the diagnostic process and enhance the effectiveness of treatment. We aspire that this study will bring insight into the often-overlooked complications associated with obesity.
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Affiliation(s)
- Agnieszka Kozioł-Kozakowska
- Department of Pediatrics, Gastroenterology and Nutrition, Institute of Pediatrics, Jagiellonian University Medical College, 31-008 Cracow, Poland; (A.K.-K.); (A.S.-G.)
- Interclinical Center for the Treatment of Childhood Obesity, University Children’s Hospital of Krakow, 30-663 Kraków, Poland; (A.S.); (E.S.)
| | - Dominika Januś
- Department of Pediatric and Adolescent Endocrinology, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland;
| | - Anna Stępniewska
- Interclinical Center for the Treatment of Childhood Obesity, University Children’s Hospital of Krakow, 30-663 Kraków, Poland; (A.S.); (E.S.)
- Department of Pediatric and Adolescent Endocrinology, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland;
| | - Ewa Szczudlik
- Interclinical Center for the Treatment of Childhood Obesity, University Children’s Hospital of Krakow, 30-663 Kraków, Poland; (A.S.); (E.S.)
- Department of Pediatric and Adolescent Endocrinology, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland;
| | - Anna Stochel-Gaudyn
- Department of Pediatrics, Gastroenterology and Nutrition, Institute of Pediatrics, Jagiellonian University Medical College, 31-008 Cracow, Poland; (A.K.-K.); (A.S.-G.)
| | - Małgorzata Wójcik
- Interclinical Center for the Treatment of Childhood Obesity, University Children’s Hospital of Krakow, 30-663 Kraków, Poland; (A.S.); (E.S.)
- Department of Pediatric and Adolescent Endocrinology, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland;
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Özden Ş, Tepetam FM, Örçen C, Yakut T. The phenotypic heterogeneity of obese and nonobese patients with severe asthma and comparison of omalizumab-mepolizumab treatment efficiency in these patients. Medicine (Baltimore) 2023; 102:e35247. [PMID: 37904405 PMCID: PMC10615449 DOI: 10.1097/md.0000000000035247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/24/2023] [Indexed: 11/01/2023] Open
Abstract
In obese severe asthmatics, the degree of type 2 inflammation may vary according to their atopic status and past smoking history. In this study, we aimed to analyze the clinical and physiopathological features of obese and nonobese severe asthmatics treated with omalizumab or mepolizumab treatment. In addition we aimed to compare the clinical, spirometric outcomes and total peripheral eosinophilic count (TEC) changes after treatment with these 2 biologic agents in obese and nonobese groups. In this retrospective, cross sectional study, 121 severe asthmatic treated with biologic agents (omalizumab = 88 or mepolizumab = 33) for at least 16 weeks were included. Obese (n: 44) and nonobese severe asthmatics (n: 77) were analyzed according to whether they provided a ≥ 10 pack/years (p/y) or <10 p/y smoking history and were found to be atopic. Obese and nonobese groups were compared in terms of the change in the asthma control test, asthma attacks, TEC, and forced expiratory volume in the first second (FEV1) after treatment. In patients with ≥10 p/y smoking history, nonobese group had a significantly higher TEC compared to obese group [median (min-max) 660 cells/μL (200-1500) vs 300 cells/μL (110-770); p: 0.013]. Within the nonobese group, nonatopic patients had a significantly higher TEC compared to atopic patients [median (min-max) 1200 cells/μL (100-2100) vs 310 cells/μL (0-2730); p: 0.021]. Both biologic agents had similar effects on improving asthma control test and in reducing asthma attacks; however, mepolizumab was more effective in suppressing TEC. The improvement in FEV1 in obese group following biologic 2 agents was very similar but in nonobese group, mepolizumab was found to be superior (510 mL vs. 295 mL; p: 0.034). In our real-life study, nonobese severe asthmatics with ≥10 p/y smoking history and those that were nonatopic had higher TEC. Compared to omalizumab, mepolizumab was superior at reducing TEC in all asthmatics and in improving FEV1 in nonobese group.
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Affiliation(s)
- Şeyma Özden
- Department of Immunology and Allergy, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Fatma Merve Tepetam
- Department of Immunology and Allergy, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cihan Örçen
- University of Health Sciences, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Tuğçe Yakut
- Department of Immunology and Allergy, University of Health Sciences, Diyarbakir Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
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Stefani C, Pecoraro L, Flodmark CE, Zaffanello M, Piacentini G, Pietrobelli A. Allergic Diseases and Childhood Obesity: A Detrimental Link? Biomedicines 2023; 11:2061. [PMID: 37509700 PMCID: PMC10377533 DOI: 10.3390/biomedicines11072061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Several epidemiological studies have described childhood obesity as a risk factor for atopic disease, particularly asthma. At the same time, this association seems to be more conflicting for allergic rhinitis, atopic dermatitis, and chronic urticaria. This article aims to deepen the possibility of a relationship between childhood obesity and allergic diseases. As regards asthma, the mechanical and inflammatory effects of obesity can lead to its development. In addition, excess adiposity is associated with increased production of inflammatory cytokines and adipokines, leading to low-grade systemic inflammation and an increased risk of asthma exacerbations. Allergic rhinitis, atopic dermatitis, food allergies, and chronic urticaria also seem to be related to this state of chronic low-grade systemic inflammation typical of obese children. Vitamin D deficiency appears to play a role in allergic rhinitis, while dyslipidemia and skin barrier defects could explain the link between obesity and atopic dermatitis. Starting from this evidence, it becomes of fundamental importance to act on body weight control to achieve general and allergic health, disentangling the detrimental link between obesity allergic diseases and childhood obesity. Further studies on the association between adiposity and atopy are needed, confirming the biologically active role of fat tissue in the development of allergic diseases and exploring the possibility of new therapeutic strategies.
