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American Journal of Sports Science and Medicine. 2014, 2(1), 21-26
DOI: 10.12691/AJSSM-2-1-4
Research Article

Peak Expiratory Flow Rate – A Consistent Marker of Respiratory Illness Associated with Childhood Obesity

Basuli Goswami1, Anindita Singha Roy1, Rishna Dalui1 and Amit Bandyopadhyay1,

1Department of Physiology, Sports and Exercise Physiology Lablratory, University of Calcutta, University College of Science and Technology, Kolkata, India

Pub. Date: February 12, 2014
(This article belongs to the Special Issue Role of Exercise in Prevention of Obesity in Children)
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Basuli Goswami, Anindita Singha Roy, Rishna Dalui and Amit Bandyopadhyay. Peak Expiratory Flow Rate – A Consistent Marker of Respiratory Illness Associated with Childhood Obesity. American Journal of Sports Science and Medicine. 2014; 2(1):21-26. doi: 10.12691/AJSSM-2-1-4

Abstract

Childhood obesity is a prevalent global health problem that leads to onset of serious health problems. One of such major health problems is respitarory disorders induced by obesity especially in childhood. Peak expiratory flow rate (PEFR) is a convenient tool for quantitative and qualitative estimation of pulmonary function, which can easily be measured by peak flow meter. Present review has been focused to find out the applicability of PEFR as a marker of childhood obesity induced respiratory complications. Several studies revealed that obesity has strong association with PEFR that was significantly lower in individuals with obesity. Such association was attributed to the increased airway resistance and respiratory muscle dysfunction as a result of excess fat deposition. BMI, a good predictor of obesity also exhibited significant correlated with spirometric variables, e.g., FEV1, FVC, PEFR, etc. Waist to hip ratio has also been found to be an alternative of BMI for prediction of PEFR. Researchers hypothesised that fat accumulation over the chest wall reduces the PEFR mostly among all the pulmonary function indices and negative correlation was observed between pulmonary function parameters and visceral adiposity that in turn establishes that visceral fat deposition negatively affects the pulmonary activities and affects airway hyper responsiveness (AHR) in asthmatic and non-asthmatic children. Evidences further suggest that obesity causes asthma in children. It may further be hypothesized that PEFR is a good marker to diagnose the pulmonary disorders originated as a result of obesity that in turn may be evaluated from BMI or waist to hip ratio.

Keywords

Obesity, PEFR, child, BMI

Copyright

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]  Peter, T., Kuo, Hadlay L., Conn, Eugene A. DeFelice, Health & Obesity, Lippincott-Raven Publishers. 1983, 2.
 
[2]  Mercedes, D., Onis,C, Adelheid W, Onyango, and Borghi E.,”Comparison of the WHO Child Growth Standards and the CDC 2000 Growth Charts”, The Journal of Nutrition, 37, 144-48,2007.
 
[3]  Price, JFK, Arthur, N, and Macstephen AO, “Correlation between Body Mass Index and Peak Expiratory Flow Rate of an Indigenous Nigerian Population in the Niger Delta Region”, Research Journal of Recent Sciences, 2(2). 28-32. Feb. 2013.
 
[4]  Gundogdu Z, Eryilmaza N, “Correlation between peak flow and body mass index in obese and non-obese children in Kocaeli, Turkey”, Primary Care Respiratory Journal, 20. 403-6, 2011.
 
[5]  Dixit, M.B., Raje, S., Agrawal, M.J., “Lung function with spirometry: an Indian perspective-I. Peak expiratory flow rates”. Indian Journal of Physiology and Pharmacology, 49(1). 8-18. 2005.
 
[6]  Tantisira, K.G., Weiss, S.T., “Complex interactions in complex traits: obesity and asthma”, Thorax, 56(Suppl 2).64-73. 2001.
 
[7]  Camargo, C.A., Weiss, S.T., Zhang, S., Willett, W.C., Speizer, F.E., “Prospective study of body mass index, weight change, and risk of adult-onset asthma in women”, Archives of Internal Medicine, 159. 2582-2588. 1999.
 
