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Glucocorticoid‐related changes in body mass index among children and adolescents with rheumatic diseases
Author(s) -
Shiff Natalie J.,
Brant Rollin,
Guzman Jaime,
Cabral David A.,
Huber Adam M.,
Miettunen Paivi M.,
Roth Johannes,
Scuccimarri Rosie,
Alos Nathalie,
Atkinson Stephanie A.,
Collet Jean Paul,
Couch Robert,
Cummings Elizabeth A.,
Dent Peter B.,
Ellsworth Janet,
Hay John,
Houghton Kristin,
Jurencak Roman,
Lang Bianca,
Larche Maggie,
LeBlanc Claire,
Rodd Celia,
SaintCyr Claire,
Stein Robert,
Stephure David,
Taback Shayne,
Rauch Frank,
Ward Leanne M.
Publication year - 2013
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.21785
Subject(s) - medicine , body mass index , prednisone , glucocorticoid , confidence interval , obesity , overweight , endocrinology
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.