Associação entre o ganho de peso e a prevalência e gravidade de sibilância e asma no primeiro ano de vida
Association between weight gain and the prevalence and severity of wheezing and asthma in the first year of life
Gustavo F. Wandalsen; Leila V. Borges; Nathália Barroso; Anna Carolina P. Navarro; Fabíola Suano-Souza; Elaine X. Prestes; Herberto Chong Neto; Nelson Rosário Filho; Ana Carolina Dela Bianca; Carolina S. Aranda; Décio Medeiros; Emanuel Sarinho; Lilian S. Moraes; Javier Mallol; Dirceu Solé
Resumo
Objetivo: Avaliar a relação entre diferentes padrões de ganho de peso no primeiro ano de vida e a prevalência e gravidade de sibilância e asma em crianças. Métodos: Foram analisadas as respostas ao questionário EISL de 9.159 pais moradores das cidades de São Paulo, Recife, Cuiabá, Curitiba e Belém. Os dados referidos do peso de nascimento e com um ano de vida foram convertidos em escore z (z). Foram considerados como tendo ganho de peso acelerado aqueles com diferença entre os pesos superior a 0,67 z, e ganho de peso excessivo aqueles com diferença superior a 2,01 z. Resultados: Ganho de peso acelerado foi observado em 55,7% dos lactentes, e ganho excessivo em 20,8%. Lactentes com ganho de peso acelerado apresentaram, de modo significante, maior prevalência de sibilância recorrente (18,9% vs 18,2%) e de hospitalização por sibilância (8,9% vs 7,5%). Entre os lactentes com ganho de peso excessivo houve, de modo significante, maior prevalência de hospitalização por sibilância (10,1% vs 7,8%) e do diagnóstico médico de asma (8,7% vs 7,3%). A presença de aleitamento materno por pelo menos seis meses foi associada de forma significante com menor prevalência de ganho de peso acelerado (45,2% vs 51,4%). Conclusões: A maioria dos lactentes avaliados apresentou ganho de peso superior ao esperado durante o primeiro ano de vida. Ganho de peso acelerado e ganho de peso excessivo no primeiro ano de vida foram associados a formas mais graves de sibilância, enquanto que o ganho de peso excessivo foi associado ao diagnóstico médico de asma, independentemente da presença do aleitamento materno.
Palavras-chave
Abstract
Objective: To evaluate the relationship between different patterns of weight gain in the first year of life and the prevalence and severity of wheezing and asthma in infants. Methods: Responses of 9,159 parents to the questionnaire of the Estudio Internacional de Sibilancias en Lactantes (EISL, International Study of Wheezing in Infants) were analyzed. Families lived in the cities of São Paulo, Recife, Cuiabá, and Belém. Reported weight at birth and at one year were converted to z scores (z). Rapid weight gain was defined as a difference in weight greater than 0.67z, and excessive weight gain, greater than 2.01z. Results: Rapid weight gain was observed in 55.7% of the infants, and excessive weight gain in 20.8%. Infants with rapid weight gain showed a significantly higher prevalence of recurrent wheezing (18.9% vs. 18.2%) and hospitalization for wheezing (8.9% vs. 7.5%). Infants with excessive weight gain had a significantly higher prevalence of hospitalization for wheezing (10.1% vs. 7.8%) and medical diagnosis of asthma (8.7% vs. 7.3%). Breastfeeding for at least six months was significantly less frequent among infants with rapid weight gain (45.2% vs. 51.4%). Conclusions: The majority of the infants evaluated showed weight gain above the expected in the first year of life. Rapid weight gain and excessive weight gain in the first year of life were significantly associated with more severe patterns of wheezing in infancy, and excessive weight gain was also associated with a medical diagnosis of asthma, regardless of the presence of breastfeeding.
Keywords
References
1. Mallol J, García-Marcos L, Solé D, Brand P, EISL Study Group. International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax. 2010;65:1004-9.
2. Martinez F, Wright A, Taussig L, Holberg C, Halonen M, Morgan W. Asthma and wheezing in the first six years of life. N Engl J Med. 1995;332:133-8.
3. Matricardi P, Illi S, Gruber C, Keil T, Nickel R, Wahn U, et al. Wheezing in childhood: incidence, longitudinal patterns and factors predicting persistence. Eur Respir J. 2008:32:585-92.
4. Devulapalli C, Carlsen K, Haland G, Munthe-Kaas M, Pettersen M, Mowinckel P, et al. Severity of obstructive airways disease by age 2 years predicts asthma at 10 years of age. Thorax. 2008;63:8-13.
5. Solé D, Wandalsen G, Camelo-Nunes I, Naspitz C, ISAAC Brasil. Prevalência de sintomas de asma, rinite e eczema atópico entre crianças e adolescentes brasileiros identificados pelo International Study of Asthma and Allergies in Childhood - ISAAC. J Pediatr (Rio J). 2006;82:341-6.
