Faculty of Medicine, University of Porto and Hospital São João, Porto, Portugal.
Allergy. 2013 Apr;68(4):425-39. doi: 10.1111/all.12106. Epub 2013 Mar 1.
Asthma and obesity are chronic multifactorial conditions that are associated with gene-environment interaction and immune function. Although the data are not fully consistent, it seems that obesity increases the risk of asthma and compromises asthma control.
To investigate the impact that weight changes have on asthma.
We carried out a systematic review of three large biomedical databases. Studies were scrutinized and critically appraised according to agreed exclusion and inclusion criteria. Quality assessment of eligible papers was conducted using the GRADE method. Meta-analyses of comparable studies were carried out.
Thirty studies met the eligibility criteria of the review. Interventions were limited to dietary manipulation in three studies, one of which also used anti-obesity drugs, and bariatric surgery in four. All the other studies reported observational data. Becoming obese increased the odds for incident asthma by 1.82 (95% CI 1.47, 2.25) in adults and 1.98 (95% CI 0.71, 5.52) in children. Weight loss was associated with significant improvement in mean scores for symptoms, rescue medication score, and asthma exacerbations in the only randomized controlled trial. Similarly, evidence gathered from observational studies, with follow-up ranging between 8 weeks to 1 year, and from changes 1 year after bariatric surgery showed improvements in all asthma control-related outcomes. Changes in lung function were reported in one randomized controlled and eight observational studies of asthmatic subjects, with conflicting results. Either improvement after weight loss, decline with weight gain, or no effects at all were reported. Changes in airway inflammation and responsiveness were reported only by observational studies.
Weight increases above the obesity threshold significantly increase the risk of asthma. The available studies show weak evidence of benefits from weight reduction on asthma outcomes.
哮喘和肥胖都是慢性多因素疾病，与基因-环境相互作用和免疫功能有关。尽管数据不完全一致，但肥胖似乎会增加哮喘的风险并影响哮喘的控制。
研究体重变化对哮喘的影响。
我们对三个大型生物医学数据库进行了系统综述。根据商定的排除和纳入标准，对研究进行了仔细审查和批判性评估。使用 GRADE 方法对合格论文进行质量评估。对具有可比性的研究进行了荟萃分析。
有 30 项研究符合综述的入选标准。干预措施仅限于三项研究中的饮食干预，其中一项还使用了抗肥胖药物，四项研究中采用了减肥手术。所有其他研究均报告了观察性数据。在成年人中，肥胖使哮喘发病的几率增加 1.82 倍（95%CI 1.47，2.25），在儿童中增加 1.98 倍（95%CI 0.71，5.52）。唯一的随机对照试验显示，体重减轻与症状平均评分、急救药物评分和哮喘加重的显著改善相关。同样，从观察性研究中收集的证据，随访时间从 8 周到 1 年不等，以及减肥手术后 1 年的变化，表明所有与哮喘控制相关的结果都得到了改善。一项随机对照试验和八项观察性研究报告了哮喘患者的肺功能变化，结果存在冲突。报告显示，减肥后肺功能改善，体重增加后肺功能下降，或者根本没有影响。只有观察性研究报告了气道炎症和反应性的变化。
体重超过肥胖阈值的增加显著增加了哮喘的风险。现有研究仅提供了体重减轻对哮喘结果有益的微弱证据。