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Affiliation(s)
- Camilla Stefani
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | | | - Marco Zaffanello
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
| | - Angelo Pietrobelli
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
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6
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Starr S, Wysocki M, DeLeon JD, Silverstein G, Arcoleo K, Rastogi D, Feldman JM. Obesity-related pediatric asthma: relationships between pulmonary function and clinical outcomes. J Asthma 2023; 60:1418-1427. [PMID: 36420526 PMCID: PMC10191971 DOI: 10.1080/02770903.2022.2152351] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We hypothesized that children with obesity-related asthma would have worse self-reported asthma control, report an increased number of asthma symptoms and have lower FEV1/FVC associated with worse clinical asthma outcomes compared to children with asthma only. METHODS Cross sectional analyses examined two hundred and eighteen (obesity-related asthma = 109, asthma only = 109) children, ages 7-15 that were recruited from clinics and hospitals within the Bronx, NY. Pulmonary function was assessed by forced expiratory volume in the first second (percent predicted FEV1) and the ratio of FEV1 to the forced vital capacity of the lungs (FEV1/FVC). Structural equation modeling examined if pulmonary function was associated with asthma control and clinical outcomes between groups. RESULTS Lower percent predicted FEV1 was associated with increased hospitalizations (p = 0.03) and oral steroid bursts in the past 12 months (p = 0.03) in the obesity-related asthma group but not in the asthma only group. FEV1/FVC was also associated with increased hospitalizations (p = 0.02) and oral steroid bursts (p = 0.008) in the obesity-related asthma group but not the asthma only group. Lower FEV1/FVC was associated with the number of asthma symptoms endorsed in the asthma only group but not in the obesity-related asthma group. Percent predicted FEV1 and FEV1/FVC was not associated with asthma control in either group. CONCLUSIONS Pulmonary function was associated with oral steroid bursts and hospitalizations but not self-reported asthma control, suggesting the importance of incorporating measures of pulmonary function into the treatment of pediatric obesity-related asthma.
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Affiliation(s)
- Sheena Starr
- Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building, 1165 Morris Park Ave., Bronx NY, 10467
| | - Matthew Wysocki
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Department of Psychiatry & Behavioral Sciences, 3415 Bainbridge Ave, Bronx, NY 10467
| | - Jesenya D. DeLeon
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Department of Psychiatry & Behavioral Sciences, 3415 Bainbridge Ave, Bronx, NY 10467
| | - Gabriella Silverstein
- Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building, 1165 Morris Park Ave., Bronx NY, 10467
| | - Kimberly Arcoleo
- University of Rhode Island, College of Nursing, 350 Eddy Street, Providence, RI 02903
| | - Deepa Rastogi
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Department of Psychiatry & Behavioral Sciences, 3415 Bainbridge Ave, Bronx, NY 10467
| | - Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building, 1165 Morris Park Ave., Bronx NY, 10467
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Department of Psychiatry & Behavioral Sciences, 3415 Bainbridge Ave, Bronx, NY 10467
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7
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Chen L, Agalliu I, Roth A, Rastogi D. Association of fractional exhaled nitric oxide with asthma morbidity in urban minority children. J Asthma 2023; 60:553-564. [PMID: 35499408 PMCID: PMC10170416 DOI: 10.1080/02770903.2022.2073549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/01/2022] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Fractional exhaled nitric oxide (FeNO) is a well-established measure of allergic airway inflammation and possible useful adjunct disease management tool. We investigated the association of baseline and follow-up FeNO measurements with disease burden in minority children with persistent asthma. METHODS A retrospective chart review was conducted on 352 African American and Hispanic children seen at an urban Asthma Center in Bronx, NY. Demographic, clinical characteristics, and pulmonary function tests (PFTs) were compared between children with low, intermediate, and high baseline FeNO levels. Among 95 children with subsequent follow up visits, associations of change in FeNO with demographics, clinical characteristics, and PFTs were examined using mixed effects linear regression models. RESULTS A higher proportion of children with intermediate (54%) and high FeNO (58%) levels had lower airways obstruction compared to those with low FeNO levels (33%). Children with intermediate FeNO levels had more annual hospitalizations (2.8 ± 6.2) compared to those with low and high FeNO levels (1.3 ± 2.8 and 1.3 ± 2.5). These associations did not differ between ethnicities. An increase in FeNO over time was associated with higher BMI z-scores (β = 6.2, 95% CI: 1.0 to 11.4) and two or more hospitalizations in the past year (β = 16.1, 95% CI: 1.5 to 30.8). CONCLUSIONS Intermediate and high FeNO levels are associated with lower airways obstruction and hospitalizations. Initial and serial FeNO measurements can be a useful adjunctive tool in identifying asthma-related morbidity in urban African American and Hispanic children.
