The metabolic syndrome and its components in pediatric survivors of allogeneic hematopoietic stem cell transplantation

Abstract

Metabolic syndrome (MetS) is a known complication after hematopoietic stem cell transplantations (HSCT) that contributes to long-term morbidity. We assessed the prevalence of components of the MetS in pediatric survivors of allogeneic HSCT and identified associated risk factors. Thirty-eight patients, median age at HSCT, 8.5 years, were evaluated at a median of 3.9 years post-HSCT. Overweight or obesity was seen in 23.7% of the patients, 15.8% had hypertension, 15.8% had hypertriglyceridemia, and 13% had low high-density lipoprotein cholesterol levels according to age and gender. Four (10.5%) met the criteria of MetS; all were transplanted for malignant disease. Twelve patients (31.6%) had at least one component of the MetS. The 5-year probability of developing components of the MetS revealed that patients with BMI-Z score ≥0 at HSCT were significantly at higher risk than those with lower BMI-Z. Patients who developed components of the MetS had higher levels of insulin, homeostasis model assessment, uric acid, leptin, and lower adiponectin levels. Multivariable regression analysis revealed that BMI-Z-score >1.036 at time of evaluation was associated with 4.3-fold increased risk (P=.050) and adiponectin levels ≤6 μg/mL were associated with 6.7-fold increased risk of develop components of the MetS (P=.007). Overweight and obesity and adiponectin levels may be useful as markers in HSCT survivors.

Body fat measurements using bioelectrical impedance in pediatric patientstreated with hematopoietic cell transplantation

“…MetS is a well-known LE reported in childhood cancer survivors [11]. In various studies, prevalence of MetS in patients after HCT was increased and ranged from 7.5% to as much as 32% [1]. According to the IDF consensus, MetS is diagnosed on the basis of central obesity plus any two of the following: raised triglycerides, reduced high density lipoprotein (HDL) cholesterol, raised blood pressure, and raised fasting blood plasma glucose (or type 2 diabetes mellitus) [4].…”

“…The metabolic syndrome (MetS) is one of the known late complications of hematopoietic cell transplantation (HCT), although the precise mechanisms of its development in patients treated with HCT are still unknown [1,2]. Obesity defined in terms of body mass index (BMI) is one of the components of MetS [3][4][5][6].…”

Total Body Irradiation and Risk of Diabetes Mellitus; A Meta-Analysis

“…Patient's age was not part of the exclusion criteria as both adult and pediatric patients were included in our analysis. Studies that did not assess the direct association of DM/IGM with TBI or did not have eligible study population were excluded (Chemaitilly et al, 2009;Majhail et al, 2009;Baker et al, 2010;Frisk et al, 2011;Sohn et al, 2011;Bizzarri et al, 2015;Davis et al, 2015;Wei et al, 2015;Wilhelmsson et al, 2015;Wei et al, 2016;Bielorai et al, 2017;Friedman et al, 2017).…”

“…From such an astounding number; at the aftermath of the battle, what consequences are the survivors encountering? (Hilgendorf et al, 2015) Previous studies had mentioned the possibilities of developing hypertension, dyslipidemia as well as endocrinologic abnormalities with various risk factors (Baker et al, 2007;Hoffmeister et al, 2010;Wei et al, 2016;Bielorai et al, 2017). Not to mention known co-morbidities from the treatment itself such as graft versus host disease (GVHD) (Socie and Ritz, 2014;Arora et al, 2016) or infectious complications (Nakano et al, 2014;Kumar et al, 2015) which are well known to associate with the immunocompromised state rendered by the treatments (Michael et al, 2013).…”

Long‐term Follow‐up of Hematopoietic Stem Cell Transplant Survivors: A Focus on Screening, Monitoring, and Therapeutics

“…129 Late complications related to hypothyroidism, hyperthyroidism, metabolic syndrome, dyslipidemia, hypertension, and diabetes are frequent after HCT and require judicious monitoring and treatment as clinically indicated. 130,131 Thyroid Disorders Thyroid disorders have been observed post-HCT and untreated thyroid disorders can lead to cardiac and metabolic complications. 132 Monitoring of free thyroxine (T4) and thyroid stimulating hormone (TSH) should occur annually after HCT or as clinically indicated.…”