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Obesity linked to 10% of childhood asthma

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Obesity a modifiable risk factor for childhood asthma

While there has long been recognition of an association between childhood obesity and childhood asthma, the incidence of pediatric obesity–related asthma has not been well known. This study therefore addresses that gap in knowledge, and does so among children with a range of racial and ethnic backgrounds and while addressing potential confounders such as comorbidities and sociodemographic variables.

The findings show how significant a contribution obesity makes to the burden of childhood asthma, and also points to the potential increase in childhood asthma incidence that may arise with the increase in childhood obesity.

However, the good news is that this offers what may be the first modifiable risk factor for childhood asthma, which presents an opportunity for primary prevention of this common childhood condition.

Deepa Rastogi, MBBS, MS, is from the department of pediatrics at the Albert Einstein College of Medicine, New York. These comments are taken from an editorial (Pediatrics. 2018 Dec;142(6):e20182979.). No conflicts of interest were declared.



Around one-quarter of new asthma cases in children with obesity may be attributable to their obesity, according to research published in Pediatrics.

Obese child on a scale moodboard/thinkstockphotos

Jason E. Lang, MD, MPH, of Duke University, Durham, N.C., and his coauthors used the PEDSnet clinical data research network to conduct a retrospective cohort study of 507,496 children aged 2-17 years from 2009-2015, comparing the incidence of asthma in overweight and obese children to the incidence in healthy weight children.

The overall rate of new diagnoses of asthma was 2.4 per 1,000 patient years among normal-weight children and 3.2 per 1,000 patient years among obese children.

After adjustment for factors such as age, ethnicity, insurance status, sex, allergic rhinitis, food allergy, and proton pump inhibitor use, overweight children had a 17% higher risk of incident asthma, and obese children had a 26% higher risk of asthma, compared with children of normal weight. The relative risk of spirometry-confirmed asthma was 29% higher in obese children compared with normal-weight children, and the association between obesity and asthma persisted even when a second asthma encounter was required for the diagnosis.

Overall, the authors estimated that 23%-25% of clinically diagnosed asthma in children with obesity could be specifically attributed to obesity, and that in the overall population of children 10% of asthma was attributable to obesity.

“Currently, there are few known preventable risk factors that can be used to reduce childhood asthma,” wrote Dr. Lang and his coauthors. “With these data, it is suggested that reducing the onset of obesity in childhood would significantly reduce the public health burden of asthma in children.”

They noted that with current estimates of U.S. pediatric asthma prevalence being around 6-8 million cases, obesity could therefore account for up to 1 million of these cases.

The study was funded by the Patient-Centered Outcomes Research Institute, the Nemours Children’s Hospital and Nemours Children’s Health System. One author declared advisory board positions and consultancies with the pharmaceutical industry. The remaining researchers said they had no conflicts of interest.

SOURCE: Lang J et al. Pediatrics. 2018 Dec;142(6):e20182119.

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