BMI at school age and incident asthma admissions in early adulthood: a prospective study of 310,211 children

Charlotte Suppli Ulrik,1,2 Søren N Lophaven,3 Zorana Jovanovic Andersen,3 Thorkild IA Sørensen,4 Jennifer L Baker4,5 1Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark; 2Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; 3Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; 4Section of Metabolic Genetics and Section of Epidemiology, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark; 5Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark Background: Excess body weight in adulthood is associated with risk for asthma admission (AA). Our aim was to investigate if this association also applies to the relation between body mass index (BMI) in childhood and AAs in early adulthood (age 20–45 years). Methods: This was a prospective study of 310,211 schoolchildren (born 1930–1989) from the Copenhagen School Health Records Register. Height and weight were measured annually, and generated BMI z-scores were categorized as low (lower quartile), normal (interquartile) and high (upper quartile). Associations between BMI at ages 7–13 and AA were estimated by Cox regressions, and presented as hazard ratios (HRs) and 95% confidence intervals (CI). Main outcome was incident hospital AAs (extracted from the Danish National Patient Register) in early adulthood. Results: During 4,708,607 person-years of follow-up, 1,813 incident AAs were observed. Non-linear associations were detected between childhood BMI and AAs. The risk of AA increased for females in the highest BMI category in childhood, with the highest HR of 1.3 (95% CI 1.16–1.55) at the age of 13 years. By contrast, males in the low BMI category had a higher risk of AA in early adulthood, with the highest HR of 1.24 (95% CI 1.03–1.51) at the age of 12 years. Females with an increase in BMI between ages 7 and 13 years had an increased risk of AA compared with females with stable BMI (HR 1.28, 95% CI 1.10–1.50). Conclusion: The association between childhood BMI and AA in early adulthood is non-linear. High BMI increases the risk of AA in females, whereas low BMI increases the risk in males. Keywords: BMI, childhood, asthma, admissions, sex, adiposit