Glucocorticoid-related changes in body mass index among children and adolescents with rheumatic disease
Arthritis Care & Research , 08/01/2012
Shiff NJ et al. – In children with rheumatic disease starting moderate and high doses of glucocorticoids, body mass index (BMI) Z–score peaked at 4 months and only half returned to within +0.25 SD of their baseline BMI Z–score by 18 months.Methods
- Children (n=130) initiating GC for a rheumatic disease were assessed every 3 months for 18 months.
- BMI, weight and height Z-scores trajectories were described according to GC starting dose in prednisone equivalents: high (≥1.0 mg/kg/d), low (<0.2 mg/kg/d to a maximum of 7.5 mg/d), and moderate (between high and low) dose.
- The impact of GC dosing, underlying diagnosis, pubertal status, physical and disease activity on BMI Z-scores and on percent body fat were assessed with longitudinal mixed effects growth curve models.
- GC starting dose was high in 59% and moderate in 39%.
- Peak BMI Z-score was +1.29 at 4 months with high-dose and +0.69 at 4.2 months with moderate dose (p<0.001).
- Overall, 50% (95% CI, 41%, 59%) of children returned to within +0.25 standard deviations (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.
- Proportion of days in receipt of GC, 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.