Rapid weight gain in early life is associated with severity of respiratory syncytial virus (RSV) bronchiolitis in children

Main Article Content

You Ree Kim
Hak Kyoun Cho
Eun Hye Lee
Yong-Sung Choi
Hoi Soo Yoon
Mi Young Han
Yeong Ho Rha
Hae Woon Jung


weight gain, obesity, bronchiolitis, wheezing, respiratory syncytial virus


Objectives: This study aimed to investigate whether rapid weight gain in early life was associated with the severity of respiratory syncytial virus (RSV) bronchiolitis in children.
Methods: We retrospectively reviewed 190 patients (1–24 months) hospitalized for RSV bronchiolitis. Parameters of bronchiolitis severity were compared between rapid (change in weight z-score from birth >0.67, n = 65) and normal weight gain groups (n = 125). We assessed for correlations between bronchiolitis severity and weight gain. Linear regression was performed to predict for bronchiolitis severity based on weight gain, controlling for covariates. SPSS was used for statistical analyses.
Results: The rapid weight gain group had longer mean durations of tachypnea (2.3±2.0 vs. 1.7±1.8 days, P = 0.027), wheezing (3.2±2.5 vs. 1.6±1.8 days, P < 0.001), and chest retractions (1.5±2.2 vs. 0.6±1.3 days, P = 0.007). Correlations of weight gain with tachypnea (r = 0.146), wheezing (r = 0.279), and chest retractions (r = 0.179) were statistically significant. Weight gain predicted for tachypnea (B = 0.485, P = 0.013) and wheezing (B = 0.846, P = 0.001) durations after adjusting for covariates of severity (age, sex, current weight, RSV type, coin-fection, recurrent bronchiolitis, hospital stay, fever, oxygen supplementation, maximal respi-ratory and heart rates, and laboratory indices).
Conclusions: Our findings suggest an association between weight gain and severity of RSV bronchiolitis in young children. Weight gain was significantly associated with the durations of tachypnea and wheezing. The trajectory of weight gain in early life may play a significant role in the clinical course of RSV bronchiolitis.

Abstract 109 | PDF Downloads 48 XML Downloads 0 HTML Downloads 3


1. Øymar K, Skjerven HO, Mikalsen IB. Acute bronchiolitis in infants, a review. Scand J Trauma Resusc Emerg Med. 2014;22(1):23. https://doi.org/10.1186/1757-7241-22-23

2. Bueno FU, Piva JP, Garcia PC, Lago PM, Einloft PR. Outcome and characteristics of infants with acute viral bronchiolitis submitted to mechanical ventilation in a Brazilian pediatric intensive care. Rev Bras Ter Intensiva. 2009;21(2):174–182. https://doi.org/10.1590/S0103-507X2009000200010

3. Meissner HC. Viral bronchiolitis in children. N Engl J Med. 2016;374(1):62–72. https://doi.org/10.1056/NEJMra1413456

4. Tracey VV, De NC, Harper JR. Obesity and respiratory infec-tion in infants and young children. Br Med J. 1971;1(5739): 16–18. https://doi.org/10.1136/bmj.1.5739.16

5. Shibli R, Rubin L, Akons H, Shaoul R. Morbidity of overweight (>or=85th percentile) in the first 2 years of life. Pediatrics. 2008;122(2):267–272. https://doi.org/10.1542/peds.2007-2867

6. den Dekker HT, Jaddoe VWV, Reiss IK, de Jongste JC, Duijts L. Fetal and infant growth patterns and risk of lower lung func-tion and asthma. The Generation R study. Am J Respir Crit Care Med. 2018;197(2):183–192. https://doi.org/10.1164/ rccm.201703-0631OC

7. Sonnenschein-van der Voort AM, Arends LR, de Jongste JC, Annesi-Maesano I, Arshad SH, Barros H, et al. Preterm birth, infant weight gain, and childhood asthma risk: a meta-analysis of 147,000 European children. J Allergy Clin Immunol. 2014;133(5):1317–1329. https://doi.org/10.1016/j.jaci.2013.12. 1082

8. Rzehak P, Wijga AH, Keil T, Eller E, Bindslev-Jensen C, Smit HA, et al. Body mass index trajectory classes and inci-dent asthma in childhood: results from 8 European birth cohorts – a Global Allergy and Asthma European Network ini-tiative. J Allergy Clin Immunol. 2013;131(6):1528–1536. https:// doi.org/10.1016/j.jaci.2013.01.001

