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Asma e obesidade em idade pediátrica : artigo de revisão bibliográfica
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Resumo(s)
A associação entre asma e obesidade foi descrita em crianças e em adultos em diversos estudos. Esta associação torna-se importante por crianças com asma obesas terem pior controlo dos sintomas e pior resposta à terapêutica que crianças de peso normal. Esta revisão tem o objetivo de reunir informação sobre a interacção entre ambas, assim como os mecanismos responsáveis por esta interação e que não são ainda compreendidos completamente.
Vários mecanismos foram implicados na associação entre as duas patologias: mecanismos genéticos, envolvendo entre outros, os genes codificadores para o tumor necrosis factor-α, para o recetor glucocorticoide e para o recetor da vitamina D; mecanismos epigenéticos, associados à alimentação materna durante a gravidez e aleitamento materno; alterações mecânicas, envolvendo a redução de volume de reserva expiratório e da capacidade residual funcional; mediadores inflamatórios, como níveis de leptina e adiponectina; fatores hormonais, referente aos níveis de estrogénios e mecanismos envolvidos no stress oxidativo.
O conhecimento desta associação e a compreensão dos mecanismos de causalidade pelos profissionais de saúde são importantes para que possam existir medidas objetivas de prevenção e desenvolvimento de novas terapêuticas que permitam a redução das implicações clínicas negativas, num grupo de crianças particularmente difícil de tratar.
An association between asthma and obesity has been reported in children as well as in adults. This association has an increasing importance because obese asthmatic children have a worse symptom control and therapeutic response compared to normal weight asthmatic children. This revision has the objective to gather information about this complex interaction and to study the responsible mechanisms not yet completely understood. Many mechanisms were proposed to explain the asthma and obesity interaction: genetic, regarding the tumor necrosis factor-α, glucocorticoid and vitamin D receptor coding genes; epigenetic, associated to maternal nutrition during pregnancy and breastfeeding; mechanic, involving the reduction in functional residual capacity and expiratory reserve volume; inflammatory, like the levels of leptin and adiponectin; hormonal, concerning estrogen levels and mechanisms involved in the oxidative stress. Understanding this association and the causality mechanisms is very important because it leads to a more effective prevention and to the development of new therapies, to reduce negative clinical outcomes in this group of particularly difficult to treat children.
An association between asthma and obesity has been reported in children as well as in adults. This association has an increasing importance because obese asthmatic children have a worse symptom control and therapeutic response compared to normal weight asthmatic children. This revision has the objective to gather information about this complex interaction and to study the responsible mechanisms not yet completely understood. Many mechanisms were proposed to explain the asthma and obesity interaction: genetic, regarding the tumor necrosis factor-α, glucocorticoid and vitamin D receptor coding genes; epigenetic, associated to maternal nutrition during pregnancy and breastfeeding; mechanic, involving the reduction in functional residual capacity and expiratory reserve volume; inflammatory, like the levels of leptin and adiponectin; hormonal, concerning estrogen levels and mechanisms involved in the oxidative stress. Understanding this association and the causality mechanisms is very important because it leads to a more effective prevention and to the development of new therapies, to reduce negative clinical outcomes in this group of particularly difficult to treat children.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Palavras-chave
Asma Obesidade Pediatria