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Association of pediatric psoriasis severity with excess and central adiposity: an international cross-sectional study
Amy S Paller1, Katherine Mercy, Mary J Kwasny
1Department of Dermatology, Northwestern University, 676 N St Clair, Ste 1600, Chicago, IL 60611, USA. apaller@northwestern.edu
Insights
Children with psoriasis globally show higher rates of excess adiposity and central adiposity. Early monitoring and lifestyle changes are recommended due to associated metabolic risks.
Area of Science:
- Pediatric dermatology
- Metabolic health
- Obesity research
Background:
- Psoriasis is a chronic inflammatory disease affecting children.
- Excess adiposity and central adiposity are linked to metabolic complications.
- The relationship between adiposity and pediatric psoriasis severity requires further investigation.
Purpose of the Study:
- To investigate the association between excess adiposity and central adiposity with the severity of pediatric psoriasis.
- To compare adiposity measures in children with and without psoriasis.
- To explore geographical variations in adiposity among psoriatic children.
Main Methods:
- A multicenter, cross-sectional study involving 409 children with psoriasis across 9 countries.
- Psoriasis severity was classified using the Physician's Global Assessment and body surface area.
- Excess adiposity was measured by body mass index percentile, and central adiposity by waist circumference percentile and waist to height ratio.
Main Results:
- Children with psoriasis exhibited higher rates of excess adiposity (37.9%) compared to controls (20.5%).
- Obesity (body mass index ≥95th percentile) was significantly higher in children with psoriasis (OR 4.29), especially severe cases.
- Increased waist circumference was observed in severe psoriasis cases, particularly in the United States, though waist to height ratio was not severity-dependent.
Conclusions:
- Children with psoriasis, irrespective of severity, demonstrate increased excess and central adiposity globally.
- The findings highlight the need for early monitoring and lifestyle interventions to mitigate metabolic risks in pediatric psoriasis patients.
Objective:
To investigate the relationship of excess and central adiposity with pediatric psoriasis severity.
Design, Setting, And Participants:
Multicenter, cross-sectional study of 409 psoriatic children. Psoriasis was classified as mild (worst Physician's Global Assessment score ≤3 with body surface area ≤10%) or severe (worst Physician's Global Assessment score ≥3 with body surface area >10%). Children were enrolled from 9 countries between June 19, 2009, and December 2, 2011.
Main Outcome Measures:
Excess adiposity (body mass index percentile) and central adiposity (waist circumference percentile and waist to height ratio).
Results:
Excess adiposity (body mass index ≥85th percentile) occurred in 37.9% of psoriatic children (n=155) vs 20.5% of controls (n=42) but did not differ significantly by severity. The odds ratio (95% CI) of obesity (body mass index ≥95th percentile) overall in psoriatic children vs controls was 4.29 (1.96-9.39) and was higher with severe (4.92; 2.20-10.99) than with mild (3.60; 1.56-8.30) psoriasis, particularly in the United States (7.60; 2.47-23.34, and 4.72; 1.43-15.56, respectively). Waist circumference above the 90th percentile occurred in 9.3% of the control (n=19), 14.0% of the mild psoriasis (n=27), and 21.2% of the of severe psoriasis (n=43) participants internationally; this incidence was highest in the United States (12.0% [n=13], 20.8% [16], and 31.1% [32], respectively). Waist to height ratio was significantly higher in psoriatic (0.48) vs control (0.46) children but was unaffected by psoriasis severity. Children with severe psoriasis at its worst, but mild at enrollment, showed no significant difference in excess or central adiposity from children whose psoriasis remained severe.
Conclusions:
Globally, children with psoriasis have excess adiposity and increased central adiposity regardless of psoriasis severity. The increased metabolic risks associated with excess and central adiposity warrant early monitoring and lifestyle modification.
Trial Registration:
clinicaltrials.gov Identifier: NCT00879944
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