Atopic Dermatitis is Associated with Stunting and Poor Growth: Results from Indonesian Infants

Background/Aims: As the leading paediatric chronic inflammatory skin disease, atopic dermatitis (AD) inflicts substantial health burdens. Although avoidance of causative food could reduce AD severity, it often leads to unnecessary food intake limitations, and ultimately nutritional deficiencies and poor growth. This early growth insufficiency is related to later adverse metabolic outcomes. This study aimed to examine how AD status affects infancy growth in Indonesian population.

Method: From single primary healthcare in Jakarta, 395 mother-infant dyads were recruited to the Indonesian Prospective Study of Atopic Dermatitis in Infants (ISADI). All infants were term, vaginally-delivered, with no significant pregnancy comorbidities. Weight, height, waist circumference, and skinfolds were measured between 0-12 months. Growth measures were converted to the standard deviation scores (SDS) based on WHO growth standard, adjusted for infant sex and visit age. AD was diagnosed based on Hanifin and Rajka criteria by a paediatrician/dermatologist.

Results: The prevalence of AD in our cohort was 15.2% (N=60) and most of them (40%) were diagnosed as early as 3 months of age. Compared to controls, infants with AD had poor gains in weight (mean+SD -0.15+0.38 vs 0.36+0.92, respectively; p<0.0001) and adiposity measured by skinfolds (-0.97+2.1 vs -0.32+1.86, p=0.048) between 9-12 months. At 12 months, infants suffering from AD were significantly shorter compared to controls (B=-1.17, p<0.0001), adjusted for infant and parental factors. Stunting (length <-2 SDS) prevalence in this cohort ranged between 16.2-26.6% across time points. Children with AD had significantly higher stunting prevalence at 12 months than controls (29.8% vs 13.1%, OR=3.84, p=0.002).

Conclusions: Among Indonesian infants, AD occurrence during infancy was associated with stunting and poor growth between 9-12 months. In line with previous investigations, we assume that AD may affect not only the skin but also induce systemic inflammation and intestinal mucosa damage and malassimilation, which may have long-term health implications.