{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:46:01Z","timestamp":1760237161724,"version":"build-2065373602"},"reference-count":54,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T00:00:00Z","timestamp":1583107200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81673193"],"award-info":[{"award-number":["81673193"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Guangdong Natural Science Fund","award":["2017A030310249"],"award-info":[{"award-number":["2017A030310249"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Childhood asthma and obesity have posed a parallel epidemic over the past few decades. However, whether asthma diagnosis is associated with obesity, and what the roles of lifestyle factors play in this relationship, remained unclarified. This study aimed to investigate the association between asthma and weight status in Chinese children and explore the potential mediating and\/or modifying roles of lifestyle factors in the association. In this cross-sectional study, 16,837 children aged 6\u201312 years were recruited from Guangzhou, China. Participants\u2019 information on physician-diagnosed asthma was collected from parents, and data on physical activity, screen time, and sleeping were reported in a validated questionnaire. Height and weight were objectively measured, and weight status was classified by body mass index (BMI). Multiple logistic regression analysis and mediation analysis were used. Results showed that asthmatic children were at significantly higher risk of obesity (odds ratio (OR) 1.51, 95% confidence interval (CI) 1.03, 2.21) compared with non-asthmatic children. More importantly, this increased risk was even greater in children with moderate-to-vigorous physical activity &lt;60 min\/d and children with screen time &gt;2 h\/d (both Pinteraction &lt; 0.05). Also, a positive relationship of asthma with overweight was found in children with screen time &gt;2 h\/d (OR 3.92, 95% CI 1.56, 9.88), while a negative association was observed between asthma and underweight in children aged 9\u201312 years (OR 0.23, 95% CI 0.06, 0.92). Mediation analysis indicated that these associations were not mediated by physical activity, screen time, or sleeping. The findings suggested that physician-diagnosed asthma was associated with higher risks of overweight and obesity, and these risks might be exacerbated by insufficient physical activity and prolonged screen time.<\/jats:p>","DOI":"10.3390\/ijerph17051599","type":"journal-article","created":{"date-parts":[[2020,3,3]],"date-time":"2020-03-03T03:13:28Z","timestamp":1583205208000},"page":"1599","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Association between Physician-Diagnosed Asthma and Weight Status among Chinese Children: The Roles of Lifestyle Factors"],"prefix":"10.3390","volume":"17","author":[{"given":"Lijuan","family":"Lai","sequence":"first","affiliation":[{"name":"Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xia","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weiqing","family":"Tan","sequence":"additional","affiliation":[{"name":"Health Promotion Centre for Primary and Secondary Schools of Guangzhou Municipality, Guangzhou 510020, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3132-2945","authenticated-orcid":false,"given":"Yajun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,3,2]]},"reference":[{"key":"ref_1","first-page":"248","article-title":"Piecewise Mixed Effects Model to Compare the Weight-gain Patter ns Before and After Diagnosis of Asthma in Children Younger than 5 Years","volume":"6","author":"Hossain","year":"2015","journal-title":"J. Biometr. Biostat."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/ACI.0000000000000339","article-title":"The effect of obesity, weight gain, and weight loss on asthma inception and control","volume":"17","author":"Forno","year":"2017","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1164\/rccm.201605-1039OC","article-title":"Obesity and Airway Dysanapsis in Children with and without Asthma","volume":"195","author":"Forno","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1038\/oby.2012.5","article-title":"Higher prevalence of obesity among children with asthma","volume":"20","author":"Black","year":"2012","journal-title":"Obesity"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1111\/j.1398-9995.2009.02081.x","article-title":"Fitness, daily activity and body composition in children with newly diagnosed, untreated asthma","volume":"64","author":"Vahlkvist","year":"2009","journal-title":"Allergy"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2443","DOI":"10.1542\/peds.2006-1846","article-title":"Asthma as a barrier to children\u2019s physical activity: Implications for body mass index and mental health","volume":"118","author":"Glazebrook","year":"2006","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1038\/oby.2000.74","article-title":"Asthma and maternal body mass index are related to pediatric body mass index and obesity: Results from the Third National Health and Nutrition Examination Survey","volume":"8","author":"Epstein","year":"2000","journal-title":"Obes. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1097\/NNR.0b013e318255679c","article-title":"Daytime physical activity levels in school-age children with and without asthma","volume":"61","author":"Tsai","year":"2012","journal-title":"Nurs. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1081\/JAS-54635","article-title":"Relationship between body mass index and asthma characteristics in a group of Italian children and adolescents","volume":"42","author":"Vignolo","year":"2005","journal-title":"J. Asthma"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.ehb.2012.10.002","article-title":"Examining the temporal relationships between childhood obesity and asthma","volume":"14","author":"Green","year":"2014","journal-title":"Econ. Hum. Biol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1164\/rccm.201608-1691OC","article-title":"Effects of Childhood Asthma on the Development of Obesity among School-aged Children","volume":"195","author":"Chen","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1800504","DOI":"10.1183\/13993003.00504-2018","article-title":"Does early onset asthma increase childhood obesity risk? A pooled analysis of 16 European cohorts","volume":"52","author":"Contreras","year":"2018","journal-title":"Eur. Respir. