Incidence and Risk Factors for Obesity and Short Stature in Childhood Nephrotic Syndrome: A Prospective Cohort Study
Bibliographic record
Abstract
Background: Children with nephrotic syndrome are at risk of obesity and short stature from repeated steroid treatment. The incidence, timing, and risk factors for these outcomes remain uncertain. Methods: We evaluated longitudinal growth and obesity in children (1-18yr) enrolled in Insight into Nephrotic Syndrome: Investigating Genes, Health, and Therapeutics (INSIGHT). We included nephrotic syndrome cases diagnosed from 1996-2019 in Greater Toronto. Growth parameters were measured at annual clinic visits. Primary outcomes were de novo obesity (body mass index (BMI) Z-score ≥+2) and short stature (height Z-score ≤-2). We calculated hazard ratios (HR) using Cox proportional hazards models. Results: We included 531 children with nephrotic syndrome (24% frequently relapsing (FRNS) by 1-year). At their initial clinic visit (within 1-year of diagnosis), 23.5% of cases were obese, 51.8% were overweight (BMI Z-score ≥+1), and 4.9% had short stature. At the last clinic visit, the prevalence of obesity had decreased (17.3%) and short stature was unchanged (3.8%). During median 4.2-year follow-up, 69 (17.7%) children developed obesity and 16 (3.3%) developed short stature, among those without obesity or short stature initially. Total relapse count was a significant predictor for de novo obesity (adjusted HR 1.03, 95%CI 1.01-1.06, p=0.01) and short stature (unadjusted HR 1.06, 95%CI 1.02-1.10, p=0.01). Children with >6 and >12 total relapses were more likely to develop obesity and short stature, respectively. Conclusions: Obesity is common among children with nephrotic syndrome early after diagnosis, but prevalence decreases over time. Effective relapse prevention may reduce steroid exposure and the risks of de novo obesity or short stature. Funding: Government Support - Non-U.S. - Obesity and height outcomes, by FRNS classification within 1-year of diagnosis Outcome Overall (n=531) Non FRNS (n=404) FRNS (n=127) Prevalent obesity at initial clinic visit, n (%) 125/531 (23.5) 89/404 (22.0) 36/127 (28.4) De novo obesity during follow-up, n (%) 69/390 (17.7) 46/302 (15.2) 23/88 (26.1) Prevalent obesity at last clinic visit, n (%) 91/526 (17.3) 65/399 (16.3) 26/127 (20.5) Prevalent short stature at initial clinic visit, n (%) 26/531 (4.9) 21/404 (5.2) 5/127 (3.9) De novo short stature during follow-up, n (%) 16/488 (3.3) 8/369 (2.2) 8/119 (6.7) Prevalent short stature at last clinic visit, n (%) 20/525 (3.8) 13/398 (3.3) 7/127 (5.5) Change in BMI Z-score during follow-up, mean (SD) -0.52 (1.23) -0.48 (1.19) -0.65 (1.34) Change in height Z-score during follow-up, mean (SD) +0.19 (0.84) +0.22 (0.79) +0.09 (0.97)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".