Asthma and lower airway disease
Body mass index trajectory classes and incident asthma in childhood: Results from 8 European Birth Cohorts—a Global Allergy and Asthma European Network initiative

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Background

The causal link between body mass index (BMI) or obesity and asthma in children is still being debated. Analyses of large longitudinal studies with a sufficient number of incident cases and in which the time-dependent processes of both excess weight and asthma development can be validly analyzed are lacking.

Objective

We sought to investigate whether the course of BMI predicts incident asthma in childhood.

Methods

Data from 12,050 subjects of 8 European birth cohorts on asthma and allergies were combined. BMI and doctor-diagnosed asthma were modeled during the first 6 years of life with latent growth mixture modeling and discrete time hazard models. Subpopulations of children were identified with similar standardized BMI trajectories according to age- and sex-specific “World Health Organization (WHO) child growth standards” and “WHO growth standards for school aged children and adolescents” for children up to age 5 years and older than 5 years, respectively (BMI-SDS). These types of growth profiles were analyzed as predictors for incident asthma.

Results

Children with a rapid BMI-SDS gain in the first 2 years of life had a higher risk for incident asthma up to age 6 years than children with a less pronounced weight gain slope in early childhood. The hazard ratio was 1.3 (95% CI, 1.1-1.5) after adjustment for birth weight, weight-for-length at birth, gestational age, sex, maternal smoking in pregnancy, breast-feeding, and family history of asthma or allergies. A rapid BMI gain at 2 to 6 years of age in addition to rapid gain in the first 2 years of life did not significantly enhance the risk of asthma.

Conclusion

Rapid growth in BMI during the first 2 years of life increases the risk of asthma up to age 6 years.

Section snippets

Study design and population

Inclusion criteria for the present analyses were anthropometric measurement of weight and length at birth with at least 3 follow-ups over the first 6 years of life and reported asthma diagnosis for at least 2 follow-ups. In addition, data on age at each measurement for both weight and height and asthma diagnosis needed to be available.

The number of infants at birth and at each measurement period with anthropometric measurements of weight and height are listed in Table I for each analyzed birth

Results

The average BMI-SDS and its SD at birth and for each follow-up year for each study and separated for boys and girls seem to be, with some exceptions (AMICS-Barcelona at years 1, 3, 4, and 6 for boys; AMICS-Menorca at years 3 and 4 for boys; and GINIplus at birth), rather homogenous across the cohorts (Table II).18, 19

The percentage of incident asthma events is 4.1% in the first 2 years of life and 2.8% and 2.5% in the time periods of 3 to 4 years and 5 to 6 years, respectively.

Estimates of

Discussion

Children with a rapid BMI-SDS gain in the first 2 years of life (BMI-SDS trajectory classes 3 and 2) had a higher risk for asthma incidence within the first 6 years of life than children with a less pronounced weight gain slope in childhood (BMI-SDS trajectory class 1). For children with a persistent rapid BMI-SDS gain from birth up to age 6 years (class 3), this effect on incident asthma was similar but not statistically significant, even without adjustment for sex, birth weight,

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    Supported by the Global Allergy and Asthma European Network (GA2LEN) under the Sixth Framework Programme for Research of the European Union (project no. FOOD-CT-2004-506378) and the “Kompetenznetz Adipositas (Competence Network Obesity)” funded by the Federal Ministry of Education and Research of Germany (FKZ: 01GI0826). Personal and financial support was provided by the Munich Center of Health Sciences (MCHEALTH) as part of the Munich Ludwigs-Maximilians-Universität LMU innovative is gratefully acknowledged. Each of the 8 analyzed birth cohorts had their own funding. The GINIplus study was funded for 3 years by grants of the Federal Ministry for Education, Science, Research, and Technology (Grant No. 01 EE 9401-4), and the 6-year follow-up of the GINIplus study was partly funded by the Federal Ministry of Environment (IUF, FKZ 20462296). The LISAplus study was funded by grants of the Federal Ministry for Education, Science, Research, and Technology (Grant No. 01 EG 9705/2 and 01EG9732), and the 6-year follow-up of the LISAplus study was partly funded by the Federal Ministry of Environment (IUF, FKS 20462296). The MAS study was funded by grants from the German Federal Ministry of Education and Research (BMBF; reference nos. 07015633, 07 ALE 27, 01EE9405/5, 01EE9406) and the German Research Foundation (DFG; reference no. KE 1462/2-1). The DARC study was funded by Danish National Ministry of Health. The PIAMA-NHS study received funding from The Netherlands Organization for Health Research and Development; The Netherlands Organization for Scientific Research; The Netherlands Asthma Fund, The Netherlands Ministry of Spatial Planning Housing, and the Environment; and The Netherlands Ministry of Health, Welfare, and Sport. PIPO was funded by the Research Foundation Flanders (FWO, Fonds Wetenschappelijk Onderzoek Vlaanderen) and by the Ministry of Health of the Flemish Community. The AMICS-Barcelona study was funded by Fondo de Investigación Sanitaria, ISCIII, Ministero de Sanidad y Servicios Sociales, Spain (FIS 95/0314, FIS 96/0799, FIS 00/0021, FIS 03/0296), Istituto Superiore di Sanitá, CIRT-1999 SGR 00241, COLT Foundation and the Fifth European Program (QLK4-CT-2000-00263). The AMICS-Menorca study was funded by Fondo de Investigación Sanitaria, ISCIII, Ministerio de Sanidad y Servicios Sociales, Spain (grants G03/176, CB06/02/0041, 97/0588, 00/0021-2, PI061756 and PS0901958), EC contract no. QLK4-CT-2000-00263 and Fundacion Roger Torne.

    Disclosure of potential conflict of interest: T. Keil has received grants from and is employed by Charité Berlin. The rest of the authors declare that they have no relevant conflicts of interest.

    For a list of study group members, see this article’s Online Repository at www.jacionline.org.

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