Association between childhood atopic dermatitis, malnutrition, and low bone mineral density: A US population‐based study. Issue 1 (February 2015)

• Record Type: Journal Article
• Authors: Silverberg, Jonathan I.
• Is Part Of: Pediatric allergy and immunology. Volume 26:Issue 1(2015)
• Page Start: 54
• Page End: 61
• Publication Date: 2015-02
• Subjects: Allergy in children -- Periodicals; Immunologic diseases in children -- Periodicals; 617
• DOI: 10.1111/pai.12315
• Languages: English
• ISSNs: 0905-6157

Abstract

<abstract abstract-type="main" id="pai12315-abs-0001"> <title>Abstract</title> <sec id="pai12315-sec-0001" sec-type="section"> <title>Background</title> <p>Children with atopic dermatitis (AD) have multiple risk factors for low bone mineral density (BMD).</p> </sec> <sec id="pai12315-sec-0002" sec-type="section"> <title>Methods</title> <p>We analyzed data from 3049 children and adolescents aged 8–19 yrs from the 2005–2006 National Health and Nutrition Examination Survey, including a cross‐sectional questionnaire, dual energy X‐ray absorptiometry, and blood samples.</p> </sec> <sec id="pai12315-sec-0003" sec-type="section"> <title>Results</title> <p>In multivariate models that controlled for age, sex, race/ethnicity, level of education and household income, body mass index (BMI), and smoking in the household, AD was associated with lower BMD <italic>z</italic>‐score for the total femur (survey linear regression; adjusted β [95% CI]: −0.42 [0.68, −0.16]), including trochanter (−0.29 [−0.54, −0.05]) and femoral neck (−0.29 [−0.53, −0.05]) and total lumbar spine (−0.31 [−0.52, −0.11]). Children with AD had higher median levels of serum IgE (110.0 vs. 53.0 kU/l), peripheral lymphocyte (2.9 vs. 2.5 × 10<sup>3</sup> cells/μl), and eosinophil counts (0.3 vs. 0.2 × 10<sup>3</sup> cells/μl) (Mann–Whitney <italic>U</italic>‐test, p ≤ 0.003 for all), but not CRP levels (0.03 vs. 0.04 mg/dl) and higher odds of 25‐OH vitamin D deficiency (survey logistic regression; odds ratio [OR] [95% CI]: 4.81 [1.21, 20.81]), low calcium (2.56 [1.24, 5.28]), low alkaline phosphatase (2.56 [1.20, 5.44]), and higher tertiles of LDH (tertile 2: 6.36 [1.75, 23.18]; tertile‐3: 4.57 [1.32, 15.85]), but not parathyroid hormone (PTH) or albumin. Finally, children with AD had higher rates of low BMD, that is, BMD <italic>z</italic>‐score <−2, of the femur (23.4% vs. 18.4%) and spine (35.3% vs. 24.5%). In multivariate logistic regression models of low BMD of femur and/or spine using stepwise selection of the 30 sociodemographic and clinical factors, laboratory values, and medications used, AD remained a significant covariate (1.33 [1.32–1.34]). The covariates with the largest effects on low BMD were low PTH and albumin, higher basophil count, Hispanic ethnicity, and BMI <5th percentile. Among children with AD, 56.2% of those with Hispanic origin, 52.8% with BMI <5th percentile, 75.0% with low albumin, and 54.0% with low PTH had low BMD.</p> </sec> <sec id="pai12315-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Children with AD have lower BMD, particularly those with malnutrition and Hispanic ethnicity.</p> </sec> </abstract>