Impact of overweight and obesity on patient-reported health-related quality of life in systemic lupus erythematosus

Abstract

Objectives Associations between BMI and health-related quality of life (HRQoL) in SLE have been implied, but data are scarce. We determined the impact of overweight and obesity on HRQoL in a large SLE population. Methods We pooled cross-sectional baseline data from the BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) trials (N = 1684). HRQoL was evaluated using the 36-item Short Form Health Survey (SF-36), Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale and the European Quality of Life 5-dimension questionnaire (EQ-5D). Comparisons between BMI groups were conducted using the Mann–Whitney U test and adjustments using linear regression. Clinical relevance was determined by minimal clinically important differences (MCIDs). Results In total, 43.2% of the patients had BMI above normal and 17.4% were obese. Overweight and obese patients reported worse SF-36 physical component summary (PCS), physical functioning, role physical, bodily pain and FACIT-Fatigue scores than normal weight patients. Divergences were greater than corresponding MCIDs and more prominent with increasing BMI. Despite no clinically important difference in SF-36 mental component summary scores across BMI categories, patients experienced progressively diminished vitality and social functioning with increasing BMI. In linear regression analysis, BMI above normal and obesity were associated with worse PCS (standardized coefficient β = −0.10, P < 0.001 and β = −0.17, P < 0.001, respectively), FACIT-Fatigue (β = −0.11, P < 0.001 and β = −0.16, P < 0.001) and EQ-5D (β = −0.08, P = 0.001 and β = −0.12, P < 0.001) scores, independently of demographic and disease-related factors. The impact of BMI on the PCS and FACIT-Fatigue was more pronounced than that of SLE activity. Conclusion Patients with SLE and BMI above normal experienced clinically important HRQoL diminutions in physical aspects, fatigue and social functioning. A survey of potential causality underlying this association is warranted.

Contribution of abnormal BMI to adverse health-related quality of life outcomes after a 52-week therapy in patients with SLE

“…We recently showed that self-reported physical health, fatigue and social functioning were gradually worse with increasing BMI. In the same report, we showed that pre-obese and obese patients with SLE experienced more prominent impairments in physical aspects of HRQoL and more prominent fatigue than normal weight patients, with these divergences exceeding cut-offs for clinically important differences [ 10 ]. In the present study, we demonstrated a detrimental effect of overweight and obesity on the efficacy of a 52-week intervention with ST plus belimumab or placebo with regard to physical aspects of HRQoL, vitality and social functioning.…”

“…Data from current literature advocate that obesity is associated with higher SLE disease activity [ 7 ] and negatively impacts on HRQoL [ 8 , 9 ]. Recently, we demonstrated that SLE patients’ self-reported physical health, fatigue and social functioning were gradually worse with increasing BMI, and that overweight patients experienced clinically important impairments regarding physical aspects of HRQoL and fatigue [ 10 ]. Importantly, the impact of high BMI on these HRQoL aspects was greater than that of SLE disease activity.…”

Fatigue in Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Comparison of Mechanisms, Measures and Management

“…In an individual with active SLE or RA, fatigue is, therefore, often compounded by the use of corticosteroids. Lastly, fatigue in SLE has been shown to be associated with overweight and obesity in a body mass index (BMI)-level-dependent manner [59].…”

Lifestyle Interventions and Weight Management in Systemic Lupus Erythematosus Patients: A Systematic Literature Review and Metanalysis

“…In this context, several studies have shown that obesity is an independent risk factor associated with worse SLE disease activity [ 2 ], dyslipidemia [ 20 ], cumulative organ damage [e.g. nephritis] [ 21 ], depression [ 22 ], fatigue [ 22 , 23 ] and decreased quality of life [ 20 , 23 ]. A meta-analysis published by Sun et al, 2017 [ 24 ] showed that patients with SLE were more susceptible to develop metabolic syndrome compared with healthy individuals.…”