Soup Kettle Topics: Physical Conditioning – Obesity, Overweight

Title: Characteristics and Correlates of Asthma in a University Clinic Population
Author: Bailey, W. C.; Richards, J. M., Jr.; Manzella, B. A.; Brooks, C. M.; Windsor, R. A.; Soong, S. J.; (Date: Oct, 1990)
Journal: Chest; V. 98; Issue: 4; Pages: 821-8

Abstract: To contribute more comprehensive information about the characteristics of asthma, this article analyzed patients served by the University of Alabama at Birmingham Comprehensive Asthma Program. Their physicians rated one fifth of these patients as having “severe” asthma with the remainder about equally divided between “moderate” and “mild”. One in two first received a diagnosis of asthma ten or more years previously. Common comorbidities were hypertension, obesity, rhinitis, bronchitis, sinusitis, and arthritis. One half had visited an emergency room or been hospitalized for asthma in the past year. Inhaled bronchodilators and continuous theophylline were the most commonly prescribed medications. Side effects, especially tachycardia and insomnia, were common and almost exclusively associated with theophylline or corticosteroid therapy. Spirometric assessment showed chronic airflow obstruction in those with more severe asthma. Prevalence of respiratory symptoms, intensity of medication regimen, incidence of side effects, and health care utilization increased as asthma severity increased.
Notes: Journal Article
Author Address: Division of Pulmonary and Critical Care Medicine, University of Alabama, Birmingham.

Title: Increased Incidence of Asthmalike Symptoms in Girls Who Become Overweight or Obese During the School Years
Author: Castro-Rodriguez, J. A.; Holberg, C. J.; Morgan, W. J.; Wright, A. L.; Martinez, F. D.; (Date: May, 2001)
Journal: Am J Respir Crit Care Med; V. 163; Issue: 6; Pages: 1344-9

Abstract: The possibility of a causal relationship is suggested by recent concomitant increases in the prevalence of obesity and asthma. In a general population sample, prevalence and incidence of asthma symptoms, skin tests, and body mass index (BMI) were ascertained at mean ages of 6.3 (n = 688) and 10.9 (n = 600) yr. Lung function, bronchodilator responsiveness, and daily peak flow variability were measured at 11 yr of age. There was no association between BMI at age 6 and wheezing prevalence at any age. Females, but not males, who were overweight or obese at 11 yr of age were more likely to have current wheezing at ages 11 and 13 but not at ages 6 or 8. This effect was strongest among females beginning puberty before the age of 11. Females who became overweight or obese between 6 and 11 yr of age were 7 times more likely to develop new asthma symptoms at age 11 or 13 (p = 0.0002); at age 11 their peak flow variability and bronchodilator responsiveness were significantly more likely to be increased. In females, becoming overweight or obese between 6 and 11 yr of age increases the risk of developing new asthma symptoms and increased bronchial responsiveness during the early adolescent period.
Notes: Journal Article
Author Address: Respiratory Sciences Center, University of Arizona, College of Medicine, Tucson, AZ 85724, USA.

Title: Association between Obesity and Asthma in 4-11 Year Old Children in the Uk
Author: Figueroa-Munoz, J. I.; Chinn, S.; Rona, R. J.; (Date: Feb, 2001)
Journal: Thorax; V. 56; Issue: 2; Pages: 133-7

