ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2019-3-183-191ssmu-2416Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEW AND LECTURESБронхиальная астма и ожирение у детей: что мы знаем?Asthma and obesity in children: what do we know?https://orcid.org/0000-0002-7571-5460НовикГ. А.NovikG. A.

д-р мед. наук, профессор, зав. кафедрой педиатрии им. проф. И.М. Воронцова, 194100, г. Санкт-Петербург, ул. Литовская, 2;

гл. внештатный детский специалист по профилактической медицине Минздрава России по СЗФО, г. Санкт-Петербург

DM, Professor, Head of the Department of Pediatrics,

2, Litovskaya Str., Saint-Petersburg, 194100

ga_novik@mail.ruХалеваЕ. Г.KhalevaE. G.

аспирант, кафедра педиатрии им. проф. И.М. Воронцова,

194100, г. Санкт-Петербург, ул. Литовская, 2

PhD Student, Department of Pediatrics, 

2, Litovskaya Str., Saint-Petersburg, 194100

https://orcid.org/0000-0002-3056-403XМакароваС. Г.MakarovaS. G.

д-р мед. наук, зав. отделом профилактической педиатрии, 119991, г. Москва, Ломоносовский проспект, 2/1;

профессор, кафедра факультетской педиатрии, 117997, г. Москва, ул. Островитянова, 1;

гл. внештатный детский специалист по профилактической медицине Минздрава России по ЦФО, г. Москва

DM, Professor, Head of the Department of Preventive Pediatrics, 2/1, Lomonosov Av., Moscow, 119991;

1, Ostrovitianov Str., Moscow, 117997

https://orcid.org/0000-0001-7035-0100ЖдановаМ. В.ZhdanovaM. V.

канд. мед. наук, доцент, зав. учебной частью, кафедра педиатрии им. профессора И.М. Воронцова,

194100, г. Санкт-Петербург, ул. Литовская, 2

PhD, Associate Professor,

2, Litovskaya Str., Saint-Petersburg, 194100

Санкт-Петербургский государственный педиатрический медицинский университет (СПбГПМУ)РоссияSt. Petersburg State Pediatric Medical UniversityRussian FederationНациональный медицинский исследовательский центр здоровья детей (НМЦЗД); Российский национальный исследовательский медицинский университет им. Н.И. Пирогова (РНИМУ им. Н.И. Пирогова)РоссияNational Medical Research Center for Children’s Health (NMRCCH); Pirogov Russian National Research Medical University (RNRMU)Russian Federation201927102019183183191Copyright © Новик Г.А., Халева Е.Г., Макарова С.Г., Жданова М.В., 20192019Новик Г.А., Халева Е.Г., Макарова С.Г., Жданова М.В.Novik G.A., Khaleva E.G., Makarova S.G., Zhdanova M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/2416

Результаты большого количества исследований указывают на взаимосвязь ожирения и бронхиальной астмы у детей. В обзоре рассмотрены механизмы развития «тучной астмы»: анатомические изменения дыхательных путей, системное воспаление, продукция адипокинов, нарушение метаболизма глюкозы и инсулина, генетические и эпигенетические факторы, изменения в микробиоме дыхательных путей и (или) кишечника. Показано, что пациенты с «тучной астмой» отличаются более тяжелым течением болезни, низким качеством жизни и снижением ответа на противоастматическую терапию. Снижение массы тела у детей с астмой может привести к улучшению самочувствия пациентов, но данные об эффективности терапевтических вмешательств у таких детей ограничены.

The results of a large number of studies indicate the relationship of obesity and bronchial asthma in children. The review highlights the mechanisms of development of the so-called obese asthma: morphological changes in the respiratory tract, systemic inflammation, adipokine production, impaired glucose and insulin metabolism, genetic and epigenetic factors, changes in the microbiome of the respiratory tract and(or) intestines. The relationship of asthma and obesity can have both a genetic basis and can occur under the influence of a complex of pathogenic factors, and they can be especially important at the “early programming” stage. Obesity increases the risk of asthma development, and in patients with existing asthma due to a number of mechanisms it increases the severity or makes it difficult to achieve control of asthma. Studies showed that patients with obese asthma are distinguished by a more severe course of the disease, poor quality of life and a decreased response to therapy for asthma. Weight loss in children with asthma can lead to an improved well-being of patients, but data on the effectiveness of therapeutic interventions in these children is limited. Comorbidity of asthma and obesity is a complex multifactorial phenotype in children, which requires further study. Being overweight or obese needs to be taken into account as part of asthma treatment in this category of patients.

