Long Term Trends in Asthma Burden Attributable to High Body Mass Index Among Children Aged 0 14?Years in Asia, 1990 2050: An Analysis from the Global Burden of Disease Study 2023.

BACKGROUND: Childhood overweight and obesity represent a growing global public health challenge. Given the substantial socioeconomic heterogeneity across Asia, a systematic assessment of the disease burden attributable to high body mass index (BMI) in children and its evolving characteristics is critical. Within the GBD 2023 risk attribution framework for children, asthma is the only disease outcome currently included. Therefore, this study focuses on the asthma burden attributable to high BMI in children. OBJECTIVE: To systematically analyze the trends and characteristics of asthma burden attributable to high BMI among children aged 0 14 years in Asia from 1990 to 2050. METHODS: Data on the number of disability-adjusted life years (DALYs) and crude DALY rates (CDR) for asthma attributable to high BMI among children in Asian were obtained from the Global Burden of Disease Study (GBD) 2023. Trends were measured using estimated annual percentage change (EAPC), and future projections were made with a Bayesian age-period-cohort (BAPC) model. Spearman's correlation assessed the link between disease burden and the Socio-Demographic Index (SDI), and a decomposition analysis examined drivers of DALY changes. RESULTS: Children in East Asian had the highest CDR for asthma attributable to high BMI (16.28/100,000) in 2023 and experienced the largest increase from 1990 to 2023 (EAPC=1.57%/year), with future trends projected to rise through 2023-2050 (EAPC=4.49%/year). In high-income Asia Pacific, the 2023 CDR (14.49/100,000) reflected a steady decline since 1990 (EAPC=-0.82%/year). Children in South Asian had the lowest CDR (1.94/100,000). In most countries and territories, the increase in CDR was greater among girls than boys, a sex disparity particularly pronounced in South Asia and Southeast Asia. SDI was positively correlated with the CDR (ρ=0.54, P<0.001) and its EAPC during 1990-2023 (ρ=0.33, P=0.021). Decomposition analysis showed epidemiological change as the main driver of East Asia's rising burden. CONCLUSION: The high BMI-attributed asthma burden in children is most severe and rising fastest in East Asia, while South and Southeast Asia show pronounced sex disparities. These findings provide an epidemiological foundation for targeted prevention and control strategies.