The Generation R Study Group.
Division of Respiratory Medicine and Allergology and.
Am J Respir Crit Care Med. 2020 Feb 1;201(3):348-355. doi: 10.1164/rccm.201905-0942OC.
Obesity has been implicated as a pathogenic factor in asthma, but the underlying role of general and organ fat is unclear. We hypothesized that organ fat, rather than the total fat mass, increases the risk of asthma. In a population-based prospective cohort study among 5,421 children aged 10 years, we measured general fat including body mass index and fat mass index by dual-energy X-ray absorptiometry, and organ fat including subcutaneous fat index, visceral fat index, pericardial fat index, and liver fat fraction by magnetic resonance imaging. Lung function was measured by spirometry. Current asthma was assessed by questionnaire. Higher body mass index and fat mass index were associated with higher FEV (-score difference [95% confidence interval (CI)], 0.16 [0.14 to 0.19] and -score difference [95% CI], 0.06 [0.03 to 0.09] per SD score increase, respectively), higher FVC (-score difference [95% CI], 0.19 [0.17 to 0.22] and -score difference [95% CI], 0.07 [0.04 to 0.10]), and lower FEV/FVC ratio (-score difference [95% CI], -0.07 [-0.10 to -0.05] and -score difference [95% CI], -0.03 [-0.06 to -0.00]) but not with forced expiratory flow after exhaling 75% of FVC or asthma. Higher visceral fat index, independent of fat mass index, was associated with higher FVC (-score difference [95% CI], 0.07 [0.03 to 0.10]), lower FEV/FVC (-score difference [95% CI], -0.05 [-0.09 to -0.01]), and higher risk of asthma (odds ratio, 1.20; 95% CI, 1.01 to 1.43 per SD score increase). No other organ fat measures were independently associated with lung function or asthma. The obesity-asthma link is driven mainly by visceral fat, independent of total fat mass; therefore, abdominal fat might contribute to asthma development.
肥胖已被认为是哮喘的致病因素，但总体脂肪和器官脂肪的潜在作用尚不清楚。我们假设器官脂肪而不是总脂肪量会增加哮喘的风险。在一项基于人群的前瞻性队列研究中，我们对 5421 名 10 岁儿童进行了研究，通过双能 X 射线吸收法测量了一般脂肪，包括体重指数和脂肪质量指数，通过磁共振成像测量了器官脂肪，包括皮下脂肪指数、内脏脂肪指数、心包脂肪指数和肝脂肪分数。通过肺活量计测量肺功能。通过问卷调查评估当前哮喘。较高的体重指数和脂肪质量指数与较高的 FEV（得分差异[95%置信区间（CI）]，0.16 [0.14 至 0.19]和得分差异[95%CI]，0.06 [0.03 至 0.09]，每增加 1 个 SD 评分）、较高的 FVC（得分差异[95%CI]，0.19 [0.17 至 0.22]和得分差异[95%CI]，0.07 [0.04 至 0.10]）和较低的 FEV/FVC 比值（得分差异[95%CI]，-0.07 [-0.10 至 -0.05]和得分差异[95%CI]，-0.03 [-0.06 至 -0.00]）相关，但与呼出 FVC 的 75%时的用力呼气流量或哮喘无关。独立于脂肪质量指数的较高内脏脂肪指数与较高的 FVC（得分差异[95%CI]，0.07 [0.03 至 0.10]）、较低的 FEV/FVC（得分差异[95%CI]，-0.05 [-0.09 至 -0.01]）和哮喘风险较高（比值比，1.20；95%CI，每增加 1 个 SD 评分增加 1.01 至 1.43）相关。其他器官脂肪测量值与肺功能或哮喘无关。肥胖与哮喘的联系主要是由内脏脂肪驱动的，与总脂肪量无关；因此，腹部脂肪可能有助于哮喘的发展。
