Objective: Obesity is frequently reported in patients treated for childhood leukaemia. Obesity, particularly abdominal obesity, is one of the main characteristics of the metabolic syndrome and a risk factor for cardiovascular disease and non-insulin-dependent diabetes mellitus (NIDDM). Design: All patients treated for acute lymphoblastic leukaemia (ALL) before the onset of puberty in the region of western Sweden, between 1973 and, and in first remission, were included. 35 out of 47 patients aged 20-32 years participated. 19 patients had received cranial radiotherapy, and the median follow-up time was 20 years. The focus of this report was to study body composition and signs of the metabolic syndrome and correlate the findings to spontaneous growth hormone (GH) secretion. Methods: Body composition was assessed using dual-energy X-ray absorbtiometry (DEXA). We analyzed serum concentrations of insulin, glucose, leptin and lipids. Results: No patient was obese according to World Health Organization criteria (body mass index, BMI $ 30 kg/m 2 ) but one-third were overweight (BMI 25-29.9 kg/m 2 ). The maximal GH peak during 24 h (GH max ) was correlated to percentage of total body fat (r ¼ 2 0.42; P ¼ 0.017), trunk fat (r ¼ 2 0.5; P ¼ 0.005) and fat-free mass (r ¼ 0.42; P ¼ 0.017). GH max was also correlated to s-triglycerides (r ¼ 2 0.54; P ¼ 0.001), low-density lipoprotein-cholesterol (r ¼ 2 0.382; P ¼ 0.024) and high-density lipoprotein-cholesterol (r ¼ 0.45; P ¼ 0.007). Conclusions: We found little effect on BMI but an increased percentage of total body fat, especially trunk fat, and a tendency for an unfavourable lipid profile in adult survivors of childhood leukaemia. These findings were related to low endogenous GH secretion due to cranial irradiation. European Journal of Endocrinology 153 81-89

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The self-reported health of children treated on NOPHO-AML protocols without HSCT was good, and their use of health care services was limited. Reported health and social outcomes were comparable to those of their siblings. Many survivors were smoking which may increase the risk of late effects.

Objective: Treatment for childhood leukaemia induces many risk factors for development of decreased bone mineral density (BMD). Physical activity is also known to affect BMD. The aim was to study BMD and markers of bone turnover in a well-defined group of survivors of acute lymphoblastic leukaemia (ALL) who had all reached final height as well as peak bone mass, taking both previous treatment and physical activity into consideration. Design: All patients treated for ALL before the onset of puberty in the region of western Sweden, between 1973 and 1985, in first remission were included. Thirty-five out of forty-seven patients aged 20 -32 years participated. Nineteen patients had received cranial radiotherapy, and the median follow-up time was 20 years. Methods: BMD was assessed using dual-energy X-ray absorbtiometry (DEXA). Serum concentrations of markers of bone turnover were analysed. Physical performance was measured using a performance exercise capacity stress test. Results: BMD was slightly reduced in lumbar spine (2 0.4 SD), but not in femoral neck or total body. BMD in femoral neck was correlated to physical performance and dose of corticosteroid, but no correlation was found with spontaneous growth hormone (GH) secretion. Markers of bone turnover were also correlated to physical performance, but not to GH secretion. Conclusions: Physical fitness seems to be the most important factor in developing and preserving normal bone mineral density in ALL patients. We propose that lifestyle education promoting physical activity is encouraged from an early point in time for these patients.