детиподросткибронхиальная астмаожирениефизическая активностьпитаниеchildrenadolescentsbronchial asthmaobesityphysical activitynutritionReferencesThe Global Asthma Report 2014. URL: http://www.globalasthmareport.org/burden/burden.php.The Global Asthma Report 2014. URL: http://www.globalasthmareport.org/burden/burden.php.Pearce N., Aït-Khaled N., Beasley R., Mallol J., Keil U., Mitchell E. et al. Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2007; 62 (9): 758–766.Pearce N., Aït-Khaled N., Beasley R., Mallol J., Keil U., Mitchell E. et al. Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2007; 62 (9): 758–766.Намазова-Баранова Л.С., Огородова Л.М., Томилова А.Ю., Деев И.А., Алексеева А.А., Вишнева Е.А., Громов И.А., Евдокимова Т.А., Камалтынова Е.М., Коломеец И.Л., Торшхоева Р.М. Распространенность астмаподобных симптомов и диагностированной астмы в популяции подростков. Педиатрическая фармакология. 2009; 6 (3): 59–55.Namazova-Baranova L.S., Ogorodova L.M., Tomilova A.Yu., Deev I.A., Alekseeva A.A., Vishneva E.A., Gromov I.A., Evdokimova T.A., Kamaltynova E.M., Kolomeets I.L., Torshkhoeva R.M. Prevalence of asthma-like symptoms and diagnosed asthma in the population of adolescents. Pediatric Pharmacology. 2009; 6 (3): 59–65 (in Russ.).Баранов А.А., Намазова-Баранова Л.С., Хаитов Р.М., Ильина Н.И., Курбачева О.М., Новик Г.А., Петровский Ф.И., Вишнева Е.А., Алексеева А.А., Селимзянова Л.Р. Клинические рекомендации. Бронхиальная астма у детей. М., 2016: 65.Baranov A.A., Namazova-Baranova L.S., Haitov R.M., Il’ina N.I., Kurbacheva O.M., Novik G.A., Petrovskij F.I., Vishneva E.A., Alekseeva A.A., Selimzyanova L.R. Clinical guidelines: asthma in children. Moscow, 2016: 65 (in Russ.).Трунцова Е.С. Физическое развитие подростков с бронхиальной астмой. Журнал научных статей Здоровье и образование в XXI веке. 2016; 18 (5): 35–40.Truntsova E.S. Anthropometric measurements of adolescents with asthma. Journal of Scientific Articles Health and Millennium Education. 2016; 18 (5): 35–40 (in Russ.).Фурман Е.Г., Ярулина А.М., Софронова Л.В. Состояние функции внешнего дыхания и дыхательной мускулатуры у детей с ожирением. Педиатрическая фармакология. 2015; 12 (2): 143–147. DOI: 10.15690/ pf.v12i2/1276.Furman E.G., Yarulina A.M., Sofronova L.V. Lung function and respiratory muscle strength in obese in children. Pediatric Pharmacology. 2015; 12 (2): 143–147 (in Russ.). DOI: 10.15690/ pf.v12i2/1276.Уразова С.Н., Галимгожина Н.И., Карпова Р.К, Иванова Н.Д., Шакенова Г.К., Смаилова К.И. Лечебная программа по ведению детей с бронхиальной астмой и ожирением. Медицинский журнал Западного Казахстана. 2012; 3 (35): 251.Urazova S.N., Galimgozhina N.I., Karpova R.K., Ivanova N.D., Shakenova G.K., Smailova K.I. Treatment algorithm for the management of children with asthma and obesity. Medical Journal of West Kazakhstan. 2012; 3 (35): 251 (in Russ.).Chen Y.C., Dong G.H., Lin K.C., Lee Y.L. Gender difference of childhood overweight and obesity in predicting the risk of incident asthma: a systematic review and meta-analysis. Obes. Rev. 2013; 14 (3): 222–231. DOI: 10.1111/j.1467-789X.2012.01055.x.Chen Y.C., Dong G.H., Lin K.C., Lee Y.L. Gender difference of childhood overweight and obesity in predicting the risk of incident asthma: a systematic review and meta-analysis. Obes. Rev. 2013; 14 (3): 222–231. DOI: 10.1111/j.1467-789X.2012.01055.x.Forno E., Celedón J.C. The effect of obesity, weight gain, and weight loss on asthma inception and control. Curr. Opin. Allergy Clin. Immunol. 2017 Apr.; 17 (2): 123– 130. DOI: 10.1097/ACI.0000000000000339.Forno E., Celedón J.C. The effect of obesity, weight gain, and weight loss on asthma inception and control. Curr. Opin. Allergy Clin. Immunol. 2017 Apr.; 17 (2): 123– 130. DOI: 10.1097/ACI.0000000000000339.Borrell L.N., Nguyen E.A., Roth L.A. et al. Childhood obesity and asthma control in the GALA II and SAGE II studies. Am. J. Respir. Crit. Care Med. 2013; 187 (7): 697–702. DOI: 10.1164/rccm.201211-2116OC.Borrell L.N., Nguyen E.A., Roth L.A. et al. Childhood obesity and asthma control in the GALA II and SAGE II studies. Am. J. Respir. Crit. Care Med. 2013; 187 (7): 697–702. DOI: 10.1164/rccm.201211-2116OC.Ahmadizar F., Vijverberg S.J., Arets H.G. et al. Childhood obesity in relation to poor asthma control and exacerbation: a meta-analysis. Eur. Respir. J. 2016; 48 (4): 1063–1073. DOI: 10.1183/13993003.00766-2016.Ahmadizar F., Vijverberg S.J., Arets H.G. et al. Childhood obesity in relation to poor asthma control and exacerbation: a meta-analysis. Eur. Respir. J. 2016; 48 (4): 1063–1073. DOI: 10.1183/13993003.00766-2016.Denlinger L.C., Phillips B.R., Ramratnam S. et al. Inflammatory and comorbid features of patients with severe asthma and frequent exacerbations. Am. J. Respir. Crit. Care Med. 2017; 195 (3): 302–313. DOI: 10.1164/rccm.201602-0419OC.Denlinger L.C., Phillips B.R., Ramratnam S. et al. Inflammatory and comorbid features of patients with severe asthma and frequent exacerbations. Am. J. Respir. Crit. Care Med. 2017; 195 (3): 302–313. DOI: 10.1164/rccm.201602-0419OC.Okubo Y., Nochioka K., Hataya H. et al. Burden of obesity on pediatric in patients with acute asthma exacerbation in the United States. J. Allergy Clin. Immunol. Pract. 