The lipid profile in obese asthmatic children compared to non-obese asthmatic children

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Pascal, M. Vazquez-Ortiz, M.M. Folque, R. Jimenez-Feijoo, J. Lozano, O. Dominguez, M. Piquer-Gibert, M.T. Giner, M. Alvaro, M. Dias da Costa, B. García-Paba, A. Machinena, L. Alsina, J. Yagüe, A.M. Plaza-Martin" "autores" => array:15 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Pascal" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Vazquez-Ortiz" ] 2 => array:2 [ "nombre" => "M.M." "apellidos" => "Folque" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Jimenez-Feijoo" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Lozano" ] 5 => array:2 [ "nombre" => "O." "apellidos" => "Dominguez" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Piquer-Gibert" ] 7 => array:2 [ "nombre" => "M.T." "apellidos" => "Giner" ] 8 => array:2 [ "nombre" => "M." "apellidos" => "Alvaro" ] 9 => array:2 [ "nombre" => "M." "apellidos" => "Dias da Costa" ] 10 => array:2 [ "nombre" => "B." "apellidos" => "García-Paba" ] 11 => array:2 [ "nombre" => "A." 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"apellidos" => "Plaza-Martin" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054616000070?idApp=UINPBA00004N" "url" => "/03010546/0000004400000004/v1_201607130013/S0301054616000070/v1_201607130013/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0301054615001470" "issn" => "03010546" "doi" => "10.1016/j.aller.2015.09.002" "estado" => "S300" "fechaPublicacion" => "2016-07-01" "aid" => "722" "copyright" => "SEICAP" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Allergol Immunopathol (Madr). 2016;44:341-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 102 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 66 "PDF" => 34 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "FLG single nucleotide polymorphisms in chronic idiopathic urticaria" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "341" "paginaFinal" => "345" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Soltani, A. Saghazadeh, M. Movahedi, M. Tavakol, M. Sadr, E. Farhadi, N. Rezaei" "autores" => array:7 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Soltani" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Saghazadeh" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Movahedi" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Tavakol" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Sadr" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Farhadi" ] 6 => array:2 [ "nombre" => "N." "apellidos" => "Rezaei" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054615001470?idApp=UINPBA00004N" "url" => "/03010546/0000004400000004/v1_201607130013/S0301054615001470/v1_201607130013/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "The lipid profile in obese asthmatic children compared to non-obese asthmatic children" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "346" "paginaFinal" => "350" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L.-J. Fang, C.-S. Huang, Y.-C. Liu, Y.-M. Su, K.-S. Wan" "autores" => array:5 [ 0 => array:3 [ "nombre" => "L.-J." "apellidos" => "Fang" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "C.-S." "apellidos" => "Huang" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Y.-C." "apellidos" => "Liu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Y.-M." "apellidos" => "Su" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:4 [ "nombre" => "K.-S." "apellidos" => "Wan" "email" => array:1 [ 0 => "gwan1998@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Pediatrics, Taipei City Hospital-Renai Branch, Taiwan" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pediatrics, Taipei City Hospital-Mother & Child Branch, Taiwan" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "IntroductionThe global prevalence rates of current asthma in children aged 6–7 years and 13–14 years have been reported to be 11.7% and 14.1%, respectively.<a class="elsevierStyleCrossRef" href="#bib0170">1</a> Increasing evidence suggests that obesity is a risk factor for asthma, and that weight loss can improve symptoms. Improved clinical findings have also been associated with decreased levels of serum cholesterol and triglycerides, striking reductions in markers of oxidative stress and increased levels of the antioxidant uric acid. The pro-inflammatory role of serum cholesterol in asthma has been studied with contradicting results. A modest but significant association between higher levels of serum cholesterol and asthma, independent of age, gender, body mass index (BMI), socio-economic status and serum high sensitivity C reactive protein has been reported.<a class="elsevierStyleCrossRef" href="#bib0175">2</a> Moreover, hypercholesterolaemia and obesity have been reported to independently increase the risk of asthma.<a class="elsevierStyleCrossRef" href="#bib0180">3</a> Compliance with an alternative day calorie restriction diet has been reported to be associated with improvements in symptoms and pulmonary function, and reductions in oxidative stress and inflammation.<a class="elsevierStyleCrossRef" href="#bib0185">4</a> In addition, Buchowski showed that oxidative stress can be rapidly reduced and the reduction sustained through a modest reduction in caloric intake, suggesting potential health benefits for overweight and obese women.<a class="elsevierStyleCrossRef" href="#bib0190">5</a> However, Ouyang reported that although adiposity is associated with asthma, a higher percentage of body fat, and lower high-density lipoprotein (HDL) and higher low-density lipoprotein (LDL) levels were associated with a greater risk of allergic sensitisation mostly in lean Chinese subjects.<a class="elsevierStyleCrossRef" href="#bib0195">6</a> Thus, a genetic influence on these traits may exist. Ahmad reported that gender and ethnicity were significantly associated with asthma, and that obesity was positively associated with asthma in children aged 13–17 years.