di Palmo Emanuela, Filice Emanuele, Cavallo Alessandra, Caffarelli Carlo, Maltoni Giulio, Miniaci Angela, Ricci Giampaolo, Pession Andrea
Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
Department of Medicine and Surgery, Pediatric Clinic, University of Parma, 43126 Parma, Italy.
Children (Basel). 2021 Feb 25;8(3):177. doi: 10.3390/children8030177.
Prevalence of childhood obesity is progressively increasing, reaching worldwide levels of 5.6% in girls and of 7.8% in boys. Several evidences showed that obesity is a major preventable risk factor and disease modifier of some respiratory conditions such as asthma and Obstructive Sleep Apnea Syndrome (OSAS). Co-occurrence of asthma and obesity may be due to common pathogenetic factors including exposure to air pollutants and tobacco smoking, Western diet, and low Vitamin D levels. Lung growth and dysanapsis phenomenon in asthmatic obese children play a role in impaired respiratory function which appears to be different than in adults. Genes involved in both asthma and obesity have been identified, though a gene-by-environment interaction has not been properly investigated yet. The identification of modifiable environmental factors influencing gene expression through epigenetic mechanisms may change the natural history of both diseases. Another important pediatric respiratory condition associated with obesity is Sleep-Disordered Breathing (SDB), especially Obstructive Sleep Apnea Syndrome (OSAS). OSAS and obesity are linked by a bidirectional causality, where the effects of one affect the other. The factors most involved in the association between OSAS and obesity are oxidative stress, systemic inflammation, and gut microbiota. In OSAS pathogenesis, obesity's role appears to be mainly due to mechanical factors leading to an increase of respiratory work at night-time. However, a causal link between obesity-related inflammatory state and OSAS pathogenesis still needs to be properly confirmed. To prevent obesity and its complications, family education and precocious lifestyle changes are critical. A healthy diet may lead to an improved quality of life in obese children suffering from respiratory diseases. The present review aimed to investigate the links between obesity, asthma and OSAS, focusing on the available evidence and looking for future research fields.
儿童肥胖症的患病率正在逐步上升，在全球范围内，女孩的患病率达到5.6%，男孩为7.8%。多项证据表明，肥胖是一些呼吸系统疾病（如哮喘和阻塞性睡眠呼吸暂停综合征（OSAS））的主要可预防风险因素和疾病调节因素。哮喘和肥胖并存可能归因于共同的致病因素，包括接触空气污染物和吸烟、西式饮食以及低维生素D水平。肥胖哮喘儿童的肺部生长和发育异常现象在呼吸功能受损中起作用，这似乎与成人不同。虽然已经确定了与哮喘和肥胖相关的基因，但基因与环境的相互作用尚未得到充分研究。通过表观遗传机制确定影响基因表达的可改变环境因素可能会改变这两种疾病的自然病程。另一种与肥胖相关的重要儿科呼吸系统疾病是睡眠呼吸障碍（SDB），尤其是阻塞性睡眠呼吸暂停综合征（OSAS）。OSAS和肥胖通过双向因果关系相互关联，其中一方的影响会作用于另一方。OSAS与肥胖之间关联最密切的因素是氧化应激、全身炎症和肠道微生物群。在OSAS的发病机制中，肥胖的作用似乎主要是由于机械因素导致夜间呼吸功增加。然而，肥胖相关炎症状态与OSAS发病机制之间的因果关系仍需得到充分证实。为了预防肥胖及其并发症，家庭教育和早期生活方式改变至关重要。健康饮食可能会改善患有呼吸系统疾病的肥胖儿童的生活质量。本综述旨在研究肥胖、哮喘和OSAS之间的联系，重点关注现有证据并寻找未来的研究领域。
