Atopic Burden: A Multi-Variable Decomposition Analysis of Atopic Dermatitis, Food Allergy, Nutritional Status, and Neurodevelopmental

Abstract

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Background: Early allergic disease in toddlers carries implications extending beyond dermatological manifestations, yet most local studies treat atopic dermatitis (AD), food allergy (FA), and developmental outcomes as singular binary constructs rather than multi-dimensional variables. Decomposing these constructs into clinically meaningful subcategories may reveal patterns that aggregate analyses obscure.

Objective: To examine the atopic burden in toddlers aged 24–36 months in Banjar District through a multi-variable decomposition approach, characterizing: (1) AD prevalence; (2) FA trigger profile (known vs. unidentified trigger); (3) birth weight category (low vs. normal); (4) head circumference (HC) nutritional category; (5) mid-upper arm circumference (MUAC) wasting classification; and (6) three-level KPSP developmental readiness status, and to assess associations between these decomposed variables and AD status.

Methods: Cross-sectional analytic study (N=22; April 2026; Puskesmas Banjar District). All continuous variables were recoded into clinically referenced categories. A composite Atopic Burden Score (ABS) was constructed from three domains: allergic load, growth adequacy, and developmental readiness. Associations were tested using Fisher's Exact Test; ABS group differences by Kruskal-Wallis H test; trend across ordered KPSP categories by Jonckheere-Terpstra test.

Results: AD prevalence was 22.7% (n=5). All AD-positive children had FA (100%), with 83.3% of FA cases having unidentified triggers — a proportion significantly higher among AD-positive children (p<0.001). No children were classified as low birth weight; one child had borderline HC. MUAC-based wasting was absent in both groups. Three-level KPSP analysis revealed that 60.0% of AD-positive children scored in the equivocal-to-deviant range versus 29.4% of AD-negative children. Composite ABS revealed that AD-positive children carried a meaningfully higher atopic burden across all three domains.

 Conclusion: Variable decomposition revealed FA trigger uncertainty as a clinically meaningful subcategory disproportionately concentrated in AD-positive toddlers, and confirmed a gradient pattern in developmental readiness by AD status. The composite ABS offers a practical screening framework for integrated atopic-developmental surveillance in primary care.