Body Composition and Fat Deposition in Children with Cushing Disease and Associations with Cardiometabolic Risk Factors.

Abstract

To compare body composition and fat distribution in children with Cushing disease (CD) with body mass index (BMI)-matched peers with obesity and evaluate associations with cardiometabolic risk factors (CRFs). In a retrospective cohort study, we compared 23 pediatric patients with active CD and 46 age-, sex-, and BMI z-score-similar controls. Anthropometric measurements, fasting biochemistry, and whole-body dual-energy X-ray absorptiometry had already been performed. Patients with CD had a greater percentage of total body fat than their BMI-similar controls (47.8% [SD 7.8] in female patients with CD vs 40.0% [SD 10.1] in control patients, P = .016; 46.6% [SD 8.5] in male patients with CD vs 38.3% [SD 9.9] in control patients, P = .019). However, fat distribution, assessed by proportions of fat between the trunk and the limbs, did not differ significantly between the 2 groups, suggesting that a more central obesity phenotype is not clearly identified in this pediatric CD group. In control patients, CRFs showed strong correlations with BMI and markers of fat deposition and distribution, yet in patients with CD, CRFs showed variable correlations with certain factors associating only with markers of fat deposition and distribution rather than BMI. Pediatric patients with CD have greater adiposity and reduced lean and bone mass compared with BMI-similar peers, despite similar fat distribution. BMI underestimates fat burden in patients with CD and measures derived from dual-energy X-ray absorptiometry may better reflect metabolic risk. Comprehensive body composition assessment should be considered in pediatric patients with CD for risk stratification and management. ClinicalTrials.gov ID: NCT00001595; NCT00001723; NCT00001522.