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Joint effects of birth outcomes and childhood body mass index on respiratory symptoms

Wen-Hua Wang, Pau-Chung Chen, Wu-Shiun Hsieh, Yungling Leo Lee
European Respiratory Journal 2012 39: 1213-1219; DOI: 10.1183/09031936.00091311
Wen-Hua Wang
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Pau-Chung Chen
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Wu-Shiun Hsieh
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Yungling Leo Lee
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  • For correspondence: leolee@ntu.edu.tw
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    Figure 1–

    A spline interpolation curve demonstrating the relationship between probability of doctor-diagnosed asthma and childhood body mass index (BMI). The probability was adjusted for parental education level, number of smokers at home, incense burning, active smoking, alcohol use and history of rhinitis and eczema.

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  • Table 1– Characteristics of 78,011 middle-school students in Taiwan from 1995 to 1996
    At birth
     Weight g3272.9±459.6
      <300016009 (20.5)
      3000–349935759 (45.9)
      ≥350026243 (33.6)
     Gestational age weeks39.7±1.2
      <371822 (2.3)
      37–4274007 (94.9)
      ≥422182 (2.8)
     LBW2897 (3.7)
     Pre-term#1822 (2.3)
     SGA8200 (10.5)
    Current assessment
     Age yrs
      1320849 (26.7)
      1426545 (34.0)
      1525500 (32.7)
      165117 (6.6)
     Height cm159.9±7.7
     Weight g52.8±11.3
     BMI20.6±3.5
    Parental education level yrs
     <718544 (23.8)
     7–919952 (25.6)
     10–1226017 (33.4)
     ≥1313498 (17.3)
    Number of smokers at home
     034802 (44.6)
     125403 (32.6)
     ≥217806 (22.8)
    Incense burning
     Yes41427 (53.1)
    Active smoking
     Yes1718 (2.2)
    Alcohol use
     Yes1016 (1.3)
    History of rhinitis
     Yes17185 (22.3)
    History of eczema
     Yes5892 (7.6)
    • Data are presented as mean±sd or n (%). LBW: low birthweight (denotes birthweight <2,500 g); SGA: small for gestational age; BMI: body mass index. #: pre-term denotes gestational age <37 weeks.

  • Table 2– Association between sex- and age-specified z-score of childhood body mass index and respiratory outcomes
    Written questionnaireVideo questionnaire
    Ever wheeze1.07** (1.04–1.09)1.10** (1.06–1.13)
    Current wheeze1.06* (1.01–1.11)1.06* (1.00–1.13)
    Night wheeze1.00 (0.94–1.07)1.05* (1.01–1.10)
    Severe wheeze1.03 (0.95–1.12)1.08** (1.04–1.11)
    Wheeze with exercise1.16** (1.13–1.19)1.16** (1.14–1.19)
    Asthma1.02 (0.98–1.06)
    Night cough1.08** (1.05–1.10)1.14** (1.10–1.17)
    • Data are presented as OR (95% CI). All models were adjusted for parental education level, number of smokers at home, incense burning, active smoking, alcohol use and history of rhinitis and eczema. *: p <0.05; **: p<0.01.