[8]  Figueroa,M.J., Chinn, S., Rona, R.. “Association between obesity and asthma in 4-11 year old children in the UK”. Thorax, 56. 133-7. 2001.
 
[9]  Gennuso, J, Epstein, L.H., Paluch, R.A., Cerny, F., “The relationship between asthma and obesity in urban minority children and adolescents”, Archives of Pediatrics and Adolescent Medicine, 152. 1197-1200. 1998.
 
[10]  Gilliland, F.D., Berhane, K., Islam, T., McConnell, R., Gauderman, W.J., Gilliland, S.S., Avol, E., and Peters, J.M., “Obesity and the Risk of Newly Diagnosed Asthma in School-age Children”, American Journal of Epidemiology, 158(5). 406-415. 2003.
 
[11]  Mahoney, L.T., Buras, T.L., Stanford, W., “Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: the Muscatine study”. Journal of American College of Cardiology, 27. 277-84. 1996.
 
[12]  Rigatto, A.M., Alves, S.C., Gonçalves, C.B., Firmo, J.F., Provin, L.M., “Ventilatory performance in obesity”, Saude Review, 7. 57-62. 2005.
 
[13]  Sin, D.D., Man, S.F., “Impaired lung function and serum leptin in men and women with normal body weight: A population based study”, Thorax, 58. 695-8. 2003.
 
[14]  Tenório, L.H.S., Santos, A.C., Oliveira, A.S., Lima, A.M.J., Brasileiro, M.S., “Obesity and pulmonary function tests in children and adolescents: a systematic review”, Revista Paulista de Pediatria, 30(3). 423-30. 2012.
 
[15]  Chatterjee, S., Chatterjee, P., and Bandyopadhyay, A., “Cardiorespiratory fitness of obes boys”. Indian Journal of Physiology and Pharmacology, 49 (3). 353-357. 2005.
 
[16]  Bandyopadhyay, A., “Cardiorespiratory fitness of obes boys”. Indian Journal of Physiology and Pharmacology, 12. 56(4). 94-96. 2012.
 
[17]  Cole, T.J., Bellizzi, M.C., Flegal, K.M., Dietz, W.H., “Establishing a standard definition for child overweight and obesity worldwide: international survey”, British Medical Journal, 320. 1240-3. 2000.
 
[18]  World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation, Geneva, 3-5 Jun 1997.Geneva: WHO, 1998 (WHO/NUT/98.1).
 
[19]  De, O.M., Onyango, A.W., Borghi, E., Siyam, A., Nishida, C., Siekmann, J., “Development of a WHO growth reference for school-aged children and adolescents”. Bulletin of World Health Organisation, 85. 660-7. 2007.
 
[20]  World Health Organization. World Health Organization Child Growth Standards. 2006. March, 2012.
 
[21]  Kuczmarski, R., Ogden, C.L., Grummer, L.M., CDC Growth Charts: United States. Hyattsville, MD: National Center for Health Statistics; 2000.
 
[22]  Gannett: The Information Company, Annual Report – 2006. McLean, VA, 2007.
 
[23]  Ülger, Z., Demir, E., Tanaç, R. “The effect of childhood obesity on respiratory tests and airway hyperresponsiveness”. Turkish Journal of Pediatrics, 48. 43-50. 2006.
 
[24]  McMahon, C., Semina, E.V., and Link, B.A., “Using zebrafish to study the complex genetics of glaucoma”, Comparative Biochemistry and Physiology - Part C: Toxicology. 138(3), 343-350. 2004.
 
[25]  Alberti, K., Zimmet, P., “New diagnostic criteria and classification of diabetes—again?”, Diabetes Medicine, 15. 7. 2004.
 
[26]  Rashad, M., Roberts, E.A. ‘Nonalcoholic Steatohepatitis in Children’. Journal of Pediatric Gastroenterology and Nutrition, 30(1), 48-53, 2000.
 
