|Year : 2022 | Volume
| Issue : 3 | Page : 209-213
The Nutritional Status of Children with Asthma and Its Relationship with Acute Exacerbations
Helen O Akhiwu1, Ibrahim Aliyu2, Collins John1, Esther S Yiltok1, Stephen Oguche1
1 Department of Paediatrics, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
2 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University Kano, Kano State, Nigeria
|Date of Submission||08-Dec-2021|
|Date of Decision||13-Dec-2021|
|Date of Acceptance||15-Jan-2022|
|Date of Web Publication||2-Jun-2022|
Helen O Akhiwu
Department of Paediatrics, Jos University Teaching Hospital, Lamingo Permanent Site, Jos, Plateau State
Source of Support: None, Conflict of Interest: None
Background: Asthma is a chronic inflammatory disease of the airways. There is increasing international interests in the role of nutrition in asthma control. Objectives: This study was carried out to determine the nutritional status of children with asthma using the World Health Organization (WHO) growth reference charts for height, weight, and body mass index (BMI) for age and to determine the relationship if any between nutritional status and frequency of acute asthmatic exacerbations. Materials and Methods: It was a descriptive cross-sectional study of children aged 6–17 years with asthma attending the pediatric respiratory clinic of a tertiary hospital from October 2017 to March 2019. All the values obtained were interpreted using the WHO reference growth charts z-scores. Results: A total of 71 children participated in the study. The study showed that 94% of the children with asthma were of normal height with 2.6% stunted and 2.6% severely stunted. There was no significant association between the height and the frequency of acute exacerbation. About 65% of the children had normal BMI. Those that were wasted/severely wasted were 19.7%, whereas 15.5% were overweight/at risk of overweight. There was no significant association between the BMI and the frequency of acute exacerbations (P > 0.05). The odds of having more frequent exacerbations in children with either above normal or below normal BMI were 1.05 (0.11–10.44) and 0.81 (0.08–7.88), respectively. Conclusion: Majority of the children with asthma were of normal height. Despite the fact that there were more children who were wasted/severely wasted than overweight/risk of overweight, these findings were not significantly associated with more frequent acute exacerbations.
Keywords: Acute exacerbations, nutritional status, pediatric asthma
|How to cite this article:|
Akhiwu HO, Aliyu I, John C, Yiltok ES, Oguche S. The Nutritional Status of Children with Asthma and Its Relationship with Acute Exacerbations. Int J Med Health Dev 2022;27:209-13
|How to cite this URL:|
Akhiwu HO, Aliyu I, John C, Yiltok ES, Oguche S. The Nutritional Status of Children with Asthma and Its Relationship with Acute Exacerbations. Int J Med Health Dev [serial online] 2022 [cited 2022 Jul 7];27:209-13. Available from: https://www.ijmhdev.com/text.asp?2022/27/3/209/346437
| Introduction|| |
Asthma is a disease characterized by chronic airway inflammation. It is defined by symptoms of wheezing, shortness of breath, chest tightness and/or cough, and variable expiratory airflow limitation. Asthma is a serious global health problem with an estimated 334 million people globally suffering from the disease with reports of its prevalence on the rise in many countries, especially among children.
There is increasing international interest in the causal role of nutrition in the development of asthma. Obesity has been recognized to be common among children with asthma, and associations between asthma and obesity have been stated in past studies, with higher body mass index (BMI) and overweight being risk factors for asthma in children in the developed countries.,,
Some studies, have showed that underweight children have lower lung function and lower body fat, which were associated with higher occurrence of asthma symptoms in them. This finding has also been supported by reports that normal lung growth might be affected in malnourished children, leading to an increased likelihood of the occurrence of asthma symptoms., In a study carried out in Bangladesh which is a developing country, it was also observed that stunting and underweight were significantly associated with wheezing episodes. Therefore, it appears that though in the developed countries obesity has been observed to be associated with more asthma symptoms, in the developing countries, of which Nigeria is one of, undernutrition may be the significant association with asthma symptoms.
