Childhood Obesity Hidden Impact: (IMSDs)

New research has brought light to the association between childhood obesity and development of immune mediated skin diseases (IMSDs)

The post COVID pandemic has changed the lives of people in terms of health, habits and habitat. One such change seen is the increasing trend of childhood obesity post COVID due to reduced physical activity because of school closure and lockdown during COVID and increase in consumption of food. New research has brought light to the association between childhood obesity and development of immune mediated skin diseases (IMSDs) like atopic dermatitis, alopecia areata and psoriasis.¹ The precise mechanism causing development of chronic inflammatory skin disease due to obesity is still uncertain, however excessive adipose tissue has been assumed to trigger proinflammatory mechanisms that lead to development of IMSDs.² Adipose tissue helps in recruitment of macrophages and cytotoxic T cells and produces adipokines that produces inflammatory mediators like TNF-α and IL-6 which are associated with pathogenesis of atopic dermatitis, alopecia areata and psoriasis.³ Also, obesity can disarray the skin barrier function and affect the leptin activity causing immune imbalance and leading to chronic low-grade inflammatory state.⁴ However, the precise role and mechanism is yet to be fully understood.

IMSDs have deleterious effect on the quality of life of children and their families in terms of emotional, physical, social and functional well-being.⁵ The treatment options available like biologics have been shown to be effective for treating children with atopic dermatitis and psoriasis but due to restricted options and lack of clinical trial for systemic therapy has made it difficult to treat in children.^6,7

A study was conducted on 2,161,900 Korean children from 2009 to 2020 to study the relation between obesity or changes in body weight and development of IMSDs. The study found that association of IMSDs was more with obese children than children with normal weight. Atopic dermatitis was the most common IMSDs seen among the three common IMSDs. Children who gained weight i.e. became overweight from normal had higher risk of developing atopic dermatitis than children who were normal weight and children who lost weight had lower risk of developing atopic dermatitis than children who maintained their overweight state.¹ Another remarkable finding showed a notable association between BMI increase from 30 -36 months to 42-49 months, 54-60 months, and 66-71 months and increased risk of atopic dermatitis.

A systematic review and meta-analysis found that patients with psoriasis had higher chances of obesity that those without psoriasis. And few case control studies done on children also showed that children with psoriasis were more prone to being obese at the time of diagnosis. But no significant association was found between change in BMI and risk of alopecia areata and psoriasis.

In conclusion although many studies have found association between childhood obesity and IMSDs more studies are required to understand the mechanism and to truly prove the association. Irrespectively childhood obesity is associated with other non-communicable diseases like diabetes and hypertension and interventions are necessary through nutritional management, exercise and change in habits to prevent IMSDs and other non-communicable diseases to live a healthier life.

References:

1. Childhood Obesity, Weight Change, and Pediatric Immune-Mediated Skin Diseases, Journal of Investigative Dermatology (2024). DOI: 10.1016/j.jid.2024.01.037
2. Darlenski R, Mihaylova V, Handjieva-Darlenska T. The link between obesity and the skin. Frontiers in nutrition. 2022 Mar 10;9:855573
3. Armstrong AW, Harskamp CT, Armstrong EJ. The association between psoriasis and obesity: a systematic review and meta-analysis of observational studies. Nutrition & diabetes. 2012 Dec;2(12):e54-.
4. Boguniewicz M, Leung D. Atopie Dermatitis. InAnti-Infective Applications of Interferon-Gamma 2020 Jul 24 (pp. 67-84). CRC Press.
5. Brihan I, Ianoși SL, Boda D, Hălmăjan A, Zdrîncă M, Fekete LG. Implications of self esteem in the quality of life in patients with psoriasis. Experimental and Therapeutic Medicine. 2020 Dec 1;20(6):1-.
6. Aslam N, Saleem H, Murtazaliev S, Quazi SJ, Khan S. FDA approved biologics: can etanercept and ustekinumab be considered a first-line systemic therapy for pediatric/adolescents in moderate to severe psoriasis? A systematic review. Cureus. 2020 Aug;12(8).
7. Branisteanu DE, Georgescu S, Serban IL, Pinzariu AC, Boda D, Maranduca MA, Glod M, Branisteanu CI, Bilibau R, Dimitriu A, Nicolescu AC. Management of psoriasis in children. Experimental and Therapeutic Medicine. 2021 Dec 1;22(6):1-8.