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Study Links Poor Physical Fitness to Children’s Eye Allergies

CHICAGO, Illinois — Children who are more physically fit seem to be less prone to eye allergies, according to a study of more than 1 million 10-year-olds in Taiwan that was reported at the annual meeting of the American Academy of Ophthalmology (AAO).

Dr Tsai-Chu Yeh

“The rising prevalence of allergic diseases, particularly in the pediatric population, is a serious global public health concern,” lead researcher Tsai-Chu Yeh, MD, said in an AAO press release. “Although symptoms in allergic conjunctivitis are often considered minor, it tends to have a chronic course with multiple recurrent episodes and can negatively affect school performance and quality of life in children.”

The researchers, from the Taipei Veterans General Hospital and National Yang Ming Chiao Tung University in Taipei City, Taiwan, set out to assess the relationship between physical fitness in children and the development of allergic conjunctivitis (AC), Yeh said in an interview with Medscape Medical News.

Physical Fitness in Children

“Increased physical activity has been found to improve musculoskeletal health, cardiovascular outcomes, enhance psychological health, and plays an important role in the growth and development of children,” Yeh said.

“Physical fitness is closely related to physical activity and may be influenced by genetic and environmental factors,” she added. “In contrast with physical activity, physical fitness can be evaluated with objective measures, and therefore stands as an integrated measurement of health status. Yet, the relationship between physical fitness and AC have remained relatively unexplored.”

The study evaluated the 6-year cumulative incidence of AC in 1.27 million 10-year-olds who had at least one year of follow-up. The data were obtained from the following databases: Taiwan’s National Student Fitness Tests (NSFTD), National Health Insurance Research, and Air Quality Monitoring System. The study population took the Taiwanese national fitness test from grades 4 (ages 9 to 10 years) and 13 (ages 18 and 19 years) from 2010 to 2018.

The NSFTD includes results of the annual physical fitness test, including minutes for 800-meter run (cardiorespiratory endurance), number of bent-leg curl-ups (musculoskeletal endurance), distance of standing broad jumps (musculoskeletal power), and distance of two-leg sit-and-reach (flexibility fitness). The study tracked AC occurrence through national registries.

Study Results

The study divided the population into four different groups based on musculoskeletal power (MP) test results, and found that those in the group with the best MP tests had a 6-year cumulative incidence of AC of 0.64% while those in the worst MP test group had an incidence of 0.88% (P < .001).

A multivariate analysis also found that a number of other factors were associated with AC occurrence, including female sex, worse air quality, greater urbanization, asthma, allergic rhinitis, and antibiotic use. High urbanization conferred almost a fourfold risk — an adjusted hazard ratio of 3.67 — for AC (95% CI, 3.4 to 3.97; P < .001).

“It is by far the largest single study to date and adds significantly to our knowledge on physical fitness and subsequent AC risks,” Yeh told Medscape. “This is the first attempt to characterize physical fitness, determined by objective measure, in children at the population level.

“In light of our results,” Yeh added, “interventions designed to prevent AC should focus not only on reducing environmental pollution but also on improving physical fitness.”

AC May Hinder Physical Fitness

Dr Yi Ning Strube

However, improving physical fitness in this population may not be as straightforward as the study implies, Yi Ning Strube, MD, MS, associate professor of pediatric ophthalmology and adult strabismus at Queen’s University in Kingston, Ontario, told Medscape.

While she called the abundance of physical fitness data on children collected by Taiwan “amazing,” Strube noted that children with AC often have asthma or allergic rhinitis, or both, which can hinder their physical activity.

“I don’t think you can conclude from this study that being less physically fit causes AC, and a more plausible conclusion is that having AC reduces your ability to be physically active, even independent of associated asthma and allergic rhinitis,” Strube said. “Regardless, I think this study emphasizes the importance of diagnosing and treating AC as a disease with significant consequences aside from direct ocular consequences, including reduced physical fitness.”

Yeh said additional studies with longitudinal measurements of physical fitness will be needed to validate the findings and better identify preventive measures.

Yeh has disclosed no relevant financial relationships. Strube disclosed serving as a consultant to Santen Canada.

American Academy of Ophthalmology (AAO) 2022 Annual Meeting: Poster 62. Presented September 29, 2022.

Richard Mark Kirkner is a medical journalist based in the Philadelphia area.

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