6533b829fe1ef96bd128ad44

RESEARCH PRODUCT

Early-life weight gain, prematurity, and asthma development.

subject

description

Early childhood asthma is a clinical syndrome, the development and clinical manifestations of which result from a complex interplay among airway anatomy, physiology, and inflammation. Although multiple phenotypes of early childhood wheezing and asthma have been described, the mechanisms that promote and differentiate these phenotypes remain poorly understood. Over the past decade, substantial understanding has emerged as to the early-life factors that influence childhood asthma development. One area of great interest has been the relationships between patterns of fetal and infant growth, subsequent wheezing, and asthma. Although several studies strongly suggest that intrauterine growth patterns do not influence the risk of childhood wheezing or asthma, Pike et al noted an inverse association between fetal growth and risk of atopic wheeze by age 3 years. The relationship between birth weight and subsequent asthma is inconsistent, with studies finding absent, inverse, or positive associations between birth weight and asthma. Postnatal weight gain in early life has consistently been identified as an important contributor to asthma risk, with several large studies showing greater weight gain in infancy being associated with an increased risk for incident asthma. This was recently illustrated in a study of 12,050 subjects from 8 European birth cohorts, which reported that rapid growth in body mass index (BMI) during the first 2 years of life increased the risk of asthma up to 6 years of age, with no additional effect of rapid BMI gains between 2 and 6 years of age. In this issue of the Journal, Sonnenschein-van der Voort et al advance our understanding of these associations through an analysis of more than 147,000 children participating in 31 European birth cohort studies. The occurrence of preschool (first 4 years of life) wheezing and asthma (between 5 and 10 years of age) was identified by using questionnaires adapted from the International Study on Asthma and Allergy in Childhood. The authors used random-effects meta-analysis on individual