The bidirectional association between wheezing and obesity during adolescence and the beginning of adulthood in the 1993 birth cohort, Pelotas, Brazil

Weisshahn, Nícolas Kickhofel; Oliveira, Paula Duarte de; Wehrmeister, Fernando César; Gonçalves, Helen; Menezes, Ana Maria Baptista

doi:10.36416/1806-3756/e20220222

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Jornal Brasileiro de Pneumologia

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ORIGINAL ARTICLE • J. bras. pneumol. 48 (06) • 2022 • https://doi.org/10.36416/1806-3756/e20220222 copy

The bidirectional association between wheezing and obesity during adolescence and the beginning of adulthood in the 1993 birth cohort, Pelotas, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the bidirectional association between wheezing and obesity during adolescence and the beginning of adulthood in a cohort in southern Brazil.

Methods:

This prospective longitudinal study used data from the 1993 birth cohort in Pelotas, Brazil. The following outcome variables were measured at 22 years of age: self-reported wheezing during the last 12 months and obesity (BMI ≥ 30 kg/m²). The following exposure variables were measured at ages 11, 15, and 18: self-reported wheezing (no wheezing or symptom presentation in 1, 2, or 3 follow-ups) and obesity (non-obese or obese in 1, 2, or 3 follow-ups). Crude and adjusted logistical regression stratified by sex were used in the analyses. The reference category was defined as participants who presented no wheezing or obesity.

Results:

A total of 3,461 participants had data on wheezing and 3,383 on BMI. At 22 years of age, the prevalence of wheezing was 10.1% (95%CI: 9.1; 11.2), and obesity, 16.2% (95%CI: 15.0; 17.6). In females, the presence of wheezing in two follow-ups revealed a 2.22-fold (95%CI: 1.36; 3.61) greater chance of developing obesity at 22 years of age. Meanwhile, the presence of obesity in two follow-ups resulted in a 2.03-fold (95%IC: 1.05; 3.92) greater chance of wheezing at 22 years of age. No associations were found between wheezing and obesity in males.

Conclusions:

The obtained data suggest a possible positive bidirectional association between wheezing and obesity, with greater odds ratios in the wheezing to obesity direction in females and in the category of occurrence of exposure in two follow-ups.

Keywords:
Asthma; BMI; Respiratory Sounds; Wheezing; Body Weight

		Included in the analyses^a
	Original Cohort (n=5,249)	Wheezing from age 11 to 18 (n=3,461)		Obesity from age 11 to 18 (n=3,383)
	% (95% CI)	% (95% CI)	p-value*	% (95% CI)	p-value*
Sex			0.098		0.249
Male	49.6 (48.2;51.0)	47.8 (46.1;49.5)		48.3 (46.6;50.0)
Female	50.4 (49.0;51.7)	52.2 (50.5;53.9)		51.7 (50.0;53.3)
Birthweight (grams)			0.521		0.277
< 2,500	10.3 (9.5;11.1)	9.5 (8.5;10.5)		9.5 (8.6;10.6)
2,500 - 2,999	26.4 (25.2;27.6)	26.0 (24.6;27.5)		25.6 (24.1;27.1)
3,000 - 3,499	38.8 (37.5;40.1)	39.0 (37.4;40.6)		38.8 (37.1;40.4)
≥ 3,500	24.5 (23.4;25.7)	25.5 (24.0;26.9)		26.1 (24.7;27.7)
Gestational age (weeks)			0.222		0.178
≤ 36	11.5 (10.6;12.4)	10.2 (9.2;11.3)		10.1 (9.1;11.3)
37 - 38	20.0 (18.9;21.2)	20.1 (18.7;21.5)		20.1 (18.6;21.5)
≥ 39	68.5 (67.1;69.8)	69.7 (68.0;71.3)		69.8 (68.1;71.4)
Maternal schooling during pregnancy (years)			0.262		0.121
0 - 4	28.0 (26.8;29.2)	26.6 (25.2;28.1)		26.1 (24.6;27.6)
5 - 8	46.2 (44.9;47.6)	47.9 (46.2;49.6)		48.0 (46.3;49.7)
≥ 9	25.8 (24.6;26.9)	25.4 (24.0;26.9)		25.9 (24.4;27.4)
Maternal smoking during pregnancy			0.590		0.406
No	66.6 (65.3;67.9)	67.2 (65.6;68.7)		67.5 (65.9;69.0)
Yes	33.4 (32.1;34.7)	32.8 (31.3;34.4)		32.5 (31.0;34.1)
Family income (minimum wages)			0.407		0.064
≤ 1	18.8 (17.8;19.9)	18.1 (16.8;19.4)		16.9 (15.7;18.2)
1.1 - 3	41.8 (40.5;43.2)	41.5 (39.8;43.1)		42.1 (40.4;43.8)
3.1 - 6	23.5 (22.3;24.6)	25.2 (23.8;26.7)		25.7 (24.2;27.2)
6.1 - 10	8.4 (7.7;9.2)	8.0 (7.2;9.0)		8.3 (7.4;9.4)
≥ 10	7.5 (6.8;8.2)	7.2 (6.4;8.1)		7.0 (6.2;7.9)