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Affiliation(s)
- Laura Chen
- Department of Pediatrics, Section of Respiratory, Allergy-Immunology, and Sleep Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06520, USA
| | - Ilir Agalliu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Avenue, Bronx, NY, 10461, USA
| | - Adam Roth
- Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway, Bronx, NY, 10461, USA
| | - Deepa Rastogi
- Division of Pulmonary and Sleep Medicine, Children’s National Health System, George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue, Washington, DC, 20010, USA
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Triasih R, Setyowireni D, Nurani N, Setyati A. Prevalence, Management, and Risk Factors of Asthma Among School-Age Children in Yogyakarta, Indonesia. J Asthma Allergy 2023; 16:23-32. [PMID: 36636706 PMCID: PMC9830052 DOI: 10.2147/jaa.s392733] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose Childhood asthma in developing countries has been increasing, but underdiagnosed and undertreated. We reported prevalence, management, and risk factors of asthma among school-age children in Yogyakarta, Indonesia. Patients and Methods We recruited children aged 6-7 years and 13-14 years attending schools in all districts in Yogyakarta, Indonesia. The schools were randomly selected via cluster random sampling. We used the Indonesian version of the Global Asthma Network (GAN) questionnaire, and the methodology employed by this study was in accordance with the GAN's protocol. Results A total of 2106 children aged 6-7 years and 3142 adolescents aged 13-14 years were eligible for analysis. The prevalence of current wheeze in children and adolescents was similar, which was 4.6%. Inhalation therapy was reported in <30% of those with asthma. Risk factors for current wheeze in children were wheezing in infancy period, ever had pneumonia, the house was passed by trucks every day, and fast-food consumption in the previous 12 months; whereas exclusive breastfeeding for more than 6 months decreased the risk of current wheeze. In adolescence, obesity, consumption of fast food once or twice a week, and paracetamol in the previous 12 months increased the risk of current wheeze. Conclusion The prevalence of current wheeze in children and adolescents in Indonesia was quite low. The use of inhalation therapy was limited. Respiratory problems during infancy, environmental, and nutritional factors play a role in the development of asthma.
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Affiliation(s)
- Rina Triasih
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia,Correspondence: Rina Triasih, Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Dr. Sardjito Hospital, Jl. Kesehatan 1, Yogyakarta, 55284, Indonesia, Tel +62 81392764269, Fax +6274 583745, Email
| | - Dwikisworo Setyowireni
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Neti Nurani
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Amalia Setyati
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia
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Abstract
Background: In recent years, an increase of allergies and asthma has been observed throughout the world, more so in Western countries than in less developed ones. Although genetics may play a role in this increase, there are many other factors that may have contributed to the upsurge. Objective: The purpose of the present report was to review the many factors associated with modernization and lifestyle that may have contributed to the allergy and/or asthma epidemic, with a particular focus on those aspects that have particular relevance for the allergist/immunologist. Results: The marked rise in allergy and asthma has been significantly seen in more-developed countries, greater in urban than in rural areas, more pronounced in affluent than in poorer societies, and in individuals who have migrated from developing countries to industrialized countries. A widely accepted explanation for this rise is the "hygiene hypothesis," which postulates a critical dependence on microbial infection for maintenance of a healthy balanced immune system and that extremely clean external environments, often found in the developed world, can derail equilibrated immune development. With the control of infectious diseases, the immune system shifts from a balanced equilibrated immunologic structure to a more Th2 driven proinflammatory state often associated with IgE and eosinophil-related disorders. Conclusion: Modernization has been associated with increased development of allergies and asthma through a cleaner environment and more exposure to allergens and to multiple other contributory factors. The marked reduction in infectious diseases in recent decades permitted the immune system to switch from fighting infectious disease agents and parasites to reacting adversely (hypersensitivity) to benign environmental agents (allergens) and even to self-antigens (autoimmunity).
