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Research Article
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Childhood Obesity and Asthma Severity: Is There a Link? |
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N. El Helaly,
Y. Kamel,
E. Abd Elaziz,
A. Elwan
and
M. Nabih
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ABSTRACT
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The aim of this study was to prove the relation between
childhood obesity and asthma severity and that weight reduction improves
asthma outcome. The study included 40 children with age range of 6-12
years divided into two groups; group I included 20 overweight moderate
persistent asthmatics who will follow a weight reduction diet for 6 months
and group II including 20 non obese moderate persistent asthmatics. All
patients were assessed initially and after 6 months clinically and by
Spirometric examination. Comparing both groups I and II at the beginning
of the study as regards their spirometric results; group II had higher
values in all parameters (FVC, FEV1, PEF and FEF 25-75) with p values
of 0.001, 0.004, 0.001 and 0.001, respectively. There was also a marked
statistically significant difference between all parameters of spirometry
in group I before and after weight loss with a p-value of 0.001 in all
parameters. Obesity is a cause of poor asthma control and weight reduction
can be used as an adjunctive to decrease the need for medications and
improve quality of life in obese children with persistent asthma.
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INTRODUCTION
Asthma is a chronic inflammatory disorder of the air ways and it is prevalent
world wide, especially in developed countries where its prevalence is increasing
to epidemic properties in some areas. (Busse et al.,
2001).
Obesity is the most prevalent nutritional disorder among children in western
countries; it affects 40% of children in the United States (Stenius-Aarniala
et al., 2000).
Obesity is a major cause of mortality accounting for approximately 300,000
deaths each year. The parallel time trend with increasing prevalence of asthma
has induced a debate about potential link between both conditions (Shore
and Fredbary, 2005).
The prevalence of both obesity and asthma has clearly increased in recent decades,
giving rise to speculation that they may be related, studies have found that
obesity precedes and predicts the onset of asthma (time effect), that increased
obesity leads to more severe asthma (dose-response effect) and that weigh reduction
improves asthmatic symptoms (Guerra et al., 2004).
In explanation for the parallel increase of asthma and obesity, it might be
based on genetic factors. Several overlapping linkage peaks for obesity and
asthma have been identified in genome wide linkage studies (CA et al.,
1999; Mai et al., 2005; Litonjua
and Gold, 2008).
Recent investigations towards elucidating a shared genetic basis for these
two disorders have identified polymorphism in specific regions of chromosomes
5q 6p11q 12q, each of which containing one or more genes encoding receptors
that are relevant to asthma (Vollmer et al., 1999;
Calfee et al., 2006; Cope
et al., 2008).
Mechanical properties of the respiratory system associated with obesity such
as diminished tidal lung expansion may partially account for this association
with asthma (Seo et al., 2005; Mc-Vey
et al., 2007; De Santis-Moniaci and Altshuler,
2007).
Several studies revealed a reduction in functional residual capacity and diffusion
impairment in obese children and there were reduction in static lung volume
correlated with the degree of obesity, also several studies proved that weight
reduction can results in prevalent of lung function and symptoms among asthmatic
adults. (Fuhlbrigge et al., 2006; Juniper
et al., 2004; Chong et al., 2006).
The prevalence of asthma and obesity made us search for a link between
both in children and whether weight reduction can ameliorate asthma and
help improving the pulmonary functions and control asthma symptoms.
MATERIALS AND METHODS
The study was conducted at the Out Patient Clinic of the Pulmonology
Department of Pediatric Hospital Cairo University during the period of
January and June 2008; it included 40 children with moderate persistent
asthma (according to the GINA, 2007 classification) with age range 6-12
years and was divided into two groups:
Group I: Included 20 over weight moderate persistent asthmatics
and they underwent a 6 month protocol of proper diet control for weight
reduction.
Group II: Also included 20 but non obese age and sex matched moderate
persistent asthmatic.
Exclusion criteria
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Children with history of acute asthmatic attacks within
the past 6 months |
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Children receiving systemic steroids within past year |
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Children with any systemic diseases |
*All patients were evaluated at the beginning and after 6 months from
the onset of the study and for each patient the followings were done:
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Detailed history taking including family history of
asthma and or obesity (for the obese group) |
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Full Clinical Examination |
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Anthropometric Measurements |
*Height: Measured by the same examiner using a wall-mounted harperder
5 stadiometer (Hattain Limited, Crymchy, Dyfeed, United Kingdom).
*Weight: using a calibrated electronic scale (Seca, Homburg, Germany).