[27]  Dietz, WH., Jr, Gross, W.L., Kirkpatrick, J.A., “Jr Blount disease (tibia vara): another skeletal disorder associated with childhood obesity”. Journal of Paediatrics. 101.735. 1982.
 
[28]  Henderson, R.C., “Tibia vara: a complication of adolescent obesity. Journal of Paediatrics.121:482-486. 1992.
 
[29]  Daniels, S.R., “Complications of obesity in children and adolescents”. International Journal of Obesity (Lond). 33(Suppl 1). S60-5, 2009.
 
[30]  Steven, D., Stovitz, Perrie, E., Vazquez G., Duval S, SchwimmerJ.B., “Musculoskeletal pain in obese children and adolescents”, Acta Paediatrica, 97 (4). 489 493. 2008.
 
[31]  Li, X., Quiñones, M.J., Wang, D., Bulnes, I., Jimenez, X., Rosa, R., Aurea, G.L.,Taylor, K.D., Hsueh, W.A., Rotter, J.I., Yang, H., “Genetic effects on obesity assessed by bivariate genome scan: the Mexican-American coronary artery disease study”. Obesity, 14(7):1192-200. Jul. 2006.
 
[32]  Xavier, S., Mandal, S., “The psychosocial impacts of obesity in children and young people: A future health perspective”. Public Health Medicine, 6(1).23-27.2005.
 
[33]  Griffiths, L.J., Parsons, T.J., Hill, A.J., “Self-esteem and quality of life in obese children and adolescents: a systematic review”. International Journal of Paediatrics Obesity, 5(4). 282-304. 2010.
 
[34]  Bandyopadhyay, A., “Pulmonary function studies in young healthy Malayasians of Kelantan, Malayasia”. Indian Journal of Medical Research, 134. 653-657.2011.
 
[35]  Bandyopadhyay, A., Bhattacharjee, I., Dalui, R., Pal, S., “Pulmonary function studies of healthy Non-smoking male University students of Kolkata, India- Revisited”. Malaysian Journal of Medical Sciences, 20(2),17-24. 2013.
 
[36]  Bandyopadhyay, A., Tripathy, S., Kamal, R.B., Basak, A.K., “Peak expiratory flow rate in college students of Uttar Pradesh, India”. Indian Biologist. 39(1), 71-75. 2007.
 
[37]  Jain, S.K., Kumar, R., Sharma, D.A., “Peak Expiratory flow rates (PEFR) in healthy Indian adults: A statistical evaluation-I”, Lung India, 1(3), 88-91. 1983.
 
[38]  American Thoracic Society: Standardization of Spirometry; 1994 Update. American Journal of Respiratory Critical Care Medicine, 152.1107-1136. 1995.
 
[39]  Bandyopadhyay, A., Basak, A.K., Tripathy, S., Bandyopadhyay, P., “Peak Expiratory flow rates in female brick-field workers of West Bengal, India”. Ergonomics SA, 18(1):22-27. 2006.
 
[40]  Jain, P., Kavuru, M.S., Emerman, C.L., and Ahmad M., “Utility of peak expiratory flow monitoring”, Chest, 114. 861-876. 1998.
 
[41]  Kumar, D., Puri, R., Sinha, N., Hasan,S.N., Agarwal, V., Mishra, S.B., “Peak expiratory flow rate assessment in obese and non-obese subjects in western Uttar Pradesh”. The Indian Journal of Research and Reports in Medical Sciences, 3(3): 9-12. 2013.
 
[42]  Benjaponpitak, S., Direkwattanachai, C., Kraisarin, C., Sasisakulporn, C., “Peak expiratory flow rate values of students in Bangkok”, J Med Assoc Thai, 82(Supp.l).137-43. 1999.
 
[43]  Rangnathan, S., Li, C., Wood, L., Rangnathan, G., “Adipose tissue tumor necrosis factor and interleukin-6 expression in human obesity and insulin resistance”, American Journal of Physiology and Endocrinology Metabolism, 280.745-51. 2001.
 