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Affiliation(s)
- Sami L Bahna
- From the Allergy and Immunology Section, Department of Pediatrics, and
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10
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Kickhofel Weisshahn1 N, Duarte de Oliveira1 P, César Wehrmeister1 F, Gonçalves1 H, Maria Baptista Menezes1 A. The bidirectional association between wheezing and obesity during adolescence and the beginning of adulthood in the 1993 birth cohort, Pelotas, Brazil. J Bras Pneumol 2022; 48:e20220222. [DOI: 10.36416/1806-3756/e20220222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/30/2022] [Indexed: 11/12/2022] Open
Abstract
Objective: To analyze the bidirectional association between wheezing and obesity during adolescence and the beginning of adulthood in a cohort in southern Brazil. Methods: This prospective longitudinal study used data from the 1993 birth cohort in Pelotas, Brazil. The following outcome variables were measured at 22 years of age: self-reported wheezing during the last 12 months and obesity (BMI = 30 kg/m2). The following exposure variables were measured at ages 11, 15, and 18: self-reported wheezing (no wheezing or symptom presentation in 1, 2, or 3 follow-ups) and obesity (non-obese or obese in 1, 2, or 3 follow-ups). Crude and adjusted logistical regression stratified by sex were used in the analyses. The reference category was defined as participants who presented no wheezing or obesity. Results: A total of 3,461 participants had data on wheezing and 3,383 on BMI. At 22 years of age, the prevalence of wheezing was 10.1% (95%CI: 9.1; 11.2), and obesity, 16.2% (95%CI: 15.0; 17.6). In females, the presence of wheezing in two follow-ups revealed a 2.22-fold (95%CI: 1.36; 3.61) greater chance of developing obesity at 22 years of age. Meanwhile, the presence of obesity in two follow-ups resulted in a 2.03-fold (95%IC: 1.05; 3.92) greater chance of wheezing at 22 years of age. No associations were found between wheezing and obesity in males. Conclusions: The obtained data suggest a possible positive bidirectional association between wheezing and obesity, with greater odds ratios in the wheezing to obesity direction in females and in the category of occurrence of exposure in two follow-ups.
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Affiliation(s)
| | - Paula Duarte de Oliveira1
- 1. Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas (RS), Brasil
| | | | - Helen Gonçalves1
- 1. Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas (RS), Brasil
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11
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He L, Xi X. Interaction between serum cotinine and body mass index on asthma in the children: a cross-sectional study. BMC Pediatr 2022; 22:499. [PMID: 35999590 PMCID: PMC9400283 DOI: 10.1186/s12887-022-03571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study was to explore the interaction between serum cotinine (a marker of environmental tobacco smoke exposure) and body mass index (BMI) on asthma in children. Methods This cross-sectional study relied on representative samples of American children included in the National Health and Nutrition Examination Survey in 1999–2018. Multivariate logistic regression analyses were to evaluate the association between serum cotinine level, BMI z-score and asthma. Serum cotinine was dichotomized at 0.0436 ng/mL. Interactions were examined by the estimated joint effect of BMI and serum cotinine levels. We also performed interaction analyses in age and ethnicity subgroups. Results Among the 11,504 children aged 3 to 12 years included in the analysis, 15.86% (n = 1852) had childhood asthma, 15.68% (n = 1837) were overweight, and 17.31% (n = 2258) were obese. Compared to low serum cotinine, high serum cotinine was significantly associated with asthma [odds ratio (OR) = 1.190, 95% confidence interval (CI): 1.004–1.410]. Overweight (OR = 1.275, 95%CI: 1.079–1.506) and obesity (OR = 1.636, 95%CI: 1.354–1.977) were significantly associated with asthma compared with normal weight. The adjusted attributable proportion of interaction = 0.206 (95%CI: 0.075–0.337) and the adjusted synergy index = 1.617 (95%CI: 1.126–2.098) indicated that there was a significant synergistic effect of serum cotinine levels and BMI on asthma. In males, females, non-Hispanic White and other Hispanic, there were synergistic interactions between serum cotinine levels and BMI on asthma. Conclusion A synergistic interaction between serum cotinine and overweight/obesity on childhood asthma was found. For children with asthma, both intensive weight interventions in overweight or obese children and intensive passive smoking interventions in children exposed to the environment may be important. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03571-0.
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Affiliation(s)
- Li He
- School of Medicine, Xinjiang University of Science & Technology, No.89, Beijing Road, Yingxia Township, 841000, Korla City, Xinjiang, People's Republic of China.
| | - Xiaojing Xi
- Department of Quality Management, Medical Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, People's Republic of China
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12
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Brew BK, Caffrey Osvald E, Gong T, Hedman AM, Holmberg K, Larsson H, Ludvigsson JF, Mubanga M, Smew AI, Almqvist C. Pediatric asthma and non-allergic comorbidities: a review of current risk and proposed mechanisms. Clin Exp Allergy 2022; 52:1035-1047. [PMID: 35861116 PMCID: PMC9541883 DOI: 10.1111/cea.14207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Abstract
It is increasingly recognized that children with asthma are at a higher risk of other non‐allergic concurrent diseases than the non‐asthma population. A plethora of recent research has reported on these comorbidities and progress has been made in understanding the mechanisms for comorbidity. The goal of this review was to assess the most recent evidence (2016–2021) on the extent of common comorbidities (obesity, depression and anxiety, neurodevelopmental disorders, sleep disorders and autoimmune diseases) and the latest mechanistic research, highlighting knowledge gaps requiring further investigation. We found that the majority of recent studies from around the world demonstrate that children with asthma are at an increased risk of having at least one of the studied comorbidities. A range of potential mechanisms were identified including common early life risk factors, common genetic factors, causal relationships, asthma medication and embryologic origins. Studies varied in their selection of population, asthma definition and outcome definitions. Next, steps in future studies should include using objective measures of asthma, such as lung function and immunological data, as well as investigating asthma phenotypes and endotypes. Larger complex genetic analyses are needed, including genome‐wide association studies, gene expression–functional as well as pathway analyses or Mendelian randomization techniques; and identification of gene–environment interactions, such as epi‐genetic studies or twin analyses, including omics and early life exposure data. Importantly, research should have relevance to clinical and public health translation including clinical practice, asthma management guidelines and intervention studies aimed at reducing comorbidities.
