Childhood body mass index trajectories and asthma and allergies: A systematic review

Chia-Lun Chang; Gulshan Bano Ali; Jonathan Pham; Shyamali C Dharmage; Caroline J Lodge; Mimi L K Tang; Adrian J Lowe

doi:10.1111/cea.14366

Childhood body mass index trajectories and asthma and allergies: A systematic review

Clin Exp Allergy. 2023 Sep;53(9):911-929. doi: 10.1111/cea.14366. Epub 2023 Jul 3.

Authors

Chia-Lun Chang¹, Gulshan Bano Ali¹, Jonathan Pham^{1

2}, Shyamali C Dharmage^{1

3}, Caroline J Lodge^{1

3}, Mimi L K Tang^{4

5

6}, Adrian J Lowe^{1

3}

Affiliations

¹ Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
² Asthma, Allergy and Clinical Immunology Service, Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
³ Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.
⁴ Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
⁵ Department of Allergy Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia.
⁶ Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.

PMID: 37401045
DOI: 10.1111/cea.14366

Abstract

Background: Previous systematic reviews have focused on associations between single time point measures of Body Mass Index (BMI) and asthma and allergic diseases. As BMI changes dynamically during childhood, examination of associations between longitudinal trajectories in BMI and allergic diseases is needed to fully understand the nature of these relationships.

Objective: To systematically synthesise the association between BMI trajectories in childhood (0-18 years) and allergic diseases (asthma, eczema, allergic rhinitis, or food allergies outcomes).

Design: We conducted a systematic review following the PRISMA guidelines, and two independent reviewers assessed the study quality using the ROBINS-E and GRADE tools. A narrative synthesis was performed as the statistical heterogeneity did not allow a meta-analysis.

Data sources: A search was performed on PubMed and EMBASE databases on 4th January 2023.

Eligibility criteria: Longitudinal cohort studies assessing the associations between childhood BMI trajectories and allergic diseases were included.

Results: Eleven studies met the inclusion criteria with a total of 37,690 participants between 0 and 53 years of age. Ten studies examined asthma outcomes, three assessed association with allergic rhinitis, two assessed eczema, and one assessed food allergy. High heterogeneity and high risk of bias were observed. Overall, the quality of evidence was very low. Nevertheless, two consistent findings were identified: (1) a persistently high BMI between 6 and 10 years of age may be associated with an increased risk of asthma at 18 years and (2) a rapid increase in BMI in the first 2 years of life may be associated with subsequent asthma.

Conclusions: Maintaining a normal BMI trajectory during childhood may reduce the risk of asthma. Future research that adequately addresses confounding and includes longer-term follow-up is needed. Moreover, additional studies examining potential associations with eczema, food allergies, and allergic rhinitis outcomes are needed.

Keywords: Paediatric; allergy; asthma; body mass index trajectories; obesity.

Publication types

Review