Body Composition and Adipose Tissue Distribution in Juvenile Dermatomyositis and Associations with Cardiac Function

Birgit Nomeland Witczak¹, Kristin Godang², Thomas Schwartz³, Nicoleta Cristina Olarescu⁴, Berit Flatø^5,6, Jens Bollerslev^5,7, Ivar Sjaastad^5,8,9 and Helga Sanner^5,6, ¹Oslo University Hospital, Institute for Experimental Medical Research, Oslo University Hospital, Oslo, Norway, Oslo, Norway, ²Department of Specialised Endocrinology, Oslo University Hospital, Section of Specialised Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway, Oslo, Norway, ³Department of Infectious Diseases, Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway, Oslo, Norway, ⁴Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway., Section of Specialised Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway, Oslo, Norway, ⁵Institute for Clinical Medicine, University of Oslo, Oslo, Norway, Oslo, Norway, ⁶Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway, Oslo, Norway, ⁷Section of Specialised Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway, Oslo, Norway, ⁸Department of Cardiology, Oslo University Hospital, Oslo, Norway, Oslo, Norway, ⁹Institute for Experimental Medical Research, Oslo University Hospital, Oslo, Norway, Oslo, Norway

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: adipose tissue, cardiovascular disease and juvenile dermatomyositis

Session Information

Date: Wednesday, November 16, 2016

Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects III: Autoinflammatory Diseases and Juvenile Dermatomyositis

Session Type: ACR Concurrent Abstract Session

Session Time: 11:00AM-12:30PM

Background/Purpose: Lipodystrophy and metabolic abnormalities occur frequently in juvenile dermatomyositis (JDM) and redistribution of adipose tissue has been reported in several rheumatic diseases. Visceral adipose tissue (VAT) is closely linked to cardiovascular disease. We aimed to assess body composition, with emphasis on VAT, in JDM patients and controls, and explore the associations with cardiac function.

Methods: Fifty-nine JDM patients and 59 age- and sex matched controls from the general population, were included in a cross sectional study median 16.8 years after disease onset. Body composition including fat mass (kg) and lean mass (kg) was analyzed by total body dual-energy X-ray absorptiometry (DXA). Total body fat percentage was defined as the ratio of total fat mass/(total lean mass + total fat mass). VAT (g) was quantified by DXA only in individuals above 18 years, including 38 JDM patient and 35 controls (missing data in 3 controls). Long axis strain (LAS) and early diastolic tissue velocity (E’) assessed by echocardiography were used as markers for systolic and diastolic cardiac function, respectively. Inactive disease was measured by the PRINTO criteria.

Results: In JDM patients, median age was 21.5 (IQR 15.3-35.3) years and 36/59 (61%) were female; 29/59 (49.2%) had inactive disease. Cumulative prednisolone dose was median 7.9 g (IQR 3.5-12.8). 17/59 (28%) of the patients were on prednisolone and/or DMARD at follow-up. BMI was similar between JDM patients and controls (22.3kg/m² (4.8) vs 22.5kg/m (4.5), p=0.752). JDM patients had higher percentage total body fat (31.2% (7.9) vs 28.2% (7.5), p=0.017) and lower lean mass (41.4kg (12.9) vs 44.9kg (13.6), p=0.008) compared with controls. Fat mass was comparable in patients vs controls (data not shown). VAT was three times higher in patients compared with controls (726g (IQR 193-1183) vs 232g (IQR 72-751), p=0.022), no difference was seen between patients with active and inactive disease. VAT correlated negatively with LAS in all patients, and even more in patients with active disease (rsp -0.397, p=0.018 and rsp -0.750, p=0.000 respectively). VAT correlated negatively with E’ in all patients and in the subgroups with active and inactive disease (rsp -0.584, p= 0.000; rsp -0.567, p=0.014 and rsp -0.554, p=0.014 respectively). VAT correlated with systolic and diastolic blood pressure (BP) in all patients, and in patients with active and inactive disease. No correlation between VAT and LAS, E’, Diastolic BP was observed in controls. No correlation was found between VAT and use of medication at follow-up or cumulative prednisolone dose.

Conclusion: Patients with JDM had a higher total body fat percentage and a lower lean mass compared with matched controls, despite similar BMI. A redistribution of adipose tissue in JDM patients was demonstrated, as VAT was three times higher in patients compared with controls. Both systolic and diastolic cardiac dysfunction were associated with higher VAT in patients, but not in controls. This suggests that the increased visceral adipose may contribute to subclinical heart disease in JDM.

Disclosure: B. N. Witczak, None; K. Godang, None; T. Schwartz, None; N. C. Olarescu, None; B. Flatø, None; J. Bollerslev, None; I. Sjaastad, None; H. Sanner, None.

To cite this abstract in AMA style:

Witczak BN, Godang K, Schwartz T, Olarescu NC, Flatø B, Bollerslev J, Sjaastad I, Sanner H. Body Composition and Adipose Tissue Distribution in Juvenile Dermatomyositis and Associations with Cardiac Function [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/body-composition-and-adipose-tissue-distribution-in-juvenile-dermatomyositis-and-associations-with-cardiac-function/. Accessed .

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