Abstract: BACKGROUND: There is evidence of a positive association between asthma and obesity in adults and in children. We investigated, in a large sample of English and Scottish primary school children, whether there is a consistent association between fatness and asthma symptoms in Britain. METHODS: A cross sectional analysis was made of 18 218 children aged 4-11 years who participated in the 1993 or 1994 surveys of the National Study of Health and Growth (NSHG). Children belonged either to English or Scottish representative samples, or an English inner city sample. Asthma attacks in the previous year, occasional wheeze, or persistent wheeze were the symptoms used in the analysis. Body mass index (BMI) and the sum of triceps and subscapular skinfolds converted to standard deviation scores (SDS) were used to assess levels of fatness. RESULTS: A total of 14 908 children (81.8%) were included in the analysis. In the multiple logistic analysis BMI and asthma (asthma attacks or wheeze) were associated in the representative sample (OR for the comparison of the 10th and 90th centiles of BMI 1.28, 95% CI 1.11 to 1.48), but sum of skinfolds was unrelated to asthma symptoms in most analyses. The association between asthma and BMI was stronger in girls than in boys in the inner city sample, but less convincingly in the representative sample. CONCLUSIONS: Levels of obesity are associated with asthma symptoms regardless of ethnicity. The association is more consistent for BMI than for sum of skinfolds, partly because obese children are more advanced in their maturation than other children. There is some evidence that, as in adults, the association is stronger in girls than in boys, but only in the multiethnic inner city sample.
Notes: Journal Article
Author Address: Department of Public Health Sciences, King’s College, 5th Floor, Capital House, 42 Weston Street, London SE1 3QD, UK.

Title: Effects of Weight Loss on Peak Flow Variability, Airways Obstruction, and Lung Volumes in Obese Patients with Asthma
Author: Hakala, K.; Stenius-Aarniala, B.; Sovijarvi, A.; (Date: Nov, 2000)
Journal: Chest; V. 118; Issue: 5; Pages: 1315-21

Abstract: STUDY OBJECTIVES: To clarify the pathophysiologic features of the relation between asthma and obesity, we measured the effects of weight reduction on peak expiratory flow (PEF) variability and airways obstruction, compared to simultaneous changes in lung volumes and ventilatory mechanics in obese patients with stable asthma. METHODS: Fourteen obese asthma patients (11 women and 3 men; aged 25 to 62 years) were studied before and after a very-low-calorie-diet period of 8 weeks. PEF variability was determined as diurnal and day-to-day variations. FEV(1) and maximal expiratory flow values were measured with a flow-volume spirometer. Lung volumes, airways resistance (Raw), and specific airways conductance were measured using a constant-volume body plethysmograph. Minute ventilation was monitored in patients in supine and standing positions. RESULTS: As patients decreased their body mass index (SD) from 37.2 (3.7) to 32.1(4.2) kg/m(2) (p < 0. 001), diurnal PEF variation declined from 5.5% (2.4) to 4.5% (1.5) (p = 0.01), and day-to-day variation declined from 5.3% (2.6) to 3. 1% (1.3) (p < 0.005). The mean morning PEF, FEV(1), and FVC increased after weight loss (p = 0.001, p < 0.005, and p < 0.05, respectively). Flow rate at the middle part of FVC (FEF(25-75)) increased even when related to lung volumes (FEF(25-75)/FVC; p < 0. 05). Functional residual capacity and expiratory reserve volume were significantly higher after weight loss (p < 0.05 and p < 0.005, respectively). A significant reduction in Raw was found (p < 0.01). Resting minute ventilation decreased after weight loss (p = 0.01). CONCLUSION: Weight loss reduces airways obstruction as well as PEF variability in obese patients with asthma. The results suggest that obese patients benefit from weight loss by improved pulmonary mechanics and a better control of airways obstruction.
Notes: Journal Article
Author Address: Department of Medicine, Helsinki University Hospital, Helsinki, Finland.

Title: Exercise-Induced Bronchospasm in Nonasthmatic Obese Children
Author: Kaplan, T. A.; Montana, E.; (Date: Apr, 1993)
Journal: Clin Pediatr (Phila); V. 32; Issue: 4; Pages: 220-5

Abstract: The frequency, degree, and pattern of bronchial reactivity to exercise were compared in 13 obese and 14 control children, ages 6 to 10 years, with no history of asthma. Spirometry was performed before and every three minutes after a seven-minute exercise challenge on a treadmill. There were 11 obese children and 6 controls who had at least a 15% fall in at least one of three monitored pulmonary function parameters (P < .05). The group mean percentage falls in FEV1 and FEF25%-75% were significantly greater in the obese group than in the controls. The pattern of bronchospasm, occurring soon after the exercise challenge, is consistent with that found in the known asthmatic population. A significant correlation was found between triceps skin-fold thickness and degree of fall in FEF25%-75% (r = .55, P < .005). This study demonstrated that significantly greater frequency and degree of bronchospasm of the smaller airways occur in obese children, partially related to the amount of subcutaneous fat. Whether exercise-induced bronchospasm leads to exercise avoidance and obesity or whether obesity causes or enhances bronchial hyperreactivity to exercise requires further study.
Notes: Journal Article
Author Address: Department of Pediatrics, School of Medicine, University of Miami, Florida 33101.

Title: Leptin Regulates Proinflammatory Immune Responses
Author: Loffreda, S.; Yang, S. Q.; Lin, H. Z.; Karp, C. L.; Brengman, M. L.; Wang, D. J.; Klein, A. S.; Bulkley, G. B.; Bao, C.; Noble, P. W.; Lane, M. D.; Diehl, A. M.; (Date: Jan, 1998)
Journal: Faseb J; V. 12; Issue: 1; Pages: 57-65

Abstract: Obesity is associated with an increased incidence of infection, diabetes, and cardiovascular disease, which together account for most obesity-related morbidity and mortality. Decreased expression of leptin or of functional leptin receptors results in hyperphagia, decreased energy expenditure, and obesity. It is unclear, however, whether defective leptin-dependent signal transduction directly promotes any of the conditions that frequently complicate obesity. Abnormalities in tumor necrosis factor alpha expression have been noted in each of the above comorbid conditions, so leptin deficiency could promote these complications if leptin had immunoregulatory activity. Studies of rodents with genetic abnormalities in leptin or leptin receptors revealed obesity-related deficits in macrophage phagocytosis and the expression of proinflammatory cytokines both in vivo and in vitro. Exogenous leptin up-regulated both phagocytosis and the production of proinflammatory cytokines. These results identify an important and novel function for leptin: up-regulation of inflammatory immune responses, which may provide a common pathogenetic mechanism that contributes to several of the major complications of obesity.
Notes: Journal Article
Author Address: Department of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA.

Title: Association of Being Overweight with Greater Asthma Symptoms in Inner City Black and Hispanic Children
Author: Luder, E.; Melnik, T. A.; DiMaio, M.; (Date: Apr, 1998)
Journal: J Pediatr; V. 132; Issue: 4; Pages: 699-703

Abstract: OBJECTIVE: To determine whether the weight status of inner city black and Hispanic children with asthma differs from that of their peers and to assess whether overweight asthmatic children experience greater asthma symptoms. STUDY DESIGN: A cross-sectional study in an ambulatory chest clinic of an inner city medical center. METHODS: We studied black and Hispanic children aged 2 to 18 years (n = 209) with the single diagnosis of asthma. The peer control subjects consisted of a sample of black and Hispanic children aged 6 to 13 years (n = 1017), enrolled in the New York City schools. Asthma symptoms, the number of asthma medications prescribed, and peak expiratory flow rate (PEFR) measurements were used to classify asthma severity and relate to body mass index (BMI). Bivariate categorical analysis and chi 2 tests were performed to examine the relationship between high BMI and the individual measures of asthma severity. RESULTS: The prevalence of overweight was significantly higher in children with moderate to severe asthma than in their peers. The risk of overweight based on a BMI in the 85th percentile or greater was significantly associated with the following measures of asthma severity: (1) the number of school days missed per year; (2) a PEFR less than or equal to 60% of the predicted PEFR; and (3) the number of asthma medications prescribed. CONCLUSIONS: The prevalence of overweight was significantly higher in children with moderate to severe asthma than in their peers, and being overweight was associated with significantly more severe asthma symptoms. Further studies in overweight asthmatic children are needed, including the effect of weight loss on lung function and other markers of asthma severity.
Notes: Journal Article
Author Address: Jack and Lucy Clark Department of Pediatrics, Mount Sinai School of Medicine, New York, NY 10029, USA.

