Journal List > Allergy Asthma Respir Dis > v.3(4) > 1059113

Cha, Woo, Kim, Kim, and Ahn: Factors associated with obesity of acute bronchiolitis in infants: association of obesity with disease severity

Abstract

Purpose

Both under-nutrition and obesity may be associated with severity of viral infection. We investigated the association of obesity with clinical factors and the severity of acute bronchiolitis in infants.

Methods

We reviewed 740 infants younger than 1 year of age who were admitted with the first episode of acute bronchiolitis between 2010 and 2013. Subjects were classified into 3 groups according to the weight-for-length Z-score.

Results

Younger age (3.6±2.6 months) was more frequent in the obesity group (P<0.001). Infants aged ≤6 months (90%) dominantly included in the obesity group. Logistic regression showed that age (younger than 3 months) was independently associated with the overweight and obesity groups with acute bronchiolitis in infants (odds ratio [OR], 1.77; P=0.001 for overweight; OR, 4.67; P<0.001 for obesity). Moreover, the obesity group was associated with an increased risk of chest retraction, hypoxia, respiratory syncytial virus detection, length of stay (more than 5 days), and need for oxygen supplement. These factors tended to increase from the overweight group toward the obesity group.

Conclusion

Younger than 3 months of age was a risk factor for developing worse clinical course in overweight and obesity groups with acute bronchiolitis in infants. Careful attention should be paid to the clinical course of younger obese infants with acute bronchiolitis.

Figures and Tables

Fig. 1

Age distribution in normal, overweight, and obesity groups with acute bronchiolitis in infants.

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Table 1

Dermographic and clinical characteristics of the subjects (n=740)

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Characteristic Value
Sex
 Male:female 469:271
Age (mo) 6.0±3.3
 ≤3 200 (27.0)
 4-6 219 (29.6)
 7-12 321 (43.3)
WFL Z-score*
 Normal 473 (63.9)
 Overweight 246 (33.2)
 Obesity 21 (2.8)
Clinical index
 Tachypnea 605 (81.7)
 Wheezing 593 (80.1)
 Retraction 197 (26.6)
 Hypoxia 116 (15.7)
Severity
 Fever§ 297 (40.1)
 Fever duration (day) 2.4±1.0
 Length of stay (day) 5.9±2.4
 O2 therapy 116 (15.7)
Virus study 654 (88.4)
 RSV 263 (40.2)
 Non-RSV 38 (5.8)

Values are presented as mean±standard deviation or number (%).

WFL, weight-for-length; RSV, respiratory syncytial virus.

*Normal, -2≤WFL Z-score<1; overweight, 1≤WFL Z-score<3; obesity, 3≤WFL Z-score. 1-3 months, respiratory rate≥55/min; 4-6 months, respiratory rate≥50/min; 7-12 months, respiratory rate≥45/min. Percutaneous oxygen saturation<95%. §Fever episode in total duration of disease. Supplement oxygen when percutaneous oxygen saturation<95%.

Table 2

Comparison of clinical factor between normal, overweight, and obesity groups

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Variable Normal (n = 473) Overweight (n = 246) Obesity (n = 21) P-value
Sex
 Male:female 307:166 149:97 13:8 0.514
Age (mo) 6.5 ± 3.2 5.4 ± 3.2 3.6 ± 2.6 < 0.001
 ≤3 105 (22.2) 83 (33.7) 12 (57.1) < 0.001
 4-6 130 (27.5) 82 (33.3) 7 (33.3) 0.110
 7-12 238 (50.3) 81 (32.9) 2 (9.5) < 0.001
RSV detection 164 (34.7) 89 (36.2) 11 (52.4) 0.243
Clinical index
 Tachypnea 399 (84.4) 191 (77.6) 15 (71.4) 0.011
 Wheezing 380 (80.3) 195 (79.3) 17 (81.0) 0.938
 Retraction 121 (25.6) 67 (27.2) 9 (42.9) 0.202
 Hypoxia 78 (16.5) 34 (13.8) 4 (19.0) 0.550

Values are presented as mean±standard deviation or number (%).

Table 3

Comparison of severity between normal, overweight, and obesity groups

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Variable Normal (n = 473) Overweight (n = 246) Obesity (n = 21) P-value
Fever 310 (65.5) 147 (59.8) 12 (57.1) 0.105
Fever duration (day) 2.5 ± 1.6 2.3 ± 1.3 2.0 ± 1.8 0.392
Length of stay (day) 5.9 ± 2.4 5.8 ± 2.3 6.0 ± 2.5 0.855
Length of stay ( > 5 day) 331 (70.0 ) 17 (6.9) 16 (76.2) 0.932
O2 therapy 78 (16.5) 34 (13.8) 4 (19.0) 0.550

Values are presented as number (%) or mean±standard deviation.

Table 4

Risk factors in overweight and obesity group with acute bronchiolitis in infants*

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Factor Overweight Obesity
OR 95% CI P-value OR 95% CI P-value
Age, ≤ 3 mo 1.773 1.259-2.497 0.001 4.673 1.917-11.391 < 0.001
Male sex 1.181 0.857-1.627 0.310 0.879 0.357-2.163 0.778
RSV detection 1.068 0.774-1.473 0.688 2.073 0.862-4.982 0.103
Tachypnea 0.644 0.436-0.951 0.027 0.464 0.174-1.234 0.124
Wheezing 0.936 0.638-1.372 0.734 1.040 0.342-3.164 0.945
Retraction 1.089 0.768-1.543 0.632 2.182 0.897-5.306 0.085
Hypoxia 0.810 0.524-1.253 0.344 1.189 0.389-3.628 0.762
Fever 0.871 0.635-1.194 0.391 0.704 0.279-1.777 0.457
LOS, > 5 day 0.957 0.684-1.340 0.800 1.344 0.483-3.740 0.571
O2 therapy 0.810 0.524-1.253 0.344 1.189 0.389-3.628 0.762

OR, odds ratio; CI, confidence Interval; LOS, length of stay.

*Analysis based upon logistic regression model.

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