Associations between systemic and local corticosteroid use with metabolic syndrome and body mass index

CONTEXT:
Use of systemic corticosteroids (CSs) may induce adverse cardiometabolic alterations, potentially leading to obesity and metabolic syndrome (MetS). Although evidence is accumulating that local CSs have considerable systemic effects, their effects on cardiometabolic factors in the general population remain unclear.

OBJECTIVE:
To investigate the association between overall CS use and specific CS types with MetS, body mass index (BMI), and other cardiometabolic traits.

DESIGN:
Cross-sectional cohort study.

SETTING:
General population from the northern Netherlands.

PARTICIPANTS:
A total of 140,879 adult participants in the population-based Lifelines Cohort Study.

MAIN OUTCOME MEASURES:
BMI, waist circumference, systolic and diastolic blood pressure, fasting metabolic serum parameters, and a comprehensive set of potential confounding factors.

RESULTS:
In women, overall, systemic, and local CS use was associated with higher odds of having MetS. Among local female users, only nasal (odds ratio [OR], 1.20 [95% confidence interval (CI), 1.06 to 1.36]) and inhaled CSs [OR, 1.35 (95% CI, 1.24 to 1.49)] users were more likely to have MetS. In men, no association was found between overall and specific CS use and presence of MetS. Use of local-only CSs in women, specifically inhaled CSs in both sexes, was associated with higher BMI.

CONCLUSIONS:
Use of local CSs, particularly inhaled types, as well as systemic CSs, was associated with higher likelihood of having MetS, higher BMI, and other adverse cardiometabolic traits, especially among women. Because the inhaled agents are the main group of prescribed CSs, this might be a substantial risk to public health in case of a yet-to-be-proven causal relationship.