9. van der Gugten AC, Koopman M, Evelein AM, Verheij JM, Uiterwall CSPM, van der Ent CK. Rapid early weight gain is associated with wheeze and reduced lung function in childhood. Eur Respir J. 2012;39(2):403–410. https://doi. org/10.1183/09031936.00188310

10. Balekian DS, Linnemann RW, Hasegawa K, Thadhani R, Carmargo CA Jr. Cohort study of severe bronchiolitis during infancy and risk of asthma by age 5 years. J Allergy Clin Immunol Pract. 2017;5(1):92–96. https://doi.org/10.1016/j. jaip.2016.07.004

11. Carroll KN, Wu P, Gebretsadik T, Griffin MR, Dupont WD, Mitchel EF, et al. The severity-dependent relationship of infant bronchiolitis on the risk and morbidity of early child-hood asthma. J Allergy Clin Immunol. 2009;123(5):1055–1061. https://doi.org/10.1016/j.jaci.2009.02.021

12. Akiyama N, Segawa T, Ida H, Mezawa H, Noya M, Tamez S, et al. Bimodal effects of obesity ratio on disease duration of respiratory syncytial virus infection in children. Allergol Int. 2011;60(3):305–308. https://doi.org/10.2332/ allergolint.10-OA-0252

13. Cha MA, Woo YR, Kim HJ, Kim MS, Ahn YH. Factors associ-ated with obesity of acute bronchiolitis in infants: association of obesity with disease severity. Allergy Asthma Respir Dis. 2015;3(4):281–287. https://doi.org/10.4168/aard.2015.3.4.281

14. Mei Z, Grummer-Strawn LM, Thompson D, Dietz WH. Shifts in percentiles of growth during early childhood: analy-sis of longitudinal data from the California Child Health and Development Study. Pediatrics. 2004;113(6):e617–e627. https://doi.org/10.1542/peds.113.6.e617

15. Yin L, Song Y, Liu Y, Ye Z. A risk factor for early wheezing in infants: rapid weight gain. BMC Pediatr. 2019;19(1):352. https://doi.org/10.1186/s12887-019-1720-3

16. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, et al. Korean National Growth Charts: review of developmental pro-cess and an outlook. Korean J Pediatr. 2007;51:2008. https:// doi.org/10.3345/kjp.2008.51.1.1

17. Ong KK, Ahmed ML, Emmett PM, Preece MA, Dunger DB. Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ. 2000;320(7240): 967–971. https://doi.org/10.1136/bmj.320.7240.967

18. Nuolivirta K, Koponen P, Helminen M, Korppi M. Weight gain in infancy and post-bronchiolitis wheezing. Acta Paediatr. 2012;101(1):38–42. https://doi.org/10.1111/j.1651-2227.2011.02414.x

19. Rifas-Shiman SL, Rich-Edwards JW, Scanlon KS, Kleinman KP, Gillman MW. Misdiagnosis of overweight and underweight chil-dren younger than 2 years of age due to length measurement bias. MedGenMed. 2005;7(4):56. https://www.medscape.com/ viewarticle/515767 [accessed 11 Nov 2020]

20. Johnson W, Cameron N, Dickson P, Emsley S, Raynor P, Seymour C, et al. The reliability of routine anthropometric data collected by health workers: a cross-sectional study. Int J Nurs Stud. 2009;46(3):310–316. https://doi.org/10.1016/j. ijnurstu.2008.10.003

21. Howe LD, Tilling K, Lawlor DA. Accuracy of height and weight data from child health records. Arch Dis Child. 2009;94(12):950–954. https://doi.org/10.1136/adc.2009.162552

22. Eckhardt CL, Eng H, Dills JL, Wisner KL. The prevalence of rapid weight gain in infancy differs by the growth reference and age interval used for evaluation. Ann Hum Biol. 2016;43(1):85–90. https://doi.org/10.3109/03014460.2014.1002533

23. Toschke AM, Grote V, Koletzko B, von Kries R. Identifying children at high risk for overweight at school entry by weight gain during the first 2 years. Arch Pediatr Adolesc Med. 2004;158(5):449– 452. https://doi.org/10.1001/archpedi.158.5.449

24. Bozaykut A, Paketci A, Sezer RG, Paketci C. Evaluation of risk factors for recurrent wheezing episodes. J Clin Med Res. 2013;5(5):395. https://doi.org/10.4021/jocmr1543w

