Atopic dermatitis and skin disease
Infant-onset eczema in relation to mental health problems at age 10 years: Results from a prospective birth cohort study (German Infant Nutrition Intervention plus)

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Background

Cross-sectional studies suggest an association between eczema and mental health problems, but the temporal relationship is unclear.

Objective

To assess the association between infant-onset eczema and mental health problems in a prospective study.

Methods

Between 1995 and 1998, a birth cohort study was recruited and followed until age 10 years. Physician-diagnosed eczema, comorbidities, and a broad set of environmental exposures were assessed at age 1, 2, 3, 4, 6, and 10 years. First, we investigated the association between infant-onset eczema (age 1-2 years) and mental health problems at age 10 years according to the Strengths and Difficulties Questionnaire. Second, we analyzed the likelihood of mental health problems at age 10 years in relation to the course of eczema.

Results

A total of 2916 infants were eligible for analysis. Compared with participants never diagnosed as having eczema, children with infant-onset eczema had a significantly increased risk for possible/probable mental health problems (Strengths and Difficulties Questionnaire total score) at age 10 years (odds ratio, 1.49; 95% CI, 1.13-1.96) and for emotional symptoms (odds ratio, 1.62; 95% CI, 1.25-2.09). Eczema limited to infancy predicted a significantly higher risk for conduct problems at age 10 years. The strength of the association between eczema and emotional problems at age 10 years increased with increasing eczema persistence.

Conclusion

Infants with eczema are at increased risk for mental health problems at age 10 years. Even if cleared afterward, eczema at age 1 to 2 years may cause persistent emotional and behavioral difficulties.

Section snippets

Study design

In the German Infant Nutrition Intervention plus (GINIplus) study, 5991 children born between 1995 and 1998 were recruited in 2 German cities (Munich and Wesel). Details of the study design have been described elsewhere.10, 11, 12

The parents of 2252 newborns with a positive family history of allergic disease (intervention group) agreed to participate in a randomized controlled trial to compare the effect of hydrolyzed formulas versus conventional cow's milk formula on the development of

Study population and follow-up

Fig 1 shows the flow of the study population from screening of newborns through to the 10-year follow-up. The original cohort included 5991 newborns, 2252 and 3739 of whom belonged to the intervention group and nonintervention group, respectively. A total of 4671 children participated in the 1-year assessment, and 2985 children were followed up at age 10 years. The following analyses are based on 2916 children with complete follow-up information until the age of 10 years and without missing

Main findings

Our study indicates that children with physician-diagnosed eczema within their first 2 years of life are at statistically significantly increased risk for mental health problems at age 10 years compared with children without eczema. They show more emotional difficulties and conduct problems. Even if cleared after the first 2 years of life, infant eczema appears to be independently associated with emotional symptoms, conduct problems, and possibly also hyperactivity/inattention at age 10 years.

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    The German Infant Nutrition Intervention study was funded for 3 years by grants of the Federal Ministry for Education, Science, Research and Technology (grant no. 01 EE 9401-4). The 6-year follow-up of the German Infant Nutrition Intervention plus study was partly funded by the Federal Ministry of Environment (Institut für Umweltmedizinische Forschung, FKZ20462296). This study was supported in part by Ludwig-Maximilians-Universität's innovative research priority project MC-Health (subproject I).

    Disclosure of potential conflict of interest: S. Koletzko has received speakers' honoraria from Nestle Nutrition and Danone and has received research support from Nestle Nutrition and Mead Johnson. A. von Berg has received a speakers' honorarium from Nestle and has provided legal consultation services or expert witness testimony relevant to Airsonett. The rest of the authors have declared that they have no conflict of interest.

    These authors contributed equally to this work.

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