[44]  Shaheen, S.O., Sterne. J.A.C., Montgomery, S.M., Azima. H.A., “Birth weight, body mass index and asthma in young adults”, Thorax, 54. 396-402. 1999.
 
[45]  Siregar, F.Z., Panggabean, G., Daulay, R.M., Lubis, H.M., “Comparison of peak expiratory flow rate (PEFR) before and after physical exercise in obese and non-obese children”, Paediatrica Indonesiana, 49(1). Jan., 20-4, 2009.
 
[46]  Gianinis. H.H., Bianca. O., Collins, L.C., Hoberty, P.D., Walker. J.F., Fletcher. E.C., Peiris. A.N., “The effects of body fat distribution on pulmonary function tests”, Chest, 107. 1298-302. 1995.
 
[47]  Raju, P.S., Prasad, K.V., Ramana, Y.V., Murthy, K.J., “Pulmonary function tests in Indian girls prediction equations”, Indian Journal of Pediatrics, 71. 893-7. 2004.
 
[48]  Salome, C.C.M., King, G.G.G., Berend, N., “Physiology of obesity and effects on lung function”, Journal of Applied Physiology, 108(1). 11. 2006.
 
[49]  Onadeko, B.O., Falase, A.O., and Ayeni, O., “Pulmonary function studies in Nigerian sports - men. African Journal of Medicine and Science, 5: 291-295. 1976.
 
[50]  Jaja, S.I., and Ojo, G.O., “Peak flow rate in young Nigerian adults”. Nigerian Journal of Physiological Sciences, 1(2): 24-30. 1983.
 
[51]  Azah, N., Antai, E.J., Peters, E.J. and Osim, E.E., “Normal lung function values of Nigerian children aged 6 – 16 years. Nigerian Journal of Physiological Sciences, 17(1–2): 74-75. 2002.
 
[52]  Quanjer, P.H., Tammeling, G.J., Cotes, J.E., Pedersen, O.F., Peslin, R., Yernault, J.C., “Lung volumes and forced ventilatory flows: official statement of the European Respiratory Society”, European Respiratory Journal, 6(16). 5-40. 1993.
 
[53]  Chowgule RV, Shetye VM, Parmar JR. Lung function tests in normal Indian children. Indian Pediatrics, 32(2):185-91. Jul. 1996.
 
[54]  Carson J.W., Hoey H, Taylor MR., “Growth and other factors affecting peak expiratory flow rate”, Archives of Disease in Children, 64(1). 96-102. 1989.
 
[55]  Primhak, R., Coates, F.S., “Malnutrition and peak expiratory flow rate”. European Respiratory Journal, 1(9):801-3.Oct. 1988.
 
[56]  Must, A., Strauss, R.S., “Risks and consequences of childhood and adolescent obesity”. International Journal of Obesity, 23. S2–S11. 1999.
 
[57]  McClean, K.M., Kee F, Young IS, Elborn JS, Obesity and the lung: Epidemiology, Thorax, 63(7). 649-54. 2007.
 
[58]  Rubinstein, I., Zamel, N., DuBarry, L., Hoffstein, V., “Airflow limitation in morbidly obese, nonsmoking men”, Annals of Internal Medicine, 112. 828-32. 1990.
 
[59]  Saxena, Y., Purwar, B., Upmanyu, R., “Adiposity: Determinant of Peak Expiratory Flow Rate in Young Indian Adults Male”, The Indian Journal of Chest Diseases & Allied Sciences, 53, 29-33, 2011.
 
[60]  Gibson, G.J., “Obesity, respiratory function and breathlessness”, Thorax, 55(Suppl.1). S41-S44. 2000.
 
[61]  Eisenmann, J.C., Arnall, D.A., Kanuho, V., Interpretter, C., Coast, J.R., “Obesity and pulmonary function in Navajo and Hopi children”, Ethnicity & Disease, 17.14-18. 2007.
 
