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Original research
Body composition and respiratory outcomes in children: a population-based prospective cohort study
  1. Tong Wu1,2,
  2. Susana Santos1,3,4,5,
  3. Hugo G Quezada‐Pinedo1,6,
  4. Meike W. Vernooij2,7,
  5. Vincent W.V. Jaddoe1,5,
  6. Stefan Klein2,
  7. Liesbeth Duijts6,8,
  8. Edwin H.G. Oei2
  1. 1 The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2 Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  3. 3 EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
  4. 4 Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
  5. 5 Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  6. 6 Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Rotterdam, The Netherlands
  7. 7 Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  8. 8 Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Professor Edwin H.G. Oei, Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands; e.oei{at}erasmusmc.nl

Abstract

Background Body composition might influence lung function and asthma in children, but its longitudinal relations are unclear. We aimed to identify critical periods for body composition changes during childhood and adolescence in relation to respiratory outcomes in adolescents.

Methods In a population-based prospective cohort study, we measured body mass index, fat mass index (FMI), lean mass index (LMI) and the ratio of android fat mass divided by gynoid fat mass (A/G ratio) by dual-energy X-ray absorptiometry at 6, 10 and 13 years. At 13 years, lung function was measured by spirometry, and current asthma was assessed by questionnaire.

Results Most prominently and consistently, higher FMI and A/G ratio at age 13 years were associated with lower forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and forced expiratory flow after exhaling 75% of FVC (FEF75) (range Z-score difference −0.13 (95% CI −0.16 to –0.10) to −0.08 (95% CI −0.11 to –0.05) per SD score increase), and higher LMI at all ages was associated with higher FEF75 (range Z-score difference 0.05 (95% CI 0.01 to 0.08) to 0.09 (95% CI 0.06 to 0.13)). Between the ages of 6 and 13 years, normal to high FMI and A/G ratio were associated with lower FEV1/FVC and FEF75 (range Z-score difference −0.20 (95% CI −0.30 to –0.10) to −0.17 (95% CI −0.28 to –0.06)) and high to high LMI with higher FEF75 (range Z-score difference0.32 (95% CI 0.23 to 0.41)). Body composition changes were not associated with asthma.

Conclusion Adolescents with higher total and abdominal fat indices may have impaired lung function, while those with a higher lean mass during childhood and adolescence may have better small airway function. Public health measures should focus on a healthy body composition in adolescents to minimise respiratory morbidity.

  • asthma
  • asthma epidemiology
  • paediatric asthma

Data availability statement

No data are available. The datasets generated and/or analyzed during the current study are not publicly available due to individual privacy consideration, but are available from the data managers (datamanagementgenr@erasmusmc.nl) and Director Generation R, Vincent Jaddoe (v.jaddoe@erasmusmc.nl) after a written agreement about the use of the data made via the Technology Transfer Office of Erasmus MC.

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Data availability statement

No data are available. The datasets generated and/or analyzed during the current study are not publicly available due to individual privacy consideration, but are available from the data managers (datamanagementgenr@erasmusmc.nl) and Director Generation R, Vincent Jaddoe (v.jaddoe@erasmusmc.nl) after a written agreement about the use of the data made via the Technology Transfer Office of Erasmus MC.

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Footnotes

  • LD and EH.O contributed equally.

  • Contributors TW, SS, SK, LD and EO participated in the conception and design of the study and contributed to the acquisition of data, formal analysis, writing of the original draft, interpretation of results and manuscript editing critically for important intellectual content. EO acted as the guarantor. HQ-P contributed to the formal analysis, interpretation of results and manuscript editing critically for important intellectual content. MV contributed to the interpretation of results and the manuscript editing critically for important intellectual content. VJ participated in the conception and design of the study and contributed to the acquisition of data, interpretation of results and manuscript editing critically for important intellectual content. All authors have read and approved the final version of the manuscript for publication and agreed with the order of presentation of the authors.

  • Funding The Generation R Study is made possible by financial support from the Erasmus Medical Center, Rotterdam, the Erasmus University Rotterdam and the Netherlands Organisation for Health Research and Development. TW is supported by a China Scholarship Council (CSC) PhD Fellowship for his PhD study at Erasmus Medical Center, Rotterdam, the Netherlands. The scholarship file number is 201906260304, CSC URL: http://www.csc.edu.cn/. LD is supported by funding for projects from the European Union's Horizon 2020 research and innovation programme (LIFECYCLE, grant agreement No. 733206, 2016; EUCAN-Connect grant agreement No. 824989; ATHLETE, grant agreement No. 874583), ZonMW, The Netherlands (CoKIDS study No. 10150062010006). The researchers are independent from the funders. The study sponsors had no role in the study design, data analysis, interpretation of the data or writing of this report.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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