2016; 4: 1227–1231. DOI: 10.1016/j.jaip.2016.06.004.Okubo Y., Nochioka K., Hataya H. et al. Burden of obesity on pediatric in patients with acute asthma exacerbation in the United States. J. Allergy Clin. Immunol. Pract. 2016; 4: 1227–1231. DOI: 10.1016/j.jaip.2016.06.004.Aragona E., El-Magbri E., Wang J. et al. Impact of obesity on clinical outcomes in urban children hospitalized for status asthmaticus. Hosp. Pediatr. 2016; 6 (4): 211– 218. DOI: 10.1542/hpeds.2015-0094.Aragona E., El-Magbri E., Wang J. et al. Impact of obesity on clinical outcomes in urban children hospitalized for status asthmaticus. Hosp. Pediatr. 2016; 6 (4): 211– 218. DOI: 10.1542/hpeds.2015-0094.Forno E., Lescher R., Strunk R. et al. Decreased response to inhaled steroids in overweight and obese asthmatic children. J. Allergy Clin. Immunol. 2011; 127 (3): 741–749. DOI: 10.1016/j.jaci.2010.12.010.Forno E., Lescher R., Strunk R. et al. Decreased response to inhaled steroids in overweight and obese asthmatic children. J. Allergy Clin. Immunol. 2011; 127 (3): 741–749. DOI: 10.1016/j.jaci.2010.12.010.van Gent R., van der Ent C.K., Rovers M.M. et al. Excessive body weight is associated with additional loss of quality of life in children with asthma. J. Allergy Clin. Immunol. 2007; 119 (3): 591–596. DOI:10.1016/j.jaci.2006.11.007.van Gent R., van der Ent C.K., Rovers M.M. et al. Excessive body weight is associated with additional loss of quality of life in children with asthma. J. Allergy Clin. Immunol. 2007; 119 (3): 591–596. DOI:10.1016/j.jaci.2006.11.007.Forno E., Young O.M., Kumar R. et al. Maternal obesity in pregnancy, gestational weight gain, and risk of childhood asthma. Pediatrics. 2014; 134 (2): e535–546. DOI: 10.1542/peds.2014-0439.Forno E., Young O.M., Kumar R. et al. Maternal obesity in pregnancy, gestational weight gain, and risk of childhood asthma. Pediatrics. 2014; 134 (2): e535–546. DOI: 10.1542/peds.2014-0439.Dumas O., Varraso R., Gillman M.W. et al. Longitudinal study of maternal body mass index, gestational weight gain, and offspring asthma. Allergy. 2016; 71 (9): 1295– 1304. DOI: 10.1111/all.12876.Dumas O., Varraso R., Gillman M.W. et al. Longitudinal study of maternal body mass index, gestational weight gain, and offspring asthma. Allergy. 2016; 71 (9): 1295– 1304. DOI: 10.1111/all.12876.Melen E., Granell R., Kogevinas M. et al. Genome-wide association study of body mass index in 23 000 individuals with and without asthma. Clin. Exp. Allergy. 2013; 43 (4): 463–474. DOI: 10.1111/cea.12054.Melen E., Granell R., Kogevinas M. et al. Genome-wide association study of body mass index in 23 000 individuals with and without asthma. Clin. Exp. Allergy. 2013; 43 (4): 463–474. DOI: 10.1111/cea.12054.Murphy A., Tantisira K.G., Soto-Quiros M.E. et al. PRKCA: a positional candidate gene for body mass index and asthma. Am. J. Hum. Genet. 2009; 85 (1): 87–96. DOI: 10.1016/j.ajhg.2009.06.011.Murphy A., Tantisira K.G., Soto-Quiros M.E. et al. PRKCA: a positional candidate gene for body mass index and asthma. Am. J. Hum. Genet. 2009; 85 (1): 87–96. DOI: 10.1016/j.ajhg.2009.06.011.Kuo N.W., Tung K.Y., Tsai C.H. et al. Beta3-Adrenergic receptor gene modifies the association between childhood obesity and asthma. J. Allergy Clin. Immunol. 2014; 134 (3): 731–733. DOI: 10.1016/j.jaci.2014.03.018.Kuo N.W., Tung K.Y., Tsai C.H. et al. Beta3-Adrenergic receptor gene modifies the association between childhood obesity and asthma. J. Allergy Clin. Immunol. 2014; 134 (3): 731–733. DOI: 10.1016/j.jaci.2014.03.018.Rastogi D., Suzuki M., Greally J.M. Differential epigenome-wide DNA methylation patterns in childhood obesity-associated asthma. Sci. Rep. 2013; 3: 2164. DOI: 10.1038/srep02164.Rastogi D., Suzuki M., Greally J.M. Differential epigenome-wide DNA methylation patterns in childhood obesity-associated asthma. Sci. Rep. 2013; 3: 2164. DOI: 10.1038/srep02164.Ahangari F., Sood A., Ma B. et al. Chitinase 3-like-1 regulates both visceral fat accumulation and asthma-like Th2 inflammation. Am. J. Respir. Crit. Care Med. 2015; 191 (7): 746–757. DOI: 10.1164/rccm.201405-0796OC.Ahangari F., Sood A., Ma B. et al. Chitinase 3-like-1 regulates both visceral fat accumulation and asthma-like Th2 inflammation. Am. J. Respir. Crit. Care Med. 2015; 191 (7): 746–757. DOI: 10.1164/rccm.201405-0796OC.