http://cme.medscape.com/viewarticle/708355?src=cmemp

From Medscape Medical News CME
Large Waist Size Linked to Asthma in Women CME

News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd

Authors and Disclosures

CME Released: 09/03/2009; Valid for credit through 09/03/2010

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This article is intended for primary care clinicians, pulmonologists, gynecologists, and other specialists who care for women with obesity or asthma.
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Laurie Barclay, MD
freelance writer and reviewer, MedscapeCME
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Brande Nicole Martin
is the News CME editor for Medscape Medical News.
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.

Désirée Lie, MD, MSEd
Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California
Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.
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CME Released: 09/03/2009; Valid for credit through 09/03/2010

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September 3, 2009 — Large waist size is associated with increased asthma prevalence, even among women considered to have normal body weight, according to results from the California Teachers Study cohort reported online in the August 25 issue of Thorax.

“Obesity is a risk factor for asthma, particularly in women, but few cohort studies have evaluated abdominal obesity which reflects metabolic differences in visceral fat known to influence systemic inflammation,” write J. Von Behren, MPH, from Northern California Cancer Center in Berkeley, California, and colleagues. “A study was undertaken to examine the relationship between the prevalence of asthma and measures of abdominal obesity and adult weight gain in addition to body mass index (BMI) in a large cohort of female teachers.”

Questionnaires were completed in 1995, 1997, 2000, and 2005. Allowing adjustment for age, smoking, and race/ethnicity, multivariable linear modeling was used to calculate prevalence odds ratios (ORs) for current asthma. At baseline, 11,500 (13%) of 88,304 women studied from the cohort were obese, defined as BMI of more than 30 kg/m2, and 1334 were extremely obese, defined as BMI of more than 40 kg/m2.

The adjusted OR for adult-onset asthma was 1.40 (95% confidence interval [CI], 1.31 – 1.49) for overweight women vs those of normal weight and 3.30 (95% CI, 2.85 – 3.82) for extremely obese women. Even among women with normal BMI, large waist circumference (WC; > 88 cm) was linked to increased prevalence of asthma (OR, 1.37; 95% CI, 1.18 – 1.59).

Compared with obese women whose waist was 88 cm or less, obese women who also had abdominal obesity had a greater risk for asthma (OR, 2.36 vs 1.57). The risk for severe asthma episodes, reflected in urgent medical visits and hospital admissions, was also greater in obese and overweight women.

“This study confirms the association between excess weight and asthma severity and prevalence, and showed that a large waist was associated with increased asthma prevalence even among women considered to have normal body weight,” the study authors write. “All measures of obesity were strongly associated with increased asthma prevalence. Even being modestly overweight was associated with higher asthma prevalence in this population.”

Limitations of this study include lack of data on several recognized risk factors for asthma, mostly cross-sectional data, reliance on self-report for physician diagnosis of asthma, and possible selection bias or participation bias.

“These findings are particularly troubling because a majority of American adults are now overweight or obese,” the study authors conclude. “In the next phase of this study we will prospectively ascertain new asthma cases and will be able to evaluate BMI, waist size and weight change as risk factors for incident asthma in women.”

The National Cancer Institute supported this study. The study authors have disclosed no relevant financial relationships.

Thorax. Published online August 25, 2009. Abstract

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