Glucocorticoid-related changes in body mass index among children and adolescents with rheumatic diseases Academic Article uri icon

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abstract

  • OBJECTIVE: To examine the temporal and dose-related effects of glucocorticoids (GCs) on body mass index (BMI) in children with rheumatic diseases. METHODS: Children initiating GCs for a rheumatic disease (n = 130) were assessed every 3 months for 18 months. BMI, weight, and height Z score trajectories were described according to GC starting dosage in prednisone equivalents: high (≥1.0 mg/kg/day), low (<0.2 mg/kg/day to a maximum of 7.5 mg/day), and moderate (between high and low) dosage. The impact of GC dosing, underlying diagnosis, pubertal status, physical activity, and disease activity on BMI Z scores and on percent body fat was assessed with longitudinal mixed-effects growth curve models. RESULTS: The GC starting dose was high in 59% and moderate in 39% of patients. The peak BMI Z score was +1.29 at 4 months with high-dose GCs and +0.69 at 4.2 months with moderate-dose GCs (P < 0.001). Overall, 50% (95% confidence interval 41-59%) of the children returned to within +0.25 SD of their baseline BMI Z score. Oral GC dose over the preceding 3 months was the most significant determinant of BMI Z score and percent body fat. The proportion of days in receipt of GCs, disease activity, and a diagnosis of systemic-onset juvenile idiopathic arthritis were also associated with BMI Z scores. The correlation between changes in BMI and changes in percent body fat was 0.09. CONCLUSION: In children with rheumatic diseases starting moderate and high doses of GCs, BMI Z scores peaked at 4 months, and only half returned to within +0.25 SD of their baseline BMI Z score after 18 months.

authors

  • Shiff, Natalie J
  • Brant, Rollin
  • Guzman, Jaime
  • Cabral, David A
  • Huber, Adam M
  • Miettunen, Paivi M
  • Roth, Johannes
  • Scuccimarri, Rosie
  • Alos, Nathalie
  • Atkinson, Stephanie
  • Collet, Jean Paul
  • Couch, Robert
  • Cummings, Elizabeth A
  • Dent, Peter Boris
  • Ellsworth, Janet
  • Hay, John
  • Houghton, Kristin
  • Jurencak, Roman
  • Lang, Bianca
  • Larche, Margaret
  • LeBlanc, Claire
  • Rodd, Celia
  • Saint-Cyr, Claire
  • Stein, Robert
  • Stephure, David
  • Taback, Shayne
  • Rauch, Frank
  • Ward, Leanne M

publication date

  • January 2013