[62]  Guo, S.S., Roche, A.F., Chumlea, W.C., Gardner, J.D., Siervogel, R.M., “The predictive value of childhood body mass index values for overweight at age 35 year”, American Journal of Clinical Nutrition, 59. 810-819. 1994.
 
[63]  Ylikahri, M., Mustajoki, P., Stenius, A.B., Poussa, T., Kvarnström, J., Grönlund, E.L., “Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study”, British Medical Journal, 320.827-32.2000.
 
[64]  Sudha, D., Chandra, S.E., Saikumar, P., “Comparison of peak expiratory flow rate and total body fat among the south Indian children aged around 6 to 10 years”, International Journal of Medical Research & Health Sciences, 2(1). 1-7. 2013.
 
[65]  Canoy, D., Luben, R., “Welch A, Abdominal obesity and respiratory function in men and women in the EPIC-Norfolk Study, United Kingdom”. American Journal of Epidemiology,159. 1140-9. 2004.
 
[66]  Gokbel, H., Atas, S., “Exercise-induced bronchospasm in nonasthmatic obese and nonobese boys”, Journal of Sports Medicine and Physical Fitness, 39.361-4. 1999.
 
[67]  Huang, S.L., Shiao, G., Chou, P., “Association between body mass index and allergy in teenage girls in Taiwan”, Clinical and Experimental Allergy, 29. 323-9.1999.
 
[68]  Kaplan, T.A., Montana, E., “Exercise-induced bronchospasm in nonasthmatic obese children”, Clinical Pediatrics, 32. 220-5. 1993.
 
[69]  Litonjua, A.A., Sparrow, D., Celedon, J.C., “Association of body mass index with the development of methacholine airway hyperresponsiveness in men: The Normative Aging Study”. Thorax, 57.581-5. 2002
 
[70]  Steniusa, B. Poussa, T., Kvarnstrom, J., “Immediate and long term effects of weight reduction in obese people with asthma: randomized controlled study”. British Medical Journal, 320. 827-32. 2000.
 
[71]  Moudgil, H., “Prevalence of obesity in asthmatic adults”, British Medical Journal, 321.448. 2000.
 
[72]  Redd, S.C., “Asthma in the United States: burden and current theories”. Environmental Health Perspectives, 110(suppl 4). 557. 2002.
 
[73]  “von, M.E., Schwartz, J., Neas, L.M., “Relation of body mass index to asthma and atopy in children: The National Health and Nutrition Examination Study III”. Thorax, 56. 835-8-60. 2001.
 
[74]  Toelle, B.G., Peat, J.K, Salome, C.M, Mellis, C.M, Woolcock, A.J. “Toward a definition of asthma for epidemiology”. American Review of Respiratory Diseases, 146. 633-637. 1992.
 
[75]  Sposato, B., Scalese, M., Migliorini, M.G., Riccardi. M.P., Balducci, M.T., Petruzzelli, L., and Scala, R., “Obesity can influence children’s and adolescents’ airway hyperresponsiveness differently”, Multidisciplinary Respiratory Medicine, 8(1). 60. 2013.
 
[76]  Jang, A.S., Lee, J.H., Park, S.W., “Severe airway hyperresponsiveness in school-aged boys with a high body mass index”. Korean Journal of Internal Medicine, 21.10-14. 2006.
 
[77]  Castro, J.A., Holberg, C.J., Morgan, W.J., Wright, A.L., Martinez, F.D., “Increased incidence of asthma like symptoms in girls who become overweight or obese during the school years”, American Journal of Respiratory and Critical Care Medicine, 163.1344-9. 2001.
 
[78]  Chinn, S., “Obesity and asthma”. Paediatric Respiratory Review. 7. 223-228. 2006.
 
[79]  Flaherman, V., “Rutherford G.W., “A meta-analysis of the effect of high weight on asthma”. Archives of Disease in Children, 91:334-339. 2006.
 
