Association of Pediatric Psoriasis Severity With Excess and Central Adiposity

Abstract

Objective Investigate the relationship of excess and central adiposity with pediatric psoriasis severity. Design, Setting and Participants Multi-center, cross-sectional study of 409 psoriatic children. Psoriasis was classified as mild (worst Physician’s Global Assessment (PGA) <3 with body surface area (BSA) <10%) or severe (worst PGA >3 with BSA >10%). Children were enrolled from 9 countries July 2009-December 2011. Main Outcome Measures Excess adiposity (body mass index (BMI) percentile) and central adiposity (waist circumference (WC) percentile and waist-to-height ratio). Results Excess adiposity (BMI >85th percentile) occurred in 37.8% (n=155) of psoriatics vs. 20.5% (n=42) of controls, but did not differ by severity. The odds of obesity (BMI >95th percentile) overall in psoriatics vs. controls were OR=4.29, 95% CI=1.96-9.39, but were higher with severe (OR=4.92, CI=2.20-10.99) than mild (OR=3.60, CI=1.56-8.30) psoriasis, particularly in the U.S. (OR=7.60, CI=2.47-23.34, and OR=4.72, CI=1.43-15.56, respectively). WC >90th percentile occurred in 9.3% (n=19) of controls, 14.0% (n=27) of mild, and 21.2% (n=43) of severe psoriatics internationally, and especially in the U.S. (12.0% of controls, 20.8% of mild, and 31.1% of severe psoriatics). Waist-to-height ratio was significantly higher in psoriatic (0.48) vs. control (0.46) children, but unaffected by psoriasis severity. Children with severe psoriasis at their worst, but mild at enrollment, showed no difference in excess or central adiposity from children who remained severe at enrollment. Conclusion Globally, children with psoriasis have both excess adiposity and increased central adiposity, regardless of severity. The increased metabolic risks associated with excess and central adiposity warrant early monitoring and lifestyle modification.

Childhood psoriasis

“…A mild psoriasis diagnosis is given when less than 3% of the body surface area is affected, for moderate psoriasis the spread is between 3% and 10%, and for severe psoriasis 10% or more of the body surface is affected [13].…”

“…W postaci łagodnej zmiany obejmują mniej niż 3%, a w postaci umiarkowanej 3-10% powierzchni ciała. Zmiany obejmujące powyżej 10% powierzchni ciała wskazują na łuszczycę o ciężkim przebiegu [13].…”

“…Psoriasis in children results in less physical activity, as pruritus intensifies during exercise, and children are reluctant to engage in exercise that would expose their skin lesions. The decreased activity or its total absence may contribute to overweight and obesity [13]. Zhu et al report that in overweight children, the course of psoriasis is more severe than in their counterparts with normal body weight [28].…”

“…The risk profile for our younger patients is still under investigation, but a pattern linking psoriasis and the metabolic syndrome seems to be emerging [1,8,9,13,20,[28][29][30][31][32][33][34].…”

The impact of obesity on psoriasis

“…Jednocześnie stwierdzono, że u otyłych dzieci z łusz-czycą choroby te częściej były obecne w najbliższej rodzinie (odpowiednio 41% i 48%) w porównaniu z dziećmi z łuszczycą i prawidłową masą ciała (odpowiednio 30% i 34%) [16]. Nie ma obecnie badań oceniających wpływ redukcji masy ciała na nasilenie łuszczycy u dzieci, jednak rekomenduje się, aby rodziny, w których stwierdza się łuszczycę i otyłość, obejmować szczególnymi działaniami w zakresie profilaktyki i modyfikacji stylu życia [16]. 306 Dorota Krasowska, Michał Adamczyk dokrynologicznie narząd, który istotnie oddziałuje na homeostazę całego organizmu.…”