J Korean Med Sci.  2011 Dec;26(12):1541-1547. 10.3346/jkms.2011.26.12.1541.

Association Between Body Mass Index and Asthma Symptoms Among Korean Children: A Nation-Wide Study

• Suh M
• Kim HH
• Choi DP
• Kim KW
• Sohn MH
• Ha KH
• Hwang WJ
• Kim C
• Kim KE
• Shin DC

• KMID: 1786008
• DOI: http://doi.org/10.3346/jkms.2011.26.12.1541

Abstract

The purpose of this study was to investigate the association between body mass index (BMI) and the prevalence of wheeze using nation-wide cross-sectional study in Korean children. Total 50,200 children from 427 elementary schools were randomly selected according to residential areas (metropolitan, provincial, rural, and industrial areas) by the cluster sampling method. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires were used to measure the prevalence of wheeze. Among 31,026 respondents, 25,322 were analyzed. BMI was classified into quartiles based on BMI-for-age percentile. In all residential areas, pets at home and visible mold or moisture were associated with an increased prevalence of wheeze in both genders. However, other living environment factors were not consistently associated among residential areas and gender. Among girls, lowest BMI was negatively associated with prevalence of wheeze and highest BMI was positively associated in all residential areas. In multilevel logistic regression analysis, environmental tobacco smoking exposure, pets at home, visible mold or moisture, and being in the lowest and highest BMI quartile were significantly associated with the prevalence of wheeze in both genders. BMI has become an important risk factor for asthma symptoms among Korean children.

Keyword

Asthma; Body Mass Index; Child; Residence Characteristics

MeSH Terms

Allergens
Asthma/*epidemiology
Body Composition
*Body Mass Index
Child
Cross-Sectional Studies
*Environmental Exposure
Female
Fungi/immunology
Humans
Male
Pets/immunology
Questionnaires
Republic of Korea/epidemiology
*Residence Characteristics
Tobacco Smoke Pollution
Water

Reference

1. Hong SJ, Lee MS, Sohn MH, Shim JY, Han YS, Park KS, Ahn YM, Son BK, Lee HB. Korean ISAAC Study Group. Self-reported prevalence and risk factors of asthma among Korean adolescents: 5-year follow-up study, 1995-2000. Clin Exp Allergy. 2004. 34:1556–1562.

2. Kim HM, Park J, Kim HS, Kim DH, Park SH. Obesity and cardiovascular risk factors in Korean children and adolescents aged 10-18 years from the Korean National Health and Nutrition Examination Survey, 1998 and 2001. Am J Epidemiol. 2006. 164:787–793.

3. Suh M, Kim HH, Sohn MH, Kim KE, Kim C, Shin DC. Prevalence of allergic diseases among Korean school-age children: a nationwide cross-sectional questionnaire study. J Korean Med Sci. 2011. 26:332–338.

4. von Mutius E, Schwartz J, Neas LM, Dockery D, Weiss ST. Relation of body mass index to asthma and atopy in children: the National Health and Nutrition Examination Study III. Thorax. 2001. 56:835–838.

5. Scholtens S, Wijga AH, Seidell JC, Brunekreef B, de Jongste JC, Gehring U, Postma DS, Kerkhof M, Smit HA. Overweight and changes in weight status during childhood in relation to asthma symptoms at 8 years of age. J Allergy Clin Immunol. 2009. 123:1312–1318.

6. Hjellvik V, Tverdal A, Furu K. Body mass index as predictor for asthma: a cohort study of 118,723 males and females. Eur Respir J. 2010. 35:1235–1242.

7. Lee SI, Shin MH, Lee HB, Lee JS, Son BK, Koh YY, Kim KE, Ahn YO. Prevalences of symptoms of asthma and other allergic diseases in Korean children: a nationwide questionnaire survey. J Korean Med Sci. 2001. 16:155–164.

8. Hong SJ, Lee MS, Lee SY, Ahn KM, Oh JW, Kim KE, Lee JS, Lee HB. for the Korean ISAAC Study Group. High body mass index and dietary pattern are associated with childhood asthma. Pediatr Pulmonol. 2006. 41:1118–1124.

9. Nordling E, Berglind N, Melén E, Emenius G, Hallberg J, Nyberg F, Pershagen G, Svartengren M, Wickman M, Bellander T. Traffic-related air pollution and childhood respiratory symptoms, function and allergies. Epidemiology. 2008. 19:401–408.

10. Basagaña X, Sunyer J, Kogevinas M, Zock JP, Duran-Tauleria E, Jarvis D, Burney P, Anto JM. Socioeconomic status and asthma prevalence in young adults: the European Community Respiratory Health Survey. Am J Epidemiol. 2004. 160:178–188.

