Children with autoimmune hepatitis receiving standard-of-care therapy demonstrate long-term obesity and linear growth delay
Background:. Standard-of-care therapy in children with autoimmune hepatitis (AIH) includes induction with prednisone 1–2 mg/kg daily with gradual weaning of the dose. We aimed to test the hypothesis that children with AIH receiving standard-of-care treatment have altered growth trajectories. Methods...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health/LWW
2025-02-01
|
| Series: | Hepatology Communications |
| Online Access: | http://journals.lww.com/10.1097/HC9.0000000000000624 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832540437159608320 |
|---|---|
| author | Or Steg Saban Shannon M. Vandriel Syeda Aiman Fatima Celine Bourdon Amrita Mundh Vicky L. Ng Simon C. Ling Robert H.J. Bandsma Binita M. Kamath |
| author_facet | Or Steg Saban Shannon M. Vandriel Syeda Aiman Fatima Celine Bourdon Amrita Mundh Vicky L. Ng Simon C. Ling Robert H.J. Bandsma Binita M. Kamath |
| author_sort | Or Steg Saban |
| collection | DOAJ |
| description | Background:. Standard-of-care therapy in children with autoimmune hepatitis (AIH) includes induction with prednisone 1–2 mg/kg daily with gradual weaning of the dose. We aimed to test the hypothesis that children with AIH receiving standard-of-care treatment have altered growth trajectories.
Methods:. Children diagnosed with AIH between 1997 and 2023 at SickKids had serial growth measurements. Mixed effect models assessed the impact of time and daily steroid exposure on z-scores. Kaplan-Meier survival methods were used to estimate the cumulative incidence of new-onset growth impairments. A time-dependent Cox proportional hazards model was constructed to determine predictors for growth impairments.
Results:. Sixty-one children (66% females, median age at diagnosis 11.5 y) were included. BMIz showed a sharp increase, and HAZ declined significantly without returning to baseline. Each 1 mg/kg/d prednisone exposure increased BMIz gain in the first 6 months by 0.27 ([95% CI: 0.11, 0.42], p = 0.001), and decreased HAZ by −0.02 ([95% CI: −0.03, −0.01], p = 0.005). Children diagnosed before puberty exhibited a higher occurrence of excessive weight gain (72.2% vs. 49.3%; log-rank p < 0.01) and obesity (63% vs. 31.5%; log-rank p < 0.01) compared to those diagnosed during puberty. In a Cox proportional-hazards model, young age at diagnosis and daily prednisone dose >10 mg 6 months after diagnosis were predictors for linear growth delay.
Conclusions:. This study demonstrates that children with AIH receiving standard-of-care therapy demonstrate altered growth trajectories, long-term excess weight gain, obesity, and linear growth delay. Young age at diagnosis and >10 mg of daily prednisone at 6 months are predictors for linear growth delay. These data indicate the need to re-evaluate standard treatment algorithms for pediatric AIH in terms of steroid dosing and potential nonsteroid alternatives. |
| format | Article |
| id | doaj-art-09bc5a40ca184f428ac9015ea290208e |
| institution | Kabale University |
| issn | 2471-254X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Hepatology Communications |
| spelling | doaj-art-09bc5a40ca184f428ac9015ea290208e2025-02-05T02:10:59ZengWolters Kluwer Health/LWWHepatology Communications2471-254X2025-02-019210.1097/HC9.0000000000000624HC90000000000000624Children with autoimmune hepatitis receiving standard-of-care therapy demonstrate long-term obesity and linear growth delayOr Steg Saban0Shannon M. Vandriel1Syeda Aiman Fatima2Celine Bourdon3Amrita Mundh4Vicky L. Ng5Simon C. Ling6Robert H.J. Bandsma7Binita M. Kamath8 1 Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada 1 Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada 1 Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada 2 Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada 1 Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada 1 Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada 1 Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada 1 Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada 1 Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, CanadaBackground:. Standard-of-care therapy in children with autoimmune