  • Table 3– Association between birth conditions and respiratory outcomes
    Ever wheezeCurrent wheezeNight wheezeSevere wheezeWheeze with exerciseAsthmaNight cough
    Written questionnaire
     Birthweight g
      <30001.06 (0.99–1.14)0.97 (0.85–1.11)1.08 (0.90–1.28)1.12 (0.89–1.41)1.11 (1.03–1.19)1.17 (1.07–1.28)1.08 (1.02–1.15)
      3000–3499ref.ref.ref.ref.ref.ref.ref.
      ≥35001.02 (0.96–1.08)1.00 (0.89–1.12)1.05 (0.90–1.22)1.23 (1.01–1.49)1.07 (1.01–1.15)0.97 (0.90–1.05)1.03 (0.97–1.08)
     Gestational age weeks
      <371.09 (0.93–1.29)0.97 (0.71–1.33)1.43 (0.95–2.15)1.40 (0.86–2.28)1.04 (0.86–1.25)1.15 (0.93–1.42)1.19 (1.03–1.37)
      37–42ref.ref.ref.ref.ref.ref.ref.
      ≥421.07 (0.92–1.24)1.05 (0.80–1.39)0.89 (0.61–1.31)0.94 (0.58–1.52)1.13 (0.96–1.33)1.14 (0.94–1.37)1.15 (1.01–1.31)
     LBW
      Not LBWref.ref.ref.ref.ref.ref.ref.
      LBW1.11 (0.97–1.27)1.01 (0.79–1.31)1.21 (0.87–1.69)0.99 (0.64–1.52)1.07 (0.92–1.24)1.10 (0.92–1.31)1.11 (0.99–1.25)
     Pre-term#
      Not pre-termref.ref.ref.ref.ref.ref.ref.
      Pre-term1.09 (0.92–1.29)0.97 (0.71–1.32)1.43 (0.95–2.16)1.40 (0.86–2.28)1.04 (0.86–1.25)1.15 (0.93–1.42)1.18 (1.02–1.36)
     SGA
      Not SGAref.ref.ref.ref.ref.ref.ref.
      SGA1.10 (1.01–1.19)1.03 (0.88–1.20)1.01 (0.82–1.24)0.92 (0.70–1.21)1.15 (1.06–1.26)1.17 (1.05–1.30)1.10 (1.03–1.19)
    Video questionnaire
     Birthweight g
      <30001.05 (0.96–1.14)0.92 (0.77–1.10)1.12 (1.00–1.25)1.03 (0.94–1.12)1.14 (1.07–1.21)1.09 (1.00–1.20)
      3000–3499ref.ref.ref.ref.ref.ref.
      ≥35001.03 (0.96–1.11)0.95 (0.82–1.10)1.00 (0.90–1.10)0.99 (0.92–1.07)1.06 (1.00–1.12)0.92 (0.85–1.00)
     Gestational age weeks
      <371.01 (0.82–1.25)1.00 (0.65–1.54)1.03 (0.77–1.36)0.99 (0.80–1.21)1.12 (0.97–1.31)1.09 (0.87–1.36)
      37–42ref.ref.ref.ref.ref.ref.
      ≥421.09 (0.91–1.30)1.38 (0.93–2.03)1.09 (0.86–1.39)1.00 (0.84–1.20)1.01 (0.88–1.16)1.15 (0.95–1.39)
     LBW
      Not LBWref.ref.ref.ref.ref.ref.
      LBW1.07 (0.90–1.26)0.98 (0.70–1.38)1.12 (0.90–1.40)1.00 (0.84–1.18)1.16 (1.02–1.30)1.23 (1.04–1.46)
     Pre-term#
      Not pre-termref.ref.ref.ref.ref.ref.
      Pre-term1.01 (0.82–1.25)0.99 (0.64–1.52)1.02 (0.77–1.36)0.99 (0.80–1.21)1.12 (0.97–1.31)1.08 (0.87–1.35)
     SGA
      Not SGAref.ref.ref.ref.ref.ref.
      SGA1.09 (0.98–1.21)1.00 (0.81–1.24)1.17 (1.02–1.34)1.08 (0.98–1.20)1.16 (1.08–1.25)1.19 (1.07–1.32)
    • Data are presented as OR (95% CI). LBW: low birthweight (denotes birth weight <2,500 g); SGA: small for gestational age; ref.: reference group. #: pre-term denotes gestational age <37 weeks. All models were adjusted for parental education level, number of smokers at home, incense burning, active smoking, alcohol use and history of rhinitis and eczema.

  • Table 4– Effects of low birthweight (LBW)# and sex- and age-specified z-score of childhood body mass index on respiratory outcomes
    Written questionnaireVideo questionnaire
    Ever wheeze
     LBW0.97 (0.84–1.11)1.02 (0.86–1.20)
     Not LBW1.07** (1.04–1.10)1.10** (1.06– 1.13)
    Current wheeze
     LBW1.13 (0.85–1.51)1.04 (0.71–1.53)
     Not LBW1.06* (1.01–1.11)1.07* (1.00–1.14)
    Night wheeze
     LBW1.01 (0.68–1.50)0.96 (0.76–1.20)
     Not LBW1.01 (0.95–1.08)1.06* (1.01–1.10)
    Severe wheeze
     LBW0.72 (0.43–1.22)0.85 (0.71–1.02)
     Not LBW1.04 (0.96–1.13)1.09** (1.05–1.12)
    Wheeze with exercise
     LBW1.05 (0.91–1.21)1.13* (1.01–1.27)
     Not LBW1.16** (1.13–1.19)1.17** (1.14–1.19)
    Asthma
     LBW0.96 (0.81–1.15)
     Not LBW1.02 (0.99–1.06)
    Night cough
     LBW1.12* (1.00–1.26)1.13 (0.96–1.33)
     Not LBW1.08** (1.05–1.10)1.14** (1.10–1.18)
    • Data are presented as OR (95% CI). #: birthweight <2,500 g. All models were adjusted for parental education level, number of smokers at home, incense burning, active smoking, alcohol use and history of rhinitis and eczema. *: p<0.05; **: p<0.01.

