Abstract
Obesity is an important public health problem. WHO estimates that about 39 million children younger than 5 years of age are overweighted or obese. On the other hand, asthma is the most prevalent chronic disease in childhood, and thus, many children share those two conditions. In the present paper we review the epidemiology of children with asthma and obesity, as well as the consequences of being obese on the respiratory system. On the one hand obesity produces an underlying T-helper 2 (TH2) low inflammation state in which numerous cytokines, which could have an impact in the respiratory system play, a role. On the other hand, some respiratory changes have been described in obese children and, specially, the development of the so called “dysanapsis” (the disproportionate scaling of airway dimensions to lung volume) which seems to be common during the first stages of life, probably related to the early development of this condition. Finally, this review deals with the role of adipokines and insulin resistance in the inception and worsening of asthma in the obese child.
Highlights
Obesity has become a real pandemic and is a major public health concern; the WorldHealth Organization estimates that in 2020 there were 39 million overweight or obese children under the age of five years, and that in 2016 there were over 340 million overweight or obese children and teenagers aged 5–19
It is important to recall that there is a clear correlation between childhood or teenage body mass index (BMI) and adult BMI [2] and, so it can be stated that it is very probable that the obese child or teenager continues to be obese at adult age; the consequences of childhood obesity on public health will remain for many years
This increase correlates with BMI (r = 0.42; p = 0.0005) and the relative mRNA expression of RORC (p = 0.013) and IL-17A (p = 0.014) were both upregulated in the overweight children compared to those who were not overweight [36]
Summary
Obesity has become a real pandemic and is a major public health concern; the World. Health Organization estimates that in 2020 there were 39 million overweight or obese children under the age of five years, and that in 2016 there were over 340 million overweight or obese children and teenagers aged 5–19. In children with central obesity, higher percentages of Th17 cells have been found than in children from the control group [35] and it was shown that, after Ionomycin stimulated peripheral blood mononuclear cells, there is a significant increase in TH17 cells (34.7 ± 1.54% vs 25.4 ± 2.38%; p = 0.0023) in obese children without asthma, allergic rhinitis, atopic dermatitis nor autoimmune diseases, compared to the non-obese controls This increase correlates with BMI (r = 0.42; p = 0.0005) and the relative mRNA expression of RORC (p = 0.013) and IL-17A (p = 0.014) were both upregulated in the overweight children compared to those who were not overweight [36]. Obesity induces a situation of persistent TH2-low inflammation which is probably initiated by M1 macrophages infiltrating adipose tissue Those cells start a cascade of cytokines release that, acting upon CD4 lymphocytes, maintain elevated levels of interleukins such as IFN-γ and IL-6, typical of TH2-low inflammation. The levels of those cytokines are related to neutrophiles in the airway of individuals with impaired lung function [33]
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