title: Obesity in children with congenital adrenal hyperplasia in the Minnesota cohort: importance of adjusting body mass index for height-age.
abstract: OBJECTIVE
  To evaluate obesity and overweight in children with congenital adrenal hyperplasia (CAH) and associations with glucocorticoids, fludrocortisone and disease control. Adjusting body mass index-for-height-age (BMIHA) percentile is proposed to correct misclassification of obese/overweight status in CAH children with advanced bone age and tall-for-age stature.
  
  
  METHODS
  Longitudinal.
  
  
  METHODS
  One hundred and ninety-four children with CAH seen from 1970 to 2013: 124 salt wasting (SW); 70 simple virilizing (SV); 102 females.
  
  
  METHODS
  Body mass index (BMI) end-points were overweight (85-94 percentile) and obese (≥95 percentile).
  
  
  RESULTS
  Approximately 50% of the children had at least one BMI measurement ≥95 percentile and about 70% had at least one ≥85 percentile. Using BMIHApercentiles, obesity incidence decreased slightly in SW children (47-43%) and markedly in SV children (50-33%); however, overweight status was not reduced. Only 6% of SW and 1% of SV children were persistently obese (≥3 clinic visits) when BMIHAwas applied, whereas overweight status persisted in 35% of SW and 33% of SV children. Most obesity or overweight when using BMIHAoccurred before age 10 and there was no association with hydrocortisone (HC) or fludrocortisone dosing. Adiposity rebound for SW children occurred by 3·3 years and in SV females by age 3·8 years, over a year earlier than the adiposity rebound for healthy children.
  
  
  CONCLUSIONS
  Children with CAH are at higher risk for early onset obesity and overweight with or without using BMIHAbut rates of persistent obesity were lower than previously reported. Careful HC dosing during early childhood is needed to prevent increased weight gain and an early adiposity rebound.
authors.affiliation: Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.
authors.forename: Kyriakie
authors.identifier: http://orcid.org/0000-0002-5741-3629
authors.initials: K
authors.lastname: Sarafoglou
authors.affiliation: Pediatric Endocrinology Barbara Davis Center, University of Colorado Denver, Denver, CO, USA.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Forlenza
authors.affiliation: Global Health, Rollins School of Public Health of Emory University, Atlanta, GA, USA.
authors.forename: O
authors.initials: O
authors.lastname: Yaw Addo
authors.affiliation: Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kyllo
authors.affiliation: The Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Aida
authors.initials: A
authors.lastname: Lteif
authors.affiliation: Institute of Child Health, University College London, London, UK.
authors.forename: P C
authors.initials: PC
authors.lastname: Hindmarsh
authors.affiliation: Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Petryk
authors.affiliation: Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Gonzalez-Bolanos
authors.affiliation: Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Miller
authors.affiliation: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: William
authors.initials: W
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000150:complications / Q000175:diagnosis*; D000367:Age Factors; D001827:Body Height; D015992:Body Mass Index; D002648:Child; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D009765:Obesity / Q000175:diagnosis / Q000209:etiology; D050177:Overweight / Q000175:diagnosis* / Q000209:etiology