  • Table 5– Effects of pre-term# and sex- and age-specified z-score of body mass index on respiratory outcomes
    Written questionnaireVideo questionnaire
    Ever wheeze
     Pre-term0.95 (0.80–1.12)0.95 (0.76–1.18)
     Not pre-term1.07** (1.04–1.10)1.10** (1.07–1.13)
    Current wheeze
     Pre-term1.08 (0.76–1.54)0.89 (0.53–1.49)
     Not pre-term1.06* (1.01–1.11)1.07* (1.00–1.14)
    Night wheeze
     Pre-term0.82 (0.52–1.30)0.94 (0.70–1.27)
     Not pre-term1.01 (0.95–1.08)1.05* (1.01–1.10)
    Severe wheeze
     Pre-term0.96 (0.54–1.70)0.93 (0.74–1.15)
     Not pre-term1.03 (0.95–1.12)1.08** (1.05–1.11)
    Wheeze with exercise
     Pre-term1.05 (0.87–1.25)1.12 (0.97–1.29)
     Not pre-term1.16** (1.13–1.19)1.17** (1.14–1.19)
    Asthma
     Pre-term0.90 (0.72–1.14)
     Not pre-term1.02 (0.99–1.06)
    Night cough
     Pre-term1.02 (0.89–1.17)1.26* (1.04–1.54)
     Not pre-term1.08** (1.05–1.10)1.13** (1.10–1.17)
    • Data are presented as OR (95% CI). All models were adjusted for parental education level, number of smokers at home, incense burning, active smoking, alcohol use and history of rhinitis and eczema. #: pre-term denotes gestational age <37 weeks. *: p<0.05; **: p<0.01.

  • Table 6– Effects of being small for gestational age (SGA) and sex- and age-specified z-score of childhood body mass index on respiratory outcomes
    Written questionnaireVideo questionnaire
    Ever wheeze
     SGA1.06 (0.98–1.15)1.06 (0.96–1.17)
     Not SGA1.07** (1.04–1.10)1.10** (1.07–1.14)
    Current wheeze
     SGA1.08 (0.92–1.26)1.04 (0.84–1.29)
     Not SGA1.06* (1.00–1.11)1.07* (1.00–1.14)
    Night wheeze
     SGA0.94 (0.77–1.15)0.96 (0.84–1.10)
     Not SGA1.01 (0.95–1.08)1.07** (1.02–1.12)
    Severe wheeze
     SGA0.91 (0.69–1.19)1.02 (0.93–1.13)
     Not SGA1.04 (0.96–1.14)1.09** (1.05–1.12)
    Wheeze with exercise
     SGA1.11* (1.02–1.20)1.15** (1.07–1.23)
     Not SGA1.16** (1.13–1.20)1.17** (1.14–1.20
    Asthma
     SGA1.01 (0.91–1.13)
     Not SGA1.02 (0.99–1.06)
    Night cough
     SGA1.08* (1.01–1.16)1.09 (0.99–1.20)
     Not SGA1.08** (1.05–1.10)1.14** (1.11–1.18)
    • Data are presented as OR (95% CI). All models were adjusted for parental education level, number of smokers at home, incense burning, active smoking, alcohol use and history of rhinitis and eczema. *: p<0.05; **: p<0.01.

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Joint effects of birth outcomes and childhood body mass index on respiratory symptoms
Wen-Hua Wang, Pau-Chung Chen, Wu-Shiun Hsieh, Yungling Leo Lee
European Respiratory Journal May 2012, 39 (5) 1213-1219; DOI: 10.1183/09031936.00091311

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Joint effects of birth outcomes and childhood body mass index on respiratory symptoms
Wen-Hua Wang, Pau-Chung Chen, Wu-Shiun Hsieh, Yungling Leo Lee
European Respiratory Journal May 2012, 39 (5) 1213-1219; DOI: 10.1183/09031936.00091311
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