[80]  Braback, L., Hjern, A., Rasmussen, F., “Body mass index, asthma and allergic rhinoconjunctivitis in Swedish conscripts: a national cohort study over three decades”. Respiratory Medicne, 99, 1010–1014. 2005.
 
[81]  Nystad, W., Meyer, H.E., Nafstad, P., Tverdal, A., “Engeland A. Body mass index in relation to adult asthma among 135,000 Norwegian men and women”. American Journal of Epidemiology 160. 969-976. 2004.
 
[82]  Chen, Y., Dales, R., Krewski, D., Breithaupt, K., “Increased effects of smoking and obesity on asthma among female Canadians: the national populationhealth survey”, American Journal of Epidemiology. 150. 255-262. 1999.
 
[83]  Mishra, V., “Effect of obesity on asthma among adult Indian women”, International Journal of Obesity Related Metabolic Disorder, 28, 1048-1058. 2004.
 
[84]  El-Baz, F.M., Abdelaziz, E.A., Abdelaziz, A.A., Kamel, T.B., Fahmy, A., “Impact of obesity and body fat distribution on pulmonary function of Egyptian children”, Egyptian Journal of Bronchology, 3(1). 49-58, 2009.
 
[85]  Price, J.F.K., Arthur, N., and Macstephen, A.O., “Correlation between Body Mass Index and Peak Expiratory Flow Rate of an Indigenous Nigerian Population in the Niger Delta Region”, Research Journal of Recent Sciences, 2(2). 28-32. Feb. 2013.
 
[86]  Paralikar, S.J., Kathrotia, R.G., Pathak, N.R., Jani, M.B., “Assessment of pulmonary functions in obese adolescent boys”, Lung India, 29(3). Jul-Sep., 236-40, 2012.
 
[87]  Harik R.I., Wise. R.A., Fleg. J.L., “The effect of gender on the relationship between body fat distribution and pulmonary function”, Journal of Clinical Epidemiology, 54. 399-406. 2001.
 
[88]  Lazarus, R., Sparrow, D., Weiss, S.T., “Effects of obesity and fat distribution on ventilatory function: the normative aging study”. Chest, 111:891-898. 1997.
 
[89]  Klein, S., Allison, D.B., Heymsfield, S.B., Kelley, D.E., Leibel, R.L., Nonas, C., Kahn, R., “Waist circumference and cardiometabolic risk: a consensus statement from shaping America’s health: Association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Association”. Diabetes Care, 30. 1647-165.2007.
 
[90]  Carey, I.M., Cook, D.G., Strachan, D.P., “The effects of adiposity and weight change on forced expiratory volume decline in a longitudinal study of adults”, International Journal of Obesity Related Metabolic Disorder, 23. 979-85. 1999.
 
[91]  Nageshwari, K., Sharma, R., Kohli, D.R., “Assessment of respiratory and sympathetic cardiovascular parameters in obese school children”, Indian Journal of Physiology and Pharmacology, 51. 235-43. 2007.
 
[92]  Lin, C.K., Lin, C.C., “Work of breathing and respiratory drive in obesity, Respirology (Carlton, Vic.)”, 17(3). 402-11. 2012.
 
[93]  Parameswaran, K., Todd, D., Soth, M., “Altered respiratory physiology in obesity”, Canadian Respiratory Journal, 13(4). 2003-2010.
 
[94]  Sood, A., “Obesity, adipokines, and lung disease”. Journal of Applied Physiology, 108(3), 744-53, 2010.
 
[95]  Naimark, A., Cherniack, R., “Compliance of the respiratory system and its components in health and obesity”, Journal of Applied Physiology, 15, 377-382, 1960.
 
[96]  DiGregorio, G.B., Lu, T., Rassouli, N., Ranganathan, G., “Adiponectin expression from human adipose tissue, Relation to obesity, insulin resistance and tumor necrosis factor-alpha expression”, Diabetes, 52. 1779-85. 2003.
 
[97]  Gasteyer, C., Tremblay, A., “Metabolic impact of body fat distribution”, Journal of Endocrinological Investigation, 25. 876-83. 2002.