Nigeria has a high burden of undernutrition,, and only a few studies in the world have explored the relationship between undernutrition and asthma. To the best of authors’ knowledge and review of English literature, no study has been carried out in Africa on the relationship between undernutrition and asthma.
This study was therefore carried out to determine the relationship if any between nutritional status and frequency of acute asthmatic exacerbations in Nigerian children. This is in line with the Global Initiative for Asthma Program (GINA—a medical guideline organization which works with public healthcare professionals globally to reduce the prevalence morbidity and mortality of asthma) recommendation that the asthma management programs in each country need to be based on the best available scientific evidence. This is to allow doctors to provide effective medical care for asthma tailored to the local healthcare peculiarities and resources. Hence, the resultant conclusions would help contribute important information needed for policy-making toward reducing the documented rising burden of the disease. This is because management of asthma in children is moving beyond just medications, but more toward a holistic approach to the disease.
| Materials and Methods|| |
The study was a descriptive cross-sectional study carried out in the Pediatric Respiratory Clinic of a teaching hospital. All consecutive patients aged 6–17 years diagnosed with asthma in children, according to the 2017 GINA guidelines, seen in the Pediatrics Respiratory Clinic were recruited over an 18-month period from October 2017 to March 2019. Patients with underlying cardiac (congenital or acquired heart diseases, etc.) or respiratory morbidities (pulmonary tuberculosis, lung abscess, etc.) and sickle cell disease were excluded from the study.
Each patient/caregiver had the study and their participation explained to them in detail after which they received a patient information sheet. When their understanding of the study was ascertained, they were required to sign/thumbprint the consent forms. Assent was also obtained from children aged 7 years and above. The researcher administered the questionnaire. Ethical approval was obtained from the Ethics Review Board of the teaching hospital.
For each of the subjects, the standing height was measured in centimeters (cm). The height of the child was measured using the combined measuring scale for height and weight to the nearest 0.1 cm. Similarly, the body weights were measured in kilogram (kg) to the nearest 0.1 kg. The BMI was calculated as weight (kilogram)/height (m)2. The BMI, height, and weights were interpreted using the WHO growth reference charts z-scores.,,
The height for age z-scores (HAZ) was interpreted as −2 to 3 as normal, less than −2 as stunted, and less than −3 as severely stunted. For BMI, greater than 3 was defined as obese, greater than 2–3 as overweight, greater than 1–2 as risk of overweight, 1 to −2 as normal, below −2 as thinness, and below −3 as severe thinness.
The data obtained were entered into IBM SPSS Statistics for Windows version 22.0 (IBM Corp., Armonk, NY, USA) and analyzed. Absolute numbers and simple percentages were used to present the data on sex, BMI, social class, and frequency of symptoms in the last 12 months. Quantitative variables such as height and age were described using means and standard deviation. χ2 for trend was used to determine the association between the frequency of acute exacerbation and height as well as the frequency of acute exacerbation and BMI. A P-value of less than 0.05 was considered significant.
The odds ratio and 95% confidence interval were used to determine the odds of having more frequent exacerbations in children with either above normal or below normal BMI. For this purpose, the children were grouped into those with normal BMI and those with above normal BMI and those with below normal BMI.
| Results|| |
A total of 71 children were recruited for the study with a male-to-female ratio of 1:1.6. The mean age of the study population was 11.8 ± 3.6 with about half of the patients in social class 2. Among the subjects, 94.4% of the patients were of normal height and 64.8% of them were of normal weight. Other information on patients’ socio-demographic characteristics is presented in [Table 1].
