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A new quarter of pediatric asthma cases is linked to obesity



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About 23% -27% of new asthma cases in children are caused directly by obesity, according to a new study.

"In the absence of excess weight and obesity, 10 percent of all asthma cases in children in the United States can be avoided," wrote Dr. Jason Lang, MD, MPH, Allergy and Immunology and Pulmonary Medicine Departments at Duke University School of Medicine. Duke of Children and Hospital in Durham, North Carolina, and colleagues.

The findings were published online today Pediatrics.

Obesity has been associated with new cases of asthma among adults, and researchers estimate that obesity causes approximately 250,000 new adult cases a year. This study is the first to measure risk and risk among a large and diverse national population of children.

Lang and colleagues used the PEDSnet clinical trial network to compare the incidence of asthma among overweight and / or obese children with healthy children aged 2-17 years. They analyzed data from 507,496 children and 19,581,972 sessions between January 2009 and December 2015. The researchers matched single children classified as obese or obese in a 1: 1 ratio with children whose weight was within a healthy range. Children were also adjusted for demographic characteristics and insurance status. The average observation period was 4 years.

The prevalence was defined as at least two sessions with a diagnosis of asthma and at least one prescription of asthma.

In general, the adjusted risk for incident asthma was higher among overweight children (relative risk) [RR], 1.17; 95% confidence interval [CI], 1.25 – 1.25) and obese children (RR, 1.26, 95% CI, 1.18 – 1.34). The adjusted risk for asthma confirmed by spirometry was higher among obese children (RR, 1.29, 95% CI, 1.16 to 1.42).

Some measures prevent asthma

The findings are important because there are a number of measures to prevent childhood asthma, the researchers note.

These data indicate that reducing obesity among children "will significantly reduce the burden of public health," they write.

In the lender Editorial article MD, MS, of Montefiore Children's Hospital, Albert Einstein College of Medicine in the Bronx, New York, says the numbers show another reason for these findings. She explains that the incidence of asthma in children has remained at 10% for many years despite advances in early diagnosis, management, and reducing environmental factors. At the same time, obesity rates are almost 20% and rising among some groups, these new data show how it can increase children's asthma rates.

"[W]e observes a 5% increase in childhood asthma due to obesity, indicating that over time asthma induced by obesity will become a major type of childhood asthma, "she said.

Rastogi notes the research power is that the database, PEDSnet, includes data from eight major US child health centers, allowing a broad view on races, ethnicity, and various definitions of asthma.

The adjustment of children to demographic characteristics and the state of insurance separates the possible entanglement of these variables, she says.

In light of the findings, Rastogi suggests that doctors measure waist circumference and measure metabolic abnormalities in evaluating obese children with diabetes to better identify those at risk of developing lung complications.

"Because there are normative values ​​for waist circumference and metabolic disorders in children, those with evidence [one or more] Of these complications associated with obesity should be those that are actively filtered for asthma, "she writes.

Another study, she says, should be investigated why some obese children develop asthma and some do not, need to differentiate between obese children As a result Of asthma from those who develop asthma As a result Of obesity. This knowledge, said Rastogi, will help develop novel targeted therapies.

Children between the ages of 2 and 17 were eligible for inclusion in the study if they had an age-appropriate body mass index of at least 85 percent and no asthma or wheezing diagnosis was noted before or during the study period.

The study included children without formal asthma without formal diagnosis and those diagnosed with asthma within 18 months of the initial visit. Children were also out if they recorded cystic fibrosis, mucous dyskinesia, pediatric cancer, inflammatory bowel disease, or bronchopulmonary dronplasia.

The study was funded by the Institute for Research and Research Results by the patient and by institutional development funds from Nemours Children's Hospital and the Nemours Children's Health System.

One of the authors reports that he serves on the advisory boards of Merck, Sanofi Pasteur and Pfizer, and works as a consultant to Pfizer, but does not receive funding from these bodies.

The other authors of the study, Verstogi, found no relevant financial relationship.

Pediatrics. Posted on November 26, 2018. Full text, editorial

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