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Overweight, Obesity, and Incident Asthma

A Meta-analysis of Prospective Epidemiologic Studies

¹ Department of Medicine, National Jewish Medical and Research Center, Denver, Colorado; and ² University of Colorado at Denver and Health Sciences Center, Denver, Colorado

Correspondence and requests for reprints should be addressed to E. Rand Sutherland, M.D., M.P.H., National Jewish Medical and Research Center, 1400 Jackson Street, J220, Denver, CO 80206. E-mail: sutherlande{at}njc.org

Rationale: Although obesity has been implicated as an asthma risk factor, there is heterogeneity in the published literature regarding its role in asthma incidence, particularly in men.

Objectives: To quantify the relationship between categories of body mass index (BMI) and incident asthma in adults and to evaluate the impact of sex on this relationship.

Methods: Online bibliographic databases were searched for prospective studies evaluating BMI and incident asthma in adults. Independent observers extracted data regarding annualized asthma incidence from studies meeting predetermined criteria, within defined categories of normal weight (BMI < 25), overweight (BMI, 25–29.9), and obesity (BMI 30). Data were analyzed by inverse-variance–weighted, random-effects meta-analysis. Stratified analysis between BMI categories and within sex was performed.

Results: Seven studies (n = 333,102 subjects) met inclusion criteria. Compared with normal weight, overweight and obesity (BMI 25) conferred increased odds of incident asthma, with an odds ratio (OR) of 1.51 (95% confidence interval [CI], 1.27–1.80). A dose–response effect of elevated BMI on asthma incidence was observed; the OR for incident asthma for normal-weight versus overweight subjects was 1.38 (95% CI, 1.17–1.62) and was further elevated for normal weight versus obesity (OR, 1.92; 95% CI, 1.43–2.59; p < 0.0001 for the trend). A similar increase in the OR of incident asthma due to overweight and obesity was observed in men (OR, 1.46; 95% CI, 1.05–2.02) and women (OR, 1.68; 95% CI, 1.45–1.94; p = 0.232 for the comparison).

Conclusions: Overweight and obesity are associated with a dose-dependent increase in the odds of incident asthma in men and women, suggesting asthma incidence could be reduced by interventions targeting overweight and obesity.

Key Words: risk factors • epidemiology • body weight • respiratory tract diseases

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Although obesity has been implicated as an asthma risk factor, there is heterogeneity in the published literature regarding its role in asthma incidence, particularly in men. What This Study Adds to the Field Asthma incidence increases by 50% in overweight/obese individuals. There is a dose–response relationship between body weight and asthma, and female sex does not disproportionately affect the obesity–asthma relationship.

 

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