Glucocorticoid‐related changes in body mass index among children and adolescents with rheumatic diseases

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.

Prevalence of overweight in children and adolescents with juvenile idiopathic arthritis

“…The debate about the use of GCs and short stature (short stature leading to a higher BMI compared to normal stature) is ongoing (32), as GCs affect growth in many ways, as summarized by Umławska et al (34). Many studies have shown a significant relationship between short-term and long-term use of GCs and retarded growth (35)(36)(37)(38).…”

Variation in Preventive Care in Children Receiving Chronic Glucocorticoid Therapy

“…However, we performed a manual validation that demonstrated high sensitivity and specificity of our automated health record search. Additionally, patients in the cohort had the expected changes in BMI and height Z-scores characteristic of children receiving glucocorticoid therapy(34). Third, the majority of our cohort received primary care outside our health network and may have had preventive care not captured in our electronic health record.…”

Changes in Body Mass Index in Children with Juvenile Idiopathic Arthritis Treated with Tumor Necrosis Factor Inhibitors

“…BMI is not the only available measure for the assessment of weight gain in children, but its use has been widely adopted 16 , and a recent study of children with rheumatic diseases demonstrated significant increases in BMI z-score associated with treatment with systemic GC 24 . Height and weight measurements were obtained by appropriately trained medical staff members as part of routine care, but a strict protocol for obtaining these measurements was not undertaken.…”