Body Composition and Fat Deposition in Children with Cushing Disease and Associations with Cardiometabolic Risk Factors.

Children with Cushing disease had a greater percentage of total body fat than their BMI-matched controls.

• Female patients with CD had 47.8% (SD 7.8) total body fat vs 40.0% (SD 10.1) in female controls (P = .016)
• Male patients with CD had 46.6% (SD 8.5) total body fat vs 38.3% (SD 9.9) in male controls (P = .019)
• Study included 23 pediatric patients with active CD and 46 age-, sex-, and BMI z-score-similar controls
• Retrospective cohort study design using whole-body dual-energy X-ray absorptiometry (DXA)

Fat distribution between trunk and limbs did not differ significantly between pediatric CD patients and BMI-matched controls.

• Proportions of fat between the trunk and the limbs were assessed as the measure of fat distribution
• The findings suggest that 'a more central obesity phenotype is not clearly identified in this pediatric CD group'
• This was an unexpected finding given the classically described central adiposity in Cushing syndrome

Pediatric patients with CD had reduced lean mass and bone mass compared with BMI-similar peers.

• Reduced lean and bone mass were identified despite similar fat distribution between groups
• BMI-matched controls were used to isolate the effects of hypercortisolism beyond general obesity
• DXA was used to assess body composition including lean and bone mass components

Cardiometabolic risk factors correlated with different variables in CD patients compared to controls.

• In control patients, cardiometabolic risk factors (CRFs) showed strong correlations with BMI and markers of fat deposition and distribution
• In patients with CD, CRFs showed variable correlations, associating only with markers of fat deposition and distribution rather than BMI
• This suggests BMI is an inadequate surrogate for cardiometabolic risk in pediatric CD patients
• Fasting biochemistry was used to assess cardiometabolic risk factors

BMI underestimates fat burden in pediatric patients with Cushing disease.

• Despite being matched on BMI z-score, CD patients had significantly higher total body fat percentages than controls
• DXA-derived measures were suggested to better reflect metabolic risk than BMI in this population
• The authors recommend that 'comprehensive body composition assessment should be considered in pediatric patients with CD for risk stratification and management'