Asthma and insulin resistance in morbidly obese children and adolescents
Asthma and insulin resistance in morbidly obese children and adolescents
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DOI：
10.1080/02770900701423597
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发表时间：
2007-01-01
影响因子：
1.9
通讯作者：
Gershan, William
中科院分区：
文献类型：
--
作者：
Al-Shawwa, Baha A.;Al-Huniti, Nidal H.;Gershan, William
背景肥胖被公认为是胰岛素抵抗增加的状态，并被认为是儿童和青少年哮喘患病率和哮喘严重程度的重要危险因素。然而，人们对哮喘和肥胖相关的具体因素知之甚少。最近，肥胖症的促炎状态及其与胰岛素抵抗的关系已被认识到。我们推测病态肥胖对哮喘的影响与胰岛素抵抗有关。方法.对威斯康星州儿童医院肥胖管理项目的患者队列进行回顾性分析。从程序数据库中收集变量，并对缺失变量进行图表审查。如果评估医生通过病史证实诊断和/或患者接受吸入性皮质类固醇，则认为患者患有哮喘。采用稳态模型评估（HOMA）计算胰岛素抵抗（IR）。进行多变量逻辑回归以确定与哮喘发病率显著相关的变量。结果在纳入研究的415名患者中，146名（35%）患有哮喘，269名（65%）是非哮喘。哮喘（AG）和非哮喘（NAG）组在平均年龄（11.3 vs. 11.5岁）、性别（45% vs. 43%男性）、平均体重指数（BMI）（36.4 vs. 34.9）和吸烟暴露（43% vs. 42%）方面相似。哮喘的Fhx在AG（71%）显著高于NAG（40%）。AG的IR水平+/- SD为8.5 +/- 9.7，而NAG为5.3 +/- 6.7（p < 0.0001）。多因素回归分析发现以下变量与哮喘相关：年龄（p < 0.05）、吸烟（p <0.05）、哮喘Fhx阳性（p < 0.0001，比值比3.1）和IR（p < 0.0001，比值比4.1）。结论病态肥胖哮喘患者与病态肥胖非哮喘患者相比具有更高程度的胰岛素抵抗。我们推测胰岛素抵抗的促炎症状态可能是肥胖患者哮喘发病的原因之一。未来的前瞻性研究应该将胰岛素抵抗作为肥胖儿童和青少年哮喘的一个可能的危险因素。
Background. Obesity is well recognized as a state of increased insulin resistance and has been implicated as a significant risk factor for both asthma prevalence and asthma severity in children and adolescents. However, little is known about the specific factors that relate asthma and obesity. Recently, the pro-inflammatory state in obesity and its association with insulin resistance have been recognized. We hypothesize that the effect of morbid obesity on asthma is related to insulin resistance. Methods. The patient cohort in the obesity management program at the Children's Hospital of Wisconsin was retrospectively reviewed. Variables were collected from the program data base and chart review was done for missing variables. Patients were considered to have asthma if the evaluating physician confirmed the diagnosis through history and/or the patient had been on inhaled corticosteroids. Insulin resistance (IR) was calculated using a homeostasis model assessment (HOMA). Multivariate logistic regression was performed to identify variables that were significantly related to the odds of having asthma. Results. Of the 415 patients included in the study, 146 (35%) were asthmatic and 269 (65%) were non-asthmatic. The asthma (AG) and non-asthma (NAG) groups were similar with respect to mean age (11.3 vs. 11.5 years), gender (45% vs. 43% males), mean body mass index (BMI) (36.4 vs. 34.9), and exposure to smoking (43% vs. 42%). Fhx of asthma was significantly higher in AG (71%) compared to NAG (40%). IR level +/- SD was 8.5 +/- 9.7 in AG compared to 5.3 +/- 6.7 in NAG (p < 0.0001). Multivariate regression analysis found the following variables to be associated with having asthma: younger age (p < 0.05), smoking exposure (p < 0.05), positive Fhx of asthma (p < 0.0001, odds ratio of 3.1), and IR (p < 0.0001, odds ratio of 4.1). Conclusion. Morbidly obese asthma patients have a higher degree of insulin resistance compared to morbidly obese non-asthma patients. We speculate that the pro-inflammatory state of insulin resistance may contribute to the pathogenesis of asthma in obese patients. Future prospective studies should address insulin resistance as a possible risk factor for asthma in obese children and adolescents.