Abstract
Prevalence of childhood obesity is progressively increasing, reaching worldwide levels of 5.6% in girls and of 7.8% in boys. Several evidences showed that obesity is a major preventable risk factor and disease modifier of some respiratory conditions such as asthma and Obstructive Sleep Apnea Syndrome (OSAS). Co-occurrence of asthma and obesity may be due to common pathogenetic factors including exposure to air pollutants and tobacco smoking, Western diet, and low Vitamin D levels. Lung growth and dysanapsis phenomenon in asthmatic obese children play a role in impaired respiratory function which appears to be different than in adults. Genes involved in both asthma and obesity have been identified, though a gene-by-environment interaction has not been properly investigated yet. The identification of modifiable environmental factors influencing gene expression through epigenetic mechanisms may change the natural history of both diseases. Another important pediatric respiratory condition associated with obesity is Sleep-Disordered Breathing (SDB), especially Obstructive Sleep Apnea Syndrome (OSAS). OSAS and obesity are linked by a bidirectional causality, where the effects of one affect the other. The factors most involved in the association between OSAS and obesity are oxidative stress, systemic inflammation, and gut microbiota. In OSAS pathogenesis, obesity’s role appears to be mainly due to mechanical factors leading to an increase of respiratory work at night-time. However, a causal link between obesity-related inflammatory state and OSAS pathogenesis still needs to be properly confirmed. To prevent obesity and its complications, family education and precocious lifestyle changes are critical. A healthy diet may lead to an improved quality of life in obese children suffering from respiratory diseases. The present review aimed to investigate the links between obesity, asthma and OSAS, focusing on the available evidence and looking for future research fields.
Highlights
Obesity in childhood represents a major global health challenge [1] mainly playing as a risk factor for morbidity in adulthood [2].The prevalence of obesity shows a worrying increase of epidemic proportions
Rastogi et al described differential patterns of DNA methylation in children as a function of their obesity and asthma status. They studied DNA methylation in peripheral blood mononuclear cells of eight asthmatic and obese children in comparison with a population of eight children with only asthma, obesity, or healthy controls. Children with both asthma and obesity had a distinctive appearance characterized by reduced methylation of the promoter of chemokine ligand type 5 (CCL5), interleukin 2 receptor antagonist (IL2RA), and T-box transcription factor 21 (TBX21) genes involved in Th1 polarization that is observed in obese asthmatics [52]
Another important pediatric respiratory condition associated with overweight and obesity is Sleep-Disordered Breathing (SDB), especially Obstructive Sleep Apnea Syndrome (OSAS)
Summary
Obesity in childhood represents a major global health challenge [1] mainly playing as a risk factor for morbidity in adulthood [2]. Obesity is associated with several complications [6] It is a major risk factor directly correlated with childhood hypertension and other metabolic chronic conditions including stroke [7], prediabetes and type 2 diabetes mellitus [8,9], dyslipidemia [10], non-alcoholic fatty liver disease, and/or gallstones [11,12]. Obesity is a major preventable risk factor and disease modifier of many respiratory conditions, mainly involved in wheeze, dyspnea, and orthopnea both in adults and children, affecting the prevalence and the severity of several lung diseases, which has been testified during the SARS-CoV-2 pandemics [14,15]. Relevant articles were included in this review with the aim of highlighting the most relevant connection between obesity and two frequent respiratory chronic diseases, asthma, and obstructive sleep apnea syndrome
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