An obesity-preventive lifestyle score is negatively associated with pediatric asthma.

PURPOSE: Lifestyle (diet and physical activity) may increase asthma risk, but evidence in this area is lacking. The aims of the present study were to calculate an obesity-preventive lifestyle score comprising of eating and physical activity behaviors and investigate the overall effect of lifestyle on asthma in children. METHODS: A cross-sectional case-control study was carried out in 514 children (217 asthma cases and 297 healthy controls). Data were collected on medical history, anthropometry, dietary intake, and physical activity. We constructed an overweight/obesity-preventive score (OPLS) using study-specific quartile rankings for nine target lifestyle behaviors that were either favorable or unfavorable in preventing obesity (i.e., screen time was an unfavorable lifestyle behavior). The score was developed using the recommendations of the Expert Committee of American Academy of Pediatrics. Score values ranged from 0-18 points; the higher the score, the more protective against high body weight. RESULTS: The OPLS was negatively associated with obesity indices (BMI, waist circumference, and hip circumference), (p < 0.05). Control children had a higher score when compared to asthma cases (9.3 ± 2.7 vs. 8.6 ± 2.9, p = 0.007). A high OPLS was protective against physician-diagnosed asthma (OR 0.92; 95% CI 0.86-0.98, p = 0.014), adjusted for several confounders. The OPLS was no longer protective after adjustment for BMI. CONCLUSION: Higher adherence to an obesity-preventive lifestyle score-consistent with several behaviors for the prevention of childhood overweight/obesity-is negatively associated with obesity indices and lowers the odds for asthma in children. Lifestyle behaviors that contribute to a higher body weight may contribute to the obesity-asthma link. These findings are hypothesis-generating and warrant further investigation in prospective intervention studies.

OC19 - Measuring feasibility, reliability and validity of the Greek version of PedsQL cardiac module.

UNLABELLED: Theme: Cardiology Introduction: Measuring quality of life (QoL) in children and adolescents with congenital heart disease (CHD) is of great clinical importance. OBJECTIVE: The aim of the study was: (a) to adapt the PedsQL Cardiac Module for children aged two to 18 years with CHD in a sample of the Greek population; (b) to determine its reliability and validity. METHODS: Forward and backward translation methodology was used. Parents and children completed the instrument during: (a) hospitalization and (b) visits in the paediatric cardiology outpatient department. Cross-informant variance between children and parents was thoroughly assessed. RESULTS: Missing item responses did not exceed 5%. All internal consistency reliability coefficients for the inventory exceeded the minimum standards for group comparisons, over 0.75. Hypothesized correlations between cardiac module and core scales were statistically significant, (p<0.05). Agreement between children and parents was relatively high. Pilot study results will be additionally presented. CONCLUSION: The findings support the feasibility, reliability and validity of the Greek translation of the PedsQL Cardiac Module in children with congenital heart defect (CHD).

Determinants of quality of life in children and adolescents with CHD: a systematic review.

PURPOSE: This review aims to outline a systematic approach for the assessment of quality of life in children and adolescents with CHD and to cite its main determinants. METHODS: A systematic critical literature search in PubMed, Scopus, and Cinahl databases resulted in 954 papers published after 2000. After the quality assessment, 32 original articles met the inclusion criteria. RESULTS: Methodological quality of the included studies varied greatly, showing a moderate quality. Impaired quality of life was associated with more severe cardiac lesions. Children with CHD, after cardiac surgery, reported diminished quality of life concerning physical, psycho-social, emotional, and school functioning. The majority of clinical studies showed significant differences among children and their parents' responses regarding their quality of life, with a tendency of children to report greater quality of life scores than their parents. According to our analysis, concerning children with CHD, the most cited determinants of their quality of life were as follows: (a) parental support; (b) lower socio-economic status; (c) limitations due to physical impairment; (d) sense of coherence; as well as (e) the level of child's everyday anxiety and depression. These findings suggest that differences in quality of life issues may exist across lesion severities. CONCLUSION: Quality of life in children with CHD should be assessed according to age; severity; therapeutic approach; acceptance of the disease; and personality features. Effective management and early recognition of significant impairments in quality of life could impact clinical outcomes in children with CHD.

Associations between central obesity and asthma in children and adolescents: a case-control study.

INTRODUCTION: Evidence supports a significant yet weak association between high-body weight and asthma in children. However, most studies investigating the obesity-asthma link use Body Mass Index (BMI) to evaluate body fatness. The relationship between body fat distribution and asthma remains largely unknown, especially in children. This pediatric case-control investigation examined associations between central obesity/high-body weight and asthma diagnosis. METHODS: Five-hundred and fourteen children (217 physician diagnosed asthma cases and 297 healthy controls) of 5-11 years were recruited. Height, weight and waist circumference were measured. Asthma symptoms, past medical history, personal lifestyle, socioeconomic status, diet and physical activity history were also collected. RESULTS: A higher proportion of children with asthma were centrally obese [(≥90th waist percentile) 15.2 vs. 9.4%, p<0.0001; (≥90th waist-to-height ratio percentile) 39.6 vs. 24.2%, p<0.0001)]. Regression analyses revealed that centrally obese children were more likely to have asthma (high-waist circumference (OR = 1.99, 95% CI: 1.07-3.68) and high-waist circumference to height ratio (OR = 2.24, 95% CI: 1.47-3.40), following adjustment for various confounders. Overweight/obese participants (BMI defined) were more likely to be asthmatic [odds ratio (OR) = 1.52, 95% confidence interval (CI): 1.03-2.70)] when compared to controls. CONCLUSIONS: Presence of central obesity and high-body weight (at least overweight) as assessed by waist circumference, waist-to-height ratio, and BMI are associated with asthma diagnosis. More studies are needed, especially in children and adolescents, to confirm these findings and better understand how body fat distribution impacts the obesity-asthma relationship.

Childhood overweight/obesity and asthma: is there a link? A systematic review of recent epidemiologic evidence.

Asthma and overweight/obesity prevalence are both increasing worldwide. Overweight/obesity has been suggested as a risk factor for developing asthma. The aim of this review is to present and evaluate recent publications that help answer the question: "Is increased body weight (at least overweight status) related to asthma in children?" A systematic review of epidemiologic literature was carried out using the MEDLINE database. Epidemiologic studies on young human subjects (ie, infants, children, and adolescents), published in English during the period 2006-2011 were included. A comprehensive literature search yielded 434 studies for further consideration. Forty-eight studies fulfilled the review's eligibility criteria. Two researchers applied the MOOSE Guidelines for Meta-Analysis and Systematic Reviews of Observational Studies on all identified studies. Current evidence supports a weak yet significant association between high body weight and asthma. New information indicates that central obesity in children increases asthma risk. Also, the link between high body weight and asthma may be stronger in nonallergic asthma. There are mixed results about the importance of sex. Although the nature of the association between overweight/obese status and asthma remains unclear, prospective studies point that high body weight precedes asthma symptoms. These data add weight to the importance of preventing and treating a high body weight against asthma outcomes. Available research in children has not studied adequately the influence of weight change (either gain or loss) on asthma symptoms, an area of clinical importance. Beyond energy control, the role of diet as a possible inflammatory stimulus warrants further investigation. Limited data seem to favor the promotion of breastfeeding in attenuating the overweight/obesity-asthma relationship. Finally, future research should include weight intervention studies assessing various measures of body fat in relation to well-defined asthma outcomes.