Increased Risk of Asthma in Overweight Children Born Large for Gestational Age

PURPOSE OF THE STUDY. To investigate the association of being born large for gestational age (LGA) with having asthma at 8 years of age in children who are atopic and nonatopic within the Prevention and Incidence of Asthma and Mite Allergy birth cohort study. STUDY POPULATION. Complete data on asthma diagnosis, anthropometric measurements, specific immunoglobulin E measurements, atopic disease at the age of 8 years, and potential confounders were available for 1608 children born from the original cohort of 4146 pregnant women enrolled in the Prevention and Incidence of Asthma and Mite Allergy study. METHODS. LGA was defined as a birth weight >90th percentile for sex, gestational age, and parity compared with Dutch reference values. Asthma was defined as positive answers to at least 2 of the following items at the age of 8 years: at least 1 episode of wheezing in the past 12 months, asthma medications prescribed in the last 12 months, and a parental report of a doctor’s diagnosis of asthma at any time. Being overweight was defined by using the age- and sex-specific cutoff points of the International Obesity Task Force for BMI. Odds ratios for the association between being LGA at birth and asthma at age 8 years were estimated by using logistic regression analyses performed with SPSS 20 (IBM SPSS Statistics, IBM Corporation, Armonk, NY) for the total population and for children who are atopic and nonatopic separately. Being overweight was assessed as a potential modifier of the association between LGA and asthma. Potential effect modification by atopic disease and sex was assessed by using stratification. RESULTS. After adjustment for potential confounders, the authors did not find an association between being LGA at birth and having asthma at age 8 years in the total population assessed. However, in children who were nonatopic, born LGA, and overweight at age 8 years, the odds of asthma were significantly increased compared with children who were not LGA and not overweight (adjusted odds ratio: 7.04; 95% confidence interval: 2.02–24.4). CONCLUSIONS. Study findings reveal that children who were nonatopic and were born LGA may be a higher-risk group for asthma than their peers who were not LGA. If confirmed in subsequent research, knowledge of this risk may be important for prevention interventions. REVIEWER COMMENTS. Being overweight is a known risk factor for childhood asthma, and it is more strongly associated with asthma in children who are nonatopic. The