Нетребенко О.К., Украинцев С.Е. Что может грудное молоко и чего не могут смеси: от ингредиентов к пониманию долгосрочных эффектов. Педиатрия. Журнал имени Г.Н. Сперанского. 2017; 96 (3): 151–158. DOI: 10.24110/0031-403X-2017-96-3-144-151.Netrebko O.K., Ukraintsev S.E. What breast milk can and what mixtures cannot: from ingredients to understanding long-term effects. Pediatrics. Journal named after G.N. Speransky. 2017; 96 (3): 144–151 (in Russ.). DOI: 10.24110/0031-403X-2017-96-3-144-151.Langley-Evans S.C. Nutrition in early life and the programming of adult disease: a review. J. Hum. Nutr. Diet. 2015; 1: 1–14. DOI: 10.1111/jhn.12212.Langley-Evans S.C. Nutrition in early life and the programming of adult disease: a review. J. Hum. Nutr. Diet. 2015; 1: 1–14. DOI: 10.1111/jhn.12212.Vickers M.H. Early life nutrition, epigenetics and programming of later life disease. Nutrients. 2014; 6 (6): 2165–2178. DOI: 10.3390/nu6062165.Vickers M.H. Early life nutrition, epigenetics and programming of later life disease. Nutrients. 2014; 6 (6): 2165–2178. DOI: 10.3390/nu6062165.Dogaru C.M., Nyffenegger D., Pescatore A.M. et al. Breastfeeding and childhood asthma: systematic review and meta-analysis. Am. J. Epidemiol. 2014; 179 (10): 1153–1167. DOI: 10.1093/aje/kwu072.Dogaru C.M., Nyffenegger D., Pescatore A.M. et al. Breastfeeding and childhood asthma: systematic review and meta-analysis. Am. J. Epidemiol. 2014; 179 (10): 1153–1167. DOI: 10.1093/aje/kwu072.Yan J., Liu L., Zhu Y. et al. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health. 2014; 14: 1267. DOI: 10.1186/1471- 2458-14-1267.Yan J., Liu L., Zhu Y. et al. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health. 2014; 14: 1267. DOI: 10.1186/1471- 2458-14-1267.Rice J.L., Romero K.M., Galvez Davila R.M. et al. Association between adherence to the Mediterranean diet and asthma in peruvian children. Lung. 2015; 193: 893–899. DOI: 10.1007/s00408-015-9792-9.Rice J.L., Romero K.M., Galvez Davila R.M. et al. Association between adherence to the Mediterranean diet and asthma in peruvian children. Lung. 2015; 193: 893–899. DOI: 10.1007/s00408-015-9792-9.Lv N., Xiao L., Ma J. Dietary pattern and asthma: a systematic review and metaanalysis. J. Asthma Allergy. 2014; 7: 105–121. DOI: 10.2147/JAA.S49960.Lv N., Xiao L., Ma J. Dietary pattern and asthma: a systematic review and metaanalysis. J. Asthma Allergy. 2014; 7: 105–121. DOI: 10.2147/JAA.S49960.Han Y.Y., Forno E., Brehm J. еt al. Diet, interleukin-17, and childhood asthma in Puerto Ricans. Ann. Allergy Asthma Immunol. 2015; 115: 288–293. e1. DOI: 10.1016/j.anai.2015.07.020.Han Y.Y., Forno E., Brehm J. еt al. Diet, interleukin-17, and childhood asthma in Puerto Ricans. Ann. Allergy Asthma Immunol. 2015; 115: 288–293. e1. DOI: 10.1016/j.anai.2015.07.020.Dumitriu I.E. et al. Release of high mobility group ox 1 by dendritic cells controls T cell activation via the receptor for advanced glication end products. The Journal of Immunology. 2005; 174 (2): 7506–7515.Dumitriu I.E. et al. Release of high mobility group ox 1 by dendritic cells controls T cell activation via the receptor for advanced glication end products. The Journal of Immunology. 2005; 174 (2): 7506–7515.Milutinovic P.S. et al. The receptor for advanced glycation end products is a central mediator of asthma pathogenesis. Am. J. Pathol. 2012; 181 (4): 1215–1225. DOI: 10.1016/j.ajpath.2012.06.031.Milutinovic P.S. et al. The receptor for advanced glycation end products is a central mediator of asthma pathogenesis. Am. J. Pathol. 2012; 181 (4): 1215–1225. DOI: 10.1016/j.ajpath.2012.06.031.De Christopher L.R., Uribarri J., Tucker K.L. Intakes of apple juice, fruit drinks and soda are associated with prevalent asthma in US children aged 2–9 years. Public Health Nutrition. 2016; 19 (1): 123–130. DOI: 10.1017/S1368980015000865.De Christopher L.R., Uribarri J., Tucker K.L. Intakes of apple juice, fruit drinks and soda are associated with prevalent asthma in US children aged 2–9 years. Public Health Nutrition. 2016; 19 (1): 123–130. DOI: 10.1017/S1368980015000865.Wood L.G., Garg M.L., Gibson P.G. A high-fat challenge increases airway inflammation and impairs bronchodilator recovery in asthma. J. Allergy Clin. Immunol. 2011; 127 (5): 1133–1140. DOI: 10.1016/j.jaci.2011.01.036.Wood L.G., Garg M.L., Gibson P.G. A high-fat challenge increases airway inflammation and impairs bronchodilator recovery in asthma. J. Allergy Clin. Immunol. 