Dr. Rodd has received consultancy fees, speaking fees, and/or honoraria (less than $10,000 each) from the Association of Endocrinologists of Quebec and BC Children's Hospital.
Special Theme Articles: Obesity and the Rheumatic Diseases
Glucocorticoid-related changes in body mass index among children and adolescents with rheumatic diseases
Article first published online: 27 DEC 2012
Copyright © 2013 by the American College of Rheumatology
Arthritis Care & Research
Volume 65, Issue 1, pages 113–121, January 2013
How to Cite
Shiff, N. J., Brant, R., Guzman, J., Cabral, D. A., Huber, A. M., Miettunen, P. M., Roth, J., Scuccimarri, R., Alos, N., Atkinson, S. A., Collet, J. P., Couch, R., Cummings, E. A., Dent, P. B., Ellsworth, J., Hay, J., Houghton, K., Jurencak, R., Lang, B., Larche, M., LeBlanc, C., Rodd, C., Saint-Cyr, C., Stein, R., Stephure, D., Taback, S., Rauch, F., Ward, L. M. and and The Canadian Steroid-associated Osteoporosis in the Pediatric Population Consortium (2013), Glucocorticoid-related changes in body mass index among children and adolescents with rheumatic diseases. Arthritis Care Res, 65: 113–121. doi: 10.1002/acr.21785
- Issue published online: 27 DEC 2012
- Article first published online: 27 DEC 2012
- Accepted manuscript online: 23 JUL 2012 02:52PM EST
- Manuscript Accepted: 19 JUN 2012
- Manuscript Received: 1 FEB 2012
- Canadian Institutes of Health Research
- Children's Hospital of Eastern Ontario
- Women and Children's Health Research Institute
- University of Alberta
- Clinician Investigator Program
- University of British Columbia
- Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship Master Award
- Canadian Institutes for Health Research New Investigator Award
- Canadian Child Health Clinician Scientist Career Enhancement Award
- Research Chair Award from the University of Ottawa
To examine the temporal and dose-related effects of glucocorticoids (GCs) on body mass index (BMI) in children with rheumatic diseases.
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.
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.
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.