Beneficial Effect of Diet Intervention on School Children with Atopic Dermatitis

Jae Hyuck Lee; Seung Wan Hong; Sung-Ae Kim; Hee Joung Choi; Mi Kyung Kim; Young-Sung Suh

doi:10.15384/kjhp.2016.16.1.32

Korean J Health Promot > Volume 16(1); 2016 > Article

Lee, Hong, Kim, Choi, Kim, and Suh: Beneficial Effect of Diet Intervention on School Children with Atopic Dermatitis

Original Article

Korean Journal of Health Promotion 2016;16(1):32-36.

Published online: January 20, 2016

DOI: https://doi.org/10.15384/kjhp.2016.16.1.32

Beneficial Effect of Diet Intervention on School Children with Atopic Dermatitis

Jae Hyuck Lee¹, Seung Wan Hong¹, Sung-Ae Kim², Hee Joung Choi³, Mi Kyung Kim⁴, Young-Sung Suh^1,

¹Department of Family Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea

²Department of Dermatology, Keimyung University Dongsan Medical Center, Daegu, Korea

³Department of Pediatrics, Keimyung University Dongsan Medical Center, Daegu, Korea

⁴Department of Endocrinology, Keimyung University Dongsan Medical Center, Daegu, Korea

Corresponding author: Young-Sung Suh, MD, PhD Department of Family Medicine, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea
Tel: +82-53-250-7263, Fax: +82-53-250-7071 E-mail: ysseo@dsmc.or.kr

Received September 18, 2015 Accepted February 18, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background

Atopic dermatitis (AD) is one of the most common skin disorders affecting infants and children. Food allergy is a strong risk factor for the development of AD. This study was designed to evaluate the improvement of symptoms among AD patients in the late childhood while they take the customized (organic, balanced, non-allergic, diverse vegetable, little saturated fat and trans fat free) diet.

Methods

Nineteen children with AD who agreed to the written consent were enrolled in the study from October to December, 2014. We supplied them with the customized diet for 8 weeks. Clinical evaluations, blood tests and nutritional status were conducted at baseline, at 4th and at 8th week. Eczema area and severity index (EASI) and Scoring atopic dermatitis (SCORAD) were used to determine the severity of AD.

Results

The mean age of 19 patients was 8.5±1.54 years. EASI and SCORD index were decreased after diet intervention (2.6±3.06 [standard deviation] vs. 2.0±2.93 P＝0.026, 24.9±10.76 vs. 20.0±12.65 P＝0.009). Pruritus scores using visual analogue scale, rated by patients and hemoglobin revealed statistically significant improvement after diet intervention.

Conclusions

The customized diet helps to improve the symptoms of atopic dermatitis and the nutritional indicators. Additional long-term and large-scale studies are required as well as the development of various diets.

Keywords: Dermatitis, Atopic, Eczema, Diet, Severity of illness index

Table 1.

General characteristics of all participants^a

	0 wk	4 wk	8 wk	P^b
Height, cm	131.6±11.42	131.7±11.46	132.2±11.41	0.049
Weight, kg	30.1±2.62	30.9±2.53	30.8±2.48	0.822
Body mass index, kg/m²	17.3±3.43	17.3±3.15	17.2±3.06	0.347
Fat, kg	7.1±6.24	7.8±6.03	7.2±5.70	0.003
Fat free mass, kg	23.7±5.51	23.0±5.30	23.7±5.38	0.003
Body fat, %	20.5±8.07	23.0±7.64	21.02±7.24	0.001

^aValues are presented as Mean±SD unless otherwise indicated.

^bP-value was calculated by repeated-measures ANOVA.

Table 2.

Comparing EASI and subscales before and after diet intervention^a

	0 wk	4 wk	8 wk	P^b
EASI scale	2.6±3.06	1.6±2.05	2.0±2.93	0.026
Head and Neck	0.17±0.32	0.08±0.15	0.13±0.25	0.288
Upper limbs	0.50±0.59	0.31±0.35	0.45±0.65	0.105
Trunk	0.47±1.09	0.27±0.71	0.31±0.66	0.567
Lower limbs	1.5±2.46	0.88±1.76	1.1±1.81	0.008

Abbreviation: EASI, eczema area severity index.

^aValues are presented as Mean±SD unless otherwise indicated.

^bP-value was calculated by repeated-measures ANOVA.

Table 3.

Comparing SCORAD index and subscales before and after diet intervention^a

	0 wk	4 wk	8 wk	P^b
SCORAD Index	24.9±10.76	19.1±9.93	20.0±12.65	0.009
Area	7.1±9.38	6.6±7.58	7.1±13.97	0.873
Erythema	1.2±0.54	1.0±0.75	1.2±0.86	0.461
Excoriation	0.95±0.71	0.53±0.51	0.42±0.51	0.002
Edema/Papulation	n 0.95±0.52	0.11±0.32	0.42±0.51	＜0.001
Oozing/crusting	0.42±0.69	0.89±0.57	0.84±0.50	0.005
Lichenification	0.53±0.51	0.26±0.45	0.32±0.48	0.075
Xerosis	1.1±0.57	1.0±0.62	0.74±0.45	0.128
Itching sensation	4.4±1.79	3.3±2.04	3.6±2.01	0.018
Sleep disturbance	1.2±1.76	1.8±1.74	1.2±1.70	0.236

Abbreviation: SCORAD, scoring atopic dermatitis.

