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A4469 - Early Childhood Asthma and the Risk of New Onset Obesity: An Individual Participant Meta-Analysis of 16 European Birth Cohorts
Author Block: Z. Contreras1, Z. Chen1, T. Roumeliotaki2, I. Annesi-Maesano3, N. Baiz3, A. Von Berg4, A. Bergstrom5, C. Bindslev-Jensen6, S. Crozier7, L. Duijts8, S. Ekstrom5, E. Eller6, M. Fantini9, F. Forastiere10, B. Gerhard11, D. Gori9, M. Harskamp-van Ginkel12, J. Heinrich13, C. Iñiguez14, H. Inskip7, T. Keil15, M. Kogevinas16, S. Lau15, I. Lehmann17, D. Maier11, E. van Meel8, M. Mommers18, M. Murcia19, D. Porta10, H. Smit20, M. Standl13, N. Stratakis21, J. Sunyer16, C. Thijs18, M. Torrent22, T. Vrijkotte12, A. Wijga23, K. Berhane1, F. Gilliland1, L. Chatzi1; 1Preventive Medicine, University of Southern California, Los Angeles, CA, United States, 2Social Medicine, University of Crete, Heraklion, Greece, 3Epidemiology of Allergic and Respiratory Diseases, INSERM, Paris, France, 4Pediatrics, Marien Hosp Wesel, Wesel D 46483, Germany, 5Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden, 6Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis (ORCA), Odense, Denmark, 7MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom, 8Pediatrics, Erasmus MC, University Medical Center, Rotterdam, Netherlands, 9Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy, 10Epidemiology, Lazio Regional Health Service, Rome, Italy, 11Biomax Informatics AG, Martinsried, Germany, 12Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands, 13Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany, 14Statistics and Operational Research, University of Valencia, Valencia, Spain, 15Pediatrics, Charité, Berlin, Germany, 16ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain, 17Environmental Immunology/Core Facility Studies, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany, 18Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre+, Maastricht, Netherlands, 19CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain, 20Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands, 21NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands, 22Ib-salut, Area de Salut de Menorca, Menorca, Spain, 23Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Biltho
Background: The prevalence of both asthma and obesity has increased considerably over the past few decades, spurring research into possible links between these conditions. Most research to date has focused on obesity as a risk factor for asthma, but little is known regarding the potential role of asthma in obesity incidence.
Methods: We pooled individual data from 16 European birth cohorts, which collected information on asthma phenotypes using validated questionnaires. Children’s height and weight were obtained from physical exams and health records. Obesity was defined according to the International Obesity Task Force Criteria (IOTF). We followed 21, 643 non-obese children at 3-4 years of age and examined obesity incidence up to 8 years of age. We used Cox proportional hazards models with a random effect for cohort to estimate pooled hazard ratios for the association between having doctor-diagnosed asthma and wheezing symptoms at 3-4 years of age or younger, and obesity onset by end of follow-up. Confounder selection was based on directed acyclic graphs. To assess the consistency of our results, we also calculated cohort-specific effects and combined them using random effects meta-analysis.
Results: The prevalence of doctor-diagnosed asthma and wheezing in the last 12 months at 3-4 years of age was 5.7% and 12.5%, respectively. Children with doctor-diagnosed asthma at 3-4 years of age had a 62% higher risk for incident obesity than those without asthma (adjusted HR (aHR): 1.62, 95% CI: 1.17, 2.24). Children with active asthma at 3-4 years of age (wheeze in the last 12 months and doctor-diagnosed asthma), exhibited an even greater risk for developing obesity (aHR: 1.92, 95% CI: 1.28, 2.91) than those without active asthma. When assessing wheezing patterns, risk was most pronounced for children who had persistent wheezing (aHR: 1.50, 95% CI: 1.08, 2.09) compared to those with transient or late onset wheezing. Our meta-analysis results were similar to our pooled estimates with no significant heterogeneity between cohorts. When further excluding overweight children at baseline, we found comparable, but attenuated results. Stratification by sex and parental asthma history did not reveal any differences by subgroup.
Conclusion: Early childhood asthma and wheezing may contribute to an increased risk of developing obesity in later childhood. Further investigation of the early biological and lifestyle factors that may underlie the greater risk of obesity in asthmatic children is warranted.