Minor impact of juvenile arthritis on nutritional status in young adult patients

Haugen, Margaretha; Lien, Gunhild; Flatø, Berit; Kvammen, Janne Anita; Vinje, Odd; Sørskaar, Dag; Førre, Ø

doi:10.1002/art.10799

Cited by 16 publications

(12 citation statements)

References 19 publications

(16 reference statements)

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“…Haugen et al [22] compared nutritional status with BC measurements by DXA from 220 individuals aged older than 20 years who had been diagnosed as JIA in childhood and healthy controls. They reported that the final height and BMI of the sample were within normal range, except among women with the systemic subtype and those who had used or were using corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Excess of adiposity in female children and adolescents with juvenile idiopathic arthritis

et al. 2012

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This study aims to evaluate the body composition (BC) of female children and adolescents with juvenile idiopathic arthritis (JIA). A cross-sectional, controlled study was performed to compare the BC between 42 JIA girls and 35 healthy controls, matched for age and gender. Weight and height were used to calculate body mass index (BMI), classified as a Z-score (Z-BMI). BC was evaluated by dual-energy X-ray absorptiometry (DXA; DPX-L, Lunar). The fat mass index (FMI) was calculated as the ratio between total fat mass and height squared (kilograms per square metre). The lean mass index (LMI) was calculated as the ratio between total lean mass and height squared (kilograms per square metre). In JIA patients, the median of age was 13 years (6-19) and median disease duration was 84 months (10.0-215.0). The main disease subtype was polyarticular arthritis (54.8%). We observed that 61.9% of patients had normal Z-BMI. JIA girls had higher median Z-BMI scores (0.17 vs. -0.48, p = 0.034), total body fat percentages (26.5% vs. 16.4%, p = 0.001), truncal fat (4.52 vs. 2.32, p = 0.011) and FMI (4.83 vs. 2.23, p < 0.001). For LMI, there was no difference between JIA girls and controls (13.45 vs. 12.45, p = 0.212). We did not find association between FMI and age, disease subtype, number of limited and/or active joints, months since diagnosis and use of corticosteroids or methotrexate. BC changes found in JIA girls, such as fatness and adiposity, indicate a potentially greater risk for developing hypertension, diabetes mellitus and cardiovascular diseases. These findings emphasise the importance of evaluating nutritional status and body composition to minimise the emergence of chronic diseases later in life.

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Section: Discussionmentioning

confidence: 99%

Excess of adiposity in female children and adolescents with juvenile idiopathic arthritis

et al. 2012

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Section: Discussionunclassified

“…Alguns estudos observacionais associaram o uso, duração ou dose cumulativa de glicocorticóide com redução na estatura (4,7,12,19,21,22) . A maioria desses estudos não utilizou análise multivariável para ajustar para o efeito de possíveis fatores de viés, como subtipo, duração e severidade da doença (7,19,21,22) . Zak et al (12) e Garcia-Consuegra Molina et al (4) apresentaram modelos de regressão linear múltipla em que o uso de glicocorticóides foi considerado um fator independente para a redução da estatura ou baixa velocidade de crescimento.…”

Section: Discussionunclassified

“…Lofthouse et al (5) observaram IMC mais baixo e mais baixo PCT em pacientes com o subtipo poliarticular em comparação com um grupo de controles normais. Haugen et al (22) estudando 220 adultos com AIJ observaram IMC similar em pacientes com doença ativa, inativa e controles normais, mas os pacientes apresentaram menor PCT do que os controles normais. Cleary et al (3) observaram IMC mais baixo em pacientes com inflamação articular persistente e número mais elevado de juntas com perda de amplitude de movimento.…”

Section: Discussionunclassified

“…Diversas características clínicas têm sido correlacionadas com o comprometimento nutricional: duração e atividade da doença (4,6,8,12,15) , redução da ingestão dietética (2) , subtipo sistêmico ou poliarticular de doença (4,5,8,12,20) e uso de glicocorticóide. No entanto, há divergências sobre a associação do uso de glicocorticóide e sua dosagem com a redução da estatura, havendo estudos sugerindo uma associação relevante (4,7,12,19,(21)(22) e outros estudos sem demonstrar associação (5)(6)8,20) . Diante desses dados divergentes na literatura, nosso objetivo foi estudar a prevalência do estado nutricional comprometido em um grupo de pacientes com AIJ.…”

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Impacto da atividade inflamatória e uso de glicocorticóide nas variáveis nutricionais da artrite idiopática juvenil

Bisotto¹,

Xavier

Machado³

et al. 2005

Rev. Bras. Reumatol.

