The role of childhood Asthma in obesity development: A Nationwide US Multicohort Study

behalf of program collaborators for Environmental Influences on Child Health Outcomes

doi:10.1097/ede.0000000000001421

The role of childhood Asthma in obesity development: A Nationwide US Multicohort Study

behalf of program collaborators for Environmental Influences on Child Health Outcomes

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Rationale: Asthma and obesity often co-occur. It has been hypothesized that asthma may contribute to childhood obesity onset. Objectives: To determine if childhood asthma is associated with incident obesity and examine the role of asthma medication in this association. Methods: We studied 8, 716 children between ages 6 and 18.5 years who were nonobese at study entry participating in 18 US cohorts of the Environmental influences on Child Health Outcomes program (among 7, 299 children with complete covariate data mean [SD] study entry age = 7.2 [1.6] years and follow up = 5.3 [3.1] years). Measurements and Main Results: We defined asthma based on caregiver report of provider diagnosis. Incident obesity was defined as the first documented body mass index ≥95th percentile for age and sex following asthma status ascertainment. Over the study period, 26% of children had an asthma diagnosis and 11% developed obesity. Cox proportional hazards models with sex-specific baseline hazards were fitted to assess the association of asthma diagnosis with obesity incidence. Children with asthma had a 23% (95% confidence intervals [CI] = 4, 44) higher risk for subsequently developing obesity compared with those without asthma. A novel mediation analysis was also conducted to decompose the total asthma effect on obesity into pathways mediated and not mediated by asthma medication use. Use of asthma medication attenuated the total estimated effect of asthma on obesity by 64% (excess hazard ratios = 0.64; 95% CI = -1.05, -0.23). Conclusions: This nationwide study supports the hypothesis that childhood asthma is associated with later risk of obesity. Asthma medication may reduce this association and merits further investigation as a potential strategy for obesity prevention among children with asthma.

Original language	English (US)
Pages (from-to)	131-140
Number of pages	10
Journal	Epidemiology
Volume	33
Issue number	1
DOIs	https://doi.org/10.1097/ede.0000000000001421
State	Published - Jan 1 2022

