饮食诱导肥胖儿童哮喘患者体重减轻：一项随机对照试验。

Diet-induced weight loss in obese children with asthma: a randomized controlled trial.

机构信息

Centre for Asthma and Respiratory Diseases, University of Newcastle, Newcastle, NSW, Australia.

出版信息

Clin Exp Allergy. 2013 Jul;43(7):775-84. doi: 10.1111/cea.12115.

DOI:10.1111/cea.12115

PMID:23786284

Abstract

BACKGROUND

Obesity is highly prevalent in asthmatic children and associated with worse clinical outcomes. Energy restriction to induce weight loss in asthmatic children has not been investigated in a randomized controlled trial (RCT).

OBJECTIVE

To assess if (1) weight loss can be achieved in obese asthmatic children using a dietary intervention; and (2) changes in asthma outcomes occur following diet-induced weight loss.

METHODS

In a 10-week pilot RCT, obese asthmatic children, aged 8-17 years, were randomized to a wait-list control (WLC) (n = 15) or dietary-intervention group (DIG) (n = 13). Lung function, Asthma Control Questionnaire (ACQ) score, and sputum and systemic inflammation were assessed at baseline and post-intervention. (Australian New Zealand Clinical Trials Registry: ACTRN12610000955011).

RESULTS

Body mass index (BMI) z-score reduced significantly in the DIG vs. the WLC (-0.2 [-0.4, -0.1] vs. 0.0 [-0.1, 0.0], P = 0.014). Expiratory reserve volume (ERV) increased significantly within the DIG, but not compared to the WLC (0.7 [0.0, 1.0] L vs. 0.3 [0.0, 0.8] L, P = 0.355). ACQ improved significantly in the DIG, compared to the WLC (-0.4 [-0.7, 0.0] vs. 0.1 [0.0, 0.6], P = 0.004). Airway and systemic inflammation did not change within the DIG. In comparison, C-Reactive Protein (CRP) increased significantly in the WLC (-0.4 [-0.5, 0.4] vs. 0.7 [-0.1, 1.9], P = 0.037). Change (∆) in BMI z-score correlated with ∆CRP (r = 0.47, P = 0.012) and ∆exhaled nitric oxide (eNO) (r = 0.46, P = 0.034), and ∆ACQ was associated with ∆CRP (r = 0.43, P = 0.029).

CONCLUSION AND CLINICAL RELEVANCE

Dietary intervention can induce acute weight loss in obese asthmatic children with subsequent improvements in static lung function and asthma control. Systemic and airway inflammation did not change following weight loss. However, changes in BMI z-score were associated with changes in airway and systemic inflammation and this requires further investigation in a larger RCT. This is the first weight loss RCT conducted in obese asthmatic children. Diet-induced weight loss can achieve significant improvements in clinical outcomes for obese children with asthma.

摘要

背景

肥胖在哮喘儿童中非常普遍，与更差的临床结果相关。在随机对照试验 (RCT) 中尚未研究过通过能量限制来诱导肥胖的哮喘儿童减肥。

目的

评估（1）是否可以通过饮食干预使肥胖的哮喘儿童减轻体重；以及（2）饮食诱导的体重减轻后哮喘结果是否发生变化。

方法

在一项为期 10 周的先导性 RCT 中，将年龄在 8-17 岁的肥胖哮喘儿童随机分为等待名单对照组 (WLC) (n = 15) 或饮食干预组 (DIG) (n = 13)。在基线和干预后评估肺功能、哮喘控制问卷 (ACQ) 评分以及痰液和全身炎症。(澳大利亚新西兰临床试验注册中心：ACTRN12610000955011)。

结果

与 WLC 相比，DIG 中的 BMI z 评分显著降低 (-0.2 [-0.4, -0.1] 与 0.0 [-0.1, 0.0]，P = 0.014)。DIG 中呼气储备量 (ERV) 显著增加，但与 WLC 相比没有增加 (0.7 [0.0, 1.0] L 与 0.3 [0.0, 0.8] L，P = 0.355)。与 WLC 相比，DIG 中的 ACQ 显著改善 (-0.4 [-0.7, 0.0] 与 0.1 [0.0, 0.6]，P = 0.004)。DIG 中的气道和全身炎症没有变化。相比之下，CRP 在 WLC 中显著增加 (-0.4 [-0.5, 0.4] 与 0.7 [-0.1, 1.9]，P = 0.037)。BMI z 评分的变化 (∆) 与 ∆CRP (r = 0.47, P = 0.012) 和 ∆呼出气一氧化氮 (eNO) (r = 0.46, P = 0.034) 相关，而 ∆ACQ 与 ∆CRP (r = 0.43, P = 0.029) 相关。

结论和临床相关性

饮食干预可以使肥胖的哮喘儿童急性减重，随后静息肺功能和哮喘控制得到改善。体重减轻后，全身和气道炎症没有变化。然而，BMI z 评分的变化与气道和全身炎症的变化相关，这需要在更大的 RCT 中进一步研究。这是在肥胖的哮喘儿童中进行的首次减肥 RCT。饮食诱导的体重减轻可以使肥胖的哮喘儿童显著改善临床结局。