Clinical Features and Management of Non-HIV-Related Lipodystrophy in Children: A Systematic Review

Abstract

Context: Lipodystrophy syndromes are characterized by generalized or partial absence of adipose tissue.

Objective: We conducted a systematic review to synthesize data on clinical and metabolic features of lipodystrophy (age at onset, < 18 years).

Data source: Sources included Medline, Embase, Cochrane Library, Scopus and Non-Indexed Citations from inception through January 2016.

Study selection: Search terms included lipodystrophy, and age 0 to 18 years. Patients with unambiguous diagnosis of lipodystrophy were included. Lipodystrophy secondary to HIV treatment was excluded.

Data synthesis: We identified 1141 patients from 351 studies. Generalized fat loss involving face, neck, abdomen, thorax, and upper and lower limbs was explicitly reported in 65% to 93% of patients with congenital generalized lipodystrophy (CGL) and acquired generalized lipodystrophy (AGL). In familial partial lipodystrophy (FPL), fat loss occurred from upper and lower limbs, with sparing of face and neck. In acquired partial lipodystrophy (APL), upper limbs were involved while lower limbs were spared. Other features were prominent musculature, acromegaloid, acanthosis nigricans and hepatosplenomegaly. Diabetes mellitus was diagnosed in 48% (n = 222) of patients with CGL (mean age at onset, 5.3 years). Hypertriglyceridemia was observed in CGL, AGL and FPL. Multiple interventions were used, with most patients receiving ≥ 3 interventions and being ≥ 18 years of age at the initiation of interventions.

Conclusions: To our knowledge, this is the largest reported pooled database describing lipodystrophy patients with age at onset < 18 years. We have suggested core and supportive clinical features and summarized data on available interventions, outcomes and mortality.

Figure 1.

The process of study selection. ¹We extracted data from studies in Russian, French, Polish, Spanish, Italian, and Portuguese and excluded studies in German, Japanese, Dutch, Hebrew, Hungarian, Korean, Norwegian, and Slovakian. ²Lipodystrophy related to HIV treatment, secondary to drug administration (insulin, growth hormone, steroids, antibiotics, and vaccinations), secondary to recurrent pressure, infantile centrifugal abdominal lipodystrophy, localized lipodystrophy, juvenile-onset dermatomyositis, and secondary to systemic diseases such as uncontrolled DM, thyrotoxicosis, anorexia nervosa, malnutrition, malignancy, and chronic infections were excluded. ³Age at onset of lipodystrophy, <18 y vs ≥18 y.

Figure 2.

Distribution of adipose tissue in 4 major lipodystrophies (CGL, AGL, FPL, APL). Red, fat loss in >72% patients; brown, fat loss in 57% to 72% patients; blue, fat loss in <57% patients; and green, fat sparing. Please refer to Table 1 for the exact reported frequencies of the sites of fat loss in each of the 4 major lipodystrophies. For the purposes of uniformity in the pictorial representation, frequency cutoffs of >72%, 57% to 72%, and <57% were used.