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Affiliation(s)
- Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.,National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Clinical Medicine, University of New South Wales, Australia
| | - Emma Caffrey Osvald
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.,Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Sweden
| | - Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Anna M Hedman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Kirsten Holmberg
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.,School of Medical Sciences, Örebro University, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.,Department of Pediatrics, Orebro University Hospital, Orebro, Sweden
| | - Mwenya Mubanga
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Awad I Smew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.,Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Sweden
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13
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Stevens DR, Rohn MCH, Hinkle SN, Williams AD, Kumar R, Lipsky LM, Grobman W, Sherman S, Kanner J, Chen Z, Mendola P. Maternal body composition and gestational weight gain in relation to asthma control during pregnancy. PLoS One 2022; 17:e0267122. [PMID: 35442986 PMCID: PMC9020691 DOI: 10.1371/journal.pone.0267122] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 04/02/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Poor asthma control is common during pregnancy and contributes to adverse pregnancy outcomes. Identification of risk factors for poor gestational asthma control is crucial. OBJECTIVE Examine associations of body composition and gestational weight gain with asthma control in a prospective pregnancy cohort (n = 299). METHODS Exposures included pre-pregnancy body mass index (BMI), first trimester skinfolds, and trimester-specific gestational weight gain. Outcomes included percent predicted forced expiratory volumes (FEV1, FEV6), forced vital capacity (FVC), peak expiratory flow (PEF), FEV1/FVC, symptoms (activity limitation, nighttime symptoms, inhaler use, and respiratory symptoms), and exacerbations (asthma attacks, medical encounters). Linear and Poisson models examined associations with lung function (β (95% confidence interval (CI)), asthma symptom burden (relative rate ratio (RR (95%CI)), and exacerbations (RR (95%CI)). RESULTS Women with a BMI ≥ 30 had lower percent predicted FVC across pregnancy (βThirdTrimester: -5.20 (-8.61, -1.78)) and more frequent night symptoms in the first trimester (RR: 1.66 (1.08, 2.56)). Higher first trimester skinfolds were associated with lower FEV1, FEV6, and FVC, and more frequent night symptoms and inhaler use across pregnancy. Excessive first trimester gestational weight gain was associated with more frequent activity limitation in the first trimester (RR: 3.36 (1.15, 9.80)) and inhaler use across pregnancy (RRThirdTrimester: 3.49 (1.21, 10.02)). CONCLUSIONS Higher adiposity and first trimester excessive gestational weight gain were associated with restrictive changes in lung function and symptomology during pregnancy.
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Affiliation(s)
- Danielle R. Stevens
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - Matthew C. H. Rohn
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - Stefanie N. Hinkle
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - Andrew D. Williams
- UND School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Rajesh Kumar
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Leah M. Lipsky
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - William Grobman
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Seth Sherman
- The Emmes Company, Rockville, MD, United States of America
| | - Jenna Kanner
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - Zhen Chen
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - Pauline Mendola
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
- School of Public Health and Health Professions, University at Buffalo, Buffalo NY, United States of America
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14
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Abstract
Obesity is a major risk factor for the development of asthma, and the prevalence of obesity is higher in people with asthma than in the general population. Obese people often have severe asthma-recent studies in the United States suggest that 60% of adults with severe asthma are obese. Multiple mechanisms link obesity and asthma, which are discussed in this article, and these pathways contribute to different phenotypes of asthma among people with obesity. From a practical aspect, changes in physiology and immune markers affect diagnosis and monitoring of disease activity in people with asthma and obesity. Obesity also affects response to asthma medications and is associated with an increased risk of co-morbidities such as gastroesophageal reflux disease, depression, and obstructive sleep apnea, all of which may affect asthma control. Obese people may be at elevated risk of exacerbations related to increased risk of severe disease in response to viral infections. Interventions that target improved dietary quality, exercise, and weight loss are likely to be particularly helpful for this patient population.