2011; 127 (5): 1133–1140. DOI: 10.1016/j.jaci.2011.01.036.Vo P., Bair-Merritt M., Camargo C.A. The potential role of vitamin D in the link between obesity and asthma severity/control in children. Expert Rev. Respir. Med. 2015; 9 (3): 309–325. DOI: 10.1586/17476348.2015.1042457.Vo P., Bair-Merritt M., Camargo C.A. The potential role of vitamin D in the link between obesity and asthma severity/control in children. Expert Rev. Respir. Med. 2015; 9 (3): 309–325. DOI: 10.1586/17476348.2015.1042457.Hornsby E., Pfeffer P.E., Laranjo N., Cruikshank W., Tuzova M., Litonjua A.A., Weiss S.T., Carey V.J., O’Connor G., Hawrylowicz C. Vitamin D supplementation during pregnancy: Effect on the neonatal immune system in a randomized controlled trial. J. Allergy Clin. Immunol. 2018; 141 (1): 269–278. e1. DOI: 10.1016/j.jaci.2017.02.039.Hornsby E., Pfeffer P.E., Laranjo N., Cruikshank W., Tuzova M., Litonjua A.A., Weiss S.T., Carey V.J., O’Connor G., Hawrylowicz C. Vitamin D supplementation during pregnancy: Effect on the neonatal immune system in a randomized controlled trial. J. Allergy Clin. Immunol. 2018; 141 (1): 269–278. e1. DOI: 10.1016/j.jaci.2017.02.039.Lautenbacher L.A., Jariwala S.P., Markowitz M.E., Rastogi D. Vitamin D and pulmonary function in obese asthmatic children. Pediatr. Pulmonol. 2016; 51 (12): 1276– 1283. DOI: 10.1002/ppul.23485.Lautenbacher L.A., Jariwala S.P., Markowitz M.E., Rastogi D. Vitamin D and pulmonary function in obese asthmatic children. Pediatr. Pulmonol. 2016; 51 (12): 1276– 1283. DOI: 10.1002/ppul.23485.Макарова С.Г., Вишнева Е.А. Длинноцепочечные полинасыщенные жирные кислоты классов ω-3 и ω-6 как эссенциальный нутриент в разные периоды детства. Педиатрическая фармакология. 2013; 10 (4): 80–88.Makarova S.G., Vishneva E.A., Long-chain polyunsaturated fatty acids of ω-3 and ω-6 classes as an essential nutrient in different periods of childhood. Pediatric Pharmacology. 2013; 10 (4): 80–88 (in Russ.).Garcia-Marcos L., Castro-Rodriguez J.A., Weinmayr G., Panagiotakos D.B., Priftis K.N., Nagel G. Influence of Mediterranean diet on asthma in children: a systematic review and meta-analysis. Pediatr. Allergy Immunol. 2013; 24 (4): 330–338. DOI: 10.1111/pai.12071.Garcia-Marcos L., Castro-Rodriguez J.A., Weinmayr G., Panagiotakos D.B., Priftis K.N., Nagel G. Influence of Mediterranean diet on asthma in children: a systematic review and meta-analysis. Pediatr. Allergy Immunol. 2013; 24 (4): 330–338. DOI: 10.1111/pai.12071.D’Vaz N., Meldrum S.J., Dunstan J.A. et al. Fish oil supplementation in early infancy modulates developing infant immune responses. Clin. Exp. Allergy. 2012; 42 (8): 1206–1216. DOI: 10.1111/j.1365-2222.2012.04031.x.D’Vaz N., Meldrum S.J., Dunstan J.A. et al. Fish oil supplementation in early infancy modulates developing infant immune responses. Clin. Exp. Allergy. 2012; 42 (8): 1206–1216. DOI: 10.1111/j.1365-2222.2012.04031.x.Han Y.Y., Forno E., Celedon J.C. Adiposity, fractional exhaled nitric oxide, and asthma in U.S. children. Am. J. Respir. Crit. Care Med. 2014; 190 (1): 32–39. DOI: 10.1164/rccm.201403-0565OC.Han Y.Y., Forno E., Celedon J.C. Adiposity, fractional exhaled nitric oxide, and asthma in U.S. children. Am. J. Respir. Crit. Care Med. 2014; 190 (1): 32–39. DOI: 10.1164/rccm.201403-0565OC.Vuillermin P.J., Macia L., Nanan R., Tang M.L., Collier F., Brix S. The maternal microbiome during pregnancy and allergic disease in the offspring. Semin. Immunopathol. 2017; 39 (6): 669–675. DOI: 10.1007/s00281-017-0652-y.Vuillermin P.J., Macia L., Nanan R., Tang M.L., Collier F., Brix S. The maternal microbiome during pregnancy and allergic disease in the offspring. Semin. Immunopathol. 2017; 39 (6): 669–675. DOI: 10.1007/s00281-017-0652-y.Gatford K.L., Wooldridge A.L., Kind K.L., Bischof R., Clifton V.L. Pre-birth origins of allergy and asthma. J. Reprod. Immunol. 2017; 123: 88–93. DOI: 10.1016/j.jri.2017.07.002.Gatford K.L., Wooldridge A.L., Kind K.L., Bischof R., Clifton V.L. Pre-birth origins of allergy and asthma. J. Reprod. Immunol. 2017; 123: 88–93. DOI: 10.1016/j.jri.2017.07.002.Vuillermin P.J., Macia L., Nanan R., Tang M.L., Collier F., Brix S. The maternal microbiome during pregnancy and allergic disease in the offspring. Semin. Immunopathol. 2017; 39 (6): 669–675. DOI: 10.1007/s00281-017-0652-y.Vuillermin P.J., Macia L., Nanan R., Tang M.L., Collier F., Brix S. The maternal microbiome during pregnancy and allergic disease in the offspring. Semin. Immunopathol. 2017; 39 (6): 669–675. DOI: 10.1007/s00281-017-0652-y.Pitter G., Ludvigsson J.F., Romor P. et al. Antibiotic exposure in the first year of life and later treated asthma, a population based birth cohort study of 143,000 children. Eur. J. Epidemiol. 2016; 31 (1): 85–94. DOI: 10.1007/s10654-015-0038-1.Pitter G., Ludvigsson J.F., Romor P. et al. Antibiotic exposure in the first year of life and later treated asthma, a population based birth cohort study of 143,000 children. Eur. J. Epidemiol. 