Asthma and lower airway disease
Asthma control, adiposity, and adipokines among inner-city adolescents

https://doi.org/10.1016/j.jaci.2010.01.053Get rights and content

Background

There is an association between adiposity and asthma prevalence, but the relationship to asthma control is unclear.

Objectives

We sought to understand the relationships among adiposity, sex, and asthma control in inner-city adolescents with asthma.

Methods

We prospectively followed 368 adolescents with moderate-to-severe asthma (ages 12-20 years) living in 10 urban areas for 1 year. Asthma symptoms and exacerbations were recorded, and pulmonary function and exhaled nitric oxide levels were measured every 6 weeks. Adiposity measures (body mass index [BMI] and dual-energy X-ray absorptiometric scans) were made, and blood was collected for measurement of allergy markers, adiponectin, leptin, TNF-α, IL-6, and C-reactive protein levels.

Results

More than 60% of female subjects and 50% of male subjects were above the 85th percentile of BMI for age. Higher BMI was associated with more symptom days (R = 0.18, P = .02) and exacerbations (R = 0.18, P = .06) among female subjects only. Adiponectin was inversely related to asthma symptoms (R = −0.18, P < .05) and exacerbations (R = −0.20, P < .05) and positively with FEV1/forced vital capacity ratio (R = 0.15, P < .05) in male subjects only independent of body size. There was no relationship between adiposity or adipokines and total IgE levels, blood eosinophil counts, and exhaled nitric oxide levels. Dual-energy X-ray absorptiometry provided little additional value in relating adiposity to asthma outcome in this population of adolescents.

Conclusion

Adiposity is associated with poorer asthma control in female subjects. Adiponectin is associated with improved asthma control in male subjects.

Section snippets

Study design and population

The Asthma Adiposity Study included 368 adolescents 12 to 20 years of age enrolled from among ACE study participants in 10 major urban areas of the United States. All appropriate institutional review boards approved this study. Written informed consent and assent were obtained. The ACE study was a randomized, double-blind, parallel-group trial with a 3-week run-in period to characterize participants, establish treatment, and evaluate adherence.37 The main objective of the ACE study was to

Results

The average age of the Asthma Adiposity Study participants was 14.2 (± 2.0) years, and slightly more than half were male (54.1%). Nearly two thirds were African American (62.5%), and the remainder were predominantly Hispanic (22.6%). Family income levels were low, with approximately 50% having incomes of less than $15,000 per year. Because most research investigations have found effects of obesity to differ between male and female subjects, the initial characteristics table (Table I) presents

Discussion

In this study of inner-city adolescents with asthma, we have provided an extensive analysis of the relationship between obesity and asthma morbidity using a prospective, well-characterized, and closely monitored cohort. Our major finding is that, as in the case between asthma prevalence and obesity,19, 20 sex has substantial influence on the relationship of adiposity to asthma morbidity. In female adolescents only, increased BMI and body fat were associated with worse asthma control, more

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    This project has been funded in whole or in part with Federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, under contract numbers NO1-AI-25496 and NO1-JAI-25482 and from the National Center for Research Resources, National Institutes of Health, under grants RR00052, M01RR00533, M01RR00071, 5UL1RR024992-02, and 5M01RR020359-04.

    Disclosure of potential conflict of interest: J. Kumar has received research support from the National Heart, Lung, and Blood Institute; is President of the Illinois Society of Allergy, Asthma, and Immunology; and is a member of the American Thoracic Society. G. R. Bloomberg has received research support from the National Institutes of Health/National Institute of Allergy and Infectious Diseases. H. Mitchell has received research support from the National Institutes of Health/National Institute of Allergy and Infectious Diseases. C. M. Kercsmar is on the Speakers' Bureau for Merck; and has received research support from Sepracor. E. Matsui has received research support from the National Institutes of Health. S. Steinback has received research support from the National Institutes of Health/National Institute of Allergy and Infectious Diseases; and has served as an expert witness on the topic of bronchiolitis. S. J. Szefler is a Consultant for GlaxoSmithKline, Genentech, Merck, Boeringher-Ingelheim, Novartis, and Schering Plough; has received research support from the NIH/NHLBI Childhood Management Program (CAMP), NHLBI Childhood Asthma Research and Education (CARE), NIH/NHLBI Asthma Clin Res Network (ACRN), NIH/NIAID Inner City Asthma Consortium (ICAC), GlaxoSmithKline, NJH/NHLBI Asthma Net, and NEEHS/EPA Childhood Environmental Health Center Grant. C. A. Sorkness is on the Advisory Board for GlaxoSmithKline, Schering Plough, AstraZeneca, and Novartis; and has received research support from Schering Plough and Sanofi. W. J. Morgan is a consultant for, and Chair of the Data Safety Monitoring Board for the Cystic Fibrosis Foundation; is a Consultant and Chair of the North American Scientific Advisory Group for the Epidemiologic Study of Cystic Fibrosis for Genentech; is a Consultant for Novartis; has received research support from the NIH/University of Wisconsin and Novartis. S. J. Teach has received research support from Novartis; has served as an expert witness on the topics of wheezing, pneumonia, and dehydration; and is a volunteer for the NIAID Food Allergy Guidelines. V. N. Gan has received research support from Baylor College of Medicine/Texas Department of State Health Services. The other authors declare they have no conflicts of interest.

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