1. One-tenth of new diagnoses of pediatric asthma could potentially be avoided with the elimination of childhood obesity.
Evidence Rating Level: 2 (Good)
Study Rundown: Despite increased efforts to prevent and reduce obesity, rates of childhood obesity continue to increase, with almost 20% of children in the United States meeting obesity criteria. Asthma, a major cause of pediatric morbidity and a major source of healthcare expenditures worldwide, has been linked to obesity in the adult population, but the relationship has not been fully defined in children. This study involved prospective analysis of retrospectively collected data from PEDSnet to examine the link between weight and subsequent development of asthma in pediatric patients. Results showed overweight and obese children had increased risk of being diagnosed with asthma. The incidence of asthma was directly attributable to obesity in about 1 out of every 4 obese pediatric patients with a new diagnosis of asthma. Furthermore, the study found that about 10% of all new asthma cases would not occur in the absence of pediatric overweight and obesity. This study is limited by potential selection bias and data collection inaccuracies inherent in retrospective studies. Also, due to the retrospective study design, it is impossible to make draw conclusions about a causal relationship between obesity and asthma. Nevertheless, results from this study suggest interventions to reduce pediatric obesity would also have a significant impact on preventing new cases of pediatric asthma.
In-depth [retrospective cohort]: This study analyzed data collected from the PEDSnet, a research network that collects and standardizes clinical data from the electronic medical records at 8 major pediatric hospitals in the United States. Data used in this study was from clinical visits involving 507 496 (25.5% overweight and 24.5% obese, 50.7% male, 55.4% white), pediatric patients aged 2 to 17 years from 2009 to 2015. Patients were included if they had a body mass index ≥85th percentile, no previous diagnosis of asthma or wheezing, and 2 subsequent clinic visits over the following 12 months. Patients were age-matched with control patients with normal weight who lived in the same geographical region. Patients were observed for the development of asthma (at least 2 visits with an asthma diagnosis, and at least 1 asthma medication prescription). Results showed an overall incidence rate of 2.7 cases per 1000 patient years (2.4 per 1000 years in normal weight patients versus 3.2 per 1000 among children with obesity). Other factors associated with increased asthma incidence included male sex, African-American race, Medicaid or no insurance, younger age, history of allergies or use of various medications. The population attributable risk (PAR) of asthma due to overweight and obesity was 0.28. Clinically diagnosed asthma in the entire population was found to be directly attributable to obesity in 10% of new asthma cases.
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