Table_1_Bidirectional Association Between Asthma and Obesity During Childhood and Adolescence: A Systematic Review and Meta-Analysis.doc

Objective: Co-occurrence of pediatric asthma and obesity has been widely reported, yet the causal directions between these two disorders are still not well-understood. The objective of this meta-analysis is to explore whether there is a possibility of a bidirectional association for these two disorders in children and adolescents.
Methods: PubMed, Embase, Web of Science, and CENTRAL databases were searched up to August 2020. Cohort studies reporting the associations of obesity with risk of physician-diagnosed asthma or physician-diagnosed asthma with risk of obesity in children and adolescents were eligible for the review.
Results: A total of 3,091 records were identified from the four databases, with final inclusion of nine. Six studies reported the association between obesity and risk of asthma; three studies reported the association between asthma and risk of childhood obesity. As evaluated by the Newcastle–Ottawa quality assessment scale, all studies were assessed as high-quality studies. There was a statistically significant association between obesity and increased risk of physician-diagnosed asthma in children and adolescents. The pooled RR was 1.39 (95% CI: 1.28, 1.50; p < 0.001), with significant heterogeneity across studies (I2 = 81.7%; pheterogeneity < 0.001). The pooled RR in boys was 1.53 (95% CI: 1.17, 1.99; p = 0.002), but such a significant association was not observed in girls (RR = 1.17, 95% CI: 0.79, 1.72; p = 0.434). For the association of asthma with risk of childhood obesity, the pooled RR was 1.47 (95%CI: 1.25, 1.72; p < 0.001) without statistical heterogeneity (I2 = 0%, pheterogeneity = 0.652).
Conclusion: There is a bidirectional association between obesity and asthma during childhood and adolescence, suggesting that childhood obesity drives an increase in the onset of asthma; meanwhile, childhood asthma may also increase risk of obesity for children and adolescents.

研究目的：儿童哮喘与肥胖的共患现象已被广泛报道，但二者之间的因果方向仍未得到充分阐明。本荟萃分析旨在探讨儿童及青少年群体中，这两种疾病是否存在双向关联的可能性。
研究方法：检索截至2020年8月的PubMed、Embase、Web of Science及CENTRAL数据库。本综述纳入的队列研究需满足：报告肥胖与儿童青少年医师确诊哮喘风险的关联，或报告医师确诊哮喘与儿童青少年肥胖风险的关联。
研究结果：共从4个数据库中检索到3091条记录，最终纳入9项研究。其中6项研究探讨了肥胖与哮喘风险的关联，3项研究探讨了哮喘与儿童肥胖风险的关联。经纽卡斯尔-渥太华质量评价量表（Newcastle–Ottawa quality assessment scale）评估，所有研究均被评为高质量研究。儿童及青少年群体中，肥胖与医师确诊哮喘的风险升高存在统计学显著关联：合并相对危险度（relative risk, RR）为1.39（95%置信区间（confidence interval, CI）：1.28, 1.50；p < 0.001），各研究间存在显著异质性（I²=81.7%；p_异质性 < 0.001）。亚组分析显示，男性群体的合并RR为1.53（95%CI：1.17, 1.99；p=0.002），但女性群体未观察到此类显著关联（RR=1.17，95%CI：0.79, 1.72；p=0.434）。针对哮喘与儿童肥胖风险的关联，合并RR为1.47（95%CI：1.25, 1.72；p < 0.001），各研究间无统计学异质性（I²=0%，p_异质性=0.652）。
研究结论：儿童及青少年群体中，肥胖与哮喘存在双向关联，提示儿童肥胖会推动哮喘发病风险升高；同时，儿童哮喘也可能增加儿童青少年群体的肥胖发病风险。