ACANTHOSIS NIGRICANS IN SCHOOL AGE CHILDREN IN FORT WORTH TEXAS Ximena Urrutia-Rojas, DrPH John A. Menchaca, MD Naveed Ahmad, MD Manuel Bayona, MD, PhD Rosa Rosario-Rosado, MS University of North Texas Health Science Center School of Public Health at Fort Worth, Texas

INTRODUCTION Acanthosis nigricans (AN) is a skin disorder characterized by diffuse hyperplasia of the spinous layer of the skin Manifested as dark skin pigmentation Lesions are typically found on the posterior and lateral neck, axillae, groin, and around umbilicus and nipples It has been established that these skin lesions are associated with obesity and hyperinsulinemia Its epidemiology, however is largely unknown

AN Mild

AN Severe

IMPORTANCE OF AN ADA Criteria for Testing Type 2 Diabetes Mellitus in Children and Adolescents * Overweight (BMI > 85 th percentile for age and sex, weight for height >85 th percentile, or weight > 120% of ideal for height) Plus Any two of the Following Factors Family history of type 2 diabetes in first- or second-degree relative Race/ethnicity (American Indian, African-American, Hispanic, Asian/Pacific Islander Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia) * Pediatrics. Vol. 105 No. 3 March

PURPOSE The purpose of this study is to identify and assess factors associated with Acanthosis nigricans in school age children in Fort Worth, Texas.

METHODS 17 schools were selected from FWISD by stratified sample based on geographic location, ethnicity, and socio-economic status Selected schools provided a representative sample of the population All students attending 5 th grade in selected schools were invited A total of 1,066 (67.7%) children participated

METHODS A questionnaire was sent to the parents of each child to collect data on family history, diet, and physical activity Acanthosis nigricans was assessed by the physician. Height, weight, body mass index (BMI), and blood pressure were measured at school by a registered nurse or a physician Overweight / obese children were defined as children with BMI above 85 th %tile / 95 th %tile of NHANES criteria

DATA ANALYSIS Data was analyzed using SPSS Continuous variables were dichotomized Crude and adjusted odds ratio was used as a measure of association for all variables Adjusted analysis was performed by using binary logistic regression Adjustment was made for age, gender, and obesity

DEMOGRAPHIC CHARACTERISTICS Age:Mean 10.7 Range(8 – 13) Gender: Female52% Overweight/Obese:30% (BMI >85 th percentile of NHANES)* High Systolic BP:19.9% (Systolic BP > 95 th percentile)** Family History of DM:53.7% Acanthosis nigricans + :14.6% * Pediatrics. Vol. 105 No. 3 March ** Pediatrics 1996; 98 (4):

Study Factors as Associated to AN OR OR Adjusted 95% CI Age Grp , 1.24 Being Male , 0.78 Being Hispanic , 2.12 Obesity , High Syst. BP , 2.76 High Diast. BP , 2.50

Study Factors as Associated to AN OR Crude OR Adjusted 95% CI FH of DM , 1.53 >2 Hrs TV , 3.19 <2 Hrs Activity , 1.26 Daily Lunch at , 1.92 Cafeteria Frequent Chips , 1.90 Frequent Sweets , 1.36

Summary of Study Factors as Associated to AN

RESULTS Males are 48% less likely to have AN Hispanics are more likely to have AN As expected Obesity is strongly associated with AN Systolic and Diastolic blood pressure are associated with AN Watching TV for more than 2 hours daily increased the likely hood to present AN Family history of DM, physical activity at home, lunch at cafeteria, and eating chips and sweets more frequently were not found to be associated with AN

CONCLUSIONS These findings provide evidence to better understand the epidemiology of AN, that is largely unknown As AN is one of the risk factors of T2DM, any child having any degree of AN should be screened for other risk factors of T2DM like obesity, high blood pressure, and family history of DM