title: Central obesity and high blood pressure in pediatric patients with atopic dermatitis.
abstract: OBJECTIVE
  Atopic dermatitis (AD) is associated with multiple potential risk factors for obesity and high blood pressure (BP), including chronic inflammation, sleep disturbance, and mental health comorbidity. Previous studies found associations between general obesity and AD. However, it is unknown whether AD is associated with central obesity and/or high BP.
  
  
  OBJECTIVE
  To determine whether central obesity and high BP are increased in pediatric AD.
  
  
  METHODS
  This case-control study performed in multicenter pediatric dermatology practices in the United States recruited 132 children (age range, 4-17 years) with active moderate to severe AD and 143 healthy controls from April 1, 2009, through December 31, 2012.
  
  
  METHODS
  Diagnosis and severity of AD assessed by a pediatric dermatologist.
  
  
  METHODS
  Body mass index, waist circumference, waist to height ratio, systolic BP, and diastolic BP.
  
  
  RESULTS
  Moderate to severe AD was associated with body mass index for age and sex of 97th percentile or greater (logistic regression; odds ratio [OR], 2.64; 95% CI, 1.15-6.06), International Obesity Task Force obesity cutoffs (OR, 2.38; 95% CI, 1.06-5.34), waist circumference in the 85th percentile or greater (OR, 3.92; 95% CI, 1.50-10.26), and waist to height ratio of 0.5 or greater (OR, 2.22; 95% CI, 1.10-4.50). Atopic dermatitis was associated with higher BP for age, sex, and height percentiles (systolic BP: OR, 2.94; 95% CI, 1.04-8.36; diastolic BP: OR, 3.68; 95% CI, 1.19-11.37), particularly a systolic BP in the 90th percentile or higher (OR, 2.06; 95% CI, 1.09-3.90), in multivariate models that controlled for demographics, body mass index and waist circumference percentiles, and history of using prednisone or cyclosporine. Atopic dermatitis was associated with higher systolic BP in Hispanics/Latinos (general linear model; β, .23; 95% CI, .04-.43) and Asians (β, .16; 95% CI, .03-.30). Severe to very severe AD was associated with systolic BP in the 90th percentile or higher (adjusted OR, 3.14; 95% CI, 1.13-8.70). Atopic dermatitis was associated with a family history of hypertension (adjusted OR, 1.88; 95% CI, 1.14-3.10) and type 2 diabetes mellitus (adjusted OR, 1.64; 95% CI, 1.02-2.68) but not obesity or hyperlipidemia.
  
  
  CONCLUSIONS
  Moderate to severe pediatric AD may be associated with central obesity and increased systolic BP.
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois2Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Silverberg
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Lauren
authors.initials: L
authors.lastname: Becker
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Mary
authors.initials: M
authors.lastname: Kwasny
authors.affiliation: Department of Dermatology, Baylor University Medical Center, Dallas, Texas.
authors.forename: Alan
authors.initials: A
authors.lastname: Menter
authors.affiliation: Department of Dermatology, University of California, San Francisco.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Cordoro
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Paller
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003876:Dermatitis, Atopic / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D015994:Incidence; D008297:Male; D056128:Obesity, Abdominal / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology