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Association Between Atopic Dermatitis and Height, Body Mass Index, and Weight in Children

Educational Objective
To describe the association between atopic dermatitis and heigh, body mass index, and weight among children.
1 Credit CME
Key Points

Question  What are the associations between atopic dermatitis and height, body mass index (BMI), and weight in children?

Findings  In this cohort study of 10 611 children (1834 with atopic dermatitis), atopic dermatitis was associated with somewhat shorter stature and higher BMI among young children, but these associations attenuated by age 14 years and 5.5 years, respectively. Atopic dermatitis was associated with somewhat decreased weight, and this association did not change with age.

Meaning  Associations between atopic dermatitis and decreased height and increased BMI in early childhood may be transient, with correction by adolescence; somewhat decreased weight may persist with age.

Abstract

Importance  Atopic dermatitis may be associated with short stature and obesity in children, but most previous studies have been either small or cross-sectional.

Objective  To evaluate the association between atopic dermatitis and height, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and weight throughout childhood.

Design, Setting, and Participants  TARGet Kids! (The Applied Research Group for Kids) is an ongoing prospective longitudinal cohort study that collects data at routine physician visits throughout childhood. In this cohort, children aged 5 or younger were followed up into adolescence at regular physician visits at general pediatric and family practices in Toronto, Canada, from June 2008 to February 2021.

Exposure  Parental report of atopic dermatitis.

Main Outcomes and Measures  Primary outcomes were length-for-age and BMI-for-age z scores. The secondary outcome was weight-for-age z score. Linear mixed effects models were used to estimate associations between atopic dermatitis and each outcome. In secondary analyses, interaction terms were included between atopic dermatitis and age.

Results  A total of 10 611 children were included in the analysis, with mean (SD) baseline age of 23 (20) months; 5070 (47.8%) participants were female. Participants were followed for a median (range) of 28.5 (0.0-158.0) months. A total of 1834 (17.3%) children had atopic dermatitis during follow-up. Atopic dermatitis was associated with lower length-for-age z score (−0.13; 95% CI, −0.17 to −0.09; P < .001), higher BMI z score (0.05; 95% CI, 0.01 to 0.09; P = .008), and lower weight-for-age z score (−0.07; 95% CI, −0.10 to −0.04; P < .001) compared with children without atopic dermatitis. The associations between atopic dermatitis and height and BMI changed with age, diminishing by age 14 years and 5.5 years, respectively. Based on World Health Organization growth tables, children with atopic dermatitis were on average 0.5 cm shorter with 0.2 more BMI units at age 2 years and 0.6 cm shorter with no difference in BMI at age 5 years than children without atopic dermatitis after adjusting for covariates. There was no evidence of interaction between atopic dermatitis and age with respect to weight.

Conclusions and Relevance  In this cohort study, atopic dermatitis was associated with shorter stature, higher BMI, and lower weight in early childhood, but these associations were small and, for height and BMI, attenuated with age and resolved by adolescence.

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Article Information

Accepted for Publication: September 19, 2021.

Published Online: November 17, 2021. doi:10.1001/jamadermatol.2021.4529

Corresponding Author: Aaron M. Drucker, MD, ScM, Women’s College Hospital, 76 Grenville St, Toronto, ON M5S1B2, Canada (aaron.drucker@wchospital.ca).

Author Contributions: Dr Nicholas had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Maguire and Drucker contributed equally as co–senior authors.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Nicholas.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Nicholas, Keown-Stoneman, Maguire.

Obtained funding: Maguire, Drucker.

Administrative, technical, or material support: Keown-Stoneman, Maguire.

Supervision: Keown-Stoneman, Maguire, Drucker.

Conflict of Interest Disclosures: Dr Drucker reported receiving compensation from the British Journal of Dermatology (reviewer and Section Editor), the American Academy of Dermatology (guidelines writer), and the National Eczema Association (grant reviewer) and has served as a paid consultant for the Canadian Agency for Drugs and Technologies in Health outside the submitted work. No other disclosures were reported.

Funding/Support: Funding for this study was obtained from the Department of Medicine, Women’s College Hospital and the Canadian Institutes of Health Research.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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