Atopic Dermatitis Associated with Short Stature, High BMI in Children

Aaron M. Drucker, MD, ScM

New data from Canada suggested that atopic dermatitis was associated with shorter stature, higher body mass index, and lower weight in early childhood.

Despite this, the associations were considered small. Regarding height and BMI, these associations were attenuated with age and resolved by adolescence.

Investigators led by Aaron M. Drucker, MD, ScM, Women’s College Hospital in Toronto, noted that several smaller studies had found associations between atopic dermatitis and lower height in children.

However, the largest US study found no such association, and there had been more evidence to support an association between the disease and excess weight.

As such, Drucker and colleagues intended to better characterize the association between atopic dermatitis and growth trajectories in a cohort study of children in the Toronto area.

The Methods

Drucker and investigators used data from a prospective, longitudinal cohort study TARGet Kids!, alternatively known as The Applied Research Group for Kids.

Since June 2008, children aged 5 and younger were enrolled into the study and followed up into adolescence with an ongoing, open longitudinal cohort study that evaluated multiple health conditions, which lasted until February 2021.

A total of 10,611 children were included in the present analysis, with a mean baseline age of 23 months. Nearly half of all participants were female (47.8%).

The primary exposure of the study was atopic dermatitis, which was assessed by a parental report on baseline as well as a series of follow-up questionnaires in response to the question “Has your child been diagnosed with any of the following conditions? Please check ALL that apply”, followed by “Eczema/Atopic Dermatitis” being 1 of several conditions listed.

The height of each participating child was measured with a calibrated stadiometer (Seca) for children older than 2 years, and length boards were utilized for children younger than 2 years.

Weight was measured using a precision digital scale (Seca) to the nearest 0.01 kg, while BMI was calculated by dividing weight in kilograms by height in meters squared.

The primary outcomes of the study were height and BMI, while secondary outcome was weight-for-age z scores.

The Findings

Investigators recorded Atopic dermatitis was associated with lower mean z-height (−0.13; 95% CI, −0.17 to −0.09; P < .001) compared with children without atopic dermatitis, after adjusting for co- variates

Based on World Health Organization (WHO) growth tables, the model estimated that children with atopic dermatitis were, on average, approximately 0.5 cm shorter at age 2 years and 0.6 cm shorter at age 5 years than children without atopic dermatitis after adjusting for the covariates.

Such differences were attenuated with older age and became similar once the children reached 14 years, however.

Atopic dermatitis was also associated with higher mean z-BMI (0.05; 95% CI, 0.01 to 0.09; P = .008) compared with children without atopic dermatitis, after adjusting for covariates.

Additionally, atopic dermatitis was associated with lower mean z-weight (−0.07; 95% CI, −0.10 to −0.04; P < .001). Despite this, there was no evidence of an interaction between atopic dermatitis and age at a 5% level of significance (P = .08).

Overall, though these associations between atopic dermatitis and height and weight were prevalent in their study, investigators were unsure of whether these associations would persist throughout childhood.

“Prospective studies with longer time horizons are needed to measure longer-term associations and to evaluate the potential mediating effects of atopic dermatitis disease severity, associated sleep disturbance, and treatment,” the team wrote.

The study, “Association Between Atopic Dermatitis and Height, Body Mass Index, and Weight in Children,” was published online in JAMA Dermatology.