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Open Access Research

Weight loss on stimulant medication: how does it affect body composition and bone metabolism? – A prospective longitudinal study

Alison Poulton1*, Julie Briody2, Thomas McCorquodale3, Elaine Melzer1, Markus Herrmann34, Louise A Baur5 and Gustavo Duque3

Author Affiliations

1 Department of Paediatrics, Sydney Medical School Nepean, The University of Sydney, Penrith, NSW, Australia

2 Department of Nuclear Medicine, The Children’s Hospital at Westmead, Sydney, NSW, Australia

3 Ageing Bone Research Program, Sydney Medical School Nepean, The University of Sydney, Penrith, NSW, Australia

4 Central Laboratory of Clinical Pathology, Central Hospital of Bolzano, Bolzano, Italy

5 University of Sydney Discipline of Paediatrics and Child Health, The Children’s Hospital at Westmead, Sydney, NSW, Australia

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International Journal of Pediatric Endocrinology 2012, 2012:30  doi:10.1186/1687-9856-2012-30

Published: 5 December 2012

Abstract

Objective

Children treated with stimulant medication for attention deficit hyperactivity disorder (ADHD) often lose weight. It is important to understand the implications of this during growth. This prospective study was designed to quantify the changes in body composition and markers of bone metabolism on starting treatment.

Methods

34 children (29 boys) aged 4.7 to 9.1 years newly diagnosed with ADHD were treated with dexamphetamine or methylphenidate, titrating the dose to optimise the therapeutic response. Medication was continued for as long as clinically indicated. Body composition and bone density (dual-energy X-ray absorptiometry) were measured at baseline, 6 months and 3 years; changes were analysed in Z-scores based on data from 241 healthy, local children. Markers of bone turnover were measured at baseline, 3 months and 3 years.

Results

Fat loss of 1.4±0.96kg (total fat 5.7±3.6 to 4.3±3.1kg, p<0.001) occurred in the first 6 months. There were significant reductions over 3 years in the sex and height corrected Z-scores for lean tissue, bone mineral content, bone mineral density and ratio of central to total fat (−0.84±0.86, p=0.003; -0.55±0.31, p<0.0001; -0.41±0.28, p<0.0001 and −0.55±0.62, p=0.006 respectively). Propeptide of type I collagen indicated a significant reduction in bone turnover after 3 months (564±202 to 458±96ng/ml, p=0.019), which was fully recovered after 3 years (619±276ng/ml).

Conclusions

Stimulant medication was associated with early fat loss and reduced bone turnover. Lean tissue including bone increased more slowly over 3 years of continuous treatment than would be expected for growth in height. There was long-term improvement in the proportion of central fat for height. This study shows that relatively minor reductions in weight on stimulant medication can be associated with long-term changes in body composition. Further study is required to determine the effects of these changes on adult health.

Keywords:
Body composition; Attention deficit hyperactivity disorder; Stimulant medication; Bone biochemistry; Weight loss