Relation of body mass index to asthma and atopy in children: the National Health and Nutrition Examination Study III
- aUniversity Children's Hospital, D-80337 Munich, Germany, bDepartment of Environmental Health, Harvard School of Public Health, Boston, USA, cChanning Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
- Dr E von Mutius
- Received 26 September 2000
- Revision requested 2 December 2000
- Revised 28 June 2001
- Accepted 26 July 2001
BACKGROUND An increase in the prevalence of obesity and asthma over recent decades has been reported in affluent societies. Both overweight and obesity have been shown to be inversely related to having been breastfed, which is also a potential protective factor against childhood atopic diseases. The aim of this analysis was to explore the relation of body mass index (BMI) to asthma and atopy in a large representative sample of the United States population.
METHODS Children aged 4–17 years were included in the NHANES III survey. Prevalences of atopic diseases and potential confounding factors such as exposure to environmental tobacco smoke, birth weight, breast feeding, and household size were assessed using structured interviews with parents. Height and weight were measured, and BMI was calculated as kg/m2 and transformed into Z scores. Children underwent skin prick tests for atopy to a battery of food and inhalant allergens.
RESULTS The prevalence of asthma (8.7% v 9.3%v 10.3% v14.9%, p=0.0001) and atopy (48.6% v 50.5%v 53.0% v53.2%, p=0.05) rose significantly with increasing quartiles of BMI. After adjustment for confounders, a significant positive association between BMI and asthma remained (adjusted OR 1.77, 95% confidence interval 1.44 to 2.19 between the highest and lowest quartiles of BMI), whereas no independent relation between BMI and atopy was evident. No effect modification by sex or ethnic group was seen.
CONCLUSIONS The effects of increased BMI on asthma may be mediated by mechanical properties of the respiratory system associated with obesity or by upregulation of inflammatory mechanisms rather than by allergic eosinophilic inflammation of the airway epithelium.
Dr von Mutius was supported by a joint grant by the NHLBI and the German Ministry for the Sciences and Technology.