Infant growth patterns and asthma and lung function in adolescent

Published: February 28, 2021

Obesity is a potential modifiable risk factor for asthma and poor lung function in children, but reported associations are not consistent. One of the reasons for these inconsistent findings may be because previous studies have only investigated the impact of obesity by measuring body mass index (BMI) at one time point. Examining both age of onset and persistence of obesity, using BMI growth patterns, may help clarify these relationships. Despite the first two years of life being the most critical window for the development of the respiratory system, and a highly dynamic period for growth, no previous study has investigated the associations between BMI growth patterns in this period and respiratory diseases.

In a recent research article in The Journal of Allergy and Clinical Immunology (JACI), Ali et al examined whether BMI growth patterns during the first two years of life are associated with the development of asthma and poor lung function during adolescence. They used information from 620 children with family history of allergic diseases, enrolled in Melbourne Atopic Cohort Study (MACS).  BMI growth patterns were developed using group-based trajectory modelling, based on body weight and length/height collected at 18 time points from birth to 2-years.  Asthma and lung function outcomes were assessed at 12 and 18 years.  

Ali et al identified a total of five BMI growth patterns in the first two years of life, average, below average, persistently low, early low and catch up, and persistently high. Compared to the “average growth pattern”, children belonging to the “early low and catch up” and “persistently high” growth pattern were at higher risk of asthma at 18 years (23% and 42% respectively). These same growth patterns were also associated with lower ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) of lungs (2.1% and 3.1% respectively), and high fractional exhaled nitric oxide levels (16 ppb and 13 ppb) at 18 years compared to the average growth patterns. In addition, children belonging to the “persistently low” growth pattern had an increased risk of lower FEV1 (183.9 ml) and FVC of lungs (207.8 ml) at 18 years.

These findings suggest that “early low & catch up” and “persistently high” growth patterns in the first two years of life are associated with asthma and obstructive lung function pattern in adolescence. Having a persistently low growth pattern at an early age is associated with a restrictive pattern. Maintaining normal growth patterns in early life may lead to improved adolescent respiratory health.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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