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Moitra, S.* ; Carsin, A.E.* ; Abramson, M.J.* ; Accordini, S.* ; Amaral, A.F.S.* ; Anto, J.* ; Bono, R.* ; Casas Ruiz, L.* ; Cerveri, I.* ; Chatzi, L.* ; Demoly, P.* ; Dorado-Arenas, S.* ; Forsberg, B.* ; Gilliland, F.* ; Gislason, T.* ; Gullón, J.A.* ; Heinrich, J. ; Holm, M.* ; Janson, C.* ; Jõgi, R.* ; Gómez Real, F.* ; Jarvis, D.* ; Leynaert, B.* ; Nowak, D.* ; Probst-Hensch, N.* ; Sánchez-Ramos, J.L.* ; Raherison-Semjen, C.* ; Siroux, V.* ; Guerra, S.* ; Kogevinas, M.* ; Garcia-Aymerich, J.*

Long-term effect of asthma on the development of obesity among adults: An international cohort study, ECRHS.

Thorax 78, 128-135 (2023)

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INTRODUCTION: Obesity is a known risk factor for asthma. Although some evidence showed asthma causing obesity in children, the link between asthma and obesity has not been investigated in adults. METHODS: We used data from the European Community Respiratory Health Survey (ECRHS), a cohort study in 11 European countries and Australia in 3 waves between 1990 and 2014, at intervals of approximately 10 years. We considered two study periods: from ECRHS I (t) to ECRHS II (t+1), and from ECRHS II (t) to ECRHS III (t+1). We excluded obese (body mass index≥30 kg/m²) individuals at visit t. The relative risk (RR) of obesity at t+1 associated with asthma at t was estimated by multivariable modified Poisson regression (lag) with repeated measurements. Additionally, we examined the association of atopy and asthma medication on the development of obesity. RESULTS: We included 7576 participants in the period ECRHS I-II (51.5% female, mean (SD) age of 34 (7) years) and 4976 in ECRHS II-III (51.3% female, 42 (8) years). 9% of participants became obese in ECRHS I-II and 15% in ECRHS II-III. The risk of developing obesity was higher among asthmatics than non-asthmatics (RR 1.22, 95% CI 1.07 to 1.38), and particularly higher among non-atopic than atopic (1.47; 1.17 to 1.86 vs 1.04; 0.86 to 1.27), those with longer disease duration (1.32; 1.10 to 1.59 in >20 years vs 1.12; 0.87 to 1.43 in ≤20 years) and those on oral corticosteroids (1.99; 1.26 to 3.15 vs 1.15; 1.03 to 1.28). Physical activity was not a mediator of this association. CONCLUSION: This is the first study showing that adult asthmatics have a higher risk of developing obesity than non-asthmatics, particularly those non-atopic, of longer disease duration or on oral corticosteroids.

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