Early growth characteristics and the risk of reduced lung function and asthma: A meta-analysis of 25,000 children - 06/04/16

Doi : 10.1016/j.jaci.2015.08.050

Herman T. den Dekker, MD ^a,^b,^c, Agnes M.M. Sonnenschein-van der Voort, MSc, PhD ^a,^b,^c, Johan C. de Jongste, MD, PhD ^a, Isabella Anessi-Maesano, MD, PhD ^d,^e, S. Hasan Arshad, DM ^f,^g,^h, Henrique Barros, MD, PhD ⁱ, Caroline S. Beardsmore, PhD ^j, Hans Bisgaard, MD, DMSci ^k,^l, Sofia Correia Phar, MD, MSc ⁱ, Leone Craig, PhD, MSc, BSc ^m,ⁿ, Graham Devereux, MD, PhD ⁿ, C. Kors van der Ent, MD, PhD ^o, Ana Esplugues, PhD ^p,^q,^r, Maria P. Fantini, MD ^s, Claudia Flexeder, MSc ^t, Urs Frey, MD, PhD ^u, Francesco Forastiere, MD, PhD ^v, Ulrike Gehring, PhD ^w, Davide Gori, MD ^s, Anne C. van der Gugten, MD, PhD ^o, A. John Henderson, MD, PhD ^x, Barbara Heude, PhD ^y,^z, Jesús Ibarluzea, PhD ^r,^aa, Hazel M. Inskip, MSc, PhD ^bb, Thomas Keil, MD, MScPH ^cc,^dd, Manolis Kogevinas, MD, PhD ^r,^ee,^ff,^gg, Eskil Kreiner-Møller, MD ^k,^l, Claudia E. Kuehni, MD ^hh, Susanne Lau, MD, PhD ⁱⁱ, Erik Mélen, MD, PhD ^jj, Monique Mommers, PhD ^kk, Eva Morales, MD, PhD ^r,^ff,^gg,^ll, John Penders, PhD ^kk, Katy C. Pike, MD, PhD ^g, Daniela Porta, MSc ^v, Irwin K. Reiss, MD, PhD ^mm, Graham Roberts, DM ^f,^g,^h, Anne Schmidt, MD ^u,ⁿⁿ, Erica S. Schultz, MD ^jj, Holger Schulz, MD ^t, Jordi Sunyer, MD, PhD ^r,^ff,^gg,^ll, Matias Torrent, MD, PhD ^oo, Maria Vassilaki, MD, MPH, PhD ^pp, Alet H. Wijga, PhD ^qq, Carlos Zabaleta, MD ^rr, Vincent W.V. Jaddoe, MD, PhD ^b,^c,^ss, Liesbeth Duijts, MD, PhD ^a,^b,^mm,^⁎
^a Department of Pediatrics, Division of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
^b Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
^c Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
^mm Department of Pediatrics, Division of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands
^ss Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
^d EPAR, UMR-S 707 INSERM Paris, France
^e EPAR, UMR-S 707, Université Pierre et Marie Curie Paris, France
^f David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, United Kingdom
^g Faculty of Medicine, University of Southampton, Southampton, United Kingdom
^h NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
ⁱ Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
^j Division of Child Health, Department of Infection, Immunity & Inflammation, University of Leicester and Institute for Lung Health, Leicester, United Kingdom
^k Copenhagen Prospective Studies on Asthma in Childhood (COPSAC2000), Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
^l Danish Pediatric Asthma Center, Copenhagen University Hospital, Gentofte, Denmark
^m Public Health Nutrition Research Group, University of Aberdeen, Aberdeen, United Kingdom
ⁿ Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
^o Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
^p Faculty of Nursing and Chiropody, Valencia, Spain
^q FISABIO, Valencia, Spain
^r CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
^s Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
^t Helmholtz Zentrum München, Institute of Epidemiology I, Neuherberg, Germany
^u University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
^v Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
^w Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
^x School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
^y CESP Inserm, UMRS 1018, Team 10, Villejuif, France
^z Université Paris-Sud, UMRS 1018 Team 10, Villejuif, France
^aa Public Health Division of Gipuzkoa, San Sebastian, Spain
^bb MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
^cc Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
^dd Institute for Clinical Epidemiology and Biometry, University of Würzburg, Wurzburg, Germany
^ee National School of Public Health, Athens, Greece
^ff Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
^gg Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
^hh Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
ⁱⁱ Department of Pediatric Pneumology and Immunology, Charité University Medical Centre, Berlin, Germany
^jj Institute of Environmental Medicine, Karolinska Institutet, Stockholm, and Sach's Children Hospital, Stockholm, Switzerland
^kk Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
^ll Universitat Pompeu Fabra (UPF), Barcelona, Spain
ⁿⁿ Division of Respiratory Medicine, Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
^oo IB-SALUT, Area de Salut de Menorca, Balearic Islands, Spain
^pp Department of Social Medicine, School of Medicine, University of Crete, Crete, Greece
^qq Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
^rr Nuestra Señora de la Antigua Hospital, OSAKIDETZA Basque Health Service, San Sebastian, Spain

