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/m2) 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.
Footnotes
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Supported by the American College of Rheumatology Research and Education Foundation and National Institutes of Health (NIH) T32-AR07442-23. Robert I. Berkowitz discloses that data from the sibutramine trial were supported in part by grant DK054713 from the NIH, and from the Clinical and Translational Research Center at The Children’s Hospital of Philadelphia, by grants UL1RR024134 (National Center for Research Resources) and UL1TR000003 (National Center for Advancing Translational Sciences). Knoll Pharmaceutical Co. and Abbott Laboratory provided an unrestricted educational grant that was used to support a postdoctoral fellow and several student research assistants involved in the sibutramine trial. Neither Knoll Pharmaceutical Co. nor Abbott Laboratories contributed to the design and conduct, in the collection, analysis, and interpretation of the data, or in the preparation, review, or approval of manuscripts pertaining to the sibutramine data.
- Accepted for publication September 3, 2014.