The χ2 for trend test showed that there was no significant association between frequency of acute exacerbation and height or BMI with P = 0.08 and 0.8, respectively [Table 2] and [Table 3].
|Table 2: Relationship between height and frequency of acute exacerbation|
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The odds of having more frequent exacerbations in children with either above normal or below normal BMI were calculated and found not to be different because the 95% confidence interval (CI) crossed the null value of 1 [Table 4] and [Table 5].
|Table 4: Determination of the odds of children with frequent exacerbation having above normal BMI (N=57)|
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|Table 5: Determination of the odds of children with frequent exacerbation having below normal BMI (N=60)|
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| Discussion|| |
This study demonstrates the nutritional status of children with asthma in our environment. This study found that 94% of the children with asthma were of normal height, whereas 2.8% of them were stunted and 2.8% severely stunted [Table 1]. This study did not find a significant association between the height and the frequency of acute exacerbation. In a study by Lipsberga and Kazoka, in which the authors reviewed 46 articles published on bronchial asthma in children from 2003 to 2014, they observed that most of the studies documented that children with bronchial asthma tend to be of lower height than normal children and that the height was impacted by the severity of the disease among other factors. While in a study by Jain et al., there was no significant difference found between the height of children with asthma and those without asthma, and therefore no relationship could be inferred between height and frequency of acute exacerbations. The study of Lima et al. in Brazil also documented that stunting was not found to be significantly associated with asthma.
About 65% of the children had normal BMI. Although those that were thin and severely thin were 19.7%, which was higher than 15.5% who were overweight and at risk of overweight, there was no significant association between the BMI and the frequency of acute exacerbations [Tables 2] and . This finding is similar to what was documented by Morishita et al. in Brazil, where over 60% of the children were of normal weight and there was no significant association between nutritional status and asthma exacerbations. Some other studies, however, have documented that overweight and obese children are at higher risk of developing asthma than normal-weight children, and that obesity in children is associated with an increased risk of asthma exacerbation. Obesity has also been linked to increased systemic leukotriene inflammation. These leukotrienes are pro-inflammatory substances released from mast cells, and they play a key role in bronchoconstriction in patients with asthma. Thus, excess adipose tissue might contribute to airway inflammation, exacerbating asthma symptoms., In contrast, a study carried out in Bangladesh observed that stunting and underweight were significantly associated with wheezing episodes. This was attributed to the fact that underweight children have lower lung function, which was associated with higher occurrence of asthma symptoms in them. These varying findings from different regions, therefore, stress the fact that although genetic factors play an important role in an individual’s risk of asthma, social, environmental, and behavioral factors must also contribute.
Our study documented that there was no significant difference in the odds of children with above normal BMI having more frequent exacerbation than children with below normal BMI.
| Conclusion|| |
This study showed that most children with asthma were of normal height and that although there were more children that were wasted/severely wasted than overweight/risk of overweight, these findings were not significantly associated with more frequent acute exacerbations.
What is already known on this topic
- In developed countries, asthma is usually associated with obesity.
- The Global Initiative for Asthma Program recommends a management program of asthma based on the best available scientific evidence tailored to the local healthcare systems.
What this study adds
- In our environment, almost 20% of children with asthma were thin/severely thin.
- Obesity was not found in children with asthma.
- In our environment, height and BMI were not found to be significantly associated with more acute asthma exacerbations.
HOA designed the study and wrote the first draft of the manuscript.
HOA, IA, CJ, and SO wrote the protocol.
HOA, EY, and CJ managed the data collection.
HOA, IA, CJ, EY, and SO managed the analysis of the data and literature searches.
All authors have read and agreed to the final manuscript.
Financial support and sponsorship
The research reported in this publication was supported by the Fogarty International Centre (FIC) of the National Institutes of Health and also the Office of the Director, National Institutes of Health (NIH), National Institute of Nursing Research (NINR), and the National Institutes of Neurological Disorders and Stroke (NINDS) under award number D43TW010130. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Global Initiative for Asthma. Global strategy for asthma management and prevention, 2016. Available from: www.ginasthma.org
. Accessed August 12, 2017.
Global Asthma Network. The Global Asthma Report. 2014. Available from: www.globalasthmanetwork.org
. Accessed August 12, 2017.
Nurmatov U, Nwaru BI, Devereux G, Sheikh A Confounding and effect modification in studies of diet and childhood asthma and allergies. Allergy 2012;67:1041-59.
Okabe Y, Adachi Y, Itazawa T, Yoshida K, Ohya Y, Odajima H, et al
. Association between obesity and asthma in Japanese preschool children. Pediatr Allergy Immunol 2012;23:550-5.