<a class="elsevierStyleCrossRef" href="#bib0200">7</a> In addition, Fessler reported that cholesterol promotes Th2 immunity and allergic inflammation in rodents. Reports of both direct and inverse associations between serum cholesterol and atopy in different populations suggest that ethnicity or other demographic variables may modify these relationships.<a class="elsevierStyleCrossRef" href="#bib0205">8</a> Asthma and obesity are associated disorders, however the mechanisms responsible for this relationship are unclear. The aim of this study was to examine the lipid profiles of mild to moderate asthmatic children and investigate the association between dyslipidaemia and asthma and the effect of asthma and obesity on hyperlipidaemia.Material and methodsRenai and Mother & Child branches of Taipei City Hospital participated in this study, and the research protocol was approved by the Institutional Review Board of each branch. From January 1, 2013 to October 23, 2014, 160 persistent asthmatic patients (asthma symptoms ≥3 days per week or ≥3 nights per week) aged 6–17 years with asthma diagnosed by a doctor were asked to participate in this study. We excluded patients who had used systemic corticosteroids two weeks before the study. The participants were divided into four groups based on BMI: Group I normal weight (BMI=20–25kg/m2, n=30); Group II under-weight (BMI<20kg/m2, n=30); Group III overweight (BMI=25–30kg/m2, n=25); and Group IV obese (BMI>30kg/m2, n=25). Fasting blood sugar, fasting insulin, and HbA1c were measured to exclude the possibility of pre-diabetes. Lipid profiles including total cholesterol, HDL, LDL, apo-A1, apo-B and triglycerides were measured before breakfast. All parents/guardians of participants gave informed consent (as the legal age of consent in Taiwan is 20). SPSS software (version 1.2 for Windows; SPSS Inc., Chicago, IL, USA) was used for all analyses. A p-value of less than 0.05 was considered to be statistically significant.ResultsThe lipid profiles of the four groups showed that the level of HDL increased in the following order: obesity>overweight>underweight>normal weight (75.84±13.95, 68.56±15.28, 64.17±13.93, and 63.17±14.3mg/dl; respectively, p=0.007). There were no significant differences in cholesterol, triglyceride and LDL levels in all four groups (p>0.05). Levels of fasting blood sugar and fasting insulin were within normal limits in all of the four groups. There were no cases of pre-diabetes in any of the four groups (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>DiscussionThe association between hypercholesterolaemia and obesity with airway hyperresponsiveness has drawn increasing attention due to the potential role of cholesterol and lipid homeostasis in lung physiology and asthma.<a class="elsevierStyleCrossRef" href="#bib0210">9</a> However, the mechanism responsible for this obesity-asthma association is unknown. A high-fat meal can lead to significant increases in nitric oxide (FeNO), total cholesterol, and especially triglycerides. This suggests that a high-fat diet may contribute to chronic inflammatory diseases of the airway and lungs.<a class="elsevierStyleCrossRef" href="#bib0215">10</a> The disease burden of asthma appeared normal in normal weight and slightly overweight women rather than obese and markedly obese women suggests that the development of asthma may be a point on the trajectory of chronic obesity or that asthma and obesity are concurrent disorders.<a class="elsevierStyleCrossRef" href="#bib0220">11</a> Asthma and obesity are associated disorders, however obesity in patients with difficult-to-treat asthma has been reported to be inversely related with sputum eosinophils and exhaled FeNO, and positively associated with the presence of co-morbid factors and reduced lung volume. In addition, a higher BMI has been reported to be associated with elevated FeNO. This suggests that factors other than airway inflammation alone may explain the relationship between obesity and severity of asthma.<a class="elsevierStyleCrossRefs" href="#bib0225">12,13</a> In addition, obese adolescent males with mild persistent asthma have been reported to have a significantly higher prevalence of metabolic syndrome than obese males without asthma.<a class="elsevierStyleCrossRef" href="#bib0235">14</a> Thus, when studying the lipid profile of asthmatic patients, those with pre-diabetes should be excluded. Studies exploring the effect on obesity of eating fast food and watching television have reported that frequent and very frequent consumption of fast food was associated with a higher BMI in children,<a class="elsevierStyleCrossRefs" href="#bib0240">15,16</a> and that a higher number of hours of watching television was positively associated with BMI in both adolescents and children with an apparent dose response effect.<a class="elsevierStyleCrossRef" href="#bib0250">17</a> Therefore, it seems that all risk factors for obesity are related to asthma and even asthma exacerbation.Although cholesterol exerts complex effects on inflammation, the relationship between cholesterol and asthma/wheezing has been reported to be independent of BMI and C reactive protein and similar between atopic and non-atopic participants.<a class="elsevierStyleCrossRef" href="#bib0255">18</a> Plasma secretory A2 (sPLA2) has been shown to have functions relevant to asthmatic inflammation, including eicosanoid synthesis and effects on dendritic cells and T cells, and also to provide a biological link between asthma, inflammation, increased BMI, lipid metabolism and antioxidants. Interactions among these factors may be pertinent to the pathophysiology and increasing prevalence of both asthma and obesity.<a class="elsevierStyleCrossRef" href="#bib0260">19</a> El-Shaboury reported a significant increase in the incidence of endogenous hypertriglyceridaemia but not of hypercholesterolaemia in asthmatic patients.