Bibliographical note

Funding Information:
Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, under award numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), and UH3OD023287 (L.C.), UH3OD023318 (A.D.), UH3OD023282 (J.G. and D.G.), UH3OD023287 (C.B. and F.G.), UH3OD023365 (I.H.-P.), UH3OD02375 (M.K.), UH3OD023248 (D.D.), UH3OD023286 (E.O.), UH3OD023320 (J.A.), UH3OD023349 (T.O’C.), UH3OD023389 (L.L.), UH3OD023288 (C.M.E.), UH3OD023268 (A.A.L.), UH3OD023305 (L.T.), UH3OD023337 (R.W.), UH3OD023347 (B.L.), UH3OD023253 (C.C.), UH3OD023279 (A.E.), UH3OD023271 (C.K.), UH3OD023348 (T.M.O’S.), UH3OD023249 (J.B.S. and Y.Z.), UH3OD023289 (Y.Z.), UH3OD023271 (K.N.C.), UH3OD023282 (R.L.M.). N.S. was supported by NIH R21 ES029681 and P30 ES007048-23, and NIH P30 DK048522-24. E.G. was supported by NIH P50 ES026086-04S1. L.C. was additionally supported by NIH R01ES029944, R01ES030364, R01ES030691, R21ES28903, R21ES029681, and P30ES007048. A.D. was additionally supported by NIH R24ES029490, R01NR014800, and P50ES026071. C.B. was additionally supported by NIH P30ES007048, P50ES026086, and EPA grant R83615801. I.H.-P. and collection of data for the CHARGE/ReCHARGE cohort were additionally supported by NIEHS R01ES015359, and NIH UG3OD023365. M.K. was additionally supported by NIH P01ES022832, and US EPA: RD83544201. D.D. was additionally supported by NIH R01 DK076648. E.O. and data collection for Project Viva were additionally supported by R01 HD034568. J.A. was additionally supported by NIH R34 HL142995. T.O’C. was additionally supported by NIH R01 097293. L.L. was additionally supported by NIH R01 HD042608, R01 DA020585, R01 DK090264. A.B. was supported by NIH R01 HL135235, P01HL108808, and R01 ES025124. C.M. was additionally supported by NIH R01 HL105447. B.L. was additionally supported by NIH/NICHD—R01HD072267. A.E. was additionally supported by NIH U01HD045935. C.K. was additionally supported by UG3OD023271. J.B.S. and Y.Z. were additionally supported by NIH 1UG3OD023249. Y.Z. was additionally supported by NIH UG3OD023289 and K01DK120807. E.C. was additionally supported by NIH UG3OD023281. B.L. was additionally supported by NIH/OD—UG3OD023347. I.M.A. was additionally supported by NIH R01 HD0345568 and UG3OD023286. K.N.C. was additionally supported by UG3OD023271, R01 HL109977, and R01 HL132338. J.G. was additionally supported by UM1 AI114271. A.A.was supported by NIH UH3 OD023251. N.T.M. was additionally supported by NIH K01HL141589. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding Information:
Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, under award numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), and UH3OD023287 (L.C.), UH3OD023318 (A.D.), UH3OD023282 (J.G. and D.G.), UH3OD023287 (C.B. and F.G.), UH3OD023365 (I.H.-P.), UH3OD02375 (M.K.), UH3OD023248 (D.D.), UH3OD023286 (E.O.), UH3OD023320 (J.A.), UH3OD023349 (T.O'C.), UH3OD023389 (L.L.), UH3OD023288 (C.M.E.), UH3OD023268 (A.A.L.), UH3OD023305 (L.T.), UH3OD023337 (R.W.), UH3OD023347 (B.L.), UH3OD023253 (C.C.), UH3OD023279 (A.E.), UH3OD023271 (C.K.), UH3OD023348 (T.M.O'S.), UH3OD023249 (J.B.S. and Y.Z.), UH3OD023289 (Y.Z.), UH3OD023271 (K.N.C.), UH3OD023282 (R.L.M.). N.S. was supported by NIH R21 ES029681 and P30 ES007048-23, and NIH P30 DK048522- 24. E.G. was supported by NIH P50 ES026086-04S1. L.C. was additionally supported by NIH R01ES029944, R01ES030364, R01ES030691, R21ES28903, R21ES029681, and P30ES007048. A.D. was additionally supported by NIH R24ES029490, R01NR014800, and P50ES026071. C.B. was additionally supported by NIH P30ES007048, P50ES026086, and EPA grant R83615801. I.H.-P. and collection of data for the CHARGE/ReCHARGE cohort were additionally supported by NIEHS R01ES015359, and NIH UG3OD023365. M.K. was additionally supported by NIH P01ES022832, and US EPA: RD83544201. D.D. was additionally supported by NIH R01 DK076648. E.O. and data collection for Project Viva were additionally supported by R01 HD034568. J.A. was additionally supported by NIH R34 HL142995. T.O'C. was additionally supported by NIH R01 097293. L.L. was additionally supported by NIH R01 HD042608, R01 DA020585, R01 DK090264. A.B. was supported by NIH R01 HL135235, P01HL108808, and R01 ES025124. C.M. was additionally supported by NIH R01 HL105447. B.L. was additionally supported by NIH/NICHD - R01HD072267. A.E. was additionally supported by NIH U01HD045935. C.K. was additionally supported by UG3OD023271. J.B.S. and Y.Z. were additionally supported by NIH 1UG3OD023249. Y.Z. was additionally supported by NIH UG3OD023289 and K01DK120807. E.C. was additionally supported by NIH UG3OD023281. B.L. was additionally supported by NIH/OD - UG3OD023347. I.M.A. was additionally supported by NIH R01 HD0345568 and UG3OD023286. K.N.C. was additionally supported by UG3OD023271, R01 HL109977, and R01 HL132338. J.G. was additionally supported by UM1 AI114271. A.A.was supported by NIH UH3 OD023251. N.T.M. was additionally supported by NIH K01HL141589. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

