Chang Chia-Lun, Ali Gulshan Bano, Pham Jonathan, Dharmage Shyamali C, Lodge Caroline J, Tang Mimi L K, Lowe Adrian J
Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
Asthma, Allergy and Clinical Immunology Service, Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
Clin Exp Allergy. 2023 Sep;53(9):911-929. doi: 10.1111/cea.14366. Epub 2023 Jul 3.
Previous systematic reviews have focused on associations between single time point measures of Body Mass Index (BMI) and asthma and allergic diseases. As BMI changes dynamically during childhood, examination of associations between longitudinal trajectories in BMI and allergic diseases is needed to fully understand the nature of these relationships.
To systematically synthesise the association between BMI trajectories in childhood (0-18 years) and allergic diseases (asthma, eczema, allergic rhinitis, or food allergies outcomes).
We conducted a systematic review following the PRISMA guidelines, and two independent reviewers assessed the study quality using the ROBINS-E and GRADE tools. A narrative synthesis was performed as the statistical heterogeneity did not allow a meta-analysis.
A search was performed on PubMed and EMBASE databases on 4th January 2023.
Longitudinal cohort studies assessing the associations between childhood BMI trajectories and allergic diseases were included.
Eleven studies met the inclusion criteria with a total of 37,690 participants between 0 and 53 years of age. Ten studies examined asthma outcomes, three assessed association with allergic rhinitis, two assessed eczema, and one assessed food allergy. High heterogeneity and high risk of bias were observed. Overall, the quality of evidence was very low. Nevertheless, two consistent findings were identified: (1) a persistently high BMI between 6 and 10 years of age may be associated with an increased risk of asthma at 18 years and (2) a rapid increase in BMI in the first 2 years of life may be associated with subsequent asthma.
Maintaining a normal BMI trajectory during childhood may reduce the risk of asthma. Future research that adequately addresses confounding and includes longer-term follow-up is needed. Moreover, additional studies examining potential associations with eczema, food allergies, and allergic rhinitis outcomes are needed.
以往的系统评价主要关注体重指数（BMI）单一时点测量值与哮喘及过敏性疾病之间的关联。由于BMI在儿童期会动态变化，因此需要研究BMI纵向轨迹与过敏性疾病之间的关联，以全面了解这些关系的本质。
系统综合儿童期（0至18岁）BMI轨迹与过敏性疾病（哮喘、湿疹、过敏性鼻炎或食物过敏结局）之间的关联。
我们按照PRISMA指南进行了系统评价，两名独立评审员使用ROBINS-E和GRADE工具评估研究质量。由于统计异质性不允许进行荟萃分析，因此进行了叙述性综合分析。
于2023年1月4日在PubMed和EMBASE数据库进行了检索。
纳入评估儿童期BMI轨迹与过敏性疾病之间关联的纵向队列研究。
11项研究符合纳入标准，共有37690名年龄在0至53岁之间的参与者。10项研究考察了哮喘结局，3项评估了与过敏性鼻炎的关联，2项评估了湿疹，1项评估了食物过敏。观察到高度异质性和高偏倚风险。总体而言，证据质量非常低。然而，确定了两个一致的发现：（1）6至10岁期间持续高BMI可能与18岁时哮喘风险增加有关；（2）生命最初2年BMI快速增加可能与随后的哮喘有关。
儿童期维持正常的BMI轨迹可能会降低哮喘风险。需要未来的研究充分解决混杂因素并包括更长时间的随访。此外，还需要更多研究考察与湿疹、食物过敏和过敏性鼻炎结局的潜在关联。
