Background Obesity increases both the risk of asthma and asthma severity and is a well-known risk factor for insulin resistance and the metabolic syndrome (MS) in children and adolescents. Objective ...We aimed to examine the association among obesity, insulin sensitivity, MS, and lung function in US adolescents with and without asthma. Methods We performed a cross-sectional study of 1429 adolescents aged 12 to 17 years in the 2007-2010 National Health and Nutrition Examination Survey. Adjusted regression was used to assess the relationships among obesity, insulin sensitivity/resistance, MS, and lung function in children with and without asthma. Results Insulin resistance was negatively associated with FEV1 and forced vital capacity (FVC) in adolescents with and without asthma, whereas MS was associated with lower FEV1 /FVC ratios, with a more pronounced decrease found among asthmatic patients; these associations were driven by overweight/obese adolescents. Higher body mass index was associated with a decrease in FEV1 /FVC ratios among adolescents with insulin resistance. Compared with healthy participants, adolescents with MS had an approximately 2% decrease in FEV1 /FVC ratios, adolescents with asthma had an approximately 6% decrease, and those with MS and asthma had approximately 10% decreased FEV1 /FVC ratios ( P < .05). Conclusion Insulin resistance and MS are associated with worsened lung function in overweight/obese adolescents. Asthma and MS synergistically decrease lung function, as do obesity and insulin resistance. These factors might contribute to the pathogenesis of asthma severity in obese patients and warrant further investigation.
Background Obesity has been associated with higher risk of asthma and asthma severity both in children and adults. However, studies evaluating the relation between obesity and rhinitis have yielded ...conflicting results. Methods We performed a cross-sectional study of obesity indicators and rhinitis using data from 8165 participants in the 2005-2006 National Health and Nutrition Examination Survey. Allergic rhinitis was defined as physician-diagnosed hay fever or allergy, the presence of symptoms in the past 12 months, and at least 1 positive allergen-specific IgE level. Nonallergic rhinitis was defined as a physician's diagnosis and symptoms but no positive allergen-specific IgE levels. Multivariate regression was used to assess the relationship between obesity and rhinitis in children and adults. Results In adults, overweight or obesity was associated with increased odds of nonallergic rhinitis (adjusted odds ratio, 1.43; 95% CI, 1.06-1.93; P = .02). Similarly, central obesity was associated with increased odds of nonallergic rhinitis in adults (adjusted odds ratio, 1.61; 95% CI, 1.20-2.16; P < .01). In an analysis stratified by sex, the observed associations were attenuated and became nonstatistically significant in female adults but remained significant in male adults. Overweight, obesity, or central obesity were not associated with allergic rhinitis in adults. In children, central obesity was associated with reduced odds of allergic rhinitis (adjusted odds ratio, 0.35; 95% CI, 0.19-0.64; P < .01). After stratification by sex, this association was similar in female and male children. Conclusions In adults, obesity is associated with increased odds of nonallergic rhinitis, particularly in male subjects. In children, central obesity is associated with reduced odds of allergic rhinitis, regardless of sex.
Background Total IgE is a therapeutic target in patients with allergic diseases. DNA methylation in white blood cells (WBCs) was associated with total IgE levels in an epigenome-wide association ...study of white subjects. Whether DNA methylation of eosinophils explains these findings is insufficiently understood. Methods We tested for association between genome-wide DNA methylation in WBCs and total IgE levels in 2 studies of Hispanic children: the Puerto Rico Genetics of Asthma and Lifestyle Study (PR-GOAL; n = 306) and the Genes-environments and Admixture in Latino Americans (GALA II) study (n = 573). Whole-genome methylation of DNA from WBCs was measured by using the Illumina Infinium HumanMethylation450 BeadChip. Total IgE levels were measured by using the UniCAP 100 system. In PR-GOAL WBC types (ie, neutrophils, eosinophils, basophils, lymphocytes, and monocytes) in peripheral blood were measured by using Coulter Counter techniques. In the GALA II study WBC types were imputed. Multivariable linear regression was used for the analysis of DNA methylation and total IgE levels, which was first conducted separately for each cohort, and then results from the 2 cohorts were combined in a meta-analysis. Results CpG sites in multiple genes, including novel findings and results previously reported in white subjects, were significantly associated with total IgE levels. However, adjustment for WBC types resulted in markedly fewer significant sites. Top findings from this adjusted meta-analysis were in the genes ZFPM1 ( P = 1.5 × 10−12 ), ACOT7 ( P = 2.5 × 10−11 ), and MND1 ( P = 1.4 × 10−9 ). Conclusions In an epigenome-wide association study adjusted for WBC types (including eosinophils), methylation changes in genes enriched in pathways relevant to asthma and immune responses were associated with total IgE levels among Hispanic children.
Vitamin D insufficiency (a serum 25-hydroxy vitamin D level of <30 ng/mL) has been associated with asthma morbidity.
To examine vitamin D insufficiency, asthma, and lung function among US children ...and adults.
