营养治疗对超重/肥胖系统性红斑狼疮患儿体成分的影响

Effect of nutritional therapy on body composition in overweight/obese children with systemic lupus erythematosus

目的 探讨营养治疗对正在应用激素治疗的超重/肥胖系统性红斑狼疮(systemic lupus erythematosus,SLE)患儿体成分的影响。方法 招募2018年12月至2022年6月北京儿童医院应用糖皮质激素(glucocorticoid,GC)治疗的7~18岁超重/肥胖SLE患儿。符合纳入、排除标准并签署知情同意书后,首先全部纳入观察组。观察组给予营养治疗,能量目标为身高对应50百分位数年龄的轻度体力活动推荐摄入量的基础上减少10%;随访24周后,为防止患儿间信息交流对研究的影响,暂中断入组6个月以上。后续按照纳入、排除标准继续完成对照组入组,对照组给予营养教育。各组均在入组后4、12、24周进行门诊随访,主要监测指标:人体学测量、实验室检查,并记录糖皮质激素用量。结果 最终纳入60例患儿,其中观察组40例,对照组20例。两组间基线数据(性别、年龄、体质量指数、GC用量等)差异均无统计学意义。两组患儿基线时的体脂率(body fat percentage,BFP)与内脏脂肪面积(visceral fat area,VFA)差异无统计学意义;随访12、24周后,观察组BFP和VFA均较基线时显著降低(P<0.05),对照组BFP和VFA均较基线时显著升高(P<0.05);两组患儿12、24周时GC用量均较基线显著减少(P<0.05),但两组间差异无统计学意义(P>0.05)。结论 营养治疗可改善激素治疗过程中超重/肥胖SLE患儿的体脂率和内脏脂肪面积。

Objective To investigate the effects of nutritional therapy on body composition in overweight/obese children with systemic lupus erythematosus(SLE) during the treatment with glucocorticoid(GC).Methods The SLE children(7-18 years old) who received GC treatment and were overweight/obese admitted in our hospital from December 2018 to June 2022 were recruited in this study.After meeting the inclusion and exclusion criteria and signing the informed consent form,all subjects were included in the observation group.Then,nutrition therapy was given with an energy target of the 90% of the level recommended by the Dietary Guidelines for Chinese Residents according to ages.After the intervention for 24 weeks,a break for 6 months was given to these subject in order to avoid information exchange among them.Subsequently,our inclusion and exclusion criteria were employed again to recruit the subjects in the control group.The children from the control group were only given nutrition education.All these participants were followed up by clinic visits at 4,12 and 24 weeks after intervention.Main observation indicators included anthropometric measurement,results of laboratory tests,and dosage of GC.Results There were 60 SLE children enrolled in this study,and 40 in the observation group and 20 in the control group.No statistical differences were found in baseline data(sex ratio,age,BMI and dosage of GC) between the 2 groups.No differences were seen in body fat percentage(BPF) and visceral fat area(VFA) at baseline between the 2 groups.But the 2 indicators were decreased in the observation group(P<0.05),and increased in the control group(P<0.05) in 12 and 24 weeks after intervention.The dosage of GC was declined in both group in 12 and 24 weeks(P>0.05),but there was no difference between the 2 groups(P<0.05).Conclusion Nutritional therapy can improve BFP and VFA in overweight/obese SLE children during the treatment with GC.