<a class="elsevierStyleCrossRef" href="#bib0265">20</a> Another study established a critical role of ATP-binding cassette transporter A1 in reverse cholesterol and phospholipids transport in airway smooth muscle cells, suggesting that dysregulation of cholesterol homeostasis in these cells may be important in the pathogenesis of asthma.<a class="elsevierStyleCrossRef" href="#bib0210">9</a>It has recently been shown that diet-induced dyslipidaemia alters trafficking of immune cells to the lung in a manner that may have important implications for the pathogenesis of acute lung injury, asthma, and pneumonia. Conversely, cholesterol-targeting pharmacological agents such as statins, apolipoprotein mimetic peptides, and liver X receptor agonists have shown early promise in the treatment of several lung disorders including asthma.<a class="elsevierStyleCrossRef" href="#bib0270">21</a> Apolipoprotein A1 (apo-A1) is a key component of HDL that mediates reverse cholesterol transport from cells and reduces vascular inflammation. In an animal model, endogenous apo-A1 was found to negatively regulate OVA-induced neutrophilic airway inflammation, primarily via a G-CSF-dependent mechanism. This suggests that apo-A1 may play an important role in modulating the severity of neutrophilic airway inflammation in asthma.<a class="elsevierStyleCrossRef" href="#bib0275">22</a> Apo-A1 mimetic peptides have been shown to attenuate airway inflammation, airway remodelling, and airway hyperreactivity in murine models of experimental asthma. Thus, site-directed delivery of apo-A1 mimetic peptides may represent a novel treatment approach for asthma.<a class="elsevierStyleCrossRefs" href="#bib0280">23–25</a> Cholesterol-lowering drugs (or statins) possess pleiotropic immunomodulatory properties, and this has opened a new area of research regarding the anti-inflammatory and anti-proliferative properties of statins. Thus, statins may modulate mevalonate-dependent and independent pathways, and the emerging area of cholesterol, sphingolipid, and lipid raft biology in lung diseases may lead to new therapeutic targets.<a class="elsevierStyleCrossRef" href="#bib0295">26</a>The mean plasma lipid level after long-term slow-release theophylline treatment has been reported to be significantly higher than that before treatment.<a class="elsevierStyleCrossRef" href="#bib0300">27</a> However, Allayee showed that serum levels of all lipids were significantly lower in patients taking montelukast and theophylline compared to a placebo, and thus asthma medication may have some beneficial effects for asthmatics with respect to the risk of cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0305">28</a> No significant changes in serum fasting triglyceride concentrations have been reported before and after inhaled corticosteroid therapy, and only high-dose inhaled corticosteroids have been reported to have a minor effect on lipid metabolism after long periods of use in asthmatic patients.<a class="elsevierStyleCrossRef" href="#bib0310">29</a> Moreover, beta 2-adrenergic stimulation has been reported to have no effect on basal serum lipid levels.<a class="elsevierStyleCrossRef" href="#bib0315">30</a>In the current study, the HDL concentration was obviously increased in the obese and overweight children and even in the normal weight and underweight group, however the cholesterol and triglyceride levels were within normal limits in all of the four study groups. This means that persistent asthma and even asthma exacerbations occurred independently of the lipid profit of the participants. Hypercholesterolaemia is a risk factor for asthma, independent of obesity, and serum total cholesterol and non-HDL have been reported to be inversely related to asthma.<a class="elsevierStyleCrossRef" href="#bib0255">18</a> This is in contrast to Chen's study, in which asthma was associated with high LDL levels and this association was amplified in overweight and obese subjects.<a class="elsevierStyleCrossRef" href="#bib0320">31</a> Moreover, our results are different from other studies which showed that high serum triglyceride and low serum HDL levels were associated with wheezing after adjusting for adiposity.<a class="elsevierStyleCrossRefs" href="#bib0325">32,33</a>In conclusion, understanding the relationship between lipid profiles and asthma does not completely clarify why the prevalence of asthma is higher in obese children. However, body weight control with a restricted calorie intake may become a therapeutic treatment for children with asthma.Ethical disclosuresProtection of human subjects and animals in researchThe authors declare that no experiments were performed on humans or animals for this investigation.Confidentiality of dataThe authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.Right to privacy and informed consentThe authors have obtained the informed consent of the patients and/or subjects mentioned in the article. The author for correspondence is in possession of this document.Conflicts of interestAll authors declare that there are no conflicts of interest that may be inherent in this submission." 