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Obesity-related asthma linked to metabolic dysregulation
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Mechanical fat load of truncal adiposity, metabolic dysregulation and inflammation, and the relationships between them may influence the pathophysiology of obesity-related asthma, according to a recent review of the literature published in Pediatrics.
Nandini Vijayakanthi, MBBS, DNB, from the Departments of Pediatrics at Albert Einstein College of Medicine in Bronx, New York, and colleagues performed a review of studies that examined the relationships between asthma and mechanisms, mechanical effect, weight, diet, physical activity, obesity-mediated inflammation, obesity-mediated metabolic dysregulation, dyslipidemia, epigenetics and genetics.
“Together, these studies on the mechanisms underlying obesity-related asthma suggest a complex interplay among mechanical fat load of truncal adiposity, metabolic dysregulation, and inflammation,” Vijayakanthi and colleagues wrote in their review.
Although the studies that suggested an association between truncal adiposity, asthma and altered lung mechanics did not investigate metabolic dysregulation, Vijayakanthi and colleagues speculated that it may have existed in these patients in tandem with truncal adiposity, particularly among black men and Hispanic men.
“In keeping with this speculation, insulin resistance and dyslipidemia were found to be predictors of FEV1/forced-vital-capacity ratio and expiratory reserve volume, the two pulmonary function indices that are decreased among obese asthmatics, and mediated the association of body mass index and waist circumference with these indices, suggesting that biological factors other than mechanical fat load may mediate the influence of obesity on pulmonary function,” the researchers wrote.
They also found an association between obesity-related asthma and factors such as diet, inflammation and dyslipidemia, with some studies linking diet-induced metabolic regulation to maternal diet in utero. The researchers note this association could be followed in future studies that evaluate pharmacologic interventions for these patients.
“Because these metabolic abnormalities are obesity-mediated but do not develop in all obese children, quantification of these metabolic biomarkers may help identify obese children at risk for developing obesity-mediated pulmonary morbidity,” Vijayakanthi and colleagues wrote.
The researchers made the following recommendations to pediatricians for clinical practice based on results from the studies evaluated:
- Routine evaluation for truncal adiposity by measuring waist circumference among their patients who are overweight obese;
- Routine evaluation for metabolic dysregulation, specifically for insulin resistance and dyslipidemia in fasting blood among obese children, particularly in those with truncal adiposity;
- Elucidation of respiratory symptoms among obese children, particularly those with truncal adiposity, or metabolic dysregulation;
- Testing for pulmonary function deficits among obese children, especially those with truncal adiposity, or metabolic dysregulation;
- Ensure good asthma control and encourage physical activity for weight control because there is no therapy specific for obesity-related asthma, and these children are suboptimally responsive to inhaled steroids; and
- Encourage parents to monitor dietary intake, with increased intake of foods included in a Mediterranean diet and decreased consumption of processed foods.
“In summary, obesity-related asthma is an emerging health problem among children,” Vijayakanthi and colleagues wrote. “Although it appears to be distinct from normal-weight asthma, further investigations are needed to better define its pathophysiology.” – by Jeff Craven
Disclosure: The researchers report no relevant financial disclosures.
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