Long-term systemic glucocorticoid therapy and weight gain: a population-based cohort study

Abstract

Objectives To describe the variation in weight gain in people chronically exposed to systemic glucocorticoids in primary care and to identify the risk factors for weight gain. Methods Data were analysed from the British database, The Health Improvement Network. Body weight variations of individuals prescribed systemic glucocorticoids for at least 3 months at a mean dose ≥10 mg/day were described. The risk factors associated with weight gain ≥10% of the usual weight were assessed. Results A total of 31 516 adults prescribed glucocorticoids and 26 967 controls were included in the study. During glucocorticoid exposure, only 12 475 (39.6%) individuals gained >2 kg compared with their usual weight. Younger women were more likely to gain weight (mean weight gain in 18–39-year-old glucocorticoid-exposed women: 3.6 kg (s.d. 8.6) compared with 2 kg (s.d. 7.3) in the control group; the absolute mean difference was 1.6 kg (95% CI 0.9, 2.2; P < 0.001). Weight gain ≥10% of the usual weight was observed in 10.2% (n = 3208) of those chronically exposed to glucocorticoids. Women, younger people, those living in areas of higher deprivation, smokers, those on higher doses of the drug and those previously exposed to glucocorticoids were at higher risk. The risk was lower in people prescribed glucocorticoids for an inflammatory condition when compared with asthma or chronic obstructive pulmonary disease. Conclusion After taking into account usual weight rather than weight just before glucocorticoid initiation and the natural history of weight variation, the amount of weight gain induced by systemic glucocorticoids as prescribed in primary care is less than usually thought. Clinical trial registration 18THIN081.

MECHANISMS IN ENDOCRINOLOGY: Local and systemic effects of glucocorticoids on metabolism: new lessons from animal models

“…Weight gain, due to increased appetite (62) rather than suppression of resting energy expenditure (60,63), is one of the most significant side effects of chronic glucocorticoid treatment. In humans treated with exogenous glucocorticoids, weight gain is common but highly variable: ~10% of subjects gain >10% of their body weight, although many (45%) experience no weight change at all (64). Interestingly, glucocorticoids may also affect macronutrient preference, as healthy women who increased their cortisol levels upon stress exposure also increased their intake of sweets and high-fat foods (65).…”

Response Variability to Drug Testing in Two Models of Chemically Induced Colitis

“…Both treatment strategies in DSS-colitis showed a loss in weight regardless of sex, which is contradictory to our understanding that glucocorticoids induce weight gain. Nevertheless, this fact is dose and time-dependent [ 54 , 55 ], and our experiment does not imply chronic exposure to this treatment. On the other hand, treatment with MTADV induced an increment in the expression of Nos2 regardless of sex, while, in males, Tnfa, among others, was increased, showing a pro-inflammatory profile.…”

Nutritional recommendations during long-term administration of glucocorticoids

“…U poređenju s kontrolnom grupom pacijenata, koji nisu bili podvrgnuti GC lečenju, razlika u povećanju telesne mase ispitanika na GC terapiji iznosi svega 1,6 kg. Dakle, povećanje težine, promena telesne kompozicije i apetita tokom GC lečenja nije toliko izraženo kao što se ranije mislilo, tačnije, s vremenom se i u opštoj populaciji primećuje slično povećanje težine, koje ne mora da bude posledica GC lečenja (27). Moguće je da ova pojava oslikava sveukupan nepravilan stil života odrasle populacije.…”