Title: Circulating Insulin Concentrations, Smoking, and Alcohol Intake Are Important Independent Predictors of Leptin in Young Healthy Men
Author: Mantzoros, C. S.; Liolios, A. D.; Tritos, N. A.; Kaklamani, V. G.; Doulgerakis, D. E.; Griveas, I.; Moses, A. C.; Flier, J. S.; (Date: May, 1998)
Journal: Obes Res; V. 6; Issue: 3; Pages: 179-86

Abstract: OBJECTIVE: Leptin, an adipocyte-secreted hormone, has been shown to signal the status of energy stores to the brain, regulate energy homeostasis, and mediate the neuroendocrine response to food deprivation. Obesity is associated with increased leptin levels, and several hormones, including insulin and glucocorticoids, have been associated with leptin levels and expression in rodents. Although obesity has been strongly associated with increased leptin in humans, a significant percentage of leptin’s variability remains unexplained. The role of endogenous hormones, demographic factors, or certain life-style factors in explaining the residual variability of leptin levels has not yet been clarified. We performed this cross-sectional study to document the relative importance of obesity, lifestyle factor, and endogenous hormones in determining serum leptin levels. RESEARCH METHODS AND PROCEDURES: We measured serum concentrations of insulin, cortisol, testosterone, growth hormone, and dehydroepiandrosterone sulfate; ascertained anthropometric, demographic, and lifestyle characteristics; and studied these variables in relationship to serum leptin concentrations in a sample of young healthy men. RESULTS: Obesity and alcohol intake were independently and positively associated with circulating leptin concentrations. Additionally, cigarette smoking was negatively and independently associated with leptin concentrations. Finally, serum insulin concentration was an independent hormonal determinant of circulating leptin concentrations, whereas serum testosterone was negatively associated with leptin only by bivariate analysis. DISCUSSION: We conclude that, in addition to obesity, cigarette smoking, alcohol intake, and serum insulin levels are associated with leptin levels in a population of healthy young men.
Notes: Journal Article
Author Address: Division of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.

Title: Body Weight and the Prevalence of Chronic Diseases
Author: Negri, E.; Pagano, R.; Decarli, A.; La Vecchia, C.; (Date: Mar, 1988)
Journal: J Epidemiol Community Health; V. 42; Issue: 1; Pages: 24-9

Abstract: The relation between body mass index and prevalence of 17 chronic diseases or groups of diseases was analysed using data from the 1983 Italian National Health Survey, based on a sample of 72,284 individuals aged 15 or over randomly selected within strata of geographical area, size of place of residence and of household in order to be representative of the whole Italian population. The prevalence of diabetes was directly and strongly related to body weight (age-adjusted relative risk estimates being 1.5 for overweight and 2.7 for obese men compared with normal weight individuals; 1.6 and 2.4 for overweight and obese women). Other conditions directly related to self-reported measures of body weight were hypertension (relative risk = 1.7 for obese men and 1.9 for women), myocardial infarction (relative risk = 1.5 for obese men, 1.6 for women), other heart diseases (relative risk = 1.7 for obese men, 1.5 for women), haemorrhoids or varices (relative risk = 1.2 for obese men, 1.5 for women), cholelithiasis (relative risk = 1.2 for obese men, 1.4 for women), urolithiasis and arthritis. Chronic respiratory disorders showed a U-shaped relation to measures of body weight, since their prevalence was elevated in both under- and over-weight individuals. Anaemias and gastroduodenal ulcer showed an inverse relation to body weight, whereas no association was apparent with allergy, liver cirrhosis, and psychiatric or neurological disorders.(ABSTRACT TRUNCATED AT 250 WORDS)
Notes: Journal Article
Author Address: Consorzio Interuniversitario Lombardo per l’Elaborazione Automatica, Milan, Italy.

