title: Association of pediatric psoriasis severity with excess and central adiposity: an international cross-sectional study.
abstract: OBJECTIVE
  To investigate the relationship of excess and central adiposity with pediatric psoriasis severity.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00879944
authors.affiliation: Department of Dermatology, Northwestern University, 676 N St Clair, Ste 1600, Chicago, IL 60611, USA. apaller@northwestern.edu
authors.forename: Amy S
authors.initials: AS
authors.lastname: Paller
authors.forename: Katherine
authors.initials: K
authors.lastname: Mercy
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Kwasny
authors.forename: Siew Eng
authors.initials: SE
authors.lastname: Choon
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Cordoro
authors.forename: Giampiero
authors.initials: G
authors.lastname: Girolomoni
authors.forename: Alan
authors.initials: A
authors.lastname: Menter
authors.forename: Wynnis L
authors.initials: WL
authors.lastname: Tom
authors.forename: Anne M
authors.initials: AM
authors.lastname: Mahoney
authors.forename: Annet M
authors.initials: AM
authors.lastname: Oostveen
authors.forename: Marieke M B
authors.initials: MM
authors.lastname: Seyger
mesh_terms: D050154:Adiposity; D000293:Adolescent; D015992:Body Mass Index; D001830:Body Surface Area; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011565:Psoriasis / Q000473:pathology*; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference
references.citation: Pediatrics. 2009 Jan;123(1):84-8
references.pmid: 19117864
references.citation: J Pediatr. 2005 Apr;146(4):482-8
references.pmid: 15812450
references.citation: N Engl J Med. 1992 Nov 5;327(19):1350-5
references.pmid: 1406836
references.citation: Am J Clin Nutr. 2010 Nov;92(5):1257-64
references.pmid: 20861173
references.citation: Pediatrics. 1999 Jun;103(6 Pt 1):1175-82
references.pmid: 10353925
references.citation: JAMA. 2012 Feb 1;307(5):483-90
references.pmid: 22253364
references.citation: Ann Epidemiol. 2003 Nov;13(10):683-91
references.pmid: 14599732
references.citation: Arch Intern Med. 2002 Oct 14;162(18):2074-9
references.pmid: 12374515
references.citation: Pediatrics. 2004 Aug;114(2):e198-205
references.pmid: 15286257
references.citation: Arch Dermatol. 2007 Feb;143(2):239-42
references.pmid: 17310004
references.citation: Br J Dermatol. 2010 Mar;162(3):633-6
references.pmid: 19922529
references.citation: Arch Pediatr Adolesc Med. 2010 Jul;164(7):598-607
references.pmid: 20603458
references.citation: Clin Dermatol. 2007 Nov-Dec;25(6):574-80
references.pmid: 18021895
references.citation: Arch Dermatol. 2011 Apr;147(4):419-24
references.pmid: 21173301
references.citation: Obes Surg. 2004 Sep;14(8):1132-4
references.pmid: 15479606
references.citation: Pharmacol Res. 2008 Apr;57(4):290-5
references.pmid: 18400510
references.citation: J Am Diet Assoc. 2005 Jan;105(1):131-8
references.pmid: 15635359
references.citation: J Am Acad Dermatol. 2010 Jun;62(6):979-87
references.pmid: 19962785
references.citation: J Eur Acad Dermatol Venereol. 2008 Mar;22(3):341-4
references.pmid: 18005022
references.citation: Pediatrics. 2007 Dec;120 Suppl 4:S193-228
references.pmid: 18055652
references.citation: Pediatr Dermatol. 2000 May-Jun;17(3):174-8
references.pmid: 10886746
references.citation: Vital Health Stat 11. 2002 May;(246):1-190
references.pmid: 12043359
references.citation: J Bone Joint Surg Am. 1993 Aug;75(8):1141-7
references.pmid: 8354672
references.citation: J Am Acad Dermatol. 2004 Oct;51(4):563-9
references.pmid: 15389191
references.citation: Eur J Immunol. 2009 Sep;39(9):2629-35
references.pmid: 19662632
references.citation: Int J Obes Relat Metab Disord. 2000 Nov;24(11):1453-8
references.pmid: 11126342
references.citation: Br J Dermatol. 2010 Nov;163(5):1099-101
references.pmid: 20716218
references.citation: Clin Exp Dermatol. 2009 Mar;34(2):140-4
references.pmid: 19018791
references.citation: Arch Intern Med. 2007 Aug 13-27;167(15):1670-5
references.pmid: 17698691
references.citation: Arch Dermatol. 2009 Jun;145(6):700-3
references.pmid: 19528427
references.citation: Br J Dermatol. 2009 Aug;161(2):484-6
references.pmid: 19519836
references.citation: JAMA. 2006 Apr 5;295(13):1549-55
references.pmid: 16595758
references.citation: Ann Epidemiol. 2000 Jul;10(5):263-70
references.pmid: 10942873
references.citation: Int J Pediatr Obes. 2010;5(1):97-101
references.pmid: 19606372
references.citation: N Engl J Med. 2008 Jan 17;358(3):241-51
references.pmid: 18199863
references.citation: J Nutr. 2007 Jan;137(1):144-8
references.pmid: 17182816
references.citation: Obes Surg. 2006 Jan;16(1):94-7
references.pmid: 16417765
references.citation: Pediatr Dermatol. 2010 Nov-Dec;27(6):614-7
references.pmid: 21078106
references.citation: Public Health Nutr. 2010 Oct;13(10):1566-74
references.pmid: 20100388
references.citation: J Am Diet Assoc. 2007 Jan;107(1):81-91
references.pmid: 17197275
references.citation: JAMA. 2006 Oct 11;296(14):1735-41
references.pmid: 17032986
references.citation: Am J Clin Nutr. 2004 Mar;79(3):379-84
references.pmid: 14985210
references.citation: J Pediatr. 2004 Oct;145(4):439-44
references.pmid: 15480363
references.citation: J Pediatr. 1982 Nov;101(5):735-7
references.pmid: 7131149
references.citation: J Am Acad Dermatol. 2009 Feb;60(2):218-24
references.pmid: 19022533
references.citation: J Am Acad Dermatol. 2006 Nov;55(5):829-35
references.pmid: 17052489
references.citation: Arch Dermatol. 2005 Dec;141(12):1537-41
references.pmid: 16365254
references.citation: Obes Res. 2001 Mar;9(3):179-87
references.pmid: 11323443
references.citation: Obes Rev. 2002 Aug;3(3):203-8
references.pmid: 12164473
references.citation: Public Health Nutr. 2010 Dec;13(12):1990-6
references.pmid: 20359376
references.citation: Int J Obes (Lond). 2011 Jan;35(1):38-45
references.pmid: 20877285
references.citation: Am J Clin Nutr. 2002 Jun;75(6):971-7
references.pmid: 12036801
references.citation: Am J Clin Nutr. 2008 Nov;88(5):1242-7
references.pmid: 18996858
references.citation: Acta Paediatr. 2002;91(12):1307-12
references.pmid: 12578286
references.citation: Obes Rev. 2012 Mar;13(3):275-86
references.pmid: 22106927
references.citation: J Pediatr. 2011 Oct;159(4):577-83
references.pmid: 21524758
references.citation: J Atheroscler Thromb. 2002;9(3):127-32
references.pmid: 12226553