2016; 31 (1): 85–94. DOI: 10.1007/s10654-015-0038-1.Bailey L.C., Forrest C.B., Zhang P. et al. Association of antibiotics in infancy with early childhood obesity. JAMA Pediatr. 2014; 168 (11): 1063–1069. DOI: 10.1001/jamapediatrics.2014.1539.Bailey L.C., Forrest C.B., Zhang P. et al. Association of antibiotics in infancy with early childhood obesity. JAMA Pediatr. 2014; 168 (11): 1063–1069. DOI: 10.1001/jamapediatrics.2014.1539.Depner M., Ege M.J., Cox M.J. et al. Bacterial microbiota of the upper respiratory tract and childhood asthma. Journal of Allergy and Clinical Immunology. 2017; 139 (3): 826–834. DOI: 10.1016/j.jaci.2016.05.050.Depner M., Ege M.J., Cox M.J. et al. Bacterial microbiota of the upper respiratory tract and childhood asthma. Journal of Allergy and Clinical Immunology. 2017; 139 (3): 826–834. DOI: 10.1016/j.jaci.2016.05.050.Khan M.J., Gerasimidis K., Edwards C.A., Shaikh M.G. Role of gut microbiota in the aetiology of obesity: proposed mechanisms and review of the literature. J. Obesity. 2016; 2016: 7353642. DOI:10.1155/2016/7353642.Khan M.J., Gerasimidis K., Edwards C.A., Shaikh M.G. Role of gut microbiota in the aetiology of obesity: proposed mechanisms and review of the literature. J. Obesity. 2016; 2016: 7353642. DOI:10.1155/2016/7353642.Forno E., Onderdonk A.B., McCracken J. et al. Diversity of the gut microbiota and eczema in early life. Clin. Mol. Allergy. 2008; 6: 11. DOI: 10.1186/1476-7961-6-11.Forno E., Onderdonk A.B., McCracken J. et al. Diversity of the gut microbiota and eczema in early life. Clin. Mol. Allergy. 2008; 6: 11. DOI: 10.1186/1476-7961-6-11.Fujimura K.E., Sitarik A.R., Havstad S. et al. Neonatal gut microbiota associates with childhood multisensitized atopy and T cell differentiation. Nat. Med. 2016; 22 (10): 1187–1191. DOI: 10.1038/nm.4176.Fujimura K.E., Sitarik A.R., Havstad S. et al. Neonatal gut microbiota associates with childhood multisensitized atopy and T cell differentiation. Nat. Med. 2016; 22 (10): 1187–1191. DOI: 10.1038/nm.4176.Elazab N., Mendy A., Gasana J. et al. Probiotic administration in early life, atopy, and asthma: a meta-analysis of clinical trials. Pediatrics. 2013; 132 (2): e666–676. DOI: 10.1542/peds.2013-0246.Elazab N., Mendy A., Gasana J. et al. Probiotic administration in early life, atopy, and asthma: a meta-analysis of clinical trials. Pediatrics. 2013; 132 (2): e666–676. DOI: 10.1542/peds.2013-0246.Shore S.A., Cho Y. Obesity and asthma: microbiome-metabolome interactions. Am. J. Respir. Cell Mol. Biol. 2016; 54 (5): 609–617. DOI: 10.1165/rcmb.2016-0052PS.Shore S.A., Cho Y. Obesity and asthma: microbiome-metabolome interactions. Am. J. Respir. Cell Mol. Biol. 2016; 54 (5): 609–617. DOI: 10.1165/rcmb.2016-0052PS.Forno E., Han Y.Y., Muzumdar R.H., Celedon J.C. Insulin resistance, metabolic syndrome, and lung function in US adolescents with and without asthma. J. Allergy Clin. Immunol. 2015; 136 (2): 304–311. DOI: 10.1016/j.jaci.2015.01.010.Forno E., Han Y.Y., Muzumdar R.H., Celedon J.C. Insulin resistance, metabolic syndrome, and lung function in US adolescents with and without asthma. J. Allergy Clin. Immunol. 2015; 136 (2): 304–311. DOI: 10.1016/j.jaci.2015.01.010.Karampatakis N., Karampatakis T., Galli-Tsinopoulou A. et al. Impaired glucose metabolism and bronchial hyperresponsiveness in obese prepubertal asthmatic children. Pediatr. Pulmonol. 2017; 52 (2): 160–166. DOI: 10.1002/ppul.23516.Karampatakis N., Karampatakis T., Galli-Tsinopoulou A. et al. Impaired glucose metabolism and bronchial hyperresponsiveness in obese prepubertal asthmatic children. Pediatr. Pulmonol. 2017; 52 (2): 160–166. DOI: 10.1002/ppul.23516.Rastogi D., Fraser S., Oh J. et al. Inflammation, metabolic dysregulation, and pulmonary function among obese urban adolescents with asthma. Am. J. Respir. Crit. Care Med. 2015; 191 (2): 149–160. DOI: 10.1164/ rccm.201409-1587OC.Rastogi D., Fraser S., Oh J. et al. Inflammation, metabolic dysregulation, and pulmonary function among obese urban adolescents with asthma. Am. J. Respir. Crit. Care Med. 2015; 191 (2): 149–160. DOI: 10.1164/ rccm.201409-1587OC.Sanchez Jimenez J., Herrero Espinet F.J., Mengibar Garrido J.M. et al. Asthma and insulin resistance in obese children and adolescents. Pediatr. Allergy Immunol. 2014; 25 (7): 699–705. DOI: 10.1111/pai.12294.Sanchez Jimenez J., Herrero Espinet F.J., Mengibar Garrido J.M. et al. Asthma and insulin resistance in obese children and adolescents. Pediatr. Allergy Immunol. 