11. Lee SY, Kim YN, Kang YJ, Jang MJ, Kim J, Moon JS, Lee CG, Oh K, Kim YT, Nam CM. The methodology for developing the 2007 Korean growth charts and blood pressure nomogram in Korean children and adolescents. Korean J Pediatr. 2008. 51:26–32.

12. Tai A, Volkmer R, Burton A. Association between asthma symptoms and obesity in preschool (4-5 year old) children. J Asthma. 2009. 46:362–365.

13. Ginde AA, Santillan AA, Clark S, Camargo CA Jr. Body mass index and acute asthma severity among children presenting to the emergency department. Pediatr Allergy Immunol. 2010. 21:480–488.

14. Huang F, del-Río-Navarro BE, Monge JJ, Torres Alcántara S, Ontiveros JA, Olivos EN, Martinez de Castro NG, Zhao L, Hong E. Endothelial activation and systemic inflammation in obese asthmatic children. Allergy Asthma Proc. 2008. 29:453–460.

15. Kim KW, Shin YH, Lee KE, Kim ES, Sohn MH, Kim KE. Relationship between adipokines and manifestations of childhood asthma. Pediatr Allergy Immunol. 2008. 19:535–540.

16. Jang AS, Lee JH, Park SW, Shin MY, Kim DJ, Park CS. Severe airway hyperresponsiveness in school-aged boys with a high body mass index. Korean J Intern Med. 2006. 21:10–14.

17. Thomsen SF, Ulrik CS, Kyvik KO, Sørensen TI, Posthuma D, Skadhauge LR, Steffensen I, Backer V. Association between obesity and asthma in a twin cohort. Allergy. 2007. 62:1199–1204.

18. Hancox RJ, Milne BJ, Poulton R, Taylor DR, Greene JM, McLachlan CR, Cowan JO, Flannery EM, Herbison GP, Sears MR. Sex differences in the relation between body mass index and asthma and atopy in a birth cohort. Am J Respir Crit Care Med. 2005. 171:440–445.

19. Beckett WS, Jacobs DR Jr, Yu X, Iribarren C, Williams OD. Asthma is associated with weight gain in females but not males, independent of physical activity. Am J Respir Crit Care Med. 2001. 164:2045–2050.

20. Villamor E, Iliadou A, Cnattingius S. Is the association between low birth weight and asthma independent of genetic and shared environmental factors? Am J Epidemiol. 2009. 169:1337–1343.

21. Metsälä J, Kilkkinen A, Kaila M, Tapanainen H, Klaukka T, Gissler M, Virtanen SM. Perinatal factors and the risk of asthma in childhood: a population-based register study in Finland. Am J Epidemiol. 2008. 168:170–178.

22. Kim H, Bernstein JA. Air pollution and allergic disease. Curr Allergy Asthma Rep. 2009. 9:128–133.

23. Wong GW, Chow CM. Childhood asthma epidemiology: insights from comparative studies of rural and urban populations. Pediatr Pulmonol. 2008. 43:107–116.

24. Adler A, Tager I, Quintero DR. Decreased prevalence of asthma among farm-reared children compared with those who are rural but not farm-reared. J Allergy Clin Immunol. 2005. 115:67–73.

25. Tantisira KG, Colvin R, Tonascia J, Strunk RC, Weiss ST, Fuhlbrigge AL. Childhood Asthma Management Program Research Group. Airway responsiveness in mild to moderate childhood asthma: sex influences on the natural history. Am J Respir Crit Care Med. 2008. 178:325–331.

26. Banach A, Wade TJ, Cairney J, Hay JA, Faught BE, O'Leary DD. Comparison of anthropometry and parent-reported height and weight among nine year olds. Can J Public Health. 2007. 98:251–253.

27. Krul AJ, Daanen HA, Choi H. Self-reported and measured weight, height and body mass index (BMI) in Italy, the Netherlands and North America. Eur J Public Health. 2011. 21:414–419.

28. Crane J, Mallol J, Beasley R, Stewart A, Asher MI. International Study of Asthma and Allergies in Childhood Phase I Study Group. Agreement between written and video questions for comparing asthma symptoms in ISAAC. Eur Respir J. 2003. 21:455–461.

29. Musaad SM, Patterson T, Ericksen M, Lindsey M, Dietrich K, Succop P, Khurana Hershey GK. Comparison of anthropometric measures of obesity in childhood allergic asthma: central obesity is most relevant. J Allergy Clin Immunol. 2009. 123:1321–1327.

30. Lindsay RS, Hanson RL, Roumain J, Ravussin E, Knowler WC, Tataranni PA. Body mass index as a measure of adiposity in children and adolescents: relationship to adiposity by dual energy x-ray absorptiometry and to cardiovascular risk factors. J Clin Endocrinol Metab. 2001. 86:4061–4067.