Asthma
Asthma medication
Childhood
ECHO
Obesity

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Publisher link

10.1097/ede.0000000000001421

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Cite this

@article{71c2c6a3fb314af0a3fcba80b9e1f103,

title = "The role of childhood Asthma in obesity development: A Nationwide US Multicohort Study",

abstract = "Rationale: Asthma and obesity often co-occur. It has been hypothesized that asthma may contribute to childhood obesity onset. Objectives: To determine if childhood asthma is associated with incident obesity and examine the role of asthma medication in this association. Methods: We studied 8, 716 children between ages 6 and 18.5 years who were nonobese at study entry participating in 18 US cohorts of the Environmental influences on Child Health Outcomes program (among 7, 299 children with complete covariate data mean [SD] study entry age = 7.2 [1.6] years and follow up = 5.3 [3.1] years). Measurements and Main Results: We defined asthma based on caregiver report of provider diagnosis. Incident obesity was defined as the first documented body mass index ≥95th percentile for age and sex following asthma status ascertainment. Over the study period, 26% of children had an asthma diagnosis and 11% developed obesity. Cox proportional hazards models with sex-specific baseline hazards were fitted to assess the association of asthma diagnosis with obesity incidence. Children with asthma had a 23% (95% confidence intervals [CI] = 4, 44) higher risk for subsequently developing obesity compared with those without asthma. A novel mediation analysis was also conducted to decompose the total asthma effect on obesity into pathways mediated and not mediated by asthma medication use. Use of asthma medication attenuated the total estimated effect of asthma on obesity by 64% (excess hazard ratios = 0.64; 95% CI = -1.05, -0.23). Conclusions: This nationwide study supports the hypothesis that childhood asthma is associated with later risk of obesity. Asthma medication may reduce this association and merits further investigation as a potential strategy for obesity prevention among children with asthma.",

keywords = "Asthma, Asthma medication, Childhood, ECHO, Obesity",

author = "{behalf of program collaborators for Environmental Influences on Child Health Outcomes} and Nikos Stratakis and Erika Garcia and Aruna Chandran and Tingju Hsu and Akram Alshawabkeh and Aris, {Izzuddin M.} and Aschner, {Judy L.} and Carrie Breton and Allison Burbank and Camargo, {Carlos A.} and Carroll, {Kecia N.} and Zhanghua Chen and Claud, {Erika C.} and Dana Dabelea and Dunlop, {Anne L.} and Elliott, {Amy J.} and Assiamira Ferrara and Ganiban, {Jody M.} and Gern, {James E.} and Gold, {Diane R.} and Gower, {William A.} and Irva Hertz-Picciotto and Karagas, {Margaret R.} and Karr, {Catherine J.} and Barry Lester and Leve, {Leslie D.} and Litonjua, {Augusto A.} and Yunin Ludena and McEvoy, {Cindy T.} and Miller, {Rachel L.} and Mueller, {Noel T.} and O'Connor, {Thomas G.} and Emily Oken and O'Shea, {T. Michael} and Frederica Perera and Stanford, {Joseph B.} and Katherine Rivera-Spoljaric and Andrew Rundle and Leonardo Trasande and Wright, {Rosalind J.} and Yue Zhang and Yeyi Zhu and Kiros Berhane and Frank Gilliland and Lida Chatzi and Benjamin, {D. K.} and Smith, {P. B.} and Newby, {K. L.} and Hecht, {S. S.} and Jacobson, {L. P.}",

