Mediators Linking Obesity to Childhood Asthma: the Role of Puberty,
Physical Fitness, and Pulmonary Function
Abstract
Background: Obesity and asthma are highly associated, but the mechanisms
underlying the association remain unknown. We examined five mediators
linking obesity with childhood asthma: (1) pulmonary function
impairment, (2) airway inflammation, (3) physical fitness, (4)
sleep-disordered breathing (SDB), and (5) early puberty. Methods: A
Mendelian randomization (MR) study with mediation analysis of data
obtained from 5,965 children as part of the Taiwan Children Health
Study. Cross-sectional regression analysis, MR two-stage least squares
method, and MR sensitivity analysis were carried out to investigate each
causal pathway. Prospective cohort analyses were used to confirm the
findings. Results: The increased asthma risk associated with obesity was
found to be mostly mediated through impaired pulmonary function, low
physical fitness, early puberty. In the MR analysis, body mass index was
negatively associated with FEV1/FVC and physical fitness index (β= −2.17
and −0.71; 95% CI, −3.92 to −0.42 and −1.30 to −0.13, respectively) and
positively associated with early puberty (OR, 1.09; 95% CI,
1.02–1.17). High FEV1/FVC and physical fitness index reduced the risk
of asthma (OR, 0.98 and 0.93; 95% CI, 0.97–0.99 and 0.88–0.98,
respectively), whereas SDB and early puberty increased the risk of
asthma (OR, 1.03 and 1.22; 95% CI, 1.01–1.05 and 1.05–1.42,
respectively). The three main mediators were low physical fitness,
impaired pulmonary function, and early puberty, with mediation
proportions of 91.4%, 61.6%, and 28.3%, respectively. Temporal
causality was further strengthened in prospective cohort analyses.
Conclusions: Interventions promoting physical fitness and pulmonary
function might effectively reduce obesity-induced asthma risk.