^∗Corresponding author: Liesbeth Duijts, MD, PhD, Erasmus University Medical Center Rotterdam, Sp-3435, PO Box 2060, 3000 CB Rotterdam, The Netherlands.Erasmus University Medical Center RotterdamSp-3435PO Box 20603000 CB RotterdamThe Netherlands

Abstract

Background

Children born preterm or with a small size for gestational age are at increased risk for childhood asthma.

Objective

We sought to assess the hypothesis that these associations are explained by reduced airway patency.

Methods

We used individual participant data of 24,938 children from 24 birth cohorts to examine and meta-analyze the associations of gestational age, size for gestational age, and infant weight gain with childhood lung function and asthma (age range, 3.9-19.1 years). Second, we explored whether these lung function outcomes mediated the associations of early growth characteristics with childhood asthma.

Results

Children born with a younger gestational age had a lower FEV₁, FEV₁/forced vital capacity (FVC) ratio, and forced expiratory volume after exhaling 75% of vital capacity (FEF₇₅), whereas those born with a smaller size for gestational age at birth had a lower FEV₁ but higher FEV₁/FVC ratio (P < .05). Greater infant weight gain was associated with higher FEV₁ but lower FEV₁/FVC ratio and FEF₇₅ in childhood (P < .05). All associations were present across the full range and independent of other early-life growth characteristics. Preterm birth, low birth weight, and greater infant weight gain were associated with an increased risk of childhood asthma (pooled odds ratio, 1.34 [95% CI, 1.15-1.57], 1.32 [95% CI, 1.07-1.62], and 1.27 [95% CI, 1.21-1.34], respectively). Mediation analyses suggested that FEV₁, FEV₁/FVC ratio, and FEF₇₅ might explain 7% (95% CI, 2% to 10%) to 45% (95% CI, 15% to 81%) of the associations between early growth characteristics and asthma.

Conclusions

Younger gestational age, smaller size for gestational age, and greater infant weight gain were across the full ranges associated with childhood lung function. These associations explain the risk of childhood asthma to a substantial extent.

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Key words : Preterm birth, low birth weight, infant growth, asthma, lung function, children, meta-analysis

Abbreviations used : ATS, ERS, FEF_25-75, FEF₇₅, FVC, GLI, SDS

Plan

Subjects' characteristics

Early growth measures and lung function outcomes

Early growth, lung function, and asthma

Discussion

Disclosure of potential conflict of interest: I. Anessi-Maesano has received a grant from the FP7 MeDALL project (Mechanisms of the Development of ALLergy, FP7 no. 261357) and has board memberships with the European Respiratory Journal, Clinical and Experimental Allergy, the International Journal of Tuberculosis and Lung Disease, BMC Public Health, the European Respiratory Review, Multidisciplinary Respiratory Medicine, Therapeutic Advances in Respiratory Disease, Multidisciplinary Review Frontiers in Medicine, and La lettre du pneumologue. S. H. Arshad has received grants from the National Institutes of Health (NIH) and the Medical Research Council and has consultant arrangements with Merck & Co. U. Frey and A. Schmidt have received grants from the Swiss National Science Foundation. A. J. Henderson has received grants from the Medical Research Council and the Wellcome Trust. H. M. Inskip has received grants from the UK Medical Research Council, the British Heart Foundation, Asthma Research UK, the British Lung Foundation, the Food Standards Agency, and the Dunhill Medical Trust; is deputy chair of a grant-funding board for the UK Medical Research Council; and has her employment funded by the Medical Research Council. S. Lau has received grants from the German Research Foundation, Allergopharma, and Symbiopharma and has consultant arrangements with Merck. K. C. Pike has received grants from the Food Standards Agency and the British Lung Foundation. The rest of the authors declare that they have no relevant conflicts of interest.

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Early growth characteristics and the risk of reduced lung function and asthma: A meta-analysis of 25,000 children - 06/04/16

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