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Pulmonary function tests using Med Graphics Spirometry
and the following parameters were measured: |
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Forced Vital Capacity (FVC) |
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Forced expiratory volume in the first second (FEV1) |
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Forced Mid Expiratory Flow (FEF 25-75%) |
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Peak Expiratory Flow (PEF) |
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Results of spirometry are being expressed as a percentage
of predicted value adjusted for gender, age and height |
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FVC, FEV and FEF 25-75% are considered abnormal if they
were less than 80% of the normal predicted value |
Statistical analysis: Statistical package of social science (SPSS)
program was used for data analysis. Data was summarized as Mean ±
SD and percentage.
Mc Nemer test was used for analysis of 2 qualitative data in follow up.
Independent and dependant t-test is used for data analysis.
Pearson Correlation was done to detect relation between two variables.
r is considered weak if <0.25, mild between 0.25 and 0.5, moderate
if more than or equal 0.5. <0.75 and strong if more than or equal 0.75,
p-value is considered significant if <0.05.
RESULTS
Demographic data of the studies group is shown in Table
1.
There was a great improvement in all parameters after the 6 months diet
control regimen in group I with a statistically significant difference
with p-value 0.001 in all parameters. While in group II the improvement
was not significant (Table 2).
Table 1: |
Demographic data of the studied groups |
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Data are expressed as Mean ± SD |
Table 2: |
Comparison between PFT parameter in group I and II before
and after 6 months of a weigh reduction diet (in group I) |
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Fig. 1: |
The correlation graphs represented in a scattered dot graph
with the vertical column presenting the body weight and the horizontal column
presenting the (a) FEV1, (b) FVC, (c) PEF and (d) FEF, respectively |
Table 3: |
Comparison between PFT of both group I and II at the end of
the study |
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Table 4: |
Correlation between b.wt. and PFT in group I |
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*Correlation is significant at the 0.01 level (2-tailed) |
Seeing the results of PFT of both groups after 6 months of a proper weight
reduction diet, theres no statistical significant difference in
all parameters except in the FEF 25-75 (Table 3).
There was a negative correlation between the body weight and the PFT
levels in all parameters in Group I before loosing weight with a p-value
of 0.0001 in all parameters (Table 4, Fig.
1a-d).
DISCUSSION
Asthma is the most prevalent chromic illness of childhood and has a major impact
on lifestyle (Ostrom et al., 2005). Also obesity
is a major cause of morbidity in children and a number of prospective studies
have shown that weight gain can precede the development of asthma, (Gidding
et al., 1995; Rajeshwari et al., 2005;
Nicklas et al., 2004). There is evidence of a
positive association between asthma and obesity in adults and children (Hammerman
et al., 2002; Hong and Mahamitra, 2005; Locke
and Marks, 2007).
Comparing both groups I and II at the beginning of the study regarding
their PFT, we found that Group II had higher values than Group I in all
parameters (FVC, FEV, PEF and FEF 25-75) with p-values (0.001, 0.004,
0.001 and 0.001, respectively) and this proves that non obese patients
had better Spirometric values than obese patients of the same class (moderate
persistent asthma).
These results agree with studies which found that increased obesity leads to
move severe asthma (Hammerman et al., 2002; Hong
et al., 2005; Laforest et al., 2006).
Also there was a marked statistically significant difference between
all parameters of PFI in Group I before and after loosing weight with
a p-value of FVC, FEV, PEF and FEF25-75 being 0.001, these results proved
that PFT results were much better after losing weight.
These results agree with studies that found that increased obesity leads to
more severe asthma and that weight reduction improves asthmatic symptoms (Belessis
et al., 2004; Damore et al., 2008).
Also results partially agree with Laforest et al.
(2006), who said that there is no association between obesity and asthma
in young children, however there is a relation between obesity and asthma in
girls who were over weight at the age of 6-11 being more at risk of developing
asthma at the age of 11-13 (Lyell et al., 2005).
Now comparing the PFT results of both group I and II at the end of the
study, after Group I patients lost weight, regarding FVC, FEV, PEF and
FEF 25-75%, there were insignificant difference with a p-value being,
(respectively) this proves that when the obese patients lost weight and
become in the normal range they had nearly similar results as the non
obese.
This is supported by studies which conclude that therapies targeting weight
loss may provide an approach to asthma treatment (Shore and
Fredberg, 2005; Vollmer et al., 1999).
Correlation between body weight with PFT (FVC, EEV, PEF and PEF 25-27%)
at the beginning of the study in Group I showed a negative correlation
in all parameters with a p-value of 0.0001, proving that the more the
body weight the less the PFT levels.
CONCLUSION AND RECOMMENDATION
In the light of evidences found, we conclude the nature of the relationship;
obesity is a cause of poor asthma control and asthmatics are more liable
to sedentary life (due to their recurrent asthmatic attacks which limits
their exercise ability) and thus to obesity.
Also weight reduction programs can be used as an adjunctive to decrease
the need for medications and to improve the quality of life in obese patients
with persistent asthma.
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