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Affiliation(s)
- Anne E Dixon
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Loretta G Que
- Department of Medicine, Duke Health, Rm 279 MSRB1, Durham, North Carolina
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15
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Fainardi V, Passadore L, Labate M, Pisi G, Esposito S. An Overview of the Obese-Asthma Phenotype in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020636. [PMID: 35055456 PMCID: PMC8775557 DOI: 10.3390/ijerph19020636] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 12/14/2022]
Abstract
Asthma is the most common chronic disease in childhood. Overweight and obesity are included among the comorbidities considered in patients with difficult-to-treat asthma, suggesting a specific phenotype of the disease. Therefore, the constant increase in obesity prevalence in children and adolescents raises concerns about the parallel increase of obesity-associated asthma. The possible correlation between obesity and asthma has been investigated over the last decade by different authors, who suggest a complex multifactorial relationship. Although the particular non-eosinophilic endotype of obesity-related asthma supports the concept that high body weight precedes asthma development, there is ongoing debate about the direct causality of these two entities. A number of mechanisms may be involved in asthma in combination with obesity disease in children, including reduced physical activity, abnormal ventilation, chronic systemic inflammation, hormonal influences, genetics and additional comorbidities, such as gastroesophageal reflux and dysfunctional breathing. The identification of the obesity-related asthma phenotype is crucial to initiate specific therapeutic management. Besides the cornerstones of asthma treatment, lifestyle should be optimized, with interventions aiming to promote physical exercise, healthy diet, and comorbidities. Future studies should clarify the exact association between asthma and obesity and the mechanisms underlying the pathogenesis of these two related conditions with the aim to define personalized therapeutic strategies for asthma management in this population.
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16
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Ronco L, Folino A, Goia M, Crida B, Esposito I, Bignamini E. Do not forget asthma comorbidities in pediatric severe asthma! Front Pediatr 2022; 10:932366. [PMID: 35967579 PMCID: PMC9372496 DOI: 10.3389/fped.2022.932366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Asthma is the most common chronic respiratory disease in childhood. The long-term goals in managing asthma aim to control symptoms and prevent exacerbations, as well as to reduce side effects of therapy and mortality disease-related. Most of patients have mild to moderate asthma and respond well to standard therapies. However, a minor proportion of children with asthma has severe disease that remains uncontrolled despite optimal adherence to prescribed therapy and treatment of contributory factors, including trigger exposures and comorbidities, which can mimic or worsen asthma and contribute to exacerbations and poor quality of life. Evaluation of comorbidities is fundamental to optimize the management of the disease in a subgroup of patients with poor responder asthma. The overall aim of this article is to describe characteristics of main pediatric severe asthma comorbidities reported in literature, giving clinicians tools to recognize and manage properly these conditions.
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Affiliation(s)
- Lucia Ronco
- Department of Pediatric Science, School of Medicine, University of Turin, Turin, Italy
| | - Anna Folino
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Manuela Goia
- Pediatric Pulmonology Unit, Regina Margherita Children Hospital, AOU Cittá Della Salute e Della Scienza, Turin, Italy
| | - Benedetta Crida
- Pediatric Pulmonology Unit, Regina Margherita Children Hospital, AOU Cittá Della Salute e Della Scienza, Turin, Italy
| | - Irene Esposito
- Pediatric Pulmonology Unit, Regina Margherita Children Hospital, AOU Cittá Della Salute e Della Scienza, Turin, Italy
| | - Elisabetta Bignamini
- Pediatric Pulmonology Unit, Regina Margherita Children Hospital, AOU Cittá Della Salute e Della Scienza, Turin, Italy
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17
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Aris IM, Sordillo JE, Rifas-Shiman SL, Young JG, Gold DR, Camargo CA, Hivert MF, Oken E. Childhood patterns of overweight and wheeze and subsequent risk of current asthma and obesity in adolescence. Paediatr Perinat Epidemiol 2021; 35:569-577. [PMID: 33749887 PMCID: PMC8380670 DOI: 10.1111/ppe.12760] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/25/2021] [Accepted: 02/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Obesity and asthma in childhood often co-occur. Few studies have examined this relationship using repeated measures of body mass index (BMI) or asthma symptoms (such as wheeze). OBJECTIVE We compared two analytic approaches for repeated measures data to investigate this relationship. METHODS Our baseline sample consisted of 1277 children enrolled in a Boston-area cohort with BMI or wheeze at age 1 year and no missing covariates. We used latent class growth models (LCGM) and inverse probability weighting (IPW) of marginal structural models to examine the extent to which presence of overweight across childhood was associated with early adolescent current asthma, and conversely of repeated measures of wheeze across childhood with early adolescent obesity. RESULTS Using LCGM, a "persistent" childhood overweight class (vs "never") was associated with higher risk of asthma in early adolescence (RR 1.9; 95% CI 1.1, 3.0), while "persistent" childhood wheeze (vs "never") was associated with higher risk of obesity in early adolescence (RR 2.7; 95% CI 1.0, 6.4) after adjusting for baseline covariates. An IPW analysis treating childhood overweight and wheeze as time-varying exposures and adjusting for baseline and time-varying covariates resulted in weaker and less precise associations of "persistent" (vs "never") overweight with adolescent asthma (RR 1.3; 95% CI 0.3, 3.0), and of "persistent" (vs "never") wheeze with adolescent obesity (RR 2.3; 95% CI 0.4, 5.3). CONCLUSION Our point estimates from both approaches suggest an association between "persistent" childhood overweight and adolescent asthma, and between "persistent" childhood wheeze and adolescent obesity. LCGM results were stronger and more precise, whereas IPW results were less conclusive with wider 95% confidence intervals containing the null. The precision gained from LCGM may be at the expense of bias, and the use of both approaches helps to shed some light on this tradeoff.