25. Paranjothy S, Dunstan F, Watkins WJ, Hyatt M, Demmier JC, Lyons RA, et al. Gestational age, birth weight, and risk of respiratory hospital admission in childhood. Pediatrics. 2013;132(6):e1562–e1569. https://doi.org/10.1542/peds.2013-1737

26. Hokken-Koelega AC, De Ridder MA, Lemmen RJ, Den Hartog H, De Muinck Keizer-Schrama SM, Drop SL. Children born small for gestational age: Do they catch up? Pediatr Res. 1995;38(2): 267–271. https://doi.org/10.1203/00006450-199508000-00022

27. Sheng YJ, Xu SS, Li XJ, Lui JL, Wu XL, Xu XF. Low birth weight contributed to increased serum IL-6 levels in infantile respiratory syncytial virus infection. BMC Pediatr. 2017;17(1):205. https://doi.org/10.1186/s12887-017-0961-2

28. Krechowec S, Thompson N, Breier B. Fetal growth restric-tion and the developmental origins of adult disease hypoth-esis: experimental studies and biological consequences. In: Kiess W, Chernausek SD, Hokken-Koelega ACS, editors. Small for gestational age. Causes and Consequences, Basel: Karger Publishers; 2009. p. 26–43. https://doi.org/10.1159/000165959

29. Wheeler T, Barker DJP, O’Brien PMS, editors. Fetal programming: influences on development and disease in later life. London: RCOG Press; 1999.

30. Forno E, Han YY, Mullen J, Celedón JC. Overweight, obesity, and lung function in children and adults – a meta-analysis. J Allergy Clin Immunol Pract. 2018;6(2):570–581. https://doi. org/10.1016/j.jaip.2017.07.010

31. Weinmayr G, Forastiere F, Büchele G, Jaensch A, Strachan DP, Nagel G. Overweight/obesity and respiratory and allergic disease in children: international study of asthma and allergies in childhood (ISAAC) phase two. PLoS One. 2014;9(12):e113996. https://doi.org/10.1371/journal.pone.0113996

32. Forno E, Weiner DJ, Mullen J, Sawicki G, Kurland G, Han YY, et al. Obesity and airway dysanapsis in children with and without asthma. Am J Respir Crit Care Med. 2014;19(3):314–323.

33. Ferrante AW, Jr. The immune cells in adipose tissue. Diabetes Obes Metab. 2013;15(s3):34–38. https://doi.org/10.1111/dom. 12154

34. Kelishadi R, Roufarshbaf M, Soheili S, Payghambarzadeh F, Masjedi M. Association of childhood obesity and the immune system: a systematic review of reviews. Child Obes. 2017;13(4):332–346. https://doi.org/10.1089/chi.2016.0176

35. Falagas ME, Kompoti M. Obesity and infection. Lancet Infect Dis. 2006;6(7):438–446. https://doi.org/10.1016/S1473-3099(06) 70523-0

36. Chen ZG, Li M, Ji JZ, Zhang Y, Chen H, Chen YF, et al. The role of serum leptin in infants with wheezing after respiratory syncytial virus infected. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2009;23(1):38–40. https://doi.org/10.3760/cma. j.issn.1003-9279.2009.01.014

37. Kawamata R, Gunji Y, Ozaki A, Wakabayashi K, Miyajimaa Y, Monden Y, et al. Relationships between adipokine profiles, physique index, and severity of bronchiolitis in infancy. Fetal Pediatr Pathol. 2017;36(5):347–356. https://doi.org/10.1080/15 513815.2017.1332121

38. Mancuso P. Obesity and lung inflammation. J Appl Physiol (1985). 2010;108(3):722–728. https://doi.org/10.1152/japplphysiol.00781. 2009

39. Medoff BD, Okamoto Y, Leyton P, Weng M, Sandall BP, Raher MJ, et al. Adiponectin deficiency increases allergic airway inflammation and pulmonary vascular remodeling. Am J Respir Cell Mol Biol. 2009;41:397–406. https://doi.org/10.1165/ rcmb.2008-0415OC

40. Duarte-Dorado DM, Madero-Orostegui DS, Rodriguez-Martinez CE, Nino G. Validation of a scale to assess the severity of bronchiolitis in a population of hospitalized infants. J Asthma. 2013;50(10):1056–1061. https://doi.org/10.3109/02770903.2013. 834504