6. Yunginger JW, Reed CE, O’Connell EJ, Melton LJ, O’Fallon WM, Silverstein MD. A community-based study of the epidemiology of asthma: incidence rates, 1964-1983. Am Rev Respir Dis. 1992;146:888-94.
7. Mallol J, García-Marcos L, Aguirre V, Martinez-Torres A, PerezFernández V, Gallardo A, et al. The International Study of Wheezing in Infants: questionnaire validation. Int Arch Allergy Immunol. 2007;144:44-50.
8. Chong Neto H, Rosário N, Dela Bianca A, Solé D, Mallol J. Validation of questionnaire for epidemiologic studies of wheezing in infants. Pediatr Allergy Immunol. 2007;18:86-7.
9. García-Marcos L, Mallol J, Solé D, Brand P, EISL Study Group. International study of wheezing in infants: risk factors in affluent and non-affluent countries during the first year of life. Pediatr Allergy Immunol. 2010;21:878-88.
10. van der Gugten A, Koopman M, Evelein A, Verheij T, Uiterwaal C, van der Ent C. Rapid early weight gain is associated with wheeze and reduced lung function in childhood. Eur Respir J. 2012;39:403-10.
11. van der Voort A, Jaddoe V, Raat H, Moll H, Hofman A, de Jongste J, Duijts L. Fetal and infant growth and asthma symptoms in preschool children. Am J Respir Crit Care Med. 2012;185:731-7.
12. Flexeder C, Thiering E, Brüske I, Koletzko S, Bauer C, Wichmann H, et al. Growth velocity during infancy and onset of asthma in schoolaged children. Allergy. 2012;67:257-64.
13. WHO Child Growth Standards: Methods and development: Length/ height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. Geneva: World Health Organization, 2006.
14. Paul I, Camera L, Zeiger R, Guilbert T, Bacharier L, Taussig L, et al. Relatioship between infant weight gain and later asthma. Pediatr Allergy Immunol. 2010;21:82-9.
15. Ministério da Saúde. Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher – PNDS 2006: dimensões do processo reprodutivo e da saúde da criança. Ministério da Saúde, Centro Brasileiro de Análise e Planejamento. Brasília: Ministério da Saúde, 2009. 300 p.
16. Monteiro P, Victoria C, Barros F, Monteiro L. Birth size, early childhood growth, and adolescent obesity in a Brazilian birth cohort. Int J Obes Relat Metab Disord. 2003;27:1274-82.
17. Ekelund U, Ong K, Linné Y, Neovius M, Brage S, Dunger D, et al. Upward weight percentile crossing in infancy and arly childhood independently predicts fat mass in young adults: the Stockholm Weight Development Study (SWEDES). Am J Clin Nutr. 2006;83:324‑30.
18. Koletzko B, Symonds ME, Olsen SF, Early Nutrition Programming Project, Early Nutrition Academy. Programming research: where are we and where do we go from here? Am J Clin Nutr. 2011;94 (6 Suppl):S2036-43.
19. Stettler N, Stallings V, Troxel A, Zhao J, Schinnar R, Nelson S, et al. Weight gain in the first week of life and overweight in adulthood: a cohort study of European American subjects fed infant formula. Circulation. 2005;19:1897-903.
20. Dixon A, Holguin F, Sood A, Salome C, Pratley R, Beuther D, et al. American Thoracic Society Ad Hoc Subcommittee on Obesity and Lung Disease. An official American Thoracic Society Workshop report: obesity and asthma. Proc Am Thorac Soc. 2010;7:325-35.
21. Forno E, Lescher R, Strunk R, Weiss S, Fuhbrigge A, Celedón J, et al. Decreased response to inhaled steroids in overweight and obese asthmatic children. J Allergy Clin Immunol. 2011;127:741-9.
22. Flaherman V, Rutherford G. A meta-analysis of the effect of high weight on asthma. Arch Dis Child. 2006;91:334-9.
23. Taylor B, Mannino D, Brown C, Crocker D, Twum-Baah N, Holguin F. Body mass índex and asthma severity in the National Asthma Survey. Thorax. 2008;63:14-20.
24. Turner S, Zhang G, Young S, Cox M, Goldblatt J, Landau L, et al. Associations between postnatal weight gain, change in postnatal pulmonary function, formula feeding and early asthma. Thorax. 2008;63:234-9.
25. Nuolivirta K, Koponen P, Helminen M, Korppi M. Weight gain in infancy and post-bronchiolitis wheezing. Acta Paediatr. 2012;101:38-42.
26. Arenz S, Rückerl R, Koletzko B, von Kries R. Breast-feeding and childhood obesity: a systematic review. Int J Obes Relat Metab Disord. 2004;28:1247-56.
Submitted date:
11/26/2012
Accepted date:
03/26/2013
Facebook
LinkedIn
Mendeley
StumbleUpon
Reddit
Email