Sharon Bout-Tabaku1, Justine Shults2, Babette S Zemel2, Mary B Leonard2, Robert I Berkowitz2, Nicolas Stettler2, Jon M Burnham2. 1. From the Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital; the Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatrics, Division of Rheumatology, Division of Gastroenterology and Nutrition, Division of Nephrology, The Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; the Lewin Group, Falls Church, Virginia, USA.S. Bout-Tabaku, MD, MSc, Assistant Professor, Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital, and the Ohio State University College of Medicine; J. Shults, PhD, Associate Professor of Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, B.S. Zemel, PhD, Professor of Pediatrics, Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine; M.B. Leonard, MD, MSCE, Professor of Pediatrics, Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine; R.I. Berkowitz, MD, Professor of Psychiatry, University of Pennsylvania School of Medicine; N. Stettler, MD, MSCE, Managing Consultant, the Lewin Group; J.M. Burnham, MD, MSCE, Associate Professor of Pediatrics, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine. sharon.bout-tabaku@nationwidechildrens.org. 2. From the Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital; the Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatrics, Division of Rheumatology, Division of Gastroenterology and Nutrition, Division of Nephrology, The Children's Hospital of Philadelphia; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; the Lewin Group, Falls Church, Virginia, USA.S. Bout-Tabaku, MD, MSc, Assistant Professor, Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital, and the Ohio State University College of Medicine; J. Shults, PhD, Associate Professor of Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, B.S. Zemel, PhD, Professor of Pediatrics, Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine; M.B. Leonard, MD, MSCE, Professor of Pediatrics, Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine; R.I. Berkowitz, MD, Professor of Psychiatry, University of Pennsylvania School of Medicine; N. Stettler, MD, MSCE, Managing Consultant, the Lewin Group; J.M. Burnham, MD, MSCE, Associate Professor of Pediatrics, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine.
Abstract
OBJECTIVE: In adults, osteoarthritis (OA) is associated with obesity and knee alignment. Whether knee alignment differences develop during childhood and are associated with obesity is unknown. We assessed the distribution of knee alignment in children and adolescents, and determined how knee alignment differs between obese and nonobese children. METHODS: This cross-sectional study examined knee alignment in 155 healthy weight and 165 obese subjects. Knee alignment [metaphyseal-diaphyseal angle (MDA) and anterior tibiofemoral angle (ATFA)] and fat mass were measured using whole body dual-energy X-ray absorptiometry (DEXA). National reference data were used to generate age- and sex-specific body mass index (BMI, kg/m(2)) Z-scores. Multivariable linear regression was used to identify independent factors associated with ATFA and MDA. RESULTS: The mean MDA and ATFA were similar between obese and nonobese subjects. In stratified analyses, females had greater variability in MDA and ATFA values (p < 0.001 and p = 0.04, respectively) at higher BMI Z-scores. Compared with healthy weight controls, obese subjects had less valgus of the MDA prior to the onset of puberty (+ 2.0°, p = 0.001), but had greater valgus at later pubertal stages (-1.9°, p = 0.01). CONCLUSION: We found significantly greater variability in knee alignment among females at higher BMI Z-scores, and greater valgus alignment in obese adolescents in late puberty. The major limitation is the use of DEXA for assessment of alignment, which needs validation against longstanding radiographs. Longitudinal studies are needed to determine whether childhood obesity is a risk factor for progressive malalignment that may predispose to pain and risk of early osteoarthritis.
OBJECTIVE: In adults, osteoarthritis (OA) is associated with obesity and knee alignment. Whether knee alignment differences develop during childhood and are associated with obesity is unknown. We assessed the distribution of knee alignment in children and adolescents, and determined how knee alignment differs between obese and nonobese children. METHODS: This cross-sectional study examined knee alignment in 155 healthy weight and 165 obese subjects. Knee alignment [metaphyseal-diaphyseal angle (MDA) and anterior tibiofemoral angle (ATFA)] and fat mass were measured using whole body dual-energy X-ray absorptiometry (DEXA). National reference data were used to generate age- and sex-specific body mass index (BMI, kg/m(2)) Z-scores. Multivariable linear regression was used to identify independent factors associated with ATFA and MDA. RESULTS: The mean MDA and ATFA were similar between obese and nonobese subjects. In stratified analyses, females had greater variability in MDA and ATFA values (p < 0.001 and p = 0.04, respectively) at higher BMI Z-scores. Compared with healthy weight controls, obese subjects had less valgus of the MDA prior to the onset of puberty (+ 2.0°, p = 0.001), but had greater valgus at later pubertal stages (-1.9°, p = 0.01). CONCLUSION: We found significantly greater variability in knee alignment among females at higher BMI Z-scores, and greater valgus alignment in obese adolescents in late puberty. The major limitation is the use of DEXA for assessment of alignment, which needs validation against longstanding radiographs. Longitudinal studies are needed to determine whether childhood obesity is a risk factor for progressive malalignment that may predispose to pain and risk of early osteoarthritis.
Authors: William Colyn; Rintje Agricola; Nele Arnout; Jan A N Verhaar; Johan Bellemans Journal: Knee Surg Sports Traumatol Arthrosc Date: 2016-10-14 Impact factor: 4.342
Authors: Michał Brzeziński; Zbigniew Czubek; Aleksandra Niedzielska; Marek Jankowski; Tomasz Kobus; Zbigniew Ossowski Journal: BMC Musculoskelet Disord Date: 2019-02-18 Impact factor: 2.362
Authors: María Orosia Lucha-López; José Miguel Tricás-Moreno; Elena Gaspar-Calvo; Ana Carmen Lucha-López; Concepción Vidal-Peracho; César Hidalgo-García; Santos Caudevilla-Polo; Pablo Fanlo-Mazas Journal: J Int Med Res Date: 2018-06-25 Impact factor: 1.671