Obesity and the Risk of Pediatric Multiple Sclerosis

A new study is suggesting that achieving healthy weight or adjusting medication dosage according to BMI could improve therapy response among pediatric patients with multiple sclerosis (MS).

Analyses showed that obesity appears to be associated with an increased pediatric MS risk and that obese patients did not respond well to first-line medications.

In order to evaluate any potential associations between obesity with pediatric MS risk and with first-line therapy response among children, investigators conducted a single-center retrospective study that included pediatric with relapsing-remitting pediatric MS.

Using medical records and database at the Center for MS in Childhood and Adolescence in Gōttingen, Germany, investigators obtained information on 524 patients. From the 524, a cohort of 453 patients were included in the present analysis.

Of the 453 included in the study, 306 were female, the mean age of the group at diagnosis was 13.7 (2.7) years, mean duration of the disease was 38.4 months, and 27.8% (126) of the population was considered overweight or obese at time of diagnosis. 



Investigators noted that data on participants’ BMIs were stratified by sex and age, using German BMI references, and they were compared with the BMI data of 14,747 controls from a nationwide child health surgery for odds ratio estimates. Investigators compared measurements including baseline magnetic resonance imaging findings, intervals between first and second MS attacks, annualized relapse rates before and during treatment with interferon beta-1a or -1b and glatiramer acetate frequency of second-line treatment, and Expanded Disability Status Scale (EDSS) scores.

These measurements were compared between non-overweight, overweight, and obese patients. Non-overweight was defined as a BMI in the 90th percentile or less, overweight was defined as between the 90th and 97th percentile, and obese as 97th percentile or greater.

Results showed that obesity was associated with statistically significant twofold odds of MS in both sexes. Obese patients also had statistically significantly more relapses on first-line treatment with interferon beta and glatiramer acetate (ARR, 1.29 vs 0.72; P < .001) and higher rates of second line-treatment (21 [56.8%] of 37 vs 48 [38.7%] of 124; P = .06). &#8232;

Investigators noted that interval between first and second MS attacks, pretreatment relapses, baseline neuroimaging, and EDSS progression scores were not correlated with BMI.

Investigators pointed out multiple limitations within their study. The study being a tertiary referral center for pediatric MS means it may have attracted a higher number of patients with less benign disease. Additionally, BMI measurements were taken within 6 months of diagnosis and may not accurately reflect BMI to changes in status. &#8232;

This study, titled “Association of Obesity With Multiple Sclerosis Risk and Response to First-line Disease Modifying Drugs in Children,” is published in JAMA Neurology. &#8232;&#8232;&#8232;