A study including health data for more than 500,000 children in the United States suggests that obesity might be to blame for approximately 23 to 27 percent of asthma in children who are obese.
This could mean about 10 percent of all children ages 2 to 17 with asthma—almost one million children—might have avoided the illness by maintaining a healthy weight, according to researchers at Duke University and collaborators with the National Pediatric Learning Health System (PEDSnet). The findings were published November 26, 2018 in Pediatrics.
“Asthma is the number one chronic disease in children and some of the causes such as genetics and viral infections during childhood are things we can’t prevent,” says Jason E. Lang, MD, associate professor of pediatrics at Duke and the study’s lead author. “Obesity may be the only risk factor for childhood asthma that could be preventable. This is another piece of evidence that keeping kids active and at a healthy weight is important.”
For the retrospective study, researchers analyzed data for 507,496 children from more than 19 million physician visits at six major children’s health centers. The data were entered into a clinical research data network called PEDSnet between 2009 and 2015.
Those classified as having asthma had been diagnosed at two or more physician appointments and had also received a prescription, such as an inhaler. Tests of their lung function also confirmed they had the disease.
Children classified as obese—those with a body-mass index (BMI) in the 95th percentile or above for their age and sex—had a 30-percent increased risk of developing asthma than peers of a healthy weight. Asthma did not affect just those with obesity. Children who were overweight but not obese (BMI in the 85th to 94th percentile) also had a 17-percent increased asthma risk compared to healthy-weight peers.
The researchers calculated asthma risk using several models and adjusted for risk factors such as sex, age, socioeconomic status and allergies. The results remained similar.
The study has several limitations, Lang says, including that the data were collected during physician visits and not in a controlled clinical research setting. He says more experiments are needed to prove overweight and obesity directly cause changes that lead to asthma because scientists don’t completely understand how or why this would occur.
Scientists have explored hypotheses including potential differences in how children’s lungs and airways develop when they are overweight, and inflammatory changes in the body due to obesity. Still, these findings and others, such as how asthma often improves with weight loss, suggests obesity plays a key role or is directly to blame, says Lang.
“I think it’s reasonable to be concerned that it’s a causal relationship,” he says. “It appears that becoming overweight or obese as a child significantly increases your risk of developing asthma, and it’s a significant increase, directing attention again to the importance of preventing obesity at an early age.”