ESPE Abstracts

Introduction: The coexistence of asthma and obesity presents a significant clinical challenge, as both conditions independently contribute to systemic inflammation, metabolic dysregulation, and impaired respiratory function. Metabolic markers can potentially provide insights into the pathophysiological mechanisms that link obesity and asthma. The aimof this study was to investigate the association between metabolic markers, vitamin D and lung function in children with asthma and obesity.

Methods: A cross-sectional study was conducted at Sidra medicine, Doha, Qatar. Markers including glycosylated hemoglobin (HbA1c), fasting plasma glucose, insulin, C-peptide, and homeostatic measure of insulin resistance (HOMA-IR), liver function enzymes (Alanine aminotransferase (ALT), and Aspartate aminotransferase (AST)), and vitamin D levels were measured in children aged 6-18 years. Metabolic markers were compared between overweight/obesity with asthma (OO-A, n = 100), and overweight/obese without asthma (OO, n = 100) using two-sample t-test or Mann-Whitney U-test. Chi-squared test was used to compare the proportion of pre-diabetes between the groups.

Results: The mean HbA1c and the prevalence of pre-diabetes (≥ 5.7%) were higher in OO-A compared to their counterparts without asthma (P = 0.008 and P = 0.005 respectively). However, OO-A group had lower number of individuals with HOMA-IR ≥ 2.50 as compared to the OO group (P = 0.026). No significant difference was observed in other glycemic markers between the two groups. Only ALT showed a positive correlation with HOMA-IR in both OO-A (rho=0.2716, P = 0.018) and OO children (rho=0.2787, P = 0.011). Vitamin D showed a negative correlation with BMI in both OO-A (rho=-0.2785, P = 0.008) and OO (rho=-0.2796, P = 0.012) groups. HbA1c was negatively associated with FVC % predicted (P = 0.019) and FEV1 % predicted (P = 0.012) in OO-A group. Trend to a significant difference (P = 0.09) in HOMA-IR was observed, a decrease in HOMA-IR in OO-A using glucocorticoids

Conclusion: The study assessed the association between asthma and obesity, by comparing the levels of metabolic markers, liver enzymes and vitamin D in overweight/obese children with asthma and without asthma. We found an increase in HbA1c, increased incidence of pre-diabetes. The observed reduced incidence of insulin resistance in overweight/obese children with asthma as compared to their counterparts without asthma, indicate a complex interaction of obesity and asthma in obese children with asthma. It is possible that glucocorticoids use is a modifying factor improving inflammation and ability for exercise and in turn improving insulin resistance Our results also highlight the importance of considering both respiratory and metabolic factors in the management of pediatric asthma associated with obesity