Using data from the National Health and Nutrition Examination Survey from 2001 to 2010, we examined vitamin D insufficiency and (1) current asthma or wheeze in 10,860 children (6-17 years) and 24,115 adults (18-79 years) and (2) lung function in a subset of participants. Logistic or linear regression was used for the multivariable analysis, adjusting for age, sex, race/ethnicity, income, body mass index, smoking, and C-reactive protein level.
Vitamin D insufficiency was associated with current asthma (odds ratio, 1.35; 95% CI, 1.11-1.64) and current wheeze in children, as well as with current wheeze in adults (odds ratio, 1.17; 95% CI, 1.04-1.31). After stratifying the analysis by race/ethnicity and (in adults) current smoking, vitamin D insufficiency was associated with current asthma and wheeze in non-Hispanic white children only; in adults, vitamin D insufficiency was associated with current wheeze in non-Hispanic whites and blacks. Vitamin D insufficiency was also associated with lower FEV
and forced vital capacity in children and adults. When analyzing each National Health and Nutrition Examination Survey wave separately, vitamin D insufficiency prevalence was 72% to 76% from 2001 to 2006, and then decreased from 2007 to 2010 (64%-65%); interestingly, asthma prevalence decreased for the first time from the period 2007 to 2008 (8.2%) to the period 2009 to 2010 (7.4%).
We show racial/ethnic-specific associations between vitamin D insufficiency and current asthma or wheeze in children and adults. Moreover, we report parallel recent decrements in the prevalence of vitamin D insufficiency and asthma.
Background Whether adiposity indicators other than body mass index (BMI) should be used in studies of childhood asthma is largely unknown. The role of atopy in “obese asthma” is also unclear. ...Objectives To examine the relationship among adiposity indicators, asthma, and atopy in Puerto Rican children, and to assess whether atopy mediates the obesity-asthma association. Methods In a study of Puerto Rican children with (n = 351) and without (n = 327) asthma, we measured BMI, percent of body fat, waist circumference, and waist-to-hip ratio. The outcomes studied included asthma, lung function, measures of atopy, and, among cases, indicators of asthma severity or control. We performed mediation analysis to assess the contribution of atopy to the relationship between adiposity and asthma. Results BMI, percent of body fat, and waist circumference were associated with increased odds of asthma. Among cases, all 3 measures were generally associated with lung function, asthma severity/control, and atopy; however, there were differences depending on the adiposity indicator analyzed. Atopy considerably mediated the adiposity-asthma association in this population: allergic rhinitis accounted for 22% to 53% of the association with asthma, and sensitization to cockroach mediated 13% to 20% of the association with forced vital capacity and 29% to 42% of the association with emergency department visits for asthma. Conclusions Adiposity indicators are associated with asthma, asthma severity/control, and atopy in Puerto Rican children. Atopy significantly mediates the effect of adiposity on asthma outcomes. Longitudinal studies are needed to further investigate the causal role, if any, of adiposity distribution and atopy on “obese asthma” in childhood.
Dietary patterns might influence the pathogenesis of asthma in Puerto Ricans, the ethnic group most affected by this disease in the United States.
To examine the association among diet, T-helper cell ...type 17 cytokines, and asthma in Puerto Rican children.
As part of a case-control study of 678 Puerto Rican children 6 to 14 years old in San Juan, participants completed a 75-item questionnaire on the child's food consumption in the prior week. Foods were aggregated into 7 groups: fruits, vegetables, grains, protein foods, dairy, fats, and sweets. Logistic regression was used to evaluate consumption frequency of each group, plasma T-helper cell type 17 cytokine levels, and asthma. Based on this analysis, a food score (range -2 unhealthy diet: high consumption of dairy products and sweets, low consumption of vegetables and grains to +2 healthy diet: high consumption of grains and vegetables, low consumption of dairy and sweets) was created to identify dietary patterns.
High consumption of grains was associated with lower odds of asthma (adjusted odds ratio aOR 0.52, 95% confidence interval CI 0.33-0.82), whereas frequent consumption of dairy products (aOR 1.93, 95% CI 1.32-2.84) or sweets (aOR 1.82, 95% CI 1.08-2.72) was associated with higher odds of asthma. A healthier diet (each 1-point increment in food score) was associated with lower levels of interleukin-17F (β = -1.48 pg/mL, 95% CI -1.78 to -1.20) and with 36% decreased odds of asthma (aOR 0.64, 95% CI 0.53-0.77).
A healthy diet, with frequent consumption of vegetables and grains and low consumption of dairy products and sweets, was associated with lower levels of interleulin-17F and decreased odds of childhood asthma in Puerto Ricans.
Prematurity, atopy, and childhood asthma in Puerto Ricans Rosas-Salazar, Christian, MD; Ramratnam, Sima K., MD; Brehm, John M., MD, MPH ...