2014; 25 (7): 699–705. DOI: 10.1111/pai.12294.Singh V.P., Aggarwal R., Singh S. et al. Metabolic syndrome is associated with increased oxo-nitrative stress and asthma-like changes in lungs. PLoS One. 2015; 10 (6): e0129850. DOI: 10.1371/journal.pone.0129850.Singh V.P., Aggarwal R., Singh S. et al. Metabolic syndrome is associated with increased oxo-nitrative stress and asthma-like changes in lungs. PLoS One. 2015; 10 (6): e0129850. DOI: 10.1371/journal.pone.0129850.Dekkers B.G., Schaafsma D., Tran T. et al. Insulin-induced laminin expression promotes a hypercontractile airway smooth muscle phenotype. Am. J. Respir. Cell Mol. Biol. 2009; 41 (4): 494–504. DOI: 10.1165/ rcmb.2008-0251OC.Dekkers B.G., Schaafsma D., Tran T. et al. Insulin-induced laminin expression promotes a hypercontractile airway smooth muscle phenotype. Am. J. Respir. Cell Mol. Biol. 2009; 41 (4): 494–504. DOI: 10.1165/ rcmb.2008-0251OC.Agrawal A., Mabalirajan U., Ahmad T., Ghosh B. Emerging interface between metabolic syndrome and asthma. Am. J. Respir. Cell Mol. Biol. 2011; 44 (3): 270–275. DOI: 10.1165/rcmb.2010-0141TR.Agrawal A., Mabalirajan U., Ahmad T., Ghosh B. Emerging interface between metabolic syndrome and asthma. Am. J. Respir. Cell Mol. Biol. 2011; 44 (3): 270–275. DOI: 10.1165/rcmb.2010-0141TR.Guler N., Kirerleri E., Ones U., Tamay Z., Salmayenli N., Darendeliler F. Leptin: does it have any role in childhood asthma? J. Allergy Clin. Immunol. 2004; 114 (2): 254–259. DOI: 10.1016/j.jaci.2004.03.053.Guler N., Kirerleri E., Ones U., Tamay Z., Salmayenli N., Darendeliler F. Leptin: does it have any role in childhood asthma? J. Allergy Clin. Immunol. 2004; 114 (2): 254–259. DOI: 10.1016/j.jaci.2004.03.053.Mai X.M., Büttcher M.F., Leijon I. Leptin and asthma in overweight children at 12 years of age. Pediatr. Allergy Immunol. 2004; 15 (6): 523–530. DOI: 10.1111/j.1399-3038.2004.00195.x.Mai X.M., Büttcher M.F., Leijon I. Leptin and asthma in overweight children at 12 years of age. Pediatr. Allergy Immunol. 2004; 15 (6): 523–530. DOI: 10.1111/j.1399-3038.2004.00195.x.Cottrell L., Neal W.A., Ice C. et al. Metabolic abnormalities in children with asthma. Am. J. Respir. Crit. Care Med. 2011; 183 (4): 441–448. DOI: 10.1164/rccm.201004-0603OC.Cottrell L., Neal W.A., Ice C. et al. Metabolic abnormalities in children with asthma. Am. J. Respir. Crit. Care Med. 2011; 183 (4): 441–448. DOI: 10.1164/rccm.201004-0603OC.Del-Rio-Navarro B.E., Castro-Rodriguez J.A., Garibay Nieto N. et al. Higher metabolic syndrome in obese asthmatic compared to obese nonasthmatic adolescent males. J. Asthma. 2010; 47 (5): 501–506. DOI: 10.3109/02770901003702808.Del-Rio-Navarro B.E., Castro-Rodriguez J.A., Garibay Nieto N. et al. Higher metabolic syndrome in obese asthmatic compared to obese nonasthmatic adolescent males. J. Asthma. 2010; 47 (5): 501–506. DOI: 10.3109/02770901003702808.Chen Y.C., Tung K.Y., Tsai C.H. et al. Lipid profiles in children with and without asthma: interaction of asthma and obesity on hyperlipidemia. Diabetes Metab. Syndr. 2013; 7: 20–25. DOI: 10.1016/j.dsx.2013.02.026.Chen Y.C., Tung K.Y., Tsai C.H. et al. Lipid profiles in children with and without asthma: interaction of asthma and obesity on hyperlipidemia. Diabetes Metab. Syndr. 2013; 7: 20–25. DOI: 10.1016/j.dsx.2013.02.026.Vijayakanthi N., Greally J.M., Rastogi D. Pediatric obesity-related Asthma: The role of metabolic Dysregulation. Pediatrics. 2016; 137 (5): e20150812. DOI: 10.1542/ peds.2015-0812.Vijayakanthi N., Greally J.M., Rastogi D. Pediatric obesity-related Asthma: The role of metabolic Dysregulation. Pediatrics. 2016; 137 (5): e20150812. DOI: 10.1542/ peds.2015-0812.Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. Geneva, World Health Organization, 2000 (WHO Technical Report Series, No. 894. URL: http://whqlibdoc.who.int/trs/WHO_ TRS_ 894.pdf).Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. Geneva, World Health Organization, 2000 (WHO Technical Report Series, No. 894. URL: http://whqlibdoc.who.int/trs/WHO_ TRS_ 894.pdf).Lobstein T. et al. for the IASO International Obesity Task Force. Obesity in children and young people: a crisis in public health. Obesity Reviews, 2004; 5 (Suppl. 1): 4–104.Lobstein T. et al. for the IASO International Obesity Task Force. Obesity in children and young people: a crisis in public health. Obesity Reviews, 2004; 5 (Suppl. 1): 4–104.Ghavamzadeh S., Khalkhali H.R., Alizadeh M. TV viewing, independent of physical activity and obesogenic foods, increases overweight and obesity in adolescents. J. Health Popul. Nutr. 2013; 31 (3): 334–342.Ghavamzadeh S., Khalkhali H.R., Alizadeh M. TV viewing, independent of physical activity and obesogenic foods, increases overweight and obesity in adolescents. J. Health Popul. Nutr. 2013; 31 (3): 334–342.Cox R., Skouteris H., Rutherford L., Fuller-Tyszkiewicz M., Dell’Aquila D., Hardy L.L. Television viewing, television content, food intake, physical activity and body mass index: a cross-sectional study of preschool children aged 2–6 years. Health Promot. J. Austr. 