note = "Funding Information: Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, under award numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), and UH3OD023287 (L.C.), UH3OD023318 (A.D.), UH3OD023282 (J.G. and D.G.), UH3OD023287 (C.B. and F.G.), UH3OD023365 (I.H.-P.), UH3OD02375 (M.K.), UH3OD023248 (D.D.), UH3OD023286 (E.O.), UH3OD023320 (J.A.), UH3OD023349 (T.O{\textquoteright}C.), UH3OD023389 (L.L.), UH3OD023288 (C.M.E.), UH3OD023268 (A.A.L.), UH3OD023305 (L.T.), UH3OD023337 (R.W.), UH3OD023347 (B.L.), UH3OD023253 (C.C.), UH3OD023279 (A.E.), UH3OD023271 (C.K.), UH3OD023348 (T.M.O{\textquoteright}S.), UH3OD023249 (J.B.S. and Y.Z.), UH3OD023289 (Y.Z.), UH3OD023271 (K.N.C.), UH3OD023282 (R.L.M.). N.S. was supported by NIH R21 ES029681 and P30 ES007048-23, and NIH P30 DK048522-24. E.G. was supported by NIH P50 ES026086-04S1. L.C. was additionally supported by NIH R01ES029944, R01ES030364, R01ES030691, R21ES28903, R21ES029681, and P30ES007048. A.D. was additionally supported by NIH R24ES029490, R01NR014800, and P50ES026071. C.B. was additionally supported by NIH P30ES007048, P50ES026086, and EPA grant R83615801. I.H.-P. and collection of data for the CHARGE/ReCHARGE cohort were additionally supported by NIEHS R01ES015359, and NIH UG3OD023365. M.K. was additionally supported by NIH P01ES022832, and US EPA: RD83544201. D.D. was additionally supported by NIH R01 DK076648. E.O. and data collection for Project Viva were additionally supported by R01 HD034568. J.A. was additionally supported by NIH R34 HL142995. T.O{\textquoteright}C. was additionally supported by NIH R01 097293. L.L. was additionally supported by NIH R01 HD042608, R01 DA020585, R01 DK090264. A.B. was supported by NIH R01 HL135235, P01HL108808, and R01 ES025124. C.M. was additionally supported by NIH R01 HL105447. B.L. was additionally supported by NIH/NICHD—R01HD072267. A.E. was additionally supported by NIH U01HD045935. C.K. was additionally supported by UG3OD023271. J.B.S. and Y.Z. were additionally supported by NIH 1UG3OD023249. Y.Z. was additionally supported by NIH UG3OD023289 and K01DK120807. E.C. was additionally supported by NIH UG3OD023281. B.L. was additionally supported by NIH/OD—UG3OD023347. I.M.A. was additionally supported by NIH R01 HD0345568 and UG3OD023286. K.N.C. was additionally supported by UG3OD023271, R01 HL109977, and R01 HL132338. J.G. was additionally supported by UM1 AI114271. A.A.was supported by NIH UH3 OD023251. N.T.M. was additionally supported by NIH K01HL141589. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, under award numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), and UH3OD023287 (L.C.), UH3OD023318 (A.D.), UH3OD023282 (J.G. and D.G.), UH3OD023287 (C.B. and F.G.), UH3OD023365 (I.H.-P.), UH3OD02375 (M.K.), UH3OD023248 (D.D.), UH3OD023286 (E.O.), UH3OD023320 (J.A.), UH3OD023349 (T.O'C.), UH3OD023389 (L.L.), UH3OD023288 (C.M.E.), UH3OD023268 (A.A.L.), UH3OD023305 (L.T.), UH3OD023337 (R.W.), UH3OD023347 (B.L.), UH3OD023253 (C.C.), UH3OD023279 (A.E.), UH3OD023271 (C.K.), UH3OD023348 (T.M.O'S.), UH3OD023249 (J.B.S. and Y.Z.), UH3OD023289 (Y.Z.), UH3OD023271 (K.N.C.), UH3OD023282 (R.L.M.). N.S. was supported by NIH R21 ES029681 and P30 ES007048-23, and NIH P30 DK048522- 24. E.G. was supported by NIH P50 ES026086-04S1. L.C. was additionally supported by NIH R01ES029944, R01ES030364, R01ES030691, R21ES28903, R21ES029681, and P30ES007048. A.D. was additionally supported by NIH R24ES029490, R01NR014800, and P50ES026071. C.B. was additionally supported by NIH P30ES007048, P50ES026086, and EPA grant R83615801. I.H.-P. and collection of data for the CHARGE/ReCHARGE cohort were additionally supported by NIEHS R01ES015359, and NIH UG3OD023365. M.K. was additionally supported by NIH P01ES022832, and US EPA: RD83544201. D.D. was additionally supported by NIH R01 DK076648. E.O. and data collection for Project Viva were additionally supported by R01 HD034568. J.A. was additionally supported by NIH R34 HL142995. T.O'C. was additionally supported by NIH R01 097293. L.L. was additionally supported by NIH R01 HD042608, R01 DA020585, R01 DK090264. A.B. was supported by NIH R01 HL135235, P01HL108808, and R01 ES025124. C.M. was additionally supported by NIH R01 HL105447. B.L. was additionally supported by NIH/NICHD - R01HD072267. A.E. was additionally supported by NIH U01HD045935. C.K. was additionally supported by UG3OD023271. J.B.S. and Y.Z. were additionally supported by NIH 1UG3OD023249. Y.Z. was additionally supported by NIH UG3OD023289 and K01DK120807. E.C. was additionally supported by NIH UG3OD023281. B.L. was additionally supported by NIH/OD - UG3OD023347. I.M.A. was additionally supported by NIH R01 HD0345568 and UG3OD023286. K.N.C. was additionally supported by UG3OD023271, R01 HL109977, and R01 HL132338. J.G. was additionally supported by UM1 AI114271. A.A.was supported by NIH UH3 OD023251. N.T.M. was additionally supported by NIH K01HL141589. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: Copyright {\textcopyright} 2021 Wolters Kluwer Health, Inc. All rights reserved.",

