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Objective: To determine whether obesity in women with systemic lupus erythematosus (SLE) is independently associated with worse patient-reported outcomes (PROs).Methods: Data were derived from a prospective study of adult women with a diagnosis of SLE that was verified by medical record review. Two established definitions for obesity were used: fat mass index (FMI) ≥13 kg/m2 and body mass index (BMI) ≥30 kg/m2 . Dependent variables included 4 validated PROs: disease activity as assessed by the Systemic Lupus Activity Questionnaire (SLAQ), depressive symptoms as assessed by the Center for Epidemiologic Studies Depression Scale (CES-D), pain as assessed by the Short Form 36 (SF-36) pain subscale, and fatigue as assessed by the SF-36 vitality subscale. We used multivariable linear regression to evaluate the associations of obesity with PROs, while controlling for potential confounders (age, race, education, income, smoking, disease duration, disease damage, and prednisone use).Results: The analysis included 148 participants, 32% of whom were obese. In the multivariate regression model, obesity was associated with worse scores for each PRO. Mean adjusted scores for the SLAQ and CES-D comparing obese versus non-obese participants were 14.8 versus 11.5 (P = 0.01) and 19.8 versus 13.1 (P < 0.01), respectively. The obese group also reported worse mean adjusted scores for pain (38.7 versus 44.2; P < 0.01) and fatigue (39.6 versus 45.2; P = 0.01).Conclusion: In a representative sample of women with SLE, obesity (as defined by both FMI and BMI) was independently associated with worse PROs, including disease activity, depressive symptoms, and symptoms of pain and fatigue. Obesity may represent a modifiable target for improving outcomes among obese women with SLE. [ABSTRACT FROM AUTHOR]

Objective To examine relationships of obesity and physical inactivity to cognitive impairment in women with systemic lupus erythematosus (SLE). Methods Body composition was measured with dual x-ray absorptiometry (DXA) for 138 women with SLE. Obesity was defined by total percent body fat. Physical activity was ascertained with the self-reported International Physical Activity Questionnaire; inactivity was defined as expenditure of <600 metabolic equivalent minutes/week. Cognitive function was assessed with a 12-index neuropsychological battery. Impairment was defined as age-adjusted Z scores ≤1.5 SDs below the mean on 1 of 3 of tests completed. Scores were obtained for the total battery and for memory and executive function components. Multivariate analyses examined the relationship of obesity and physical activity, individually and combined, to cognitive impairment, controlling for education, race/ethnicity, disease activity, glucocorticoid use, and depression. Results Fifteen percent of subjects were cognitively impaired, 28% were physically inactive, and 50% were obese. Five percent of active women were impaired on the executive function battery compared to 23% of those who were inactive ( P = 0.003). Obese women were more likely to be impaired on the total battery (6% versus 23%; P = 0.007) and on the executive function portion (2% versus 19%) than nonobese women. In multivariate analysis, both inactivity and DXA-defined obesity were significantly associated with impairment in executive function (inactivity: odds ratio [OR] 9.4, 95% confidence interval [95% CI] 1.7-52.8; obesity: OR 14.8, 95% CI 1.4-151.0). Conclusion Both obesity and inactivity were significantly and independently associated with impairment in cognitive function. If longitudinal studies show that physical inactivity and obesity are precursors to cognitive impairment, these may become important targets for intervention. [ABSTRACT FROM AUTHOR]

Objective Obesity is associated with high rates of disability in the general population. The nature of the relationship between obesity and disability in systemic lupus erythematosus (SLE), a condition with a high background rate of disability, is unknown. Methods Data were from 2 interviews, 4 years apart, of a longitudinal cohort of individuals with SLE (n = 716 women). Body mass index (BMI) was calculated from self-reported height and weight; obesity was classified by usual (BMI ≥30) and revised (BMI ≥26.8) definitions. Three measures of functioning were examined: the Short Form 36 (SF-36) Health Survey physical function (PF) subscale, Valued Life Activities (VLA) Disability Questionnaire, and employment. Multivariate analyses controlled for demographics, SLE duration and disease activity, glucocorticoid use, depression, and comorbidities. Prospective analyses also controlled for baseline function. Results At a BMI of ≥30, 27.8% of the subjects were obese; at a BMI of ≥26.8, 40.6% of the subjects were obese. Regardless of obesity definition, obese women exhibited poorer baseline function, with decrements ranging from 20-33% depending on the functional measure and obesity definition. With a BMI of ≥26.8, the adjusted SF-36 PF scores were 4.3 points lower for obese women ( P < 0.0001), VLA difficulty was 0.09 higher ( P = 0.01), and odds of employment were 80% of nonobese women (odds ratio 0.8, 95% confidence interval 0.5-1.1). At the 4-year followup, women who were obese at baseline had poorer function and experienced greater functional declines. Conclusion Obesity was associated with clinically significant negative effects on function, both concurrently and prospectively. This negative impact occurred at a lower BMI than is often considered problematic clinically. Because of the high rate of SLE-related disability, addressing preventable risk factors such as obesity may improve long-term SLE outcomes. [ABSTRACT FROM AUTHOR]

Objective To determine the prevalence of obesity and evaluate how accurately standard anthropometric measures identify obesity among women with systemic lupus erythematosus (SLE). Methods Dual x-ray absorptiometry (DXA), height, weight, and waist and hip circumference measurements were collected from 145 women with SLE. Three anthropometric proxies of obesity (body mass index [BMI] ≥30 kg/m2, waist circumference [WC] ≥88 cm, and waist:hip ratio [WHR] ≥0.85) were compared with a DXA-based obesity criterion. Correspondence between measures was assessed with Cohen's kappa. Receiver operating characteristic curves determined optimal cut points for each anthropometric measure relative to DXA. Framingham cardiovascular risk scores were compared among women who were classified as not obese by both traditional and revised anthropometric definitions, obese by both definitions, and obese only by the revised definition. Results Of the 145 women, 28%, 29%, 41%, and 50% were classified as obese by WC, BMI, WHR, and DXA, respectively. Correspondence between anthropometric and DXA-based measures was moderate. Women misclassified by anthropometric measures had less truncal fat and more appendicular lean and fat mass. Cut points were identified for anthropometric measures to better approximate DXA estimates of percent body fat: BMI ≥26.8 kg/m2, WC ≥84.75 cm, and WHR ≥0.80. Framingham risk scores were significantly higher in women classified as obese by either traditional or revised criteria. Conclusion A large percentage of this group of women with SLE was obese. Substantial portions of women were misclassified by anthropometric measures. Utility of revised cut points compared with traditional cut points in identifying risk of cardiovascular disease or disability remains to be examined in prospective studies, but results from the Framingham risk score analysis suggest that traditional cut points exclude a significant number of at-risk women with SLE. [ABSTRACT FROM AUTHOR]