Eneli I U, Karmaus W K, Davis S, Kuehr J
Department of Pediatrics and Human Development, Michigan State University, East Lansing, Michigan 48824, USA.
Pediatr Pulmonol. 2006 Jun;41(6):530-7. doi: 10.1002/ppul.20391.
Increased body mass index has been linked to wheezing, a diagnosis of asthma, and morbidity. We investigated the association between body mass index (BMI), breastfeeding, and airway hyperresponsiveness (AHR) in 536 German schoolchildren. We analyzed consecutive surveys in 1994-1995 and 1997, conducted as part of the Child Health and Environment Cohort Study in Hesse, Germany. The questionnaire included questions adapted from the German version of the International Study of Asthma and Allergy in Childhood (ISAAC). A bronchial challenge test using 4.5% hypertonic saline was conducted during the 1997 survey. AHR was defined as a fall in forced expiratory volume in 1 sec (FEV(1)) of > or = 15%. Of 536 children who participated in the 1997 survey (median age, 10.3 years), 82 (15%) tested positive for AHR. In a multivariate analysis, there was no association between AHR determined at age 10 years and the highest quintile of BMI compared to the lowest quintile at age 4 years (odds ratio (OR), 1.4; 95% confidence interval (CI), 0.5-3.6), 7-8 years (OR, 0.6; 95% CI, 0.1-2.5), or 10 years (OR, 1.1; 95% CI, 0.2-4.3). Breastfeeding for 12 weeks or longer protected against AHR (OR, 0.4; 95% CI, 0.2-0.9). However, when children in the highest quintile of BMI at age 4 years had been breastfed for 8 weeks or less, the prevalence of AHR at age 10 years was significantly increased (27.7%, P = 0.01). In conclusion, our results demonstrate a protective effect of breastfeeding against AHR, and reinforce the need to encourage breastfeeding. Although there was no association between BMI and AHR, our finding of an interactive effect of high BMI and short breastfeeding on AHR suggests a complex etiological pathway that needs to be further explored.
体重指数增加与喘息、哮喘诊断及发病率相关。我们在536名德国学童中调查了体重指数（BMI）、母乳喂养与气道高反应性（AHR）之间的关联。我们分析了1994 - 1995年和1997年连续进行的调查，这些调查是德国黑森州儿童健康与环境队列研究的一部分。问卷包含改编自德文版《儿童哮喘和过敏国际研究》（ISAAC）的问题。在1997年的调查中进行了使用4.5%高渗盐水的支气管激发试验。AHR定义为第1秒用力呼气量（FEV(1)）下降≥15%。在参与1997年调查的536名儿童（中位年龄10.3岁）中，82名（15%）AHR检测呈阳性。在多变量分析中，10岁时测定的AHR与4岁时BMI最高五分位数相比最低五分位数之间无关联（比值比（OR）为1.4；95%置信区间（CI）为0.5 - 3.6），7 - 8岁时（OR为0.6；95% CI为0.1 - 2.5）或10岁时（OR为1.1；95% CI为0.2 - 4.3）。母乳喂养12周或更长时间可预防AHR（OR为0.4；95% CI为0.2 - 0.9）。然而，4岁时BMI处于最高五分位数的儿童若母乳喂养8周或更短时间，10岁时AHR的患病率显著增加（27.7%，P = 0.01）。总之，我们的结果表明母乳喂养对AHR有保护作用，并强化了鼓励母乳喂养的必要性。虽然BMI与AHR之间无关联，但我们发现高BMI与短时间母乳喂养对AHR有交互作用，这提示了一条需要进一步探索的复杂病因途径。