2012; 23 (1): 58–62.Cox R., Skouteris H., Rutherford L., Fuller-Tyszkiewicz M., Dell’Aquila D., Hardy L.L. Television viewing, television content, food intake, physical activity and body mass index: a cross-sectional study of preschool children aged 2–6 years. Health Promot. J. Austr. 2012; 23 (1): 58–62.Ghavamzadeh S., Khalkhali H.R., Alizadeh M. TV viewing, independent of physical activity and obesogenic foods, increases overweight and obesity in adolescents. J. Health Popul. Nutr. 2013; 31 (3): 334–342.Ghavamzadeh S., Khalkhali H.R., Alizadeh M. TV viewing, independent of physical activity and obesogenic foods, increases overweight and obesity in adolescents. J. Health Popul. Nutr. 2013; 31 (3): 334–342.Corbo G.M., Forastiere F., De Sario M. et al. Sidria-2 Collaborative Group.Wheeze and asthma in children: associations with body mass index, sports, television viewing, and diet. Epidemiology. 2008; 19 (5): 747–755. DOI: 10.1097/EDE.0b013e3181776213.Corbo G.M., Forastiere F., De Sario M. et al. Sidria-2 Collaborative Group.Wheeze and asthma in children: associations with body mass index, sports, television viewing, and diet. Epidemiology. 2008; 19 (5): 747–755. DOI: 10.1097/EDE.0b013e3181776213.Sherriff A., Maitra A., Ness A.R. et al. Association of duration of television viewing in early childhood with thesubsequent development of asthma. Thorax. 2009; 64 (4): 321–325. DOI: 10.1136/thx.2008.104406.Sherriff A., Maitra A., Ness A.R. et al. Association of duration of television viewing in early childhood with thesubsequent development of asthma. Thorax. 2009; 64 (4): 321–325. DOI: 10.1136/thx.2008.104406.Rasmussen F., Lambrechtsen J, Siersted H.C., Hansen H.S., Hansen N.C. Low physical fi tness in childhood is associated with the development of asthma in young adulthood: the Odense schoolchild study. Eur. Respir. J. 2000; 16 (5): 866–870.Rasmussen F., Lambrechtsen J, Siersted H.C., Hansen H.S., Hansen N.C. Low physical fi tness in childhood is associated with the development of asthma in young adulthood: the Odense schoolchild study. Eur. Respir. J. 2000; 16 (5): 866–870.Vlaski E., Stavric K., Seckova L., Kimovska M., Isjanovska R. Influence of physical activity and television-watching time on asthma and allergic rhinitis among young adolescents: preventive or aggravating? Allergol. Immunopathol. (Madr.). 2008; 36 (5): 247–253.Vlaski E., Stavric K., Seckova L., Kimovska M., Isjanovska R. Influence of physical activity and television-watching time on asthma and allergic rhinitis among young adolescents: preventive or aggravating? Allergol. Immunopathol. (Madr.). 2008; 36 (5): 247–253.Jensen M.E., Gibson P.G., Collins C.E. et al. Diet-induced weight loss in obese children with asthma: a randomized controlled trial. Clin. Exp. Allergy. 2013; 43 (7): 775–784. DOI: 10.1111/cea.12115.Jensen M.E., Gibson P.G., Collins C.E. et al. Diet-induced weight loss in obese children with asthma: a randomized controlled trial. Clin. Exp. Allergy. 2013; 43 (7): 775–784. DOI: 10.1111/cea.12115.Van Leeuwen J.C., Hoogstrate M., Duiverman E.J., Thio B.J. Effects of dietary induced weight loss on exercise- induced bronchoconstriction in overweight and obese children. Pediatr. Pulmonol. 2014; 49 (2): 1155– 1161. DOI: 10.1002/ppul.22932.Van Leeuwen J.C., Hoogstrate M., Duiverman E.J., Thio B.J. Effects of dietary induced weight loss on exercise- induced bronchoconstriction in overweight and obese children. Pediatr. Pulmonol. 2014; 49 (2): 1155– 1161. DOI: 10.1002/ppul.22932.Willeboordse M., Kant K.D., Tan F.E. et al. A multifactorial weight reduction programme for children with overweight and asthma: a randomized controlled trial. PLoS One. 2016; 11 (6): e0157158. DOI: 10.1371/journal.pone.0157158.Willeboordse M., Kant K.D., Tan F.E. et al. A multifactorial weight reduction programme for children with overweight and asthma: a randomized controlled trial. PLoS One. 2016; 11 (6): e0157158. DOI: 10.1371/journal.pone.0157158.Luna-Pech J.A., Torres-Mendoza B.M., Luna-Pech J.A. et al. Normocaloric diet improves asthma-related quality of life in obese pubertal adolescents. Int. Arch. Allergy Immunol. 2014; 163 (4): 252–258. DOI: 10.1159/000360398.Luna-Pech J.A., Torres-Mendoza B.M., Luna-Pech J.A. et al. Normocaloric diet improves asthma-related quality of life in obese pubertal adolescents. Int. Arch. Allergy Immunol. 2014; 163 (4): 252–258. DOI: 10.1159/000360398.

The authors declare that there are no conflicts of interest present.