Overweight in relation to allergic disease in childhood and adolescence

Abstract

The prevalences of childhood overweight and allergic diseases have increased in parallel during the last decades. The overall aim of this thesis was to investigate the associations between overweight (maternal and childhood) and allergic diseases, as well as lung function, throughout childhood up to adolescence. In addition, we investigated the validity of self-reported height, weight and corresponding body mass index (BMI) among Swedish adolescents.

All studies were based on the BAMSE study, a population-based birth cohort of 4,089 children followed until age 16 years. Maternal BMI was obtained from the Swedish medical birth register, while childhood BMI was measured at clinical investigations, collected from child and school health care records and self-reported. Allergic diseases were assessed by repeated questionnaires regarding symptoms and medications, while allergic sensitization to inhalant allergens was defined by the presence of specific immunoglobulin E (IgE)-antibodies in blood. Lung function was measured by spirometry at 8 and 16 years and by impulse oscillometry (IOS) at 16 years.

The results of Study I showed that maternal BMI in early pregnancy was associated with asthma, but not rhinitis, eczema or allergic sensitization in the offspring up to 16 years. The association was strongest for persistent asthma, while no increased risk was observed for transient asthma. Categorization of maternal BMI showed that maternal obesity, but not overweight, was significantly associated with childhood asthma. However, the child’s own weight status could partly explain the observed association between maternal BMI and asthma in the offspring.

In Study II, we found that girls with persistent asthma had a higher BMI and an increased risk of overweight throughout childhood, compared to girls without asthma. Girls with transient asthma had an increased risk of overweight at ages 4-7.9 years, whereas girls with late-onset asthma had a tendency towards an increased risk of overweight at age ≥15 years. In boys, the difference in BMI between children with and without asthma was smaller, and no consistent association was observed between asthma phenotypes and overweight.

In Study III, we observed that overweight and obesity at age 8 years were associated with increased forced vital capacity (FVC) and to some extent forced expiratory volume in one second (FEV1), but reduced FEV1/FVC ratios at 8 and 16 years. The strongest association with FEV1/FVC was observed for persistent overweight at both 8 and 16 years, whereas no significant association was found for transient overweight. Cross-sectional analyses of IOS showed that overweight and obesity were associated with higher peripheral airway resistance and reactance at 16 years.

The result of Study IV showed that self-reported and measured height and weight were highly correlated at 16 years (r=0.98 for height, r=0.96 for weight). On average, self-reported weight was underreported by 1.1 kg and height was overreported by 0.5 cm, leading to an underestimation of BMI by 0.5 kg/m2. The accuracy of self-reported BMI was somewhat lower among girls and among overweight and obese participants, compared to normal weight participants.

Our results suggest that maternal and childhood overweight and obesity are associated with asthma and evidence of airway obstruction in children and adolescents. The association between maternal BMI and asthma may, to some extent, be mediated through childhood overweight and seems to be explained by non-allergic mechanisms. In addition, we conclude that web-based self-reported BMI can be used as a valid, quick and cost-effective alternative to measured BMI among Swedish adolescents. The accuracy however declines with increasing BMI, and is somewhat lower among girls compared to boys.