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Affiliation(s)
- Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Joanne E Sordillo
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jessica G Young
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Diane R Gold
- Department of Environmental Health, Harvard T.H Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos A Camargo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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18
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Krawiec C, Fang X, Zhou S, Williams D, Thomas NJ. Frequency of persistent obesity 5 years after first time diagnosis of status asthmaticus. CLINICAL RESPIRATORY JOURNAL 2021; 15:1368-1374. [PMID: 34453494 DOI: 10.1111/crj.13444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES When a severe asthma exacerbation occurs in an obese pediatric patient, it is unknown if this body type persists in future encounters. Persistent obesity can lead to future asthma exacerbations. The main study objective is to evaluate the persistence of a BMI percentile ≥85th in children 5 years after the first reported diagnosis of status asthmaticus. We hypothesized that a hospital admission for status asthmaticus was associated with persistence of a BMI percentile ≥85th. METHODS This was a long-term retrospective observational cohort study utilizing TriNetX ® electronic health record (EHR) data. We included subjects aged 2 to 18 years of age with a diagnosis of status asthmaticus. Study population was divided into two groups based on their admission body mass index percentile: (underweight/healthy weight [<85th percentile] and overweight/obese [≥85th percentile]) and evaluated for the following outcomes: age, race, ethnicity, diagnostic codes, and BMI percentiles (initially and 5 years after diagnosis of status asthmaticus). RESULTS A total of 129 subjects (n%) (76 [58.9%] underweight/healthy weight and 53 [41.1%] overweight/obese) were included. Children that were initially overweight/obese with status asthmaticus had significantly increased odds of continuing to be overweight/obese 5 years after diagnosis compared to children who were underweight/healthy weight at baseline (OR = 7.50 [95% confidence interval, 3.20-17.60; p < 0.001]). CONCLUSIONS Overweight/obese asthmatic children are at risk of continuing to be obese several years after being diagnosed with status asthmaticus. This study reinforces the notion that when an asthmatic obese child presents with status asthmaticus, a thorough evaluation of nutrition, physical activity, and asthma control should be considered to reduce the risk of persistent obesity and possibly future asthma exacerbations.
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Affiliation(s)
- Conrad Krawiec
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Xinying Fang
- Division of Biostatistics and Bioinformatics, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.,Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Shouhao Zhou
- Division of Biostatistics and Bioinformatics, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.,Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Duane Williams
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Neal J Thomas
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA.,Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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19
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Dietert RR. Microbiome First Medicine in Health and Safety. Biomedicines 2021; 9:biomedicines9091099. [PMID: 34572284 PMCID: PMC8468398 DOI: 10.3390/biomedicines9091099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
Microbiome First Medicine is a suggested 21st century healthcare paradigm that prioritizes the entire human, the human superorganism, beginning with the microbiome. To date, much of medicine has protected and treated patients as if they were a single species. This has resulted in unintended damage to the microbiome and an epidemic of chronic disorders [e.g., noncommunicable diseases and conditions (NCDs)]. Along with NCDs came loss of colonization resistance, increased susceptibility to infectious diseases, and increasing multimorbidity and polypharmacy over the life course. To move toward sustainable healthcare, the human microbiome needs to be front and center. This paper presents microbiome-human physiology from the view of systems biology regulation. It also details the ongoing NCD epidemic including the role of existing drugs and other factors that damage the human microbiome. Examples are provided for two entryway NCDs, asthma and obesity, regarding their extensive network of comorbid NCDs. Finally, the challenges of ensuring safety for the microbiome are detailed. Under Microbiome-First Medicine and considering the importance of keystone bacteria and critical windows of development, changes in even a few microbiota-prioritized medical decisions could make a significant difference in health across the life course.
