The Role of Childhood Asthma in Obesity Development A Nationwide US Multicohort Study

• Type of Material: Article
• Authors: Anne Dunlop, Emory University; Nikos Stratakis, University of Southern California; Erika Garcia, University of Southern California; Aruna Chandran, Johns Hopkins Bloomberg School of Public Health; Tingju Hsu, Johns Hopkins Bloomberg School of Public Health; Akram Alshawabkeh, Northeastern University; Izzuddin M Aris, Harvard Medical School; Judy L Aschner, Hackensack Meridian School of Medicine; Carrie Breton, University of Southern California; Allison Burbank, University of North Carolina; Carlos Jr A Camargo, Harvard Medical School; Kecia N Carroll, Vanderbilt University; Zhanghua Chen, University of Southern California; Erika C Claud, University of Chicago; Dana Dabelea, University of Colorado, Aurora; Amy J Elliott, Avera Res Inst; Assiamira Ferrara, Kaiser Permanente Northern California Division of Research; Jody Ganiban, George Washington University; James E Gern, University of Wisconsin; Diane R Gold, Harvard University; William A Gower, University of North Carolina; Irva Hertz-Picciotto, University of California Davis; Margaret R Karagas, Dartmouth College; Catherine J Karr, University of Washington; Barry Lester, Brown Alpert Medical School; Leslie D Leve, University of Oregon; Augusto A Litonjua, University of Rochester; Yunin Ludena, University of California Davis; Cindy T McEvoy, Oregon Health and Science University; Rachel L Miller, Icahn School of Medicine at Mount Sinai; Noel T Mueller, Johns Hopkins Bloomberg Sch Publ Hlth; Thomas G O'Connor, University of Rochester; Emily Oken, Harvard Medical School; Michael T O'Shea, University of North Carolina; Frederica Perera, Columbia University; Jospeh B Stanford, University of Utah; Katherine Rivera-Spoljaric, Washington University; Andrew Rundle, Columbia University; Leonardo Trasande, NYU; Rosalind J Wright, Icahn School of Medicine at Mount Sinai; Yue Zhang, University of Utah; Yeyi Zhu, Kaiser Permanente Northern Calif Div Res; Kiros Berhane, Columbia University; Frank Gilliland, University of Southern California; Lida Chatzi, University of Southern California
• Language: English
• Date: 2022-01-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 Wolters Kluwer Health, Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/EDE.0000000000001421
• Title of Journal or Parent Work: EPIDEMIOLOGY
• Volume: 33
• Issue: 1
• Start Page: 131
• End Page: 140
• Grant/Funding Information: Dr. Nikos Stratakis was supported by NIH R21 ES029681 and P30 ES007048-23, and NIH P30 DK048522-24. Dr. Erika Garcia was supported by NIH P50 ES026086-04S1. Dr. Leda Chatzi was additionally supported by NIH R01ES029944, R01ES030364, R01ES030691, R21ES28903, R21ES029681, P30ES007048. Dr. Anne Dunlop was additionally supported by NIH R24ES029490, R01NR014800, P50ES026071. Dr. Carrie Breton was additionally supported by NIH P30ES007048, P50ES026086 and EPA grant R83615801. Dr. Irva Hertz-Picciotto and collection of data for the CHARGE/ReCHARGE cohort were additionally supported by NIEHS R01ES015359, and NIH UG3OD023365. Dr. Margaret Karagas was additionally supported by NIH P01ES022832, and US EPA: RD83544201. Dr. Dana Dabelea was additionally supported by NIH R01 DK076648. Dr. Emily Oken and data collection for Project Viva were additionally supported by R01 HD034568. Dr. Judy Aschner was additionally supported by NIH R34 HL142995. Dr. Thomas O’Connor was additionally supported by NIH R01 097293. Dr. Leslie Leve was additionally supported by NIH R01 HD042608, R01 DA020585, R01 DK090264. Dr. Allison Burbank was supported by NIH R01 HL135235, P01HL108808, and R01 ES025124. Dr. Cindy McEvoy was additionally supported by NIH R01 HL105447. Dr. Lester was additionally supported by NIH/NICHD - R01HD072267. Dr. Amy Elliot was additionally supported by NIH U01HD045935. Dr. Catherine Karr was additionally supported by UG3OD023271. Drs. Joseph B. Stanford and Yue Zhang were additionally supported by NIH 1UG3OD023249. Dr. Yeyi Zhu was additionally supported by NIH UG3OD023289 and K01DK120807. Dr. Erika Claud was additionally supported by NIH UG3OD023281. Dr. Barry Lester was additionally supported by NIH/OD - UG3OD023347. Dr. Izzuddin M. Aris was additionally supported by NIH R01 HD0345568 and UG3OD023286. Dr. Kecia N. Carroll was additionally supported by UG3OD023271, R01 HL109977, and R01 HL132338. Dr. James Gern was additionally supported by UM1 AI114271. Dr. Akram Alshawabkeh was supported by NIH UH3 OD023251. Dr. Noel T. Mueller was additionally supported by NIH K01HL141589.; Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, under award numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), and UH3OD023287 (Dr. Leda Chatzi), UH3OD023318 (Dr. Anne Dunlop), UH3OD023282 (Drs. James Gern and Diane Gold), UH3OD023287 (Drs. Carrie Breton and Frank Gilliland), UH3OD023365 (Dr. Irva Hertz-Picciotto), UH3OD02375 (Dr. Margaret Karagas), UH3OD023248 (Dr. Dana Dabelea), UH3OD023286 (Dr. Emily Oken), UH3OD023320 (Dr. Judy Aschner), UH3OD023349 (Dr. Thomas O’Connor), UH3OD023389 (Dr. Leslie Leve), UH3OD023288 (Dr. Cindy McEvoy), UH3OD023268 (Dr. Augusto A. Litonjua), UH3OD023305 (Dr. Leonardo Trasande), UH3OD023337 (Dr. Rosalind Wright), UH3OD023347 (Dr. Barry Lester), UH3OD023253 (Dr. Carlos Camargo), UH3OD023279 (Dr. Amy Elliott), UH3OD023271 (Dr. Catherine Karr), UH3OD023348 (Dr. T. Michael O’Shea), UH3OD023249 (Drs. Joseph B. Stanford and Yue Zhang), UH3OD023289 (Dr. Yey Zhu), UH3OD023271 (Dr. Kecia N. Carroll), UH3OD023282 (Dr. Rachel L. Miller).
• Keywords: Science & Technology; AGONIST; DISPARITIES; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; COMMUNITY; CHILDREN; STIMULATION; obesity; MEDIATION; ECHO; MEDICATION USE; QUESTIONNAIRE; DIAGNOSIS; asthma; INCREASES ENERGY-EXPENDITURE; asthma medication; childhood

