Early and progressive insulin resistance in young, non‐obese cancer survivors treated with hematopoietic stem cell transplantation

Bizzarri, Carla; Pinto, Rita Maria; Ciccone, Sara; Brescia, Letizia Pomponia; Locatelli, Franco; Cappa, Marco

doi:10.1002/pbc.25603

Cited by 41 publications

(29 citation statements)

References 46 publications

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“…Exposure to TBI has also been identified as an independent risk factor for the development of CVRFs and metabolic syndrome among childhood cancer survivors [34, 41, 80-83]. Importantly, metabolic syndrome after TBI may occur in the absence of obesity.…”

Section: Metabolic Syndromementioning

confidence: 99%

“…It is well-established that survivors treated with TBI during childhood are also at increased risk for diabetes [4, 9, 14, 16, 17, 30-32], with risk estimated to be 12.6-fold greater than siblings after adjusting for BMI (95% CI, 6.2–25.3, p < 0.001) [9]. Hyperinsulinemia and insu lin resistance, rather than pancreatic insufficiency, are thought to be the primary pathophysiologic mechanisms underlying diabetes development after TBI [15, 31, 33, 34], although it is likely that other TBI-associated endocrinopathies also contribute to risk [35]. …”

Section: Diabetesmentioning

confidence: 99%

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Diabetes and Metabolic Syndrome in Survivors of Childhood Cancer

2019

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Endocrine complications, including diabetes and metabolic syndrome, are highly prevalent in childhood cancer survivors. These metabolic derangements may contribute to survivors’ risk of excess cardiovascular morbidity and premature mortality. This review summarizes existing knowledge on risk of diabetes and metabolic syndrome among childhood cancer survivors, focusing specifically on known risk factors, potential mechanisms, and screening recommendations. Early diagnosis via standardized risk-based screening can improve long-term outcomes in this population. Additional work is needed to elucidate the mechanisms underlying these metabolic complications and to inform the design of risk-reducing interventions and optimize long-term cardiometabolic health among survivors of childhood cancer.

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Section: Metabolic Syndromementioning

confidence: 99%

Section: Diabetesmentioning

confidence: 99%

Diabetes and Metabolic Syndrome in Survivors of Childhood Cancer

2019

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“…However, a waist/height ratio of 40.5 was associated with abnormal glucose tolerance in 85%, compared with 42% of patients with normal glucose tolerance, and 23% of controls. 16 HSCT survivors may present normal body mass index (BMI) but develop significant changes in their body composition, resulting in increased visceral and IM fat and a reduction of muscle mass. This finding termed 'sarcopenic obesity' leads to loss of myocyte insulin receptors and increase in adipocyte insulin receptors, which are less efficient in binding insulin and clearing glucose.…”

Section: Transplant-related Factorsmentioning

confidence: 99%

“…The factors related with hyperinsulinemia and abnormal glucose tolerance are time elapsed from HSCT, history of GVHD, hypogonadism 15 and TBI. 16 Body composition In the general population, obesity is associated with reduced glucose tolerance, type 2 DM and MS. Despite higher risk for PTDM and other cardiovascular risk factors, obesity is not a major concern in long-term allo-HSCT survivors.…”

Section: Transplant-related Factorsmentioning

confidence: 99%

How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

Fuji

Rovó

Ohashi

et al. 2016

Bone Marrow Transplant

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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients frequently develop glucose intolerance and post-transplant diabetes mellitus (PTDM). The clinical importance of PTDM and its detrimental impact on HSCT outcomes are underrecognized. After allo-HSCT, various mechanisms can contribute to the development of PTDM. Here we review information about hyperglycemia and PTDM after allo-HSCT as well as PTDM after solid organ transplantation and describe ways to manage hyperglycemia/PTDM after allogeneic HSCT. Taking into consideration a lack of well-established evidence in the field of allo-HSCT, more studies should be conducted in the future, which will require closer multidisciplinary collaboration between hematologists, endocrinologists and nutritionists.

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“…Endocrine disorders including growth hormone deficiency, hypothyroidism, and gonadal failure are well described [1,2]. There is also emerging evidence of increased cardiometabolic abnormalities such as hypertension, dyslipidaemia, insulin resistance, and impaired glucose tolerance from early adulthood [3][4][5][6]. Cardiovascular diseases are the most common non-neoplastic causes of mortality in childhood cancer survivors and occur at a significantly younger age than the general population [7].…”

Section: Introductionmentioning

confidence: 99%

Identifying Cardiovascular Risk in Survivors of Childhood Leukaemia Treated with Haematopoietic Stem Cell Transplantation and Total Body Irradiation

et al. 2017

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Background: Survivors of childhood with haematopoietic stem cell transplantation and total body irradiation (HSCT/TBI) have an increased cardiometabolic risk without overt obesity. Aim: To describe cardiometabolic risk in HSCT/TBI survivors and identify anthropometric measurements of adiposity representative of cardiometabolic risks in HSCT/TBI survivors. Method: Childhood leukaemia survivors treated with HSCT/TBI (n = 21, 11 males) were compared with chemotherapy-only (n = 31) and obese non-leukaemic controls (n = 30). All subjects (16–26 years) had blood pressure and auxological measurements (body mass index, waist and hip circumferences) and blood tests (triglycerides, high-density lipoprotein [HDL], and oral glucose tolerance tests). Central adiposity was defined as either increased waist circumference (WC), waist-to-height ratio (WHtR) (>0.5), or waist-to-hip ratio (WHR) (males >0.9, females >0.85). Results: HSCT/TBI survivors showed higher prevalence of hypertriglyceridaemia than both comparison groups and higher prevalence of reduced HDL compared to the chemotherapy-only group. The WHR reported a higher prevalence of increased adiposity in HSCT/TBI survivors compared with WC and WHtR, but such differences were not observed in the other groups. In the HSCT survivors, WHR had the highest number of significant associations with metabolic risk factors, and metabolic risks worsen with time elapsed since primary treatment. Conclusions: HSCT/TBI survivors have high cardiometabolic risk that is not sufficiently reflected by WC alone. WHR is a useful surrogate marker for increased cardiometabolic risk in HSCT/TBI survivors.

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Early and progressive insulin resistance in young, non‐obese cancer survivors treated with hematopoietic stem cell transplantation

Cited by 41 publications

References 46 publications

Diabetes and Metabolic Syndrome in Survivors of Childhood Cancer

Diabetes and Metabolic Syndrome in Survivors of Childhood Cancer

How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

Identifying Cardiovascular Risk in Survivors of Childhood Leukaemia Treated with Haematopoietic Stem Cell Transplantation and Total Body Irradiation

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