To examine the association between body mass index (BMI) percentile and asthma in children 2–11 years of age, we performed a cross-sectional analysis of 853 Black and Hispanic children from a community-based sample of 2- to 11-year olds with measured heights and weights screened for asthma by the Harlem Children’s Zone Asthma Initiative. Current asthma was defined as parent/guardian-reported diagnosis of asthma and asthma-related symptoms or emergency care in the previous 12 months. Among girls, asthma prevalence increased approximately linearly with increasing body mass index (BMI) percentile, from a low of 12.0% among underweight girls (BMI ≤5th percentile) to a high of 33.3% among girls at risk for overweight (BMI 85th–94th percentile). Among boys, asthma prevalence was associated in a U-shaped curve with the extremes of BMI percentile, that is, 36.4% among underweight boys, 19.1% among normal weight boys (BMI 6th–84th percentile), and 34.8% among overweight boys (>95th percentile). After adjusting for age, race/ethnicity, and household smoking, among girls, having asthma was associated with being at risk for overweight (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.4–5.0) and being overweight (OR, 2.1; 95% CI, 1.2–3.8) compared to normal weight; among boys, having asthma was associated both with overweight (OR, 2.4; 95% CI, 1.4–4.3) and with underweight (OR, 2.9; 95% CI, 1.1–7.7). Large, prospective studies that include very young children are needed to further explore the observed association between underweight and asthma among boys. Early interventions that concomitantly address asthma and weight gain are needed among pre-school and school-aged children.
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Dashed lines represent 95% confidence limits
Dashed lines represent 95% confidence limits
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Financial and ongoing program support for the Harlem Children’s Zone Asthma Initiative is provided by the Robin Hood Foundation (grant RHF CU516688), the Anne E. Dyson Community Pediatrics Training Initiative, the National Institute of Environmental Health Sciences (grant 5 R25 ES012574-02), the American Legacy Foundation (grant 5052), the Centers for Disease Control and Prevention through the Harlem Health Promotion Center (grant U48/CCU209663-08), and the Kellogg Scholars in Health Disparities Program.
Past and present participants in the Harlem Children’s Zone Asthma Initiative include the named authors on this article, as well as (in alphabetical order) T. Berry Brazelton, Geoffrey Canada, Jason Corburn, Jazmine Credell, Linda Cushman, Lisa Desrochers, Daouda Diarrassouba, Shannon Farley, Lee Farrow, Keith Faulkner, Jacqueline Fox-Pascal, Regina Garrett, Cynthia Golembeski, Katrina Gonzalez, Roger Hayes, Vincent Hutchinson, Marilyn Joseph, Daniel Kass, Renuka Kher, Sandra Klihr-Beall, Lucille Lebovitz, Rasuli Lewis, Marty Lipp, Cara McAteer, Brian McClendon, Robert Mellins, Dennis Mitchell, Carolyn Nash, Eric Polley, Yvonne Pradier, Doris Prester, Miriam Ramos, David Saltzman, Gwendolyn Scott, Carron Sherry, Donna Shelley, Caressa Singleton, Joshua Sparrow, Seth Spielman, Gabriel Stover, Denise Sutton, Dawn Sykes, Michael Weinstein, Mizetta Wilson, and Candace Young.
Kwon and Ortiz share co-first aithorship. Ortiz and Nicholas are with the Department of Pediatrics, Harlem Hospital Center/Columbia University, New York, NY, USA; Kwon and Borrell are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA; Swaner, Shoemaker, and Jean-Louis are with the Harlem Children’s Zone, Inc., New York, NY; Northridge and Vaughan are with the Harlem Health Promotion Center, Mailman School of Public Health, Columbia University, New York, NY, USA; Northridge is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; Vaughan is with the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA; Marx is with the Department of Education, New York City, NY, USA; Goodman is with the East and Central Harlem District Public Health Office, New York City Department of Health and Mental Hygiene, New York, NY, USA.
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Kwon, H.L., Ortiz, B., Swaner, R. et al. Childhood Asthma and Extreme Values of Body Mass Index: The Harlem Children’s Zone Asthma Initiative. JURH 83, 421–433 (2006). https://doi.org/10.1007/s11524-006-9050-9