Although children with psoriasis are at greater risk for developing various comorbidities than children without psoriasis, obesity is a stronger independent risk factor than psoriasis in comorbidity development, according to recently published study results in JAMA Dermatology.
“In recent years, it has become increasingly clear that psoriasis is more than a ‘skin-deep’ condition and that it may frequently be associated with other systemic comorbidities, even in children,” Megha M. Tollefson, MD, of the dermatology department at Mayo Clinic, Rochester, Minnesota, and colleagues wrote. “There is mounting evidence that children with psoriasis are more likely to be obese than children without psoriasis, but this finding begs the question of whether the systemic comorbidities that are seen in children with psoriasis are attributable to obesity, or whether psoriasis is an independent risk factor for these comorbidities.”
Tollefson and colleagues used data from the Optum Laboratories Data Warehouse, which includes data for 150 million privately insured and Medicare Advantage enrollees, to conduct a retrospective cohort study of 29,957 children diagnosed with psoriasis between 2004 and 2013 (affected children; average age, 12.0 years; 53.5% girls) and 29,957 children without psoriasis who were matched by age, sex and race. The cohorts were divided into four groups including, nonobese without psoriasis, nonobese with psoriasis, obese without psoriasis and obese with psoriasis.
There were more children in the affected children cohort who were obese (2.9%) compared with the nonaffected children (1.5%) at baseline (P < .001 for all comparisons). Children with psoriasis were significantly more likely to develop comorbidities including elevated lipid levels, hypertension, metabolic syndrome, polycystic ovarian syndrome, diabetes, nonalcoholic liver disease and elevated liver enzyme levels, than children without psoriasis (P < .01).
Even in children without psoriasis, obesity was a risk factor for each comorbidity developing (HR range = 2.26 to 18.11).
There was a 40% to 75% higher risk of comorbidities among nonobese children with psoriasis compared with nonobese children without psoriasis, including elevated lipid levels (HR = 1.42; 95% Ci, 1.25-1.62), hypertension (HR = 1.64; 95% CI, 1.40-1.93), diabetes (HR = 1.58; 95% CI, 1.27-1.95), metabolic syndrome (HR = 1.62; 95% CI, 1.13-2.33), polycystic ovarian syndrome (HR = 1.49; 95% CI, 1.18-1.88), nonalcoholic liver disease (HR = 1.76; 95% CI, 1.16-2.65) and elevated liver enzyme levels (HR = 1.46; 95% CI, 1.27-1.67).
Significant interaction did not occur between psoriasis and obesity regarding comorbidity risk except for hypertension (P = .03).
“Children with psoriasis have higher rates of obesity, hyperlipidemia, hypertension, diabetes, metabolic syndrome, polycystic ovarian syndrome, nonalcoholic liver disease and elevated liver function enzyme levels than children who do not have psoriasis,” the authors concluded. “Children with psoriasis are also at increased risk to develop these comorbidities, irrespective of obesity status. However, these children who are obese are much more likely to develop comorbidities than those who are not obese, even in the population of children with psoriasis … Our results highlight the particular importance of screening obese patients because obesity is a much larger contributor to comorbidity development.” – Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.