BMI Linked to Age of EoE Diagnosis, Symptoms of Nausea

Rebecca Koenigsberg, DO

New research shows body mass index (BMI) is associated with symptoms and age of diagnosis for pediatric patients with eosinophilic esophagitis.

A team, led by Rebecca Koenigsberg, DO, Indiana University, examined the connection between BMI and other factors related to EoE in a study presented during the American Academy of Allergy, Asthma & Immunology Annual Meeting (AAAAI) 2022.

There remains a lack of understanding on how body mass index impacts the risk of EoE for pediatric patients.

Exploring the Data

In the study, the investigators reviewed the records of newly diagnosed pediatric patients with EoE at an academic center between 2015-2018 and collected data regarding demographics, symptom presentation, and endoscopic findings. The data was compared between the normal or underweight individuals and the overweight or obese subpopulations.

The team identified 341 pediatric patients with EoE during the study period, 68.9% (n = 233) were male. The weight class distribution was 67% (n = 231) of the population was normal or underweight and 33% (n = 110) of the study was deemed overweight or obese.

Finding Trends

One interesting aspect falls along the line of when the patients were first diagnosed with the disorder.

Compared to the participants in the normal or underweight cohort, patients who were overweight or obese were more likely to be diagnosed at an older age (P = 0.008). This patient group was also more likely to present with nausea (P = 0.0342) or abdominal pain (P = 0.0433).

On the other hand, the normal cohort of patients were more likely to have an IgE mediated food allergy (P = 0.0181), be tested for food allergies (P = 0.0162), and infant allergies (P = 0.0025), and have vertical lines on endoscopy (P = 0.0328).

There were also sex trends found within the patient population.

For example, females were more likely to be overweight or obese when diagnosed with EoE in comparison to males (P = 0.0449). There was also no significant differences found in the length of symptoms prior to diagnosis, race, insurance, history of atopic dermatitis, asthma, or allergic rhinitis between the 2 groups.

“Obese/overweight children diagnosed with EoE were more likely to be older upon diagnosis; female; and to present with nausea and abdominal pain compared to normal/underweight children,” the authors wrote. “Normal/ underweight children were more likely to have IgE-mediated food allergies and vertical lines on endoscopy compared to obese/overweight children.”

Limitations

The study did feature some limitations that should be noted, specifically the use of parental recall data and non-standardized documentation of symptoms.

The investigators said future research should include assessments of feeding behaviors prior to evaluation and the impact of therapies on symptom management in different BMI categories.

The study, “Body mass index in relation to presenting symptoms and age upon diagnosis of Eosinophilic Esophagitis,” was published online in the Journal of Allergy and Clinical Immunology.