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Affiliation(s)
- Rodney R Dietert
- Department of Microbiology and Immunology, Cornell University, Ithaca, NY 14853, USA
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20
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Stevens DR, Grobman W, Kumar R, Lipsky LM, Hinkle SN, Chen Z, Williams A, Rohn MCH, Kanner J, Sherman S, Mendola P. Gestational and Postpartum Weight Trajectories Among Women With and Without Asthma. Am J Epidemiol 2021; 190:744-754. [PMID: 33169142 DOI: 10.1093/aje/kwaa248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/06/2020] [Accepted: 11/04/2020] [Indexed: 11/14/2022] Open
Abstract
Asthma leads to increased weight gain in nonpregnant populations, but studies have not examined this association within the context of pregnancy. The association between asthma and perinatal weight trajectories was examined in the Breathe-Wellbeing, Environment, Lifestyle, and Lung Function Study (2015-2019). Multilevel linear spline models were adjusted for age, race/ethnicity, income, marital status, education, cigarette smoking, parity, study site, and prepregnancy body mass index were used to examine differences in perinatal weight trajectories between women with (n = 299) and without (n = 101) asthma. Secondary analyses were conducted to assess whether associations differed by asthma phenotypes. At 40 weeks' gestation, women with asthma gained 16.2 kg (95% confidence interval (CI): 14.6, 17.7) and women without asthma gained 13.1 kg (95% CI: 10.9, 15.4). At 3 months postpartum, women with asthma retained 10.4 kg (95% CI: 8.9, 11.9) and women without asthma retained 8.0 kg (95% CI: 5.9, 10.2). Among women with asthma, exercise-induced asthma and step 3 asthma medications were associated with excess gestational weight gain. These study findings suggest women with asthma gain and retain more weight during pregnancy and postpartum than do women without asthma.
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21
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Childhood Obesity and Respiratory Diseases: Which Link? CHILDREN-BASEL 2021; 8:children8030177. [PMID: 33669035 PMCID: PMC7996509 DOI: 10.3390/children8030177] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 12/14/2022]
Abstract
Prevalence of childhood obesity is progressively increasing, reaching worldwide levels of 5.6% in girls and of 7.8% in boys. Several evidences showed that obesity is a major preventable risk factor and disease modifier of some respiratory conditions such as asthma and Obstructive Sleep Apnea Syndrome (OSAS). Co-occurrence of asthma and obesity may be due to common pathogenetic factors including exposure to air pollutants and tobacco smoking, Western diet, and low Vitamin D levels. Lung growth and dysanapsis phenomenon in asthmatic obese children play a role in impaired respiratory function which appears to be different than in adults. Genes involved in both asthma and obesity have been identified, though a gene-by-environment interaction has not been properly investigated yet. The identification of modifiable environmental factors influencing gene expression through epigenetic mechanisms may change the natural history of both diseases. Another important pediatric respiratory condition associated with obesity is Sleep-Disordered Breathing (SDB), especially Obstructive Sleep Apnea Syndrome (OSAS). OSAS and obesity are linked by a bidirectional causality, where the effects of one affect the other. The factors most involved in the association between OSAS and obesity are oxidative stress, systemic inflammation, and gut microbiota. In OSAS pathogenesis, obesity's role appears to be mainly due to mechanical factors leading to an increase of respiratory work at night-time. However, a causal link between obesity-related inflammatory state and OSAS pathogenesis still needs to be properly confirmed. To prevent obesity and its complications, family education and precocious lifestyle changes are critical. A healthy diet may lead to an improved quality of life in obese children suffering from respiratory diseases. The present review aimed to investigate the links between obesity, asthma and OSAS, focusing on the available evidence and looking for future research fields.
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22
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Shan LS, Zhou QL, Shang YX. Bidirectional Association Between Asthma and Obesity During Childhood and Adolescence: A Systematic Review and Meta-Analysis. Front Pediatr 2020; 8:576858. [PMID: 33194908 PMCID: PMC7658650 DOI: 10.3389/fped.2020.576858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022] Open
Abstract
Objective: Co-occurrence of pediatric asthma and obesity has been widely reported, yet the causal directions between these two disorders are still not well-understood. The objective of this meta-analysis is to explore whether there is a possibility of a bidirectional association for these two disorders in children and adolescents. Methods: PubMed, Embase, Web of Science, and CENTRAL databases were searched up to August 2020. Cohort studies reporting the associations of obesity with risk of physician-diagnosed asthma or physician-diagnosed asthma with risk of obesity in children and adolescents were eligible for the review. Results: A total of 3,091 records were identified from the four databases, with final inclusion of nine. Six studies reported the association between obesity and risk of asthma; three studies reported the association between asthma and risk of childhood obesity. As evaluated by the Newcastle-Ottawa quality assessment scale, all studies were assessed as high-quality studies. There was a statistically significant association between obesity and increased risk of physician-diagnosed asthma in children and adolescents. The pooled RR was 1.39 (95% CI: 1.28, 1.50; p < 0.001), with significant heterogeneity across studies (I 2 = 81.7%; p heterogeneity < 0.001). The pooled RR in boys was 1.53 (95% CI: 1.17, 1.99; p = 0.002), but such a significant association was not observed in girls (RR = 1.17, 95% CI: 0.79, 1.72; p = 0.434). For the association of asthma with risk of childhood obesity, the pooled RR was 1.47 (95%CI: 1.25, 1.72; p < 0.001) without statistical heterogeneity (I 2 = 0%, p heterogeneity = 0.652). Conclusion: There is a bidirectional association between obesity and asthma during childhood and adolescence, suggesting that childhood obesity drives an increase in the onset of asthma; meanwhile, childhood asthma may also increase risk of obesity for children and adolescents.
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Affiliation(s)
- Li-Shen Shan
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qian-Lan Zhou
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yun-Xiao Shang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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