A74: Nutritional and Metabolic Assessment in Girls With Systemic Lupus Erythematosus
Authors: Roberta Salomão, Virgínia Ferriani, Luciana Carvalho, José Cesar Rosa, Maria Olímpia Almada, Mariana Mathias, Jacqueline Monteiro
Journal: Arthritis & Rheumatology (2014)

Background/Purpose:

Cardiovascular disease (CVD), specifically from atherosclerosis, is one of major cause of morbidity and mortality in SLE. Given their lifelong exposure to atherogenic risk factors, children and adolescents with SLE are at particularly high risk of developing premature atherosclerosis and are therefore ideal candidates for primary prevention. Nutritional and metabolic status and inflammatory biomarkers have been consistently associated with the presence of CVD in multiple studies from different populations. The aim of our study was to evaluate nutritional status, homocysteine, vitamin B12, folate, lipoproteins, TNF-alfa, highsensitivity C-reactive protein (hs-CRP) concentrations and food intake in pediatric SLE patients and in healthy controls.



Methods:

Nineteen girls with SLE (group 1) and thirty-nine healthy girls (group 2) with the same age range were included in the study. SLE activity was assessed using SLEDAI. Clinical and nutritional evaluation including weight, height, waist circumference and body mass index (BMI) was performed. Plasma homocysteine, vitamin B12, folate, TNF-alfa, and hs-CRP concentrations were analyzed by chemiluminescent technique, lipoproteins were measured using colorimetric method and cholesterol by enzymatic standard method. Food intake was assessed using a 24 hour-recall questionnaire validated for our population and analyzed using the software DietWin version 1997–2002.



Results:

The average age of SLE patients and controls was 15.5 and 14.6, varying from 12 to 18 and 10 to 18 y, respectively. There were no significant differences regarding age (p = 0,117), pubertal stage (breast p = 0,158 and pubis p = 0,578) and nutritional status (p = 0,107) between groups. The majority of SLE patients (16/19) had active disease and have been receiving prednisone for a mean period of 5 years. Body mass index, waist circumference and systolic blood pressure (SBP) values were statistically higher in SLE group when compared to healthy girls: 24.6 × 20.9 kg/m2, p = 0.003; 79.7 × 72.6 cm, p = 0.004 and 107.5 × 101.7 mmHG, p = 0.044, respectively, but height was statistically lower (1.55 × 1.61 m, p = 0.012). Homocysteine, vitamin B12, TNF-α and hs-CRP levels were higher in SLE subjects when compared to healthy controls: 8.6 × 7.3 mmol/L, p = 0.023; 616.9 × 444.0 pmol/L, p = 0.008; 8.7 × 7.1 pg/ml, p = 0.022; 4.4 × 0.8 mg/L, p = 0.002, respectively. Plasma folate and HDL-cholesterol were lower in SLE patients compared to controls: 12.2 × 14.0 ng/ml, p = .022 and 37.6 × 44.1 mg/dL, p = 0.008, respectively). There were no significant differences in energy, macronutrients, vitamin B12, folate and pyridoxine intake between groups.



Conclusion:

Increased risk factors to cardiovascular disease such as high BMI, WC, SBP, homocysteine, TNF-alpha and C-reactive protein, in addition to low folate and HDL levels, were found in this group of SLE patients when compared to healthy controls, and food intake was comparable in both groups. Our results may signalize future cardiovascular complications in SLE pediatric patients and possible associations between nutritional status and risk factors.



This study is sponsored by FAPESP (number 2011/16141-7).