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1038\/s41366-018-0160-8","article-title":"Causal relationships between adiposity and childhood asthma: Bi-directional Mendelian Randomization analysis","volume":"43","author":"Chen","year":"2019","journal-title":"Int. J. Obes."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e666","DOI":"10.1542\/peds.2007-1236","article-title":"Asthmatic symptoms, physical activity, and overweight in young children: A cohort study","volume":"121","author":"Eijkemans","year":"2008","journal-title":"Pediatrics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"6","DOI":"10.5334\/aogh.2416","article-title":"Pediatric Asthma: A Global Epidemic","volume":"85","author":"Serebrisky","year":"2019","journal-title":"Ann. Glob. Health"},{"key":"ref_16","unstructured":"NCD Risk Factor Collaboration (NCD-RisC) (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet, 390, 2627\u20132642."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"492","DOI":"10.3109\/02770903.2015.1116084","article-title":"Racial disparity in the association between body mass index and self-reported asthma in children: A population-based study","volume":"53","author":"Joseph","year":"2016","journal-title":"J. Asthma"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/S0140-6736(11)60813-1","article-title":"The global obesity pandemic: Shaped by global drivers and local environments","volume":"378","author":"Swinburn","year":"2011","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/j.jaci.2004.11.050","article-title":"The epidemiology of obesity and asthma","volume":"115","author":"Ford","year":"2005","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s40413-017-0169-9","article-title":"Psychological and lifestyle risk factors for asthma exacerbations and morbidity in children","volume":"10","author":"Oland","year":"2017","journal-title":"World Allergy Organ. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1016\/j.pcl.2015.05.013","article-title":"Addressing Childhood Obesity: Opportunities for Prevention","volume":"62","author":"Brown","year":"2015","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.jped.2014.01.002","article-title":"Exercise, obesity, and asthma in children and adolescents","volume":"90","author":"Lang","year":"2014","journal-title":"Jornal de Pediatria"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jand.2012.08.025","article-title":"Childhood overweight\/obesity and asthma: Is there a link? A systematic review of recent epidemiologic evidence","volume":"113","author":"Papoutsakis","year":"2013","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1097\/ACI.0b013e3283292256","article-title":"What have we learnt from ISAAC phase III in the Asia-Pacific rim?","volume":"9","author":"Fok","year":"2009","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_25","first-page":"1","article-title":"Empirical changes in the prevalence of overweight and obesity among Chinese students from 1985 to 2010 and corresponding preventive strategies","volume":"26","author":"Ji","year":"2013","journal-title":"Biomed. Environ. Sci."},{"key":"ref_26","unstructured":"Lv, Y.J., Lai, L.J., Li, D.L., Cai, L., Zhu, Y.N., Feng, C.Y., Tan, W.Q., and Chen, Y.J. (2019). Reliability and Validity of the Questionnaire of Surveillance on Students\u2019 Constitution and Health for Primary School Students in Guangzhou. Matern. Child Health Care China, accept. (In Chinese)."},{"key":"ref_27","unstructured":"National Health Commission of the People\u2019s Republic of China (2020, February 20). Screening Standard for Malnutrition of School-Aged Children and Adolescents, Available online: http:\/\/www.nhc.gov.cn\/wjw\/pqt\/201407\/38b15c0a1ed444e8908e12752decaffa.shtml."},{"key":"ref_28","first-page":"97","article-title":"Body mass index reference norm for screening overweight and obesity in Chinese children and adolescents","volume":"25","author":"Gocot","year":"2004","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"660","DOI":"10.2471\/BLT.07.043497","article-title":"Development of a WHO growth reference for school-aged children and adolescents","volume":"85","author":"Onyango","year":"2007","journal-title":"Bull. World Health Organ."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1177\/0049124113494572","article-title":"Total, Direct, and Indirect Effects in Logit and Probit Models","volume":"42","author":"Breen","year":"2013","journal-title":"Sociol. Methods Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1002\/oby.22341","article-title":"Gene Coexpression Networks in Whole Blood Implicate Multiple Interrelated Molecular Pathways in Obesity in People with Asthma","volume":"26","author":"Chen","year":"2018","journal-title":"Obesity"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.annepidem.2016.06.002","article-title":"A systematic review of the relationship between asthma, overweight, and the effects of physical activity in youth","volume":"26","author":"Leinaar","year":"2016","journal-title":"Ann. Epidemiol."