Association Between Pediatric Psoriasis and Waist-to-Height Ratio in the Absence of Obesity: A Multicenter Australian Study | Cardiology | JAMA Dermatology | JAMA Network
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Original Investigation
December 2016

Association Between Pediatric Psoriasis and Waist-to-Height Ratio in the Absence of Obesity: A Multicenter Australian Study

Author Affiliations
  • 1Department of Dermatology, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
  • 2Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
  • 3Sydney Medical School Northern, The University of Sydney, St Leonards, New South Wales, Australia
  • 4Institute of Endocrinology and Diabetes and Kids Research Institute at the Children’s Hospital at Westmead, Westmead, Australia
  • 5The Children’s Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
JAMA Dermatol. 2016;152(12):1314-1319. doi:10.1001/jamadermatol.2016.3432
Key Points

Question  Is psoriasis in children associated with an increased waist-to-height ratio?

Findings  In this prospective case-control study that included 135 children with psoriasis and 73 controls aged between 5 and 16 years, children with psoriasis were significantly more likely to have increased central adiposity with waist-to-height ratio (WtHR) of 0.5 or greater.

Meaning  Measuring WtHR may be warranted in children older than 5 years with psoriasis as part of routine screening to identify those at increased cardiovascular risk.


Importance  Increasing evidence suggests that psoriasis poses a cardiometabolic risk in children, as in adults. The best way to screen for this has not yet been established. Waist-to-height ratio (WtHR) can easily identify children with increased central adiposity and is a simpler alternative to body mass index (BMI) that does not require growth charts or percentiles. Having a WtHR of 0.5 or greater is associated with future cardiovascular risk.

Objective  To determine whether children with psoriasis are more likely to have increased WtHR, obesity, and metabolic syndrome relative to children without psoriasis.

Design, Setting, and Participants  This multicenter cross-sectional prospective case-control study was conducted from February 7, 2014, to July 15, 2015, in a tertiary referral center pediatric dermatology clinic and in 2 private consultant rooms of specialist dermatologists, all located in Sydney and Gosford, New South Wales, Australia. Participants were children (110 girls and 98 boys) aged from 5 to 16 years, 135 children with psoriasis and 73 controls with noninflammatory skin conditions.

Main Outcomes and Measures  Increased central adiposity indicated by WtHR of 0.5 or higher, metabolic syndrome, and increased BMI.

Results  Of the 208 children evaluated (110 girls and 98 boys) aged from 5 to 16 years (mean age, 8.9 years), 135 had psoriasis and 73 were controls with noninflammatory skin conditions. Children with psoriasis were more likely to have increased central adiposity, with WtHR of 0.5 or greater (29% [n = 39] vs 11% [n = 8]; P = .002). Four of 53 children older than 10 years with psoriasis were found to have metabolic syndrome compared with none of 29 in the control group (8% vs 0%; P = .29). Three of 15 children with moderate to severe psoriasis had metabolic syndrome compared with 1 of 38 children with mild psoriasis (20% vs 3%; P = .06). Children with moderate to severe psoriasis had a higher mean WtHR than children with mild psoriasis (0.48 vs 0.46; P = .04). Overweight and obesity according to BMI did not vary significantly between children with psoriasis and controls (17% [n = 23] vs 16% [n = 12]; P = .91).

Conclusions and Relevance  In this Australian cohort of children with psoriasis, elevated WtHR was significantly more common in patients with psoriasis than in controls, while proportions of participants with metabolic syndrome or BMI-determined obesity were not significantly different between the 2 groups.