Childhood Asthma and Extreme Values of Body Mass Index: The Harlem Children’s Zone Asthma Initiative

Abstract

To examine the association between body mass index (BMI) percentile and asthma in children 2-11 years of age, we performed a cross-sectional analysis of 853 Black and Hispanic children from a community-based sample of 2-to 11-year olds with measured heights and weights screened for asthma by the Harlem Children's Zone Asthma Initiative. Current asthma was defined as parent/guardian-reported diagnosis of asthma and asthma-related symptoms or emergency care in the previous 12 months. Among girls, asthma prevalence increased approximately linearly with increasing body mass index (BMI) percentile, from a low of 12.0% among underweight girls (BMI e5th percentile) to a high of 33.3% among girls at risk for overweight (BMI 85th-94th percentile). Among boys, asthma prevalence was associated in a U-shaped curve with the extremes of BMI percentile, that is, 36.4% among underweight boys, 19.1% among normal weight boys (BMI 6th-84th percentile), and 34.8% among overweight boys (995th percentile). After adjusting for age, race/ethnicity, and household smoking, among girls, having asthma was associated with being at risk for overweight (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.4-5.0) and being overweight (OR, 2.1; 95% CI, 1.2-3.8) compared to normal weight; among boys, having asthma was associated both with overweight (OR, 2.4; 95% CI, 1.4-4.3) and with underweight (OR, 2.9; 95% CI, 1.1-7.7). Large, prospective studies that include very young children are needed to further explore the observed association between underweight and asthma among boys. Early interventions that concomitantly address asthma and weight gain are needed among pre-school and school-aged children.

Associations of body fat percent and body mass index with childhood asthma by age and gender

“…In contrast, in the case of the lowest BMI z-score category, the ORs, although not statistically different in this study, appeared elevated in males and reduced in females, which is consistent with the findings of several previous studies that reported low BMI to be associated with asthma particularly in males (4,11,16,17). Furthermore, BF% also demonstrated a consistent U-shape pattern of association with asthma in both preadolescent and adolescent children.…”

“…The great majority of previous studies on the association of adiposity with asthma in children used BMI as the measure of exposure and focused specifically on the highest range of BMI values (9,30,31). Only a few studies have examined associations across the whole range of BMI values with some of them reporting a linear association of BMI with asthma (1,2,7) while others reporting a U-shape association with an increased risk of asthma in both the underweight and obese groups (15)(16)(17)(18). In our study, the upper range of both measures of adiposity exhibited a positive association with asthma, which in fact appeared stronger in the case of BF% than in the respective BMI z-score category.…”

“…A review of the literature suggested that most studies (9) have focused on high BMI and shown associations with asthma, mainly in girls and women (10)(11)(12). Nevertheless, some studies have reported an increased risk of asthma amongst the underweight, whereas others have reported nonlinear, U-shape associations with BMI, at least in men and boys (4,(13)(14)(15)(16)(17)(18). Furthermore, some studies found no association between BMI and asthma in early childhood but only after the onset of puberty or during advanced adolescence (10,12).…”

U-Shaped Association between Body Mass Index and the Prevalence of Wheeze and Asthma, but not Eczema or Rhinoconjunctivitis: The Ryukyus Child Health Study

“…Most studies in adults have shown that obesity and overweight are positively associated with asthma or asthma-like symptoms (1)(2)(3)(4)(5)(6)(7)(8)(9); moreover, in some studies, this association was more pronounced in women than in men (1,(7)(8)(9). In children, on the other hand, results concerning the association of asthma with obesity have not been consistent (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Data from the National Health and Nutrition Examination Survey showed that a higher body mass index (BMI) was associated with an increased prevalence of asthma among 7505 US children aged 4-17 years (10).…”

“…In a cross-sectional study in the United States involving 853 children aged 2-11 years, the prevalence of asthma in association with the *Corresponding author: Keiko Tanaka, D.D.S., Ph.D., Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan; Tel: +81 92 801 1011 extn. 3315; Fax: +81 92 863 8892; E-mail: k-tanaka@fukuoka-u.ac.jp BMI percentile in boys followed a U-shaped curve, whereas the prevalence of asthma increased linearly with higher BMI percentiles in girls (12).…”