Abstract

Rationale: Asthma and obesity often co-occur. It has been hypothesized that asthma may contribute to childhood obesity onset. Objectives: To determine if childhood asthma is associated with incident obesity and examine the role of asthma medication in this association. Methods: We studied 8, 716 children between ages 6 and 18.5 years who were nonobese at study entry participating in 18 US cohorts of the Environmental influences on Child Health Outcomes program (among 7, 299 children with complete covariate data mean [SD] study entry age = 7.2 [1.6] years and follow up = 5.3 [3.1] years). Measurements and Main Results: We defined asthma based on caregiver report of provider diagnosis. Incident obesity was defined as the first documented body mass index ≥95th percentile for age and sex following asthma status ascertainment. Over the study period, 26% of children had an asthma diagnosis and 11% developed obesity. Cox proportional hazards models with sex-specific baseline hazards were fitted to assess the association of asthma diagnosis with obesity incidence. Children with asthma had a 23% (95% confidence intervals [CI] = 4, 44) higher risk for subsequently developing obesity compared with those without asthma. A novel mediation analysis was also conducted to decompose the total asthma effect on obesity into pathways mediated and not mediated by asthma medication use. Use of asthma medication attenuated the total estimated effect of asthma on obesity by 64% (excess hazard ratios = 0.64; 95% CI = -1.05, -0.23). Conclusions: This nationwide study supports the hypothesis that childhood asthma is associated with later risk of obesity. Asthma medication may reduce this association and merits further investigation as a potential strategy for obesity prevention among children with asthma.