},{"key":"ref_33","first-page":"36","article-title":"Asthma control in children: Is it important and can we measure it?","volume":"17","author":"Pedersen","year":"2016","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.jpeds.2016.03.063","article-title":"Associations of Physical Activity and Sedentary Behavior with Atopic Disease in United States Children","volume":"174","author":"Strom","year":"2016","journal-title":"J. Pediatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1378\/chest.12-0412","article-title":"The poorly explored impact of uncontrolled asthma","volume":"143","author":"Pedersen","year":"2013","journal-title":"Chest"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Williams, B., Powell, A., Hoskins, G., and Neville, R. (2008). Exploring and explaining low participation in physical activity among children and young people with asthma: A review. BMC Fam. Pract., 9.","DOI":"10.1186\/1471-2296-9-40"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.3349\/ymj.2017.58.5.1040","article-title":"Physical Activity, Sedentary Habits, Sleep, and Obesity are Associated with Asthma, Allergic Rhinitis, and Atopic Dermatitis in Korean Adolescents","volume":"58","author":"Lim","year":"2017","journal-title":"Yonsei Med. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1038\/sj.ijo.0803215","article-title":"Asthma and body weight change: A 20-year prospective community study of young adults","volume":"30","author":"Hasler","year":"2006","journal-title":"Int. J. Obes."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1123\/pes.2015-0122","article-title":"Obesity, Asthma, and Exercise in Child and Adolescent Health","volume":"28","author":"Lu","year":"2016","journal-title":"Pediatr. Exerc. Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e23191","DOI":"10.1136\/bmjopen-2018-023191","article-title":"Effects of screentime on the health and well-being of children and adolescents: A systematic review of reviews","volume":"9","author":"Stiglic","year":"2019","journal-title":"BMJ Open"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/S0301-0546(08)75218-2","article-title":"Influence of physical activity and television-watching time on asthma and allergic rhinitis among young adolescents: Preventive or aggravating?","volume":"36","author":"Vlaski","year":"2008","journal-title":"Allergol. Immunopathol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"485","DOI":"10.3109\/02770903.2015.1108435","article-title":"Asthma and overweight\/obese: Double trouble for urban children","volume":"53","author":"Wiesenthal","year":"2016","journal-title":"J. Asthma"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Jensen, M., Gibson, P., Collins, C., Hilton, J., and Wood, L. (2017). Lifestyle Risk Factors for Weight Gain in Children with and without Asthma. Children, 4.","DOI":"10.3390\/children4030015"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"193","DOI":"10.3109\/02770903.2013.853081","article-title":"Asthma and physical activity in multiracial girls from three US sites","volume":"51","author":"Vangeepuram","year":"2014","journal-title":"J. Asthma"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"19","DOI":"10.3109\/02770903.2015.1063646","article-title":"Relationships among obesity, physical activity and sedentary behavior in young adolescents with and without lifetime asthma","volume":"53","author":"Groth","year":"2016","journal-title":"J. Asthma"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1136\/bjsports-2014-093754","article-title":"Sedentary behaviour and diet across the lifespan: An updated systematic review","volume":"49","author":"Hobbs","year":"2015","journal-title":"Br. J. Sports Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/cea.12024","article-title":"The association between BMI, vigorous physical activity and television viewing and the risk of symptoms of asthma, rhinoconjunctivitis and eczema in children and adolescents: ISAAC Phase Three","volume":"43","author":"Mitchell","year":"2013","journal-title":"Clin. Exp. Allergy"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"615","DOI":"10.7150\/ijms.19213","article-title":"Systematic Evaluation of Corticosteroid Use in Obese and Non-obese Individuals: A Multi-cohort Study","volume":"14","author":"Savas","year":"2017","journal-title":"Int. J. Med. Sci."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.rmed.2014.11.006","article-title":"Adipose tissue content and distribution in children and adolescents with bronchial asthma","volume":"109","author":"Umlawska","year":"2015","journal-title":"Respir. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1097\/01.chi.0000222789.34229.21","article-title":"Association of depressive symptoms and disease activity in children with asthma: methodological and clinical implications","volume":"45","author":"Waxmonsky","year":"2006","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.eurpsy.2019.04.008","article-title":"Associations of major depressive disorder with chronic physical conditions, obesity and medication use: Results from the PISMA-ep study","volume":"60","author":"Rivera","year":"2019","journal-title":"Eur. Psychiatry"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"98","DOI":"10.4168\/aair.2012.4.2.98","article-title":"Role of adipokines and hormones of obesity in childhood asthma","volume":"4","author":"Yuksel","year":"2012","journal-title":"Allergy Asthma Immunol. Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/j.jaci.2008.03.005","article-title":"Asthma and obesity: Common early-life influences in the inception of disease","volume":"121","author":"Litonjua","year":"2008","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1165\/rcmb.2016-0017PS","article-title":"Mechanisms of Asthma in Obesity. Pleiotropic Aspects of Obesity Produce Distinct Asthma Phenotypes","volume":"54","author":"Dixon","year":"2016","journal-title":"Am. J. Respir. Cell Mol. Biol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/5\/1599\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:03:12Z","timestamp":1760173392000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/5\/1599"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,2]]},"references-count":54,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,3]]}},"alternative-id":["ijerph17051599"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17051599","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2020,3,2]]}}}