Predictors of being overweight or obese in survivors of pediatric acute lymphoblastic leukemia (ALL)

Abstract

Background A high prevalence of obesity has been increasingly recognized in survivors of pediatric ALL. However, longitudinal patterns of weight change during and after treatment, and associated factors, are less well elucidated. Procedure In a retrospective cohort of 83 pediatric patients with ALL diagnosed between 1985 and 2010, we examined body mass index (BMI) status at several key time points: diagnosis; end of induction; end of consolidation; every 6 months during maintenance; and yearly for up to 5 years post-treatment. Results At diagnosis, 21% were overweight (BMI = 85–94.9th percentile) or obese (BMI ≥95th percentile). At the end of treatment and 5 years post-treatment, approximately 40% were overweight or obese. The mean BMI z-score was 0.2 (58th percentile) at diagnosis and increased significantly during induction (Δ = 0.5, P <0.0001). It increased again during the first 6 months of maintenance (Δ = 0.2, P <0.01) and did not significantly change over the remainder of maintenance (BMI z-score at the end of treatment = 0.8, 79th percentile) and 5 years post-treatment (BMI z-score = 0.7, 76th percentile). High BMI z-score at diagnosis was associated with an increased risk of being overweight/obese at treatment completion (OR = 2.9, 95% CI: 1.6–5.1). Weight gain during treatment was associated with being overweight/obese 5 years post-treatment (OR = 3.8, 95% CI: 1.1–12.5). Conclusion Children with ALL are at risk of becoming overweight/obese early in treatment. Increases in weight are maintained throughout treatment and beyond. Lifestyle interventions are needed targeting weight control early during treatment, particularly for patients overweight/obese at diagnosis and those who experience substantial weight gain during treatment. Pediatr Blood Cancer 2014;61:1263–1269.

Adult Survivors of Childhood Cancer Have Poor Adherence to Dietary Guidelines

“…However, we recently reported that adult cancer survivors had worse overall diet quality than age-and sexmatched controls in the NHANES, and survivorsÕ intake patterns were particularly worse for fiber and empty calories than those in the general population (28). We need to keep in mind that childhood cancer survivors experience a substantially higher chronic disease burden than the general population (2,22,23). Even when diet quality in the survivors and general population is similarly poor, poor diet can have a much larger impact on overall health in long-term childhood cancer survivors.…”

“…These intake patterns are established risk factors for chronic diseases such as cardiovascular disease, diabetes, and obesity. The remarkably high chronic disease burden and early onset of chronic diseases in this population (2,22,23) reinforce the need to incorporate nutrition into cancer care to improve diet quality and to reduce morbidities in the growing number of children who have survived cancer.…”

DIAGNOSIS OF ENDOCRINE DISEASE: Endocrine late-effects of childhood cancer and its treatments

“…Obesity also affects a substantial proportion of ALL survivors with a prevalence of 34-46% at 10 years of follow-up (184). Although cranial irradiation represents a significant risk factor of obesity and diabetes mellitus in ALL survivors (185), those treated with chemotherapy alone continue to experience high rates of persistent obesity and overweight after many years of follow-up, likely because of their prolonged exposure to high-dose glucocorticoids (186). Patients treated with HSCT do not seem to experience higher rates of obesity than similar aged individuals from the general population, but they were reported to have increased risks of insulin resistance, glucose intolerance and abnormal body composition (187).…”

Overweight in childhood cancer survivors: the Swiss Childhood Cancer Survivor Study

“…Research on overweight prevalence has involved mostly ALL survivors (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), whereas study of risk factors has led to inconsistent conclusions (4). Studies conducted in the United States reflect the lifestyles and eating habits of CSSs in that country (10-13, 16, 17, 19-22), whereas the duration of follow-up in other studies has been only short to medium term (4,5), and many have had small (<250 participants) sample sizes (4,11,(13)(14)(15)(17)(18)(19). With this background of research in mind, we analyzed data from the Swiss Childhood Cancer Survivor Study (SCCSS) to 1) assess overweight prevalence in CCSs overall and for specific, different diagnoses; 2) compare overweight prevalence in CCSs with that in their siblings and the Swiss general population; and 3) identify sociodemographic and clinical risk factors for excessive weight.…”