This project provides evidence that inclusion of genetic evaluation is feasible and relevant in the care of childhood cancer survivors. Further study is warranted to determine optimal timing and clinical utility of this multidisciplinary and family-centered approach.

Background:Inadequate hospital stocking and the unavailability of essential antidotes is a worldwide problem with potentially disastrous repercussions for poisoned patients. Research indicates minimal progress has been made in the resolution of this issue in both urban and rural hospitals.

9552 Background: Survivors of childhood acute lymphoblastic leukemia (ALL) are at increased risk for obesity, insulin resistance and increased visceral adiposity. A history of cranial radiation therapy (CRT) worsens this risk. In non-cancer populations, adherence to a Mediterranean Diet has been shown to improve metabolic parameters and risk of diabetes mellitus. Whether diet may contribute to insulin resistance and increased adiposity in ALL survivors is not known. Methods: We surveyed 117 adult survivors of childhood ALL using the Harvard Food Frequency Questionnaire. Physical activity energy expenditure (PAEE) was measured with the SenseWear Pro2 Armband. Fasting blood was obtained on all subjects and insulin resistance was estimated using the Homeostasis Model for Insulin Resistance (HOMA-IR). Visceral adiposity was measured by abdominal CT. Adherence to a Mediterranean Diet pattern was calculated using the index developed by Trichopoulou. Subjects were compared using univariate analysis. Results: Subjects were majority female (56%); 25% were minority or Hispanic white. A history of CRT was present in 15 (29%) men and 25 (38%) women. Among all subjects, greater adherence to a Mediterranean diet pattern was associated with improved HOMA-IR (p=0.14), visceral adiposity (p=0.03), subcutaneous adiposity (p=0.005), waist circumference (p=0.02), and body mass index (p=0.03) (all unadjusted analyses). The effect of adherence to a Mediterranean diet on insulin resistance was especially notable in men who did not receive CRT (p=0.06). Higher dairy intake was found to worsen HOMA-IR (p=0.014), but other individual components of the Mediterranean diet, such as low intake of meat and high intake of fruits and vegetables, were not significant. Inclusion of PAEE did not alter our findings, although higher PAEE was associated with lower body mass index. Conclusions: Adherence to a Mediterranean diet pattern, especially low consumption of dairy products, may improve insulin resistance in survivors of childhood ALL. Further study is warranted.

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