	Obesity at 22 years of age^a (n=3,461)		Wheezing at 22 years of age^b (n=3,383)
	% (95% CI)	p-value*	% (95% CI)	p-value*
Sex		<0.001		0.154
Male	13.7 (12.1;15.5)		10.9 (9.5;12.6)
Female	18.5 (16.8;20.5)		9.4 (8.1;10.9)
Skin color		0.029		0.111
White	15.0 (13.5;16.6)		9.5 (8.3;10.9)
Black	19.1 (15.9;22.8)		12.7 (10.0;15.9)
Other	18.2 (15.5;21.2)		10.1 (8.1;12.5)
Maternal schooling during pregnancy (years)		0.007		0.035
0 - 4	17.4 (15.1;20.2)		11.9 (10.0;14.3)
5 - 8	17.5 (15.7;19.5)		9.8 (8.4;11.4)
≥ 9	12.6 (10.5;15.0)		8.9 (7.1;11.1)
Maternal smoking during pregnancy		0.100		0.011
No	15.5 (14.1;17.1)		9.2 (8.1;10.5)
Yes	17.8 (15.6;20.2)		12.1 (10.2;14.2)
Family history of asthma		0.011		<0.001
No	15.1 (13.6;16.7)		7.8 (6.8;9.1)
Yes	18.6 (16.4;21.0)		14.7 (12.8;17.0)
Parental smoking at the 11-year follow-up		0.024		0.126
Never	13.5 (11.4;15.9)		9.1 (7.4;11.2)
Ex-smoker	17.9 (15.5;20.6)		9.2 (7.5;11.4)
Smoker	17.1 (15.3;19.2)		11.3 (9.8;13.1)
Schooling at 22 years of age		0.001		<0.001
0 - 4	15.2 (8.8;24.9)		18.3 (11.3;28.1)
5 - 8	18.5 (16.0;21.2)		14.4 (12.2;17.0)
9 - 11	17.8 (15.8;19.9)		8.4 (7.1;10.0)
≥ 12 years	12.1 (10.1;14.3)		8.0 (6.5;9.9)
Asset index at 22 years of age (quintiles)		<0.001		0.020
First (poorest)	17.9 (15.1;21.1)		12.9 (10.6;15.8)
Second	18.7 (15.8;21.9)		9.6 (7.6;12.2)
Third	17.8 (15.1;20.1)		9.2 (7.2;11.6)
Fourth	15.9 (13.3;18.9)		11.3 (9.1;14.0)
Fifth (richest)	10.8 (8.6;13.5)		7.7 (5.9;10.0)
Smoking at 22 years of age		0.080		<0.001
Never	15.4 (14.0;16.9)		7.7 (6.7;8.9)
Ex-smoker	19.6 (15.7;24.3)		11.7 (8.7;15.5)
Smoker	17.9 (14.9;21.3)		20.1 (16.9;23.7)
Total physical activity ≥ 150 min/week (leisure and commuting) at age 22		0.089		0.120
No	17.7 (15.6;19.9)		9.1 (7.6;10.8)
Yes	15.4 (13.9;17.0)		10.8 (9.5;12.2)
Obesity (BMI ≥ 30 kg/m²) at age 22		-		0.002
No	-		9.5 (8.4;10.7)
Yes	-		14.0 (11.3;17.2)
Wheezing in the last 12 months at 22 years of age		0.011		-
No	15.6 (14.3;17.0)		-
Yes	20.9 (17.0;25.5)		-
Corticoid use in the last three months at the 22-year follow-up		0.783		<0.001
No	16.1 (14.7;17.5)		8.4 (7.4;9.5)
Yes	16.7 (13.2;20.8)		19.3 (15.6;23.7)
Total	16.2 (15.0;17.6)		10.1 (9.1;11.2)

	Obesity at 22 years of age^b
	Crude		Adjusted
	OR (95% CI)	p-value*	OR (95% CI)	p-value*
Wheezing from 11 to 18 years^a
Males (n=1,533)		0.807		0.357
None	1.00		1.00
One follow-up	0.87 (0.59;1.28)		0.80 (0.52;1.23)
Two follow-ups	0.98 (0.54;1.76)		0.80 (0.42;1.53)
Always wheezing	1.10 (0.42;2.88)		0.89 (0.30;2.63)
Females (n=1,709)		0.001		0.002
None	1.00		1.00
One follow-up	1.34 (1.00;1.80)		1.28 (0.91;1.79)
Two follow-ups	1.89 (1.21;2.96)		2.22 (1.36;3.61)
Always wheezing	2.04 (0.93;4.50)		1.64 (0.68;3.99)

	Wheezing at 22 years of age^b
	Crude		Adjusted
	OR (95% CI)	p-value*	OR (95% CI)	p-value*
Obesity from 11 to 18 years^a
Males (n=1,545)		0.553		0.308
None	1.00		1.00
One follow-up	0.87 (0.51;1.47)		0.88 (0.49;1.56)
Two follow-ups	1.03 (0.50;2.12)		1.33 (0.61;2.90)
Always obese	1.44 (0.69;2.99)		1.55 (0.70;3.40)
Females (n=1,708)		0.054		0.101
None	1.00		1.00
One follow-up	1.56 (0.92;2.64)		1.41 (0.77;2.58)
Two follow-ups	1.88 (1.03;3.42)		2.03 (1.05;3.92)
Always obese	1.10 (0.39;3.14)		0.98 (0.29;3.31)

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[1] Correspondence to:
Nícolas Kickhofel Weisshahn. Rua Marechal Deodoro, 1160, 3º andar, Pelotas (RS) - Brazil; CEP: 96020-220; Telefone/Fax: +55 (53) 3284 - 1300; Cell Phone: +55 (53) 98103 - 6733; E-mail: weisshahn.n@gmail.com.