Kajbaf TZ, Asar S, Alipoor MR Relationship between obesity and asthma symptoms among children in Ahvaz, Iran: A cross sectional study. Ital J Pediatr 2011;37:1.
Hawlader MD, Noguchi E, El Arifeen S, Persson LÅ, Moore SE, Raqib R, et al
. Nutritional status and childhood wheezing in rural Bangladesh. Public Health Nutr 2014;17:1570-7.
Berntsen S, Lødrup Carlsen KC, Hageberg R, Aandstad A, Mowinckel P, Anderssen SA, et al
. Asthma symptoms in rural living Tanzanian children: Prevalence and the relation to aerobic fitness and body fat. Allergy 2009;64:1166-71.
Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al
; Maternal and Child Nutrition Study Group. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013;382:427-51.
United Nations Children Fund. Improving Child Nutrition: The Achievable Imperative for Global Progress. New York: UNICEF; 2013. Available from: http//:www.unicef.org/gambia/Improving_Child_Nutrition_the_achievable_imperative_for_global_progress.pdf
. Accessed July 9, 2017.
Masoli M, Fabian D, Holt S, Beasley R Global burden of asthma. Global Initiative for Asthma (GINA) report. Asthma 2004;59:469-78.
Xavier PS Obesity in Cecil Textbook of Medicine. 21st ed. Philadelphia: W.B. Saunders Company; 2000. p. 260-70.
World Health Organization. WHO Growth Reference 5–19 Years. BMI for age. Available from: http://www.who.int/growthref/who2007_bmi_for_age/en/
. Accessed August 13, 2017.
World Health Organization. WHO Growth Reference 5–19 Years. Height-for-age (5–19 years). Available from: http://www.who.int/growthref/who2007_height_for_age/en/
. Accessed August 13, 2017.
World Health Organization. WHO Growth Reference 5–19 Years. Weight-for-age (5–10 years). Available from: http://www.who.int/growthref/who2007_weight_for_age/en/
. Accessed August 13, 2017.
Lipsberga G, Kazoka D Review of different anthropometric and nutritional measurements in children with bronchial asthma. Pap Anthropol 2015;24:107-19.
Jain P, Kant S, Mishra R Assessment of nutritional status of patients suffering from asthma. J Clin Nutr Diet 2017;3:2.
Lima R, Cesar GV, Menezes AM, Barros F Do risk factors for childhood infections and malnutrition protect against asthma? A study of Brazilian male adolescents. Am J Public Health 2003;93:1858-64.
Morishita R, Strufaldi MW, Puccini R Clinical evolution and nutritional status in asthmatic children and adolescents enrolled in primary health care. Rev Paul Pediatr 2015;33:387-93.
Black MH, Zhou H, Takayanagi M, Jacobsen SJ, Koebnick C Increased asthma risk and asthma-related health care complications associated with childhood obesity. Am J Epidemiol 2013;178:1120-8.
Chen YC, Dong GH, Lin KC, Lee YL Gender difference of childhood overweight and obesity in predicting the risk of incident asthma: A systematic review and meta-analysis. Obes Rev 2013;14:222-31.
Ahmadizar F, Vijverberg SJ, Arets HG, de Boer A, Lang JE, Kattan M, et al
. Childhood obesity in relation to poor asthma control and exacerbation: A meta-analysis. Eur Respir J 2016;48:1063-73.
Denlinger LC, Phillips BR, Ramratnam S, Ross K, Bhakta NR, Cardet JC, et al
; National Heart, Lung, and Blood Institute’s Severe Asthma Research Program-3 Investigators. Inflammatory and comorbid features of patients with severe asthma and frequent exacerbations. Am J Respir Crit Care Med 2017;195:302-13.
Pérez-Pérez A, Vilariño-García T, Fernández-Riejos P, Martín-González J, Segura-Egea JJ, Sánchez-Margalet V Role of leptin as a link between metabolism and the immune system. Cytokine Growth Factor Rev 2017;35:71-84.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]