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An alternate day calorie restriction diet has been reported to improve asthma symptoms by decreasing levels of serum cholesterol and triglycerides, reducing markers of oxidative stress and increasing levels of the antioxidant uric acid. Therefore, to investigate the lipid profile in asthmatic children may be important in asthma control treatment. Materials and methodsOne hundred and sixty newly diagnosed persistent asthmatic children were selected to participate in the study. They were divided into four groups based on their body mass index (BMI): Group I normal weight (BMI=20–24.9kg/m2, n=30); Group II under-weight (BMI<20kg/m2, n=30); Group III overweight (BMI=25–30kg/m2, n=25); and Group IV obese (BMI>30kg/m2, n=25). Fasting blood sugar, fasting insulin, and HbA1c were measured to exclude the possibility of pre-diabetes. Lipid profile measurements included total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), apo-A1, apo-B and triglycerides. ResultsThere were no significant differences in the levels of apo-A1, apo-B, triglycerides, cholesterol and LDL in all four groups. Only the level of HDL was higher in GIV>GIII>GII>GI (75.84±13.95, 68.56±15.28, 64.17±13.93, 63.17±14.34mg/dl, respectively). There were no cases of pre-diabetes in any of the four groups. ConclusionHypercholesterolaemia and hypertriglyceridaemia were not found in any of the persistent asthmatic children, and thus they are not high risk factors for asthma. Similarly, there were no differences in apo-A1 and apo-B between any of the BMI groups. No differences were found in LDL levels, however HDL levels were increased in all four groups, indicating that allergic sensitisation may have occurred. Controlling body weight and restricting calorie intake may be as important as appropriate pharmacological management in controlling asthma." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Apo-A1, apolipoprotein A1; Apo B, apolipoprotein B; HDL, high density lipoprotein cholesterol; LDL, low density lipoprotein cholesterol; TC, triglyceride." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group</th><th class="td" title="table-head " align="left" valign="top" scope="col">p value \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Normal weight [BMI 20–24.9] (n=30) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Underweight [BMI<20] (n=30) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overweight [BMI 25–30] (n=25) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Obesity [BMI>30] (n=25) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Mean±SD</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glucose (AC) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.73±6.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.60±7.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.88±8.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85±5.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.154 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Insulin (AC) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.48±4.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.13±4.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.08±4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.75±1.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.166 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HbA1C (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.01±0.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.25±0.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.13±0.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.06±0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.016<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Apo-A1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">125.37±23.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130.10±16.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130.6±18.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">121.64±19.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.312 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Apo-B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79.07±19.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.90±17.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79.2±18.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.48±19.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.056 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cholesterol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">160.30±44.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">163.17±32.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">164.84±35.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">168.20±41.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.898 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HDL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.17±14.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.17±13.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.56±15.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.84±13.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.007<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.67±32.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.10±26.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.28±28.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100.04±27.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.366 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101.00±54.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.30±57.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102.44±66.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99.32±64.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.597 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1120663.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "The HDL concentration was obviously increased in the obese and overweight children (p<0.05) and the levels of fasting blood sugar and fasting insulin were within normal limits." ] ] ] "descripcion" => array:1 [ "en" => "Lipid profiles in school children with persistent asthma (ANOVA)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib0170" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The international study of asthma and allergies in childhood (ISAAC) phase three: a global synthesis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. 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L.-J. Fangb, C.-S. Huanga, Y.-C. Liua, Y.-M. Sua, K.-S. Wana,

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gwan1998@gmail.com

Corresponding author.

