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Association between childhood atopic dermatitis, malnutrition, and low bone mineral density: A US population‐based study
Author(s) -
Silverberg Jonathan I.
Publication year - 2015
Publication title -
pediatric allergy and immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.269
H-Index - 89
eISSN - 1399-3038
pISSN - 0905-6157
DOI - 10.1111/pai.12315
Subject(s) - medicine , national health and nutrition examination survey , bone mineral , odds ratio , vitamin d and neurology , atopic dermatitis , femoral neck , body mass index , population , gastroenterology , osteoporosis , immunology , environmental health
Background Children with atopic dermatitis ( AD ) have multiple risk factors for low bone mineral density ( BMD ). Methods 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. Results 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 z ‐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 3 cells/μl), and eosinophil counts (0.3 vs. 0.2 × 10 3 cells/μl) (Mann–Whitney U ‐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 z ‐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 . Conclusions Children with AD have lower BMD , particularly those with malnutrition and Hispanic ethnicity.