Impact of metabolic and weight components on incident asthma using a real-world cohort

Background: Obesity and metabolic dysregulation (MetD) have increasing prevalence and adversely affect asthma morbidity and therapeutic response. Objective: To determine the role of weight and MetD on incident asthma in adulthood. Methods: In a retrospective, longitudinal cohort of patients, we performed a time-to-asthma diagnosis analysis after a 3-year landmark period (t(0)-t(3)) during which weight and MetD components were evaluated. We assessed incident asthma risk with MetD components and weight. Results: In total, 90,081 patients met the inclusion criteria, with 836 cases (0.93%) of incident asthma in our primary cohort. Diabetes present at t(0), but no other MetD components, was associated with increased risk of asthma (adjusted hazard ratio = 1.85, 95% CI: 1.27-2.71, P = .0002). The effect of weight on asthma risk, independent of other MetD components, identified individuals with overweight or obesity as having a 10-year attributable risk of 15.4%. Metformin was prescribed more frequently, and hemoglobin A1c levels were lower in patients with diabetes in whom asthma did not develop (P < .0001). Conclusion: Weight and diabetes prevention and management represent modifiable risk factors for adult asthma development. (c) 2024 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)