Abstract
BackgroundFactors which determine the development of atopy and the observed rural-urban gradient in its prevalence are not fully understood. High body mass index (BMI) has been associated with asthma and potentially atopy in industrialized countries. In developing countries, the transition from rural to urban areas has been associated with lifestyle changes and an increased prevalence of high BMI; however, the effect of high BMI on atopy remains unknown in this population. We therefore investigated the association between high BMI and atopy among schoolchildren living in rural and urban areas of Ghana.MethodsData on skin prick testing, anthropometric, parasitological, demographic and lifestyle information for 1,482 schoolchildren aged 6-15 years was collected. Atopy was defined as sensitization to at least one tested allergen whilst the Centres for Disease Control and Prevention (CDC, Atlanta) growth reference charts were used in defining high BMI as BMI ≥ the 85th percentile. Logistic regression was performed to investigate the association between high BMI and atopy whilst adjusting for potential confounding factors.ResultsThe following prevalences were observed for high BMI [Rural: 16%, Urban: 10.8%, p < 0.001] and atopy [Rural: 25.1%, Urban: 17.8%, p < 0.001]. High BMI was not associated with atopy; but an inverse association was observed between underweight and atopy [OR: 0.57, 95% CI: 0.33-0.99]. Significant associations were also observed with male sex [Rural: OR: 1.49, 95% CI: 1.06-2.08; Urban: OR: 1.90, 95% CI: 1.30-2.79], and in the urban site with older age [OR: 1.76, 95% CI: 1.00-3.07], family history of asthma [OR: 1.58, 95% CI: 1.01-2.47] and occupational status of parent [OR: 0.33, 95% CI: 0.12-0.93]; whilst co-infection with intestinal parasites [OR: 2.47, 95% CI: 1.01-6.04] was associated with atopy in the rural site. After multivariate adjustment, male sex, older age and family history of asthma remained significant.ConclusionsIn Ghanaian schoolchildren, high BMI was not associated with atopy. Further studies are warranted to clarify the relationship between body weight and atopy in children subjected to rapid life-style changes associated with urbanization of their environments.
Highlights
Factors which determine the development of atopy and the observed rural-urban gradient in its prevalence are not fully understood
High body mass index (BMI) has been implicated in the development of asthma in industrialized countries [14] the relationship between high BMI and atopy is not clearly established [15], but potentially mediated through elevated production of leptin, tumor necrosis factor a (TNFa) and interleukin-6 associated with increased adiposity
Underweight children were found to have a reduced likelihood of atopy. Other factors such as sex, older age, family history of asthma, occupational status of parents, educational level of parents and co-infection with intestinal parasites were associated with atopy in univariate analysis; whilst male sex, older age, and family history of asthma remained the significant predictors of atopy after multivariate adjustment
Summary
Factors which determine the development of atopy and the observed rural-urban gradient in its prevalence are not fully understood. High body mass index (BMI) has been associated with asthma and potentially atopy in industrialized countries. The transition from rural to urban areas has been associated with lifestyle changes and an increased prevalence of high BMI; the effect of high BMI on atopy remains unknown in this population. High body mass index (BMI) has been implicated in the development of asthma in industrialized countries [14] the relationship between high BMI and atopy is not clearly established [15], but potentially mediated through elevated production of leptin, tumor necrosis factor a (TNFa) and interleukin-6 associated with increased adiposity. High levels of TNFa cause an increase in the production of T-helper lymphocyte type 2 (Th2) cytokines such as interleukin-4 and interleukin; which are primary signals for activating an immune response towards atopy [15]
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