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Carlos A. Camargo, Jr, MD; Scott T. Weiss, MD; Shumin Zhang, MD; Walter C. Willett, MD; Frank E. Speizer, MD

Arch Intern Med. 1999;159:2582-2588.

Background  Obesity and asthma are common disorders, and their prevalence rates continue to rise. Although individuals with asthma may gain weight as a result of activity limitations, the relationship between body mass index (BMI), which is calculated as weight in kilograms divided by the square of height in meters, and risk of developing asthma is not known.

Methods  We performed a prospective cohort study of female US registered nurses in the Nurses' Health Study II. In 1991, after excluding women who died with probable asthma or with incomplete data, there were 85,911 participants, aged 26 to 46 years. The main outcome measure was self-report of physician-diagnosed asthma with recent use of an asthma medication.

Results  From 1991 to 1995, we identified 1596 incident cases of asthma. In a multivariate model controlling for 9 potential confounding factors (including age, race, smoking, physical activity, and energy intake), the relative risks of asthma for 6 increasing categories of BMI in 1991 were 0.9, 1.0 (reference), 1.1, 1.6, 1.7, and 2.7 (P for trend <.001). Stronger associations were found using stricter definitions for asthma, and the finding was present in a variety of subgroups. In analyses controlling for the same variables, as well as BMI at age 18, women who gained weight after age 18 were at significantly increased risk of developing asthma during the 4-year follow-up period (P for trend <.001).

Conclusions  The BMI has a strong, independent, and positive association with risk of adult-onset asthma. The increasing prevalence of obesity in developed nations may help explain concomitant increases in asthma prevalence.

From the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital (Drs Camargo, Weiss, Zhang, Willett, and Speizer), the Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School (Dr Camargo), and the Departments of Epidemiology and Nutrition (Drs Zhang and Willett) and Environmental Health (Dr Speizer), Harvard School of Public Health, Boston, Mass.

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