An obesity-preventive lifestyle score is negatively associated with pediatric asthma



Lifestyle (diet and physical activity) may increase asthma risk, but evidence in this area is lacking. The aims of the present study were to calculate an obesity-preventive lifestyle score comprising of eating and physical activity behaviors and investigate the overall effect of lifestyle on asthma in children.


A cross-sectional case–control study was carried out in 514 children (217 asthma cases and 297 healthy controls). Data were collected on medical history, anthropometry, dietary intake, and physical activity. We constructed an overweight/obesity-preventive score (OPLS) using study-specific quartile rankings for nine target lifestyle behaviors that were either favorable or unfavorable in preventing obesity (i.e., screen time was an unfavorable lifestyle behavior). The score was developed using the recommendations of the Expert Committee of American Academy of Pediatrics. Score values ranged from 0–18 points; the higher the score, the more protective against high body weight.


The OPLS was negatively associated with obesity indices (BMI, waist circumference, and hip circumference), (p < 0.05). Control children had a higher score when compared to asthma cases (9.3 ± 2.7 vs. 8.6 ± 2.9, p = 0.007). A high OPLS was protective against physician-diagnosed asthma (OR 0.92; 95% CI 0.86–0.98, p = 0.014), adjusted for several confounders. The OPLS was no longer protective after adjustment for BMI.


Higher adherence to an obesity-preventive lifestyle score—consistent with several behaviors for the prevention of childhood overweight/obesity—is negatively associated with obesity indices and lowers the odds for asthma in children. Lifestyle behaviors that contribute to a higher body weight may contribute to the obesity–asthma link. These findings are hypothesis-generating and warrant further investigation in prospective intervention studies.

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Body mass index


Forced expiratory volume in 1 s


Forced expiratory vital capacity


Metabolic equivalents


Obesity-preventive lifestyle score


Peak expiratory flow


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The authors thank all faculty, students of Athens University, Harokopio University, and all clinical staff of Penteli Children’s Hospital and the municipal multi-clinic centers in Galatsi and Pefki for their invaluable assistance. The authors also thank the participants of these studies and their families.

Author information




Dr. CP conceptualized and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. EP carried out the initial analyses, co-drafted parts of the initial manuscript, reviewed and revised the manuscript, and approved the final manuscript as submitted. Ms. MC conducted data collection and analyses, critically reviewed the manuscript, and approved the final manuscript as submitted. Dr. GA conducted data analyses, critically reviewed the manuscript, and approved the final manuscript as submitted. Dr. VM coordinated and supervised data collection, critically reviewed the manuscript, and approved the final manuscript as submitted. Ms. MD conducted data collection, critically reviewed the manuscript, and approved the final manuscript as submitted. Ms. EK conducted data collection, critically reviewed the manuscript, and approved the final manuscript as submitted. Dr. KNP contributed to the design of the study, analyses, and drafting the article.

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Correspondence to Constantina Papoutsakis.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.


Dr. Papoutsakis was supported by a post-doctoral grant, Greek State Scholarship Foundation. Dr. Chondronikola was supported by a scholarship grant, Onassis Foundation.

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Papoutsakis, C., Papadakou, E., Chondronikola, M. et al. An obesity-preventive lifestyle score is negatively associated with pediatric asthma. Eur J Nutr 57, 1605–1613 (2018).

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  • Asthma
  • Obesity
  • Lifestyle
  • Children