^aValues are presented as Mean±SD unless otherwise indicated.

^bP-value was calculated by repeated-measures ANOVA.

Table 4.

Comparing blood tests before and after diet inter vention^a

	0 wk	8 wk	P^b
WBC, Thous/uL	7.5±2.20	6.6±2.11	0.112
Eosinophil, %	4.1±3.07	3.6±2.62	0.467
Hb, g/dL	13.1±0.78	13.6±0.69	＜0.001
Hct, %	38.2±1.81	40.7±2.51	＜0.001
Platelet, Thous/uL	304.3±55.83	288.6±80.73	0.298
Total protein, g/dL	7.1±0.45	7.5±0.51	0.005
Albumin, g/dL	4.6±0.51	4.8±0.42	0.104
AST, U/L	29.3±8.31	30.1±5.38	0.624
ALT, U/L	18.2±22.23	13.7±7.50	0.222
GTP, U/L	11.6±6.06	11.2±3.82	0.607
ALP, U/L	264.8±73.26	244.3±48.44	0.176
Iron, ug/dL	72.3±21.10	80.2±25.50	0.294
TIBC, ug/dL	361.4±39.88	346.6±36.85	0.007
transferrin sat, %	20.0±5.57	23.5±7.95	0.115
Ferritin, ng/mL	56.6±31.50	57.4±37.47	0.887

Abbreviation: WBC, white blood cell; Hb, hemoglobin; Hct, hem atocrit; AST, aspartate aminotransferase; ALT, alanine aminotrans ferase; GTP, gamma-glutamyl transferase; ALP, alkaline phospha tase; TIBC, total iron-binding capacity.

^aValues are presented as Mean±SD unless otherwise indicated.

^bP-value was calculated by paired t-test.

References

1. Leung DY, Bieber T. Atopic dermatitis. Lancet 2003;361(9352):151-60.

2. Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006;368(9537):733-43.

3. Lee JH, Kim EH, Cho J, Kim HY, Suh J, Ahn K, et al. Comparison of prevalence and risk factors of atopic dermatitis by physical examination and questionnaire survey in elementary school children. Pediatr Allergy Respir Dis 2011;21(3):186-96.

4. Lee SI, Kim J, Han Y, Ahn K. A proposal: Atopic Dermatitis Organizer (ADO) guideline for children. Asia Pac Allergy 2011;1(2):53-63.

5. Spergel JM. From atopic dermatitis to asthma: the atopic march. Ann Allergy Asthma Immunol 2010;105(2):99-106. ; quiz 107–9, 117..

6. Bieber T. Atopic dermatitis. N Engl J Med 2008;358(14):1483-94.

7. Bock SA. Prospective appraisal of complaints of adverse reactions to foods in children during the first 3 years of life. Pediatrics 1987;79(5):683-8.

8. Hill DJ, Sporik R, Thorburn J, Hosking CS. The association of atopic dermatitis in infancy with immunoglobulin E food sensitization. J Pediatr 2000;137(4):475-9.

9. Kim JS. Pediatric atopic dermatitis: the importance of food allergens. Semin Cutan Med Surg 2008;27(2):156-60.

10. Fuglsang G, Madsen G, Halken S, J⊘rgensen S, Ostergaard PA, Osterballe O. Adverse reactions to food additives in children with atopic symptoms. Allergy 1994;49(1):31-7.

11. Worm M, Ehlers I, Sterry W, Zuberbier T. Clinical relevance of food additives in adult patients with atopic dermatitis. Clin Exp Allergy 2000;30(3):407-14.

12. Hanifin JM, Thurston M, Omoto M, Cherill R, Tofte SJ, Graeber M. The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp Dermatol 2001;10(1):11-8.

13. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1993;186(1):23-31.

14. Nomura I, Katsunuma T, Tomikawa M, Shibata A, Kawahara H, Ohya Y, et al. Hypoproteinemia in severe childhood atopic dermatitis: a serious complication. Pediatr Allergy Immunol 2002;13(4):287-94.

15. Dhar S, Malakar R, Banerjee R, Chakraborty S, Chakraborty J, Mukherjee S. An uncontrolled open pilot study to assess the role of dietary eliminations in reducing the severity of atopic dermatitis in infants and children. Indian J Dermatol 2009;54(2):183-5.

16. David TJ, Waddington E, Stanton RH. Nutritional hazards of elimination diets in children with atopic eczema. Arch Dis Child 1984;59(4):323-5.

17. Devlin J, Stanton RH, David TJ. Calcium intake and cows' milk free diets. Arch Dis Child 1989;64(8):1183-4.

18. Hon KL, Leung TF, Kam WY, Lam MC, Fok TF, Ng PC. Dietary restriction and supplementation in children with atopic eczema. Clin Exp Dermatol 2006;31(2):187-91.

19. McCarney R, Warner J, Iliffe S, van Haselen R, Griffin M, Fisher P. The Hawthorne effect: a randomized, controlled trial. BMC Med Res Methodol 2007;7:30.