year = "2022",

month = jan,

day = "1",

doi = "10.1097/ede.0000000000001421",

language = "English (US)",

volume = "33",

pages = "131--140",

journal = "Epidemiology",

issn = "1044-3983",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

TY - JOUR

T1 - The role of childhood Asthma in obesity development

T2 - A Nationwide US Multicohort Study

AU - behalf of program collaborators for Environmental Influences on Child Health Outcomes

AU - Stratakis, Nikos

AU - Garcia, Erika

AU - Chandran, Aruna

AU - Hsu, Tingju

AU - Alshawabkeh, Akram

AU - Aris, Izzuddin M.

AU - Aschner, Judy L.

AU - Breton, Carrie

AU - Burbank, Allison

AU - Camargo, Carlos A.

AU - Carroll, Kecia N.

AU - Chen, Zhanghua

AU - Claud, Erika C.

AU - Dabelea, Dana

AU - Dunlop, Anne L.

AU - Elliott, Amy J.

AU - Ferrara, Assiamira

AU - Ganiban, Jody M.

AU - Gern, James E.

AU - Gold, Diane R.

AU - Gower, William A.

AU - Hertz-Picciotto, Irva

AU - Karagas, Margaret R.

AU - Karr, Catherine J.

AU - Lester, Barry

AU - Leve, Leslie D.

AU - Litonjua, Augusto A.

AU - Ludena, Yunin

AU - McEvoy, Cindy T.

AU - Miller, Rachel L.

AU - Mueller, Noel T.

AU - O'Connor, Thomas G.

AU - Oken, Emily

AU - O'Shea, T. Michael

AU - Perera, Frederica

AU - Stanford, Joseph B.

AU - Rivera-Spoljaric, Katherine

AU - Rundle, Andrew

AU - Trasande, Leonardo

AU - Wright, Rosalind J.

AU - Zhang, Yue

AU - Zhu, Yeyi

AU - Berhane, Kiros

AU - Gilliland, Frank

AU - Chatzi, Lida

AU - Benjamin, D. K.

AU - Smith, P. B.

AU - Newby, K. L.

AU - Hecht, S. S.

AU - Jacobson, L. P.