Title: Airflow Limitation in Morbidly Obese, Nonsmoking Men
Author: Rubinstein, I.; Zamel, N.; DuBarry, L.; Hoffstein, V.; (Date: Jun 1, 1990)
Journal: Ann Intern Med; V. 112; Issue: 11; Pages: 828-32

Abstract: STUDY OBJECTIVE: To determine the effect of obesity on pulmonary function. DESIGN: Case-control study, using nonobese, age- and height-matched [corrected] nonsmokers. SETTING: Metabolic and obesity clinics of two major teaching hospitals. PATIENTS: One hundred and three obese, lifelong nonsmokers without cardiopulmonary disease. CONTROLS: One hundred and ninety healthy, nonobese nonsmokers recruited from among hospital personnel. MEASUREMENTS AND MAIN RESULTS: Complete pulmonary function measurements in all patients and controls. These measurements included maximum expiratory flow-volume curve, lung volumes and airway resistance using body plethysmograph, single-breath diffusing capacity for carbon monoxide, and total lung capacity using the helium dilution technique. Obese persons were found to have lower functional residual capacity, expiratory reserve volume, and total lung capacity by helium dilution than nonobese controls. In addition, residual volume and diffusing capacity were higher in the obese group. Finally, we found that obese men, but not women, had reduced maximum expiratory flow rates at 50% and 75% of exhaled vital capacity. CONCLUSION: Obesity may contribute independently of smoking habits to chronic airflow limitation in men.
Notes: Journal Article
Author Address: St. Michael’s Hospital, Toronto, Ontario.

Title: Low-Grade Systemic Inflammation in Overweight Children
Author: Visser, M.; Bouter, L. M.; McQuillan, G. M.; Wener, M. H.; Harris, T. B.; (Date: Jan, 2001)
Journal: Pediatrics; V. 107; Issue: 1; Pages: E13

Abstract: OBJECTIVE: Human adipose tissue expresses and releases the proinflammatory cytokine interleukin-6, potentially inducing low-grade systemic inflammation in persons with excess body fat. To limit potential confounding by inflammation-related diseases and subclinical cardiovascular disease, we tested the hypothesis that overweight is associated with low-grade systemic inflammation in children. DESIGN AND SETTING: The third National Health and Nutrition Examination Survey, 1988-1994, a representative sample of the US population. PARTICIPANTS: A total of 3512 children 8 to 16 years of age. OUTCOME MEASURES: Elevated serum C-reactive protein concentration (CRP; >/=.22 mg/dL) and white blood cell count (10(9) cells/L). RESULTS: Elevated CRP was present in 7.1% of the boys and 6.1% of the girls. Overweight children (defined as having a body mass index or a sum of 3 skinfolds (triceps, subscapula, and supra-iliac) above the gender-specific 85th percentile) were more likely to have elevated CRP than were their normal-weight counterparts. After adjustment for potential confounders, including smoking and health status, the odds ratio (OR) was 3.74 (95% confidence interval [CI]: 1.66-8.43) for overweight boys and the OR was 3.17 (95% CI: 1.60-6.28) for overweight girls, based on the body mass index. Based on the sum of 3 skinfolds, these ORs were 5.11 (95% CI: 2.36-11.06) and 2.89 (95% CI: 1.49-5.59) for boys and girls, respectively. Overweight was also associated with statistically significant higher white blood cell counts. The results were similar when restricted to healthy, nonsmoking, nonestrogen-using children. CONCLUSIONS: In children 8 to 16 years of age, overweight is associated with higher CRP concentrations and higher white blood cell counts. These findings suggest a state of low-grade systemic inflammation in overweight children. inflammation, obesity, children.
Notes: Journal Article
Author Address: Institute for Research in Extramural Medicine, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands.

Title: Body Build and Atopy
Author: Xu, B.; Jarvelin, M. R.; Pekkanen, J.; (Date: Feb, 2000)
Journal: J Allergy Clin Immunol; V. 105; Issue: 2 Pt 1; Pages: 393-4

Notes: Journal Article
Author Address: Unit of Environmental Epidemiology, National Public Health Institute, Kuopio, Finland.

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