Children treated with anti-TNF therapy at risk for weight gain, obesity
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Children with inflammatory bowel disease who receive anti-tumor necrosis factor treatment were more likely to see BMI levels increase and incur a risk for obesity, according to a presentation at Crohn’s and Colitis Congress.
“Crohn’s disease patients with anti-TNF exposure have a significant increase in BMI z score over time as compared to those unexposed and while for most of our patients, this increase in BMI z score is likely restorative, there is a subset of Crohn’s disease patients where anti-TNF therapy may be a risk factor for excessive weight gain and obesity,” Elana B. Mitchel, MD, MSCE, said in her presentation.
In this multicenter, longitudinal inception cohort of pediatric patients with Crohn’s disease, Mitchel and colleagues looked at more than 1,000 patients with more than 10,000 follow-up visits at 28 sites across North America over a 5-year period.
Researchers stratified patients as either not exposed to anti-TNF therapy (n = 404) or treated with anti-TNF therapy (n = 625) and looked at change in BMI z score, excessive weight gain obesity with confounders of sex, baseline BMI z score, steroid use and CRP.
“Patients exposed to anti-TNF therapy have a significantly higher BMI z score,” Mitchel said. “This effect is most apparent in the first year after diagnosis and while it dampens over time, it remains persistent.”
Mitchel showed that anti-TNF exposure had a coefficient of 0.68 change in BMI z score (95% CI, 0.58-0.77). Boys had higher BMI z scores and steroid exposure and CRP were inversely related to BMI z score, she added.
As there is not an accepted definition for excessive weight gain, Mitchel and colleagues defined it as measuring underweight or normal weight at baseline and then overweight at the end of follow-up; measuring overweight at baseline and then having obesity at the end of follow-up; measuring normal at baseline and then having a delta BMI z score greater than one; or being overweight at baseline and then a delta BMI z score greater than 0.5.
“Using logistic regression, we see that anti-TNF exposure is associated with a 1.4-fold greater odds of excessive weight gain, controlling for these other factors,” Mitchel said. “Anti-TNF exposure is associated with 1.6-fold greater odds of obesity.”
When looking at the risk factors for obesity, Mitchel showed that anti-TNF exposure put the patients at higher risk (OR = 1.58; 95% CI, 1.22-2.03). Additionally, baseline BMI z score was a “large driver” for obesity (OR = 5.66; 95% CI, 4.98-6.44) while female sex conferred a lower risk (OR = 0.56; 95% CI, 0.44-0.72).
“It’s important for providers to understand this may be an association and also to help provide anticipatory guidance and counseling to patients. Finding this finding early, noticing it, and then referring potentially to a dietitian and suggesting lifestyle changes may be important,” Mitchel said.
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Mitchel E. Pediatric IBD: Quick Shots Abstracts and Case Discussions. Presented at: Crohn’s and Colitis Congress (virtual); January 21-24, 2021.
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