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Randomized Controlled Trial
. 2013 Aug 1;188(3):319-26.
doi: 10.1164/rccm.201303-0457OC.

Body mass index is a stronger predictor than the metabolic syndrome for future asthma in women. The longitudinal CARDIA study

Nour Assad  1 , Clifford Qualls, Lewis J Smith, Alex Arynchyn, Bharat Thyagarajan, Mark Schuyler, David R Jacobs Jr, Akshay Sood
Affiliations
Randomized Controlled Trial

Body mass index is a stronger predictor than the metabolic syndrome for future asthma in women. The longitudinal CARDIA study

Nour Assad et al. Am J Respir Crit Care Med. .

Abstract

Rationale: It is hypothesized that the metabolic syndrome explains the association between body mass index (BMI) and asthma in adults.

Objectives: Our objective was to longitudinally compare the relative strengths of the associations of the metabolic syndrome and BMI with incident asthma in adults.

Methods: We included 4,619 eligible participants in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort followed over 25 years. Incident asthma was defined by a new self-reported provider asthma diagnosis plus either the presence of asthma symptoms and/or use of asthma medications. Cox proportional hazard analyses were performed.

Measurements and main results: Six hundred two subjects (417 women and 185 men) developed incident asthma over 25 years of follow-up. Metabolic syndrome predicted incident asthma among women but not men (unadjusted hazard ratios, 1.50 and 0.98; P = 0.01 and 0.93, respectively). BMI had a similar predictive association among women but not men (unadjusted hazard ratios, 1.19 and 1.04 per 5 units of BMI; P < 0.001 and 0.60, respectively). The association of metabolic syndrome with incident asthma in women was no longer statistically significant after adjustment for BMI (P = 0.44). In contrast, the association of BMI with incident asthma in women remained statistically significant after adjusting for the metabolic syndrome (P = 0.01). In a stepwise model, BMI was a stronger predictor than the metabolic syndrome (P = 0.001).

Conclusions: BMI is a stronger predictor of incident asthma among women than the metabolic syndrome. Other obesity-associated factors that are not a part of the metabolic syndrome may play a role in the BMI-asthma association in women.

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Figures

<i>Figure 1.</i>
Figure 1.
Overview of study participants. CARDIA = Coronary Artery Risk Development in Young Adults.
<i>Figure 2.</i>
Figure 2.
Kaplan-Meier survival curves for incident asthma of body mass index (BMI) categories among women (top panel) and men (bottom panel). The BMI values of study participants were averaged over 25 years.
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Comment in

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