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. 2016 Nov 4;3(12):897-907.
doi: 10.1002/acn3.365. eCollection 2016 Dec.

Distinct effects of obesity and puberty on risk and age at onset of pediatric MS

Tanuja Chitnis  1 , Jennifer Graves  2 , Bianca Weinstock-Guttman  3 , Anita Belman  4 , Cody Olsen  5 , Madhusmita Misra  6 , Gregory Aaen  7 , Leslie Benson  8 , Meghan Candee  9 , Mark Gorman  8 , Benjamin Greenberg  10 , Lauren Krupp  4 , Timothy Lotze  11 , Soe Mar  12 , Jayne Ness  13 , John Rose  14 , Jennifer Rubin  15 , Teri Schreiner  16 , Jan Tillema  17 , Amy Waldman  18 , Moses Rodriguez  17 , Charlie Casper  5 , Emmanuelle Waubant  19 ; U.S. Network of Pediatric MS Centers
Affiliations

Distinct effects of obesity and puberty on risk and age at onset of pediatric MS

Tanuja Chitnis et al. Ann Clin Transl Neurol. .

Abstract

Objective: The aim of this study was to examine the relative contributions of body mass index (BMI) and pubertal measures for risk and age of onset of pediatric MS.

Methods: Case-control study of 254 (63% female) MS cases (onset<18 years of age) and 420 (49% female) controls conducted at 14 U.S. Pediatric MS Centers. Sex- and age-stratified BMI percentiles were calculated using CDC growth charts from height and weight measured at enrollment for controls, and within 1 year of onset for MS cases. Sex-stratified associations between MS risk and age at symptom onset with both BMI and pubertal factors were estimated controlling for race and ethnicity.

Results: Only 11% of girls and 15% of boys were prepubertal (Tanner stage I) at MS onset. 80% of girls had onset of MS after menarche. BMI percentiles were higher in MS cases versus controls (girls: P < 0.001; boys: P = 0.018). BMI was associated with odds of MS in multivariate models in postpubertal girls (OR = 1.60, 95% confidence interval [CI]: 1.12, 2.27, P = 0.009) and boys (OR = 1.43, 95% CI: 1.08, 1.88, P = 0.011). In girls with MS onset after menarche, higher BMI was associated with younger age at first symptoms (P = 0.031). Younger menarche was associated with stronger effects of BMI through mediation and interaction analysis. In pubertal/postpubertal boys, 89% of whom were obese/overweight, earlier sexual maturity was associated with earlier onset of MS (P < 0.001).

Interpretation: Higher BMI in early adolescence is a risk factor for MS in girls and boys. Earlier age at sexual maturity contributes to earlier age at MS onset, particularly in association with obesity.

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Figures

Figure 1
Figure 1
(A and B) Boxplots of Body Mass Index (BMI) z‐scores calculated from height and weight for cases and controls. For MS cases, measurements were taken at the clinic visit following first symptoms, excluding cases seen more than 1 year after first symptoms. Z‐scores represent the number of standard deviations above (+) or below (‐) the average BMI adjusted for age. Boys (A) and girls (B) are plotted separately. (C) Boxplots of menstrual age reported by girls. Boxplots show the 25th and 75th percentiles (box), median (center line), mean (X), max/min or 1.5 times the interquartile range (vertical lines with caps), and observations beyond 1.5 times the interquartile range (circles).
Figure 2
Figure 2
Tanner stage for boys (A) and girls (B). Tanner stage was documented at the first clinic visit following first symptoms, excluding cases seen more than 1 year after first symptoms. (C) Menarchal status for girls at the time of first symptoms. Girls with menarche at the same age (in years) as first symptoms are counted as postmenarche.
See this image and copyright information in PMC

References

    1. Pohl D, Hennemuth I, von Kries R, Hanefeld F. Paediatric multiple sclerosis and acute disseminated encephalomyelitis in Germany: results of a nationwide survey. Eur J Pediatr 2007;166:405–412. - PubMed
    1. Ramagopalan SV, Valdar W, Criscuoli M, et al. Age of puberty and the risk of multiple sclerosis: a population based study. Eur J Neurol 2009;16:342–347. - PubMed
    1. Chitnis T. Role of puberty in multiple sclerosis risk and course. Clin Immunol 2013;149:192–200. - PubMed
    1. Ahn JJ, O'Mahony J, Moshkova M, et al. Puberty in females enhances the risk of an outcome of multiple sclerosis in children and the development of central nervous system autoimmunity in mice. Mult Scler 2015;21:735–748. - PubMed
    1. Lulu S, Graves J, Waubant E. Menarche increases relapse risk in pediatric multiple sclerosis. Mult Scler 2016;22:193–200. - PMC - PubMed