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Obesity and loss of ambulation are associated with lower extremity oedema in Duchenne muscular dystrophy

Published online by Cambridge University Press:  13 May 2022

Joshua M Freytag Open the ORCID record for Joshua M Freytag [Opens in a new window] ,
Thomas D Ryan Open the ORCID record for Thomas D Ryan [Opens in a new window] ,
Jean E Bange ,
Kelly C Bonarrigo ,
Wendy A Chouteau ,
Samuel G Wittekind Open the ORCID record for Samuel G Wittekind [Opens in a new window] ,
Cuixia Tian ,
Zhiqian Gao  and
Chet R Villa
Joshua M Freytag
Affiliation:
Heart Institute Research Core, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Thomas D Ryan
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center Location C, Cincinnati, OH, USA Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Jean E Bange
Affiliation:
Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Kelly C Bonarrigo
Affiliation:
Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Wendy A Chouteau
Affiliation:
Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Samuel G Wittekind
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center Location C, Cincinnati, OH, USA Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Cuixia Tian
Affiliation:
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Zhiqian Gao
Affiliation:
Heart Institute Research Core, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Chet R Villa*
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center Location C, Cincinnati, OH, USA Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
*
Author for correspondence: Chet R Villa, MD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH 45229, USA. Tel: +1 (513) 803 1428; Fax: 513-803-0564. E-mail: Chet.Villa@cchmc.org
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Abstract

Patients with Duchenne muscular dystrophy have multiple risk factors for lower extremity oedema. This study sought to define the frequency and predictors of oedema. Patients aged 15 years and older were screened by patient questionnaire, and the presence of oedema was confirmed by subsequent physical exam. Twenty-four of 52 patients (46%) had oedema, 12 of whom had swelling extending above the foot and two with sores/skin breakdown. There was no significant difference in age, frequency, or duration of glucocorticoid use, non-invasive respiratory support use, forced vital capacity, cardiac medication use, or ejection fraction between patients with and without oedema (all p > 0.2). Those with oedema had a greater time since the loss of ambulation (8.4 years versus 3.5 years; p = 0.004), higher body mass index (28.3 versus 24.8; p = 0.014), and lower frequency of deflazacort use (67% versus 89%; p = 0.008). Multivariate analysis revealed a longer duration of loss of ambulation (p = 0.02) and higher body mass index (p = 0.009) as predictors of oedema. Lower extremity oedema is common in Duchenne muscular dystrophy but independent of cardiac function. Interventions focused on minimising body mass index increases over time may be a therapeutic target.

Keywords

cardiaclymphaticreportedrespiratorytherapy
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 4 , April 2023 , pp. 597 - 602
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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