Background
We assessed the relationship of body mass index (BMI), smoking,
drinking and solid fuel use (r; SFU), and the individual
and combined effects of these
factors on wheezing symptoms (WS) and on diagnosed asthma (DA).
Methods We
analysed 175 000 individuals from 51 nationally representative surveys,
using self-reports of WS and DA as the measures
of asthma. The fixed-effects and
random-effects estimates of the pooled ORs between asthma and
underweight (BMI <18.5 kg/m2), obesity (BMI ≥30 kg/m2), smoking, drinking and SFU were reported.
Results
The pooled risks of all individual risk factors were significantly
associated with WS and DA (with the exception of current
smoking with DA in women and SFU
with DA in both genders). Stronger dose–response relationships were seen
in women for smoking
amounts and duration; BMI showed
stronger quadratic relationships. The combined risks were generally
larger in women than
in men, with significant risks for
underweight (OR=2.73) as well as obese (OR=2.00) smokers for WS (OR=2.13
and OR=1.58 for
DA, respectively). The magnitude of
the combined effects from low/high BMI, smoking and drinking were also
consistently higher
among women than among men in WS and
DA. SFU among underweight smokers also had positive association with WS
(men and women)
and DA (women).
Conclusions BMI, smoking, drinking and SFU—in combination—are associated with double or triple the risk of development of asthma. These
risk factors might help explain the wide variation in asthma burden across countries.
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