Childhood body mass index and wheezing disorders: a systematic review and meta-analysis

BACKGROUND: It has been claimed that overweight/obesity are associated with childhood asthma and wheezing disorders, although the results of observational studies have remained inconsistent. We conducted a systematic review and meta-analysis to investigate this. METHODS: An online search of published papers linking childhood asthma and wheezing with overweight/obesity up to May 2014 using EMBASE and Medline medical research databases was carried out. Summary odds ratios (OR) were estimated using random-effects models. Sub-group meta-analyses were performed to assess the robustness of risk associations and between-study heterogeneity. RESULTS: A total of 38 studies comprising 1,411,335 participants were included in our meta-analysis. The summary ORs of underweight (<5th percentile), overweight (>85th to <95th percentile), and obesity (≥95th percentile) were 0.85 (95% CI: 0.75 to 0.97; P=0.02), 1.23 (95% CI: 1.17 to 1.29; p<0.001), and 1.46, (95% CI: 1.36 to 1.57, P<0.001) respectively. Heterogeneity was significant and substantial in all three weight categories, and not accounted for by predefined study characteristics. CONCLUSION: Our results suggest that underweight is associated with a reduced risk of childhood asthma, and overweight and obesity are associated with an increased risk of childhood asthma. Although our findings assert that overweight/obesity and childhood asthma are associated, the causal pathway and temporal aspects of this relationship remain unanswered and deserve further epidemiological investigation.