N1 - Funding Information: Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, under award numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), and UH3OD023287 (L.C.), UH3OD023318 (A.D.), UH3OD023282 (J.G. and D.G.), UH3OD023287 (C.B. and F.G.), UH3OD023365 (I.H.-P.), UH3OD02375 (M.K.), UH3OD023248 (D.D.), UH3OD023286 (E.O.), UH3OD023320 (J.A.), UH3OD023349 (T.O’C.), UH3OD023389 (L.L.), UH3OD023288 (C.M.E.), UH3OD023268 (A.A.L.), UH3OD023305 (L.T.), UH3OD023337 (R.W.), UH3OD023347 (B.L.), UH3OD023253 (C.C.), UH3OD023279 (A.E.), UH3OD023271 (C.K.), UH3OD023348 (T.M.O’S.), UH3OD023249 (J.B.S. and Y.Z.), UH3OD023289 (Y.Z.), UH3OD023271 (K.N.C.), UH3OD023282 (R.L.M.). N.S. was supported by NIH R21 ES029681 and P30 ES007048-23, and NIH P30 DK048522-24. E.G. was supported by NIH P50 ES026086-04S1. L.C. was additionally supported by NIH R01ES029944, R01ES030364, R01ES030691, R21ES28903, R21ES029681, and P30ES007048. A.D. was additionally supported by NIH R24ES029490, R01NR014800, and P50ES026071. C.B. was additionally supported by NIH P30ES007048, P50ES026086, and EPA grant R83615801. I.H.-P. and collection of data for the CHARGE/ReCHARGE cohort were additionally supported by NIEHS R01ES015359, and NIH UG3OD023365. M.K. was additionally supported by NIH P01ES022832, and US EPA: RD83544201. D.D. was additionally supported by NIH R01 DK076648. E.O. and data collection for Project Viva were additionally supported by R01 HD034568. J.A. was additionally supported by NIH R34 HL142995. T.O’C. was additionally supported by NIH R01 097293. L.L. was additionally supported by NIH R01 HD042608, R01 DA020585, R01 DK090264. A.B. was supported by NIH R01 HL135235, P01HL108808, and R01 ES025124. C.M. was additionally supported by NIH R01 HL105447. B.L. was additionally supported by NIH/NICHD—R01HD072267. A.E. was additionally supported by NIH U01HD045935. C.K. was additionally supported by UG3OD023271. J.B.S. and Y.Z. were additionally supported by NIH 1UG3OD023249. Y.Z. was additionally supported by NIH UG3OD023289 and K01DK120807. E.C. was additionally supported by NIH UG3OD023281. B.L. was additionally supported by NIH/OD—UG3OD023347. I.M.A. was additionally supported by NIH R01 HD0345568 and UG3OD023286. K.N.C. was additionally supported by UG3OD023271, R01 HL109977, and R01 HL132338. J.G. was additionally supported by UM1 AI114271. A.A.was supported by NIH UH3 OD023251. N.T.M. was additionally supported by NIH K01HL141589. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, under award numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), and UH3OD023287 (L.C.), UH3OD023318 (A.D.), UH3OD023282 (J.G. and D.G.), UH3OD023287 (C.B. and F.G.), UH3OD023365 (I.H.-P.), UH3OD02375 (M.K.), UH3OD023248 (D.D.), UH3OD023286 (E.O.), UH3OD023320 (J.A.), UH3OD023349 (T.O'C.), UH3OD023389 (L.L.), UH3OD023288 (C.M.E.), UH3OD023268 (A.A.L.), UH3OD023305 (L.T.), UH3OD023337 (R.W.), UH3OD023347 (B.L.), UH3OD023253 (C.C.), UH3OD023279 (A.E.), UH3OD023271 (C.K.), UH3OD023348 (T.M.O'S.), UH3OD023249 (J.B.S. and Y.Z.), UH3OD023289 (Y.Z.), UH3OD023271 (K.N.C.), UH3OD023282 (R.L.M.). N.S. was supported by NIH R21 ES029681 and P30 ES007048-23, and NIH P30 DK048522- 24. E.G. was supported by NIH P50 ES026086-04S1. L.C. was additionally supported by NIH R01ES029944, R01ES030364, R01ES030691, R21ES28903, R21ES029681, and P30ES007048. A.D. was additionally supported by NIH R24ES029490, R01NR014800, and P50ES026071. C.B. was additionally supported by NIH P30ES007048, P50ES026086, and EPA grant R83615801. I.H.-P. and collection of data for the CHARGE/ReCHARGE cohort were additionally supported by NIEHS R01ES015359, and NIH UG3OD023365. M.K. was additionally supported by NIH P01ES022832, and US EPA: RD83544201. D.D. was additionally supported by NIH R01 DK076648. E.O. and data collection for Project Viva were additionally supported by R01 HD034568. J.A. was additionally supported by NIH R34 HL142995. T.O'C. was additionally supported by NIH R01 097293. L.L. was additionally supported by NIH R01 HD042608, R01 DA020585, R01 DK090264. A.B. was supported by NIH R01 HL135235, P01HL108808, and R01 ES025124. C.M. was additionally supported by NIH R01 HL105447. B.L. was additionally supported by NIH/NICHD - R01HD072267. A.E. was additionally supported by NIH U01HD045935. C.K. was additionally supported by UG3OD023271. J.B.S. and Y.Z. were additionally supported by NIH 1UG3OD023249. Y.Z. was additionally supported by NIH UG3OD023289 and K01DK120807. E.C. was additionally supported by NIH UG3OD023281. B.L. was additionally supported by NIH/OD - UG3OD023347. I.M.A. was additionally supported by NIH R01 HD0345568 and UG3OD023286. K.N.C. was additionally supported by UG3OD023271, R01 HL109977, and R01 HL132338. J.G. was additionally supported by UM1 AI114271. A.A.was supported by NIH UH3 OD023251. N.T.M. was additionally supported by NIH K01HL141589. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2022/1/1