a Department of Pediatrics, Taipei City Hospital-Renai Branch, Taiwan

b Department of Pediatrics, Taipei City Hospital-Mother & Child Branch, Taiwan

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The global prevalence rates of current asthma in children aged 6&#8211;7 years and 13&#8211;14 years have been reported to be 11&#46;7&#37; and 14&#46;1&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a> Increasing evidence suggests that obesity is a risk factor for asthma&#44; and that weight loss can improve symptoms&#46; Improved clinical findings have also been associated with decreased levels of serum cholesterol and triglycerides&#44; striking reductions in markers of oxidative stress and increased levels of the antioxidant uric acid&#46; The pro-inflammatory role of serum cholesterol in asthma has been studied with contradicting results&#46; A modest but significant association between higher levels of serum cholesterol and asthma&#44; independent of age&#44; gender&#44; body mass index &#40;BMI&#41;&#44; socio-economic status and serum high sensitivity C reactive protein has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a> Moreover&#44; hypercholesterolaemia and obesity have been reported to independently increase the risk of asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">3</span></a> Compliance with an alternative day calorie restriction diet has been reported to be associated with improvements in symptoms and pulmonary function&#44; and reductions in oxidative stress and inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">4</span></a> In addition&#44; Buchowski showed that oxidative stress can be rapidly reduced and the reduction sustained through a modest reduction in caloric intake&#44; suggesting potential health benefits for overweight and obese women&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">5</span></a> However&#44; Ouyang reported that although adiposity is associated with asthma&#44; a higher percentage of body fat&#44; and lower high-density lipoprotein &#40;HDL&#41; and higher low-density lipoprotein &#40;LDL&#41; levels were associated with a greater risk of allergic sensitisation mostly in lean Chinese subjects&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">6</span></a> Thus&#44; a genetic influence on these traits may exist&#46; Ahmad reported that gender and ethnicity were significantly associated with asthma&#44; and that obesity was positively associated with asthma in children aged 13&#8211;17 years&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">7</span></a> In addition&#44; Fessler reported that cholesterol promotes Th2 immunity and allergic inflammation in rodents&#46; Reports of both direct and inverse associations between serum cholesterol and atopy in different populations suggest that ethnicity or other demographic variables may modify these relationships&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">8</span></a> Asthma and obesity are associated disorders&#44; however the mechanisms responsible for this relationship are unclear&#46; The aim of this study was to examine the lipid profiles of mild to moderate asthmatic children and investigate the association between dyslipidaemia and asthma and the effect of asthma and obesity on hyperlipidaemia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">Renai and Mother &#38; Child branches of Taipei City Hospital participated in this study&#44; and the research protocol was approved by the Institutional Review Board of each branch&#46; From January 1&#44; 2013 to October 23&#44; 2014&#44; 160 persistent asthmatic patients &#40;asthma symptoms &#8805;3 days per week or &#8805;3 nights per week&#41; aged 6&#8211;17 years with asthma diagnosed by a doctor were asked to participate in this study&#46; We excluded patients who had used systemic corticosteroids two weeks before the study&#46; The participants were divided into four groups based on BMI&#58; Group I normal weight &#40;BMI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#8211;25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&#59; Group II under-weight &#40;BMI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&#59; Group III overweight &#40;BMI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#8211;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&#59; and Group IV obese &#40;BMI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&#46; Fasting blood sugar&#44; fasting insulin&#44; and HbA1c were measured to exclude the possibility of pre-diabetes&#46; Lipid profiles including total cholesterol&#44; HDL&#44; LDL&#44; apo-A1&#44; apo-B and triglycerides were measured before breakfast&#46; All parents&#47;guardians of participants gave informed consent &#40;as the legal age of consent in Taiwan is 20&#41;&#46; SPSS software &#40;version 1&#46;2 for Windows&#59; SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41; was used for all analyses&#46; A <span class="elsevierStyleItalic">p</span>-value of less than 0&#46;05 was considered to be statistically significant&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0015" class="elsevierStylePara elsevierViewall">The lipid profiles of the four groups showed that the level of HDL increased in the following order&#58; obesity<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>overweight<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>underweight<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>normal weight &#40;75&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;95&#44; 68&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;28&#44; 64&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;93&#44; and 63&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41;&#46; There were no significant differences in cholesterol&#44; triglyceride and LDL levels in all four groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Levels of fasting blood sugar and fasting insulin were within normal limits in all of the four groups&#46; There were no cases of pre-diabetes in any of the four groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">The association between hypercholesterolaemia and obesity with airway hyperresponsiveness has drawn increasing attention due to the potential role of cholesterol and lipid homeostasis in lung physiology and asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">9</span></a> However&#44; the mechanism responsible for this obesity-asthma association is unknown&#46; A high-fat meal can lead to significant increases in nitric oxide &#40;FeNO&#41;&#44; total cholesterol&#44; and especially triglycerides&#46; This suggests that a high-fat diet may contribute to chronic inflammatory diseases of the airway and lungs&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a> The disease burden of asthma appeared normal in normal weight and slightly overweight women rather than obese and markedly obese women suggests that the development of asthma may be a point on the trajectory of chronic obesity or that asthma and obesity are concurrent disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">11</span></a> Asthma and obesity are associated disorders&#44; however obesity in patients with difficult-to-treat asthma has been reported to be inversely related with sputum eosinophils and exhaled FeNO&#44; and positively associated with the presence of co-morbid factors and reduced lung volume&#46; In addition&#44; a higher BMI has been reported to be associated with elevated FeNO&#46; This suggests that factors other than airway inflammation alone may explain the relationship between obesity and severity of asthma&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">12&#44;13</span></a> In addition&#44; obese adolescent males with mild persistent asthma have been reported to have a significantly higher prevalence of metabolic syndrome than obese males without asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> Thus&#44; when studying the lipid profile of asthmatic patients&#44; those with pre-diabetes should be excluded&#46; Studies exploring the effect on obesity of eating fast food and watching television have reported that frequent and very frequent consumption of fast food was associated with a higher BMI in children&#44;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">15&#44;16</span></a> and that a higher number of hours of watching television was positively associated with BMI in both adolescents and children with an apparent dose response effect&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a> Therefore&#44; it seems that all risk factors for obesity are related to asthma and even asthma exacerbation&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although cholesterol exerts complex effects on inflammation&#44; the relationship between cholesterol and asthma&#47;wheezing has been reported to be independent of BMI and C reactive protein and similar between atopic and non-atopic participants&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a> Plasma secretory A2 &#40;sPLA2&#41; has been shown to have functions relevant to asthmatic inflammation&#44; including eicosanoid synthesis and effects on dendritic cells and T cells&#44; and also to provide a biological link between asthma&#44; inflammation&#44; increased BMI&#44; lipid metabolism and antioxidants&#46; Interactions among these factors may be pertinent to the pathophysiology and increasing prevalence of both asthma and obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a> El-Shaboury reported a significant increase in the incidence of endogenous hypertriglyceridaemia but not of hypercholesterolaemia in asthmatic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a> Another study established a critical role of ATP-binding cassette transporter A1 in reverse cholesterol and phospholipids transport in airway smooth muscle cells&#44; suggesting that dysregulation of cholesterol homeostasis in these cells may be important in the pathogenesis of asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It has recently been shown that diet-induced dyslipidaemia alters trafficking of immune cells to the lung in a manner that may have important implications for the pathogenesis of acute lung injury&#44; asthma&#44; and pneumonia&#46; Conversely&#44; cholesterol-targeting pharmacological agents such as statins&#44; apolipoprotein mimetic peptides&#44; and liver X receptor agonists have shown early promise in the treatment of several lung disorders including asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">21</span></a> Apolipoprotein A1 &#40;apo-A1&#41; is a key component of HDL that mediates reverse cholesterol transport from cells and reduces vascular inflammation&#46; In an animal model&#44; endogenous apo-A1 was found to negatively regulate OVA-induced neutrophilic airway inflammation&#44; primarily via a G-CSF-dependent mechanism&#46; This suggests that apo-A1 may play an important role in modulating the severity of neutrophilic airway inflammation in asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">22</span></a> Apo-A1 mimetic peptides have been shown to attenuate airway inflammation&#44; airway remodelling&#44; and airway hyperreactivity in murine models of experimental asthma&#46; Thus&#44; site-directed delivery of apo-A1 mimetic peptides may represent a novel treatment approach for asthma&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">23&#8211;25</span></a> Cholesterol-lowering drugs &#40;or statins&#41; possess pleiotropic immunomodulatory properties&#44; and this has opened a new area of research regarding the anti-inflammatory and anti-proliferative properties of statins&#46; Thus&#44; statins may