Interactions between growth and body composition in children treated with high-dose chronic glucocorticoids.
BACKGROUND
Glucocorticoid therapy retards growth during childhood and is believed to lead to a Cushingoid body habitus. However, despite prolonged, repeated courses of glucocorticoid, children with steroid-sensitive nephrotic syndrome (SSNS) have almost normal adult height. Little information exists on body composition.


OBJECTIVE
We sought to assess the effect of glucocorticoids on height and body composition by comparing children with SSNS with concurrent healthy reference children. We hypothesized that chronic glucocorticoid therapy leads to obesity, decreased lean mass, and distorted distributions of fat and lean.


METHODS
We performed a cross-sectional study of 52 subjects with SSNS (4-21 y) and 259 reference subjects. The evaluation included height, weight, and pubertal status. Fat and lean masses were assessed by dual-energy X-ray absorptiometry in all subjects. Lifetime glucocorticoid exposure was recorded for subjects with SSNS. Outcomes were expressed as SD scores (SDS).


RESULTS
Forty-one percent of subjects with SSNS were obese [body mass index (BMI) > 95th percentile], but regional fat distribution was normal. Mean total lean mass-for-height was 0.43 SD (95% CI: 0.15, 0.72) higher and mean appendicular lean mass-for-total-lean-mass was lower (-0.39 SD; 95% CI: -0.64, -0.14) in SSNS compared with reference children. The mean height-SDS in SSNS was -0.08 SD (95% CI: -0.37, 0.21) relative to national reference data, but height-SDS was significantly decreased given the degree of obesity. Height-SDS was positively associated with BMI-SDS among subjects with SSNS.


CONCLUSIONS
Glucocorticoid therapy for SSNS is complicated by obesity and relatively low appendicular lean mass. Overall height-SDS is normal because of a mitigating effect of elevated BMI on glucocorticoid-induced growth retardation.
Foster
Bethany J
BJ
Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, USA. beth.foster@muhc.mcgill.ca
Shults
Justine
J
Zemel
Babette S
BS
Leonard
Mary B
MB
D000293:Adolescent; D000328:Adult; D001823:Body Composition / Q000187:drug effects*; D001827:Body Height / Q000187:drug effects; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use*; D006128:Growth / Q000187:drug effects*; D006801:Humans; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D009765:Obesity / Q000139:chemically induced
D005938:Glucocorticoids