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Pediatrics

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

JAMA Dermatology

Published Online: November 17, 2021

Original Investigation

Article Information and Disclosures

Mathew N. Nicholas, MD¹;

Charles D. G. Keown-Stoneman, PhD^2,3;

Jonathon L. Maguire, MD, MSc^2,4,5,6;

Aaron M. Drucker, MD, ScM^1,4,7

Author Affiliations

¹Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
²The Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
³Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
⁴Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
⁵Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
⁶Department of Pediatrics, St Michael’s Hospital, Toronto, Ontario, Canada
⁷Division of Dermatology, Department of Medicine and Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada

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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.

References

Asher MI , Montefort S , Björkstén B , et al; ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006;368(9537):733-743. doi:10.1016/S0140-6736(06)69283-0 PubMed Google Scholar Crossref

Harris JM , Williams HC , White C , et al. Early allergen exposure and atopic eczema. Br J Dermatol. 2007;156(4):698-704. doi:10.1111/j.1365-2133.2006.07710.x PubMed Google Scholar Crossref

Paller AS , McAlister RO , Doyle JJ , Jackson A . Perceptions of physicians and pediatric patients about atopic dermatitis, its impact, and its treatment. Clin Pediatr (Phila). 2002;41(5):323-332. doi:10.1177/000992280204100505 PubMed Google Scholar Crossref

Wadonda-Kabondo N , Sterne JAC , Golding J , Kennedy CTC , Archer CB , Dunnill MGS ; ALSPAC Study Team. A prospective study of the prevalence and incidence of atopic dermatitis in children aged 0-42 months. Br J Dermatol. 2003;149(5):1023-1028. doi:10.1111/j.1365-2133.2003.05605.x PubMed Google Scholar Crossref

Ramirez FD , Chen S , Langan SM , et al. Association of atopic dermatitis with sleep quality in children. JAMA Pediatr. 2019;173(5):e190025. doi:10.1001/jamapediatrics.2019.0025 PubMed Google Scholar

Xu X , van Galen LS , Koh MJA , et al. Factors influencing quality of life in children with atopic dermatitis and their caregivers: a cross-sectional study. Sci Rep. 2019;9(1):15990. doi:10.1038/s41598-019-51129-5 PubMed Google Scholar Crossref

Silverberg JI . Comorbidities and the impact of atopic dermatitis. Ann Allergy Asthma Immunol. 2019;123(2):144-151. doi:10.1016/j.anai.2019.04.020 PubMed Google Scholar Crossref

Pike MG , Chang CL , Atherton DJ , Carpenter RG , Preece MA . Growth in atopic eczema: a controlled study by questionnaire. Arch Dis Child. 1989;64(11):1566-1569. doi:10.1136/adc.64.11.1566 PubMed Google Scholar Crossref

Kristmundsdottir F , David TJ . Growth impairment in children with atopic eczema. J R Soc Med. 1987;80(1):9-12. doi:10.1177/014107688708000106 PubMed Google Scholar Crossref

Palit A , Handa S , Bhalla AK , Kumar B . A mixed longitudinal study of physical growth in children with atopic dermatitis. Indian J Dermatol Venereol Leprol. 2007;73(3):171-175. doi:10.4103/0378-6323.32740 PubMed Google Scholar

Ellison JA , Patel L , Kecojevic T , Foster PJ , David TJ , Clayton PE . Pattern of growth and adiposity from infancy to adulthood in atopic dermatitis. Br J Dermatol. 2006;155(3):532-538. doi:10.1111/j.1365-2133.2006.07400.x PubMed Google Scholar Crossref

Massarano AA , Hollis S , Devlin J , David TJ . Growth in atopic eczema. Arch Dis Child. 1993;68(5):677-679. doi:10.1136/adc.68.5.677 PubMed Google Scholar Crossref

Silverberg JI , Paller AS . Association between eczema and stature in 9 US population-based studies. JAMA Dermatol. 2015;151(4):401-409. doi:10.1001/jamadermatol.2014.3432 PubMed Google Scholar Crossref

Zhang A , Silverberg JI . Association of atopic dermatitis with being overweight and obese: a systematic review and metaanalysis. J Am Acad Dermatol. 2015;72(4):606-16.e4. doi:10.1016/j.jaad.2014.12.013 PubMed Google Scholar Crossref

Carsley S , Borkhoff CM , Maguire JL , et al; TARGet Kids! Collaboration. Cohort profile: The Applied Research Group for Kids (TARGet Kids!). Int J Epidemiol. 2015;44(3):776-788. doi:10.1093/ije/dyu123 PubMed Google Scholar Crossref

Silverberg JI , Patel N , Immaneni S , et al. Assessment of atopic dermatitis using self-report and caregiver report: a multicentre validation study. Br J Dermatol. 2015;173(6):1400-1404. doi:10.1111/bjd.14031 PubMed Google Scholar Crossref

WHO Multicentre Growth Reference Study Group. WHO child growth standards based on length/height, weight and age. Acta Paediatr Suppl. 2006;450:76-85.PubMed Google Scholar

de Onis M , Onyango AW , Borghi E , Siyam A , Nishida C , Siekmann J . Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85(9):660-667. doi:10.2471/BLT.07.043497 PubMed Google Scholar Crossref

Promoting optimal monitoring of child growth in Canada: using the new World Health Organization growth charts—executive summary. Paediatr Child Health. 2010;15(2):77-83. doi:10.1093/pch/15.2.77 PubMed Google Scholar Crossref

World Health Organization. WHO child growth standards. Accessed April 2021. https://www.who.int/childgrowth/software/readme_r.pdf

van Buuren S , Groothuis-Oudshoorn K . mice: Multivariate imputation by chained equations in R. J Stat Softw. 2011;45(3):1-67. doi:10.18637/jss.v045.i03 Google Scholar

R Foundation for Statistical Computing. R: A language and environment for statistical computing. [computer program]. R Foundation for Statistical Computing; 2019.

Naimi AI . Tyler J VanderWeele. Explanation in Causal Inference: Methods for Mediation and Interaction. Oxford University Press, 2015 [book review]. Eur J Epidemiol. 2016;31(10):1065-1066. doi:10.1007/s10654-016-0189-8 Google Scholar Crossref

Harrell JFE . Regression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis. 2nd ed. Springer International Publishing; 2015. doi:10.1007/978-3-319-19425-7

Park MK , Park KY , Li K , Seo SJ , Hong CK . The short stature in atopic dermatitis patients: are atopic children really small for their age? Ann Dermatol. 2013;25(1):23-27. doi:10.5021/ad.2013.25.1.23 PubMed Google Scholar Crossref

Kim TW , Jeong J-H , Hong S-C . The impact of sleep and circadian disturbance on hormones and metabolism. Int J Endocrinol. 2015;2015:591729. doi:10.1155/2015/591729 PubMed Google Scholar

Zhou Y , Aris IM , Tan SS , et al. Sleep duration and growth outcomes across the first two years of life in the GUSTO study. Sleep Med. 2015;16(10):1281-1286. doi:10.1016/j.sleep.2015.07.006 PubMed Google Scholar Crossref

Paller AS , Siegfried EC , Thaçi D , et al. Efficacy and safety of dupilumab with concomitant topical corticosteroids in children 6 to 11 years old with severe atopic dermatitis: a randomized, double-blinded, placebo-controlled phase 3 trial. J Am Acad Dermatol. 2020;83(5):1282-1293. doi:10.1016/j.jaad.2020.06.054 PubMed Google Scholar Crossref

Dvorakova V , O’Regan GM , Irvine AD . Methotrexate for severe childhood atopic dermatitis: clinical experience in a tertiary center. Pediatr Dermatol. 2017;34(5):528-534. doi:10.1111/pde.13209 PubMed Google Scholar Crossref

Harper JI , Ahmed I , Barclay G , et al. Cyclosporin for severe childhood atopic dermatitis: short course versus continuous therapy. Br J Dermatol. 2000;142(1):52-58. doi:10.1046/j.1365-2133.2000.03241.x PubMed Google Scholar Crossref

Esteller E , Villatoro JC , Agüero A , et al. Obstructive sleep apnea syndrome and growth failure. Int J Pediatr Otorhinolaryngol. 2018;108:214-218. doi:10.1016/j.ijporl.2018.03.011 PubMed Google Scholar Crossref

Aljebab F , Choonara I , Conroy S . Systematic review of the toxicity of long-course oral corticosteroids in children. PLoS One. 2017;12(1):e0170259-e0170259. doi:10.1371/journal.pone.0170259 PubMed Google Scholar Crossref

Kelly HW , Sternberg AL , Lescher R , et al; CAMP Research Group. Effect of inhaled glucocorticoids in childhood on adult height. N Engl J Med. 2012;367(10):904-912. doi:10.1056/NEJMoa1203229 PubMed Google Scholar Crossref

Han J , Nguyen J , Kim Y , et al. Effect of inhaled corticosteroid use on weight (BMI) in pediatric patients with moderate-severe asthma. J Asthma. 2019;56(3):263-269. doi:10.1080/02770903.2018.1455853 PubMed Google Scholar Crossref

Patel L , Clayton PE , Jenney ME , Ferguson JE , David TJ . Adult height in patients with childhood onset atopic dermatitis. Arch Dis Child. 1997;76(6):505-508. doi:10.1136/adc.76.6.505 PubMed Google Scholar Crossref

Patel L . Growth and chronic disease. Annales Nestlé (English ed). 2007;65(3):129-136. doi:10.1159/000112235 Google Scholar Crossref

Low D-W , Jamil A , Md Nor N , Kader Ibrahim SB , Poh BK . Food restriction, nutrition status, and growth in toddlers with atopic dermatitis. Pediatr Dermatol. 2020;37(1):69-77. doi:10.1111/pde.14004 PubMed Google Scholar Crossref

Silverberg JI , Kleiman E , Lev-Tov H , et al. Association between obesity and atopic dermatitis in childhood: a case-control study. J Allergy Clin Immunol. 2011;127(5):1180-6.e1. doi:10.1016/j.jaci.2011.01.063 PubMed Google Scholar Crossref

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