Weight Status and Respiratory Health in Asthmatic Children


In this study,we explored the effect of adiposity as measured by BMI on lung function in 72 asthmatic school children (5–12 years) using baseline data from the Mediterranean diet enriched with fatty fish intervention study. Bronchial function was assessed using spirometry and fractional exhaled nitric oxide (FeNO). BMI categories were classified as normal and overweight/obese based on International Obesity Task Force cut-offs. Weak correlations were observed between BMI and FVC (p = 0.013) and FEV1 (p = 0.026). Median FeNO was lower in the overweight/obese as compared to normal weight group (p = 0.027). Linear regression showed an increment in FEF25–75% in the overweight/obese group as compared to normal weight after controlling for confounders namely age, height, sex, regular physical activity, medication and KIDMED score (p = 0.043; β = 11.65 units, 95% CI 0.36–22.94), although with no effect on FeNO. In conclusion, the findings of this study suggest that excess body weight could impact pulmonary dynamics in childhood asthma.

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Fig. 1



Body mass index

FEV1 :

Forced expiratory volume in 1 s


Forced vital capacity


Ratio of forced expiratory volume in 1 s and forced vital capacity


Peak expiratory flow

FEF25–75% :

Mid expiratory flow 25–75% vital capacity


Fractional exhaled nitric oxide


  1. 1.

    Forno E, Han Y-Y, Mullen J, Celedón JC (2018) Overweight, Obesity, and lung function in children and adults—a meta-analysis. J Allergy Clin Immunol Pract 6(2):570–581.e510. https://doi.org/10.1016/j.jaip.2017.07.010

    Article  PubMed  Google Scholar 

  2. 2.

    Dusser D, Montani D, Chanez P, de Blic J, Delacourt C, Deschildre A, Devillier P, Didier A, Leroyer C, Marguet C, Martinat Y, Piquet J, Raherison C, Serrier P, Tillie-Leblond I, Tonnel AB, Tunon de Lara M, Humbert M (2007) Mild asthma: an expert review on epidemiology, clinical characteristics and treatment recommendations. Allergy 62(6):591–604. https://doi.org/10.1111/j.1398-9995.2007.01394.x

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Papamichael MM, Katsardis C, Lambert K, Tsoukalas D, Koutsilieris M, Erbas B, Itsiopoulos C (2019) Efficacy of a Mediterranean diet supplemented with fatty fish in ameliorating inflammation in paediatric asthma: a randomised controlled trial. J Hum Nutr Diet 32(2):185–197. https://doi.org/10.1111/jhn.12609

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    GINA (2016) Global strategy for asthma management and prevention (GINA). GINA, Calgary

    Google Scholar 

  5. 5.

    Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320(7244):1240–1243

    CAS  Article  Google Scholar 

  6. 6.

    Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J (2005) Standardisation of spirometry. Eur Respir J 26(2):319–338. https://doi.org/10.1183/09031936.05.00034805

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    American Thoracic Society (2005) ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med 171(8):912–930. https://doi.org/10.1164/rccm.200406-710ST

    Article  Google Scholar 

  8. 8.

    Katsardis C, Alexandraki S, Paraskakis E (2015) Chapter 2: Spirometry in children 6–16 years old. In: Katsardis Ch, Koumbourlis A, Anthracopoulos M, Paraskakis E (eds) Paediatric pulmonary function testing Indications and Interpretation. NOVA Biomedical, New York, pp 15–42

    Google Scholar 

  9. 9.

    Paraskakis E, Katsardis C, Chatzimichail A (2015) Chapter 17: Exhaled NO. In: Katsardis Ch, Koumbourlis A, Anthracopoulos M, Paraskakis E (eds) Paediatric pulmonary function testing indications and interpretation. NOVA Biomedical, New York, pp 235–248

    Google Scholar 

  10. 10.

    Yao TC, Tsai HJ, Chang SW, Chung RH, Hsu JY, Tsai MH, Liao SL, Hua MC, Lai SH, Chen LC, Yeh KW, Tseng YL, Lin WC, Chang SC, Huang JL (2017) Obesity disproportionately impacts lung volumes, airflow and exhaled nitric oxide in children. PLoS ONE 12(4):e0174691. https://doi.org/10.1371/journal.pone.0174691

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Takeda T, Oga T, Niimi A, Matsumoto H, Ito I, Yamaguchi M, Matsuoka H, Jinnai M, Otsuka K, Oguma T, Nakaji H, Chin K, Mishima M (2010) Relationship between small airway function and health status, dyspnea and disease control in asthma. Respiration 80(2):120–126. https://doi.org/10.1159/000242113

    Article  PubMed  Google Scholar 

  12. 12.