Y1 - 2022/1/1

N2 - Rationale: Asthma and obesity often co-occur. It has been hypothesized that asthma may contribute to childhood obesity onset. Objectives: To determine if childhood asthma is associated with incident obesity and examine the role of asthma medication in this association. Methods: We studied 8, 716 children between ages 6 and 18.5 years who were nonobese at study entry participating in 18 US cohorts of the Environmental influences on Child Health Outcomes program (among 7, 299 children with complete covariate data mean [SD] study entry age = 7.2 [1.6] years and follow up = 5.3 [3.1] years). Measurements and Main Results: We defined asthma based on caregiver report of provider diagnosis. Incident obesity was defined as the first documented body mass index ≥95th percentile for age and sex following asthma status ascertainment. Over the study period, 26% of children had an asthma diagnosis and 11% developed obesity. Cox proportional hazards models with sex-specific baseline hazards were fitted to assess the association of asthma diagnosis with obesity incidence. Children with asthma had a 23% (95% confidence intervals [CI] = 4, 44) higher risk for subsequently developing obesity compared with those without asthma. A novel mediation analysis was also conducted to decompose the total asthma effect on obesity into pathways mediated and not mediated by asthma medication use. Use of asthma medication attenuated the total estimated effect of asthma on obesity by 64% (excess hazard ratios = 0.64; 95% CI = -1.05, -0.23). Conclusions: This nationwide study supports the hypothesis that childhood asthma is associated with later risk of obesity. Asthma medication may reduce this association and merits further investigation as a potential strategy for obesity prevention among children with asthma.

AB - Rationale: Asthma and obesity often co-occur. It has been hypothesized that asthma may contribute to childhood obesity onset. Objectives: To determine if childhood asthma is associated with incident obesity and examine the role of asthma medication in this association. Methods: We studied 8, 716 children between ages 6 and 18.5 years who were nonobese at study entry participating in 18 US cohorts of the Environmental influences on Child Health Outcomes program (among 7, 299 children with complete covariate data mean [SD] study entry age = 7.2 [1.6] years and follow up = 5.3 [3.1] years). Measurements and Main Results: We defined asthma based on caregiver report of provider diagnosis. Incident obesity was defined as the first documented body mass index ≥95th percentile for age and sex following asthma status ascertainment. Over the study period, 26% of children had an asthma diagnosis and 11% developed obesity. Cox proportional hazards models with sex-specific baseline hazards were fitted to assess the association of asthma diagnosis with obesity incidence. Children with asthma had a 23% (95% confidence intervals [CI] = 4, 44) higher risk for subsequently developing obesity compared with those without asthma. A novel mediation analysis was also conducted to decompose the total asthma effect on obesity into pathways mediated and not mediated by asthma medication use. Use of asthma medication attenuated the total estimated effect of asthma on obesity by 64% (excess hazard ratios = 0.64; 95% CI = -1.05, -0.23). Conclusions: This nationwide study supports the hypothesis that childhood asthma is associated with later risk of obesity. Asthma medication may reduce this association and merits further investigation as a potential strategy for obesity prevention among children with asthma.

KW - Asthma

KW - Asthma medication

KW - Childhood

KW - ECHO

KW - Obesity

UR - http://www.scopus.com/inward/record.url?scp=85120696052&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85120696052&partnerID=8YFLogxK

U2 - 10.1097/ede.0000000000001421

DO - 10.1097/ede.0000000000001421

M3 - Article

C2 - 34561347

AN - SCOPUS:85120696052

SN - 1044-3983

VL - 33

SP - 131

EP - 140

JO - Epidemiology

JF - Epidemiology

IS - 1

ER -

The role of childhood Asthma in obesity development: A Nationwide US Multicohort Study

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