Guerra Stefano, Sherrill Duane L, Bobadilla Arnel, Martinez Fernando D, Barbee Robert A
Arizona Respiratory Center, College of Medicine, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724-5030, USA.
Chest. 2002 Oct;122(4):1256-63. doi: 10.1378/chest.122.4.1256.
Recent studies have suggested a relationship between asthma and obesity. Despite these reports, the effect of being underweight or overweight as a risk factor for airway obstructive diseases (AODs) is not clear.
To determine whether a relation of body mass index (BMI) to asthma, chronic bronchitis (CB), or emphysema exists (analysis 1), and, if so, whether the association between obesity and asthma is modified by gender (analysis 2).
Nested case-control study from the longitudinal cohort of the Tucson Epidemiologic Study of Airways Obstructive Diseases.
Analysis 1: physician-confirmed incident cases of asthma (n = 102), CB (n = 299), or emphysema (n = 72) who denied any prior AODs. Analysis 2: all 169 incident cases of asthma, regardless of any previous AODs, stratified by gender and by other potential effect modifiers. In both analyses, we selected only subjects at least 20 years old who had weight and height measured during the study.
BMI and other risk factors were assessed prior to the onset of the AOD (cases) or prior to the last completed survey (control subjects).
A diagnosis of emphysema was significantly associated with a BMI < 18.5 (odds ratio [OR], 2.97; 95% confidence interval [CI], 1.33 to 6.68, when compared to healthy control subjects). A BMI >/= 28 increased the risk of receiving a diagnosis of asthma (OR, 2.10; 95% CI, 1.31 to 3.36) and CB (OR, 1.80; 95% CI, 1.32 to 2.46). About 30% of the patients with asthma and 25% of the patients with CB (vs 16% of the control subjects, p < 0.001) were preobese or obese, regardless whether BMI was assessed before the diagnosis or before the onset of respiratory symptoms. The relation of elevated BMI to asthma was significant only among women.
Patients with emphysema are more likely to be underweight, and patients with CB are more likely to be obese. However, the temporal relationship between abnormal BMI and the onset of COPD is uncertain. Preobese and obese women are at increased risk of acquiring asthma. This relation, particularly if it is causal, has potentially relevant public health implications.
近期研究表明哮喘与肥胖之间存在关联。尽管有这些报道，但体重过轻或超重作为气道阻塞性疾病（AODs）风险因素的影响尚不清楚。
确定体重指数（BMI）与哮喘、慢性支气管炎（CB）或肺气肿之间是否存在关联（分析1），如果存在关联，肥胖与哮喘之间的关联是否因性别而异（分析2）。
来自图森气道阻塞性疾病流行病学纵向队列研究的巢式病例对照研究。
分析1：经医生确诊的哮喘（n = 102）、CB（n = 299）或肺气肿（n = 72）新发病例，这些患者否认既往有任何AODs。分析2：所有169例哮喘新发病例，无论既往是否有AODs，按性别和其他潜在效应修饰因素分层。在两项分析中，我们仅选择年龄至少20岁且在研究期间测量过体重和身高的受试者。
在AOD发病前（病例组）或最后一次完成调查前（对照组）评估BMI和其他风险因素。
肺气肿诊断与BMI < 18.5显著相关（比值比[OR]，2.97；95%置信区间[CI]，1.33至6.68，与健康对照受试者相比）。BMI≥28增加了哮喘诊断风险（OR，2.10；95%CI，1.31至3.36）和CB诊断风险（OR，1.80；95%CI，1.32至2.46）。约30%的哮喘患者和25%的CB患者（与16%的对照受试者相比，p < 0.０01）为肥胖前期或肥胖，无论BMI是在诊断前还是呼吸道症状发作前评估的。BMI升高与哮喘的关联仅在女性中显著。
肺气肿患者更可能体重过轻，CB患者更可能肥胖。然而，BMI异常与慢性阻塞性肺疾病（COPD）发病之间的时间关系尚不确定。肥胖前期和肥胖女性患哮喘的风险增加。这种关联，特别是如果它是因果关系，可能具有潜在的公共卫生意义。