Journal of allergy and clinical immunology,
02/2014, Volume:
133, Issue:
2
Journal Article
Peer reviewed
Open access
Background Puerto Rican children share a disproportionate burden of prematurity and asthma in the United States. Little is known about prematurity and childhood asthma in Puerto Rican subjects. ...Objective We sought to examine whether prematurity is associated with asthma in Puerto Rican children. Methods We performed a case-control study of 678 children aged 6 to 14 years with (n = 351) and without (n = 327) asthma living in San Juan, Puerto Rico. Prematurity was defined by parental report for our primary analysis. In a secondary analysis, we only included children whose parents reported prematurity that required admission to the neonatal intensive care unit. Asthma was defined as physician-diagnosed asthma and wheeze in the prior year. We used logistic regression for analysis. All multivariate models were adjusted for age, sex, household income, atopy (≥1 positive IgE level to common allergens), maternal history of asthma, and early-life exposure to environmental tobacco smoke. Results In a multivariate analysis there was a significant interaction between prematurity and atopy on asthma ( P = .006). In an analysis stratified by atopy, prematurity was associated with a nearly 5-fold increased odds of asthma in atopic children (adjusted odds ratio, 4.7; 95% CI, 1.5-14.3; P = .007). In contrast, there was no significant association between prematurity and asthma in nonatopic children. Similar results were obtained in our analysis of prematurity requiring admission to the neonatal intensive care unit and asthma. Conclusions Our results suggest that atopy modifies the estimated effect of prematurity on asthma in Puerto Rican children. Prematurity might explain, in part, the high prevalence of atopic asthma in this ethnic group.
Little is known about the relation between 2 common comorbidities (depression and anxiety) and asthma or bronchodilator response (BDR).
To examine the association between depressive symptoms and ...asthma or BDR in US adults.
Cross-sectional study of 20,272 adults aged 20 to 79 years from the 2007-2012 National Health and Nutrition Examination Survey. Depressive symptoms were measured using the 9-item Patient Health Questionnaire, and classified as none to minimal, mild, moderate, moderately severe, and severe. Major depression (comprising moderately severe to severe symptoms) was defined as a 9-item Patient Health Questionnaire score of 15 or more. Anxiety was defined as 5 or more days feeling anxious in the previous month. Current asthma was defined as having been diagnosed with asthma by a doctor or health professional and 1 or more asthma attack in the previous year. BDR (as percentage of baseline FEV1) was measured in 1356 participants with FEV1/forced vital capacity of less than 0.70 and/or FEV1 less than 70% of predicted. Logistic or linear regression was used for the multivariable analysis.
Depressive symptoms were significantly and linearly associated with asthma, independently of anxiety symptoms. Subjects with major depression had 3.4 times higher odds of asthma than did those with minimal or no depressive symptoms (95% CI, 2.6-4.5; P < .01). Among adults with asthma, major depression was associated with a 4.2% reduction in BDR (95% CI, -7.5% to -0.8%; P = .02). Major depression was not associated with BDR among adults without asthma. Anxiety was not associated with asthma or BDR.
Depressive symptoms are associated with asthma in adults, independently of anxiety symptoms. Major depression is associated with reduced BDR in adults with asthma.
Diagnosing AR requires a careful history and physical examination, as well as targeted testing for allergic sensitization. Because skin testing or a large panel of specific IgE is usually not easily ...accessible to primary care physicians in underserved areas, we formulated an efficient algorithm to accurately diagnose AR (Fig 1). Because of potential detrimental effects from undertreating AR on asthma control, and relatively low risks of overtreatment (due to the safety of most AR medications), this would be particularly attractive in asthmatic children.
Little is known about differential effects of antibiotic use on allergic diseases in rural versus urban environments.
To examine whether area of residence in the first year of life modifies the ...relation between antibiotic use in early life and allergic diseases during childhood.
Cross-sectional study of allergic diseases in 1517 children (ages 6-7 years) attending 101 schools in urban and rural areas of San Francisco (Córdoba, Argentina). Current asthma, wheeze, and allergic rhinoconjunctivitis were defined on the basis of responses to a validated questionnaire from the International Study of Asthma and Allergies in Childhood. Multivariate logistic regression was used for the analysis of antibiotic use and allergic diseases.
After adjustment for paracetamol use, bronchiolitis, and other covariates, antibiotic use in the first year of life was associated with increased odds of current wheeze (odds ratio OR, 1.8; 95% CI, 1.3-2.6) and allergic rhinoconjunctivitis (OR, 1.9; 95% CI, 1.3-2.7). After stratification by area of residence, antibiotic use was associated with current wheeze (OR, 2.4; 95% CI, 1.5-4.0) and allergic rhinoconjunctivitis (OR, 2.1; 95% CI, 1.3-3.4) among children who lived in an urban area in their first year of life, but not among those who lived in a rural area in their first year of life.
Early-life antibiotic use is associated with current wheeze and allergic rhinoconjunctivitis in Argentinean children who lived in urban areas during their first year of life. Exposure to a rural environment early in life may protect against the adverse effects of antibiotics on atopic diseases in children.
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