hepatitis (AIH) includes induction with prednisone 1–2 mg/kg daily with gradual weaning of the dose. We aimed to test the hypothesis that children with AIH receiving standard-of-care treatment have altered growth trajectories. Methods:. Children diagnosed with AIH between 1997 and 2023 at SickKids had serial growth measurements. Mixed effect models assessed the impact of time and daily steroid exposure on z-scores. Kaplan-Meier survival methods were used to estimate the cumulative incidence of new-onset growth impairments. A time-dependent Cox proportional hazards model was constructed to determine predictors for growth impairments. Results:. Sixty-one children (66% females, median age at diagnosis 11.5 y) were included. BMIz showed a sharp increase, and HAZ declined significantly without returning to baseline. Each 1 mg/kg/d prednisone exposure increased BMIz gain in the first 6 months by 0.27 ([95% CI: 0.11, 0.42], p = 0.001), and decreased HAZ by −0.02 ([95% CI: −0.03, −0.01], p = 0.005). Children diagnosed before puberty exhibited a higher occurrence of excessive weight gain (72.2% vs. 49.3%; log-rank p < 0.01) and obesity (63% vs. 31.5%; log-rank p < 0.01) compared to those diagnosed during puberty. In a Cox proportional-hazards model, young age at diagnosis and daily prednisone dose >10 mg 6 months after diagnosis were predictors for linear growth delay. Conclusions:. This study demonstrates that children with AIH receiving standard-of-care therapy demonstrate altered growth trajectories, long-term excess weight gain, obesity, and linear growth delay. Young age at diagnosis and >10 mg of daily prednisone at 6 months are predictors for linear growth delay. These data indicate the need to re-evaluate standard treatment algorithms for pediatric AIH in terms of steroid dosing and potential nonsteroid alternatives.http://journals.lww.com/10.1097/HC9.0000000000000624 |
| spellingShingle | Or Steg Saban Shannon M. Vandriel Syeda Aiman Fatima Celine Bourdon Amrita Mundh Vicky L. Ng Simon C. Ling Robert H.J. Bandsma Binita M. Kamath Children with autoimmune hepatitis receiving standard-of-care therapy demonstrate long-term obesity and linear growth delay Hepatology Communications |
| title | Children with autoimmune hepatitis receiving standard-of-care therapy demonstrate long-term obesity and linear growth delay |
| title_full | Children with autoimmune hepatitis receiving standard-of-care therapy demonstrate long-term obesity and linear growth delay |
| title_fullStr | Children with autoimmune hepatitis receiving standard-of-care therapy demonstrate long-term obesity and linear growth delay |
| title_full_unstemmed | Children with autoimmune hepatitis receiving standard-of-care therapy demonstrate long-term obesity and linear growth delay |
| title_short | Children with autoimmune hepatitis receiving standard-of-care therapy demonstrate long-term obesity and linear growth delay |
| title_sort | children with autoimmune hepatitis receiving standard of care therapy demonstrate long term obesity and linear growth delay |
| url | http://journals.lww.com/10.1097/HC9.0000000000000624 |
| work_keys_str_mv | AT orstegsaban childrenwithautoimmunehepatitisreceivingstandardofcaretherapydemonstratelongtermobesityandlineargrowthdelay AT shannonmvandriel childrenwithautoimmunehepatitisreceivingstandardofcaretherapydemonstratelongtermobesityandlineargrowthdelay AT syedaaimanfatima childrenwithautoimmunehepatitisreceivingstandardofcaretherapydemonstratelongtermobesityandlineargrowthdelay AT celinebourdon childrenwithautoimmunehepatitisreceivingstandardofcaretherapydemonstratelongtermobesityandlineargrowthdelay AT amritamundh childrenwithautoimmunehepatitisreceivingstandardofcaretherapydemonstratelongtermobesityandlineargrowthdelay AT vickylng childrenwithautoimmunehepatitisreceivingstandardofcaretherapydemonstratelongtermobesityandlineargrowthdelay AT simoncling childrenwithautoimmunehepatitisreceivingstandardofcaretherapydemonstratelongtermobesityandlineargrowthdelay AT roberthjbandsma childrenwithautoimmunehepatitisreceivingstandardofcaretherapydemonstratelongtermobesityandlineargrowthdelay AT binitamkamath childrenwithautoimmunehepatitisreceivingstandardofcaretherapydemonstratelongtermobesityandlineargrowthdelay |