modulate mevalonate-dependent and independent pathways&#44; and the emerging area of cholesterol&#44; sphingolipid&#44; and lipid raft biology in lung diseases may lead to new therapeutic targets&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">26</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The mean plasma lipid level after long-term slow-release theophylline treatment has been reported to be significantly higher than that before treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">27</span></a> However&#44; Allayee showed that serum levels of all lipids were significantly lower in patients taking montelukast and theophylline compared to a placebo&#44; and thus asthma medication may have some beneficial effects for asthmatics with respect to the risk of cardiovascular disease&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">28</span></a> No significant changes in serum fasting triglyceride concentrations have been reported before and after inhaled corticosteroid therapy&#44; and only high-dose inhaled corticosteroids have been reported to have a minor effect on lipid metabolism after long periods of use in asthmatic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">29</span></a> Moreover&#44; beta 2-adrenergic stimulation has been reported to have no effect on basal serum lipid levels&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">30</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In the current study&#44; the HDL concentration was obviously increased in the obese and overweight children and even in the normal weight and underweight group&#44; however the cholesterol and triglyceride levels were within normal limits in all of the four study groups&#46; This means that persistent asthma and even asthma exacerbations occurred independently of the lipid profit of the participants&#46; Hypercholesterolaemia is a risk factor for asthma&#44; independent of obesity&#44; and serum total cholesterol and non-HDL have been reported to be inversely related to asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a> This is in contrast to Chen&#39;s study&#44; in which asthma was associated with high LDL levels and this association was amplified in overweight and obese subjects&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">31</span></a> Moreover&#44; our results are different from other studies which showed that high serum triglyceride and low serum HDL levels were associated with wheezing after adjusting for adiposity&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">32&#44;33</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; understanding the relationship between lipid profiles and asthma does not completely clarify why the prevalence of asthma is higher in obese children&#46; However&#44; body weight control with a restricted calorie intake may become a therapeutic treatment for children with asthma&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Protection of human subjects and animals in research</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Confidentiality of data</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Right to privacy and informed consent</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have obtained the informed consent of the patients and&#47;or subjects mentioned in the article&#46; The author for correspondence is in possession of this document&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">All authors declare that there are no conflicts of interest that may be inherent in this submission&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "titulo" => "Background"
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          "titulo" => "Keywords"
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          "titulo" => "Introduction"
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          "titulo" => "Ethical disclosures"
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            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Protection of human subjects and animals in research"
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              "identificador" => "sec0035"
              "titulo" => "Confidentiality of data"
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              "titulo" => "Right to privacy and informed consent"
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    "fechaRecibido" => "2015-06-19"
    "fechaAceptado" => "2015-12-03"
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          "palabras" => array:6 [
            0 => "Lipid profile"
            1 => "Obesity"
            2 => "Asthmatic children"
            3 => "Hypercholesterolemia"
            4 => "Hypertriglyceridemia"
            5 => "Pre-diabetes"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A relationship between asthma and obesity has been documented in children and adolescents&#46; An alternate day calorie restriction diet has been reported to improve asthma symptoms by decreasing levels of serum cholesterol and triglycerides&#44; reducing markers of oxidative stress and increasing levels of the antioxidant uric acid&#46; Therefore&#44; to investigate the lipid profile in asthmatic children may be important in asthma control treatment&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">One hundred and sixty newly diagnosed persistent asthmatic children were selected to participate in the study&#46; They were divided into four groups based on their body mass index &#40;BMI&#41;&#58; Group I normal weight &#40;BMI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#8211;24&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&#59; Group II under-weight &#40;BMI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&#59; Group III overweight &#40;BMI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#8211;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&#59; and