From the Department of Preventive Medicine, University of Southern California, Los Angeles, CA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Epidemiology. 2022 Jan 1;33(1):131-140. doi: 10.1097/EDE.0000000000001421.
Asthma and obesity often co-occur. It has been hypothesized that asthma may contribute to childhood obesity onset.
To determine if childhood asthma is associated with incident obesity and examine the role of asthma medication in this association.
We studied 8,716 children between ages 6 and 18.5 years who were nonobese at study entry participating in 18 US cohorts of the Environmental influences on Child Health Outcomes program (among 7,299 children with complete covariate data mean [SD] study entry age = 7.2 [1.6] years and follow up = 5.3 [3.1] years).
We defined asthma based on caregiver report of provider diagnosis. Incident obesity was defined as the first documented body mass index ≥95th percentile for age and sex following asthma status ascertainment. Over the study period, 26% of children had an asthma diagnosis and 11% developed obesity. Cox proportional hazards models with sex-specific baseline hazards were fitted to assess the association of asthma diagnosis with obesity incidence. Children with asthma had a 23% (95% confidence intervals [CI] = 4, 44) higher risk for subsequently developing obesity compared with those without asthma. A novel mediation analysis was also conducted to decompose the total asthma effect on obesity into pathways mediated and not mediated by asthma medication use. Use of asthma medication attenuated the total estimated effect of asthma on obesity by 64% (excess hazard ratios = 0.64; 95% CI = -1.05, -0.23).
This nationwide study supports the hypothesis that childhood asthma is associated with later risk of obesity. Asthma medication may reduce this association and merits further investigation as a potential strategy for obesity prevention among children with asthma.
哮喘和肥胖症经常同时发生。有人假设哮喘可能导致儿童肥胖的发生。
确定儿童哮喘是否与肥胖的发生有关，并探讨哮喘药物在这种关联中的作用。
我们研究了 8716 名年龄在 6 至 18.5 岁之间的儿童，他们在研究开始时不肥胖，参加了美国环境影响儿童健康结果项目的 18 个队列研究（在 7299 名具有完整协变量数据的儿童中，平均[SD]研究开始年龄为 7.2[1.6]岁，随访时间为 5.3[3.1]岁）。
我们根据照顾者报告的提供者诊断来定义哮喘。肥胖的定义是在确定哮喘状况后，首次记录的体重指数（BMI）≥年龄和性别第 95 百分位。在研究期间，26%的儿童被诊断患有哮喘，11%的儿童肥胖。使用性别特异性基线风险的 Cox 比例风险模型来评估哮喘诊断与肥胖发生率的关联。与没有哮喘的儿童相比，患有哮喘的儿童随后发生肥胖的风险高 23%（95%置信区间[CI] = 4，44）。还进行了一项新的中介分析，以将哮喘对肥胖的总影响分解为通过和不通过哮喘药物使用介导的途径。哮喘药物的使用使哮喘对肥胖的总估计效应减弱了 64%（超额危险比= 0.64；95%CI = -1.05，-0.23）。
这项全国性研究支持了儿童哮喘与随后肥胖风险增加相关的假设。哮喘药物可能会降低这种关联，值得进一步研究，作为预防哮喘儿童肥胖的潜在策略。