    Spathopoulos D, Paraskakis E, Trypsianis G, Tsalkidis A, Arvanitidou V, Emporiadou M, Bouros D, Chatzimichael A (2009) The effect of obesity on pulmonary lung function of school aged children in Greece. Pediatr Pulmonol 44(3):273–280. https://doi.org/10.1002/ppul.20995

    Article  PubMed  Google Scholar 

  13. 13.

    Ekstrom S, Hallberg J, Kull I, Protudjer JLP, Thunqvist P, Bottai M, Gustafsson PM, Bergstrom A, Melen E (2018) Body mass index status and peripheral airway obstruction in school-age children: a population-based cohort study. Thorax 73(6):538–545. https://doi.org/10.1136/thoraxjnl-2017-210716

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Forno E, Weiner DJ, Mullen J, Sawicki G, Kurland G, Han YY, Cloutier MM, Canino G, Weiss ST, Litonjua AA, Celedon JC (2017) Obesity and airway dysanapsis in children with and without asthma. Am J Respir Crit Care Med 195(3):314–323. https://doi.org/10.1164/rccm.201605-1039OC

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Jones MH, Roncada C, Fernandes MTC, Heinzmann-Filho JP, Sarria Icaza EE, Mattiello R, Pitrez PMC, Pinto LA, Stein RT (2017) Asthma and obesity in children are independently associated with airway dysanapsis. Front Pediatr 5:270. https://doi.org/10.3389/fped.2017.00270

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Mahut B, Beydon N, Delclaux C (2012) Overweight is not a comorbidity factor during childhood asthma: the GrowthOb study. Eur Respir J 39(5):1120–1126. https://doi.org/10.1183/09031936.00103311

    Article  PubMed  Google Scholar 

  17. 17.

    McClean KM, Kee F, Young IS, Elborn JS (2008) Obesity and the lung: 1 Epidemiology. Thorax 63(7):649–654. https://doi.org/10.1136/thx.2007.086801

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Lazovic-Popovic B, Zlatkovic-Svenda M, Durmic T, Djelic M, Djordjevic Saranovic S, Zugic V (2016) Superior lung capacity in swimmers: some questions, more answers! Rev Port Pneumol 22(3):151–156. https://doi.org/10.1016/j.rppnen.2015.11.003

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    McNulty W, Usmani OS (2014) Techniques of assessing small airways dysfunction. Eur Clin Respir J 1(1):25898. https://doi.org/10.3402/ecrj.v1.25898

    Article  Google Scholar 

  20. 20.

    Han YY, Forno E, Celedon JC (2014) Adiposity, fractional exhaled nitric oxide, and asthma in U.S. children. Am J Respir Crit Care Med 190(1):32–39. https://doi.org/10.1164/rccm.201403-0565OC

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Schmauck-Gomez JS, Menrath I, Kaiser MM, Herz A, Kopp MV (2016) Children and adolescents with asthma differ in lung function parameters and exhaled NO from children and adolescents with obesity. Klin Padiatr 228(4):189–194. https://doi.org/10.1055/s-0042-102254

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Holguin F (2013) Arginine and nitric oxide pathways in obesity-associated asthma. J Allergy (Cairo) 2013:714595. https://doi.org/10.1155/2013/714595

    CAS  Article  Google Scholar 

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We gratefully acknowledge Basilopoulos and Sklavenitis supermarkets for the provision of coupons and fish to disadvantaged families.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The first author is supported by the Australian Post Graduate Award PhD Scholarship administered by La Trobe University.

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MMP conceptualized, designed and drafted the manuscript, collected data and performed the statistical analyses. CI was in charge and co-ordinated the study. BE supervised the statistical analyses and interpretation of data. All co-authors critically revised, edited the manuscript and approved the final version as submitted. The authors confirm that the article is the authors’ original work, has not received prior publication, and is not under consideration for publication elsewhere.

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Correspondence to Maria Michelle Papamichael.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institution (La Trobe University Human Ethics Committee, HEC 16-035) and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in this study.

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Papamichael, M.M., Katsardis, C., Tsoukalas, D. et al. Weight Status and Respiratory Health in Asthmatic Children. Lung 197, 777–782 (2019). https://doi.org/10.1007/s00408-019-00273-w

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  • Asthma
  • Body mass index
  • Children
  • Lung function
  • Spirometry
  • Overweight