Group IV obese &#40;BMI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&#46; Fasting blood sugar&#44; fasting insulin&#44; and HbA1c were measured to exclude the possibility of pre-diabetes&#46; Lipid profile measurements included total cholesterol&#44; high-density lipoprotein &#40;HDL&#41;&#44; low-density lipoprotein &#40;LDL&#41;&#44; apo-A1&#44; apo-B and triglycerides&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were no significant differences in the levels of apo-A1&#44; apo-B&#44; triglycerides&#44; cholesterol and LDL in all four groups&#46; Only the level of HDL was higher in GIV<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>GIII<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>GII<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>GI &#40;75&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;95&#44; 68&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;28&#44; 64&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;93&#44; 63&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;34<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; respectively&#41;&#46; There were no cases of pre-diabetes in any of the four groups&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hypercholesterolaemia and hypertriglyceridaemia were not found in any of the persistent asthmatic children&#44; and thus they are not high risk factors for asthma&#46; Similarly&#44; there were no differences in apo-A1 and apo-B between any of the BMI groups&#46; No differences were found in LDL levels&#44; however HDL levels were increased in all four groups&#44; indicating that allergic sensitisation may have occurred&#46; Controlling body weight and restricting calorie intake may be as important as appropriate pharmacological management in controlling asthma&#46;</p></span>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Apo-A1&#44; apolipoprotein A1&#59; Apo B&#44; apolipoprotein B&#59; HDL&#44; high density lipoprotein cholesterol&#59; LDL&#44; low density lipoprotein cholesterol&#59; TC&#44; triglyceride&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Normal weight &#91;BMI 20&#8211;24&#46;9&#93; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Underweight &#91;BMI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20&#93;<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overweight &#91;BMI 25&#8211;30&#93;<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Obesity &#91;BMI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30&#93;<br>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Mean</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Glucose &#40;AC&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Insulin &#40;AC&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;166&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HbA1C &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;01<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;016<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Apo-A1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">125&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&#46;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">121&#46;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;312&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Apo-B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;90<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;056&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cholesterol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">160&#46;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>44&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">163&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>32&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">164&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">168&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>41&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;898&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HDL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;007<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LDL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>32&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#46;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&#46;58&nbsp;\t\t\t\t\t\t\n
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]

Article information

ISSN: 03010546
Original language: English

DOI:10.1016/j.aller.2015.12.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	4	0	4
2024 October	22	8	30
2024 September	23	22	45
2024 August	19	14	33
2024 July	17	6	23
2024 June	15	6	21
2024 May	19	10	29
2024 April	21	6	27
2024 March	23	12	35
2024 February	18	7	25
2024 January	10	9	19
2023 December	10	2	12
2023 November	21	6	27
2023 October	11	11	22
2023 September	11	3	14
2023 August	14	8	22
2023 July	15	9	24
2023 June	19	18	37
2023 May	40	23	63
2023 April	50	9	59
2023 March	42	1	43
2023 February	30	7	37
2023 January	23	4	27
2022 December	17	5	22
2022 November	18	7	25
2022 October	17	5	22
2022 September	13	14	27
2022 August	11	7	18
2022 July	12	9	21
2022 June	11	10	21
2022 May	32	8	40
2022 April	9	7	16
2022 March	15	7	22
2022 February	15	6	21
2022 January	16	7	23
2021 December	14	9	23
2021 November	7	10	17
2021 October	13	9	22
2021 September	16	11	27
2021 August	3	7	10
2021 July	18	7	25
2021 June	10	9	19
2021 May	12	5	17
2021 April	33	19	52
2021 March	11	9	20
2021 February	14	10	24
2021 January	10	5	15
2020 December	2	0	2
2020 October	1	0	1
2020 July	0	1	1
2018 February	2	2	4
2018 January	4	3	7
2017 December	7	1	8
2017 November	8	5	13
2017 October	3	2	5
2017 September	6	2	8
2017 August	7	3	10
2017 July	6	4	10
2017 June	4	8	12
2017 May	5	3	8
2016 July	1	0	1

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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