Session Information
Date: Monday, November 6, 2017
Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Obesity is more common in patients with SLE compared to the general population. The prevalence of obesity among SLE patients is between 28 and 50 percent. Despite the high prevalence of obesity in this population, the effect of obesity on disease activity in SLE has not been studied. We hypothesized that the BMI at cohort entry was predictive of future disease activity and that changes in BMI during cohort follow up were associated with disease activity independent of corticosteroid treatment.
Methods:
2406 patients in a prospective SLE cohort had their weight assessed at each visit. Patients were categorized into five predetermined groups based on weight: low (BMI<20 kg/m2), normal weight (reference, BMI 20-24.9 kg/m2), overweight (25-29.9 kg/m2), obese (BMI 30-34.9 kg/m2), and severely obese (BMI>35 kg/m2). To calculate adjusted mean of SLEDAI over time, we only included patients attending the clinic at 3 month intervals for a minimum of 3 visits. 1896 patients were included in the analysis. 1763 (93.0%) were females. Majority (53.0%) were Caucasians, 39.0% African American. A within-person analysis was then performed to assess whether a person’s disease activity level changed if a person’s BMI changed.
Results:
Adjusted mean of SLEDAI over time did not differ between different BMI groups (table 1). SLEDAI significantly decreased by 0.03 with one unit increase in BMI (table 2). In Table 3, we calculated association between mean centered BMI (BMI – individual average BMI) and mean centered SLEDAI (SLEDAI – individual average SLEDAI) which showed a similar association.
Table 1. Adjusted Mean of SLEDAI Over Time by BMI at Entry Visit
|
BMI |
N (%) |
SLEDAI Mean (SD) |
P value |
|
Normal (Reference) |
655(34.5) |
2.7(2.4) |
REF |
|
Low |
183(9.7) |
2.9(2.2) |
1 |
|
Overweight |
531(28) |
2.5(2.1) |
1 |
|
Obese |
290(15.3) |
2.6(2.1) |
1 |
|
Severely Obese |
237(12.5) |
2.5(2.1) |
1 |
Table 2. Association of Disease activity with continuous BMI
|
Mean difference (95% CI) |
P value |
Adj. Mean difference (95%CI)* |
P value |
|
|
BMI |
-0.03 (-0.04, 0.01) |
<0.0001 |
-0.03(-0.04,-0.02) |
<0.0001 |
* Adjust for age, race and prednisone at visit
Table 3. Association of mean centered SLEDAI with mean centered BMI
|
Mean difference (95% CI) |
P value |
Adj. Mean difference (95%CI)* |
P value |
|
|
Mean Centered BMI |
-0.06(-0.07,-0.05) |
<0.0001 |
-0.06(-0.07,-0.05) |
<0.0001 |
* Adjust for age, race and prednisone at visit
Conclusion:
Body weight at cohort entry was not predictive of future disease activity. There was an inverse correlation between changes in body mass index and disease activity even after adjusting for prednisone use. This is the first evidence to our knowledge of an obesity paradox in systemic lupus.
To cite this abstract in AMA style:
Stojan G, Fu W, Petri M. Body Mass Index and Disease Activity in Systemic Lupus Erythematosus- a Paradoxical Relationship? [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/body-mass-index-and-disease-activity-in-systemic-lupus-erythematosus-a-paradoxical-relationship/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/body-mass-index-and-disease-activity-in-systemic-lupus-erythematosus-a-paradoxical-relationship/