الفهرس 
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Abstract
Studies have shown that the prevalence of bronchial asthma and obesity is increasing concomitantly worldwide among children and young adults.
Both, asthma and obesity have serious health consequences and significant financial costs. The burden of obesity on pulmonary function in children is highlighted by the increased frequency of bronchial hyper-responsiveness, increased number of prescribed medications and inhaled corticosteroid (ICS) use, and reduced peak expiratory flow rate in overweight / obese asthmatic children compared to non-overweight asthmatic children. Excess body weight is also associated with an increase in the number of school days missed by asthmatic children and significantly reduced quality of life.
The ongoing epidemic of obesity in children has highlighted the importance of body composition for short term and long term health. Hence, components of body composition influence health outcomes, and their measurement is increasingly considered valuable in clinical practice.
The aim of our study is to evaluate the level of adiponectin as a hormone of energy metabolism in obese and non-obese asthmatic children, to investigate the association between serum adiponectin, CRP, IL- 6 level and body composition parameters in asthmatic children, its effect on asthma severity and the clinical outcome and to emphasize on the bad effect of obesity on asthma and hence show the importance of weight loss for improvement of patients.
The present study was conducted on 90 children from those attending the allergy clinic in Abo El Rich Pediatric Hospital, Faculty of medicine, Cairo University, during the period between 2013 and 2014. Their ages ranged from 7-12 years.
Cases were divided into 2 groups;
Group1: comprised 30 non-obese asthmatic children
group 2: comprised 30 obese asthmatic children
Another 30 apparently healthy children of matched age and sex as the control group, (group 3).
All cases were subjected to complete history taking and clinical examination. They comprised both males and females with an age range from 7-12 years.
Diagnosed cases of bronchial asthma were either new or on treatment with corticosteroids for less than 3 months. As for the non-obese asthmatic group BMI was <85 th percentile while in the obese asthmatic group BMI was ≥95 th percentile
Anthropometric measurements (height & weight) were taken from the 3 groups as well as body composition parameters. Laboratory samples were collected from the 3 groups including: serum adiponectin, IL6 &CRP using the ELISA method.
The present study revealed that the prevalence of both asthma and obesity was more among males with male: female ratio = 2:1 in obese (19:11) and non- obese (20:10) asthmatic groups.
Regarding severity of asthma in our cases, non-obese asthmatics were classified into 76.7% mild and 23.3% moderate cases. The obese asthmatics were classified into 30% mild, 60% moderate and 10% severe cases.
In our study, regarding anthropometric and laboratory findings; the obese asthmatic group showed highly statistically significant differences compared to the non-obese asthmatic group: (P< 0.005) regarding: weight, BMI, Fat %, FM, FFM, IMP, TBW, BMR. The obese asthmatic group showed statistically significant differences compared to the control regarding: weight, BMI, FM, FFM, IMP, TBW, BMR with p< 0.005 and in the Fat% with P<0.05. The non-obese asthmatic group showed highly significant increase in serum IL6 and CRP compared to the control group. (P< 0.005 in both). The obese asthmatic group showed highly significant increase in serum IL6 and CRP compared to the control group (p< 0.005 in both). Also, serum IL6 and CRP showed highly significant increase in the obese asthmatics compared to non-obese asthmatics (p< 0.005 in both). However, serum adiponectin level showed highly significant decrease in the obese asthmatic group compared to the control group (p= 0.005). Serum adiponectin level showed highly significant decrease in the obese asthmatics both boys and girls compared to non-obese asthmatics (p< 0.005).
In the non-obese asthmatic group: there was a negative significant correlation between IL6 and impedance (p<0.05), and a positive significant correlation with BMI (p>0.05). In the obese asthmatic group, there was a positive significant correlation between adiponectin& both fat % and impedance (p<0.05), while there was a negative significant correlation with FFM (p<0.05).
In obese asthmatics, positive significant correlations were found between severity of asthma and weight (p< 0.05), BMI (p< 0.005), FFM (p< 0.005), and BMR in K Cal (p= 0.007).
Negative significant correlation was found between severity of asthma and the impedance (p<0.005). Significant negative correlation was found between serum adiponectin level & severity of asthma in non-obese asthmatics (r= -0.361, p=0.05). Also, significant negative correlation was found between serum adiponectin level & severity of asthma in obese asthmatics (r= -0.576, p=0.001). BMI and serum adiponectin level were found to be significant predictors for the severity of asthma in obese asthmatics (p<0.01 and 0.05). Adiponectin level was a more sensitive test (85.4 %) in detecting the severity of asthma in obese asthmatics compared to serum IL 6 (36 %) and CRP (43.9 %).
In conclusion, the link between obesity and asthma is well established. However, more studies were done on asthmatic obese adults than on children especially in Egypt. We verified this relationship in children using all body composition parameters, anti-inflammatory obesity marker; adiponectin and serum inflammatory markers; CRP and IL6. Obesity aggravates the severity of asthma. Adiponectin markedly decreases in obese asthmatic children which plays a role in worsening asthma symptoms. CRP &IL6 increase sharing a big deal in the inflammation process. BMI, F%, FFM and IMP affect the level of adiponectin, CRP &IL6. Negative significant correlation was found between adiponectin and severity of asthma in obese and non-obese asthmatics which points out the important role of adiponectin in the inflammatory process in bronchial asthma with or without obesity.