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Objetivo: avaliar o estado nutricional na artrite idiopática juvenil (AIJ), a influência da atividade inflamatória e o uso de glicocorticóide. Métodos: foram estudados 116 pacientes com AIJ diagnosticados segundo os critérios da ILAR/1997. Subtipo e atividade da doença foram determinados por reumatologistas pediátricos, e a dose cumulativa de glicocorticóide foi revisada nos prontuários dos pacientes. Foram determinados os percentis do índice de massa corporal (IMC) e da prega cutânea tricipital (PCT) e o escore Z da estatura, de acordo com a OMS. Considerou-se baixo peso e baixa adiposidade quando o IMC e a PCT apresentavam-se abaixo do percentil 5. Baixa estatura foi definida por escore Z de estatura para idade menor do que -2. O nível sérico de IGF-1 foi medido por meio de radioimunoensaio. Resultados: as prevalências de baixo peso, baixa adiposidade e baixa estatura foram 16,4%, 20,7% e 10,4%, respectivamente. Níveis séricos reduzidos de IGF-1 foram observados em 14 pacientes (12,1%). Os fatores negativamente associados com o escore Z da estatura na análise de regressão multivariável foram: duração da doença (coeficiente parcial de correlação, intervalo de confiança de 95%: -0,370, -0,527 a -0,188: p< 0,001), velocidade de hemossedimentação (VHS) (-0,357, -0,516 a -0,174; p< 0,001), subtipo da doença sistêmico ou poliarticular (-0,290, -0,459 a -0,100; p= 0,003), enquanto não houve associação significante com dose cumulativa de glicocorticóide (0,086, -0,111 a 0,277: p= 0,391). Nenhuma dessas variáveis foi significativamente associada com os percentis de IMC e PCT, porém, pacientes com os subtipos sistêmico e poliarticular tenderam a apresentar percentis de IMC mais baixos (partial correlation coefficient, 95% confidence interval: -0.370, -0.527 to -0.188; p < 0.001), erythrocyte sedimentation rate (ESR) (-0.357, -0.516 to -0.174; p < 0.001), polyarticular or systemic subtype (-0.290, -0.459 to -0.100; p = 0.003), while there was no significant association with the cumulative dose of glucocorticoids (0.086, -0.111 to 0.277; p = 0.391

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Frequency of osteopenia in adolescents with early‐onset juvenile idiopathic arthritis: A long‐term outcome study of one hundred five patients

Lien¹,

Flatø²,

Haugen³

et al. 2003

Arthritis & Rheumatism

Self Cite

105

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Objective. To determine the frequency of low bone mineral content (BMC) and low bone mineral density (BMD) as long-term complications in adolescents with early-onset juvenile idiopathic arthritis (JIA), and to identify disease variables, patient characteristics, and biochemical bone markers related to low bone mass.Methods. One hundred five (87%) of 121 adolescent patients with early-onset JIA (ages 13-19 years, 80 girls and 25 boys, mean age at onset of JIA 2.8 years), from a cohort first admitted to the hospital between 1980 and 1985, were assessed after a mean disease duration of 14.2 years. BMC and BMD of the total body, the lumbar spine at L2-L4, and the femoral neck were measured by dual-energy x-ray absorptiometry. Ageand sex-specific reference values from a pooled, healthy reference population were used to calculate Z scores. Low bone mass was defined as a Z score less than ؊1 SD.Results. Among the 103 adolescent JIA patients who underwent total-body imaging, 41% had low totalbody BMC and 34% had low total-body BMD. Compared with adolescent JIA patients who had normal total-body BMC, those with low BMC had lower mean weight (P < 0.001), height (P < 0.001), lean mass (P < 0.001), and remission rates (P ‫؍‬ 0.016), had longer duration of active disease (P ‫؍‬ 0.013), had higher numbers of active and mobility-restricted joints (P < 0.001 and P ‫؍‬ 0.001, respectively), had more disability (P ‫؍‬ 0.011), had higher frequencies of joint erosions (P < 0.001), and had higher erythrocyte sedimentation rates (P ‫؍‬ 0.033). In multiple linear regression analyses of total-body BMC, 88% of the variance was explained by the duration of active disease, the number of joints with restricted mobility, the bone area, urinary deoxypyridinoline values, age, weight, and height.Conclusion. Forty-one percent of the adolescents with early-onset JIA had low bone mass >11 years after disease onset. The development of low total-body BMC was related to the duration of active disease, disease severity, measures of bone resorption, weight, and height.Osteoporosis is a public health problem worldwide. An important determinant of osteoporosis and future fracture risk is the peak bone mass achieved during the period of skeletal growth. Skeletal maturation in children is dependent on the rate of bone formation exceeding the rate of bone resorption. Peak bone mass is defined as the bone mass present at the end of skeletal maturation, which occurs after age 20 years. If a sound foundation for peak bone mass, which is partly genetically determined, is not established during the second decade of life, the young adult will experience osteopenia and an increased fracture risk (1). Children with a chronic illness such as arthritis are at risk of developing osteopenia that is influenced by (in addition to heredity and hormones) inflammation, medication, nutrition, and physical inactivity.

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Minor impact of juvenile arthritis on nutritional status in young adult patients

Cited by 16 publications

References 19 publications

Excess of adiposity in female children and adolescents with juvenile idiopathic arthritis

Excess of adiposity in female children and adolescents with juvenile idiopathic arthritis

Impacto da atividade inflamatória e uso de glicocorticóide nas variáveis nutricionais da artrite idiopática juvenil

Frequency of osteopenia in adolescents with early‐onset juvenile idiopathic arthritis: A long‐term outcome study of one hundred five patients

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