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agate
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 Posted: Sun Feb 03, 2013 6:42 pm Post subject: Obesity raises MS risk in girls, study says |
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From MedPage Today, January 31, 2013:
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Obesity Raises MS Risk in Girls
By Nancy Walsh, Staff Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
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Increasing levels of obesity in adolescent girls were associated with heightened risks for multiple sclerosis (MS) or a precursor condition known as clinically isolated syndrome (CIS), researchers found.
Among overweight girls ages 12 to 18, the odds ratio for MS/CIS was 1.58 (95% CI 0.71 to 3.50), rising to 1.78 (95% CI 0.70 to 4.49) for those who were moderately obese and 3.76 (95% CI 1.54 to 9.16) for those who were extremely obese, according to Annette Langer-Gould, MD, PhD, of Kaiser Permanente of Southern California in Pasadena, and colleagues.
In addition, the presenting symptom was more likely to be transverse myelitis in obese children than in the overweight or in those with normal weight (P=0.003), the researchers reported in the Feb. 5 issue of Neurology.
Obesity is associated with low-level systemic inflammation, but whether the obesity epidemic among youth is related to the increased recognition of MS in young patients is unknown.
To examine this possibility, Langer-Gould and colleagues analyzed data from a cohort of 75 children with demyelinating diseases and 913,097 unaffected controls from a large children's health study in Southern California.
The diagnosis of MS required two or more episodes of demyelination in the central nervous system, while CIS was a single demyelinating event without encephalopathy.
Patients' most recent body mass index (BMI) in medical records before symptom onset was used for risk calculations.
Overweight was defined as BMI at or above the 85th percentile for age, moderately obese was BMI at or above the 95th percentile, and extremely obese was BMI 1.2 times the 95th percentile.
A total of 72% of children diagnosed with MS/CIS were at least 11 years old, 52% were Hispanic, and more cases than controls were female (54.7%).
Slightly more than half of the MS/CIS group were either overweight or obese.
Among the children who developed MS/CIS between ages 2 and 11, there was a nonsignificant trend for increasing risk with higher BMI among girls (P=0.13).
There was no association for boys with increasing weight (P=0.93 for trend):
Overweight, OR 1.80 (95% CI 0.83 to 3.93)
Moderate obesity, OR 0.89 (95% CI 0.30 to 2.64)
Extreme obesity, OR 0.82 (95% CI 0.19 to 3.56)
A presenting symptom was transverse myelitis in 5.3% of those who were overweight, in 40% of those who were moderately obese, and in 55.6% of those who were extremely obese.
In contrast, optic neuritis was found in 36.8%, 50%, and 11.1%, of the overweight, moderately obese, and extremely obese patients, respectively.
Other types of first episode of CIS were identified in 57.9%, 10%, and 33.3% of the three ascending weight groups.
The diagnosis of actual MS was made in 47.3% of children who were overweight and in 50% and 66.7% of those who were moderately or extremely obese.
"Our findings suggest that the childhood obesity epidemic is likely to lead to increased morbidity from MS/CIS, particularly in adolescent girls," predicted Langer-Gould and colleagues.
It was unclear why weight did not appear to influence risk among boys, they said. Possible factors included the earlier onset of obesity in boys and the influence of puberty, as well as the effects of inflammation on hormones.
Previous research has suggested that low-level inflammation can increase the levels of estrogens in both genders and decrease male levels of androgens.
"We speculate that the rapid rise and high estrogenic exposure of obese, peripubescent girls in combination with the inflammatory mediators released by adipose tissue accelerate CIS/MS onset into adolescence," they observed.
But in boys, it may take longer for this excess exposure to estrogen to occur, delaying the development of disease into later adulthood.
Prospective studies will be needed to further clarify these concerns, the researchers said.
They also noted that pediatric MS/CIS remains a rare condition and does not warrant screening of obese adolescents for transverse myelitis, but "those caring for obese adolescents should pay careful attention in those presenting with sensory and motor symptoms referable to the spinal cord."
Limitations of the study included the small numbers, use of administrative coding data, and a lack of long-term follow-up.
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The study was supported by the National Institute of Diabetes and Digestive and Kidney Disorders and Kaiser Permanente Direct Community Benefit Funds.
The lead author is a principal investigator for clinical trials sponsored by Biogen Idec and Hoffman-LaRoche.
Source reference:
Langer-Gould A, et al "Childhood obesity and risk of pediatric multiple sclerosis and clinically isolated syndrome" Neurology 2013; 80: 548-552.
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