title: High body mass index is not associated with atopy in schoolchildren living in rural and urban areas of Ghana.
abstract: BACKGROUND
  Factors which determine the development of atopy and the observed rural-urban gradient in its prevalence are not fully understood. High body mass index (BMI) has been associated with asthma and potentially atopy in industrialized countries. In developing countries, the transition from rural to urban areas has been associated with lifestyle changes and an increased prevalence of high BMI; however, the effect of high BMI on atopy remains unknown in this population. We therefore investigated the association between high BMI and atopy among schoolchildren living in rural and urban areas of Ghana.
  
  
  METHODS
  Data on skin prick testing, anthropometric, parasitological, demographic and lifestyle information for 1,482 schoolchildren aged 6-15 years was collected. Atopy was defined as sensitization to at least one tested allergen whilst the Centres for Disease Control and Prevention (CDC, Atlanta) growth reference charts were used in defining high BMI as BMI ≥ the 85th percentile. Logistic regression was performed to investigate the association between high BMI and atopy whilst adjusting for potential confounding factors.
  
  
  RESULTS
  The following prevalences were observed for high BMI [Rural: 16%, Urban: 10.8%, p < 0.001] and atopy [Rural: 25.1%, Urban: 17.8%, p < 0.001]. High BMI was not associated with atopy; but an inverse association was observed between underweight and atopy [OR: 0.57, 95% CI: 0.33-0.99]. Significant associations were also observed with male sex [Rural: OR: 1.49, 95% CI: 1.06-2.08; Urban: OR: 1.90, 95% CI: 1.30-2.79], and in the urban site with older age [OR: 1.76, 95% CI: 1.00-3.07], family history of asthma [OR: 1.58, 95% CI: 1.01-2.47] and occupational status of parent [OR: 0.33, 95% CI: 0.12-0.93]; whilst co-infection with intestinal parasites [OR: 2.47, 95% CI: 1.01-6.04] was associated with atopy in the rural site. After multivariate adjustment, male sex, older age and family history of asthma remained significant.
  
  
  CONCLUSIONS
  In Ghanaian schoolchildren, high BMI was not associated with atopy. Further studies are warranted to clarify the relationship between body weight and atopy in children subjected to rapid life-style changes associated with urbanization of their environments.
authors.affiliation: Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Irene A
authors.initials: IA
authors.lastname: Larbi
authors.forename: Kerstin
authors.initials: K
authors.lastname: Klipstein-Grobusch
authors.forename: Abena S
authors.initials: AS
authors.lastname: Amoah
authors.forename: Benedicta B
authors.initials: BB
authors.lastname: Obeng
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wilson
authors.forename: Maria
authors.initials: M
authors.lastname: Yazdanbakhsh
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Boakye
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D015992:Body Mass Index; D002648:Child; D005260:Female; D005869:Ghana; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D012044:Regression Analysis; D012424:Rural Population; D011795:Surveys and Questionnaires; D014505:Urban Population