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Interactions between growth and body composition in children treated with high-dose chronic glucocorticoids

Bethany J Foster1, Justine Shults, Babette S Zemel

  • 1Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, USA. beth.foster@muhc.mcgill.ca

The American Journal of Clinical Nutrition
|November 9, 2004
PubMed

Insights

Children with steroid-sensitive nephrotic syndrome (SSNS) treated with glucocorticoids often become obese, impacting growth. Despite this, their final adult height remains normal due to a higher body mass index (BMI).

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Growth and Development

Background:

  • Glucocorticoid therapy is known to impede growth and cause Cushingoid body habitus in children.
  • Children with steroid-sensitive nephrotic syndrome (SSNS) often achieve near-normal adult height despite prolonged glucocorticoid treatment.
  • Limited data exists on the body composition of children undergoing long-term glucocorticoid therapy for SSNS.

Purpose of the Study:

  • To evaluate the impact of chronic glucocorticoid therapy on height and body composition in children with SSNS.
  • To compare body composition metrics in children with SSNS against healthy reference children.
  • To test the hypothesis that glucocorticoids lead to obesity, reduced lean mass, and altered fat/lean distribution.

Main Methods:

  • A cross-sectional study involving 52 children with SSNS (aged 4-21 years) and 259 healthy reference children.
  • Assessment of height, weight, and pubertal status.
  • Dual-energy X-ray absorptiometry (DXA) used to measure fat and lean mass in all participants.
  • Recording of lifetime glucocorticoid exposure for SSNS patients; outcomes expressed as SD scores (SDS).

Main Results:

  • 41% of SSNS patients were obese (BMI > 95th percentile), with normal regional fat distribution.
  • SSNS patients exhibited higher mean total lean mass-for-height (0.43 SD) but lower mean appendicular lean mass-for-total-lean-mass (-0.39 SD) compared to controls.
  • Mean height-SDS in SSNS was -0.08 SD, but significantly decreased with increasing obesity; height-SDS positively correlated with BMI-SDS.

Conclusions:

  • Glucocorticoid therapy for SSNS is associated with obesity and reduced appendicular lean mass.
  • Normal overall height-SDS in SSNS patients is attributed to a mitigating effect of elevated BMI on glucocorticoid-induced growth retardation.
Abstract

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