Long-term use of corticosteroids, including commonly prescribed local [types] such as inhaled or topical agents, may be associated with small but statistically significant increases in body weight and waist circumference, according to a population-based study of 81,361 adults.
The participants who initiated corticosteroid treatment during follow-up gained more weight annually compared with nonusers (beta = 0.034 kg/year, P = .021). New users of locally administered corticosteroids—including inhaled sprays, creams, and drops—also experienced weight gain over time (beta = 0.037 kg/year, P = .017). Initiation of systemic corticosteroids was associated with increased waist circumference (beta = 0.200 cm/year, P < .001).
Discontinuation of corticosteroid use was associated with a decrease in waist circumference (beta = −0.078 cm/year, P = .028).
“This study demonstrates that corticosteroid use, including locally administered [types], is associated with long-term increases in weight and Waist Circumference, notably in female individuals and those with overweight or obesity,” said lead study author Mostafa Mohseni, of the Obesity Center CGG at Erasmus MC at the University Medical Center Rotterdam, and colleagues.
Data were drawn from a Dutch cohort with a mean follow-up of 3.9 years. Corticosteroid use was self-reported at baseline and follow-up and verified by research staff through inspection of medication. Anthropometric measurements were performed by trained nurses.
Approximately 23.8% of the participants reported corticosteroid use during the study. Among them, 18,292 used local corticosteroids, including inhaled (n = 7,183), intranasal (n = 7,933), and dermal or ophthalmic preparations (n = 6,362).
Sex-stratified analysis showed that significant weight and waist changes were largely observed in female patients. Those who initiated corticosteroids during follow-up gained more weight compared with nonusers (beta = 0.053 kg/year, P = .004). Continued use of local corticosteroids in female patients was also associated with weight gain (beta = 0.058 kg/year, P = .028). No statistically significant associations were found in male patients.
Among the participants with a body mass index (BMI) ≥ 25 kg/m², new systemic corticosteroid use was linked to greater increases in waist circumference compared with nonusers. No statistically significant associations were observed in participants with BMI < 25 kg/m².
A short-term subanalysis of 60,956 participants during the COVID-19 pandemic showed different results. Initiation of corticosteroids during a 12-week period wasn't associated with weight gain. Instead, participants who newly began corticosteroid use experienced a small decrease in weight (beta = −0.010 kg/week, P = .010). The investigators noted this could reflect catabolic effects of illness or the early metabolic action of corticosteroids.
Study limitations included reliance on self-reported medication use and a lack of complete data on diet and physical activity. However, the large sample size and repeated anthropometric measurements supported the strength of the findings.
The investigators concluded that while systemic corticosteroids are known to affect metabolism, local corticosteroids may also contribute to long-term changes in body weight and central adiposity.
No competing interests were reported by the authors.
