Diet-induced weight loss in obese children with asthma: a randomized controlled trial
Diet-induced weight loss in obese children with asthma: a randomized controlled trial
复制标题
DOI：
10.1111/cea.12115
复制
发表时间：
2013-07-01
影响因子：
6.1
通讯作者：
Wood, L. G.
中科院分区：
文献类型：
--
作者：
Jensen, M. E.;Gibson, P. G.;Wood, L. G.
肥胖在哮喘儿童中非常普遍，并与较差的临床结局相关。尚未在随机对照试验（RCT）中研究能量限制如何诱导哮喘儿童体重减轻。目的评估（1）通过饮食干预是否可以减轻肥胖哮喘儿童的体重;（2）饮食诱导体重减轻后哮喘结局的变化。方法在为期10周的先导性随机对照试验中，将8- 17岁的肥胖哮喘儿童随机分为等待列表对照组（WLC）（n=15）和饮食干预组（DIG）（n=13）。在基线和干预后评估肺功能、哮喘控制问卷（ACQ）评分、痰液和全身炎症。（澳大利亚新西兰临床试验注册处：ACTRN 12610000955011）。结果DIG组与WLC组相比，体重指数（BMI）z评分显著降低（-0.2 [-0.4，-0.1] vs. 0.0 [-0.1，0.0]，P=0.014）。DIG组的呼气储备量（ERV）显著增加，但与WLC组相比无显著差异（0.7 [0.0，1.0]L vs. 0.3 [0.0，0.8]L，P=0.355）。与WLC相比，DIG的ACQ显著改善（-0.4 [-0.7，0.0] vs. 0.1 [0.0，0.6]，P=0.004）。DIG内气道和全身炎症没有改变。相比之下，WLC中C反应蛋白（CRP）显著升高（-0.4 [-0.5，0.4] vs. 0.7 [-0.1，1.9]，P=0.037）。BMI z评分的变化与CRP（r=0.47，P=0.012）和呼出气一氧化氮（eNO）（r=0.46，P=0.034）相关，ACQ与CRP相关（r=0.43，P=0.029）。结论和临床相关性饮食干预可以诱导肥胖哮喘儿童的急性体重减轻，随后改善静态肺功能和哮喘控制。全身和气道炎症在体重减轻后没有变化。然而，BMI z评分的变化与气道和全身炎症的变化相关，这需要在更大的RCT中进一步研究。这是第一个在肥胖哮喘儿童中进行的减肥RCT。饮食诱导的体重减轻可以显著改善肥胖哮喘儿童的临床结局。
Background Obesity is highly prevalent in asthmatic children and associated with worse clinical outcomes. Energy restriction to induce weight loss in asthmatic children has not been investigated in a randomized controlled trial (RCT). Objective To assess if (1) weight loss can be achieved in obese asthmatic children using a dietary intervention; and (2) changes in asthma outcomes occur following diet-induced weight loss. Methods In a 10-week pilot RCT, obese asthmatic children, aged 8-17years, were randomized to a wait-list control (WLC) (n=15) or dietary-intervention group (DIG) (n=13). Lung function, Asthma Control Questionnaire (ACQ) score, and sputum and systemic inflammation were assessed at baseline and post-intervention. (Australian New Zealand Clinical Trials Registry: ACTRN12610000955011). Results Body mass index (BMI) z-score reduced significantly in the DIG vs. the WLC (-0.2 [-0.4, -0.1] vs. 0.0 [-0.1, 0.0], P=0.014). Expiratory reserve volume (ERV) increased significantly within the DIG, but not compared to the WLC (0.7 [0.0, 1.0]L vs. 0.3 [0.0, 0.8]L, P=0.355). ACQ improved significantly in the DIG, compared to the WLC (-0.4 [-0.7, 0.0] vs. 0.1 [0.0, 0.6], P=0.004). Airway and systemic inflammation did not change within the DIG. In comparison, C-Reactive Protein (CRP) increased significantly in the WLC (-0.4 [-0.5, 0.4] vs. 0.7 [-0.1, 1.9], P=0.037). Change () in BMI z-score correlated with CRP (r=0.47, P=0.012) and exhaled nitric oxide (eNO) (r=0.46, P=0.034), and ACQ was associated with CRP (r=0.43, P=0.029). Conclusion and Clinical Relevance Dietary intervention can induce acute weight loss in obese asthmatic children with subsequent improvements in static lung function and asthma control. Systemic and airway inflammation did not change following weight loss. However, changes in BMI z-score were associated with changes in airway and systemic inflammation and this requires further investigation in a larger RCT. This is the first weight loss RCT conducted in obese asthmatic children. Diet-induced weight loss can achieve significant improvements in clinical outcomes for obese children with asthma.