601 Souza, et al: Nutrition in JIA Personal non-commercial use only. The Journal of Rheumatology Copyright © 2006. All rights reserved. Effect of Inflammatory Activity and Glucorticoid Use on Nutritional Variables in Patients with Juvenile Idiopathic Arthritis LETÍCIA SOUZA, SANDRA HELENA MACHADO, MARKUS BREDEMEIER, JOÃO CARLOS TAVARES BRENOL, and RICARDO MACHADO XAVIER ABSTRACT. Objective. To assess nutritional status in patients with juvenile idiopathic arthritis (JIA) and the influ- ence of inflammatory activity and glucocorticoid use. Methods. One hundred sixteen patients were evaluated. Disease subtype and disease activity were defined by the attending physician, and the cumulative glucocorticoid dose was recorded from chart review. Percentiles of body mass index (BMI) and triceps skinfold (TSF) and the Z score for height were determined: low weight and low adiposity were diagnosed when BMI and TSF were below the 5th percentile. Short stature was defined by a Z score of height for age < –2. Serum concentration of insulin- like growth factor-I (IGF-I) was measured by radioimmunoassay. Results. The prevalences of low weight, low adiposity, and short stature were 16.4%, 20.7%, and 10.4%, respectively. Low IGF-I serum level was found in 14 patients (12.1%). The factors negatively associated with the Z score of height in multivariable regression analysis were disease duration (partial correlation coefficient –0.370, 95% confidence interval: –0.527 to –0.188; p < 0.001), erythrocyte sed- imentation rate (ESR) (–0.357, –0.516 to –0.174; p < 0.001), and polyarticular or systemic disease sub- type (–0.290, –0.459 to –0.100; p = 0.003), while there was no significant correlation with the cumula- tive dose of glucocorticoids (0.086, –0.111 to 0.277; p = 0.391). None of these variables was signifi- cantly correlated with the percentiles of BMI and TSF, albeit confidence intervals for these correlation coefficients were relatively large. Patients with a systemic or polyarticular disease subtype tended to present lower percentiles of BMI (p = 0.051). Conclusion. Nutritional status is frequently compromised in patients with JIA. Duration and disease sub- type and the ESR are factors independently associated with short stature. The cumulative dose of gluco- corticoids was not independently associated with short stature or with other nutritional variables, although a relevant negative effect of glucocorticoid dose on BMI and TSF cannot be entirely excluded. (J Rheumatol 2006;33:601–8) Key Indexing Terms: JUVENILE IDIOPATHIC ARTHRITIS NUTRITIONAL VARIABLES SHORT STATURE INSULIN-LIKE GROWTH FACTOR-I From the Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. Supported in part by grants from Fundo de Incentivo à Pesquisa e Eventos do Hospital de Clínicas de Porto Alegre (FIPE/HCPA). L. Souza, MSc, Nutritionist; S.H. Machado, MD, MSc, Pediatric Rheumatologist; M. Bredemeier, MD, MSc, Rheumatologist; J.C.T. Brenol, MD, PhD, Head, Division of Rheumatology, Associate Professor of Rheumatology; R.M. Xavier, MD, PhD, Associate Professor of Rheumatology. Address reprint requests to Dr. R.M. Xavier, Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, sala 645, Porto Alegre, RS, 90035-003, Brazil. E-mail: lebisotto@hotmail.com Accepted for publication November 25, 2005. Juvenile idiopathic arthritis (JIA) is the most common chron- ic arthritis in childhood 1 . Involvement of nutritional status (anthropometric and biochemical) has often been reported in this disease. Among the anthropometric variable abnormali- ties observed in JIA, previous studies suggest that the preva- lence of low weight is between 4.0% and 46.6% 2-5 and that the prevalence of short stature is between 10.0% and 41.0% 4,6-12 . Possible causes for these abnormalities include anorexia 2 , food restrictions 13 , nutrient malabsorption 14 , increased catabolism and energy requirement 15 , limitation of physical activities 16 , reduced vitamin D absorption 17 , reduced growth hormone secretion 6 , and treatment with glucocorti- coids 7 . Among the biochemical markers of nutritional state, lower serum concentrations of albumin, iron, and insulin-like growth factor-I (IGF-I) are often observed in JIA 4 . Serum lev- els of IGF-I, which is considered the best nitrogen balance marker and is the effector agent of growth hormone 18 , are often reduced and are associated with short stature in patients with JIA 4,6,19 . Several clinical features have been associated with nutri- tional involvement: duration and activity of the dis- ease 4,6,8,12,15 , reduced dietary intake 2 , systemic or polyarticu- lar subtype of disease 4,5,8,12,20 , and the use of glucocorticoids. However, there are discordant reports concerning the associa- www.jrheum.org Downloaded on January 12, 2022 from