Acute lymphoblastic leukemia and obesity: increased energy intake or decreased physical activity?

Abstract

Background Obesity is a well-known problem in children with acute lymphoblastic leukemia (ALL), and it might be the result of an excess in energy intake, reduced energy expenditure, or both. The aim of this study is to describe energy intake and physical activity during treatment for ALL with intermittent dexamethasone (DEXA). Methods Body mass index (BMI), energy intake, and physical activity were measured in 16 ALL patients on maintenance treatment and in 17 healthy controls. ALL patients were measured during ("on DEXA") and in between ("off DEXA") DEXA treatments. Results In patients, the mean increase in BMI z-score was 1.4±1.1. Energy intake on DEXA was higher (2,125.9± 476.0 vs 1,775.1±426.1 kcal/24 h, p<0.05) and energy intake off DEXA was lower (1,305.0±249.4 vs 1,775.1± 426.1 kcal/24 h, p<0.05), compared to healthy controls. Physical activity on DEXA was lower compared to healthy controls (30.0±3.9 vs 40.0±6.0 kcal kg −1 24 h −1 , p<0.001and 7,303.1±4,622.9 vs 13,927.2±3,822.7 steps, p<0.05). Physical activity off DEXA was not different compared to healthy controls. Conclusion Weight gain in patients on ALL treatment might be owing to increased energy intake and decreased physical activity during treatment with DEXA.

Adult Survivors of Childhood Cancer Have Poor Adherence to Dietary Guidelines

“…Because cancer diagnosis directly affected cancer treatments that patients received, we focused our analyses on cancer treatments that potentially affect dietary intake. For example, glucocorticoids are known to be critically involved in regulating energy intake, storage, and mobilization (33,34). Although we saw some indications of lower diet quality in survivors who received cumulative doses of glucocorticoids >9000 mg/m 2 , there was no clear pattern or trend.…”

Obesity in Pediatric ALL Survivors: A Meta-Analysis

“…Two studies examined energy intake in pediatric ALL patients on maintenance therapy, 65,66 and both reported a significant increase in energy intake when patients were receiving corticosteroid treatment. However, whether treatment with glucocorticoids has a long-lasting impact on obesity in pediatric ALL survivors is not known.…”

Obesity and Metabolic Syndrome Among Adult Survivors of Childhood Leukemia

“…While the mechanisms underlying weight gain in children who do not receive CRT during treatment for ALL are unclear [28, 29], adiposity in these children is associated with increasing serum leptin levels and cumulative doses of glucocorticoids [26, 22]. It is possible that steroid therapies influence long-term adiposity by disrupting fat metabolism and distribution and/or by promoting an increase in energy intake during treatment [30, 31]. Nevertheless, the impact of on-therapy exposures and toxicities highlights potential opportunities for early intervention aiming to mitigate these long-term impacts of cancer therapy.…”